Don Quixote
Authors: Carmen Pinto
Journal: BMJ (2007)

“Somewhere in La Mancha, in a place whose name I do not care to remember” is one of the most famous beginnings of all books. Doctors who believe that only psychiatrists could benefit from reading Don Quixote would be surprised to hear that the 17th century English physician Thomas Sydenham advised the poet and royal physician Richard Blackmore that, to learn medicine, he should read it. And this is because, apart from the famous madness of its main character, plenty of medical knowledge is to be found in its pages.

Miguel de Cervantes was writing at the same time as William Shakespeare. In the early 17th century Spain was going through a particularly dark period in which the Inquisition made sure that no scientific ideas were allowed in from the rest of Europe. While in Flanders Vesalius was developing new anatomical and surgical concepts, in Spain doctors continued to use primitive techniques like purges, blood letting, and hot cloths. The public was in general sceptical of the medical profession, and other contemporary writers wrote very harshly about doctors. Cervantes was always fair and praised good practice at the same time as criticising what he viewed as irresponsible actions: “There are physicians that, after killing the infirm they treat, still want to be paid after their work, which is nothing else apart from signing a prescription for some medication.”

This impartial attitude towards the profession, together with his extensive knowledge of medicine, has given rise to various hypotheses—some even suggesting that Cervantes was a doctor himself. However, what it is known is that his father was a barber surgeon, and young Cervantes was probably expected to continue his father's trade. Barber surgeons, of lower rank than physicians, gave enemas, applied cups, sold unguents, and pulled teeth. Witnessing these practices and reading his father's books, combined with his immense ability as an observer, no doubt contributed to his masterly descriptions. Cervantes' excellent nosological ability is evident when he describes symptoms and signs of illness. A good example is one of his character's descriptions of pica: “I suffer from an illness that is usual in some women, who fancy eating soil, plaster, coal, and even worse things, so disgusting to look at, so much so to eat them.” We can also find many examples of preventive medicine in the conversations between Don Quixote and Sancho, in which spiritual Don Quixote advises earthy Sancho against eating or drinking too much, giving good summaries of what health is all about. The novel has plenty of examples of treatments, the most famous the balm of Fierabras, which contains rosemary among other components and which has terrible consequences for Quixote and Sancho in a famous episode.

Much has been written about Don Quixote from a psychological and psychiatric point of view. Different schools over the years have diagnosed various conditions from paranoia, persistent delusional disorder, and folie a deux to a “healthy reaction to a mad world.” In describing Don Quixote's physical appearance as a predisposing factor for his condition Cervantes seems to have been influenced by Huarte de San Juan's Examen de Ingenios para las Ciencias (1575), the first attempt to link physiology and psychology. In terms of factors that led to the illness Cervantes is clear: because Don Quixote read so many chivalry novels, “his brain dried up and this way he came to lose his sanity,” which he only recovers at the end of his life. Maybe this is why popular culture compares Don Quixote with passionate love, because, “when love recovers sanity, it is about to die.”

Not surprisingly the novel has influenced famous physicians such as Freud and Santiago Ramon y Cajal. I hope that your love for this book, like mine, never recovers sanity.