- El ingenioso hidalgo Don Quijote de la Mancha (Don Quixote), by Miguel de Cervantes Saavedra, is rivalled only by the Bible for the number of languages into which it has been translated. This masterpiece of world literature is considered to be the first modern novel. Part I was published in 1605 as a burlesque of contemporary chivalric romances; part 2 appeared in 1615 to counteract a plagiarized sequel. The hero is a lean, elderly man who, impassioned by romantic reading, thinks himself a knight. Riding on his starved horse, Rocinante, and in the company of Sancho Panza (a fat peasant whom he takes for a squire), Don Quixote leaves on a journey in which he rewrites reality as a chivalrous utopia. He fights giants that are simply windmills, rescues damsels who are simply whores, and courts Dulcinea del Toboso, who is not exactly a “lady.” Cervantes (1547–1616) was the son of an itinerant surgeon who struggled to maintain his practice and his family by travelling around Spain. The family finally settled in Madrid, where the young Cervantes received some early formal education. After travelling to Italy in 1569 to serve in the household of a nobleman, he joined the Spanish Legion. He was injured in the Battle of Lepanto (1571), losing the use of his left hand. During his return he was captured by pirates and was imprisoned in Algiers from 1575 to 1580. This experience was a turning point; numerous references to the themes of freedom and captivity would later appear in Cervantes' work. On his return to Spain he worked at a series of government jobs that involved extensive travel in Andalucia (the area in which the characters of his novel wander). Only at the end of his life was he able to obtain a patron and to devote full attention to his writings. Don Quixote, his most famous production, was translated into French and English while Cervantes was still alive. However, literary success did not bring a solution to his economic problems. He died poor, on the same day that Shakespeare died. Cervantes declared in the prologue to Don Quixote that his intent was to destroy the popularity of the Spanish romances of chivalry. Modern critics have many different interpretations,1,2 but, for the physician, a reading of Cervantes' work is likely to veer in a medical direction. Thus, the main character might be described as an elderly man with anorexia and insomnia whose attitudes may be the product of cognitive decline or fluctuating cognition, with recurrent visual hallucinations and systematized delusions resembling the variant of dementia called Lewy body disease.3 His companion, Sancho Panza, suffers from obesity, bulimia and narcolepsy. Various medical matters arise in the course of the novel, ranging from battle wounds to the psychological origins of illness. The narrator advises that a prudent knight be self-sufficient in the treatment of wounds: “the knight-errant,” he writes, “cannot at every step go looking for someone to cure him” and therefore “must be a physician, and especially a herbalist, that he may recognize in the midst of wilderness and deserts the herbs that have the virtue of curing wounds” (part 2, ch. 18). Among the healing herbs were rosemary (part 1, ch. 17) and hypericum (part 2, ch. 46), but the knight was also advised to carry medicinal preparations. Hence, “it was an established fact that all knights-errant … carried their purses well lined against accidents, and … in addition to shirts, a small chest of ointments to heal their wounded” (part 1, ch. 3). Don Quixote gave particular credence to a remedy he calls “the balsam of Fierabras”: It is a balsam the recipe of which I have in my memory, and whoever possesses it need not fear death nor consider any wound mortal. Therefore when I have made and given it to you, you have naught else to do when in any battle you see me cleft in twain (as often happens) but deftly to take up the part of the body that has fallen to the ground with the greatest care before the blood congeals and put it up again on the half that remains in the saddle, taking great pains to fit it exactly in the right place. Then you must give me just two sips to drink of the balsam I have just mentioned, and you will see me become as sound as an apple.4 For many ailments, the standard cure appears to have been bloodletting, for which one might apply to the local barber, if the community is large enough to support one: In that neighborhood there were two villages, one of which was so small that it contained neither shop nor barber, but the larger had both: so the barber of the larger village served also the smaller. It now happened that in the latter there lay a sick man needing a bloodletting, and another who wished to have his beard trimmed, for which purpose the barber came, bringing with him his brass basin. (part 1, ch. 21) The salutary effects of bloodletting might even extend, we learn, to the chastening effect of losing a little blood during a whipping: But for the present, make up your mind to agree to this whipping penance, and believe me, it will be of much profit both to your soul and your body: to your soul, because of the charity with which you perform it; to your body, because I know that you are of sanguine complexion, and it will do you no harm to draw a little blood. (part 2, ch. 35) Among the ailments that arise in the course of Cervantes' epic are the following: Syphilis: “He forgot to tell us who was the first man who ever had catarrh and who was the first to use ointment to cure himself of the French pox” (part 2, ch. 22). In Cervantes' day, syphilis was called “the French disease” in Spain and “the Spanish disease” in France; in Italy, it was known as both. Leprosy: “By God,” said Sancho, “but your worship got me a nice fellow as a witness of what you say, this gaffer with his whorish amputation or I know not what” (part 2, ch. 29). Cervantes' word here was “gafo,” which originates from “gafeded,” the Spanish word used to describe involvement of the hands in leprosy. Trichofolliculoma: “I never noticed her ugliness but only her beauty, which was enhanced in value by a mole that she had above her right lip, like a moustache with seven or eight red hairs like threads of gold and more than a span in length.” (part 2, ch. 29) Acute gastroenteritis: “[T] he poor squire discharged so swiftly and copiously at both ends that neither the rush mat on which he had thrown himself nor the blanket with which he covered himself were of the slightest use to him. He sweated and sweated in such a paroxysm of strains and stresses that not only himself but all present thought he was on the verge of death.” (part 1, ch. 17) Hirsutism: “I shall speak without tears — where, I ask you, can a duenna go with a beard? What mother or father will take pity on her? Who will give her aid? And even when she has a soft skin and tortures her face with a thousand sorts of lotions and cosmetics, she can scarcely find anyone to like her, what is she to do when she discloses a face like a jungle?” (part 2, ch. 10) Rhinophyma: “But hardly had the light of the day allowed things to be seen and distinguished, when the first object that Sancho Panza caught sight of was the squire of the Wood's nose, which was so big that it almost overshadowed his whole body. It is said, indeed, that it was of huge size, hooked in the middle, all covered with warts, and of a mulberry color like an eggplant, and that it hung down two fingers' length below his mouth.” (part 2, ch. 14)5 Somatization: “A physician was sent for, who, after feeling his pulse, took a rather gloomy view of the case and told him that he should provide for his soul's health, for that of his body was in dangerous condition.” “The physician was of the opinion that melancholy and mortification had brought him to death's door.” (part 2, ch. 74) Of course, Cervantes' medical descriptions are simply a part of the variegated background of 16th-century Spain against which his story flows. The character of Don Quixote represents an idealized and fictional world (with clear psychotic features); Sancho Panza, representing the natural world of biological existence, is a sobering exemplar of normality. These ironies challenge readers, medical or otherwise, to ask themselves to discern the differences between the fiction and the reality of experience itself.