Considerations about the Neuropsychiatric Conditions of Quixote of La Mancha. / Consideraciones sobre las condiciones neuropsiquiátricas del Quijote de la Mancha.

Don Quixote of La Mancha, the picturesque character created by Miguel de Cervantes Saavedra in his immortal book The Ingenious Nobleman Sir Quixote of La Mancha, presents several neuropsychiatric conditions, including tremor, sleep disturbances, neuropsychiatric symptoms, syncope, perception disorders and traumatic brain injury. Throughout the masterpiece, there are episodes where the aforementioned disorders are evident. This paper makes a list of them and analyses them in the light of the current knowledge of those conditions.

An early literary description of emotional syncope in the Fifth Canto of Dante Alighieri's Commedia: 'E caddi come corpo morto cade'.

Dante's Divine Comedy is universally acclaimed as one of the great masterpieces in world literature. It is written in first person singular and this gives an intimate acquaintance with the vision of the poet. In the Fifth Canto, he exquisitely describes the story of Paolo Malatesta and Francesca da Rimini, illicit lovers killed by Francesca's husband, Gianciotto Malatesta. The story, dramatically told by Francesca, deeply moves the poet, who suddenly faints. In the words of Dante himself: 'E caddi come corpo morto cade' (And fell, even as a dead body falls). This probably is the first literary description of an emotional syncope in world literature. We found that three great plastic artists (John Flaxman, William Blake and Gustave Doré) captured the crucial moment of the syncope in three extraordinary images left for posterity.

Proust, neurology and Stendhal's syndrome.

Marcel Proust is one of the most important French writers of the 20th century. His relationship with medicine and with neurology is possibly linked to the fact that his asthma was considered to be a psychosomatic disease classified as neurasthenia. Stendhal's syndrome is a rare psychiatric syndrome characterized by anxiety and affective and thought disturbances when a person is exposed to a work of art. Here, the authors describe neurological aspects of Proust's work, particularly the occurrence of Stendhal's syndrome and syncope when he as well as one of the characters of In Search of Lost Time see Vermeer's View of Delft during a visit to a museum.

History of syncope in the cardiac literature.

The rich cardiology literature of the past 100 years in which the most important forms of syncope are described - including vasodepressor syncope, postural orthostatic hypotension, and Morgagni-Stokes-Adams syncope - is fascinating. These conditions were of interest to some of our most astute clinicians who were also excellent writers. We thus have available for review the remarkable description of patients with these entities written by clinicians such as Soma Weiss, Sir Thomas Lewis, Laurence Ellis, David Sherf, Milton Shy, and Glenn Drager. In their detailed clinical descriptions we identify the pertinent symptoms and signs we see in our patients today years later. A group of brilliant basic physiologists and cardiologists was able to explain the altered physiology responsible for the clinical presentations of syncope patients. Basic investigations were done by investigators such as Arnold Weissler, James Warren, J. Erlanger and clinical cardiologists including John Parkinson, Cornelio Papp, and William Evans to name just a few. Between the early precise clinical descriptions and the subsequent thorough definition of the altered physiology, a surprisingly complete understanding of these clinical entities was established 50 years ago. It took another generation before clinicians developed methods of caring for patients with these clinical entities. The development of implantable devices, e.g., pacemakers and defibrillators, for use in Morgagni-Adams-Stokes attacks is the best example of curative therapies catching up with clinical diagnoses. Other more simple relevant therapies were developed for patients with vasodepressor syncope and postural orthostatic hypotension. Finally, the development and acceptance of clinical guidelines for the treatment of these conditions brought the original clinical observations and description of altered physiology into focus and ushered in a new generation of improved care for these patients.

Galen on "syncope".

This paper studies the Galenic views on syncope. According to Galen, syncope is a sudden prostration of the vital powers, without suspension of the respiration and it is usually a sign or complication of fever. He believed that "cardiac syncope" was a primary illness of the mouth of the oesophagus or of the stomach that affected the heart "by sympathy", meaning secondarily. The aetiology, the clinical manifestations and the treatment are presented, along with a special section referring to the connection between "marasmus", which was supposed to be a wasting of the organism of the elders due to "dryness", and syncope. Numerous authors before and after Galen treated the subject of the famous "cardiac affection": Hippocrates (4th-5th century BC), Asclepiades (2nd-1st century BC), Celsus (1st century AD), Aretaeus (2nd century AD), Soranus of Ephesus (2nd century AD), and Caelius Aurelianus (5th century AD) all see cardiac syncope as a distinct disease. Based on the Galenic descriptions, several modern medical conditions may be identified, such as congestive heart failure, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, congenital long QT syndrome or anomalies of the coronary arteries.

Faints, fits, and fatalities from emotion in Shakespeare's characters: survey of the canon.

OBJECTIVES: To determine how often Shakespeare's characters faint, fit, or die from extreme emotion; to assess Shakespeare's uniqueness in this regard; and to examine the plausibility of these dramatised events. DESIGN: Line by line search through modern editions of these late 16th and early 17th century works for accounts of characters fainting, fitting, or dying while under strong emotion and for no other apparent reason. DATA SOURCES: All 39 canonical plays by Shakespeare and his three long narrative poems; 18 similar works by seven of Shakespeare's best known contemporaries. RESULTS: 10 deaths from strong emotion are recorded by Shakespeare (three occur on stage); all are due to grief, typically at the loss of a loved one. All but two of the deaths are in the playwright's late works. Some deaths are sudden. Another 29 emotion induced deaths are mentioned as possible, but the likelihood of some can be challenged. Transient loss of consciousness is staged or reported in 18 cases (sounding like epilepsy in two) and near fainting in a further 13. Extreme joy is sometimes depicted as a factor in these events. Emotional death and fainting also occur occasionally in works by Shakespeare's contemporaries. CONCLUSIONS: These dramatic phenomena are part of the early modern belief system but are also plausible by modern understanding of physiology and disease. They teach us not to underestimate the power of the emotions to disturb bodily functions.

Sudden cardiac death: a 2400-year-old diagnosis?

Sudden cardiac death is one of the most important causes of mortality in the modern industrialized world. Although it has been described for at least several centuries, we believe in fact that Hippocrates provided a concise, but historically compelling, description of sudden cardiac death in his Aphorisms II, 41: "Those who are subject to frequent and severe fainting attacks without obvious cause die suddenly." This would be the earliest description of sudden cardiac death known. The Aphorism was analyzed in the context of genuine Hippocratic writings as well as ancient Greek culture. The Aphorism describes recurrent syncope in otherwise healthy individuals. Therefore, only certain select cardiac conditions are likely described by this Aphorism. Such conditions-long QT syndrome, hypertrophic cardiomyopathy, congenital coronary artery syndromes, and arrhythmogenic right ventricular dysplasia, chief among them-are linked by a final common pathway of an arrhythmic death. Relying solely on clinical experience based on careful history-taking and keen powers of observation, Hippocrates was the first to describe sudden cardiac death due to a select group of cardiac conditions. This analysis establishes such conditions as being an important cause of sudden death 2400 years ago, much as they are among the most important causes of sudden death today.

[Fainting in Greco-Roman medicine, especially in the traumatology and surgery fields]. / Die Ohnmacht in der griechisch-römischen Medizin, insbesondere im traumatologisch-chirurgischen Umfeld.

Occurrences of fainting are very common in medical as well as non-medical literature; in order to restrict the field to a manageable size, this article focuses mainly on surgery and traumatology. An examination of the various passages suggests that there was considerable ambiguity associated with the concept of fainting. On the one hand it was seen as a common occurrence, to be expected in the context of wounds or surgery, but on the other it was also regarded as a life-threatening force in its own right.