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Connecting Past
and Present
Connecting Past
and Present:

Exploring the Influence

of the Spanish Golden Age
in the Twentieth
and Twenty-First Centuries

Edited by

Aaron M. Kahn
Connecting Past and Present:
Exploring the Influence of the Spanish Golden Age in the Twentieth
and Twenty-First Centuries

Edited by Aaron M. Kahn

This book first published 2015

Cambridge Scholars Publishing

Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Copyright © 2015 by Aaron M. Kahn and contributors

All rights for this book reserved. No part of this book may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without
the prior permission of the copyright owner.

ISBN (10): 1-4438-7616-X

ISBN (13): 978-1-4438-7616-2


To my grandfather

John Anthony Diehl

27 July 1917 – 18 January 2015

whose indomitable spirit, devout faith, humbling wisdom,

and unconditional love for his family served as a true inspiration
to me as an academic and as a man of this world




TABLE OF CONTENTS

Acknowledgements .................................................................................... ix

Introduction ................................................................................................. 1
Connecting Past and Present
Aaron M. Kahn

Chapter One ............................................................................................... 11

The Man of La Mancha in Miniature: Don Quijote in Twenty-First-
Century Spanish Microfiction
Tyler Fisher

Chapter Two .............................................................................................. 35

The Quixotic Detective: Golden Age Intertexts in Eduaro Mendoza’s
Crime Fiction
Stacey Triplette

Chapter Three ............................................................................................ 63

On Black-Gloved Fists and Pentagonal Sieges: Cervantes’s Numancia
and the Fight Against Imperialism in Crónicas romanas (1968)
by Alfonso Sastre
Aaron M. Kahn

Chapter Four .............................................................................................. 85

The Sins of the Father are Redeemed by the Son (and Daughter):
Determinism and Moral Autonomy in Cervantes’s Novelas ejemplares
Brian Brewer

Chapter Five ............................................................................................ 109

Witnessing Crisis in Contemporary and Golden Age Spain
Elvira Vilches

Chapter Six .............................................................................................. 133

Mellifluent Influence: Octavas reales in Translation in the Royal
Shakespeare Company’s Golden Age Season
Kathleen Jeffs


viii Table of Contents

Chapter Seven.......................................................................................... 159

A Twenty-First Century Auto Sacramental?: Thomas Hürlimann’s Das
Einsiedler Welttheater (2007) and Calderón’s El gran teatro del mundo
Stephen Boyd

Chapter Eight ........................................................................................... 187

A Silly Little Thing Called Love: Foolishness, Farce, and Fancy
in Manuel Iborra’s La dama boba (2006)
Oliver Noble Wood

Contributors ............................................................................................. 211

Index ........................................................................................................ 215




ACKNOWLEDGEMENTS

I would like to express my gratitude to all the contributors of this

volume for agreeing to participate. It has been a long process, but it has
been well worth the wait. It is always pleasurable to work with colleagues
who have similar research interests. I would like to thank my colleagues at
the Sussex Centre for Language Studies, University of Sussex, for their
support. I would like to recognise my undying love for my wife Alison
Kahn and express my gratitude to her for designing the cover of this
volume. Finally, life’s journey would be incomplete without our three
lovely children, Helena Sylvie, Seth Thomas, and Lukas Diehl.

—AMK


 INTRODUCTION

CONNECTING PAST AND PRESENT

AARON M. KAHN
UNIVERSITY OF SUSSEX

In order to establish properly a context for the study of literature or

history in any given time period, one cannot always study the works,
writers, or era in isolation; rather, by performing scholarly studies on these
topics as a continuation of what has come before reveals that many
thoughts, concepts, character types, criticisms, and social issues have been
thoroughly explored by our literary ancestors. In Spain, the Golden Age is
the era most frequently revisited by writers in the twentieth and twenty-
first centuries, and this is indicative of Spaniards’ view of this epoch often
called the Renaissance. According to Stephen Gilman, there is a debate
about whether or not a Spanish Renaissance even existed, in reference to
“the failure of Spaniards—or perhaps I should say the refusal of Spaniards
—in the fifteenth, sixteenth, and seventeenth centuries to separate
themselves ideologically or to divorce themselves axiologically from what
now would be called their ‘Middle Ages’. Unlike Italy and France and far
more emphatically even than England, Spain was determining not just not
to forget but actively continue her past” (1977, 37; original emphasis).
Spain’s twentieth and thus far twenty-first centuries have contained as
much political and religious conflict as the days of the Habsburgs, and just
as in previous centuries, today’s Spaniards use the arts as a medium to
comment, often critically, on contemporary times.
We refer to this era as the Golden Age not only because of the
voluminous production of art, literature, drama and poetry, but also
because writers such as Miguel de Cervantes (1547-1616), Lope de Vega
(1562-1635), and Pedro Calderón de la Barca (1600-81), influenced by the
re-birth of the Classical masters, presented the reading and viewing public
with genuine human emotions and experiences in a more comprehensive
manner than in previous eras. With the culmination of the Reconquista in
recent memory, this is perhaps the first era of Spanish history that
2 Introduction

resembles Spain of the twentieth and twenty-first centuries. The beginning

of the twentieth century, just two short years after the disaster of the
Spanish-American War (1898) and the end of the Spanish Empire, evolved
into political crisis after political crisis. The great Spanish tragedy that was
the Civil War (1936-39) and the relative stability of the Franco
Dictatorship (1939-75), followed by the Transition and the concept of
historical memory, have provided contemporary Spanish writers with the
impetus and freedom to express their views. The natural source of
inspiration, then, is the Golden Age, that epoch of history that produced
such political and religious upheaval while also contributing to the
formation of a Spanish national identity.
The concept of a Spanish national identity is admittedly problematic.
During the Franco Dictatorship, the concept centralised into the notion of a
Castilian and Catholic country, but the caudillo was still aware that he had
to establish his regime and himself as Head of State by assuring the people
that theirs represented another legitimate era in the history of the nation
(Franco 1949, 96-97):

Historiography during the first two decades of the Franco era was largely
intended to affirm the regime’s morally correct role within Spanish history.
The government therefore used strategies both to suppress and to engender
the past, that is, to arrest dissonance in the discourse of history as well as to
assert continuity between the glories of an imperial Catholic Spain and the
illustrious present of the Franco era. (Herzberger 1991, 35)

During the time of the Habsburgs, the concept of hispanitas, the

gradual construction of a Spanish national identity, 1 formed by looking
into the past and identifying their monarchs, particularly Emperor Charles
V (1519-58 (King Charles I of Spain (1516-56)), as a natural and moral
continuation of the Roman Empire. The translation of empire from East to
West (Persians, then Greeks, then Romans, then the Roman Catholic
Church, now Spain) proved to the monarchy that their rule was God’s will.
Franco used the same rhetoric and looked to the Golden Age and the
Reconquest of Iberia to legitimise his own crusade. Frequently he
appropriated works and images from this era to connect his regime with
the golden past of the nation he envisaged.
With Franco’s death and the implementation of a democratic system of
government, Spanish politicians and public figures, and to an extent the
people as well, attempted to turn their collective backs on the past and

1
See Schmidt (1995) for a discussion of hispanitas in relation to sixteenth-century
versions of the fall of Numancia.
 Connecting Past and Present 3

look to a bright future. The pacto de olvido and the amnesty laws that
followed proved a great asset to the relatively peaceful move from
dictatorship to democracy; however, they did not leave history behind:

What made Spain’s transition special was the lack of a clean break with the
past. In essence, the transition was achieved by an unwritten, and for the
most part unspoken, pact. The Francoist establishment acknowledged that
the time had come for a change and undertook to wind up its operations on
condition that reprisals were never taken against any of its members.
(Hooper 2006, 83-84)

Describing this process as a transition accurately portrays its non-

revolutionary nature, but it was not a forgive-and-forget transaction. With
the dawn of the twenty-first century and the election of the first
administration of José Luis Rodríguez Zapatero in 2004, there was a
concerted effort to un-forget and reconcile the crimes of the past.2
Since the end of the dictatorship and with the subsequent attempt to
recuperate historical memory in Spain, the concept of memory and the re-
appropriation of history, and historiography, has been championed by
modern Spanish writers and artists; thus, Spain has once again used the
written word and visual arts to enter the past and relate to it through
twenty-first century eyes. As Paul Julian Smith states, “if the past is a
different country, then Spaniards are frequent visitors” (2006, 11). One
example is the novel of memory, “those fictions that evoke past time
through subjective remembering, most often through first-person
narration. The past that each examines (the external referent of the text) is
the past largely eschewed or appropriated by historiography under Franco,
the lived past of the Civil War and the strains of dissent that anticipated
the conflict and persisted in its aftermath” (Herzberger 1991, 35). Perhaps
what we see, then, is an attempt to re-define the Spanish identity as being
inclusive of the various cultures and languages spoken on the Iberian
Peninsula, while distancing these distinct nations from the centralised


2
Hooper (2006) reminds us, though, that in Spanish schools, the Franco era is not
emphasised or taught any differently than any other historical era: “And since the
history taught in schools usually ends with the civil war, a lot of younger Spaniards
have only the haziest idea of who he was. A number of schoolchildren interviewed
on radio for a programme in 1992 to mark the centenary of his birth were under the
impression Franco had belonged to the then governing party, the PSOE. Those
who had grown up since the end of the dictatorship are baffled, and even annoyed,
by the way foreigners continue to refer to the country in which they live as ‘Post-
Franco Spain’ more than thirty years after his death” (80).
4 Introduction

Francoist vision. The natural progression for this task is to use past
symbols of Spanishness and make them contemporary.
The contribution of Cervantes’s famous novel Don Quijote de la
Mancha (1605 and 1615), perhaps the most enduring symbol in Spanish
history, to the cultural, social, and literary history of not only Spain, but
also the rest of the Western world, cannot be understated; perhaps more
scholarly studies have been produced on this book than on any other single
literary work in human history. Carroll B. Johnson refers to Don Quijote
as the second-best-selling book of all time, calling it the centre of the
history of the novel (2000, 19). It should be no surprise, then, that it has
had a profound influence on literary production up to and including our
own times. With the wide proliferation of quixotic characters and
adaptations of the would-be knight-errant’s adventures and misadventures,
there has arisen in recent years a sub-genre of short-short stories, labelled
microfiction. The shear volume and diversity of episodes, characters, and
settings, along with social criticism, have resulted in imitations that are
just as numerous and varied. The microcuentos celebrate the art of
economy of language in the attempt to pare down these episodes into a
minimal number of words (see Chapter One).
On the opposite end of the genre spectrum from microfiction lies a
series of detective novels with quixotic and picaresque structures, thus
demonstrating further how contemporary Spanish authors have looked to
the past of their nation with the aim of drawing parallels between eras.
Post-Franco Spain, while providing a more moral form of governance with
a liberal democracy and political pluralism, has also formed a breeding
ground for poverty, crime, and corruption at a level unseen in the days of
dictatorship. Don Quijote once again offers such a range of concepts and
images that an author can exploit in the creation of a hero or anti-hero. A
flawed protagonist whose experiences and interactions tap into a variety of
literary genres most commonly related to Spain establishes a direct link to
the famous hidalgo (see Chapter Two).
While Don Quijote has proved to be an ample source of material for
subsequent generations of writers, the emergence of the professional
theatre in the sixteenth and seventeenth centuries produced a wealth of
dramatic output. With the stage also comes a commentary on the political,
social, and cultural scene of the era; theatrical works provide us with
perhaps the most genuine depiction of daily life and the concerns that
filled it. As most plays were written to be performed, they did not have to
go through the same rigorous censoring process as published works, and as
a result they could more quickly comment on current affairs. The theatre has
a long history of social commentary, and writers such as Juan de la Cueva
 Connecting Past and Present 5

(1543-1612),3 Miguel de Cervantes, and other pre-Lopean contemporaries

appear to have used the stage for these purposes. In Cervantes’s case, La
destrucción de Numancia (c. 1583), which was not published for the first
time until 1784, has been studied as a piece of political rhetoric; in
addition, in subsequent centuries, playwrights have used the story and
Cervantes’s version of it as a voice of those politically and militarily
oppressed by imperial powers (see Chapter Three).
As Spain of the early twenty-first century suffers through a harsh
economic reality, resulting in a great deal of poverty and a high level of
unemployment, we see that economic hardship is nothing new to the
Iberian Peninsula. Economics as a topic and the concept of a credit crunch
were well established in the sixteenth and seventeenth centuries, and in
fact contributed to the expansion of the Spanish Empire. Relying on the
exemplarity of Cervantes’s novelas as well as studying past circumstances
of economic turmoil in the country, contemporary Spaniards are able to
attain an ampler vision of their current situation (see Chapters Four and
Five).
Most academic scholars of Golden Age Spanish drama study the works
and the playwrights more as literature than as performative works.
However, we must not forget that most of the works were composed to be
viewed by an audience rather than read in print. Even when studied in
translation, the approach tends to fall more in line with literary theory than
drama theory. When one combines a study of performance and translation,
we see the works and their creators from an alternative perspective. The
forms of verse employed by the original writers contained meaning, and
often were used in specific situations and for types of characters. The
question for the translator and dramaturge, then, is how to treat the rhyme,
rhythm, and versification when translating from one language to another,
four hundred years later. Study of performance carries with it a wider
significance when analysing adaptations in translation, but perhaps the role
of verses and verse changes is not as straightforward as is sometimes
stated (see Chapter Six).
Our scholarly approach differs, though, when the adaptation is not only
performed in a context and a language not traditionally associated with
Golden Age Spain or Spanish academic studies, but also when it is a
radical re-writing of the text. In Spain, perhaps more so than any other
Western European country, theatrical works were collected and printed,


3
There exists some disagreement among scholars about Cueva’s dates. Here I
follow Reyes Cano’s conclusions based on baptismal and death records he has
found (1981).
6 Introduction

thus ensuring a wider dissemination of the texts, and with the presence of
Spain branching out over much of the continent in one form or another, so
too travelled peninsular drama and literature. While more often than not
the most famous of playwrights were the ones whose works were printed
and distributed, these writers were no less influential; their impact has
trickled down to the twenty-first century. In particular, the German
Romantics of the late eighteenth and early nineteenth centuries sparked a
renewed interest in the works of Lope de Vega, Miguel de Cervantes, and
Pedro Calderón de la Barca. We see now a “re-discovery” of classical
Spanish drama in the German-speaking theatrical tradition (see Chapter
Seven).
Adaptations of theatrical works in Spain have also appeared in
cinemas, and throughout the twentieth century these productions have
taken on various meanings. The evolution of the medium of film has also
allowed its exploitation, and while two-thirds of Spanish films that appear
on television or in cinemas are based on literary texts (Wheeler 2012,
135), the significance of specifically Golden Age plays adapted to the
silver screen has political roots in terms of national identity.4 During the
Franco regime, the dictator appropriated the texts and images of the
Spanish Golden Age in order to promote his personal brand of Spanish
nationalism and to feed into his own cult of personality as Generalissimo.
In fact, Pilar Miró’s film production of El perro del hortelano (1996)
represented the first time in nearly twenty years that a Lope de Vega play
had been adapted to the screen, directly because “in the transition period,
Golden Age drama was often construed as a reactionary art form that had
enjoyed special treatment under Franco” (Smith 2006, 166-67). However,
Miró’s film and Manuel Iborra’s La dama boba (2006) offer political and
social commentary to a contemporary audience in a way that could not
have been possible during the Franco era (see Chapter Eight).
In this volume, experts on the Spanish Golden Age from the United
Kingdom, Ireland and the United States offer analyses of contemporary
works that have been influenced by the classics from the sixteenth and
seventeenth centuries. Part of the formation of a sense of national identity
is founded on the recognition and appreciation of what has come
beforehand, and no other era in the history of Spanish literature and drama
represents the talent and fascination that Spaniards and non-Spaniards
alike possess with the artistic legacy of this country.

4
“A nation is nothing without the stories it tells itself about itself. Since nations are
intimately tied up with narrative acts, it seems inevitable that cinema, the most
powerful narrative machine of the twentieth century, has had something to say in
the formation of national identities, Spanish included” (Triana Toribio 2003, 6).
 Connecting Past and Present 7

Tyler Fisher opens this collection by studying the adaptations of

Cervantes’s masterpiece Don Quijote in the form of short-short stories, or
microcuentos. In contemporary Spain, microfictional re-visions of the
original novel have proliferated. This study examines relevant microfiction
from the first twelve years of the twenty-first century. Drawing on the
Spanish government’s database Libros editados en España (www.mcu.es),
it establishes a corpus of quixotic microcuentos and charts the most
significant trends in their techniques of articulation. The essay principally
addresses the question of what the abbreviated form permits that other
forms do not, in terms of intertextual exploitation. In an apparent paradox,
the microcuentos offer ample scope for imagining Don Quixote’s
extradiegetic existences, for challenging Cervantes’s theoretical assertions,
and for following up narrative loose ends in the original text. They invite
innovative re-readings of Don Quijote under a more microscopic lens.
Stacey Triplette’s chapter explores Golden Age intertexts in Eduardo
Mendoza’s four detective novels: El misterio de la cripta embrujada
(1979), El laberinto de las aceitunas (1982), La aventura del tocador de
señoras (2001), and El enredo de la bolsa y la vida (2012). Mendoza
mentions the picaresca, the esperpento, Don Quijote, and Charles Dickens
as four touchstone influences on his detective fiction. Mendoza adapts
motifs from the picaresque, Don Quijote, and the comedia in order to draw
parallels between Post-Franco Spain and the Golden Age. Numerous overt
and subtle borrowings serve as an exemplary purpose; they warn readers
that Spain of the Transición risks repeating the mistakes of the imperial
age. Mendoza represents a world in which, despite the reforms of
democracy, widespread poverty persists, a traditional aristocracy
maintains control, and restrictive notions of what it means to be Spanish
exclude many from full participation in society.
My contribution explores Alfonso Sastre’s play Crónicas romanas
(1968), a loose adaptation of Cervantes’s Numancia. The latter has
produced conflicting readings by academics, some arguing that the play
promotes Spanish imperialism in the sixteenth century and others
championing an interpretation of the drama as being negatively critical of
Spain’s expansion. However, in the twentieth and twenty-first centuries,
the play has repeatedly been used as a voice against repression in various
adaptations. Sastre’s work draws upon the tradition of Numancia
representing a criticism of the repression of individuals by commenting on
various political topics of the mid-to-late twentieth century, including Che
Guevara, the Viet Nam War, and the Franco Dictatorship.
Returning to Cervantine prose, Brian Brewer offers a study on
determinism and moral autonomy in Cervantes’s Novelas ejemplares
8 Introduction

(1613). Parent-child relationships figure prominently in most of the twelve

short stories that make up Cervantes’s collection of Novelas ejemplares,
and together they form one of the major thematic motifs of the work. An
exploration of this theme throughout the volume reveals an intricate
depiction of the values of parent-child relationships that bring the
collection into a new light. From within the tradition of an established
code of moral conduct Cervantes demonstrates a striking modernity by
denying the primacy of blood and the determinism of class and gender to
celebrate the freedom and spiritual independence of the morally
autonomous individual.
With the massive minting of worthless copper and its frequent
oscillations value, seventeenth-century Spaniards complained that money
was no longer a source of income, but rather the cause of shock and
emotional strain. The vagaries of vellón inspired reflections about a world
upside down, deceit, and delusion in both economic writings and literary
discourse. Elvira Vilches explores how these Baroque concerns are central
to understanding the reactions to the financial meltdown that followed the
collapse of Bankia in the summer of 2012. She argues that these parallels
between the past and the present suggest that crisis brings about similar
feelings of dejection and confusion through which the self sees itself poor
and and the world empty. Her essay establishes a dialogue between
mercantilist discourse, Baroque writers, journalist writing for the New
Yorker and El País, and Antonio Muñoz Molina’s Todo lo que era sólido
(2013).
Kathleen Jeffs draws upon her experiences as a translator and
dramaturge to discuss the practical applications of translation for modern
productions of Spanish Golden Age plays in English. How might looking
at the occurrence of microsequences featuring one verse form be of use to
translators and acting companies? The answer to that question is in the
transferability of analytical methods employed by scholars such as Vitse and
Güell to the translation and rehearsal processes. Jeffs isolates octavas reales
in three plays used in the 2004 Royal Shakespeare Company (RSC) season
of Spanish Golden Age plays in order to demonstrate how this verse form,
native to Italy but adopted by writers of the comedia, can provide the
translator and theatrical ensemble with clues to the structure and
characterisation of the comedia. She focuses on the octavas reales in Lope
de Vega’s El perro del hortelano (1618), Cervantes’s Pedro de Urdemalas
(1615), and La venganza de Tamar (1621-24) by Tirso de Molina (1579-
1648).
Staying with drama, Stephen Boyd studies contemporary adaptations
of the Calderón’s work in the German-speaking world. Das Einsiedler
 Connecting Past and Present 9

Welttheater (2000) and Das Einsiedler Welttheater (2007) by the

contemporary Swiss dramatist, Thomas, are radical (the second even more
so than the first) re-writings of Calderón de la Barca’s famous auto
sacramental, El gran teatro del mundo (c. 1636). Boyd’s chapter locates
Hürlimann’s play in the contexts of the German Romantic “re-discovery”
of Calderón and of the Einsiedeln theatre festival tradition, before going
on to ponder the ways in which it contrasts with the Spanish source text,
and some of the ways in which Hürlimann is, paradoxically, faithful to
Calderón.
Concluding the volume, Oliver Noble Wood’s chapter focuses on film
adaptations of Lopean plays. The two most recent adaptations of works by
Lope are Pilar Miró’s El perro del hortelano and Manuel Iborra’s La dama
boba. The 1613 play on which the latter is based raises questions about the
position of women in Golden Age Spain, and passes comment on social
and cultural conventions of the day. Combining imitation and invention,
Iborra’s adaptation brings the play to life for a twenty-first century
audience more accustomed to Hollywood romantic comedy than Lope’s
comedia nueva. This chapter discusses the significance of some of the
changes made to the original play, paying special attention to the role and
function of farce in Iborra’s film.

Works Cited
Franco, Francisco. 1949. Franco ha dicho. Madrid: Voz.
Gilman, Stephen. 1977. “The Problem with the Spanish Renaissance.” In
Studies in the Literature of Spain: Sixteenth and Seventeenth
Centuries. Ed Michael J. Ruggerio, 37-54. Brockport, NY: SUNY
Department of Foreign Languages.
Herzberger, David K. 1991. “Narrating the Past: History and Novel in
Postwar Spain.” PMLA 106.1: 34-45.
Hooper, John. 2006. The New Spaniards. 2nd ed. London: Penguin.
Johnson, Carroll B. 2000. Don Quixote: The Quest for Modern Fiction.
Long Grove, IL: Waveland.
Reyes Cano, José María. 1981. “Documentos relativos a Juan de la Cueva:
Nuevos datos para su biografía.” Archivo Hispalense 196: 107-35.
Schmidt, Rachel. 1995. “The Development of Hispanitas in Spanish
Sixteenth-Century Versions of the Fall of Numancia.” Renaissance
and Reformation 19.2: 27-45.
Smith, Paul Julian. 2006. Spanish Visual Culture: Cinema, Television,
Internet. Manchester: Manchester UP.
10 Introduction

Triana Toribio, Nuria. 2003. Spanish National Cinema. London:

Routledge
Wheeler, Duncan. 2012. Golden Age Drama in Contemporary Spain: the
comedia on Page, Stage, and Screen. Cardiff: University of Wales
Press.
 CHAPTER ONE

THE MAN OF LA MANCHA IN MINIATURE:

DON QUIJOTE IN TWENTY-FIRST-CENTURY
SPANISH MICROFICTION

TYLER FISHER
UNIVERSITY COLLEGE LONDON

At the close of Part I of Don Quijote, Miguel de Cervantes issues his

famous challenge for another author to take up the writing of Don
Quixote’s adventures where he had left off. After hinting at a third sally
for the self-proclaimed knight and his squire, Cervantes defers an account
of this expedition and ends his novel with an epigraph, a line slightly
misquoted from Ariosto’s Orlando furioso (1516): “Forsi altro canterà con
miglior plectio”—perhaps someone else will sing with a better plectrum
(I.52). Whether intended ironically or not, this challenge was, notoriously,
taken up by the pseudonymous Alonso Fernández de Avellaneda, whose
Segundo tomo (1614) had profound repercussions for Cervantes’s own
sequel. And though Cervantes undertook to leave his protagonist sound of
mind and soundly buried at the end of Part II, literary resurrections have
never ceased in the centuries since; the Italian epigraph has proved far
more prescient than Sansón Carrasco’s epitaph.
Among continuations and adaptations of Don Quijote, the turn of the
twenty-first century has seen a conspicuous vogue for microfiction that
engages with Cervantes’s novel. 1 In deliberately and artfully brief
narrative texts (mirocuentos), 2 ranging from only two dozen words to


1
I am grateful to Dr Inmaculada Murcia Serrano and Professor Antonio Molina
Flores for the estancia de investigación they provided me at the Universidad de
Sevilla’s Departamento de Estética e Historia de la Filosofía in June 2012, during
which I gathered many of the materials that form the basis for this study.
2
Microcuento is the prevailing term in Spanish usage, though it contends with
alternatives such as microrrelato, minificción, and cuento brevísimo. My basic
12 Chapter One

several hundred, Spanish and Spanish American authors have, with

increasing frequency, cultivated micro-literary allusions to Cervantes’s
text. With varying degrees of success and sophistication, they articulate a
dialogue with Don Quijote—a dialogue which, as I will discuss, has
precedents in the microfictions of Rubén Darío, Ernest Hemingway, and
Franz Kafka. Such precedents, however, are not the focal point of this
essay. In order to maintain a manageable scope, my selection of texts for
analysis is limited to those by Spanish authors,3 published within the last
fourteen years—that is to say, Peninsular microcuentos quijotescos of the
twenty-first century thus far. Within these parameters, I have attempted to
make an exhaustive survey of relevant texts by combing through the most
likely sources (mostly anthologies) recorded in Libros Editados en
España, an electronic database which Spain’s Ministerio de Educación,
Cultura y Deporte maintains. 4 My trawling succeeded in identifying
thirteen such microcuentos, though some have no doubt slipped through
my net. These thirteen constitute the corpus of texts, arranged
chronologically by date of their first publication, which appears as an
appendix to this essay.
Mine is certainly not the first collection of this kind to be assembled.
The fourth centenary of Don Quijote, Part I, gave rise to a spate of
anthologizing. Several projects, in print and on the World Wide Web,
attempted to bring together brief, Quijote-inspired texts as a means of
registering the novel’s legacy in the short fiction and poetry of successive
centuries. Major works such as Fielding’s Joseph Andrews (1742),
Flaubert’s Madame Bovary (1856), Dostoyevsky’s The Idiot (1869), and
Rushdie’s The Moor’s Last Sigh (1995) are widely known and widely
recognized to have drawn inspiration from Cervantes’s masterpiece
(Mancing 2006, 160-64), but what of the scattered, shorter texts—poems,
fragments, songs, adages, microcuentos, and other ephemera—based on
the Quijote? Joaquín María Aguirre’s virtual library, the Biblioteca
quijotesca, stands as the forerunner in collecting such texts. Initiated in
1997 and hosted on the virtual pages of Espéculo, the Universidad
Complutense’s electronic journal of literary studies, Aguirre’s web-

definition of microcuentos here follows the general characterization that José
María Merino formulates in “De relatos mínimos” (Ficción continua 2004, 229-
37).
3
Andrés Neuman is something of an exception within these Peninsular parameters.
Born in Argentina, he has resided in Spain since childhood and possesses both
Argentine and Spanish nationality.
4
At the time of writing, this database is accessible via
<http://www.mcu.es/webISBN/>.
 The Man of La Mancha in Miniature 13

anthology casts a wide net. Over the course of nine years, he solicited
readers’ recommendations of passages from international literature that
make reference to the Quijote. The resulting miscellany includes eighty-
one brief texts, ranging from genuine microcuentos in their entirety, such
as Juan José Arreola’s “Teoría de Dulcinea,” to excerpts that feature more
fleeting references, such as the instance in Mark Twain’s The Adventures
of Huckleberry Finn (1884) when Tom Sawyer explicitly adopts Don
Quixote’s rhetoric and reasoning. In the wake of Aguirre’s Biblioteca, but
with a specific focus on microfiction, Ramón Fabián Vique compiled
fourteen “minificciones cuyo tema es el clásico cervantino” for El cuento
en red (2004, 1). The following year Ignacio Arellano, in a special issue of
the Príncipe de Viana journal of arts and letters, assembled four of the
most well known “microcuentos quijotescos”, alongside several poems
(2005, 1041-43). Also on the occasion of the quadricentennial, Juan
Armando Epple published the most notable anthology of this kind to date;
his MicroQuijotes comprises fifty texts by Spanish and Spanish American
authors, ranging from Darío’s “D.Q.” and Borges’s quixotic speculations
in miniature, to Pía Barros’s previously unpublished “Reencarnación.”
These compilations constitute the principal efforts to bring together
micro-narrative responses to Cervantes’s novel from roughly the last
hundred years. The present study, rather than retreading their ground,
brings these efforts up to date by adding twenty-first-century microcuentos
from Spain. Moreover, it supplements their descriptive, taxonomic
approach by offering closer, critical examinations of particular texts. To
anchor these examinations, I outline a general poetics for allusive
microcuentos. The outline, in the shape of a schematic formula, is at once
descriptive, insofar as it accounts for the basic modus operandi of such
texts, and prescriptive. Instead of merely surveying and cataloguing the
microcuentos of the corpus, this approach affords an analytical
overview—a measure against which to articulate their relative merits and
deficiencies, proprieties and disproportions, felicities and faults.
Ultimately, I address the broader question of what constitutes an effective
allusion in microfiction. Standard definitions of allusion, as we will see,
prove inadequate in the light of microfictional practice and poetics.

Three Early Sallies in the Field of Quixotic Microfiction

The earliest specimens of microcuentos quijotescos are found beyond
Spain’s borders. Darío, Hemingway, and Kafka initiated this manner of
engaging with Cervantes’s novel by means of brief, narrative texts. At just
over 1,000 words in length, Darío’s “D.Q.” (1899) might well be the first
14 Chapter One

piece of microfiction to take the Man of La Mancha as its subject. Epple,

appropriately, begins his volume of MicroQuijotes with this text, which
adopts the form of military field notes from the Cuban front in the
Spanish-American War. A soldier deployed against the yanquis recounts
how Don Quixote mysteriously appears as the standard-bearer among a
troop of reinforcements from Spain, and, just as the news of Spain’s
ultimate defeat arrives, Don Quixote hurls himself into a nearby abyss.
The narrator, who until the apparition’s final act of despair has felt only a
vague recollection concerning the man’s identity, then recognizes him in
the description from Cervantes’s first chapter. The basic technique here—
that of moving the original protagonist(s) to a more contemporary
setting—becomes a frequent mode of transposition in subsequent
microfiction.
Although known for his own laconic, journalistic style, Hemingway
satirized extreme abbreviation in an essay, “Condensing the Classics,”
which appeared in The Toronto Star Weekly, 20 August 1921. The impulse
to miniaturize Cervantes’s magnum opus, to reduce a novel of more than
385,000 words—and more than a thousand pages—to a few lines, takes
centre stage in this light-hearted satire. Hemingway pokes fun at a project,
purportedly financed by Andrew Carnegie, that undertook to write précis
of classics by William Shakespeare, Victor Hugo, and others for
consumption by overworked businessmen. Instead of literary précis,
Hemingway proposes, “there is a quicker way to present the matter to
those who must run while reading: reduce all literature to newspaper
headlines, with a short news dispatch following, to give the gist of the
matter” (1985 [1921], 102). Don Quijote is his first candidate for such
treatment. Applying the conventional form and diction of twentieth-
century journalism to the novel’s most famous episode produces the
following:

CRAZED KNIGHT IN WEIRD TILT

MADRID, SPAIN (By Classic News Service) (Special).— War hysteria is
blamed for the queer actions of “Don” Quixote, a local knight who was
arrested early yesterday morning when engaged in the act of “tilting” with
a windmill. Quixote could give no explanation of his actions. (1985 [1921],
103)5

Like Darío, Hemingway also transposes Don Quijote to the

contemporary era. This transposition, however, is not a matter of inserting


5
The capitalization and punctuation here reproduces Hemingway’s own.
 The Man of La Mancha in Miniature 15

the Don into current events, as Darío had done with the Spanish-American
War, but of retelling an iconic episode in a contemporary manner, treating
the episode as if it were a current event. The reportorial format and diction
render a substantially altered protagonist. Instead of attributing this
knight’s madness to diet, insomnolence, and reading, the narrator cites
“war hysteria,” an early twentieth-century term for the condition now
called post-traumatic stress disorder or PTSD. This opens up the
possibility that Hemingway’s protagonist has actually experienced real
combat in the past, rather than simply donning “unas armas que habían
sido de sus bisabuelos” (I.1). This “crazed knight,” moreover, can offer
“no explanation of his actions,” while the original Quixote seldom refrains
from drawing on his reading to explain his actions and inactions alike.
Reticence is not one of his virtues. A lack of explanation, of course,
enables the dispatch to remain brief, and with the elimination of Sancho
Panza from the scenario, no further follow-up statement is necessary or
available. As if in recognition of these essential differences, there is no
acknowledgement of Cervantes’s authorship; the by-line credits only the
fictional press agency.
The report of an early morning arrest in Hemingway’s version may
serve to telescope the novel of 1605, for it recalls the detention of Don
Quixote on the morning of his final departure from Juan Palomeque’s inn
(the cuadrilleros’ attempts at arresting him, and the alternative form of
detention that the priest contrives [I.45-46]). The dispatch from the Classic
News Service, then, bridges the most well known episode among the early
chapters and the arrest that initiates Part I’s dénouement, roughly and
schematically encapsulating the whole. Of course, it is not simply a matter
of “condensing” this Classic, as the title of Hemingway’s essay would
suggest, but of excerpting the basic scenario of Cervantes’s eighth chapter
to create a condensed version that also offers an innovative treatment of
the novel’s principal character and motifs by means of reconfiguring its
diction, form, and style. It points at once back to the original and beyond
to further possibilities of permuting protagonists, plots, and modes of
presentation. While lampooning the abridgement of literary classics,
Hemingway formulates a piece of microfiction that reimagines the
functions of a synopsis; his newspaper passage on an incident in Madrid
gives “the gist of the matter,” in his phrase, and also suggests alternative
readings of the original. As we will see, this text stands as a fruitful
precedent for several of the more accomplished Spanish microcuentos of
recent years.
Finally we turn to the third of these earliest microfictions that feature
the Quijote. Scholars have often identified Franz Kafka’s brief retelling of
16 Chapter One

Cervantes’s novel as the first of its kind (Vique 2004, 13), but it follows
Darío’s by date of composition, and Hemingway’s by date of publication.
The text began as an entry in notebook “G” of Kafka’s Octavhefte, dated
21 October 1917 and untitled. Max Brod formulated the title by which the
text is known when he published Kafka’s notebook posthumously in 1931
(Gray et al. 2005, 290-91). “Die Wahrheit über Sancho Pansa” (“The
Truth about Sancho Panza”) recasts Sancho as the principal protagonist of
the fiction:

Sancho Pansa, der sich übrigens dessen nie gerühmt hat, gelang es im
Laufe der Jahre, durch Beistellung einer Menge Ritter—und
Räuberromane in den Abend—und Nachtstunden seinen Teufel, dem er
später den Namen Don Quixote gab, derart von sich abzulenken, daß dieser
dann haltlos die verrücktesten Taten aufführte, die aber mangels eines
vorbestimmten Gegenstandes, der eben Sancho Pansa hätte sein sollen,
niemandem schadeten. Sancho Pansa, ein freier Mann, folgte gleichmütig,
vielleicht aus einem gewissen Verantwortlichkeitsgefühl, dem Don
Quixote auf seinen Zügen und hatte davon eine große und nützliche
Unterhaltung bis an sein Ende.6

Like Hemingway, Kafka alters the fundamental character of

Cervantes’s characters, but he does so more explicitly. He transposes traits
proper to the original pair so that Sancho becomes the instigator, the
name-giver, and principal manipulator. Admittedly, germs of these traits
are already present in Sancho’s character as construed by Cervantes. The
squire is capable of inventing new names (coining baciyelmo, for instance,
in I.44), of following along for the sake of diversion (II.52), and of
manipulating his master through fictions (detaining him with storytelling
in I.20, identifying a passing peasant girl as Dulcinea enchanted in II.10);
but Sancho is now the source of the chivalric romances, not the second-
hand recipient of his master’s fantasies and code of conduct. Kafka’s


6
Reinier van Straten of Magdalen College, Oxford, offers the following
translation, which helpfully eschews the many liberties that render existing,
published translations in English unsuitable for the present purposes:
Sancho Panza, who incidentally never boasted about it, was able over the years,
in the evenings and at night, by supplying heaps of romances about knights and
thieves, to distract himself in such a way from his devil, whom he later gave the
name Don Quixote, that he then indiscriminately carried out the craziest of deeds,
which however, lacking their predetermined object, which should have been Sancho
Panza himself, caused no one any harm. Sancho Panza, a free man, followed Don
Quixote with equanimity, perhaps out of a certain feeling of responsibility, on his
campaigns, and was largely and usefully diverted by them right up to his end.
 The Man of La Mancha in Miniature 17

Sancho neutralizes the torments of his daemon-like Don by lavishing

literature on him. In two sentences, “The Truth about Sancho Panza” turns
Cervantes’s simple-minded recruit into a literary exorcist, assigning to him
a quasi-authorial role as manipulative agent and catalyst, and a quasi-
readerly role as spectator and diverted follower. Sancho’s name and his
“Ende” enclose this transposition, which posits a revised explanation for
the novel’s central conceit.
These three Quijote-inspired texts inaugurated a veritable sub-genre of
microfiction on the topic, and in these three specimens we already
encounter principal techniques that feature prominently in subsequent
efforts: namely, transpositions of temporal, geographical settings and
transpositions of roles and motives. Not merely brief or abbreviated
narratives, these texts construct allusions that play with or against the
original novel, inviting the reader to engage in speculative, alternative
readings—to reimagine the genesis of the original text itself and the back
stories of its characters, for instance, or to contemplate the implications of
deploying particular elements of Cervantes’s work in different settings.
This constitutes a hallmark of the most effective microcuentos quijotescos.

A Recipe for Microfictional Allusion:

Theory and Application
Indeed, in the light of these precedents, and with reference to the
corpus of twenty-first-century microcuentos quijotescos, we can derive a
basic, generalized formula for such texts—a poetics of microfictional
allusion. One might schematically represent the essential, cooperative
ingredients as follows:

echo(es) + transposition(s) + implications(s)

a. The echo(es) of situation, character(s), or lexis may be tacit or explicit.

Allusion depends on the reader’s recognition of at least one echo.
b. The transpositions may entail alternative developments of the original
characters, situations, point of view, or transpositions of context
(geographical or temporal contexts).
c. The implications may be just that—implied, merely suggested—or the
narrative may articulate certain implications, albeit with concisely
economical expression; but the text will follow up the implications of the
transposed elements or will prompt the reader to do so.
If any one of these three principal ingredients is deficient, the allusive
microcuento will fall short. Deficiencies—or, of particular relevance to
18 Chapter One

microfiction, superfluities—in any of the three components, or in their

coherence, will result in an impaired allusion. To clarify the outworking of
this schema, we turn now to how it applies to specific examples—
examples of varying efficacy—from the chronological corpus that forms
the appendix to this essay.
José María Merino’s “La cuarta salida” offers an aptly illustrative
case. 7 The fourth sally of the title is that which the novel denies its
protagonist with his death at the close of Part II. Merino takes up
Cervantes’s own game of refracting authorial personae, source texts, and
redactions, thereby rejecting the original ending by having his bookish
protagonist revisit documentation from the “alcaná de Toledo” to
propound a victorious expedition for the hero. This microcuento’s echoes
of Cervantes are both apparent and subtle. The apparent echoes link it
unmistakably to the language of the original, reproducing verbatim various
names and epithets (“el alcaná de Toledo,” “doña Dulcinea del Toboso,”
“el ingenioso hidalgo”) and a chapter title in its entirety (a salutary reminder
that economy of language does not necessarily trump all other techniques in
microfiction). Subtler is the use of quixotic language in the form of invective
against despotic authorities. Don Quixote and Sancho use the now archaic
form “hideputa” twenty-seven times in all throughout the two parts of the
novel, and Merino’s pairing of “follones” and “malandrines” echoes Don
Quixote’s own recurring rhetoric. To cite only three instances of the latter
usage in the novel, Don Quixote berates Sancho as a “malandrín, follón, y
vestiglo” when the squire asks for wages (II.28); in the episode of the
enchanted boat, he boasts, “Mira qué de malandrines y follones me salen al
encuentro” (II.29); and he later brags to the Duke of his exploits: “Gigantes
he vencido, y follones y malandrines le he embiado [a Dulcinea]” (II.31).
These lexical echoes, whether apparent or subtle, undergird the
transpositions in this microcuento. The two chief transpositions here are
the substitution of Cervantes’s first-person authorial persona of I.9 with
Merino’s Profesor Souto, and the alternative ending which brings events
up to our present day (signalled by the use of the present tense and the first
person plural). The lexical echoes undergird the transpositions, then,
because on them depends the reader’s sense of the precision of the
academic persona and the plausibility of the premise of long-lost
documentation for the alternative ending. They lend a touch of veracity to

7
Irene Andres-Suárez, in El microrrelato español, highlights Merino’s “La cuarta
salida” as an example of intertextual “microtextos que establecen una relación
estrecha con los […] personajes [y] escenas paradigmáticas de la literatura
universal, como El Quijote de Cervantes” (2010, 82-83). She paraphrases and
summarizes “La cuarta salida” but does not offer an analysis of it.
 The Man of La Mancha in Miniature 19

the fanciful claim. Although Merino’s microcuento reports the content of

the documents indirectly, rather than quoting them directly, the archaism
and glimpses of Golden Age diction convey an impression of authenticity
and affinity with the original novel.
In this case, the reported account of the documents’ content spells out
the kinds of implications that might otherwise be left to inference and
speculation: Don Quixote’s “verdadero final” is to realize his chivalric
ambitions; he marries Dulcinea and sires a line of successful knights
errant. But in this microcuento, which enacts the very overthrow it
recounts, the implications go beyond the explicit terms of Professor
Souto’s discovery. By aligning the “mago” with the recognizable “antiguo
soldado manco,” enchanter with author, Merino takes up and elaborates a
fiction that Don Quixote constructs in the original: that an enchanter is
altering the diegetic reality (on the basis, of course, of the ruse initially
perpetrated by the priest, barber, and housekeeper in I.7). Vanquishing this
authorial mago means restoring a “texto primitivo” and the traditions of
chivalric romances, here embodied in Don Quixote’s progeny. The
prototypical romance of chivalry, Amadís de Gaula, which featured the
knightly adventures of its eponymous hero, generated a string of sequels
relating the exploits of Amadís’s son Esplandián and of Esplandián’s son
in turn. Throughout the sixteenth century, imitations and further sequels
abounded in this line. Thus, the victories of Don Quixote’s and Dulcinea’s
“linaje de caballeros andantes,” predicated on “La cuarta salida,” represent
the resumption of chivalric fiction, while the present tense conclusion with
its use of the first-person plural manifests the Don’s escape from the
diegetic “interpolación” into an extradiegetic reality (an implication which
Merino imagines more fully in “Un autor caprichoso”). Echoes,
transpositions, and implications—the three interdependent components of
allusive microcuentos closely cohere and cooperate in this example.
Textual echoes are by no means always as conspicuous as some of
those we have seen in “La cuarta salida.” Andrés Neuman’s “Héroes”
makes no explicit mention of Cervantes’s masterpiece, but it offers at least
three clues by which an alert reader can recognize this as a microcuento
quijotesco, and Neuman’s errant superhero is, in fact, inscribed within the
Quijote’s points of reference. First, one recognizes the correspondence
between this would-be hero’s “acceso de lucidez” and Don Quixote’s
occasional lapses into sanity, “un entreverado loco,” as one character
describes him, “lleno de lúcidos intervalos” (II.18). Secondly, the
reference to “una docena de malhechores” recalls the well known incident
in Don Quixote’s second sally, when he liberates a chain-gang of prisoners
condemned to the galleys: “doce hombres a pie, ensartados como cuentas
Another random document with
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circulation feeble, the respiration shallow and occasionally
interrupted by long-drawn sighs, the pupils are as a rule contracted,
constipation is present, often alternating with diarrhœa. When to
these conditions, for which no cause can be found upon careful
examination, there are added marked change in disposition, periods
of unaccountable dulness and apathy alternating with unusual
vivacity and brightness, especially when insomnia alternates with
periods of prolonged and heavy sleep, the abuse of morphia may be
suspected. If the hypodermic syringe be used the wounds made by
the needle confirm the diagnosis. These punctures are usually found
in groups upon the thighs, legs, arms, and abdomen. Close inquiry
into the habits of the patient, who either goes himself or sends at
short intervals for unusual quantities of opium or morphia to some
neighboring apothecary, is sometimes necessary to confirm the
diagnosis. Finally, the presence of morphine in the urine10 renders
the diagnosis positive, notwithstanding the most vehement
assertions of the patient as regards his innocence of the habit and
the extreme cunning with which it is concealed.
10 “According to Bouchardat, morphine, when taken in the free state or under the form
of opium, speedily appears in the urine, and may be detected by the liquid yielding a
reddish-brown precipitate with a solution of iodine in iodide of potassium. Since,
however, as we have already seen, this reagent also produces similar precipitates
with most of the other alkalies and with certain other organic substances, this reaction
in itself could by no means be regarded as direct proof of the presence of the alkaloid.
Moreover, we find that the reagent not unfrequently throws down a precipitate from
what may be regarded as normal urine, while, on the other hand, it sometimes fails to
produce a precipitate even when comparatively large quantities of the alkaloid have
been purposely added to the liquid” (Wormley, Micro-chemistry of Poisons).

The presence of meconic acid or morphine in the urine can only be positively
determined by elaborate chemical analysis. In cases of doubt the urine should be
submitted to a competent analyst. To make sure that opium or its derivatives are not
being taken, the feces must also be examined.

PROGNOSIS.—The prognosis is favorable as regards the

discontinuance of the habit for a time, doubtful as regards a
permanent cure. Relapses are apt to occur. They are more common
in men than in women, in the aged than in middle life, and in persons
of feeble physical and mental organization than in those who are
possessed of bodily and mental vigor. Relapses also occur more
frequently in those individuals addicted to alcohol, and in those who
are habitually subjected to temptation by reason of their avocation,
such as doctors, nurses, and apothecaries, than in others. The
danger of relapse is greater where the habit has been formed in
consequence of chronic painful affections than where it has been
rapidly developed in the course of acute illnesses. Of 82 men treated
by Levinstein, relapses occurred in 61; of 28 women, in 10; of 38
physicians, in 26. The danger of relapse diminishes with the lapse of
time; nevertheless, a single dose of morphine or a hypodermic
injection may, after an abstinence of months, precipitate a relapse.
Indeed, the return of the habit is in the majority of instances caused
by the thoughtlessness of medical men in prescribing in these cases
opiates for maladies which are often in themselves insignificant.

Chloral Hydrate.

The prediction made by B. W. Richardson, within two years of

Liebreich's announcement of the medicinal properties of chloral, that
its abuse would become widespread, has been abundantly fulfilled.
The consumption of this substance as a narcotic has reached an
extent in certain classes of society which raises it, after alcohol and
opium, to the third place among such agents.

SYNONYMS.—The Chloral habit, Chloralism.

ETIOLOGY.—A. Predisposing Influences.—Age exerts but little

predisposing influence. Cases occur almost exclusively in adults,
and the greater proportion of these are in middle life. The abuse of
chloral is relatively somewhat more common among males than
among females. Individuals addicted to this habit usually belong to
the refined and educated classes of society; the fascinations of
chloral remain thus far unknown to the great mass of the people.
Professional men and those engaged in literary work form a very
considerable proportion of the cases. Chloral is occasionally used by
hospital nurses, and very frequently by prostitutes. Chronic
alcoholism is an important predisposing element in the formation of
the chloral habit; in fact, morbid conditions attended by insomnia
from whatever cause tend to the formation of this habit.

B. The Exciting Cause.—Chloral is a powerful hypnotic, usually

without unpleasant after-effects. In full doses it is a depressant to the
nerve-centres at the base of the brain and to the spinal cord. It
enfeebles the action of the heart, depresses respiration, and lessens
reflex activity. It has no action on the secretions except that of the
kidneys, which it frequently augments.

The habit has in some few instances been developed in

consequence of the indulgence in a morbid desire to experience the
effects of the drug. In a majority of instances it is due to the
continuance of the medicine indefinitely after the sickness in which it
was originally prescribed has ceased. I have known apothecaries to
renew prescriptions of chloral often enough to supply a daily dose of
from forty to sixty grains for years—in one instance for more than
four years.

The dose taken by victims of the chloral habit varies greatly. Thirty or
forty grains daily is a moderate amount. Not rarely this quantity is
repeated twice or oftener within the space of twenty-four hours. The
tolerance after a time exhibited by the organism for enormous doses
of alcohol and opium is not established, as a rule, in regard to
chloral. The victim of the latter after a little time discovers the
average dose required to produce narcotic effects, and, while he
may vary it within limits, he is liable to acute toxic effects if it be
greatly exceeded. Death from such excesses is not uncommon.

SYMPTOMATOLOGY.—I. Symptoms Due to Habitual Excesses.—The

habitual use of chloral, notwithstanding its ruinous consequences in
a certain proportion of the cases, is less dangerous than that of
opium or morphine. Many individuals take chloral in considerable
doses for years without obvious ill effect. The craving for it is much
less intense than that for opium or morphine, and is readily satisfied
by other drugs. In point of fact, persons addicted to chloral very
frequently exchange it for other narcotics. For these reasons the
chloral habit is more easily cured.

Derangements of the digestive system are common, but by no

means constant. They are (1) primary, and due to the direct irritant
action of the drug upon the mucous tissues of the month and
stomach; and (2) secondary, due to its effects upon the nervous
system and the circulation. Irritation of the mucous membranes is
very common. This not rarely amounts to gastro-duodenal catarrh
with its characteristic symptoms. Jaundice is common, sometimes
intense. A sense of fulness with pain and tenderness in the hepatic
region is frequent. Constipation, with clay-colored stools, is the rule.
It occasionally alternates with diarrhœa. The tongue is often coated
and the breath foul. On the other hand, in a fair proportion of the
cases the digestive organs are not affected. Chloral has been said to
occasionally exert even a favorable influence upon appetite and
digestion when taken before meals. The recent observations of
Fiumi and Favrat11 in a man suffering from a gastric fistula and
insomnia have shown that chloral hydrate in twenty- or forty-grain
doses, administered before or at the beginning of a meal, retarded
digestion by increasing the secretion of mucus in the stomach. The
acidity of the gastric juice is diminished temporarily. The secretion of
pepsin is not changed. Taken two hours after meals, doses not
exceeding forty grains caused no derangement of gastric digestion.
11 Archives Ital. de Bioloqie, vol. vi. No. 3.

Persons not habituated to chloral usually experience a sense of

constriction upon swallowing it, and a disagreeable after-taste.

The circulation is much affected. Chloral weakens, and finally

paralyzes, the vaso-motor centre, and thus dilates the vessels; it at
the same time weakens the action of the heart. Its habitual use is
attended by flushing of the face, congestion of the eyes, and fulness
of the head. The heart's action is weak, intermittent, irregular;
palpitation occurs; the pulse is full and compressible or small and
weak. It is usually slow.

The blood undergoes changes corresponding to the general

disturbances of nutrition. What the special changes in its
composition may be is not known. Many of the cases, even after the
prolonged use of the drug in considerable doses, show few
evidences of malnutrition or of anæmia. In the greater number,
however, wasting is marked, and the physical signs and rational
symptoms of profound anæmia are present. Deterioration in the
composition of the blood is further indicated by petechiæ,
hemorrhage from mucous surfaces, sponginess of the gums, and
serous effusions.

The respiration is not permanently affected, save in grave cases. It is

then slow, irregular, and shallow. Dyspnœa is common and easily
provoked. It is usually accompanied by cough and abundant frothy
expectoration. These symptoms vanish upon the discontinuance of
the drug. In a fatal case of chloral-poisoning seen by the writer, in
which the daily use of the narcotic in non-poisonous amounts had
been for a long time varied at intervals of five or six weeks by doses
sufficient to induce prolonged coma, death was preceded by
Cheyne-Stokes respiration. This patient was a retired dentist, and
kept the solution of chloral in a large unlabelled bottle. The actual
doses taken were not ascertained.

The muscular system shares in the general malnutrition. The

muscles become flabby and wasted. Persons addicted to chloral are
very frequently of nervous organization and sedentary habits, and
hence of poor muscular development prior to the use of the drug.

The kidneys show no constant derangement. In a certain proportion

of the cases chloral acts as a diuretic, largely increasing the urinary
excretion. Albumen is present in a certain proportion of the graver
cases, when it is apt to be associated with anæmia, serous
effusions, and a tendency to hemorrhages from mucous tracts. The
occurrence of casts and the persistence of albuminuria after the
discontinuance of chloral suggest an antecedent or coincidently
developed nephritis. The reducing substance present in the urine
after small doses of chloral is uro-chloralic acid (Mering and
Musulus). It gives the reaction of sugar with the copper and bismuth
tests, but is levogyrate. Glycosuria is occasionally encountered.

Vesical and urethral irritation occurs in a small proportion of the

cases. When these symptoms vanish upon the discontinuance of the
drug and recur upon its resumption, it may be fairly assumed that
they are due to its action. A great number of morbid phenomena
relating to the genito-urinary tract and to the urine, that have been
ascribed to the action of chloral in those addicted to its use, are due
to associated conditions rather than to the drug itself.

It has been claimed upon evidence that does not appear to the writer
adequate that chloral sometimes acts upon the sexual system as an
aphrodisiac, sometimes as the reverse. More or less complete
impairment of sexual power and appetite is the rule in individuals
addicted to great excesses in narcotics of all kinds. Menstruation is
not arrested by chloral as by morphine, nor does it necessarily cause
sterility in the female.

The skin undergoes nutritive disturbances of a marked kind. As a

result of individual peculiarity, single doses or medicinal doses
continued for brief periods of time have occasionally caused
erythematous, urticarious, papular, vesicular, and pustular eruptions.
Of these, the first named is of most frequent occurrence. The
habitual abuse of chloral causes in many individuals chronic
congestion of the face, neck, and ears. This redness is often very
striking. It is increased by the use of alcohol. Erythematous patches
upon the chest, in the neighborhood of the larger articulations, and
upon the backs of the hands and feet, also occasionally occur. They
are often associated with urticaria. General eruptions resembling
measles, scarlatina, and even mild variola, are said to have been
observed after large doses of chloral. Purpura is by no means rare in
old cases, and falling of the hair and atrophy and loss of the nails
occur.
The nervous system bears the blunt of the disturbance, and the
more significant symptoms relate directly to it.

The hypnotic effect is usually preserved. Hence the chloral habitué is

dull, apathetic, somnolent, disposed to neglect his ordinary duties
and affairs. He passes much of his time in a state of dreamy lethargy
or in deep and prolonged sleep, from which he awakes unrefreshed
and in pain. In one of my cases, however, even larger doses than
usual at length failed to induce more than fitful slumber, and the
insomnia which led to the formation of the habit finally reasserted
itself, reinforced by the unutterable miseries of chloralism.

Headache is a frequent symptom. It is usually general, sometimes

frontal, often referred to the top of the head. It is commonly severe,
not rarely agonizing, and is described as a pressure, weight, or a
constricting band. It is associated with injection of the eyes, flushing
of the face, confusion of thought, inability to converse intelligently or
to articulate distinctly, and other evidences of cerebral congestion.
Vertigo is common.

Sensory disturbances are frequently present. They consist in local

areas of hyperæsthesia, more frequently of anæsthesia, numbness
of the hands and fingers or of the feet, formication of the surface of
the body and limbs, and burning or neuralgic pains in the face, chest,
and extremities. The pains in the limbs are almost characteristic.
They are acute and persistent, neuralgic in character, but not
localized to particular nerve-tracts. They are more common in the
legs than in the arms, and occupy by preference the calves of the
legs and the flexor muscles between the elbows and the wrists. They
do not implicate the joints, are not aggravated to any grave extent by
movement, and are often temporarily relieved by gentle frictions. The
pains of chloralism have been described as like encircling bands
above the wrists and ankles.

Sensations of chilliness alternating with flashes of heat are

experienced. The temperature is, in the absence of complications,
normal. Excessive doses are followed by a reduction of one or more
degrees Fahrenheit, lasting several hours.
Among the motor disturbances are the following:

Tremor.—This symptom is not common. It is neither so pronounced

nor so distinctly rhythmical as that of alcoholism or the opium habit. It
is increased upon voluntary effort. It affects chiefly the hands and
arms and the tongue.

Palsy.—Loss of power in the lower extremities has been observed in

a number of instances. It varies in degree from paresis to complete
paraplegia. Its occurrence may be gradual or sudden. It passes
away upon the discontinuance of the habit. In many respects this
condition resembles alcoholic paraplegia.

Impairment of Co-ordinating Power.—Ataxic phenomena are

sometimes present. The patient has difficulty in walking in the dark,
cannot stand with his eyes closed, has trouble in buttoning his
clothes, and the like.

Impairment or Abolition of the Knee-jerk.—In a man aged fifty, who

had taken thirty to sixty grains of chloral hydrate at night for eighteen
months, the writer observed complete loss of the knee-jerk, which,
however, reappeared in the course of a few weeks after the
discontinuance of the drug.

In rare cases epileptiform seizures have occurred.

Chloral produces in certain individuals, even as the result of a single

dose, congestion and irritation of the conjunctiva. Apart from this
idiosyncrasy, its habitual use not infrequently causes conjunctivitis.
This affection is occasionally of a severe grade and accompanied by
œdema of the eyelids and great photophobia. Retinal congestion
has been noted by several observers. Amblyopia, disappearing upon
the cessation of the habit, has also been observed.

Psychical Derangements.—The mental and moral perversion caused

by immoderate chloral-taking shows itself rapidly. The transient
stimulating effects of the dose of opium or morphine in those
accustomed to these drugs are seen not at all or to a very slight
extent in chloralism. Hence the mental state is characterized by
dulness, apathy, confusion, and uncertainty. These conditions
alternate with periods of irritability and peevishness. The physical
sufferings of the chloral-taker in the daily intervals of abstinence are
greater than those of the morphine-taker; his mental depression less.
The one is tormented by the agony of pain, the other by the anguish
of craving. To the former repetition of the dose brings stupor and
sleep, to the latter exhilaration and activity. In certain respects,
however, the effects of these drugs upon the mind are similar. They
alike produce intellectual enfeeblement, inability to concentrate the
mind, habitual timidity, and impairment of memory. In the worse
cases of chloralism hallucinations, delusions, and delirium occur.
Acute mania may occur, and dementia constitutes a terminal state.

II. Symptoms Due to Abstinence from Chloral.—The symptoms

occasioned by the abrupt discontinuance of even large habitual
doses of chloral are not, as a rule, severe. In this respect the
difference between this drug and opium and its derivatives is very
marked. The chloral-taker not infrequently substitutes some other
narcotic, as alcohol or opium, for his usual doses without discomfort,
and in many instances voluntarily abstains from the drug, without
replacing it by others for periods of weeks or months.

The more important of the symptoms induced by sudden

discontinuance relate to the nervous system. Insomnia is usual. It is
not always readily controlled, and constitutes one of the principal
difficulties in the management of these cases. Headache is rarely
absent; it is in many cases accompanied by vertigo. Occipital
neuralgia frequently occurs, and is often severe. Neuralgias of the
fifth pair also occur. Darting pains in the limbs are usual, and the
fixed aching pains already described as peculiar to habitual chloral
excess are present, and often persist for a long time after the
withdrawal of the drug.

Irregular flushes of heat, nervousness, restlessness, inability to fix

the attention, formication, burning sensations in various regions of
the surface of the body, are unimportant but annoying symptoms.
In a considerable proportion of the cases delirium occurs. It is
commonly associated with tremor, great prostration, complete
insomnia, sweating, inability to take food, and vomiting, and
resembles in every particular the delirium tremens of alcoholic
subjects. In the absence of this condition gastric derangements are
not of a grave kind. The nausea, vomiting, epigastric pain, and
diarrhœa which are induced by the discontinuance of opium are
absent, or if present at all only to a slight degree. As a matter of fact,
the functions of the digestive system are in a very short time much
more perfectly performed than before. Hemorrhage from the
stomach, bowel, or urinary tract may also occur.

The conjunctivitis and cutaneous eruptions usually disappear with

promptness as soon as the influence of the habitual chloral excesses
passes away.

DIAGNOSIS.—The diagnosis of the chloral habit is attended with much

less difficulty than that of the morphine habit. In the first place, there
is general and often serious derangement of health without adequate
discoverable cause. The appetite is poor and capricious, the
digestion imperfect and slowly performed; jaundice of variable
intensity, often slight, sometimes severe, occurs in many cases; the
bowels are not, as a rule, constipated. Dyspnœa upon slight exertion
is, in the absence of pulmonary, cardiac, or renal cause, of
diagnostic importance. The circulation is, as a rule, feeble. Disorders
of the skin, persistent or easily provoked conjunctivitis, puffiness
about the eyelids, and a tendency to hemorrhage from mucous
surfaces also occur. When with these symptoms, irregularly grouped
as they are, we find a tendency to recurring attacks of cerebral
congestion, persistent or frequently recurring headaches, and the
characteristic pains in the legs, the abuse of chloral must be
suspected. This suspicion becomes the more probable if there be a
history of protracted painful illness or of prolonged insomnia in the
past. The adroitness of these patients in concealing their vice, and
the astonishing persistency with which they deny it, are remarkable.
In the absence of the characteristic association of pains,
conjunctivitis, and affections of the skin the diagnosis is attended
with considerable difficulty. It becomes probable from the association
of chronic ill-health, not otherwise explicable, with perversion of the
moral nature, enfeeblement of the will and of the intellectual forces. It
is rendered positive, notwithstanding the denials of the patient, by
the discovery of the drug or the prescription by means of which it is
procured.

PROGNOSIS.—If the confirmed chloral habitué be left to himself, the

prognosis, after excessive doses or the stage of periodical
debauches has been reached, is highly unfavorable. The condition of
mind and body alike is abject. There is danger of sudden death from
cerebral congestion or heart-failure—a mode of termination by no
means rare.

On the other hand, the prognosis under treatment may be said to be

favorable. The habit is much more readily broken up, and the danger
of relapse is far less, than in cases of confirmed opium or morphine
addiction. Nevertheless, the underlying vice of organization which
impels so many individuals to the abuse of narcotics precludes a
permanent cure in a certain proportion of the cases of chloralism.
Sooner or later relapse occurs—if not relapse to chloral, relapse to
opium, morphine, or alcohol, or into that wretched condition in which
any narcotic capable of producing excitement and stupor is taken in
excess as occasion permits.

Paraldehyde.

The use of this hypnotic is not unattended with danger. In a single

case afterward under the observation of the writer paraldehyde was
used in large and increasing doses for the sake of its narcotic
properties. The patient, a young married woman whose family
history was bad, her mother having died insane, contracted the
chloral habit after an acute illness. After some months a cure was
effected without great difficulty. She relapsed into chloralism after a
second sickness which was attended with distressing insomnia. The
habit was again broken up. In consequence of over-exertion in social
life during a winter of unusual gayety insomnia recurred. For the
relief of this condition paraldehyde was prescribed with success.
Notwithstanding its disagreeable and persistent ethereal odor, and
the precautions taken by the physician, this lady managed to secure
paraldehyde at first in small quantities, afterward in half-pound
bottles from a wholesale druggist, and took it in enormous amounts,
with the result of producing aggravated nervous and psychical
disturbances corresponding to those produced by chloral, but without
the disturbances of nutrition attendant upon the abuse of the latter
drug. The patient remained well nourished, retained her appetite and
digestion, and was free from disorders of the skin and the intense
neuralgia which had been present during both periods of chloral
abuse. She suffered, however, from a persistent binding headache,
disturbances of accommodation, phosphenes, and brow-pains.
Under the influence of moderate doses she was enabled to take part
in social life with some of her old interest and vivacity. The brief
intervals of abstinence which occasionally occurred were
characterized by distressing indifference to her friends and
surroundings and by apathy and depression. At frequently-recurring
intervals the indulgence in excessive doses, constituting actual
paraldehyde-debauches, was followed at first by maniacal
excitement of some hours' duration, later by profound comatose
sleep lasting from one to three days. Upon the complete withdrawal
of the drug this patient manifested the symptoms produced by
complete abstinence in the confirmed morphine habit—yawning,
anorexia, epigastric pains, vomiting, diarrhœa, absolute
sleeplessness, extending over several days, heart-failure, collapse,
colliquative sweating, and finally well-characterized delirium tremens.
At the end of a week, under the influence of repeated small doses of
codeine, sleep was secured, and within a month convalescence was
complete. This person now continues free from addiction to any
narcotic, in good health, and able to sleep fairly well, after the lapse
of several months since the complete discontinuance of
paraldehyde.
 Cannabis Indica, Ether, Chloroform, and Cocaine.

These drugs are habitually used as narcotic stimulants by a limited

number of individuals. Cannabis indica, or Indian hemp, the
hashhish of the Arabians, is said to be largely used in India and
Egypt. It is occasionally taken by medical students and other youths
of an experimental turn of mind, but no case of habitual hashhish
addiction has come under the observation of the writer.

The use of ether as a narcotic stimulant is occasionally observed

among druggists, nurses, and other hospital attendants, but does not
give rise to clinical phenomena sufficiently marked or distinctive to
demand extended consideration in this article. The same remark
may be made of chloroform, which is also used in the same way to a
considerable extent among women suffering from neuralgia and
other painful or distressing affections of the nervous system. The fact
that individuals are every now and then found dead in bed with an
empty chloroform-bottle by their side serves to indicate the extreme
danger attending the vicious use of this substance.

Cocaine, within the short time that has elapsed since its introduction
into therapeutics, has unquestionably been largely abused, both
within the ranks of the profession and among the people. Highly
sensational accounts of the disastrous effects resulting from its
habitual use in excessive doses have appeared in the newspapers
and in certain of the medical journals. No case of this kind has fallen
under the observation of the writer, and it would appear premature to
formulate definite conclusions concerning the effects of cocaine
upon the data thus far available.

Treatment.

The treatment of the opium habit and kindred affections is a subject

which derives its importance from the following facts: First, the
gravity of the disease, as regards the functions both of the body and
of the mind; second, the enormous suffering and misfortune, alike on
the part of the patient himself and on the part of those interested in
him, which these affections entail; third, the fact that they are not
self-limited, and therefore cannot be treated with indifference or upon
the expectant plan, but are, on the other hand, progressive and
gradually destructive of all that makes life worth living, and at last of
life itself; and finally, because they are capable at the hands of skilful
and experienced physicians of a cure which in a considerable
proportion of the cases may be made permanent.

The treatment of these affections naturally arranges itself under two

headings: (a) the prophylactic, (b) the curative treatment.

a. Prophylaxis.—It is impossible to overrate the importance of a true

conception of the duty of practitioners of medicine in regard to the
prophylaxis of the opium habit and associated affections. In
communities constituted as are those in which the physicians
practise into whose hands this volume is likely to fall, a large—I may
say an enormous—proportion of the cases of habitual vicious
narcotism is due to the amiable weakness or thoughtlessness of
medical men. A majority of the cases occur either in chronic painful
affections attended or not by insomnia, or as a result of acute illness
in which narcotics have been employed to relieve pain or induce
sleep. The chronic affections constitute two classes: First, those
manifestly incurable, as visceral and external cancer, certain cases
of advanced phthisis, confirmed saccharine diabetes, and tabes
dorsalis. In such cases the use of morphine in large and often-
repeated doses, although attended with evils and likely to shorten
life, amounts to a positive boon. It is neither practicable, nor would it
be desirable, to interfere with it. To this class may be added those
cases of grave valvular or degenerative disease of the heart where
the patient has become addicted to the habitual use of narcotics.
Here, notwithstanding the evils resulting from these habits, among
which the likelihood of shortening the period of life must
unquestionably be counted, the dangers of the withdrawal of the
drug are so great that it must be looked upon as neither desirable
nor feasible. Attention must, at this point, be called to the fact that
great caution is required in the management of pregnant women
addicted to narcotics. Incautious attempts to withdraw the habitual
drug are almost certain to be followed by speedy loss of the fœtus;
and it is to my mind questionable whether anything more than the
most guarded reduction of the daily dose should be attempted while
the pregnancy continues.

The second class of chronic cases includes individuals suffering

from diseases which are remediable or capable of decided or
prolonged amelioration. Among these affections are painful diseases
curable by surgical procedures, such as certain obstinate and
intractable localized neuralgias, painful neuromas, irritable cicatrices,
pelvic and abdominal tumors, and surgical affections of the joints
and extremities. Here, either before or after radical surgical
treatment, an effort to relieve the patient from the bondage of
habitual narcotism should be made. For reasons that are obvious,
measures having this end in view should be instituted by preference
subsequently to surgical treatment. To this class also belong certain
painful affections occupying the border-region between surgery and
medicine. These are floating kidney, renal and hepatic abscess,
calculous pyelitis, cystitis, impacted gall-stones, and thoracic and
abdominal aneurism. In these cases the possibility of a cure renders
it in the highest degree desirable that the opium habit should be
stopped. Whether this attempt should be made while the patient is
under treatment for the original affection, or deferred until relief has
been obtained, is a question to be decided by the circumstances of
the particular case under consideration. Finally, we encounter a large
group of chronic painful affections coming properly under the care of
the physician in which the opium habit is frequently developed. This
group includes curable neuralgias of superficial nerves, as the
trigeminal, occipital, brachial, intercostal, crural, and sciatic, and
visceral neuralgias, as the pain of angina, gastralgia, enteralgia, and
the pelvic and reflex neuralgias of women. Here also are to be
mentioned the pains of neurasthenia, hypochondriasis, and hysteria.
In this group of affections the original disease constitutes no obstacle
to the attempt to break up the habit to which it has given rise.
The practice of using narcotics, especially the preparations of opium,
in large and increasing doses for the relief of frequently-recurring
pains, especially in neurotic individuals, is a dangerous one. When
necessary at all, the use of these drugs should be guarded with
every possible precaution. In the first place, in so far as is
practicable, the patient should be kept in ignorance of the character
of the anodyne used and of the dose. In the second place, the
physician should personally supervise and control, in so far as is
possible, the use of such drugs and the frequency of their
administration, taking care that the minimum amount capable of
producing the desired effect is employed. In the third place, the
occasional alternation of anodyne medicaments is desirable.
Fourthly, an effort—which, unfortunately, is too often likely to be
unsuccessful—should be made to prevent repeated renewals of the
prescription without the direct sanction, or indeed without the written
order, of the physician himself. Finally, the danger of yielding to the
temptation to allow a merely palliative treatment to assume too great
importance in the management of painful affections must be
sedulously shunned. Too often these precautions are neglected, and
the patient, betrayed by a dangerous knowledge of the drug and the
dose by which he may relieve not only physical pain, but also mental
depression, and tempted by the facility with which the coveted
narcotic may be obtained, falls an easy victim to habitual excesses.
The lowered moral tone of convalescence from severe illness and of
habitual invalidism increases these dangers. Yet more reprehensible
than the neglect of many physicians in these matters is the folly of
the few who do not hesitate to fully inform the patient in regard to the
medicines given to relieve pain or induce sleep, and to place in his
hands designedly the means of procuring them without restriction for
an indefinite period of time. Almost criminal is the course of those
who entrust to the patient himself or to those in attendance upon him
the hypodermic syringe. No trouble or inconvenience on the part of
the physician, no reasonable expense in procuring continuous
medical attendance on the part of the patient for the sake of relief
from pain, can ever offset, save in cases of the final stages of
hopelessly incurable painful affections, the dangers which attend
self-administered hypodermic injections.
The uniform and efficient regulation of the sale of narcotic drugs by
law would constitute an important prophylaxis against habitual
narcotism. Unfortunately, the existing laws relating to this subject are
a dead letter. They are neither adequate to control the evil nor is
their enforcement practicable. Nostrums containing narcotics, and
particularly opium and morphine, in proportions that occasionally
produce fatal results are freely dispensed at the shops to all comers.
Prescriptions calling for large amounts of opium, morphine, codeia,
chloral, cannabis indica, etc. are dispensed to the same individuals
at short intervals over the counters of apothecaries for months or
years after the illness in which they were originally prescribed is
over. Yet more, occasional cases come to light which serve to
indicate the appalling frequency with which opium, its tincture,
morphine, and solutions of chloral are directly sold to unauthorized
individuals. If the evil thus accomplished were better understood, the
paltry profit realized from such nefarious trading would rarely tempt
men to the commission of the crime which these practices constitute.

Finally, the dissemination of a wholesome knowledge of the methods

by which the opium habit and kindred affections are induced, of the
serious character of these affections, and of the dangers attendant
upon an ignorant and careless employment of narcotics, would
constitute an important measure of prophylaxis. I am fully aware of
the evils resulting from the publication of sensational writings relating
to this subject. Notwithstanding these dangers, I am convinced that a
reasonable and temperate presentation of the facts in the popular
works upon hygiene used in schools and in the family would exercise
a wholesome influence in restraining or curing the tendency to the
practice of these vices.

Where these habits have resulted in consequence of the medicinal

abuse of narcotics in acute cases from which the patient has long
recovered, a determined effort to break them up should at once be
instituted.

b. The Curative Treatment.—The responsibility assumed by the

physician in attempting to cure patients suffering from the confirmed
abuse of narcotics is often a serious one. Much judgment must be
exercised in the selection of cases. The responsibility of the
physician, beginning as it does with the judicious selection of the
cases, does not cease with the active management of the patient
until the habit has been completely broken up, but involves for a
considerable period of time such continued personal influence and
supervision as is needed to avert relapse. It is needless to say that
such supervision and influence must, after a more or less extended
period, in nearly every case come to an end, but the important fact is
to be borne in mind that the danger of relapse becomes less and
less with the progress of time; therefore, the more extended the
period during which the personal control of the physician may act as
a safeguard to his patient the better.

The question as to whether the cure should be attempted in the

patient's own home or away from it does not appear to the writer to
admit of discussion. Some trustworthy observers12 have reported
successful cases not only of the home-treatment of opium-addiction,
but even under circumstances in which the patients have been
permitted to go at large. Many physicians do not hesitate to
undertake the treatment with certain precautions at the home of the
patient. On the other hand, those whose experience in the
management of these cases is most extended look upon attempts of
this kind as likely to be unsuccessful in the great majority of the
cases of the opium or morphine habit. In cases of chloralism and the
abuse of less formidable narcotics, as cannabis indica, paraldehyde,
etc., the home-treatment, if judiciously carried out, usually succeeds,
but the cases in which the home-treatment proves successful in
curing the confirmed addiction to opium or morphine must be looked
upon as exceptional. The reasons for this are obvious. They relate to
a variety of circumstances which tend to weaken the mutual relations
of control and dependence between the physician and his patient.
The doubts, criticisms, remonstrances, even the active interference,
of the patient's friends tend to weaken the authority of the physician
and to hamper him in the management of the case; the discipline of
the sick-room is maintained with greater difficulty; the absolute
seclusion of the attendant with his patient is a practical impossibility.
Affectionate but foolish friends come with sympathy at once
disturbing and dangerous. Some devoted and trusty servant
cunningly conveys from time to time new supplies of the coveted
drug, or, if these accidents be averted, the very consciousness of the
separation which amounts to a few feet of hall-way only is in itself a
source of distress to the patient and his friends alike. Furthermore,
the period of convalescence following the treatment is attended with
the greatest danger of relapse—a danger which is much increased
by the facility of procuring narcotics enjoyed by the patient in his own
home as contrasted with the difficulties attending it away from home
under the care of a watchful attendant. The desirability of
undertaking the treatment away from the patient's home can
therefore scarcely be questioned. That this plan is more expensive,
and that it involves a radical derangement of the ordinary relations of
the patient's life, are apparent rather than real objections to it. The
very expense of the cure within the limits of the patient's ability to
pay, and the mortification and annoyance of temporary absence from
usual occupations and seclusion from friends, are in themselves
hardships that enhance the value of the cure when achieved, and
constitute, to a certain extent, safeguards against relapse. Whether
the treatment can be more advantageously carried out in a private
asylum designed for the reception of several such cases, or in a
private boarding-house, or at the home of the physician himself, is a
question to be determined by circumstances. The writer is of the
opinion that with well-trained and experienced attendants, well-
lighted, airy rooms in the upper part of a private house are to be
preferred on account of the seclusion thus secured.
12 See, for example, Waugh, “A Confirmed Case of Opium-addiction treated
Successfully at the Patient's Home, with Remarks upon the Treatment, etc.,”
Philadelphia Medical Times, vol. xvi., March 20, 1886.

In general, two methods are recognized: (a) that of the abrupt

suppression of the drug, and (b) that of the gradual diminution of the
dose. Both of these methods demand the isolation of the patient, and
to some extent at least the substitution of other narcotics. The
isolation of the patient under the care of skilled and experienced
attendants may be secured in a suitable private boarding-house, in
the home of a physician, or in a private room of a well-appointed
general or special hospital. Favorable opportunities are also afforded
in private institutions devoted to this purpose. The apartment
occupied by the patient should be so arranged as to guard against
attempts at suicide, and the furniture should be of the simplest
character. The heating and lighting arrangements must be such as to
render any accidental injury to the patient during paroxysms of
sudden maniacal excitement quite impossible. From the beginning of
the treatment the patient must under no circumstances be left alone.
Two attendants are required, one for the day and one for the night.
They should be not only skilful and experienced, but also patient and
firm; and, as a considerable proportion of the patients are persons of
education and refinement, intelligence and good manners are
desirable on the part of those who must be for a length of time not
only the nurses, but also the companions, of the sufferer. It is
desirable that the separation of the patient from his family and
friends should be made as complete as possible. During the
continuance of the active treatment no one should be admitted to the
patient except his physician and regular attendants. Communication
with his friends by letter should be interdicted. The enforcement of
this rule must be insisted upon. So soon as the acute symptoms
caused by the withdrawal of the drug subside and convalescence is
fairly established, brief visits from judicious members of the family in
the presence of the nurse may be permitted. At the earliest possible
moment open-air exercise by walking or driving must be insisted
upon, and change of scene, such as may be secured by short
journeys or by visits to the seashore, is useful. These outings require
the constant presence of a conscientious attendant.

The Treatment of the Opium and Morphine Habit.—a. The Abrupt

Discontinuance of the Drug: the Method of Levinstein.—This method
is thus described by the observer whose name it bears: Directly
upon admission the patient is given a warm bath, during which time
careful examination of his effects is made by a responsible person
for the purpose of securing the morphine which the patients,
notwithstanding their assertions to the contrary, frequently bring with