Mind on Canvas: anatomy, signs and neurosurgery in art

ORIGINAL ARTICLE

Mind on Canvas: anatomy, signs and neurosurgery in art

F. GERANMAYEH & K. ASHKAN

North West London Hospitals NHS Trust, and Department of Neurosurgery, Kings College Hospital, London, UK

Abstract

Throughout the ages, art and neuroscience have had a delicate yet definite relationship with reciprocal influence. By virtue oftheir superior power of observation, artists have often preserved neurological signs through detailed brush strokes ormeticulous carvings long before it is described in scientific literature. There has been an increasing tendency to use paintingsand drawings as independent sources for investigation of scientific history. In neuroanatomy, these tools have helped revealthe complex interrelation between arts and neurosciences that on the surface often appear as highly polarized worlds. In thisarticle we begin by giving a brief introduction to the general relationship between neuroscience and art as depicted inpaintings and drawings, and describe the artistic tendencies of the early neuroanatomists. We aim to highlight the existence ofneurosurgical themes within paintings and drawings from different eras.

Key words: Drawing, neuroanatomy, neurosurgery, neurology, painting.

Art is born of the observation and investigation of

nature. (Cicero, Roman author and orator, 106–43

BCE).

Introduction

Connections between the arts and the sciences have

existed throughout history. As the most creative

endeavours of human activity, both disciplines have

developed in parallel based on temperament and

philosophical milieu of their time.

Neuroscience per se manifests through art in

several ways. Not uncommonly, neurological ill

health can be recognized by the observant eye of an

artist. Thus, portraits have been described by Zeki, a

pioneer in neuroaesthetics, to use ‘the accidents of

each individual face to reveal inner life’.1 For

instance de Ribera and El Greco were inspired by

neurological phenomenon in their subjects, and

transformed their view of neurological signs to a

language of paint they found easy to disseminate.

At other times the will for better understanding and

teaching has pushed neurosurgeons, such as Harvey

Cushing to document their own studies through

drawing. Yet, artists such as Leonardo da Vinci have

become anatomists undertaking and drawing their

own investigations. Furthermore, sometimes it is a

work of art that is a confirmation of the presence of a

neurological disease in its creator.2–5

Science has also had a more direct influence on

art, for example, through Michel-Eugene Chevreul’s

The Law of Simultaneous Colour Contrast (1839) that

strengthened the foundations of colour theory. More

recently, the concepts of cerebral localisation of

creativity and talent, and neuroaesthetics have

attracted interest by the neuroscientists. Pioneered

by Samir Zeki, neuroaesthetics investigates the

neurological response towards an aesthetic phenom-

enon such as art and examines the neural correlates

of beauty.1,6 There is a mind on each canvas—the

artists use colours, perspectives, shapes and lines to

activate specific neuronal pathways. Thus, exploiting

our common visual organization and arousing shared

experiences beyond the reach of words.

In this paper, we will focus on a review of paintings

and drawings that portray knowledge of neuroanat-

omy throughout history, as well as those that show

neurosurgically relevant signs. We also describe

examples of neurosurgical procedures in paintings

that have contributed to our understanding of the

neurosurgical environment, techniques and reason-

ing prevalent at the time of the paintings. Our aim is

to highlight the existence of neuroscientific themes,

as shown in paintings and drawings, amongst the

neurosurgical community.

It is worth mentioning in the outset that, whilst

pictorial documents enable medical historians to

drive conclusions about a depicted scene, such

Correspondence: Mr K. Ashkan, D epartment of Neurosurgery, Kings College Hospital, D enmark Hill, London SE5 9RS, U K. Tel: 0044 203 299 3285.

Fax: 0044 203 299 3280. E-mail: keyoumars.ashkan@ kingsch.nhs.uk

Received for publication 13 November 2008. Accepted 6 April 2008.

B ritish J ournal of Neurosurgery, 2008; 1 – 12, i F irst article

ISSN 0268-8697 print/ ISSN 1360-046X online ª The Neurosurgical Foundation

D OI: 10.1080/ 02688690802109820

Downloaded By: [King's College London] At: 14:38 18 September 2008

interpretations can become erroneous, especially in

cases where no original written documentation is

available or where the picture is analysed out of its

historical context. One such example is a woodcut in

Fabricius Hildanus’ description of a novel way to

apply a seton in the neck, which was later misread by

an author of History of Neurological Surgery, 1951

edition, as a method of reduction of cervical

dislocation.7

Neuroanatomical drawings

There are extensive ancient Egyptian and Greek

manuscripts that contain fascinating textual descrip-

tions of neuroanatomy including E dwin- Smith

papyrus from 3500 BCE, I liad of the Greek poet

Homer and writings of Hippocrates, Herophilus, and

Galen, which are beyond the scope of this article and

have been covered thoroughly in the literature.8–12

After the Greek period of medicine, the centres of

intellectual enquiry moved to the Islamic cultures,

where it remained influential from 750 to 1200 CE.

Physicians, including Avicenna (980–1037 CE),

made major contributions to the body of knowledge

about neuroscience in this period. Fig. 1 is a

watercolour drawing of the nervous system taken

from the legendary book A l- Q anun F i A l- Tib b (The

Canons of M edicine) by Avicenna known as the

‘Second D octor’ (the first being Aristotle). The

figure is viewed from the back, with the head

hyper-extended so that the mouth is at the top of

the page. D ifferent colours were used to represent

pairs of nerves. The spine is drawn in continuity with

the brain stem where some cranial nerves emerge

from it. The spine has been numbered into eight

cervical, 12 thoracic, five lumbar and four sacral

segments. Some fibres from the cervical segments are

shown to cross each other at the level of brachial

plexus.

Avicenna systematically reviewed the medical

knowledge by the previous scientists and comple-

mented them by his own findings. Chapters 6–13 of

The Canons are designated to spinal anatomy and

its biomechanical aspects.13 On a personal level,

Avicenna was a gifted child born in the Persian village

of Afshama, who was a practicing physician at the age

of 20. In addition to Canons, he demands credit for

his encyclopaedia of philosophy, Shafaa, meaning

healing. His choice of names for these two books,

Canon (law), for a medical text book, and Shafaa

(healing) for a philosophical one, is intriguing.

A very similar drawing can be seen in The A natomy

of the Human B ody ( Tashrih- i b adan- i insane) by

Mansur Ibn Muhammad Ilyas (14th century),

another Persian physician, suggesting this may have

been a common method of illustrating neuroanatomy

at the time (Fig. 2). This book has five coloured

illustrations of skeleton, muscles, intestine, blood

vessels and nerves. Through the latter he describes

the anatomy of the spinal cord and nerves.

Neuroanatomy in R enaissance A rt

In Europe, the Renaissance heralded the blossoming

of medicine and art. Leonardo da Vinci (1452–

1519), who created 190 pages of drawings and

writings devoted to anatomy, was particularly fasci-

nated with the nervous system. Born in the Italian

village of Vinci, he was an illegitimate son of Ser

Piero d’Antonio, a notary, and a peasant woman

named Caterina. He produced over 5000 known

leaves of notebooks decorated with detailed direct

observational drawings ranging from mechanics to

anatomy, some written in his characteristic reversed

script or ‘mirror writing’.

He made many contributions to neurosciences,

including the discovery of neuroanatomical struc-

tures such as meningeal arteries and frontal si-

nuses.14 He injected hot wax into the brain of an

ox and produced a cast of the ventricles. This

represented the first attempt at using a solidifying

medium to determine the structure of an internal

body organ (Fig. 3).

Leonardo’s thoughts on ventricles were influenced

by previous physicians, such as Mondino, Avicenna

FIG. 1. Study of the nervous system, from Avicenna’s 11th century

treatise Canons of M edicine, al- Q anun F i A l- Tib b , Folio 123 verso.

Published in Isfehan, Iran 1632, Wellcome Library, London.

L0013312.

2 F . G eranmayeh & K. A shk an


and Galen, who wrote extensively on the ‘reciprocal

symmetry’ or ‘reciprocal harmony’ of the brain. In

Fig. 4, Leonardo draws an onion that shows by

analogy, the layered structure of the membranes

covering the eye and the brain. The main drawing

and the one below show Leonardo’s division of the

cerebral ventricles into anterior, middle and poster-

ior.15 He located the senso comune (literally common

sense) or the amalgamation of the senses in the brain,

which was also the location of the soul. He assigned

the anterior ventricle to the senso comune alongside

fantasy and imagination, the middle to cognition,

and the posterior ventricle was assigned to mem-

ory.16 In Leonardo’s eyes, the only certifiable and

reliable knowledge was that obtained directly by sight

and experience from the external world: ‘The eye,

which is termed the window to the soul, is the chief

organ whereby the senso comune can have the most

complete and magnificent view of the infinite works

of nature’.14

Leonardo is referred to by some as an artist with

the mind of a physician, but Vesalius (1514–1564) is

thought to be the opposite.17 He produced three

masterly anatomical text books; Tab ulae A natomicae

Sex , E pitome and De Humani Corporis F ab rica. These

contain unrivalled artistic quality woodcut illustra-

tions by Titian’s pupils, largely based on human

dissection. In the third and seventh parts of De

Humanis Corpora F ab rica ( Structure of the Human

B ody) , Vesalius describes peripheral nerves, and

central nervous system, respectively.18 D etailed

drawings of the cerebellum, vagus nerve and

arachnoid space are particularly fascinating (see

http: / / archive.nlm.nih.gov/ proj/ ttp/ flash/ vesalius/

vesalius.html, accessed 1 April 2008). Vesalius

criticized both the medieval methods of dissection,

which were mainly based on animal, rather than

human anatomy (due to prohibition of human

dissections in ancient Rome), and the dependence

of anatomy on authoritative texts without question-

ing them. Trusting his own eyes, Vesalius gradually

observed some errors in Galen’s work, which

attracted animosity from his contemporaries. He also

reproduced some Galenic errors such as his drawing

of the five-lobed liver in Tab ulae A natomicae Sex ,

reminding us that sometimes the presumed infallible

text is more powerful than the artist’s eye.

Michelangelo Buonarroti (1475–1564), the Italian

painter, sculptor and poet, began dissecting human

bodies at the age of 18 in the Monastery of Santo

Spirito in Florence, using corpses from surrounding

hospitals. His paintings have been referred to by

many medical specialists.19 Of particular note to

neuroanatomy is his famous fresco, on the ceiling

of the Sistine Chapel, ‘The Creation of Adam’

(http: / / mv.vatican.va/ 3_ EN/ pages/ x-Schede/ CSNs/

CSNs_ V_ StCentr_ 06_ big.html, accessed 1 April

2008). Meshberger20 has argued that the billowing

cloth structure and angels surrounding God resem-

ble a sagittal view of the brain including the frontal

lobe, whilst the major sulci are outlined by the

contours of the figures of angels. Optic chiasm, brain

stem and the pituitary gland are shown by the bifid

foot of an angel, and the vertebral artery is

represented by a green robe. He argues that perhaps

this is a coded message from Michelangelo implying

that the divine gift received from God to Adam is

intellect, rather than life itself. Adam appears alive,

stretching out with his eyes open just before being

touched by God to be created. In fact, some have

argued that given the physical similarities between

God and Adam, it is not clear who the creator is; is

God creating Adam, or does God exist in Adam’s

mind? 21 God’s left arm is wrapped around a female

figure. Some see her as Eve awaiting creation, whilst

others think her to be Sophia the Goddess of divine

wisdom and the feminine side of God.

Neurosurgical / neurol ogical signs in art

P araplegia

Scenes depicting paraplegia are not rare within the

art world, probably because this is a common

FIG. 2. Watercolour drawing of the nervous system from The

A natomy of the Human B ody by Mansur Ibn Ilyas. The figure is

viewed from the back, with the head hyper-extended so that the

mouth is at the top of the page. D ifferent colours were used to

represent pairs of nerves. Wellcome Library, London. L0006435.

M ind on canv as 3


debilitating neurological deficit. An alabaster wall

relief from the Nebuchadnezzar’s palace in Nineveh

(650 BCE) showing the Neo-Assyrian king hunting

lions from his chariot, has been used to suggest that

the early hunters were aware of the phenomenon of

paraplegia. Fig. 5 shows a section of this relief. Here,

arrows penetrate a lioness through the back resulting

in what appears to be paraplegia of her hind limbs.

A more contemporary painting ‘The Paraplegic’

(Fig. 6), by the London born Claude Rogers

(1907–1979) is a more evident example. Here, two

nurses are supporting a patient’s upper body and

right thigh, encouraging her to take a step forward.

Perhaps she has suffered a stroke.

M uscle atrophy

An example of limb atrophy may be seen in ‘St Peter

Healing the Sick with his Shadow’, a fresco painting

by Masaccio (1401–1428) in Brancacci Chapel, at

Santa Maria del Carmine Church in Florence (http: / /

en.wikipedia.org/ wiki/ Image: Masacc14.jpg, accessed

1 April 2008). Here, a beggar is shown kneeling on

the ground in front of St Peter and the crowd. His

bilaterally wasted legs have been attributed to polio,

but this has been contested by some, as the first

known epidemic of polio occurred after this piece

was painted, in the 18th century.22

‘Seiz ure’

D riven from the Greek word epilam- b anein, to be

seized or attacked, the term epilepsy was introduced

into the medical terminology by Avicenna.23

Although physicians of ancient Greek, Byzantine

or Persia, regarded seizures as a disease process,

historically people who suffered from epilepsy were

often viewed as possessed. In Homer’s time,

FIG. 3. D rawing of cerebral ventricles after injection with liquid wax by Leonardo da Vinci. The Royal Collection ª 2007, Her Majesty

Q ueen Elizabeth II.



epilepsy was regarded as a miasma casted upon the

soul by the goddess Hecate, although this belief was

later refuted by Hippocrates in his text The Sacred

Disease.24 In early Christianity the act of J esus

driving out the unclean spirit of the boy with

seizure, suggests that people with epilepsy were

regarded as being seized and needing exorcism.

This is depicted in Raphael’s (Rapha –el meaning

He/ God has healed) last painting, ‘The Transfig-

uration’ (Fig. 7), which was almost finished before

his death on Good Friday, 1520. The painting tells

two stories; the Transfiguration of Christ on Mount

Tabor in the upper section and the healing (or

rather just prior to) of the boy with evil spirits in the

lower part. The latter account comes immediately

after the description of the transfiguration in the

Gospel and is based on the following passage in the

Bible:

Teacher, I brought my son to you, because he has

an evil spirit in him and cannot talk. Whenever the

spirit attacks him, it throws him to the ground, and

he foams at the mouth, grits his teeth and becomes

stiff all over. (Mark, Chapter 9, verses 17–18)

The father wearing green, a symbol of hope, is shown

supporting his son who appears to be convulsing.

Interestingly, it is only the boy who looks up to J esus,

transcending in white light amongst Moses, Elijah

and the three disciples. Some have argued that

Raphael’s simultaneous depiction of these two

biblical events in one painting acts as a simile for

FIG. 4. Sagittal and axial sections of the human head and eye by Leonardo da Vinci c.1490. The onion shows by analogy, the layered structure

of the membranes covering the eye and the brain. Leonardo divided the cerebral ventricles into three parts and assigned the anterior ventricle

to the senso comune (literally common sense), as well as fantasy and imagination, the middle to cognition, and the posterior ventricle was

assigned to memory. The Royal Collection ª 2007, Her Majesty Q ueen Elizabeth II.

M ind on canv as 5


J esus’ transfiguration through suffering, death and

resurrection.25

‘St Catherine exorcising a possessed woman’ by

Girolamo de Benvenuto (1470–1524 CE), and

‘St Zeno exorcising the D aughter of Emperor

Gallienus’ (Fig. 8) are two other paintings that

portray epilepsy. The latter is by Fra Filippo Lippi

who completed this painting as part of the predella of

‘The Trinity with Saints Mamas, J ames, Zeno, and

J erome’ by Pesellino, after his death. The unclean

spirit is shown leaving the mouth in the shape of a

dragon. It is imperative to mention that despite such

beliefs about epilepsy in those times, people with this

disease also received great empathy in the church by

distinguished individuals such as St Valentine, the

patron saint of people with epilepsy.

B ab insk i sign

J oseph Francois Babinski (1857–1932) was the first

to recognize the neurological significance of Babinski

sign. Nevertheless, many artists had observed this

natural phenomenon in paintings of young infants

much earlier.26 Two such examples are ‘Madonna

and Child with Angels’ (http: / / it.wikipedia.org/ wiki/

Immagine: Sandro_ Botticelli_ 062.jpg, accessed 1

April 2008 and ‘Madonna and Child with Eight

Angels’ (http: / / www.wga.hu/ frames-e.html? / html/ b/

botticel/ 22/ 1madonna.html accessed 1 April 2008)

by Sandro Botticelli (1445–1510).

F acial palsy

An example of facial muscle weakness can be viewed

in a painting by Francisco de Goya (1746–1828), a

leading Spanish painter of the courts of Charles III,

Charles IV and Ferdinand VII of Spain. Fig. 9

depicts a portrait of his friend and fellow artist, ‘D on

Andres del Peral’, who has an evident left facial nerve

palsy that is still apparent despite the artist’s chosen

angle to paint the portrait as an effort to minimize

this asymmetry. It has been suggested that del Peral

suffered from a left upper motor neuron facial nerve

lesion, most probably due to a stroke.27 Of interest,

Goya fell ill at the age of 46, and subsequently was left

with partial blindness, loss of hearing and dizziness

probably due to Vogt–Koyanagi Syndrome.28

FIG. 5. Alabaster wall relief from the Assyrian North Palace at Nineveh shows an arrow penetrating a lioness in the back resulting in

paraplegia. ª Copyright the Trustees of the British Museum.

FIG. 6. ‘The Paraplegic’ (1970–1971), by Claude Rogers. Two

nurses are shown supporting a patient. ª Tate, London 2005.



P tosis

Portraits of King Henry III (1207–1272) of England

(http: / / www.npg.org.uk/ live/ search/ portrait.asp?

search¼ap&title¼&npgno¼4980% 286% 29&set¼&e

D ate¼&lD ate¼&subjNoJ s¼&subj¼&setNoJ s¼&

medium¼&rNo¼0, accessed 1 April 2008), and his

son Edward I (http: / / www.npg.org.uk/ live/ search/

portrait.asp? LinkID ¼mp67807&rNo¼1&role¼sit

accessed 1 April 2008) have been used to suggest that

the father and son both suffered from congenital

ptosis.29 In this portrait, Henry III is shown with a

raised right eyebrow, compensating for the drooping

of the right eyelid. The portraits date back to the 17th

and 18th centuries, respectively, and are based on an

earlier portrait from their lifetime, the former by an

unknown artist, and the latter by George Vertue.

Club foot

The Spanish borne artist, J osepe de Ribera (1591–

1652), spent part of his youth in Italy, living a life of

half beggar and later became the painter to the

Spanish Viceroy in Naples. His earlier works had a

religious theme, but his later paintings, such as ‘The

Beggar’ or ‘The Clubfoot’ (http: / / www.abcgallery.

com/ R/ ribera/ ribera8.html, accessed 1 April 2008)

were of a more popular genre. Although the title of

the painting suggests an orthopaedic problem, the

underlying disease depicted may have been neurolo-

FIG. 7. ‘The Transfiguration’ by Raphael, commissioned in 1517 and based on the biblical passage; ‘Teacher, I brought my son to you,

because he has an evil spirit in him and cannot talk. Whenever the spirit attacks him, it throws him to the ground, and he foams at the mouth,

grits his teeth and becomes stiff all over’. A boy who appears to be convulsing can be seen in the bottom right corner. ª Photo Vatican

Museums.

M ind on canv as 7


gical; in this painting a beggar is shown holding a

message that reads ‘give me alms for the love of

God’, suggesting that he cannot speak. He has an

evident deformity of the right leg, and flexion

deformity of the right wrist and fingers. Some have

suggested that he suffers from right infantile hemi-

paresis.30 Nevertheless, others have argued that if the

beggar had this disease, with the causative lesion

being on the left cerebral hemisphere, he would most

likely not be aphasic as in this childhood condition

the functioning hemisphere, right in this case, would

usually take on the capacity for language. They have

suggested that either he has a bilateral cerebral lesion,

or he is just seeking sympathy and ‘alms’.22

Neurosurgical p ersp ective th rough

th e artist’ s eye

Today’s sophisticated neurosurgical knowledge,

techniques and environment is a far cry from the

primordial neurosurgery that dates back to the

Neolithian period. Furthermore, the prehistoric

cranial operations had elements of magic, ritual and

religious motivations, where cranial bones obtained

from postmortem operations, were worn as charms,

amulets or talismans.31 Through art, much can be

learnt about previous neurosurgical procedures, as

well as the context and environment in which they

occurred.

Trephination

Trephining or trepanning, believed by some to be the

oldest surgical procedure, is the removal of a piece of

bone from the skull by a trepan or trephine, a name

derived from the Greek trypanon or borer. It began in

the late Paleolithic period and has been used

FIG. 8. ‘St Zeno exorcising the D aughter of Emperor Gallienus’ by Fra Filippo Lippi and workshop. This is likely to depict an epileptic

seizure. A spirit is shown leaving the body of a woman as she is exorcised by St Zeno. Photo ª the National Gallery, London. Presented by

Mr. and Mrs. Felix M Warburg through the National Art Collections Fund, 1937.

FIG. 9. ‘D on Andres del Peral’ by Francisco de Goya (1795–1798).

A left facial palsy is still apparent despite the artist’s chosen angle as

an attempt to minimize the facial asymmetry. Photo ª the National

Gallery, London.



throughout history. It was extensively discussed in

Hippocrates’ O n Wounds in the Head.32 Ancient

surgeons used scarping, grooving, boring and making

rectangular intersecting incisions to remove pieces of

cranial bone in skull injuries, or even treat melan-

choly and mental disorders.33–35

Trephination has been reported in many cultures

including Indians of Canada and the U nited States,

Europe, Africa, ancient Iran and Peru, where

comparative osteology has shown that up to 70% of

patients survived the procedure with relatively low

rate of infection.36–41 ‘The Inca Trephination’ mural

(installed at the Hall of Physical Anthropology,

Smithsonian Institution, U SA), by Alton S. Tobey,

a contemporary historical artist, is a depiction of this

practice. Tobey and his family spent weeks in South

America and in the ancient Inca city of Machu

Picchu, where he extensively researched this 16th

century practice of South American Inca Empire. He

paid attention to the excavated primitive trephination

instruments and methods of handling them, as well

as costumes and artefacts from the Peruvian culture

in order to reproduce an accurate scene. ‘The Inca

Trephination’ (http: / / www.myimagezone.com/ lib/

Thumb.aspx? f¼/ data/ 0/ 88/ 88120.J PG&l¼950, ac-

cessed 1 April 2008) shows trephination by a

FIG. 10. Woodcut drawings showing trephination in process in a home environment with an audience that includes pets and children. From

D ella Croce’s Chirugiae . . . lib ri septem, q uamplurimis instumentorum imaginib us arti chirurgicae opportunis . . . ex ornata, theoricam, practicam, ac

v erissimam ex perimentiam continents . . . Venice, G. Ziletti, 1573. (A) Folio 53 verso. (B) Folio 54 recto. Wellcome Library, London.

M ind on canv as 9


priest-surgeon of the Inca Empire on an injured

warrior in the setting of the granite-made city of

Machu Picchu, perched high in the Andes Mountain.

Two woodcut drawings (Fig. 10a,b) from the 16th

century treatise Chirurgiae univ ersalis opus ab solutum

by Giovanni Andrea D alla Croce, probably one of

the most comprehensive surgical textbooks, show

detailed scenes of trephination within a home setting.

In Fig. 10b the patient is lying prone on the bed,

surrounded by the surgeon, a woman crying, two

men warming a cloth and observers, including a

child. The presence of animals in this operating

environment provides an interesting insight into the

concepts of cleanliness and sterility prevalent at the

time. The operating room and dressings were

warmed as the cold was cereb ro fringes inimicissimus,

very dangerous to the brain. Additionally, climate

was thought to affect the outcome of the operation.

The climate of Florence and Midi of France were

regarded as very pestiferum—unfavourable.42

Cranial inj ury

Hippocrates’ (460–377 BCE) treatise entitled De

Capitis V ulnerib us, O n Wounds in the Head or O n

I nj uries of the Head, was a pioneering work in the field

of management of head injuries despite the lack of

animal or human dissections. In this treatise he

describes cranial thickness and relation to injury,

classifies cranial fractures, describes contrecoup in-

juries and various bandaging techniques.43 Neurosur-

gery later developed in the Islamic era, when

cauterization of wounds to stop bleeding was prac-

ticed.44The renaissance and post-Renaissance periods

that saw the emergence of the concept of a specialized

surgeon, were also noteworthy for their art of warfare

FIG. 11. ‘The Cure of Folly’ or ‘The Stone Operation’ by H. Bosch showing a medical charlatan attempting to apparently surgically remove a

stone from the head of patient. The translation of the inscription reads ‘Master, dig out the stones of folly, my name is castrated dachshund’,

where ‘castrated dachshund’ was a nickname for a person lacking commonsense. Museo Nacional D el Prado, Madrid.



and, later, the invention of firearms and treatments of

gunshot wounds.42 Pare, the founder of modern

French surgery and a military surgeon who served a

succession of kings, wrote numerous treatise on

management of battlefield injuries, including wounds

to the head. These contained numerous drawings, not

all by him, of surgical instruments used at the time. Of

particular note is a drawing of an elev atorium that was

used to elevate a depressed skull fracture. (See http: / /

www.nlm.nih.gov/ exhibition/ historicalanatomies/

Images/ 1200_ pixels/ ccclii.jpg, accessed 1 April

2008.) D epressed skull fractures were common in

battlefields that used maces, pole-arms and fire arms.

In using the elevator, dura was spared and bony

fragments were removed leaving gaps for the extra-

dural pus to escape. Within such an environment, it is

amazing that soldiers could survive such injuries.

Stone remov al

Several Renaissance painters have painted scenes

where attempts are made, often by medical charlatans

or itinerant quacks, to apparently surgically remove

stones from the heads of people with mental disorders

through making superficial incisions and palming

stones. There are two schools of thought on this

subject: some regard these paintings as allegory for

human idiocy and gullibility, whilst others think them

to be an actual medical procedure prevalent at that

time. Perhaps the basis for this perception could have

been the occasional postmortem finding of a calcified

frontal lobe meningioma as the cause of apparent

madness, although there is no solid evidence for this

theory. Fig. 11, ‘The Cure of Folly’ or ‘Stone

Operation’ by Hieronymus Bosch (c. 1450–1515) is

one of the first of such paintings. The translation of

the inscription reads ‘Master, dig out the stones of

folly, my name is castrated dachshund’, where

‘castrated dachshund’ was a nickname for a person

lacking common sense. There are many symbolisms

in this painting. The doctor wearing a funnel

(symbolic of deceit or false alchemist) performs the

operation and removes a tulip lying on the table,

instead of a stone. The tulip traditionally carried the

connotation of folly. The closed book balanced on the

head of the nun, overlooking the operation adds to the

sense of ‘stupidity’ of human affairs.45,46

This theme has been repeated in many paintings

including ‘The Extraction of the Stone of Madness’

(1556–1557) by Pieter Bruegel the Elder, ‘The

Extraction of the Stone’ (1650–1655) by J an Steen,

and ‘A Q uack D rawing Stones from the Head of a

Patient’ (17th century), attributed to J an de Bray

(1627–1697).

Concl usion

Here, we have attempted to explore the complex

relationship that exists between art and neuroscience,

and to show how these two apparently distinct

entities continue to influence each other. We have

briefly described drawings and paintings that,

although ambiguous at times, can be used to

illustrate neuroanatomical and neurosurgical themes

that exists in art. As history continues in the making,

the art and neuroscience will continue to flow, their

paths will cross and the human experience will enrich

on both accounts.

Ack nowl edgements

The authors would like to thank Professor G. W.

Kreutzberg for his advice and correspondence

regarding the topic of paraplegia.

Declaration of interest: The authors report no

conflicts of interest. The authors alone are respon-

sible for the content and writing of the paper.

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Mind on Canvas: anatomy, signs and neurosurgery in art