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ORIGINAL ARTICLE
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 of
their superior power of observation, artists have often preserved neurological signs through detailed brush strokes or
meticulous carvings long before it is described in scientific literature. There has been an increasing tendency to use paintings
and drawings as independent sources for investigation of scientific history. In neuroanatomy, these tools have helped reveal
the complex interrelation between arts and neurosciences that on the surface often appear as highly polarized worlds. In this
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article we begin by giving a brief introduction to the general relationship between neuroscience and art as depicted in
paintings and drawings, and describe the artistic tendencies of the early neuroanatomists. We aim to highlight the existence of
neurosurgical themes within paintings and drawings from different eras.
Art is born of the observation and investigation of Science has also had a more direct influence on
nature. (Cicero, Roman author and orator, 106–43 art, for example, through Michel-Eugène Chevreul’s
BCE). The Law of Simultaneous Colour Contrast (1839) that
strengthened the foundations of colour theory. More
recently, the concepts of cerebral localisation of
Introduction
creativity and talent, and neuroaesthetics have
Connections between the arts and the sciences have attracted interest by the neuroscientists. Pioneered
existed throughout history. As the most creative by Samir Zeki, neuroaesthetics investigates the
endeavours of human activity, both disciplines have neurological response towards an aesthetic phenom-
developed in parallel based on temperament and enon such as art and examines the neural correlates
philosophical milieu of their time. of beauty.1,6 There is a mind on each canvas—the
Neuroscience per se manifests through art in artists use colours, perspectives, shapes and lines to
several ways. Not uncommonly, neurological ill activate specific neuronal pathways. Thus, exploiting
health can be recognized by the observant eye of an our common visual organization and arousing shared
artist. Thus, portraits have been described by Zeki, a experiences beyond the reach of words.
pioneer in neuroaesthetics, to use ‘the accidents of In this paper, we will focus on a review of paintings
each individual face to reveal inner life’.1 For and drawings that portray knowledge of neuroanat-
instance de Ribera and El Greco were inspired by omy throughout history, as well as those that show
neurological phenomenon in their subjects, and neurosurgically relevant signs. We also describe
transformed their view of neurological signs to a examples of neurosurgical procedures in paintings
language of paint they found easy to disseminate. that have contributed to our understanding of the
At other times the will for better understanding and neurosurgical environment, techniques and reason-
teaching has pushed neurosurgeons, such as Harvey ing prevalent at the time of the paintings. Our aim is
Cushing to document their own studies through to highlight the existence of neuroscientific themes,
drawing. Yet, artists such as Leonardo da Vinci have as shown in paintings and drawings, amongst the
become anatomists undertaking and drawing their neurosurgical community.
own investigations. Furthermore, sometimes it is a It is worth mentioning in the outset that, whilst
work of art that is a confirmation of the presence of a pictorial documents enable medical historians to
neurological disease in its creator.2–5 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
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
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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.
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.
epilepsy was regarded as a miasma casted upon the Gospel and is based on the following passage in the
soul by the goddess Hecate, although this belief was Bible:
later refuted by Hippocrates in his text The Sacred
Disease.24 In early Christianity the act of J esus Teacher, I brought my son to you, because he has
driving out the unclean spirit of the boy with an evil spirit in him and cannot talk. Whenever the
seizure, suggests that people with epilepsy were spirit attacks him, it throws him to the ground, and
regarded as being seized and needing exorcism. he foams at the mouth, grits his teeth and becomes
This is depicted in Raphael’s (Rapha –el meaning stiff all over. (Mark, Chapter 9, verses 17–18)
He/ God has healed) last painting, ‘The Transfig-
uration’ (Fig. 7), which was almost finished before The father wearing green, a symbol of hope, is shown
his death on Good Friday, 1520. The painting tells supporting his son who appears to be convulsing.
two stories; the Transfiguration of Christ on Mount Interestingly, it is only the boy who looks up to J esus,
Tabor in the upper section and the healing (or transcending in white light amongst Moses, Elijah
rather just prior to) of the boy with evil spirits in the and the three disciples. Some have argued that
lower part. The latter account comes immediately Raphael’s simultaneous depiction of these two
after the description of the transfiguration in the biblical events in one painting acts as a simile for
6 F . G eranmayeh & K. A shk an
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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.
B ab insk i sign
J oseph Franc¸ois 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).
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.
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.
Trephination
bone from the skull by a trepan or trephine, a name
Trephining or trepanning, believed by some to be the derived from the Greek trypanon or borer. It began in
oldest surgical procedure, is the removal of a piece of the late Paleolithic period and has been used
M ind on canv as 9
throughout history. It was extensively discussed in Smithsonian Institution, U SA), by Alton S. Tobey,
Hippocrates’ O n Wounds in the Head.32 Ancient a contemporary historical artist, is a depiction of this
surgeons used scarping, grooving, boring and making practice. Tobey and his family spent weeks in South
rectangular intersecting incisions to remove pieces of America and in the ancient Inca city of Machu
cranial bone in skull injuries, or even treat melan- Picchu, where he extensively researched this 16th
choly and mental disorders.33–35 century practice of South American Inca Empire. He
Trephination has been reported in many cultures paid attention to the excavated primitive trephination
including Indians of Canada and the U nited States, instruments and methods of handling them, as well
Europe, Africa, ancient Iran and Peru, where as costumes and artefacts from the Peruvian culture
comparative osteology has shown that up to 70% of in order to reproduce an accurate scene. ‘The Inca
patients survived the procedure with relatively low Trephination’ (http: / / www.myimagezone.com/ lib/
rate of infection.36–41 ‘The Inca Trephination’ mural Thumb.aspx? f¼/ data/ 0/ 88/ 88120.J PG&l¼950, ac-
(installed at the Hall of Physical Anthropology, cessed 1 April 2008) shows trephination by a
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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.
10 F . G eranmayeh & K. A shk an
priest-surgeon of the Inca Empire on an injured The climate of Florence and Midi of France were
warrior in the setting of the granite-made city of regarded as very pestiferum—unfavourable.42
Machu Picchu, perched high in the Andes Mountain.
Two woodcut drawings (Fig. 10a,b) from the 16th
Cranial inj ury
century treatise Chirurgiae univ ersalis opus ab solutum
by Giovanni Andrea D alla Croce, probably one of Hippocrates’ (460–377 BCE) treatise entitled De
the most comprehensive surgical textbooks, show Capitis V ulnerib us, O n Wounds in the Head or O n
detailed scenes of trephination within a home setting. I nj uries of the Head, was a pioneering work in the field
In Fig. 10b the patient is lying prone on the bed, of management of head injuries despite the lack of
surrounded by the surgeon, a woman crying, two animal or human dissections. In this treatise he
men warming a cloth and observers, including a describes cranial thickness and relation to injury,
child. The presence of animals in this operating classifies cranial fractures, describes contrecoup in-
environment provides an interesting insight into the juries and various bandaging techniques.43 Neurosur-
concepts of cleanliness and sterility prevalent at the gery later developed in the Islamic era, when
time. The operating room and dressings were cauterization of wounds to stop bleeding was prac-
warmed as the cold was cereb ro fringes inimicissimus, ticed.44 The renaissance and post-Renaissance periods
very dangerous to the brain. Additionally, climate that saw the emergence of the concept of a specialized
was thought to affect the outcome of the operation. surgeon, were also noteworthy for their art of warfare
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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.
M ind on canv as 11
and, later, the invention of firearms and treatments of entities continue to influence each other. We have
gunshot wounds.42 Pare´, the founder of modern briefly described drawings and paintings that,
French surgery and a military surgeon who served a although ambiguous at times, can be used to
succession of kings, wrote numerous treatise on illustrate neuroanatomical and neurosurgical themes
management of battlefield injuries, including wounds that exists in art. As history continues in the making,
to the head. These contained numerous drawings, not the art and neuroscience will continue to flow, their
all by him, of surgical instruments used at the time. Of paths will cross and the human experience will enrich
particular note is a drawing of an elev atorium that was on both accounts.
used to elevate a depressed skull fracture. (See http: / /
www.nlm.nih.gov/ exhibition/ historicalanatomies/
Ack nowl edgements
Images/ 1200_ pixels/ ccclii.jpg, accessed 1 April
2008.) D epressed skull fractures were common in The authors would like to thank Professor G. W.
battlefields that used maces, pole-arms and fire arms. Kreutzberg for his advice and correspondence
In using the elevator, dura was spared and bony regarding the topic of paraplegia.
fragments were removed leaving gaps for the extra-
dural pus to escape. Within such an environment, it is Declaration of interest: The authors report no
amazing that soldiers could survive such injuries. conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
Stone remov al
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20 Meshberger FL. An interpretation of Michelangelo’s Creation 34 Valenstein ES. History of Psychosurgery. In: Greenblatt SH
of Adam based on neuroanatomy. J A m M ed A ssoc (ed.). The History of Neurosurgery. Park Ridge, American
1990; 264: 1837–41. Association of Neurological Surgeons, 1997.
21 Salcman M. The Creation of Adam by Michelangelo 35 Wilkinson RG. Trephination by drilling in ancient Mexico.
Buonarroti (1475–1564). Neurosurgery 2006; 59(6): N11–12. B ull N Y A cad M ed 1975; 51: 838–50.
22 Clifford Rose F. A rt, an ov erv iew. Neurology of the A rts. 36 Eftekhar B, D admehr M, Ghodsi M, ParsaPour A, Ketabchi E.
P ainting, music, literature. London: Imperial College Press, Cranial trephination in ancient Iran. Case illustration.
2004. J Neurosurg 2007; 106(1 Suppl): 70.
23 Temkin O. The falling sick ness: a history of epilepsy from the 37 Marino R, J r, Gonzales-Portillo M. Preconquest Peruvian
G reek s to the b eginnings of modern neurology, 2nd edn. Baltimore: neurosurgeons: a study of Inca and pre-Columbian trephina-
J ohns Hopkins U niversity Press, 1994. tion and the art of medicine in ancient Peru. Neurosurgery
24 Adams F (transl). The G enuine Work s of Hippocrates. New York: 2000; 47: 940–50.
W. Wood & Co., 1986. 38 Piek J , Lidke G, Terberger T, von SU , Gaab MR. Stone age
25 J anz D . Epilepsy, viewed metaphysically: an interpretation of skull surgery in Mecklenburg-Vorpommern: a systematic
the biblical story of the epileptic boy and of Raphael’s study. Neurosurgery 1999; 45: 147–51.
transfiguration. E pilepsia 1986; 27: 316–22. 39 Rawlings CE, III, Rossitch E J r. The history of trephination in
26 Massey EW, Sanders L. Babinski’s sign in medieval, Renais- Africa with a discussion of its current status and continuing
sance, and baroque art. A rch Neurol 1989; 46: 85–8. practice. Surg Neurol 1994; 41: 507–13.
27 Smith PE. Neurology in the National Gallery. J R oy Soc M ed 40 Rifkinson-Mann S. Cranial surgery in ancient Peru. Neurosur-
1999; 92(12): 649–52. gery 1988; 23: 411–16.
28 Cawthorn T. Goya’s illness. P roc R oy Soc M ed 1962; 55: 213– 41 Stone J L, Miles ML. Skull trepanation among the early Indians
17. of Canada and the U nited States. Neurosurgery 1990; 26: 1015–
29 Appenzeller O, Amm M, J ones H. A brief exploration of 19.
Downloaded By: [King's College London] At: 14:38 18 September 2008
neurological art history. J Hist Neurosci 2004; 13: 345–50. 42 Viale GL. Gunshot wounds to the head in the 16th century.
30 McHenry L. Neurology and Art. In: Clifford RF, Bynum WH Neurosurgery 2005; 57: 1306–15.
(eds) Historical A spects of the Neurosciences. New York: Raven, 43 Panourias IG, Skiadas PK, Sakas D E, Marketos SG. Hippo-
1982: 481–519. crates: a pioneer in the treatment of head injuries. Neurosurgery
31 Liu CY, Apuzzo ML. The genesis of neurosurgery and the 2005; 57: 181–9.
evolution of the neurosurgical operative environment: part 44 Gurdjian ES. Head inj ury from antiq uity to the present with special
I-prehistory to 2003. Neurosurgery 2003; 52: 3–19. reference to penetrating head wounds. Springfield: Charles C
32 Magetts EL. Trepanation of the skull by the medicine-men of Thomas, 1973.
primitive cultures, with particular reference to present-day 45 Gross CG. ‘Psychosurgery’ in renaissance art. Trends Neurosci
native East African practice. In: Brothwell D , Sandison AT 1999; 22(10): 429–31.
(eds) Diseases in antiq uity. Springfield: Charles C Thomas, 46 Salcman M. ‘The cure of folly’ or ‘The operation for the stone’
1967: 673–701. by Hieronymus Bosch (c. 1450–1516). Neurosurgery 2006; 59:
33 Lisowski FP. D isease in Antiquity. In: Brothwell D , Sandison 935–7.
AT (eds) P rehistoric and early historic trepanation. Springfield:
Charles C Thomas, 1967.