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

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 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.

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

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

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


ISSN 0268-8697 print/ ISSN 1360-046X online ª The Neurosurgical Foundation
D OI: 10.1080/ 02688690802109820
2 F . G eranmayeh & K. A shk an

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
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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 FIG. 1. Study of the nervous system, from Avicenna’s 11th century
the brain stem where some cranial nerves emerge 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.
from it. The spine has been numbered into eight L0013312.
cervical, 12 thoracic, five lumbar and four sacral
segments. Some fibres from the cervical segments are
Neuroanatomy in R enaissance A rt
shown to cross each other at the level of brachial
plexus. In Europe, the Renaissance heralded the blossoming
Avicenna systematically reviewed the medical of medicine and art. Leonardo da Vinci (1452–
knowledge by the previous scientists and comple- 1519), who created 190 pages of drawings and
mented them by his own findings. Chapters 6–13 of writings devoted to anatomy, was particularly fasci-
The Canons are designated to spinal anatomy and nated with the nervous system. Born in the Italian
its biomechanical aspects.13 On a personal level, village of Vinci, he was an illegitimate son of Ser
Avicenna was a gifted child born in the Persian village Piero d’Antonio, a notary, and a peasant woman
of Afshama, who was a practicing physician at the age named Caterina. He produced over 5000 known
of 20. In addition to Canons, he demands credit for leaves of notebooks decorated with detailed direct
his encyclopaedia of philosophy, Shafaa, meaning observational drawings ranging from mechanics to
healing. His choice of names for these two books, anatomy, some written in his characteristic reversed
Canon (law), for a medical text book, and Shafaa script or ‘mirror writing’.
(healing) for a philosophical one, is intriguing. He made many contributions to neurosciences,
A very similar drawing can be seen in The A natomy including the discovery of neuroanatomical struc-
of the Human B ody ( Tashrih- i b adan- i insane) by tures such as meningeal arteries and frontal si-
Mansur Ibn Muhammad Ilyas (14th century), nuses.14 He injected hot wax into the brain of an
another Persian physician, suggesting this may have ox and produced a cast of the ventricles. This
been a common method of illustrating neuroanatomy represented the first attempt at using a solidifying
at the time (Fig. 2). This book has five coloured medium to determine the structure of an internal
illustrations of skeleton, muscles, intestine, blood body organ (Fig. 3).
vessels and nerves. Through the latter he describes Leonardo’s thoughts on ventricles were influenced
the anatomy of the spinal cord and nerves. by previous physicians, such as Mondino, Avicenna
M ind on canv as 3

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
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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
FIG. 2. Watercolour drawing of the nervous system from The of the Sistine Chapel, ‘The Creation of Adam’
A natomy of the Human B ody by Mansur Ibn Ilyas. The figure is (http: / / mv.vatican.va/ 3_ EN/ pages/ x-Schede/ CSNs/
viewed from the back, with the head hyper-extended so that the CSNs_ V_ StCentr_ 06_ big.html, accessed 1 April
mouth is at the top of the page. D ifferent colours were used to 2008). Meshberger20 has argued that the billowing
represent pairs of nerves. Wellcome Library, London. L0006435.
cloth structure and angels surrounding God resem-
ble a sagittal view of the brain including the frontal
and Galen, who wrote extensively on the ‘reciprocal lobe, whilst the major sulci are outlined by the
symmetry’ or ‘reciprocal harmony’ of the brain. In contours of the figures of angels. Optic chiasm, brain
Fig. 4, Leonardo draws an onion that shows by stem and the pituitary gland are shown by the bifid
analogy, the layered structure of the membranes foot of an angel, and the vertebral artery is
covering the eye and the brain. The main drawing represented by a green robe. He argues that perhaps
and the one below show Leonardo’s division of the this is a coded message from Michelangelo implying
cerebral ventricles into anterior, middle and poster- that the divine gift received from God to Adam is
ior.15 He located the senso comune (literally common intellect, rather than life itself. Adam appears alive,
sense) or the amalgamation of the senses in the brain, stretching out with his eyes open just before being
which was also the location of the soul. He assigned touched by God to be created. In fact, some have
the anterior ventricle to the senso comune alongside argued that given the physical similarities between
fantasy and imagination, the middle to cognition, God and Adam, it is not clear who the creator is; is
and the posterior ventricle was assigned to mem- God creating Adam, or does God exist in Adam’s
ory.16 In Leonardo’s eyes, the only certifiable and mind? 21 God’s left arm is wrapped around a female
reliable knowledge was that obtained directly by sight figure. Some see her as Eve awaiting creation, whilst
and experience from the external world: ‘The eye, others think her to be Sophia the Goddess of divine
which is termed the window to the soul, is the chief wisdom and the feminine side of God.
organ whereby the senso comune can have the most
complete and magnificent view of the infinite works
of nature’.14 Neurosurgical / neurol ogical signs in art
Leonardo is referred to by some as an artist with
P araplegia
the mind of a physician, but Vesalius (1514–1564) is
thought to be the opposite.17 He produced three Scenes depicting paraplegia are not rare within the
masterly anatomical text books; Tab ulae A natomicae art world, probably because this is a common
4 F . G eranmayeh & K. A shk an
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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.

debilitating neurological deficit. An alabaster wall by Masaccio (1401–1428) in Brancacci Chapel, at


relief from the Nebuchadnezzar’s palace in Nineveh Santa Maria del Carmine Church in Florence (http: / /
(650 BCE) showing the Neo-Assyrian king hunting en.wikipedia.org/ wiki/ Image: Masacc14.jpg, accessed
lions from his chariot, has been used to suggest that 1 April 2008). Here, a beggar is shown kneeling on
the early hunters were aware of the phenomenon of the ground in front of St Peter and the crowd. His
paraplegia. Fig. 5 shows a section of this relief. Here, bilaterally wasted legs have been attributed to polio,
arrows penetrate a lioness through the back resulting but this has been contested by some, as the first
in what appears to be paraplegia of her hind limbs. known epidemic of polio occurred after this piece
A more contemporary painting ‘The Paraplegic’ was painted, in the 18th century.22
(Fig. 6), by the London born Claude Rogers
(1907–1979) is a more evident example. Here, two
‘Seiz ure’
nurses are supporting a patient’s upper body and
right thigh, encouraging her to take a step forward. D riven from the Greek word epilam- b anein, to be
Perhaps she has suffered a stroke. seized or attacked, the term epilepsy was introduced
into the medical terminology by Avicenna.23
Although physicians of ancient Greek, Byzantine
M uscle atrophy
or Persia, regarded seizures as a disease process,
An example of limb atrophy may be seen in ‘St Peter historically people who suffered from epilepsy were
Healing the Sick with his Shadow’, a fresco painting often viewed as possessed. In Homer’s time,
M ind on canv as 5
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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.

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


nurses are shown supporting a patient. ª Tate, London 2005.
An example of facial muscle weakness can be viewed
in a painting by Francisco de Goya (1746–1828), a
J esus’ transfiguration through suffering, death and leading Spanish painter of the courts of Charles III,
resurrection.25 Charles IV and Ferdinand VII of Spain. Fig. 9
‘St Catherine exorcising a possessed woman’ by depicts a portrait of his friend and fellow artist, ‘D on
Girolamo de Benvenuto (1470–1524 CE), and Andre´s del Peral’, who has an evident left facial nerve
‘St Zeno exorcising the D aughter of Emperor palsy that is still apparent despite the artist’s chosen
Gallienus’ (Fig. 8) are two other paintings that angle to paint the portrait as an effort to minimize
portray epilepsy. The latter is by Fra Filippo Lippi this asymmetry. It has been suggested that del Peral
who completed this painting as part of the predella of suffered from a left upper motor neuron facial nerve
‘The Trinity with Saints Mamas, J ames, Zeno, and lesion, most probably due to a stroke.27 Of interest,
J erome’ by Pesellino, after his death. The unclean Goya fell ill at the age of 46, and subsequently was left
spirit is shown leaving the mouth in the shape of a with partial blindness, loss of hearing and dizziness
dragon. It is imperative to mention that despite such probably due to Vogt–Koyanagi Syndrome.28
M ind on canv as 7
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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.

earlier portrait from their lifetime, the former by an


P tosis
unknown artist, and the latter by George Vertue.
Portraits of King Henry III (1207–1272) of England
(http: / / www.npg.org.uk/ live/ search/ portrait.asp?
Club foot
search¼ap&title¼&npgno¼4980% 286% 29&set¼&e
D ate¼&lD ate¼&subjNoJ s¼&subj¼&setNoJ s¼& The Spanish borne artist, J osepe de Ribera (1591–
medium¼&rNo¼0, accessed 1 April 2008), and his 1652), spent part of his youth in Italy, living a life of
son Edward I (http: / / www.npg.org.uk/ live/ search/ half beggar and later became the painter to the
portrait.asp? LinkID ¼mp67807&rNo¼1&role¼sit Spanish Viceroy in Naples. His earlier works had a
accessed 1 April 2008) have been used to suggest that religious theme, but his later paintings, such as ‘The
the father and son both suffered from congenital Beggar’ or ‘The Clubfoot’ (http: / / www.abcgallery.
ptosis.29 In this portrait, Henry III is shown with a com/ R/ ribera/ ribera8.html, accessed 1 April 2008)
raised right eyebrow, compensating for the drooping were of a more popular genre. Although the title of
of the right eyelid. The portraits date back to the 17th the painting suggests an orthopaedic problem, the
and 18th centuries, respectively, and are based on an underlying disease depicted may have been neurolo-
8 F . G eranmayeh & K. A shk an
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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.

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 FIG. 9. ‘D on Andre´s del Peral’ by Francisco de Goya (1795–1798).
well as the context and environment in which they A left facial palsy is still apparent despite the artist’s chosen angle as
occurred. an attempt to minimize the facial asymmetry. Photo ª the National
Gallery, London.

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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Several Renaissance painters have painted scenes Ref erences


where attempts are made, often by medical charlatans
1 Zeki S. Inner vision. In: A n ex ploration of art and the b rain. New
or itinerant quacks, to apparently surgically remove York: Oxford U niversity Press, 1999.
stones from the heads of people with mental disorders 2 Hall C. Art and mind. B M J 1993; 307: 1289.
through making superficial incisions and palming 3 Ione A, Tyler C. Neurohistory and the arts. Was Kandinsky a
stones. There are two schools of thought on this synesthete? J Hist Neurosci 2003; 12: 223–6.
subject: some regard these paintings as allegory for 4 Miller BL, Cummings J , Mishkin F, et al. Emergence of artistic
talent in frontotemporal dementia. Neurology 1998; 51: 978–82.
human idiocy and gullibility, whilst others think them 5 Podoll K, Robinson D . Migraine experiences as artistic
to be an actual medical procedure prevalent at that inspiration in a contemporary artist. J R oy Soc M ed
time. Perhaps the basis for this perception could have 2000; 93(5): 263–5.
been the occasional postmortem finding of a calcified 6 Kawabata H, Zeki S. Neural correlates of beauty. J Neurophy-
siol 2004; 91: 1699–705.
frontal lobe meningioma as the cause of apparent
7 Ruisinger MM. Misreading pictures: Fabricius Hildanus
madness, although there is no solid evidence for this (1560–1634) and the cure of spinal dislocation. J Hist Neurosci
theory. Fig. 11, ‘The Cure of Folly’ or ‘Stone 2005; 14: 334–40.
Operation’ by Hieronymus Bosch (c. 1450–1515) is 8 Goodrich J T. History of spine surgery in the ancient and
one of the first of such paintings. The translation of medieval worlds. Neurosurg F ocus 2004; 16: E2.
the inscription reads ‘Master, dig out the stones of 9 Sahlas D J . Functional neuroanatomy in the pre-Hippocratic
era: observations from the Iliad of Homer. Neurosurgery
folly, my name is castrated dachshund’, where 2001; 48: 1352–7.
‘castrated dachshund’ was a nickname for a person 10 Von Staden H (Translation). Herophilus: the art of medicine in
lacking common sense. There are many symbolisms early A lex andria. Cambridge: Cambridge U niversity Press,
in this painting. The doctor wearing a funnel 1989.
(symbolic of deceit or false alchemist) performs the 11 Galen C. Experimental section and hemisection of the spinal
cord (taken from De Locis affectib us). A nn M ed Hist 1917; 367–
operation and removes a tulip lying on the table, 71.
instead of a stone. The tulip traditionally carried the 12 Galen C. O mnia q uae ex tant in Latinum sermonem conv ersa.
connotation of folly. The closed book balanced on the Venetiis: Apud haeredes Lucaeantonii J untae; 1576.
head of the nun, overlooking the operation adds to the 13 Naderi S, Acar F, Mertol T, Arda MN. Functional anatomy of
the spine by Avicenna in his eleventh century treatise A l- Q anun
sense of ‘stupidity’ of human affairs.45,46
fi al- Tib b (The Canons of M edicine). Neurosurgery 2003; 52: 1449–
This theme has been repeated in many paintings 53.
including ‘The Extraction of the Stone of Madness’ 14 Richter J P. The Literary Work s of Leonardo da V inci. London:
(1556–1557) by Pieter Bruegel the Elder, ‘The Phaidon, 1970.
Extraction of the Stone’ (1650–1655) by J an Steen, 15 Clark K, Pedretti (ed.). Leonardo da V inci: Corpus of the
and ‘A Q uack D rawing Stones from the Head of a A natomical Studies in the Collection of Her M aj esty, the Q ueen, at
Windsor Castle. New York: Harcourt Brace J ovanovich, 1978.
Patient’ (17th century), attributed to J an de Bray 16 Pevsner J . Leonardo da Vinci’s contributions to neuroscience.
(1627–1697). Trends Neurosci 2002; 25(4): 217–20.
17 Marti-Ibanez F. The artist as physician; medical philosophy in
the Renaissance. I nt R ec M ed G en P ract Clin 1954; 167(4): 221–
Concl usion 42.
18 Vesalius A. De Humani Corporis F ab rica Lib ri Septem. Basel:
Here, we have attempted to explore the complex J ohannes Oporinus, 1543.
relationship that exists between art and neuroscience, 19 Strauss RM, Marzo-Ortega H. Michelangelo and medicine.
and to show how these two apparently distinct J R oy Soc M ed 2002; 95(10): 514–15.
12 F . G eranmayeh & K. A shk an

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.

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