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.
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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.
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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.
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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.
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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.
6 F . G eranmayeh & K. A shk an
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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.
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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.
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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.
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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.
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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.
Ref erences
1 Zeki S. Inner vision. In: A n ex ploration of art and the b rain. New
York: Oxford U niversity Press, 1999.
2 Hall C. Art and mind. B M J 1993; 307: 1289.
3 Ione A, Tyler C. Neurohistory and the arts. Was Kandinsky a
synesthete? J Hist Neurosci 2003; 12: 223–6.
4 Miller BL, Cummings J , Mishkin F, et al. Emergence of artistic
talent in frontotemporal dementia. Neurology 1998; 51: 978–82.
5 Podoll K, Robinson D . Migraine experiences as artistic
inspiration in a contemporary artist. J R oy Soc M ed
2000; 93(5): 263–5.
6 Kawabata H, Zeki S. Neural correlates of beauty. J Neurophy-
siol 2004; 91: 1699–705.
7 Ruisinger MM. Misreading pictures: Fabricius Hildanus
(1560–1634) and the cure of spinal dislocation. J Hist Neurosci
2005; 14: 334–40.
8 Goodrich J T. History of spine surgery in the ancient and
medieval worlds. Neurosurg F ocus 2004; 16: E2.
9 Sahlas D J . Functional neuroanatomy in the pre-Hippocratic
era: observations from the Iliad of Homer. Neurosurgery
2001; 48: 1352–7.
10 Von Staden H (Translation). Herophilus: the art of medicine in
early A lex andria. Cambridge: Cambridge U niversity Press,
1989.
11 Galen C. Experimental section and hemisection of the spinal
cord (taken from De Locis affectib us). A nn M ed Hist 1917; 367–
71.
12 Galen C. O mnia q uae ex tant in Latinum sermonem conv ersa.
Venetiis: Apud haeredes Lucaeantonii J untae; 1576.
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
fi al- Tib b (The Canons of M edicine).Neurosurgery 2003; 52: 1449–
53.
14 Richter J P. The Literary Work s of Leonardo da V inci. London:
Phaidon, 1970.
15 Clark K, Pedretti (ed.). Leonardo da V inci: Corpus of the
A natomical Studies in the Collection of Her M aj esty, the Q ueen, at
Windsor Castle. New York: Harcourt Brace J ovanovich, 1978.
16 Pevsner J . Leonardo da Vinci’s contributions to neuroscience.
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–
42.
18 Vesalius A. De Humani Corporis F ab rica Lib ri Septem. Basel:
J ohannes Oporinus, 1543.
19 Strauss RM, Marzo-Ortega H. Michelangelo and medicine.
J R oy Soc M ed 2002; 95(10): 514–15.
M ind on canv as 11
Downloaded By: [King's College London] At: 14:38 18 September 2008
20 Meshberger FL. An interpretation of Michelangelo’s Creation
of Adam based on neuroanatomy. J A m M ed A ssoc
1990; 264: 1837–41.
21 Salcman M. The Creation of Adam by Michelangelo
Buonarroti (1475–1564). Neurosurgery 2006; 59(6): N11–12.
22 Clifford Rose F. A rt, an ov erv iew. Neurology of the A rts.
P ainting, music, literature. London: Imperial College Press,
2004.
23 Temkin O. The falling sick ness: a history of epilepsy from the
G reek s to the b eginnings of modern neurology, 2nd edn. Baltimore:
J ohns Hopkins U niversity Press, 1994.
24 Adams F (transl). The G enuine Work s of Hippocrates.New York:
W. Wood & Co., 1986.
25 J anz D . Epilepsy, viewed metaphysically: an interpretation of
the biblical story of the epileptic boy and of Raphael’s
transfiguration. E pilepsia 1986; 27: 316–22.
26 Massey EW, Sanders L. Babinski’s sign in medieval, Renais-
sance, and baroque art. A rch Neurol 1989; 46: 85–8.
27 Smith PE. Neurology in the National Gallery. J R oy Soc M ed
1999; 92(12): 649–52.
28 Cawthorn T. Goya’s illness. P roc R oy Soc M ed 1962; 55: 213–
17.
29 Appenzeller O, Amm M, J ones H. A brief exploration of
neurological art history. J Hist Neurosci 2004; 13: 345–50.
30 McHenry L. Neurology and Art. In: Clifford RF, Bynum WH
(eds) Historical A spects of the Neurosciences. New York: Raven,
1982: 481–519.
31 Liu CY, Apuzzo ML. The genesis of neurosurgery and the
evolution of the neurosurgical operative environment: part
I-prehistory to 2003. Neurosurgery 2003; 52: 3–19.
32 Magetts EL. Trepanation of the skull by the medicine-men of
primitive cultures, with particular reference to present-day
native East African practice. In: Brothwell D , Sandison AT
(eds) Diseases in antiq uity. Springfield: Charles C Thomas,
1967: 673–701.
33 Lisowski FP. D isease in Antiquity. In: Brothwell D , Sandison
AT (eds) P rehistoric and early historic trepanation. Springfield:
Charles C Thomas, 1967.
34 Valenstein ES. History of Psychosurgery. In: Greenblatt SH
(ed.). The History of Neurosurgery. Park Ridge, American
Association of Neurological Surgeons, 1997.
35 Wilkinson RG. Trephination by drilling in ancient Mexico.
B ull N Y A cad M ed 1975; 51: 838–50.
36 Eftekhar B, D admehr M, Ghodsi M, ParsaPour A, Ketabchi E.
Cranial trephination in ancient Iran. Case illustration.
J Neurosurg 2007; 106(1 Suppl): 70.
37 Marino R, J r, Gonzales-Portillo M. Preconquest Peruvian
neurosurgeons: a study of Inca and pre-Columbian trephina-
tion and the art of medicine in ancient Peru. Neurosurgery
2000; 47: 940–50.
38 Piek J , Lidke G, Terberger T, von SU , Gaab MR. Stone age
skull surgery in Mecklenburg-Vorpommern: a systematic
study. Neurosurgery 1999; 45: 147–51.
39 Rawlings CE, III, Rossitch E J r. The history of trephination in
Africa with a discussion of its current status and continuing
practice. Surg Neurol 1994; 41: 507–13.
40 Rifkinson-Mann S. Cranial surgery in ancient Peru. Neurosur-
gery 1988; 23: 411–16.
41 Stone J L, Miles ML. Skull trepanation among the early Indians
of Canada and the U nited States. Neurosurgery 1990; 26: 1015–
19.
42 Viale GL. Gunshot wounds to the head in the 16th century.
Neurosurgery 2005; 57: 1306–15.
43 Panourias IG, Skiadas PK, Sakas D E, Marketos SG. Hippo-
crates: a pioneer in the treatment of head injuries. Neurosurgery
2005; 57: 181–9.
44 Gurdjian ES. Head inj ury from antiq uity to the present with special
reference to penetrating head wounds. Springfield: Charles C
Thomas, 1973.
45 Gross CG. ‘Psychosurgery’ in renaissance art. Trends Neurosci
1999; 22(10): 429–31.
46 Salcman M. ‘The cure of folly’ or ‘The operation for the stone’
by Hieronymus Bosch (c. 1450–1516). Neurosurgery 2006; 59:
935–7.
12 F . G eranmayeh & K. A shk an
Downloaded By: [King's College London] At: 14:38 18 September 2008
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