bioephemera

The Stone of Madness

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The Cure of Folly (The Extraction of the Stone of Madness)
oil on board
attributed to Hieronymous Bosch*, c. 1475-1490
Museo del Prado, Madrid

At one point or another, Hieronymous Bosch must have turned his paintbrush to every bizarre practice known to the fifteenth century Dutch mind, and this early piece is no exception. The composition is relatively simple: a surgeon is performing trepanation (craniotomy) on a restrained subject, while two onlookers watch. But looking closely, one can see that all is not right in Bosch’s peculiar countryside: the surgeon is wearing a funnel as a hat, and the bored female onlooker (who is robed as a nun) has a book resting on her head. Sprouting from the surgeon’s incision is a tulip flower; a second flower rests on the table (the base of which is a bulb). What’s going on here? Mere phantasmagoria, or medical history?


The calligraphic inscription around the painting is one clue: “Meester snijt die keye ras/Myne nam is Lubbert das” (Master, cut the stone out quickly, my name is Lubbert das). “Lubbert” was a typical Dutch nickname for a simple or foolish character (according to C. Gross (1999), it means “castrated dachsund!”). Bosch’s fool is appealing to a surgeon to extract a stone from his head. The stone in question is the “stone of folly” or “stone of madness” which, according to popular superstition, was a cause of mental illness, depression, or stupidity. Such stones could be located anywhere in the body, such as the bowels or back, but were most commonly assigned to the head, where a surgeon would have to cut into the skull to remove them.

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Surgeon
oil on panel
attributed to Jan Sanders van Hemessen, c. 1550
Museo del Prado, Madrid

Bosch’s piece is the earliest of a group of paintings depicting this procedure. In a later work, Jan van Hemessen’s Surgeon, the practictioner pries a stone the size of a peach pit from the forehead of his distressed patient – with remarkably little blood or mess. Pieter Huys’ version is similar to Hemessen’s, but Pieter Bruegel the Elder’s interpretation depicts the chaotic interior of an asylum or hospital, in which a number of procedures are underway simultaneously. In the foreground corner, one of the patients appears to have flipped his chair, to which he is tied, while his tenacious surgeon crawls after him.

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Cutting out the Stone of Madness, or an Operation on the Head
Pieter Bruegel, c. 1550
Musee d l’Hotel Sandelin, France

Hemessen, Huys, and Bruegel all depict the same procedure: the removal of stones from the heads of restrained patients, in the presence of nurses or assistants and other onlookers. In many ways, they appear similar to other pieces of the realistic medical genre. Yet these operations, if they were actually performed, clearly had to be shams – playacting in which the surgeon pretended to remove a pebble from the skull, in deference to the “stone of madness” superstition.

Could charlatan “surgeons” have fleeced desperate families by purporting to remove a palmed stone from an impressively bloody scalp wound? Could well-intentioned practitioners have done this as a placebo, to convince despairing patients that they had been “cured”? The scenarios seem plausible. Medical quackery was common in the sixteenth and seventeeth centuries, as doucmented in paintings, books, and edicts of the time. However, there is no historical evidence to suggest that stone extractions were actually conducted in late-medieval or Renaissance Europe, much less a widespread medical scam. Schupbach (1978) suggests that extractions were theatrical performances, farces or tableaux associated with processions and celebrations, and that these paintings were never meant as documentation of real procedures. In any case, medical historians and art historians have disputed whether the sham operations depicted in the “stone of madness” paintings reflect real events, or are allegorical.

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Excising the Stone of Folly
Pieter Huys, c. 1530-1581
Wellcome Institute Library

At this time, however, trepanning or trepanation (drilling a hole in the skull, preferably without disturbing the brain) was an established medical procedure. Archaeological evidence indicates that trepanning was practiced across Europe (indeed, worldwide) in prehistoric times; in medieval Europe, various medical experts recommended it for a variety of illnesses ranging from skull fracture to epilepsy, insanity, and melancolia. Johannes Scultetus (1595-1645) included trepanation in his influential textbook of standard medical procedures and instruments, Armamentarium chirurgicum, and Robert Burton recommended “boring the skull” as a cure for depression in Anatomy of Melancholy (1652).

While none of the Dutch paintings depicts the saw (trepan) or distinctive drills used in trepanation, the tool used by Hemessen’s surgeon to pry out the stone is reasonably consistent with the illustration that depicts prying out the perforated piece of skull in the Armamentarium. C. Gross (1999) points out the similarity between the Armamentarium trepanation and engravings depicting stone extraction, such as the one below, by Weydmans. At the very least, trepanation was likely the model these artists used as a basis for their fictional stone extractions. Whether they intended the paintings as a criticism or comment on the efficacy of trepanation is much less clear.

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Removing the Stone
engraving
HW Weydmans, 17th century
Science and Society Picture Library

So what about Bosch? His painting is much harder to reconcile with reality than the others. Not only is the scene staged most strangely (in the vacant countryside with weird props and household furniture), poor Lubbert has a blooming flower sprouting from his head! The flower, which is probably a tulip, may have its origin in a Dutch saying: according to James Harris (2004), “simpletons were referred to as tulip heads, and having a bulb in your head was synonymous with having a stone.” Colloquially the phrases might have been synonymous, but even the most skilled quack would have a hard time passing a tulip-extraction off as a legitimate cure. By making this visual pun, Bosch ensures that the scene is too incredible, too unlikely, to be mistaken for reality. Like many of Bosch’s works, it’s better read as a representation of human weakness.

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The Cure of Folly (The Extraction of the Stone of Madness) (detail)
oil on board
Hieronymous Bosch*, c. 1475-1490
Museo del Prado, Madrid

Lubbert may be the fool of the piece, but Bosch seems to reserve his greatest disapproval for the funnel-hatted surgeon and his deadpan accomplices, who presumably know better. Their skills are clearly useless to help their trusting patient. Either they’re cynically exploiting him, or they’re also fools – vain and hubristic enough to imagine they actually have the power to cure madness. Instead of specifically indicting the educated (physicians and clergy) for exploiting folk beliefs like the “stone of folly”, Bosch may have been making a larger statement on the folly of invoking medicine (and religion?) to remedy fundamental human frailties.

Bosch’s surreal visions, with their many idiosyncrasies and bizarre details, are difficult to resolve with a single interpretation. Perhaps as a result, they resonate with contemporary audiences and artists, who regularly draw on Bosch for inspiration. Filmmakers Jesse Rosensweet and Alastair Dickson used Bosch’s painting as the seed for their 2002 stop-motion animated short film, The Stone of Folly. I haven’t been able to get a hold of a copy of the film, but it won the 2002 Prix du Jury Prize at Cannes, so I’d really like to see it. Certainly the themes of overweening medical hubris and human gullibility could hardly be more current – which could be why the “Stone of Madness” paintings have garnered so much attention.

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“The Doctor”
The Stone of Folly
Jesse Rosensweet, director; Alastair Dickson, sculptor

*Some critics suggest The Cure of Folly is only partially attributable, or not attributable, to Bosch. Many paintings traditionally linked to Bosch have been relatively recently disattributed for various reasons.

More:

This post at Neurophilosophy remains one of the best trepanation resources on the web.

Gross, C. G. ‘Psychosurgery’ in Renaissance Art. TINS 1999

Harris, J.C. The Cure of Folly. Arch Gen Psychiatry 2004.

Salcman, Michael. The Cure of Folly or The Operation for the Stone. Neurosurgery 2006.

Schupbach, W. A New Look at The Cure of Folly. Med. Hist. 1978: 22:267-281.

The Cure of Folly, or Removing the Stone of Madness. Virtual Mentor 2000.

Comments

  1. #1 PhysioProf
    August 25, 2008

    BioE, what a wonderful piece of scholarship!

  2. #2 Alan
    August 26, 2008

    I agree! This is a very nicely curated work of art and medical history.

  3. #3 Bob O'H
    August 26, 2008

    Yes, nice piece. Could the stone removal have its origins in cancer surgery? I can imagine it only having to work once in the right person and it becoming popular.

  4. #4 Patricia
    August 26, 2008

    A good read you’ve put together there J.

    Bosch is one of my favorite artists whose work I sought to see at the Prado for myself :) They have quite a few of his works. I expect it is the world’s best collection given it includes the fantastic, Garden of Earthly Delights triptych.

  5. #5 Jessica Palmer
    August 26, 2008

    Bob, interesting idea. I don’t know of any cases of successful surgery for brain cancer in medieval Europe – that would make a great post, if anyone out there does! However, Michael Salcman has noted that “brain stones” (calcifications) have occasionally been described in cases of cancer, hematoma, and epilepsy. It’s possible that the discovery of such a stone in a patient’s skull led to the legend of the “stone of folly”. But since these stones are rare, and neither autopsy nor brain surgery was a common practice several centuries ago, it’s hard to imagine how the discovery would have come about. It’s probably something we’ll never know for certain.

  6. #6 Jim Thomerson
    August 26, 2008

    I wonder if there is any connection between the Bosch painting and the “tulipmania” which swept Holland at one time? Tulipmania involved a considerable amount of foolishness and folly.

  7. #7 Jessica Palmer
    August 26, 2008

    Jim – I’ve actually been meaning to write something about the tulipmania. The link would make sense, wouldn’t it? However, the kind of tulip familiar to us wasn’t cultivated in Europe until the late 16th century, and rampant tulip speculation didn’t set in until 1630 or so – too late to have influenced Bosch, who painted this work before 1500.

    So what’s up with the tulip, then? The tulip in this painting is described in the literature as a “water tulip” – and supposedly the water tulip already had the connotation of idiocy in 16th century Holland. (Some critics have also suggested it’s a lotus, not a tulip). Unfortunately, I wasn’t able to dig up any more detail on the water tulip or why exactly it was associated with foolishness. It does seem coincidental that that link was there before the tulipmania, but apparently it’s just a coincidence – if anyone else out there knows more, please weigh in. :)

  8. #8 Colin
    August 26, 2008

    Great post — thanks for writing this!

    You know, I think it’s interesting to compare this medical myth of a stone being the source of mental illness with today’s increasing obsession with pills being the source of cures for psychological problems. In Bosch’s day, the way to get better was to take something tangible out of your body, and (as you note) surgeons may even have “removed” palmed stones as placebos. Today, many people want to believe that putting a small, quasi-magical object into your body can fix all your problems, from depression to addiction, and we have placebo pills galore.

    I’m not saying that pharmaceuticals don’t contribute to mental health, at least in some cases. But I think (American) society has bought into the idea that they can cure many more woes than is really the case.

    So does this perhaps illustrate how much human minds want to place the source of sickness and cures into physical objects, rather than understand them as the systemic effects that they are?

  9. #9 Mo
    August 27, 2008

    Fascinating!

  10. #10 Eloheim
    August 28, 2008

    Ya I don’t have much to add but this piece was such a great read I have to give it up to the author. The tumor-related interpretations are interesting. Also, personally, my strongest objection to the use of the medicinal placebo is that it may well retard the discovery of the actual cause of, and cure for, a disease.

  11. #11 Hungry Hyaena
    August 28, 2008

    Absolutely fantastic post, Jessica!

    I’ve long placed Bosch’s “The Cure of Folly” in my masterwork pantheon…although he has a few works in the mix.

    In graduate school, I used the image (and subject) as the conceptual springboard for a curatorial proposal that never found a home, and I’m fond of referring to our contemporary geopolitics as “having stones in the head.”

    All the best!

  12. #12 James Bowery
    August 29, 2008

    Tibetans have an initiation in which a hole “appears” in the crown of the head, and grass is planted in the hole.

  13. #13 Jessica Palmer
    January 7, 2009

    Quick update: Richard and Maureen Park have this to say about Bosch’s use of the funnel:

    “[It] identifies the surgeon with one of the cardinal sins�greed. Trickery and deceit for monetary gain were considered forms of greed. An inverted funnel also appears twice in Bosch’s later triptych, The Temptation of St Anthony. In the central panel, to the right of the kneeling figure of the saint, the funnel is worn by a fantasy creature who stares out at the viewer. And a funnel adorns the head of a similar creature placed prominently in the foreground of the left hand wing of the triptych. This creature is wearing a red tunic and skates, and the word for idle is inscribed on a piece of paper in its beak, identifying the creature as the sin of sloth. Bosch’s great admirer, Pieter Bruegel the Elder (c1525-69), who began his career by making engravings of Bosch’s paintings, may have been inspired by such images for his representation of the giant Gula, the sin of gluttony. The inverted funnel sitting on Gula’s head has an owl perched on the top, a small square window, and a chimney billowing smoke. Gula’s mouth is open wide to allow bags of grain to be emptied inside. It is possible that both Bosch and Bruegel used the funnel as an attribute of the seven deadly sins.”

    from “Fantastic Feeding Funnels,” BMJ, 16 Dec 2008

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