The Stone of Madness

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.

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.

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.

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.

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.

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.

"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.