The Stone of Madness

remove it? Dot y? Certainly? Just have a seat and allow me to trepen your cranium just large enough to remove the stone. Better make it a big hole, Doc, I'm about as mad if they come mad, Mary to ratscure bowlepord a chest today. Sometimes I wake up in a field and I think I'm a dog. I start chasing the local clergy around it. Yes, yes, it's going to be all right now. Just let me reach inside and ah, there it is the stone of madness and folly,

the source of your mental maladies. Surgically removed. That'll be five children here you go. But can I can I keep the stone? Of course you can. Hey, Welcome to stuff to blow your mind. My name is Robert Lamb and I'm Joe McCormick. I hope to enjoyed our little skip that is, our attempt to audibly capture the spirit of a particular painting, namely, uh, the cutting of the stone or the extraction of the stone of madness or the cure of folly, whatever you want to call it,

by Hieronymous Bosh. Um this is a painting from around fourteen and it depicts uh, this sort of crazy but highly allegorical uh surgery taking place. Yeah, if you have never seen this painting, you should look it up. I'm gonna do my thing and tell you to google an image, but you really should see it to go with this episode. It will be on the landing package of of the web version of this episode. But yeah, it's a painting by Hieronymous Bosh. It's usually dated to around fifteen hundreds.

Sometimes we read one source that said it had to be after fifteen o two other people dated to the fourteen nineties UMU. As we mentioned in the past when we dealt with the some of Bosh's work, there's there's so little known about him that it's there's a certain amount of mystery involved in all of this, and one of the great things about it is the mystery of what motivated this painting, because because what's happening in the painting,

the cutting of the stone of badness. You have a patient in the the sort of the center left of the frame, who's seated in a chair in the middle of a field, and he looks quite distressed, and he's reclining back in the chair as a man in a pink robe with a tin funnel on his head cuts

into the patient's scalp. And the man, the man with the tin funnel on his head, who's doing the cutting, he looks fairly serene, wouldn't you say, Yes, he's he's he seems dedicated to the task at hand here, which you could interpret as concentration and and you know, knowing what he's doing, or you could interpret as a kind of callousness and insensitivity to this man's apparent grunting. He

looks like he's in the middle of a really good grunt. Uh. Then to the right of the guy reclining in the chair, he's having his head cut open. You have what appears to be you think this is a monk. Yeah, it looks very much like a monk. Yeah, he's got a shaved top of his head and he's in some black garments. And then to the right of the monk there is a woman with her head covered by a cloth, in a dress draped over her, with a book sitting on top of her head that's clasped with a clasp. So

what on earth do we make of this painting? I should also note that there is text with this painting, right if you have an appropriate zoomed out version, and it says this translation, of course, master cut away the stone. My name is Lubert Duss Lubert Dass. Yeah, and this is apparently a fool in Dutch literature of the time. And then the the observer that the viewer of this

particular piece would have known that. Yeah, I think at the time, calling calling a character Lubbert is kind of like us calling a character Cletus or something like that. It's like a it's like a joke and a Dutch Cletus, if you will. Yeah. So that's the the one of the key paintings that we're gonna keep referring back to.

But but we've see an overall trend uh in medieval art. Um. Yeah, medieval and early modern art in Europe seems to be following this theme set up by Bosh, or at least first interpreted by Bosh as far as we know, this theme of cutting out the stone of madness. So in the previous painting we had the guy with the tin funnel hat cutting the guy's head. He seems to be in the process of removing this titular stone stone of madness, whatever that is. But there are other paintings. There's of course,

a cutting of the stone of madness by Brugal. Right, yeah, Peter Brugal the Elder lived a fifteen fifteen to fifteen sixty nine, responsible for a number of fabulous pieces that I'm sure everyone's familiar with it and they've even had on your dorm room wall in college. I know I did, uh, And this one shows this one has a number of individuals and several different neurosurgical procedures going on in very crude and horrific fashion. Now we can point out that

this painting. You should also look this one up so you can see it for yourself. But it's much more chaotic than the last one. The last one is a sort of a concentrated scene of a single cutting taking place. Is it's a madhouse there. There are people all over having their heads examined and cut, and the multiple people doing the cutting. There's just general chaos. People are squatting and squirming in the background and trying to peek in and see what's going on. It's it looks like a

bad scene. Yeah, and and definitely remember the madhouse of it, because we'll come back to that. The third painting we want a reference here is is won by Quentin Massy's Uh he lived fourteen six to twenty nine, and this one is called an Allegory of Folly. And this one is probably it's probably my favorite of the three, just because it's so monstrous and weird. Yeah. Now it doesn't depict a surgery, but it does depict it follows the

same theme of the Stone of Madness. There seems to be so you see a guy here, he looks like he is perhaps mentally unsound in some way, and he is clutching a staff. That what is going on at the top of this staff, Robert, Well, they're there are evidently a number of different symbols going on in this piece. There's so much uh, there's so much symbology uh at play and in these these paintings, and we we don't

have time to to to tease it all apart. But yeah, he has a staff that has like a small individual that is with their with exposed buttocks emerging from the staff. He has a rooster on his head. Uh, and he's see he doesn't seem in pain by his madness. He seems a little uh mischievous, the mused. Uh. No, he seems to be contemplating the act of marrying two rats to a bowl of four yes. And on his forehead

there is a lump that you can see. It's a visible lump bulging from his forehead that appears to be this stone. It's the stone of madness. Yeah, it looks very much in a way. It also looks kind of like a third eye, which is I think something that's kind of neat about this piece that if you look at it with other artistic traditions uh loaded into your head, it kind of makes you wonder about, you know, the whole difference betwe lean enlightenment and madness, which which will

be a thing we come back to. But yeah, it looks like the stone of madness is not only in this individual's head, but it's poking through. Yeah, And so these are just a few examples, but this seems to be a general theme emerging in in medieval and early modern European art of of the stone of madness being a stone in the head associated with madness as they would understand it, and the the act of cutting for

the stone to get it out. But does this refer to a real physical thing in any way, and does the act of cutting for it represent a surgical procedure that really took place. Yeah, It's an interesting, uh mystery to consider because ultimately have like three possibilities here. One is that yes, there's something going on here to some physical malady in the head that is being removed. Okay.

Another possibility is that this is all a charlatan's game, right, It that that a quack is coming along and saying, oh, you have a problem, Well, I can take care of that. I can remove the source of it. It's like cranial psychic surgery, you know. The psychic surgeon would kind of scoop on your stomach for a minute and then sneak some chicken guts into his hand and pretend to be

pulling things out of your body. Exactly. In this case, you'd have somebody cutting at your head and then by sleight of hands, sneaking a stone into the hand and saying, well, look what I pulled out of your brain. You know, here's the problem. Yeah, it would be Yeah, in this case,

it would be precisely psychic surgery. Imagine a lot of people have seen this depicted in the movie Man in the Moon of the movie about Andy Kaufman, where he goes and this is performed for him and yeah, and they would often sometimes it would be chicken ups, but other times it would be inorganic objects. And so you're throw in a little you're throw in a little magic, little superstition, and you can easily imagine this scenario in which this essentially a medieval witch doctor of Swords of

Charlottan comes in, Ah, here's the stone. I've removed it, and now you're well. Yeah. Another option would be that there wasn't actually a stone in the head, so there wasn't a real problem that was being addressed here, and it wasn't quackery, but it was just somebody who was well meaning thought that there was some kind of thing that could be done to the head or something removed from the head to actually cure people, and it just didn't work. You know, they were wrong, but they were

well meaning. So that's what we're gonna explore in today's episode. We're gonna be talking a little bit about the medieval surgery. We're gonna be talking about trep nation. Uh. We're gonna be talking about, oh, the removal of actual stones from the body, uh, particularly in the Middle Ages. And we'll get back around to what what experts think this painting uh and and this really, this this artistic tradition is

really saying. Well, I think first we should take a look at the general atmosphere of surgery in the Middle Ages and then bridging into the early Modern period. Here. One of the things that I think about about when we think back on medieval medicine is that it easy for us to look back and make fun of people in the Middle Ages for believing and ridiculous cures. You know, like, oh, you've got migraines, you need to look at an ugly baby for thirteen minutes and then sprinkle some ground up

bore tusk in your eye. I mean, we all know that's not gonna work. It seems ridiculous to us, like, how did people fall for that? They must have been so stupid. But I'm not sure that's the case, because considering the known alternatives at the time, this superstitious kind

of try anything approach starts to make more sense. In the Middle Ages, if you were smart, the known alternatives, especially surgery, were often a last resort, and especially surgery, Yeah, to open up the body, particularly the body, Kennedy was what was a very dangerous proposition. Yeah, so you may have heard about this term barber surgeon, right, you've probably heard the story that you know, why why did barber poles have this spinning it and white kind of twirl

on them? Is it because they love candy canes and Christmas? Or is it is it just an accident? Well, no, you know that the fact you probably heard about that is that that came from you know, blood letting, essentially saying this is a place where you can get your blood let So what While the scientific ignorance of people in in medieval Europe is sometimes I think a little bit overstated, like sometimes we underestimate just how smart people in the past were about things, Medieval surgery was still

probably about as scary as you're imagining. One of the things about the time is that academic physicians, the people who really studied the body, the closest equivalent to what we would think of as doctors today. These would be the learned individuals who had some degree of access to medical texts. Yeah, they studied in universities, they knew what was up. They may have done dissections and stuff like that, but much of the actual cutting in surgery was not

done by these people. So you had your experts who were of the physicians, and then separately you had these barber surgeons or these traveling surgeons who were more just kind of like uh, skilled people who you know, they have a skill they can apply So I can cut hair, I can cut stones out, I can hear cataracts. In many cases, the authors who wrote surgical treatises of the time admitted that they had never performed the operations they

were describing. And in a way it kind of makes sense because you know, old barber cuts your hair or shaves your head if you're a monk and they shave your beard, so they've got the razor. Why not apply the razor to other things that need cutting, Like maybe if they need to extract some bone fragments from a club strike, crush wound, or if they need to do some blood letting, which truly was very common at the time. Yeah.

And plus I would imagine their status is always is already one in which they have close contact to the bodies of others. Uh, whereas I could I could imagine at being less the case for you know, learned individual. Yeah. And there's even a line in the Hippocratic oath, you know,

the Hippocratic oaths from Hippocrates, the Greek physician. Um, he has a part of the Hippocratic Oath that says, and this is for doctors, I will not use the knife, not even on sufferers from the stone, but will withdraw in favor of such men as are engaged in this work. So this is you know, doctor saying I'm not going to do any surgery. Uh. Kind of strange attitude for us to consider, but that was the thought of the time. Yeah. It's hard to imagine the medieval barber surgeon TV show.

You know, you would have the medical dramas playing out, but the the individual who has all the theories and all the the learning. Uh, they're not actually going to do any of the cutting that goes to the secondary character. Now this does still sort of apply today because of course we still have medical specializations. You have somebody who is you know, they they focus on maybe family medicine

versus somebody who's a neurosurgeon. Obviously they wouldn't try to do each other's job, you know that they have medical specialization. So that still carries through to today to some extent, but we're not in this case letting barbers do the neurosurgery. Now, why was surgery so dangerous in the Middle Ages and so just so generally awful. Well, one of the things that medieval surgeons did not have is sterile equipment or even knowledge of the need for antiseptic surgical methods uh like.

For example, there was a common belief at the time that pus was just an important part of the healing process, and that there were a few medieval surgeons who who tried things like washing wounds with wine. But it really wasn't until following Joseph Lister in the eighteen sixties that antiseptic surgery started to catch on everywhere and become the new norm. So you might have had a few people who got the right idea early on, but it was

not widespread practice to practice antiseptic surgery. So then this is one of the reasons. There's the primary reason why any opening of the body, any surgical opening, is almost invariably going to become infected because of the lack of sterility. Yeah. Yeah, putting dirty things deep inside your body, it's not good for you, like a like a grubby hand reaching in

to pull a stone if you're lower active. Who may have just been handling chicken guts while you know, I mean, who knows, or collecting dead rats for the town's local bounty anyway, So there's that they also did not have effective anesthesia and pain control. And this, I mean, you can imagine in your head exactly what the problem is, but maybe you're not imagining the extent to which this is a problem. It's not just that it hurts for the patient. It's difficult to perform internal surgery, even on

a very willing participant if they're awake. Yeah, if any of you have ever, um, it's even difficult I think for a lot of us to understand because there's a level of pain we're talking about here that a lot of people have not experienced. And even if you undergo surgical procedures thanks to anesthesia, you don't have to experience them. But I remember the one time I tried to perform a self surgery of a sort. Um. I had a tonenail issue which I which I tried to um, uh

like an ingrown issue stemming from a injury. Uh. I tried to correct it myself. Uh, and it was just like a butter knife and some hemp rope no, you know I had. And it wasn't, you know, quite surgery by any means. But um, I tried to to take care of the situation using tweezers, you know, and clippers, and the pain was just like blinding like that where there were flashes of my eyes. And then I was, okay,

I need to actually go to professional about this. But but imagine that extrapolated to not even self surgery, but yet surgery on on on any individual where high levels of pain are just going to be the norm. You're gonna have to strap the individual down or have to ruffians bring them to a wall or to a bed. You've got to hire some thugs to help you with your surgery. Yeah, And so there there were some potions

and stuff at the time. I mean, obviously people were aware of some types of drugs, but the point was that they didn't have controllable anesthesia, so they could maybe give you some hemlock or you know, these these crazy potions that were just as likely to kill you as they were to put you under. So so they might have had that in some scenarios, or they might have just tried to do it with you awake because they knew, you know, it looks like people die a lot of

times when we and that's the ties them. So this was a problem. Medieval surgery just generally bad. Common procedures that were aracticed by medieval surgeons. Blood letting that that's a big one. At the time, they believed in the you know, humorism, like the idea that there were these four humors in the body that could get out of balance and you could fix some things by letting extra

blood out. A big thing at the time was the treatment of battlefield wounds, such as the removal of arrows, and so at the time, surgery was much much more often external. From what we know at least, there's actually sort of a dearth of information about what surgeons in

in medieval Europe we're doing. We don't have quite as much information on this as we would like to have, but from the records we do have, it seems surgery was very often externals, such as the treatment of a surface wound or other problems near the outside of the body, and for all the reasons we've already stated, internal surgery, going deep inside the body for anything was dangerous and rare, though it did happen for some extremely problematic things such

as bladder stones. And we will definitely get back to stones, the bodies, the bodies lithos in uh in a bit here, but I think we should first turn our attention back thinking back on on the Bosch painting and the ones

that followed it to the head. That's right, yeah, because essentially what's going on here appears to be going on here is that they are uh, they're performing what we now call craniotomy, but what has been historically known as trep nation or trepanning, in which and this is just basically the opening of the skull and creating of a of a hole in the skull. Now we find evidence of trepinnation going back to well well before the Middle Ages in Europe. I mean it goes back to prehistoric times,

oh yeah, thousands of years. You see accounts of it among the ancient Egyptians, the Chinese, the Indians, the Romans, the Greeks, early meso American civilizations. Uh there there, that's there. There are a lot of a lot of interesting work has come out of South America and I believe also in and Papua New Guinea as well. But we've even found neolithic remains, human remains that had skulls that it

had clearly had the operation performed on them and survived. Right, there's a hole in the skull and it has been smoothed over where the person didn't die from this surgery, at least not at least not for a long time. Yeah, And so it's it's often been an archaeological uh mystery that individuals have have looked into. You know what, what's

going on with this skull? Is this the wounded? Did this was this didal just you know, clugged with something or was there some sort of a surgical procedure And if there was a surgical surgical procedure, why did they carry it out? Was it both? Was it just purely magical? Were they trying to let a demon or spirit out of the head, or were they trying to deal with a cranial and brain injuries. Because today clinical trepidation remains

a treatment for epidural and subdural hematomas. But and plus it gives us a base surgical entry point to the brain itself. Yeah. Yeah, I mean, if you've heard about trepidation before, you think about, Okay, that's just a crazy you know, why would somebody drill a hole in the skull. It's just because they thought there were demons, you know,

But there are real medical reasons, as you're saying. And I guess we don't know what the ancients knew, you know, it's hard to say whether in some cases they may have been doing it just for superstitious reasons or they

had some kind of medical prompting that was legitimate. Yeah, and you get into, uh, you know, an argument back and forth over that too, because to a certain extent, um archaeologists in the past have looked at some of these examples and they've they've said, well, there's no way that these individuals were carrying this out for legitimate medical purposes.

These are savages, these are ancient people. But there's a lot of events to suggest that they were actually dealing with They were actually performing medical procedures to deal with with head wounds, to deal with swelling of the brain um due to you know, blunt force trauma to the skull, trying to relieve that pressure by creating uh, this hole in the skull itself. Yeah, but of course trepination doesn't have necessarily a very good record in terms of the

survivability of the procedure. Oh no, Yeah. Even by the late nineteenth century, only ten percent of patients survived a Western trepination due to infection. And I want to stress Western because when you do look to some of the so called primitive cultures out there, uh, it seems that they actually may have had a lower mortality rate with their trestinations. Um. But eventually we're able to bring that up, obviously, because neurosurgery is not the uh, you know, a nine

mortality rate andever that it used to be. I mean, we're just generally better at at fighting off infection post surgery. Now. There are a lot of reasons now that surgery in

general is safer. Yeah, And a lot of people point to American neurosurgeon Harvey Cushing uh lived eighteen sixty nine through nineteen thirty nine as as one of the key individuals who was able to bring that neurosurgery mortality right down to less than ten percent um and and ultimately ushering in the modern age of neurosurgery in which some people do neurosurgery just for fun. Yeah, well for fun or for enlightenment, m consciousness extension. Yeah. I don't want to.

I don't want to go too far off the beaten path here. But we did see the rise of often self trepanned psychonauts in the nineteen sixties and seventies. You had this individual who was Dutch, interestingly enough, tying into the origins of our paintings here bosh. Yeah. Former medical student Bart Hughes lived n through two thousand and four. Uh. And he stands as voluntary trepidations pioneering visionary and so so. So he added the idea that trepidation is good for

your mind, right, yeah, he um so. And this was apparently he had been a mescal and induced revelation that his whole thing is that when we became bipeds, when we rose up on two legs, it altered the way um uh. The fluids move through our brain. It altered blood flow. It also altered the movement of cerebral spinal fluid, and and and so he thought that this would be He was trying to figure out, how can I, uh,

you know, get healthy flow of blood to the brain. Uh. So he considered, um, he considered making a hole uh in his the base of his spinal column to drain out some of the fluid. But he eventually decided, Okay, what I'll do is I'll just I'll trepan myself. I'll make this hole in my skull. And it's important to note here we're talking about just a hole in the skull.

He's not drilling all the way into brain. It's but that the premise here is that if you were to just remove a little bit of skull there, it would allow the pressure inside the brain to be relieved and therefore allow increased blood flow through the brain, allow a better removal of toxins. That there's there's actually some interesting research going on and going into this even today. Uh and they make some kind of compelling arguments for it.

But then the experts also argue that brain function is not limited by normal blood flow, and then increased brain metabolism might actually stress the system. So it's not it's not a cut and dry situation, but you have individual cut and wet situation. Yeah, but you have individuals out there who are very strong proponents all of trefinnation as a means of achieving up a higher state of consciousness. Okay,

And so this informs our interpretation of the painting. How like, are we thinking that maybe what we're seeing in this painting is we're misunderstanding it and it's a form of trefination or it's really just sort of related to the general concept. Essentially, it means that if there's any kind of stone removal going on, if removing a stone from the brain, either in fact or merely allegorically, then they're there and they're dealing with repination. And certainly tremination predated

these paintings. It was practiced to some degree at the time. And uh and and it would have been known to the artists. There were woodcuts, there were you know, instruction manuals, and as many of the medical text showing how this was this procedure was carried out. So, as you probably well know, kidney stones and bladder stones are very much a reality yes they are, and as Joe will shortly relate to us, their surgical removal is is also very

much reality and one that dates back to antiquity. But is there actually such a thing as a cranial stone? I mean, we know there there are mineral formations that can happen in the body. Can that happen in your brain? Well? Can it happen? Is is a question we'll get to. Was it happening at the time? Did individuals think that

this was happening? Uh? In the Middle Ages and in the centuries to follow well, As related by Mathis Kerschel, Frederick Mall and Philip van Karen Brook in the paper A Stone Never Cut for a New Interpretation of the Cure of Folly by Hieronymous Bosh published in the Journal International Urology. UH, there's no evidence to suggest this was ever carried out in real life. There are no historical sources from the period that mentioned genuine or fraudulent stone operations.

And I also want to add that apparently there were existing accounts of quackery that was going on in the Netherlands here in the fifteenth and sixteenth century. They don't mention any kind of fake stone removals or or fake trepid nations going on. But it was presented theatrically in performances for the masses, because clearly the painting makes us think the painting has a lot to say, and you

can imagine that extrapolated to street performances for the common individuals. Yeah, the idea was that there there were plays that had scenes of the the extraction of the stone of madness, right, cutting for the stone in the head, not unlike our little drama at the beginning of this episode. It makes you wonder because what other types of fiction that we have today depict things going on that are plausible in the same way that cutting for the stone is a

plausible thing that could have happened. You can imagine quacks cutting into people's heads pretending to remove a stone. Uh, without researching it any I would be tempted to say, um, nefarious kidney removal while on vacation place. You know, yeah, exactly if if historians of the future look back at our fiction as a as a judge to see what's happening in our culture today, and they're not, they can

tell the difference between fantasy and realistic fiction. You know, they don't think that Star Wars is happening in our culture today. But you know, they look at some kind of realistic drama where somebody has a kidney stolen in

Las Vegas, they wake up in a bathtub full of ice. Um. I mean they could conclude, oh, this must have been something that happened a lot in the early two thousands, because clearly it's depicted in their art and these are not these films are not just complete works with fantasy. So therefore maybe it happened. Yeah, and that brings us back to actual stone removal, the sort of stone removals we know. Um, we're carried out or attempted, uh in

many cases at the time. Yeah. So I mentioned earlier how in the Middle Ages coming into the early modern period, surgery really was a last resort, especially any significantly invasive surgery, deep internal surgery, that was really really a last resort at the time. Surgeons just didn't have safe, reliable ways of putting a patient to sleep. So, as we said earlier, you have to imagine internal surgery with knives going deep inside you while you're awake, or taking a drug that

might kill you. And that's that's an interesting that the real Sophie's choice there. Yeah, so you remember that line from the Hippocratic Oath, I said where I will not cut,

not even for the stone. That's sort of an indicator that of all the things people would come to an ancient or medieval doctor begging to be cut open for at the time when this was painful and dangerous, stones in the urinary tract have got to be some of the worst things to merrit a mention like this, you know, Like, so the doctor is saying, you know, of all the things that I may be tempted to do for a person that I shouldn't do, cutting for a stone has got to be near the top to merrit a mention

like this. Yeah. I mean, I I've never suffered the experience of having a stone in my body, but I know we have listeners who surely have, and I would love to hear from you and your account and how that ties into your appreciation of our episode today. Yeah, I want to read a little selection from a paper called the History of Urinary Stones in Parallel with Civilization by a met Te Feckley and Fatine says I yearly. So this is what they write during the medieval period

in Europe ten to fourteen thirty eight. There was little activity in the management of stone disease in this era. Lithotomists and that's you know, a person who would remove stones, the lithos and stone for a living. Lithotomus who were essentially commercial travelers, moving from town to town looking for business and cutting all who came their way, often uneducated

and occasionally dishonest, some were great showmen. The procedure was generally performed in the public without anesthesia and generally lasted a few minutes. However, lithotomus were held responsible for their bad results and find accordingly. So as we've said this surgery, Yeah, that sounds cute, right, the surgery is dangerous. Uh. Didn't you have some stats on the mortality rates? Yes, and these are from that a stone never cut paper. Their referenced earlier and all clue to link to that at

landing paper. This episode about around the fifteenth century, you saw about fifty percent, but our sources on that are a little I have to image approximate. Yeah, from the seventeenth century up to the mid eighteenth century, you see variable um statue. You see it as low as two point five but also as high as sixty seven point eight. It sounds like it matters who's doing your your stone cutting, yes,

as well as who is undergoing the surgery. Apparently the best outcomes occurred when you had a boy suffering a small stone. The older the individual, the larger the stone. Uh. And also if the individual is female, these would all really um tip the scales in the in favor of death. Okay, So do we have an actual account of what like? Did anybody make records of what this was like on the ground? Yes, they did, because this these tended to

be very memorable, uh for surgeries. Uh. And the one that we have here today, this one actually ties in do a painting is not a lot an engineering a second, but it concerns Jen did Dute, a Dutch blacksmith, and uh a do it yourself lithotomist did Dute yonda Dutey And so that's that's just the best name for a do it yourself a little and there and there's a painting of the painting of this individual called a Portrait of Jan d Dute by Carol uh the Establiene, and

this was painted in sixteen fifty five. I'll try to include a link to this painting so you can see it. Oh, he looks real satisfied with himself. Yeah. Explain described his painting for the listeners. Well, he's posed as if for a camera, and he's in his left hand holding up what looks like an egg, but I guess it's supposed to be a huge stone. And in his other hand he's just just kind of near the bottom of the painting, posed on the table. He's got what looks like a razor.

So and and he's he he's not exactly smiling, but he's got pride in his eyes. Yeah. And Uh, as the painting might suggest, he apparently survived at least for five years. But we know of of his case from an account written by Nicholas Tulp's seventy two text um Observationes Medicae and uh, and this is this is just

a sample translated obviously from that book. Only letting his brother help him, He instructed him to pull aside his scrotum while he grabbed the stone in his left hand and cut bravely in the perennium with a knife he had secretly prepared. I don't know why it was secretly prepared. Uh, and by standing again and again, I managed to make the wound long enough to allow the stone to pass.

To get the stone out was more difficult, and he had to stick two fingers into the wound on either side to remove it with leveraged force, and it finally popped out of hiding with an explosive noise and tearing of a bladder. Now the more courageous than careful operation was completed, and the enemy that had declared war on him was safely on the ground. He sent for a healer who sewed up the two sides of the wound together.

That's just troubling I And I will note that in the painting here portrait of Jan didot Uh, we don't see Uh. We only see Hi from the waist up. So god knows what the Finnished states of fans were just soaked in blood. Yeah, and there are other accounts out there as well. There was one in particular that I ran across years years ago, and I was trying

to find it. But in involved, I want to say, a royal individual or an astronomer, someone of you know, of means and importance, who had to undergo a stone removal surgery and it was just a bloody disaster and they ended up dying on the table. But after the life me I can't remember who it was. Okay, So we've seen that sometimes the body grows some stones inside it. You you've got these, uh, these formations of inneral deposits that can be very problematic, especially depending on where they occur.

Sometimes they're so problematic medieval surgeons would go in for them, despite how dangerous surgery was at the time. And how exactly does this affect the head, because like we've said, we're not really aware from the public record that people ever cut into people's skulls for stones at the time. But maybe, just maybe there's one sort of cranial phenomenon we could look at as a as a possible candidate

for what what's going on here? If this is intended to depict a real scene, if you're just saying, is it remotely possible that that bo just could happen? That bosh is depicting something that could have really happened. And here we want to talk about the meningioma. So, a meningioma is a name for like a class of tumors

that affect the brain and the spinal cord. Though they actually don't grow from brain or spinal cord tissue itself, but from Meninji's or the man ninjas, which are thin layers of tissue that wrap around the outside of these organs. So around the outside of your brain you've got a thin layer of this tissue, and this is where this meningioma can occur. It's it's like a tumor um and because they appear on this outer tissue, they typically happen at the top or the outer curve of the brain.

Also sometimes at the base of the skull. But this would make sense in the picture right at the top or the outer curve of the brain, that's where we see Bosch's tin funnel hat wearing. Doctor might be the generous word hutting here. So these these tumors are typically non cancerous. They're containing cysts or calcifications. Interestingly, so that would be collections of minerals, you know, stone formations, just like you might have in your bladder or something, so

a mineral collection or cyst. But of course, since they grow, they press against the brain. Even though they're non cancerous, it still need to be removed. So this could be what we're seeing in the painting. I don't know what you think about that. Yeah, I think in terms of just I don't think it it is what we're saying. But in terms of of making an argument, what is it possible? Is it? Is it realistically possible that that that there could be a stone of madness? Like this

is the closest real world possibility. Um And and in

what case would it be a stone of madness? Well, there's a paper that referred to This is a two thousand two letter to Neurology India by Prasada Krishnan uh and uh a few other co authors as well, and they they were looking at a particular individual that that had one of these uh meningioma's growing inside the skull, and they found that it can result in irrelevant speech, forgetfulness, behavioral abnormalities such as disinhibition, emotional liability, and just excessive

talking huh. So specifically they will get a sixty five year old patient uh and they they actually performed craniotomy and gross total excision of the legion, cutting her curing her of all the symptoms in the process. So, in other words, this is one case in two thousand twelve, with of course modern surgical um tools and procedures. UM at hand, the surgeons were able to remove a stone like growth from a human skull and uh, and in

doing so cure the individual of their abnormal mental state. Uh. Okay, So, while we have no evidence that operations like this took place in the Middle Ages or Bosh's time, it is at least possible that this could be the kind of thing going on here. Yeah, so it would sort of match the scene described. Yeah, so it might be a case where we're accidentally art in up giving us a glimpse of what an actual surgeon's blade with one day

and cover. Okay, Well, I've got another question though. One of the things that when I was researching medieval surgery I came across is that one one of the most common surgical procedures in medieval Europe would have been uh, treatment of battlefield wounds. Yeah, so what if what we're actually seeing is something that is that has not just grown inside the head, not a stone of madness, but a missile of madness, something that has come from the

outside and is being treated or removed. Yeah, I mean, indeed, uh, contemporary and ancient use of trefornation. Uh, it was often employed to deal with head trauma, either to you know, mitigate brain swelling due to blow a blow to the skull, or to remove a bone fragment or even a missile of some sort from uh, from underneath the skull or in the skull, or possibly in the brain. Uh. So I think you could make a granted weak case for

the stone of folly having some relation to battle injury. Um, only in this case you've not been hit by a stone from the enemy sling, but rather a dose of folly from the fate. Yeah. When I was preparing for this episode, one of the things I did was I watched part of a short documentary that had a scene about an injury that the young Henry the Fifth actually suffered on the battlefield when he was a teenager, where

he got an arrow lodged in his head. And they were talking about what happened when it was a non fatal wound, but you know at the time, of course, if they leave the arrow head in your wound, it's gonna get infected and you're gonna die. Uh. And they talked about the procedures that the surgeons of the day went through to try to remove this arrow head from his head and eventually he lived. He survived the procedure.

But this does kind of show how, even at a time when surgery is known to be very dangerous, if you've got a major head wound, you really don't have any other choice. Yeah, it's either do it and possibly die or just die. Alright. So this this brings us back though, to to the painting itself. So we've already established that cutting for a urinary stones was complicated and

dangerous treatment mortality rate. Furthermore, trepidation was an even risk your proposal at the time perhaticized mortality rate maybe maybe even more depending on who's trying to carry it out. So whether cutting into the brain or bowel, surgical practices of the time we're just not up to snuff. And as far as treatment of madness goes, this was an age before psychiatry was even a word. We didn't get back to eighteen o eight. The four humor still helps

way over our understanding of human experience. Uh, they were and there were very few treatments for uh mental illness. Uh. The asylum was really one of the few options for individuals who really had severe mental illness, which wasn't really a treatment, right, And that's actually one of the arguments for Peter Brugal the Elder's painting cutting out of the Stone of Madness, which you said, it looks like a madhouse.

One argument is is that he was depicting the brutal treatment of afflicted individuals within the madhouse, not that they were actually carved upon and had stones pulled out of their heads, but that the treatment they received was was

comparable to that level of brutality and ineffectiveness. Okay, so yeah, it's it's sort of just like an extreme example that's fictional to communicate the reality of the total, the total picture of the conditions, much like you might say, use this not really very plausible scenario of waking up in a bathtub missing kidney to depict the general sort of lawlessness of of a society something like that, you know,

the predatory nature of wherever you are Las Vegas or something. Yeah. Now, in terms of actual trepidation, it was certainly on the table for head trauma and psycho surgery was proposed in Europe as early of the twelfth century, but there are actually very few reports of it being effectively employed before, so it seems like the predominant theory here is that

this painting is there. There are a number of things going on, but one possibility here is that it's less about an actual surgery and more about a symbol for the the the the the ineffectiveness of surgery as a whole. Yeah, so it's not just about our cruelty but also about our our ignorance and fumbling. Yeah, like, we we have such a disastrous record removing these stones that are occurring

in the body. Let's just push it into a more comedic and symbolic area by having the quack surgeon or perhaps just surgeon with the you know, a boundering and incomplete understanding of human physiology, and imagine than him operating on an even more dangerous part of the human anatomy, the brain itself, and then trying to remove some stone

from from that part of the body as well. So in Bosch's painting, Uh, it seems that it's less about any about this being an actual procedure that was attempted, but more all right, let's take the stone removal surgeries that we know were occurring and that we know had

such a disastrous record. Let's extrapolate that and then and take our fictional doctor who's either a quack or just a you know, a blundering but well meaning individual who's dealing with just a limited understanding of human physiology and and uh and and and and disease and infection. And let's have him not operate on on this already dangerous part of the human body, but let's have him operate on an even more dangerous area for surgery, the human

brain itself. Let's have him pull a stone out of there. Yeah. So it's sort of a fictional symbol of not only not just like Brugal's vision of our the cruelty and chaos of the madhouse, but also of our just lack of knowledge and the way we fumble through medicine. Yeah, and they're they're additional interpretations that are sometimes thrown in as well, the quack uh interpretation that we mentioned already,

that it's essentially psychic surgery. Yeah, there's also the idea that the folly here is the patients for wishing the swift, easy removal of a thing which must be one either spiritually or you know, a few of the mysteries of alchemy. Yeah, fool and his money are easily parted. Yeah. Another one of the interpretations that I'm I'm not sure I can agree with, but I at least found very interesting and liked came from that that paper reference to Stone never

cut four, which it was good, it was interesting to read. Uh. They pointed out the three people in the painting, so that the patient is laying in this chair suffering, as you said, reclining seeming to groan get it out. You've got the doctor cut him, and then you've got the monk, and then you've got the ladies sitting there with the

book on her head. And the way they interpreted the painting was that he's surrounded by symbolic characters embodying medicine, religion, and philosophy, and that that none of them really offer him a solution, the philosopher being the what looks like a nun with the closed book, the sealed book resting atop her head. Yeah. I'm not sure if I buy that interpretation, but I like it. Yeah, I like it too. And and him Yeah, I mean, she still looks more

like a nun than a philosopher to me. But that's the that's the rough thing about interpreting these older pieces of art is they were not meant to speak to me or you. They were they were meant to speak to an individual living in the time. So they're they're kind of speaking across the time and space here and we can just do our best to try and interpret them.

But but I do like that interpretation because it takes it, it extrapolates it beyond uh, mere medical science, and it just shows this it's is comical take, but also one that that kind of just pokes fun at at our attempts to master anything. Here are the three learned individuals and what are they accomplishing with against this individual's pain, discomfort or madness boredom? Yeah, all right, so there you

have it. Uh. I'm going to make sure that the landing page for this episode links to examples of all the works of art that we referenced here, so you can pull them up, look at them, draw your own conclusions, make your own interpretations about what's going on. Um. And I will also link to that to some of the

papers that we reference here as well. But I'd say, if you are feeling not quite well in your in your mind or in your mental state, uh, let us advise you don't cut for the stone, or pay anyone else to cut for the stone. Go go see a modern medical doctor, and if that doctor has a tin funnel on his or her head, payack strap. He pay x ray. All right, hey. In the meantime, I'll be sure to visit stuff to Blow your Mind dot com. If we will find all the podcast episodes, who find videos,

who find blog posts? We find links out for our social media accounts. Uh follow us there. We're on Facebook and Twitter is blow the Mind. We're on tumbler as Stuff to Blow Your Mind. And if you want to get in touch with us with feedback on this episode or to let us know your favorite mystery from an ancient or medieval painting, you can email us at blow the Mind at how stuff works dot com for more on this and thousands of other topics. Is that how stuff works dot com. Fre