From the Vault: The Stone of Madness

Madness has always intrigued artists, and medieval paintings sometimes presented this malady's treatment via the surgical removal of cranial stone. What was the stone of madness? Was it mere fantasy, metaphor or an actual medical condition? In this classic episode of Stuff to Blow Your Mind, Robert and Joe collect their trepanation tools and investigate. (Originally published Jan 7, 2016)

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Episode Transcript

Speaker 1 (00:05):
Hey, welcome to Stuff to Blow Your Mind. My name
is Robert Lamb and I'm Joe McCormick. And this is
one of our from the Vault selections from days of Old.
That's right, this is an older episode of Stuff to
Blow Your Mind. This in this particular episode originally published
January seven, two thousand sixteen, and it is titled The
Stone of Madness. I think this may have been my

(00:27):
most embarrassing skit performance on the show. Well, we were
playing characters from a Bosch painting, so we were supposed
to sound grotesque. If even if we can't look grotesque,
you always gotta have fun being a little boshy. Yeah. Yeah,
I love episodes like this because this is another one
of those where we have art and history and early

(00:47):
ideas about human biology all coming together into a nice package. Yeah.
So those are some of the best ones, right, art,
history and paleo science. Yes, and this one was also
almost a video, is that recall? I think somebody was
turning us into cartoons, and mercifully that didn't happen. Yeah,
because the skit that you mentioned here, they were they

(01:07):
were creating an animated version of that with grotesque versions
of of ourselves. God save us from the unflinching gaze
of the animator. All right, Well, on that note, let's
dive in. Welcome to stuff to blow your mind from
how stuff works? Dot com. Maybe, why, my good fellow,

(01:41):
you look a bit mad. I am a bit mad.
Do you know? Are you a physician? Well, of course,
didn't you notice my physician's cap? You mean that beautiful
tin funnel? Yes, yes, of course. Now if you would,
can you point to the part of your body that
feels insane right here in the scuttle dock, right right here?

(02:03):
Then that's where the stone of madness awaits us? Can
you can you remove it? Dot why? 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 as they come.
I'm a man to rats to a bowl of pork,
a chest to take. Sometimes I wake up in a

(02:24):
field and I think I'm a dog. I started 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
silver Here you go. But can I can I keep

(02:47):
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 you enjoyed our little skit.
That is our attempt to audibly capture the spirit of

(03:09):
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 four
and it depicts uh, this sort of crazy but highly

(03:30):
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 page 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 sometime.

(03:50):
We read one source that said it had to be
after fifteen o two other people dated to the fourteen nineties. Um.
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,

(04:11):
because because what's happening in the painting, the cutting of
the stone of Badness. You have a patient in the
sort of the center left of the frame, who 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

(04:32):
tin funnel on his head cuts into the patient's scalp. Yes,
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 seems 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,

(04:53):
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 really good grunt. 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

(05:13):
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 straped 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

(05:36):
if you have the 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

(05:59):
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 that seems to
be following this theme set up by Bosh, or at

(06:22):
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, the
stone of madness, whatever that is. But there are other paintings.
There's of course, a cutting of the Stone of Madness

(06:42):
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

(07:03):
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. This is it's a mad
house there. There are people all over having their heads
examined and cut, and the multiple people doing the cutting.

(07:26):
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 mad house of it, because
we'll come back to that. The third painting we want
a reference here is is Won by a Quentin Massy's
uh he lived fourteen six to nine. And this one

(07:48):
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 is 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

(08:12):
clutching a staff that what is going on at the
top of the staff. Robert, Well, there 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,

(08:33):
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 natness. 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 port. Yes. And on his forehead

(08:56):
there is a lump that you can see, it's a
visible lump fulging 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

(09:17):
whole difference between 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

(09:39):
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. It's an interesting, uh mystery to consider

(10:03):
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, that that
a quack is coming along and saying, oh, you have
a problem, Well, I can take care of that. I

(10:24):
can remove the source of it. It's like cranial psychic surgery,
you know, origin 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,

(10:45):
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 up, but
other times it would be inorganic objects. And so you're
throw in a little You're throw in a little magic,

(11:05):
a little superstition, and you can easily imagine this scenario
in which this essentially a medieval witch doctorre of Swords
of Charlotton 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

(11:28):
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 medieval surgery.
We're gonna be talking about trepi nation. Uh, We're gonna
be talking about, oh, the removal of actual stones from

(11:51):
the body, uh, particularly in the Middle Ages, And we'll
get back around to what what experts think this painting
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

(12:12):
things that I think about about when we think back
on medieval medicine is that it's 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

(12:34):
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,

(12:55):
especially surgery, were often a last resort, and especially elle surgery. Yeah,
to open up the body is 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

(13:15):
barber polls have this spinning red 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

(13:36):
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

(13:56):
what we would think of as doctors today. These would
be to learn it into visuals 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 the physicians, and then separately

(14:20):
you had these barber surgeons or these traveling surgeons who
were more just kind of like 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

(14:43):
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

(15:04):
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 that being less the case for you know,
learned individual. Yeah. And there's even a line in the

(15:24):
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

(15:45):
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

(16:07):
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

(16:30):
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

(16:51):
so generally awful. Well, one of the things that medieval
surgeons did not have is sterile equipment or even knowledge
of the knee 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

(17:13):
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

(17:33):
of the reasons, this is 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

(17:54):
have just been handling chicken guts for all 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

(18:17):
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

(18:37):
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 uh like
an ingrown issue stemming from a injury. Uh. I tried

(19:00):
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 to where there

(19:21):
were flashes in my eyes. And then it was okay,
I need to actually go to to a 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.

(19:43):
You gotta hire some thugs to help you with your surgery. Yeah, 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

(20:04):
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'esthetize them. So this was a problem. Medieval
surgery just generally bad. Common procedures that were practiced by

(20:24):
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

(20:45):
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

(21:08):
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 body's lithos in uh in a bit here, but

(21:31):
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 um craniotomy, but what has been historically known as
a trap nation or trepanning, in which and this is

(21:54):
just basically the opening of the skull, creating of a
of a hole in the skull. Now we find evidence
of trepidation going back to well but before the Middle
Ages in Europe. I mean, it goes back to prehistoric times,
so 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's there.

(22:19):
There are a lot of a lot of interesting work
has come out of South America and I believe also
in 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,

(22:41):
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's going
on with this skull? Is this a wounded did this
was this just you know, clud with something, or was
there some sort of a surgical procedure and if there
was a curical surgical procedure, why did they carry it out?

(23:01):
Was it both? Were they 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 trepid nation remains a treatment
for epidural and subdural hematomas. But and plus it gives

(23:23):
us a basic surgical entry point to the brain itself. Yeah.
I mean, if you've heard about trepid nation 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

(23:43):
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, um, you know, an argument back and
forth over it too, because to a certain extent, um
archaeologists in the past have looked at some of these

(24:04):
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. Uh, but uh,
there's a lot of evidence to suggest that they were
actually dealing with they were actually performing medical procedures to
deal with with head wounds, to deal with u swelling

(24:24):
of the brain um due to you know, blunt force
trauma to the skull, trying to relieve that pressure by
creating uh this whole in the skull itself. 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

(24:47):
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 and
more reality rate with their definations. Um. But eventually we
were able to bring that up, obviously, because neurosurgery is

(25:08):
not the uh you know, a nine mortality rate and
ever that it used to be. I mean, we're just
generally better at, uh 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 lived eighteen sixty nine through

(25:28):
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 intention Yeah. I don't want to.

(25:51):
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. Yeah. Former medical student
Bart Hughes lived through two thousand and four. Uh, and

(26:13):
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 admenced. This was a mescal and induced revelation.
But his whole thing is that when we became bipeds,
when we rose up on two legs, it altered the way,

(26:35):
um uh, the fluids moved 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.
So he considered, um, he considered um making a hole

(26:57):
uh in his the base of his spinal column to
rain 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.
It's not drilling all the way into brain. It's but
the but the premise here is that if you were
to just remove a little bit of skull there, it

(27:19):
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.

(27:41):
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 individualstation situation. Yeah,
but you have individuals out there who are very strong
proponent all of trefinnation as a means of achieving up

(28:03):
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 trepidation 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 they're removing a stone from the brain,

(28:25):
either in fact or merely allegorically, then there there and
they're dealing with trepidation. And certainly trepidation 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

(28:45):
as many of the medical texts showing how this was
u 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, there's sort of 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?

(29:08):
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 that individuals think that
this was happening in the Middle Ages and in the
centuries to follow well, As related by Mathis Kerschel, Frederick Mall,

(29:30):
and Philip van karen Brock 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

(29:54):
also want to add that apparently there were existing accounts
of quackery that was going on in the nether Lands.
You're in the fifteen and sixteenth century. Doubt 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.

(30:16):
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

(30:41):
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. Yeah, there's place you
know you Yeah, exactly if if historians of the future

(31:02):
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

(31:22):
full of ice. Um. I mean they could conclude, oh,
this must have been something that happened a lot in
the early two thousand's 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

(31:45):
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 sir jury really was a last resort,
especially any significantly invasive surgery deep internal surgery, that was

(32:08):
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

(32:28):
an interesting It's it's a 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

(32:50):
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 merit a mention like this. Yeah.
I mean, I I've never suffered the experience of having

(33:11):
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 ahmet Te
Feckley and Fatine says I yearly. So this is what

(33:34):
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 the stone
for a living. Lithotomists were essentially commercial travelers, moving from
town to town looking for business and cutting all who

(33:55):
came their way, Often uneducated and occasionally dishonest, some were
great showman. 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,

(34:17):
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 that are referenced earlier and
all clue to link to that A landing page for
this episode. But around the fifteenth century you saw about fifty,
but our sources on that are a little I have
to approximate. Yeah, from the seventeenth century up to the

(34:38):
mid eighteenth century, you see variable um status. You see
it as low as two point five, but also as
high as sixty seven point eight. 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

(35:01):
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 these tended to be

(35:22):
very memorable, uh for surgeries. Uh. And one that we
have here today, this one actually ties into a painting
is all an engineering A second, but it concerns jen
did Dut a Dutch blacksmith, and uh a do it
yourself lethotomist did dute beyond dute? And uh so that's

(35:45):
that's just the best name for a do it yourself. Yeah.
And there and there's a painting of the painting of
this individual called a Portrait of Jan d Dute by
Carol uh Di Savillene, and this was painted in sixteen
fifty five. I'll try to include a ink to this
painting so you can see it. Oh, he looks real
satisfied with himself. Yeah. Explain described his painting for the listeners. Jow. Well,

(36:06):
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

(36:28):
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 six seventy two text Um Observation. He's medica

(36:50):
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 grown him 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 managed to make the wound

(37:13):
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 the bladder.
Now the more courageous than careful operation was completed, and

(37:34):
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 dedut Uh, we don't see Uh.
We only see Hi from the waist up, So God
knows what the finished state of things were just soaked

(37:57):
in blood. 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 or 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

(38:19):
dying on the table. But after the life of 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 mineral 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

(38:43):
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 crany old
phenomenon we could look at as a as a possible
candidate for what what's going on here If this is

(39:04):
intended to depict a real scene, if you're just saying,
is it remotely possible, yeah, that that 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

(39:24):
they actually don't grow from brain or spinal cord tissue itself,
but from the 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

(39:45):
um and because they appear on this outer tissue, they
typically happened 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, the
top or the outer curve of the brain. That's where
we see Bosch's tin funnel hat wearing. Doctor might be

(40:06):
the generous word cutting 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

(40:28):
non cancerous, they 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?

(40:50):
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 the referred to. This is a two
thousand to letter to Neurology India by Prasada Krishnan uh
and UH a few other co authors as well, and

(41:11):
they they were looking at a particular individual that that
had one of these um 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.

(41:33):
So specifically they will get a sixty five year old patient,
uh and UH. They they actually performed a craniotomy and
gross total excision of the legion, uh, 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

(41:55):
at hand, the surgeons were able to remove a stone
like growth from a humans goal and uh, and in
doing so cure the individual of their abnormal mental state. Huh. 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

(42:19):
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 ends 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

(42:40):
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

(43:01):
outside and is being treated or removed. Yeah, I mean indeed, uh.
Contemporary and ancient use of trefor nation. 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

(43:22):
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 face. Yeah. When I was preparing for

(43:44):
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,

(44:05):
if they leave the arrow head in your wound, it's
going to 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

(44:26):
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 your urinary stones was complicated and

(44:48):
dangerous treatment mortality rate. Furthermore, trepidation was an even riskier
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

(45:10):
before psychiatry was even a word. We didn't get back
to eighteen o eight. The four humors still held sway
over our understanding of human experience. Uh, there 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

(45:33):
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

(45:53):
were actually carved upon and had stones pulled out of
their heads, but that the treatment they were sieved 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,

(46:14):
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 or something like that,
you know, the predatory nature of wherever you are Las
Vegas or something. Yeah, Now, in terms of actual trepidation,

(46:38):
it was certainly on the table for head trauma and
psycho surgery was proposed in Europe as earlier 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 a number
of things going on, but one possibility here is that
it's less about an actual surgery and more about a

(47:01):
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

(47:26):
quack surgeon or perhaps just surgeon with you know, bundering
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

(47:51):
any about this being an actual procedure that was attempted.
But more all right, let's take the stone removal surgeries
that we know we're ocurring 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

(48:12):
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

(48:34):
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 is essentially psychic surgery. Uh. There's also the
idea that the folly here is the patients for wishing

(48:56):
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

(49:16):
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 cutting 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

(49:39):
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

(49:59):
like it. Yeah, I like it too, And yeah, I
mean she still looks more like a nun than a
philosopher to me. But that's 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 time and space

(50:22):
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 a 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

(50:44):
against this individual's pain, discomfort or madness boredom? Yeah? All right,
so there you have it. 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 him, draw
your own conclusions, make your own interpretations about what's going on.

(51:07):
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, pay extra,

(51:30):
pay pay extra? Yes, all right, hey. In the meantime,
I'll be sure to visit Stuff to Blow your Mind
dot com. That's we will find all the podcast episodes,
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(51:51):
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(52:21):
need the biggest cement. I would be