Episode Transcript
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Speaker 1 (00:03):
Welcome to stuff to blow your mind from house works
dot com. Maybe, why, my good fellow, you look a
(00:23):
bit mad? Why I have a bit mad? 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 skull, Doc, Right right here, then that's where
(00:46):
the stone of madness awaits us? Can you can you
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
(01:08):
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
(01:28):
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
(01:51):
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
(02:16):
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
(02:36):
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
(02:58):
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
(03:20):
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
(03:40):
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
(04:01):
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.
(04:24):
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,
(04:47):
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
(05:10):
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
(05:33):
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
(05:55):
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
(06:16):
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
(06:39):
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
(06:59):
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.
(07:21):
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
(07:43):
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
(08:03):
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
(08:24):
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
(08:48):
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
(09:11):
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
(09:32):
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
(09:54):
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
(10:15):
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
(10:37):
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
(10:57):
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,
(11:19):
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,
(11:42):
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?
(12:04):
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
(12:28):
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
(12:48):
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
(13:09):
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
(13:31):
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
(13:53):
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
(14:14):
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
(14:35):
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.
(14:57):
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,
(15:17):
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.
(15:39):
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
(15:59):
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,
(16:21):
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
(16:42):
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
(17:06):
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
(17:27):
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
(17:49):
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
(18:11):
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
(18:36):
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
(18:59):
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,
(19:20):
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
(19:42):
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,
(20:02):
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
(20:27):
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,
(20:50):
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,
(21:12):
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
(21:33):
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
(21:59):
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,
(22:19):
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
(22:40):
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
(23:01):
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
(23:24):
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
(23:47):
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
(24:07):
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.
(24:27):
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.
(24:49):
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
(25:11):
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
(25:33):
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
(25:53):
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.
(26:17):
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
(26:38):
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
(26:58):
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,
(27:21):
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
(27:41):
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,
(28:05):
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.
(28:30):
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
(28:52):
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
(29:18):
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
(29:39):
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.
(30:01):
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
(30:24):
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,
(30:47):
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
(31:10):
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
(31:31):
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,
(31:52):
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.
(32:13):
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
(32:37):
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
(32:57):
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.
(33:19):
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,
(33:43):
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
(34:07):
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
(34:29):
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,
(34:50):
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
(35:10):
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
(35:33):
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
(35:56):
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
(36:18):
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,
(36:41):
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.
(37:05):
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
(37:29):
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
(37:52):
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
(38:13):
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
(38:36):
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,
(39:00):
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
(39:21):
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
(39:41):
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
(40:02):
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
(40:26):
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
(40:49):
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
(41:10):
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
(41:31):
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
(41:52):
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
(42:14):
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,
(42:35):
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
(42:56):
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
(43:18):
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
(43:39):
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
(44:00):
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
(44:23):
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
(44:45):
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,
(45:06):
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
(45:28):
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
(45:49):
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,
(46:10):
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
(46:32):
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
(46:54):
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,
(47:14):
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
(47:36):
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
(47:58):
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
(48:22):
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
(48:44):
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
(49:05):
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
(49:26):
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
(49:46):
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,
(50:09):
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the Mind at how stuff works dot com for more
(50:37):
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