A Hole in the Head
Page 10
Strick has criticized the electrical stimulation methodology underlying Graziano’s results, but it is hard to see how they can be accounted for simply by artifactual spread of current.83
NOTES
This chapter derives primarily from a recent article in The Journal of the History of the Neurosciences (16: 320–331 [2007], “The Discovery of Motor Cortex and Its Background in the 18th and Early 19th Centuries”) and from an earlier piece coauthored with Charlotte Taylor and published in The Neuroscientist (9: 332–342 [2003], “Twitches versus Movements: A Story of Motor Cortex”). The latter paper originated when Taylor, then a graduate student, and Michael Graziano, a postdoc, working in my lab on motor cortex, realized that the results they were finding were related to the nineteenth-century controversy on motor cortex between David Ferrier on the one hand and G. T. Fritsch and S. Hitzig on the other.
1. Fritsch and Hitzig, 1870.
2. Ferrier, 1873.
3. Grundfest, 1963.
4. Brazier, 1988; Hitzig, 1874.
5. Grundfest, 1963; Brazier, 1988; Fritsch, 1912.
6. Herrick, 1892.
7. Finger, 2000; Kuntz, 1953.
8. Kuntz, 1953.
9. Magner, 1992.
10. Fritsch and Hitzig, 1870.
11. Breasted, 1930.
12. Hippocrates, 1927.
13. Gross, 1998a.
14. Gross, 1998a, 1998b.
15. Descartes, 1972.
16. Fearing, 1970.
17. Brazier, 1959.
18. Finger, 2000; Brazier, 1959, 1984.
19. Finger, 2000; Brazier, 1984.
20. Finger, 2000; Brazier, 1959, 1984.
21. Meyer, 1971; Clarke and O’Malley, 1996.
22. Meyer, 1971; Clarke and Bearn, 1968.
23. Gross, 1995; Hippocrates, 1927.
24. Clarke and O’Malley, 1996.
25. Dewhurst, 1982; Willis, 1664.
26. Schiller, 1992.
27. Kruger, 1963.
28. Gross, 1997a.
29. Gross, 1998a.
30. Gross, 1997a.
31. Gross, 1997a.
32. Neuburger, 1981.
33. Neuburger, 1981.
34. Gall and Spurzheim, 1835; Young, 1970; Gross, 1999d.
35. Gall and Spurzheim, 1835; Young, 1970; Gross, 1999d; Spurzheim, 1834.
36. Gall and Spurzheim, 1835; Young, 1970; Gross, 1999d; Spurzheim, 1834.
37. Gross, 1999d; Spurzheim, 1834; Zola-Morgan, 1985.
38. Young, 1970; Cooter, 1985.
39. Gross, 1999d; Clarke and O’Malley, 1996.
40. Gross, 1999d.
41. Young, 1970; Gross, 1999d; Broca, 1960; Schiller, 1992.
42. Young, 1970; Broca, 1960; Schiller, 1992.
43. Young, 1970; Gross, 1999d.
44. Finger, 2000; Young, 1970; Temkin, 1971.
45. Young, 1970; Temkin, 1971; Jackson, 1870, 1958.
46. Ferrier, 1873.
47. Jackson, 1870.
48. Hitzig, 1900.
49. Jackson, 1875.
50. Fritsch and Hitzig, 1870.
51. Hitzig, 1870.
52. Walker, 1998.
53. The county of Yorkshire is divided into three ridings, or thirds, a North, East, and West riding.
54. Viets, 1938. Crichton-Browne then abandoned the West Riding Lunatic Asylum Medical Reports to found, with Hughlings Jackson and Ferrier, the journal Brain.
55. Ferrier, 1876.
56. Ferrier, 1873, 1875, 1876, 1878, 1886; Finger, 1994, 2000; Gross, 1998a.
57. Clarke, 1970.
58. Ferrier, 1873, 1874a.
59. Anonymous, 1881a; Jefferson, 1960; Ferrier 1890.
60. Ferrier,1874–1875.
61. Ferrier, 1875
62. Ferrier, 1875.
63. Ferrier, 1873.
64. Ferrier, 1886.
65. Ferrier, 1874–1875.
66. Graziano et al., 2002a, 2002b.
67. Ferrier, 1886.
68. Fritsch and Hitzig, 1870.
69. Hitzig, 1874. Quote translated by G. Krauthammer.
70. Ferrier, 1886.
71. Gross, 1998a; Glickstein, 1985.
72. Hitzig, 1874; Brazier, 1984.
73. Ferrier, 1876.
74. Horsley and Schäfer, 1883, 1888; Beevor and Horsley, 1887; Beevor, 1887; Brown and Sherrington, 1912, 1915.
75. Cheney and Fetz, 1985.
76. Leyton and Sherrington, 1916; Penfield and Rasmussen, 1950; Woolsey et al., 1952.
77. Walshe, 1943; Fulton, 1949b; Phillips, 1975.
78. Asanuma, 1975; Scott and Kalaska, 1997.
79. Georgopoulos et al., 1986, 1992.
80. Graziano et al., 2002a, 2002b.
81. Graziano et al., 2002a, 2002b; Graziano, 2006; Graziano and Aflalo, 2007.
82. Graziano, 2006; Graziano and Aflalo, 2007.
83. Strick, 2002.
II
NEUROSCIENCE AND ART
I knew a five-year-old boy who had an insatiable thirst for art museums and art books. Among his favorites were Hieronymus Bosch and Peter Bruegel. In going over his Bosch and Bruegel books with him I was struck by images that looked like some weird version of a neurosurgical operation. In one case it looked like a flower was being extracted from the head and in another some stones were being removed. So, as described in chapter 5, I looked into this apparent “psychosurgery” in Renaissance art and its relation to trephination, a hoary practice whose history and current use are described in chapter 1.
Most of my own scientific work has been on the functions of inferior temporal cortex in object recognition. In the course of these studies I noticed that animals with damage to this part of the brain could tell left-right mirror images apart (e.g., p from q) as well as normal animals although they were severely impaired in telling apart other shapes. This led me to study left-right differences with Marc Bornstein, a colleague in the Princeton psychology department and an expert in both infant perception and art history. In chapter 6 we consider several general questions about right and left in science and art and to what extent differences between right and left are biological or social.
One of my history of neuroscience books has a Rembrandt painting of what looks like a brain dissection and another of an arm dissection. This piqued my curiosity to find out, as described in chapter 7, about Rembrandt’s portraits of doctors dissecting corpses. Curiously, one of these paintings became a putative model for the final portrait of Che Guevara.
5
“PSYCHOSURGERY” IN RENAISSANCE ART
Hieronymus Bosch and other early Renaissance artists depicted “stone operations” in which stones were supposedly surgically removed from the head as a treatment for mental illness. These works have usually been interpreted either as portraying a contemporary practice of medical charlatans or as an allegory of human folly rather than a real event. Since trepanation for head injury and mental disease was actually carried out in Europe at this time, another possible interpretation of these works is that they are derived from a common medical practice of the day.
BOSCH AND THE CURE OF FOLLY
Hieronymus Bosch (ca. 1450–1515) is one of the most enigmatic painters of all time. Art historians have variously characterized this Flemish artist as a fanatic orthodox Christian, a satirical heretic, a pornographer, and a member of a secret black-magic sect (the “Adamites”) worshipping the divinity of the sex act. His rich and flamboyant symbolism has been decoded (supposedly) in terms of alchemy, folklore and magic, various secret Christian sects, Freud and Jung, the Hebrew cabala, and the use of hallucinogenic drugs.1
Two things are clear about Bosch. One is that the plethora of conflicting interpretations reflects the imagination of art historians more than any solid evidence. The second is that Bosch had a twentieth-century mentality. His fantastic images have been viewed as anticipating Salvador Dali and the surrealist painters. Norman O. Brown said Bosch foreshadowed modern ideas of “therapeutic sexuality.” Henry Miller clai
med him as an inspiration to his own creativity. New interpretations of Bosch pour out and his images are found on such places as the covers of rock albums and novels on the holocaust.2
Perhaps the Bosch painting of most interest to neuroscientists is The Cure for Madness (or Folly), also known as The Stone Operation (figure 5.1). This painting shows someone making a surgical incision in the scalp. The inscription has been translated as “Master, dig out the stones of folly, my name is ‘castrated dachshund.”’3 This is usually interpreted as reflecting a contemporary belief that folly, stupidity, and madness were due to stones in the head. “Castrated dachshund” was an epithet for a simpleton.4
The art-historical literature is replete with a large number of conflicting interpretations of the details of this painting such as the role of the two onlookers, the funnel on the surgeon’s head, the book on the woman’s head, the fact that a water tulip—not a stone—is being extracted from the head, the gibbet in the background, and other puzzling aspects. In spite of the disagreement on the meaning of the various apparent symbols in the painting, virtually all interpretations of the paintings fall into one of two classes. The first class views the painting as representing (and ridiculing) an actual practice whereby itinerant medical charlatans deceived people into believing that they could cure mental and “psychosomatic” symptoms by removing stones from the head.5 Supposedly, the quack would make a scalp incision and then pretend to remove stones from the head. The second class of interpretation claims that there is no evidence at all for any such contemporary pseudo-medical practice.6 Rather, the painting is viewed as an allegory of the extreme stupidity and gullibility of humans, a recurrent theme in Bosch.
Figure 5.1
Painting by H. Bosch, The Cure of Folly or The Stone Operation (ca. 1490, Prado, Madrid). The text reads, “Master, dig out the stones of folly, my name is ‘castrated dachshund’.” Yale University, Harvey Cushing/ John Hay Whitney Medical Library.
After Bosch, there were a number of works, again usually Flemish, depicting the removal of stones from the head as a cure for madness and folly, including by Peter Bruegel, Jan Steen, Pieter Huys, Nicolaes Weydmans, and others (figures 5.2, 5.3, and 5.4). Following the two overall interpretations of the Bosch mentioned above, these later works have been interpreted either as depicting an actual common practice of medical quackery or simply as imitating Bosch’s allegory of human stupidity (as each of these artists was clearly influenced by Bosch).7 In both these art-historical interpretations of the depictions of “stone operations,” the possibility that legitimate surgical operations on the head were actually performed to relieve symptoms was apparently quite inconceivable.8
TREPHINING
The oldest known surgical procedure is trephining, or trepanning, the removal of a piece of bone from the skull. It began in the late Paleolithic period and has been carried out in virtually every part of the world (see chapter 1). It is still used in the modern neurosurgical suite, in traditional Kenyan medicine and as an “alternative medicine” method of enhancing consciousness. Trephining has a strong and continuing tradition in Western medicine. It is described in detail in the Hippocratic work On Wounds in the Head, where it is indicated for various types of head injury. From the Renaissance until the beginning of the nineteenth century, trephining was widely advocated for the treatment of head wounds, particularly for depressed fractures and penetrating head wounds. It was also used, at least into the eighteenth century, for the treatment of epilepsy and mental disease.9
Roger of Parma (ca. 1170) wrote in his Practica Chirurgiae (The Practice of Surgery):
For mania or melancholy a cruciate incision is made in the top of the head and the cranium is penetrated, to permit the noxious material to exhale to the outside. The patient is held in chains and the wound is treated, as above under treatment of wounds.10
Figure 5.2
Engraving by Peter Bruegel the Elder, The Witch of Malleghem (1559. Malleghem was an imaginary village populated by the gullible, “mal” meaning crazy or foolish in Flemish. The witch is shown at the end of the table on the right holding up a stone she has just “extracted” from the fellow whose chin she still grasps. The stone had been provided by her lock-lipped assistant under the table. The advertising poster on the wall shows other stones she has removed and her surgical instrument. She is surrounded by others with stones in their heads waiting to be extracted. The figure in the foreground with a knife bound flat to his head represents sympathetic magic to draw out excess blood or bad humors, a custom that is said to have survived along the lower Rhine (Grabman, 1975; Klein, 1963). The verses under the print have been translated as “Folk of Mallegem, be of good cheer; / I Lady Witch, wish to be well-loved here . . . / I have come here to cure you / . . . Hurry on, everyone / If you’ve a wasp in your dome / Or are plagued by a stone” (Klein, 1963). Yale University, Harvey Cushing/ John Hay Whitney Medical Library.
Figure 5.3
Painting by P. Huys (ca. 1562, Wellcome Institute Library; Schupbach, 1978).
Figure 5.4
Engraving by N. Weydmans, Operation for Stones in the Head. The legend reads “Come, run, be filled with joy; Here we are cutting the woman of her stone” (Klein, 1963). Yale University, Harvey Cushing/ John Hay Whitney Medical Library.
Robert Burton, in his still-in-print classic Anatomy of Melancholy (1652), similarly prescribed boring a hole in the head for melancholy:
Tis not amiss to bore the skull with an instrument, to let out the fuliginous vapors. . . . Guinerius cured a nobleman in Savoy by boring alone, leaving the hole open a month together by means of which, after two years’ melancholy and madness, he was delivered.11
Thomas Willis, Professor of Natural Philosophy at Oxford, one of the founders of the Royal Society, and author of Cerebri Anatome (1664), the first comprehensive monograph on the brain (dealing with anatomy, physiology, and clinical neurology), noted that
Threatening, bonds or strokes were “Curatory” for madmen [but] Specifick Remedies such as St. Johns-wort as well as Chirurgical Remedies such as Trephining or opening the skull [were also indicated].12
Figure 5.5 is a 1573 woodcut showing a trephination in progress in a home operation. When the operation was moved into hospital settings in the beginning of the nineteenth century, the mortality rate was so high from the rampant infections characteristic of contemporary hospitals that trephination, for any reason, declined markedly until the introduction of modern antisepsis at the end of the century.13
BOSCH AND CONTEMPORARY MEDICAL PRACTICE
Cutting through the scalp into the cranium to remove a piece of bone, a practice known as trephination, was a standard surgical procedure during the periods in which the various depictions of “stone operations” were made such as those in figures 5.1 to 5.4. Furthermore, the procedure was used to treat behavioral disorders as well as head injuries. Thus, it seems likely that Bosch, and the other artists who produced the various pictures of stone operations, knew of the existence of the actual contemporary medical procedure of trephination. Indeed, the details of their portrayal of the “stone operations” were sometimes close to the detailed instructional diagrams on trephination found in surgical handbooks such as Johannes Scultetus’s Armamentarium Chirurgicum (1655; shown in figure 5.6).
Figure 5.5
A 1573 woodcut showing a trepanation in progress. “Two people assist the surgeon, while a man warms a cloth, a women prays and two others watch” (Finger, 1994).
Figure 5.6
Detail of a figure from a 1653 work by J. Scultetus showing the start of a trepanation (Scultetus, 1655).
Thus, whatever the abstruse symbolism in Bosch’s Cure of Folly, whether he was ridiculing the church, the medical profession, trepanning, or all humanity; or whether it advocates some religious cult, some wild sexual practice, the advantages of trepanning, or nothing at all, it seems indisputable that the writing of art historians on this and similar works contains a great deal of folly. Apparently, unknown to many
of these historians, Bosch’s painting and derivatives by Bruegel and others were based on a very real medical practice of their time.
NOTES
This chapter is a version of an article previously published in Trends in Neurosciences (22: 429–431 [1999], “‘Psychosurgery’ in Renaissance Art”).
1. Gardner, 1975; Cinotti, 1969; Gibson, 1973; Snyder, 1973; Harris, 1995; Delevoy, 1990; Bango Torviso and Marias, 1982; Bax, 1979.
2. See, e.g., Kosinski, 1999; One Nation Underground by the rock group Pearls Before Swine.
3. Cinotti, 1969.
4. Cinotti, 1969; Gibson, 1973; Harris, 1995; Bax, 1979; Schupbach, 1987.
5. Bango Torviso and Marias, 1982; Fry, 1946; Grabman, 1975; Klein, 1963; Mendena, 1969.
6. Gibson, 1973; Bax, 1979; Schupbach, 1987.
7. Grabman, 1975; Klein, 1963; Menden, 1969.
8. Gibson, 1973; Menden, 1969.
9. Gross, 1999b; Lisowski, 1967; Bakay, 1985; Saul and Saul, 1997.
10. Valenstein, 1997.
11. Burton, 1652.
12. Willis, 1683.
13. Dagi, 1997.
6
LEFT AND RIGHT IN SCIENCE AND ART
WITH MARC H. BORNSTEIN
How is the left hand different from the right hand? An asymmetric object, like a hand, can exist in two left-right mirror-image forms, or enantiomorphs, a phenomenon which has fascinated philosophers, cosmologists, and artists (figures 6.1 through 6.4). Psychologists and neurophysiologists have been particularly puzzled by the extreme difficulty children and other animals have in learning to distinguish left-right mirror images. In this chapter, we propose an explanation of why mirror images are so confusing. In the natural world almost all mirror images are actually two aspects of the same object, for example, the two sides of a face or a silhouette viewed from the front and back. Therefore a perceptual mechanism that treats mirror images as equivalent would be adaptive. The perceptual equivalence of mirror images only becomes maladaptive or confusing under very special conditions. One of these is learning an orthography containing mirror images such as b and d. Difficulty in learning to read may, in part, be due to difficulty in overcoming the normal tendency to treat mirror images as the same stimulus.