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The stone of folly is a motif that appears in a selection of paintings held today by Wellcome Collection, all made between 1520 and 1799. They follow a trend started by Hieronymus Bosch, whose portrayal of the subject is now in the Museo del Prado in Madrid.

Extracting the Stone of Madness

Extracting the Stone of Madness

c.1494–1516, oil on panel by Hieronymus Bosch (c.1450–1516)

The idea depicted here was that madness might be cured through the surgical extraction of a stone from a patient's head. Today this concept may be laughable, but how we think and feel about health has always been influenced by the politics of the time – as have ideas about how people should be treated when suffering from illnesses that don't have obvious physical causes.

An Operation for Stone in the Head

An Operation for Stone in the Head

Jan van Hemessen (c.1500–c.1575) (follower of)

Wellcome Collection

This painting depicts a man undergoing a gruesome procedure in which a surgeon is extracting a stone from his head, and is by an unknown painter who took inspiration from Jan van Hemessen's version of the subject, also now held by the Prado. This painting is unusual since the stone is visible poking out of the man's forehead. Usually the stone is referenced in the painting's title but is not visible in the image, suggesting it's a metaphorical object that describes madness, and that the painter is either playing a joke or commenting on the possibility that fantasy and delusion can sometimes spill over into reality. An expectant woman holds out an empty plate to catch this curious object, probably so it can be exhibited as proof of cure to lure other victims.

This skull shows four separate holes made by the ancient surgical process of trephination. They had clearly begun to heal, which suggests that although highly dangerous, the procedure was by no means fatal.

Bronze Age skull from Jericho, Palestine, 2200–2000 BC

This skull shows four separate holes made by the ancient surgical process of trephination. They had clearly begun to heal, which suggests that although highly dangerous, the procedure was by no means fatal.

However, the idea of such invasive surgery is not quite as mad as it may seem. Archaeological evidence shows that trephination – a surgical procedure in which a small hole is made in the skull – was practised by our early ancestors from Neolithic times onwards. It's not known whether this was done for spiritual and religious reasons or as medical intervention. Quite probably both played a part, since the medicinal and the magical were not distinct categories as they are today.

Symbolic readings of paintings depicting the search for a stone inside a patient's head work on many levels. Though they clearly suggest that it's useless to want to cure stupidity in fools, it's not necessarily clear which character is playing the fool here. Perhaps the patient is hoping for a quick fix, but perhaps the joke's on the doctor who surely knows he won't find a stone rattling round his patient's head. He is ignorant at best, at worst he is out for financial gain through nefarious means. Another possibility is that the village people or relatives of the person being operated on are most foolish of all. This image could be a satirical remark on the cruel treatment of people who were seen as abnormal or defective by the community.

This undated watercolour shows a very odd scenario in which two important looking men are watching what must be a very painful procedure. Even the small comfort of a chair for the patient has been overlooked.

A Surgeon Extracting the Stone of Folly

A Surgeon Extracting the Stone of Folly c.1561

Pieter Huys (c.1520–1581)

Wellcome Collection

The hapless man at the centre of this painting from around 1651 is about to have a stone of folly removed by a focused-looking surgeon who has begun to make an incision while a press of people looks on. The assertive woman holding him down at the shoulder might be his wife. She is caught mid-gesture, authoritatively relating something of the greatest importance to another onlooker.

A quick glance along the shelf in the background sheds a little more light on the situation. A medicine jar is labelled 'conserve of wasps', which may refer to the saying 'to have a wasp in the head' – a reference to lust. There are two books. One title translates as 'lector reckless' suggesting misuse or disregard for learned knowledge, while the other is inscribed 'doctor mallard'. This doctor is definitively being labelled as a quack! Next to these objects is a jar of flour, perhaps hinting at a saying that wanting to be foolish is to want to be dusted in flour.

In this later drawing from 1645, the operation is being carried out in what looks like a public space in front of an array of curious men who closely examine the patient's progress. A woman and child appear to be keeping a horrified distance. Itinerant performers may well have carried out burlesque operations for the benefit of crowds using what was known as 'the palming technique', in which a small stone was concealed in the palm of the hand and dropped into the bloody incision. It could then be lifted out with a flourish and displayed for the enjoyment of a curious audience.

An Itinerant Operator Extracting a Tooth

An Itinerant Operator Extracting a Tooth

Jan Victors (1619–after 1676) (imitator of)

Wellcome Collection

Quack medicine men found at fairgrounds presented an all-too-real danger for desperate patients hoping for an affordable fix. Working out what sort of medical credentials an itinerant doctor might hold can't have been a comfortable task for poor people suffering from toothache. Privacy was also a luxury reserved for the better off, as this seventeenth-century painting demonstrates.

By the time this painting was made by Jacob Cats in the latter half of the eighteenth century, standardisation of the drugs and remedies available to people was well underway. This operation takes place in an apothecary in front of shelves lined with medicines. Following a Royal Proclamation made by James I of England, the Royal College of Physicians created an officially sanctioned list of all known drugs – the Pharmacopoeia Londinensis published in 1618.

Title page of Culpeper's 'Pharmacopoeia Londinensis'

Title page of Culpeper's 'Pharmacopoeia Londinensis'

The Pharmacopoeia contained herbal remedies still used today alongside less appealing medicines such as worms, lozenges of dried vipers and fox lungs. In 1649 it was translated from Latin into English by Nicholas Culpeper, meaning more people could read up on cures being offered by their apothecaries and physicians.

Nicholas Culpeper (1616–1654)

Nicholas Culpeper (1616–1654)

unknown artist

Wellcome Collection

Operations to remove the stone of folly are unlikely to have ever been performed in earnest but were instead intended to illustrate the limits of medical doctrine of the time. Much of today's pharmaceutical medicine is originally based on herbal remedies contained in the Pharmacopoeia, and perhaps paintings depicting the stone of folly are still relevant as reminders that treatment for mental illness based entirely on material substances can only take a patient so far, and that imagery and symbolism also have important roles to play.

The stone of folly is an incredibly powerful story that translates the incomprehensible experience of being mad into something concrete – a terrifying physical body that the doctor is able to surgically remove. The illness is extreme, so the imagery must be extreme to hold out the promise of a cure. It's not impossible that in some cases people may have got better thanks to the power of the metaphor.

Jessica Ramm, artist and writer