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Mind on Canvas: anatomy, signs and neurosurgery in art

Mind on Canvas: anatomy, signs and neurosurgery in art

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Published by blue.shift8714
Br J Neurosurg. 2008 Aug 5:1-12.

Geranmayeh F, Ashkan K.

Throughout the ages, art and neuroscience have had a delicate yet definite relationship with reciprocal influence. By virtue of their superior power of observation, artists have often preserved neurological signs through detailed brush strokes or meticulous carvings long before it is described in scientific literature. There has been an increasing tendency to use paintings and drawings as independent sources for investigation of scientific history. In neuroanatomy, these tools have helped reveal the complex interrelation between arts and neurosciences that on the surface often appear as highly polarized worlds. In this article we begin by giving a brief introduction to the general relationship between neuroscience and art as depicted in paintings and drawings, and describe the artistic tendencies of the early neuroanatomists. We aim to highlight the existence of neurosurgical themes within paintings and drawings from different eras.
Br J Neurosurg. 2008 Aug 5:1-12.

Geranmayeh F, Ashkan K.

Throughout the ages, art and neuroscience have had a delicate yet definite relationship with reciprocal influence. By virtue of their superior power of observation, artists have often preserved neurological signs through detailed brush strokes or meticulous carvings long before it is described in scientific literature. There has been an increasing tendency to use paintings and drawings as independent sources for investigation of scientific history. In neuroanatomy, these tools have helped reveal the complex interrelation between arts and neurosciences that on the surface often appear as highly polarized worlds. In this article we begin by giving a brief introduction to the general relationship between neuroscience and art as depicted in paintings and drawings, and describe the artistic tendencies of the early neuroanatomists. We aim to highlight the existence of neurosurgical themes within paintings and drawings from different eras.

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ORIGINAL ARTICLE
Mind on Canvas: anatomy, signs and neurosurgery in art
F. GERANMAYEH & K. ASHKAN
 North West London Hospitals NHS Trust, and Department of Neurosurgery, Kings College Hospital, London, UK 
Abstract
Throughout the ages, art and neuroscience have had a delicate yet definite relationship with reciprocal influence. By virtue of their superior power of observation, artists have often preserved neurological signs through detailed brush strokes ormeticulous carvings long before it is described in scientific literature. There has been an increasing tendency to use paintingsand drawings as independent sources for investigation of scientific history. In neuroanatomy, these tools have helped revealthe complex interrelation between arts and neurosciences that on the surface often appear as highly polarized worlds. In thisarticle we begin by giving a brief introduction to the general relationship between neuroscience and art as depicted inpaintings and drawings, and describe the artistic tendencies of the early neuroanatomists. We aim to highlight the existence of neurosurgical themes within paintings and drawings from different eras.
Key words:
Drawing, neuroanatomy, neurosurgery, neurology, painting.
Art is born of the observation and investigation of nature. (Cicero, Roman author and orator, 106–43BCE).
Introduction
Connections between the arts and the sciences haveexisted throughout history. As the most creativeendeavours of human activity, both disciplines havedeveloped in parallel based on temperament andphilosophical milieu of their time.Neuroscience
per se
manifests through art inseveral ways. Not uncommonly, neurological illhealth can be recognized by the observant eye of anartist. Thus, portraits have been described by Zeki, apioneer in neuroaesthetics, to use ‘the accidents of each individual face to reveal inner life’.
1
Forinstance de Ribera and El Greco were inspired by neurological phenomenon in their subjects, andtransformed their view of neurological signs to alanguage of paint they found easy to disseminate.At other times the will for better understanding andteaching has pushed neurosurgeons, such as Harvey Cushing to document their own studies throughdrawing. Yet, artists such as Leonardo da Vinci havebecome anatomists undertaking and drawing theirown investigations. Furthermore, sometimes it is awork of art that is a confirmation of the presence of aneurological disease in its creator.
2–5
Science has also had a more direct influence onart, for example, through Michel-Euge`ne Chevreul’s
The Law of Simultaneous Colour Contrast 
(1839) thatstrengthened the foundations of colour theory. Morerecently, the concepts of cerebral localisation of creativity and talent, and neuroaesthetics haveattracted interest by the neuroscientists. Pioneeredby Samir Zeki, neuroaesthetics investigates theneurological response towards an aesthetic phenom-enon such as art and examines the neural correlatesof beauty.
1,6
There is a mind on each canvas—theartists use colours, perspectives, shapes and lines toactivate specific neuronal pathways. Thus, exploitingour common visual organization and arousing sharedexperiences beyond the reach of words.In this paper, we will focus on a review of paintingsand drawings that portray knowledge of neuroanat-omy throughout history, as well as those that showneurosurgically relevant signs. We also describeexamples of neurosurgical procedures in paintingsthat have contributed to our understanding of theneurosurgical environment, techniques and reason-ing prevalent at the time of the paintings. Our aim isto highlight the existence of neuroscientific themes,as shown in paintings and drawings, amongst theneurosurgical community.It is worth mentioning in the outset that, whilstpictorial documents enable medical historians todrive conclusions about a depicted scene, such
Correspondence: Mr K. Ashkan, Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: 0044 203 299 3285.Fax: 0044 203 299 3280. E-mail: keyoumars.ashkan@kingsch.nhs.uk Received for publication 13 November 2008. Accepted 6 April 2008.
British Journal of Neurosurgery 
, 2008; 112, i
 First 
article
ISSN 0268-8697 print/ISSN 1360-046X online
ª
The Neurosurgical FoundationDOI: 10.1080/02688690802109820
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interpretations can become erroneous, especially incases where no original written documentation isavailable or where the picture is analysed out of itshistorical context. One such example is a woodcut inFabricius Hildanus’ description of a novel way toapply a seton in the neck, which was later misread by an author of 
History of Neurological Surgery 
, 1951edition, as a method of reduction of cervicaldislocation.
7
Neuroanatomical drawings
There are extensive ancient Egyptian and Greek manuscripts that contain fascinating textual descrip-tions of neuroanatomy including
Edwin-Smith papyrus
from 3500 BCE,
Iliad 
of the Greek poetHomer and writings of Hippocrates, Herophilus, andGalen, which are beyond the scope of this article andhave been covered thoroughly in the literature.
8–12
After the Greek period of medicine, the centres of intellectual enquiry moved to the Islamic cultures,where it remained influential from 750 to 1200 CE.Physicians, including Avicenna (980–1037 CE),made major contributions to the body of knowledgeabout neuroscience in this period. Fig. 1 is awatercolour drawing of the nervous system takenfrom the legendary book 
Al-Qanun Fi Al-Tibb
(
TheCanons of Medicine
) by Avicenna known as the‘Second Doctor’ (the first being Aristotle). Thefigure is viewed from the back, with the headhyper-extended so that the mouth is at the top of the page. Different colours were used to representpairs of nerves. The spine is drawn in continuity withthe brain stem where some cranial nerves emergefrom it. The spine has been numbered into eightcervical, 12 thoracic, five lumbar and four sacralsegments. Some fibres from the cervical segments areshown to cross each other at the level of brachialplexus.Avicenna systematically reviewed the medicalknowledge by the previous scientists and comple-mented them by his own findings. Chapters 6–13 of 
The Canons
are designated to spinal anatomy andits biomechanical aspects.
13
On a personal level,Avicenna was a gifted child born in the Persian villageof Afshama, who was a practicing physician at the ageof 20. In addition to
Canons
, he demands credit forhis encyclopaedia of philosophy,
Shafaa
, meaninghealing. His choice of names for these two books,
Canon
(law), for a medical text book, and
Shafaa
(healing) for a philosophical one, is intriguing.A very similar drawing can be seen in
The Anatomy of the Human Body (Tashrih-i badan-i insane
) by Mansur Ibn Muhammad Ilyas (14th century),another Persian physician, suggesting this may havebeen a common method of illustrating neuroanatomy at the time (Fig. 2). This book has five colouredillustrations of skeleton, muscles, intestine, bloodvessels and nerves. Through the latter he describesthe anatomy of the spinal cord and nerves.
 Neuroanatomy in Renaissance Art 
In Europe, the Renaissance heralded the blossomingof medicine and art. Leonardo da Vinci (1452– 1519), who created 190 pages of drawings andwritings devoted to anatomy, was particularly fasci-nated with the nervous system. Born in the Italianvillage of Vinci, he was an illegitimate son of SerPiero d’Antonio, a notary, and a peasant womannamed Caterina. He produced over 5000 knownleaves of notebooks decorated with detailed directobservational drawings ranging from mechanics toanatomy, some written in his characteristic reversedscript or ‘mirror writing’.He made many contributions to neurosciences,including the discovery of neuroanatomical struc-tures such as meningeal arteries and frontal si-nuses.
14
He injected hot wax into the brain of anox and produced a cast of the ventricles. Thisrepresented the first attempt at using a solidifyingmedium to determine the structure of an internalbody organ (Fig. 3).Leonardo’s thoughts on ventricles were influencedby previous physicians, such as Mondino, Avicenna
F
IG
. 1. Study of the nervous system, from Avicenna’s 11th century treatise
Canons of Medicine, al-Qanun Fi Al-Tibb,
Folio 123 verso
.
Published in Isfehan, Iran 1632, Wellcome Library, London.L0013312.
2
F. Geranmayeh & K. Ashkan
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and Galen, who wrote extensively on the ‘reciprocalsymmetry’ or ‘reciprocal harmony’ of the brain. InFig. 4, Leonardo draws an onion that shows by analogy, the layered structure of the membranescovering the eye and the brain. The main drawingand the one below show Leonardo’s division of thecerebral ventricles into anterior, middle and poster-ior.
15
He located the
senso comune
(literally commonsense) or the amalgamation of the senses in the brain,which was also the location of the soul. He assignedthe anterior ventricle to the
senso comune
alongsidefantasy and imagination, the middle to cognition,and the posterior ventricle was assigned to mem-ory.
16
In Leonardo’s eyes, the only certifiable andreliable knowledge was that obtained directly by sightand experience from the external world: ‘The eye,which is termed the window to the soul, is the chief organ whereby the
senso comune
can have the mostcomplete and magnificent view of the infinite worksof nature’.
14
Leonardo is referred to by some as an artist withthe mind of a physician, but Vesalius (1514–1564) isthought to be the opposite.
17
He produced threemasterly anatomical text books;
Tabulae AnatomicaeSex
,
Epitome
and
De Humani Corporis Fabrica
. Thesecontain unrivalled artistic quality woodcut illustra-tions by Titian’s pupils, largely based on humandissection. In the third and seventh parts of 
DeHumanis Corpora Fabrica (Structure of the HumanBody)
, Vesalius describes peripheral nerves, andcentral nervous system, respectively.
18
Detaileddrawings of the cerebellum, vagus nerve andarachnoid space are particularly fascinating (seehttp://archive.nlm.nih.gov/proj/ttp/flash/vesalius/ vesalius.html, accessed 1 April 2008). Vesaliuscriticized both the medieval methods of dissection,which were mainly based on animal, rather thanhuman anatomy (due to prohibition of humandissections in ancient Rome), and the dependenceof anatomy on authoritative texts without question-ing them. Trusting his own eyes, Vesalius gradually observed some errors in Galen’s work, whichattracted animosity from his contemporaries. He alsoreproduced some Galenic errors such as his drawingof the five-lobed liver in
Tabulae Anatomicae Sex
,reminding us that sometimes the presumed infallibletext is more powerful than the artist’s eye.Michelangelo Buonarroti (1475–1564), the Italianpainter, sculptor and poet, began dissecting humanbodies at the age of 18 in the Monastery of SantoSpirito in Florence, using corpses from surroundinghospitals. His paintings have been referred to by many medical specialists.
19
Of particular note toneuroanatomy is his famous fresco, on the ceilingof the Sistine Chapel, ‘The Creation of Adam(http://mv.vatican.va/3_EN/pages/x-Schede/CSNs/ CSNs_V_StCentr_06_big.html, accessed 1 April2008). Meshberger
20
has argued that the billowingcloth structure and angels surrounding God resem-ble a sagittal view of the brain including the frontallobe, whilst the major sulci are outlined by thecontours of the figures of angels. Optic chiasm, brainstem and the pituitary gland are shown by the bifidfoot of an angel, and the vertebral artery isrepresented by a green robe. He argues that perhapsthis is a coded message from Michelangelo implyingthat the divine gift received from God to Adam isintellect, rather than life itself. Adam appears alive,stretching out with his eyes open just before beingtouched by God to be created. In fact, some haveargued that given the physical similarities betweenGod and Adam, it is not clear who the creator is; isGod creating Adam, or does God exist in Adam’smind?
21
God’s left arm is wrapped around a femalefigure. Some see her as Eve awaiting creation, whilstothers think her to be Sophia the Goddess of divinewisdom and the feminine side of God.
Neurosurgical/neurological signs in art
Paraplegia
Scenes depicting paraplegia are not rare within theart world, probably because this is a common
F
IG
. 2. Watercolour drawing of the nervous system from
The Anatomy of the Human Body 
by Mansur Ibn Ilyas. The figure isviewed from the back, with the head hyper-extended so that themouth is at the top of the page. Different colours were used torepresent pairs of nerves. Wellcome Library, London. L0006435.
 Mind on canvas
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