Hektoen International

A Journal of Medical Humanities

Bosch’s Stone Operation: meaning, medicine, and morality

Laurinda Dixon
New York, United States


"Stone Operation" by Hieronymus Bosch

Figure 1: Hieronymus Bosch,
Cure of Folly (Stone Operation),
ca. 1488 or later, oil on panel,
Museo Nacional del Prado, Madrid.

The Stone Operation (fig. 1) (ca. 1488 or later), also known as The Cure of Folly, by the Dutch fifteenth-century painter Hieronymus Bosch (ca. 1450-1516), is, like all of his works, bizarre and incomprehensible by modern standards of reality.1 The painting depicts a surgeon, dressed in the characteristic reddish robe that marked his profession, removing something from the head of a portly seated man by means of a scalpel. The process is witnessed by a monk and his companion, a nun, who rests head-in-hand against a table, balancing a book on her head. The strange activity takes place within one of Bosch’s typically verdant landscapes, consisting of layered vistas of green fields that recede artfully into delicate blue atmosphere. The whole scene is contained within a circle, and the dark space of its surrounding rectangular panel is covered with intricate, gilded lettering and interlaced flourishes. Inscribed in elaborate calligraphy are the words, in Flemish, “Master, cut the stone out quickly / My name is Lubbert Das.”2

Strange elements like these appear frequently in Bosch’s other works, most obviously in the so-called Garden of Earthly Delights triptych (Madrid, Prado) and St. Anthony triptych (Lisbon, Museu Nacional de Arte Antiga).3 They have fascinated and challenged viewers for nearly five hundred years. The first reference to Bosch, written a generation after his death by the Spanish nobleman and art collector Felipe de Guevara, complained that most people thought of the artist merely as an “inventor of monsters and chimeras.”4 The eminent historian of Netherlandish art Erwin Panofsky placed himself at the other end of the interpretive spectrum, refusing even to attempt discussion of the problematic painter. Acknowledging the depth of Bosch’s imagery, he ended his book Early Netherlandish Painting with a clever saying borrowed from Renaissance humanism: “This too high for my wit, I prefer to omit.”5

Succeeding generations of scholars have inhabited a middle ground between over-simplification and over-interpretation.6 Because the events of Bosch’s life are only sketchily documented, scholars in disciplines ranging from art history to psychology have looked to historical context to find interpretive frameworks upon which to base their theories.7 Some present Bosch as a simple moralist, whereas others see him as a heretical madman. One group of interpreters believes that meaning in Bosch’s works was accessible only to a highly trained elite, while others claim that Bosch drew inspiration solely from bourgeois culture and morality. Yet another approach is championed by those who deny the presence of determinate meaning altogether. To them, Bosch’s paintings are visual extravaganzas, which are interesting precisely because they are impossible to decode. Most serious scholars, however, agree that Bosch’s art, strange as it is to modern sensibilities, must have possessed a profound significance for his audience. It is our challenge to resurrect the lost keys that once supplied meaning and context to his paintings.

Bosch’s message becomes more intelligible when viewed within the broader traditions and innovations of Northern Renaissance art, which employed hidden meanings and symbolism to a greater extent than ever before.8 Paintings were intended to be read like texts, and artists often collaborated with scholars and liturgical advisors when planning their compositions. The tradition of hiding deeper meanings beneath surface appearances pervaded the entire culture. In art, iconographical complexity was enlivened by a parallel interest in human nature and naturalism in the depiction of the real world. Bosch’s paintings, like the writings of contemporary moralists such as Sebastian Brant and Desidarius Erasmus, hid moral truths within disingenuous facades. By his unique blend of wit and irony, Bosch challenged his wealthy, educated patrons with the task of detecting moral and philosophical truths embedded within scenes of daily life.

Looking at the Stone Operation, scholars wonder if an operation such as Bosch depicts was ever actually performed and question if the painting represents fact or fiction. We cannot claim to know for sure what life was like five hundred years ago, especially with regard to medicine, a science which was, at best, a cobbled-together mixture of magic, superstition, and guesswork.10 However, we do know that in Bosch’s day, the concept of the “stone operation” was a metaphor for the cure of madness and stupidity. The name of Bosch’s stout patient, “Lubbert,” confirms this, for Dutch vernacular tradition gave the name to fools and idiots. Removal of the so-called “stone of folly” was an allegory of stupidity at the mercy of dishonesty and reflects the modern colloquialism of having “rocks in the head.”11 Medical historian William Schupbach believes that such a procedure never really happened, though Bosch accurately depicts the apparatus with which it could have been performed.12 Schupbach reminds us that, in Bosch’s day, the stone operation was a comedy routine performed by local rederijkers, amateur theater companies that entertained during public celebrations. An actor dressed as a physician would pretend to cut the stupid stone from the head of a cantankerous fool, holding a bladder of blood in one hand and some pebbles in the other. At the proper moment, pebbles and blood would reveal themselves and “Lubbert” would emerge from the ordeal sane, smart, and cured.

Trepanation from Hans von Gersdorff

Figure 2: Trepanation,
from Hans von Gersdorff, Feldbuch der Wundartznei, Strasburg, 1517.

It would seem, then, that Bosch’s Stone Operation is a clever allegory of foolishness. However, surgical textbooks of the time clearly describe another cure for insanity and headache achieved by trepanning, or cutting holes into the skull.13 The procedure is graphically illustrated in printed medical treatises, such as Hans von Gersdorff’s Feldbuch der Wundartznei (Book of the Art of Healing Wounds) of 1517 (fig. 2).14 An edition of the Physica, by the medieval abbess Hildegard of Bingen, shows four physicians consulting on a case involving some sort of cranial disorder.15 The object of their concern, a dull, lumpish man, reminds us of Bosch’s Lubbert. One of the doctors draws attention to a bump or lesion in the patient’s forehead while an assistant prepares for surgery. Like many early medical sources, Hildegard’s Physica, written in the twelfth century, survived in manuscript form until the printing press brought it to a broader audience. The illustrations in this edition came from earlier books because the publisher, wishing to dress up the text, simply used old printing blocks that he had on hand.16 It is therefore possible that this scene was actually originally intended to illustrate a case of the folly stone. We know that trepanning was an ancient surgical procedure, for there exist human skulls, bearing the marks of the surgeon’s scalpel, belonging to people who survived it.17 The notion of an operation that entailed cutting open somebody’s head therefore mirrors actual medical practice, though the allegory of the “stone operation” belongs to the moralizing tenor of its times. The answer, then, to the question of whether Bosch’s Stone Operation is based in reality or fantasy must be “yes” to both.

Detail, Hieronymus Bosch, Cure of Folly (Stone Operation)

Figure 3: Detail, Hieronymus Bosch, Cure of Folly (Stone Operation)

On the surface, then, the Stone Operation castigates trickery and gullibility; but a closer look reveals iconographical anomalies that inspire further questions. Why is the surgeon wearing an inverted funnel on his head, and what do the witnessing monk and nun have to do with it all? What does the red book, balanced on the head of the nun, mean? And, perhaps most confusing — why is the object being removed from Lubbert’s head not a stone at all, but a golden flower (fig. 3), similar to one that appears on the table before him? Answers to these questions emerge if we read the scene as the castigation of a particular kind of quack, the charlatan alchemist, who appears with regularity in scientific and moral treatises of the time.

The perception of alchemy as an occult, heretical science is a modern myth.18 In Bosch’s day, alchemy was early chemistry, and kings and popes alike practiced and supported learned practitioners in the hope of gaining the considerable spiritual and monetary benefits derived from making an elixir of life or turning lead into gold.19 Bosch’s knowledge of alchemy as a serious philosophy, a science that served as an adjunct to medicine, pharmacy, and metallurgy, is reflected in several large-scale paintings which were collected by the Habsburg king Philip II of Spain after the artist’s death.20 In addition to the Stone Operation, they include the famous Garden of Earthly Delights, the Prado Epiphany, and a St. Anthony triptych.21 The king intended them to adorn the famous Escorial, a complex which included a hospital and large scale distillation laboratories located in one of the towers.22 He chose the triptychs because they use the symbolism of early science to present chemistry and pharmacy as a means of Christian devotion and Church-sanctioned healing.23 However, the Stone Operation presents another view, which would have been recognized by knowledgeable scholars and skeptical critics alike as a damnation of those who practiced a difficult art without proper training or experience.

Pieter Bruegel the Elder, The Alchemist

Figure 4: Pieter Bruegel the Elder, The Alchemist. Engraving after Bruegel by Hieronymus Cock, ca. 1559, The Metropolitan Museum of Art, Harris Brisbane Dick Fund, 1926.

Like its sister science medicine, chemistry in Bosch’s day was both a popular and an elite art, based upon laboratory practice and allegorical symbolism inherited from ancient times. Early chemistry and Christianity were closely linked, and the proper practice of science could be achieved only through great learning and piety. Serious mastery of the art required endless time, extensive education, and large cash reserves. The Church provided both, and many early chemical experimenters were members of the clergy. Dishonest practitioners abounded, however, as did desperate and gullible patrons, and chemical treatises rarely miss the chance to damn charlatans to the hell-fires of their own furnaces. Perhaps the best known image of a charlatan alchemist was created by Pieter Bruegel the Elder (fig. 4). Here, the chemist-philosopher works in his chaotic laboratory amid furnaces, flasks, and bumbling assistants. He is oblivious to the fact that his wife and children are being led to the poor house.

Bosch’s Stone Operation satirizes several basic chemical concepts. The funnel-hat, worn upside-down on the surgeon’s head, was, then as now, an essential laboratory apparatus, and was illustrated in practical handbooks of distillation. It also appears in several of Bosch’s other paintings, usually worn by sinners doomed to hellfire.24 Worn upside down over the surgeon’s academic hood in Bosch’s scene, it marks him as an inept trickster masquerading as a university-trained scholar. The monk and nun who witness the operation belong to the class of scholar-ecclesiastic known to practice chemical experimentation.25 The inscription referring to the “stone,” which Lubbert implores the “master” to cut from his head, is perhaps the clearest clue of all. The goal of chemical experimentation in Bosch’s time was to achieve a transmuted healing substance, called the “philosopher’s stone” (lapis). It took many allegorical forms in the rich visual tradition of alchemical illustration, one of which was the “flower of wisdom” (flos sapientum).26 One of the oldest chemical symbols, it appears in the Roll, written by the fifteenth-century English chemist George Ripley, as a golden flower (fig. 5).27 The metaphor dates from the earliest Hellenistic chemical tracts and reappeared regularly in manuscripts and printed books, described as “the golden flower of wisdom.”28 Of course, the secret of the “stone,” which ensured its discoverer wealth, knowledge, and health, lay locked in the heads of early chemists. If it ever existed, it has never been discovered or revealed despite centuries of experimentation. However, Bosch’s foolish Lubbert has brought a bulging purse with him, and doubtless will reward the “master” if he can produce the golden flower, the chemical stone of wisdom, simply by cutting it out of his head.

The Golden Flower of Alchemy

Figure 5: The Golden Flower of Alchemy, from George Ripley, Ripley Roll, ca. 1490, by permission of the British Library, London

It has been suggested that the flower sprouting from Lubbert’s cranium is a tulip, and that the painting is a satire of the Dutch obsession with these flowers.29 However, tulips were unknown in Western Europe before 1593, when the botanist Carolus Clusius first grew bulbs from seed in his Leiden horticultural garden. The tulip frenzy did cause many instances of foolish behavior among Dutch botanists and collectors, but not until the seventeenth century.30 In fact, no flower on earth claims petals gilded with gold leaf like the ones in Bosch’s scene. But such a bloom does exist in chemical allegories as the golden flower of wisdom, the sought-after stone, with the power to heal the sick and provide instant wealth.

The golden flowers of chemistry were elusive blossoms; they were the reward for great learning, endless patience, hard work, and suffering in the service of God. However, Bosch’s Lubbert would rather submit to painful surgery than endure the long hours of study and repeated failures required for success, for he implores the master to cut the stone out “quickly.” Many a modern scholar has doubtless wished the same thing, that the rigors of study and thought required in the pursuit of wisdom could be eliminated by a mere flick of the scalpel, or that the knowledge contained in a difficult book could pass into the brain by osmosis, simply by placing it on one’s head as Bosch’s nun does. Her laziness is even more pronounced because a golden flower appears on the very table upon which she leans. The answer is right under her nose; she need only look down to see it.

Modern viewers might also ask why two of the participants in this moral farce are obviously members of the clergy, who, theoretically, should know better. Their participation in Bosch’s tableau does not mean that his painting is heretical or irreligious, for monks and nuns were fair game for satirists throughout the fifteenth century and well before.31 Bosch, like leading Northern European theologians immediately before the Reformation, found fault with the perceived laxness and corruption of the Roman Catholic Church. The abuses of the clergy at the highest levels were notorious; however, of more immediate concern to Bosch was the situation in Hertogenbosch, which was home to a large number of monasteries and religious houses. In response to this situation, the city government made several attempts to control monastic authority and economic activities, sometimes bringing local religious institutions into conflict with secular authorities.32 Though Bosch died in 1516, one year before Martin Luther began the Reformation, the misbehaving clergy in the Stone Operation were already part of contemporary wisdom.

The Stone Operation, then, is about trickery, gullibility, and impatience; a theme solidly based within the intellectual and moral traditions of the time. Bosch’s audience perceived foolishness, stupidity, and sin as interchangeable states. In the end, Bosch’s painting exposes particular types of sinners — the crafty charlatan, guilty of pretentiousness and dishonesty, and his impatient, feeble-minded victim. In the decades following Bosch’s death in 1516, the theme of the Stone Operation reappeared frequently in comical Dutch genre paintings.33 The message is timeless, and applies as well today as in the sixteenth century. Only a fool believes in a shortcut to success.



  1. A more detailed version of this paper appeared in “Mystical Metal of Gold“: Essays on Alchemy and Renaissance Culture, ed. Stanton J. Linden (Brooklyn: AMS Press, 2006). For the provenance of this painting, see Laurinda Dixon, Bosch (London: Phaidon Press, 2003), 55.
  2. “Meester snijt die keye ras / Myne name is Lubbert Das.”
  3. For discussions of alchemical meaning in these works by Bosch, see Dixon Bosch; idem, “Bosch’s Garden of Delights Triptych: Remnants of a ‘Fossil’ Science,” Art Bulletin 63 (1981): 96-113; and idem, “Bosch’s St. Anthony Triptych: An Apothecary’s Apotheosis,” Art Journal 44 (Summer, 1984): 119-31.
  4. Felipe de Guevara, Commentarios de la pintura, ca. 1560, in Wolfgang Stechow, Northern Renaissance Art, 1400-1600: Sources and Documents. Sources and Documents in the History of Art Series (Englewood Cliffs, New Jersey: Prentice-Hall, 1966), 19-20.
  5. Erwin Panofsky, Early Netherlandish Painting: Its Origins and Character (New York: Harper & Row, 1971), 358
  6. The literature on Bosch is vast. For an excellent bibliography of most of the published work on the artist, see Walter H. Gibson, Hieronymus Bosch: An Annotated Bibliography (Boston: G. K. Hall & Co., 1983).
  7. For the events of Bosch’s life, see Ester Vink, “Hieronymus Bosch’s life in ‘s-Hertogenbosch,” in Jos Koldeweij and Bernard Vermet, eds., Hieronymus Bosch, New Insights into his Life and Work (Rotterdam: NAi Publishers, 2001), 19-24. For all the extant documents relating to Bosch, his family, friends, and anybody even remotely connected with him, see G. C. M. van Dijck, Op Zoek Naar Jheronimus van Aken Alias Bosch: de Feiten: Familie, Vrienden en Opdrachtgevers ca. 1400-ca. 1635 (Zaltbommel: Europese Bibliotheek, 2001).
  8. For a complete history of Northern Renaissance art and its traditions, see James Snyder, Northern Renaissance Art: Painting, Sculpture, the Graphic Arts From 1350-1575 (New York: Prentice-Hall, 1985); and Jeffrey Chipps-Smith, The Northern Renaissance (London: Phaidon Press, 2004).
  9. Sebastian Brant (1457-1521) is best known for his satirical book Das Narrenschiff (Ship of Fools), which first appeared in German in 1494. The book became a best-seller, and underwent numerous reprints and translations throughout the fifteenth and sixteenth centuries. Desiderius Erasmus (1469-1436) was the most famous European scholar of his time. The fundamental principles of his writings include respect for common sense, hard work, moral integrity, and the recognition of free will. His Encomium moriae (In Praise of Folly), first printed in 1409, satirizes all walks of life, including the clergy.
  10. For a brief, authoritative history of medieval and Renaissance medicine, see Nancy G. Siraisi, Medieval and Early Renaissance Medicine (Chicago: University of Chicago Press, 1990).
  11. For the derivation of the name “Lubbert,” see J. B. Gils, “Het snijden van den kei,” Nederlandsch tijdschrift voor geneeskunde 84, no. 2 (1940): 1310-18; and R. H. Marijnissen and P. Ruyffelaere, Bosch (Antwerp: Mercatorfonds, 1995), 440.
  12. William Schupbach, “A New Look at the Cure of Folly,” Medical History 22 (1978): 167-81.
  13. See Hyacinthe Brabant, “Les traitements burlesques de la folie aux XVIe et XVIIe Siècles,” Travaux de l’Institut pour l’Étude de la Renaissance et de l’humanisme, Université libre de Bruxelles 5 (1976): 75-97; and Henry Meige, “L’opération des pierres de tête,” Aescalupe 22 (1932): 50-62.
  14. Hans von Gersdorff, Feldbuch der Wundartznei (Strasburg: Johannes Schott, 1517).
  15. Hildegard of Bingen, Physica (Strasburg: Johannes Schott, 1533).
  16. For discussion of this practice with regard to this illustration, see Frank J. Anderson, An Illustrated History of the Herbals (New York: Columbia University Press, 1977), 51-58.
  17. A recent archaeological discovery from England shows that, in A.D. 960, a surgeon operated on the brain of a peasant, a victim of a violent assault. By scraping a hole into the patient’s skull, the physician relieved the pressure caused by extensive cranial fractures. See Emily Flynn, “Like a Hole in the Head,” Newsweek, October 18 (2004): 10. My thanks go to Barbara Wisch for alerting me to this topical news item.
  18. The literature on the history of alchemy is vast, and cannot be summarized here. For a concise, authoritative, objective historical overview of alchemy, see Allison Coudert, Alchemy: The Philosopher’s Stone (Boulder, Colorado: Wildwood House, 1980).
  19. For historical examples of historical figures who employed alchemists for material gain, see Will H. L. Ogrinc, “Western Society and Alchemy from 1200-1500,” Journal of Medieval History 6 (March, 1980):104-32.
  20. For the Spanish king’s collections of Bosch’s paintings, see Jaco Rutgers, “Hieronymus Bosch in El Escorial. Devotional Paintings in a Monastery;” and Pilar Silva Maroto, “Bosch in Spain: On the Works Recorded in the Royal Inventories,” both in Koldeweij and Vermet, eds., Hieronymus Bosch, as in note 7, 33-48.
  21. See Dixon, Bosch, as in note 3.
  22. See J. Hossard, “La Pharmacie de l’Escorial: Ce qu’elle fut-Ce qui reste,” Revue d’histoire de la pharmacie 15 (1961-62): 134-39.
  23. On Philip II and alchemy, see Henry Kamen, Philip of Spain (New Haven and London: Yale University Press, 1997), 190. For the “golden age of alchemy,” that flourished under the patronage of Habsburg rulers, see John Weston Evans, Rudolf II and his World: A Study in Intellectual History 1576-1612 (Oxford: Clarendon Press, 1973), 196-242.
  24. The funnel appears in all of Bosch’s hell-scenes, such as in the Vienna Last Judgment (Vienna, Gemäldegalerie der Akademie der bildenden Künste).
  25. On the support of alchemy by the medieval Church, see Ogrinc, “Western Society and Alchemy,” as in note 18, 104-32.
  26. The Philosopher’s Stone was described and pictured in many ways. In addition to a flower, it appears as a king, hermaphrodite, tree, and Christ himself. It has many names in the literature of alchemy, including elixir, gold, tincture, medicine, panacea, balsam, arcanum, quintessence, hyacinth, east, morning, living fountain, ruby, crystal, diamond, Adam, paradise, Sophia, man, microcosm, salvator, servator, homunculus, sun, daughter, orphan, bird, and phoenix. See Lyndy Abraham, A Dictionary of Alchemical Imagery (Cambridge: Cambridge University Press, 1998), 79-80, 145-48. For the rich visual symbolism in alchemical manuscripts, see Gareth Roberts, The Mirror of Alchemy: Alchemical Ideas and Images in Manuscripts and Books from Antiquity to the Seventeenth Century (Toronto and Buffalo: University of Toronto Press, 1994).
  27. For the most recent discussion of George Ripley’s life and works, see George Ripley’s Compound of Alchymy (1591), ed. Stanton J. Linden (Aldershot, Burlington, Singapore, Sydney: Ashgate, 2001), vii-1vii.
  28. An early Greek source for the flower/stone metaphor is Adolphus Senior, Azoth, in Marcellin Berthelot, Collection des anciens alchimistes grecs, vol. 3 (Paris: Pierre Eugène Marcelin, 1887-88), 19.
  29. See Carl Justi, “Die Werke des Hieronymus Bosch in Spanien,” Jahrbuch der Königlichen Preuszischen Kunstsammlungen 10 (1889): 130; and Jean Doré, “L’extraction de la pierre de la folie,” in Catalogue de la VI Foire des antiquitaires. Beaux-Arts, special issue 18 (April 3-May, 1970): 46-47.
  30. On “tulipmania,” see Charles Mackay, Extraordinary Popular Delusions and the Madness of Crowds (1841; reprint, New York: Straus and Giroux, 1932), 89-97.
  31. The opinion of Enrique M. Fraguas de Pablo, “Hieronymus Bosch, ‘El Bosco’: Huisismo, Satanismo y Canto de Cisne del medievo,” in Conferencia pronunciada en la Fundacion universitarias espanoloa, vol. 3, Cuadernos des investigacione historica (Madrid: Funcacion Universitaria Espanola, Seminario “Cisneros,” 1979), 437-46.
  32. See Walter S. Gibson, Hieronymus Bosch (London: Thames & Hudson, 1973).
  33. For illustrations of the theme of the Stone Operation by later sixteenth and seventeenth-century artists, such as Pieter Bruegel the Elder, Jan van Hemessen, Jan Steen, Franz Hals, and others, see Meige, “L’opération des pierres de tête,” as in note 13.



LAURINDA DIXON, PhD, has been a professor at Syracuse University since 1982 in the Department of Art & Music Histories. Professor Dixon’s background is interdisciplinary, including a degree from the Cincinnati Conservatory of Music and a PhD in art history from Boston University. Her scholarly specialty is the relationship of art and science before the Enlightenment, and she lectures widely on the subject at universities and museums throughout the world. Her many articles in such journals as The Art Bulletin, Oud Holland, and Gazette des Beaux-Arts address the relationship of art to such subjects as chemistry, cartography, and gynecology. Professor Dixon has edited and authored nine books, most recently Hieronymous Bosch (Phaidon Press, 2003), In Sickness and in Health: Disease as Metaphor in Art (University of Delaware Press, 2003), and Perilous Chastity: Women and Illness in Pre-Enlightenment Art and Medicine (Cornell University Press, 1995).


Highlighted in Frontispiece Spring 2010 – Volume 2, Issue 2

Spring 2010  |  Sections  |  Art Essays

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