A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece

A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece

Historical Vignette A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece Pasquale De Bonis1, Jacopo Visani1, ...

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Historical Vignette

A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece Pasquale De Bonis1, Jacopo Visani1, Giorgio Zauli2, Lorenzo Mongardi1, Paolo Zamboni3, Michele Alessandro Cavallo1

Key words Bastianino - Dissection - Neuroanatomy - Renaissance - Universal Judgement -

From the 1Department of Neurosurgery, 2Division of Anatomy and Histology, Department of Morphology, Surgery, and Experimental Medicine, and 3Department of Vascular Surgery, St. Anna University Hospital, Ferrara, Italy

The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio’s Cathedral in Ferrara, Italy, painted around the end of the 16th century.

To whom correspondence should be addressed: Jacopo Visani, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2019) 127:486-489. https://doi.org/10.1016/j.wneu.2019.03.285 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.

INTRODUCTION The Renaissance represents one of the most prolific cultural moments in the history of the world and has been characterized by the rebirth of humanistic studies and the revival of the figurative arts through the study and recovery of the canons and values of the classical era. Renaissance was a cultural movement permeating all of Europe in the 15th and 16th centuries, which had seen its genesis and its maximum expression in the Italian courts. With this new cultural wave, the studies of human anatomy and physiology had great relevance and fortune and reached levels of artistic value and scientific rigor never previously seen. Moreover, during the Renaissance, the study of anatomy transcended the purely descriptive aim, promoting profound questions of nature, religion, and metaphysical philosophy. These had mainly focused, not only on the descriptive anatomy, but also, and especially, on the organic physiology and psychology and the complex relationship between the human body and its organs and the soul. In this context, a particular relevance was given to the studies on the

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brain’s anatomy because of the philosophical and scientific debate concerning the relationship between the brain’s structures and the different features of the human soul. For several centuries, Galen (130e 210 AD) was the only recognized authority in the field of medicine and natural philosophy, such that the study of human anatomy, physiology, and pathology was considered pointless. Galen was the first to support a medical doctrine based on anatomical knowledge, acquired through the anatomical dissection of different animals. In contrast to the great Greek philosopher Aristotle, who had believed that the nerves originated from the heart and that the brain had only the function of cooling the passions of the heart, Galen developed the Hippocratic theory of the brain as the anatomical seat of human superior functions. In particular, he identified the brain as the origin of the nerves and affirmed the existence of a “spiritus animalis” (i.e., animal spirit), which would be responsible for such functions as sensation and animal motion. This spirit was produced in a “rete mirabilis” (i.e., wonderful plexus), an arterial network consisting of the ramifications of the internal carotid artery over the anterior skull base, and was carried throughout the whole body by the nerves. A more specific location of different cerebral functions in the brain began to take shape in the fourth century AD with the Christian bishop Nemesius of Emesa

(alive circa 390 AD), who believed that the rational soul could be located in the hollow ventricles of the brain. Nemesius tried to reconcile the Galenic view of the brain with the Christian conception of the soul and theorized the existence of 3 cerebral ventricles, identifying them as the anatomical substrate of the main human faculties: an anterior ventricle, seat of perception; a central ventricle, seat of cognition; and a posterior ventricle, containing the memory (Figure 1). The work of Nemesius fascinated many Renaissance authors, as testified by the work of many physicians and philosophers who had participated in those years into the “questio de sede animae” (question on the site of the soul), which represented one of the main issues of philosophical debate in that era.1 The first systematic description of the ventricular system that approached modern knowledge began in the first half of the 16th century. Leonardo da Vinci (1452e1519) was the first to perform a study of the ventricular system using a cast obtained through the intrathecal injection of beeswax into an ox’s brain. He also promoted a project of an anatomy atlas, together with the Padua anatomist Marco Antonio dalla Torre (1481e1511/2), who he had met in w1510. According to some authors, the 2 would have produced some anatomy texts; however, none of these have survived to the modern era. Realdo Colombo (circa 1510e 1559) and Michelangelo (1475e1564), in 1545, also collaborated to create an anatomy

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A BRAIN HIDDEN IN FERRARA CATHEDRAL

Figure 1. Location of human faculties in the 3 different cerebral ventricles according to the theory of Nemesius.

atlas; however, they were not able to publish the atlas. Berengario da Carpi (1466e1530) was one of the pre-Vesalian major anatomists. He worked mostly in Bologna and Rome and performed numerous animal and

human anatomical dissections. He was the first to challenge Galen’s works by denying the presence of the arterial plexus Galen had described. This plexus, in fact, can be found in some mammals; however, it is not present in humans. Thus,

Figure 2. A particular of the fresco in the apse of Ferrara’s cathedral resembling a brain in the sagittal section.

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Berengario da Carpi started to promote the importance of performing dissections directly on humans instead of animals. In his work, he declared that it was impossible to find anatomical evidence demonstrating the functioning of the “spiritus animalis” described by Galen. Berengario da Carpi proposed, just as Nemesius had previously, a model of the ventricular system as a seat of human’s faculties in which he located the perception in the anterior part, the memory in the posterior part, and rational thought in the central (third) ventricle. In his work “de fractura calvae sive cranei” (on fracture of the skull or cranium), which can be considered one of the first textbooks of neurotrauma, he examined all the various types of cranial fractures and their relevant symptoms, diagnosis, prognosis and treatments. Berengario da Carpi also included indications and techniques for craniotomy and the first systematic illustration of the necessary tools. In 1521, he also produced a fluent compendium of anatomy, the Isagogae Breves (brief introduction [to anatomy]), containing illustrated tables, in which he had condensed all his anatomical knowledge, which made an immediate fortune and had a large distribution. The most important Renaissance anatomist, Andreas Vesalius (1514e1564), considered the father of modern anatomy, also worked in Bologna, Padua, and Venice. He taught anatomy by performing anatomical dissections himself, in contrast to what had previously been the custom, where the physician, while reading Galen, was only assisting dissections performed by underlings. He emphasized the need to conduct anatomical dissections directly on humans because no analogical deductions were possible with animal anatomy. The latter had represented the foundation of Galen’s studies. With Vesalius’ theories, the break with the medicine of Galen became complete, and his masterpiece “de humani corporis fabrica” (the fabric of the human body) became the reference point for future studies in the field of human anatomy. One of the most remarkable examples of Renaissance anatomical illustrations was the work performed by the Paduan anatomist Girolamo Fabrici d’Acquapendente (circa 1533e1619), a scholar of Gabriele Falloppia (1523e1562), who had succeeded to his master as a professor of

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Figure 3. (A) A panoramic view of the Universal Judgement. (B) The profile of the fresco is compared with (C) an illustration of the sagittal cross-section of the human brain; the 3 different circles indicate the optic nerves and the pituitary stalk (red circle), the third ventricle (green circle), and the midbrain with the fourth ventricle (blue circle).

medicine in Padua in 1565 and who built the world’s first anatomical theater in 1594. He produced, at the end of the 16th century, a collection of "tabulae pictae" (painted tables) representing the first colored atlas of human anatomy in history. In this historical moment, characterized by such a tumultuous evolution of the human sciences, this influence also extended to the figurative arts, with fruitful collaborations. Thus, on the one hand, the anatomists needed a detailed representation of their dissections, not only to deepen their studies, but also to promote the diffusion of their discoveries. However, on the other hand, the artists saw in the increasing number of anatomical studies an important opportunity to experience a new perspective, approaching and even overcoming, their ancient models. Furthermore, the influence of anatomical studies on the work of the

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most famous Renaissance artists has been well documented.2 Eminent examples of the associations between anatomists and artists include the tie between Leonardo da Vinci and Marco Antonio dalla Torre, Realdo Colombo and Michelangelo, and between Vesalius and Jan Stephan van Calcar (circa 1500e1546), a disciple of Titian, who illustrated some of the former’s anatomical tables and the famous title page of the “fabrica.”3 It is reasonable to think that the work of the various artists who came into contact with the great anatomists of the time, directly or through the diffusion of their works, was influenced by the discovery of new forms acquired from the anatomical dissections, among which, neuroanatomy has a particular symbolic significance. It is also well known that every great cultural and artistic movement has always had a strong reactionary connotation compared

with the previous cultural models. Thus, in the era in which the heavy yoke of the Inquisition was present, the performance of human dissection could have represented a very strong counterreaction. Therefore, even in the absence of historical evidence, several investigators have supported the hypothesis that numerous works of art by major Renaissance artists could contain hidden references to the neuroanatomical discoveries of their contemporaries or the neuroanatomical studies and dissections performed by the artists themselves. Michelangelo used to dissect dead bodies to study the details of the human anatomy. He possibly dissected the brain and spinal cord; thus, over the years, he very likely acquired an in-depth understanding of neuroanatomy. Among these, one of the best known is the interpretation given by Meshberger of the “creation of Adam,”4 one of the most famous frescos of the Sistine Chapel’s vault in which God, in the act of infusing the soul in Adam, is surrounded by a large drape resembling the human brain in sagittal section. In the same setting, other investigators have suggested that the shape of human brain and brainstem can be noted in the fresco of the “separation of light from darkness,” also in the Sistine Chapel’s vault.5 Other investigators have also suggested that the “Transfiguration of Christ,” painted by the Flemish painter Gerard David (circa 1460e1523) in 1520, resembles a coronal section of the brain.6 In David’s Transfiguration, we can find the concept of the ventricles as the abode of the soul in which God is represented in the third ventricle, which, in accordance with the philosophy and medicine of that time, was the seat of the highest intellectual faculties, with the prophets in the temporal horns of the lateral ventricles (i.e., in the posterior ventricle, which was the abode of memory). In contrast, Jesus, conduit between the Word of God and the human race, resembled the brainstem, conveying the message from the brain to limbs and other organs. Using the same perspective, we studied the fresco of the “Universal Judgement,” painted by Sebastiano Filippi, called Bastianino (1528e1602), on the vault of San Giorgio’s Cathedral in Ferrara from 1577 to 1581 (Figure 2). That fresco, despite its inevitable mannerism, presents with

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numerous differences compared with the masterpiece by Michelangelo in the Sistine Chapel. In particular, its composition resembles the profile of a human brain seen on the sagittal plane (Figure 3). In the fresco, Jesus is represented in the center of composition, furiously judging the human being by elevating his right arm (just an in Michelangelo’s Judgement), surrounded by a circle of light, located in the center of the scene. The cavity created by the light in the center of the scene with Jesus inside might represent the third ventricle, which was considered the abode of the intellect and the faculty of judgment. The central structure containing Christ and the Virgin Mary is surrounded by a cohort of angels and saints encased by a thin and almost linear profile that resembles the borders of the cerebral gyri and the corpus callosum. In contrast, the inferior part, extending downward from Jesus’ feet, composed of some angels with trumpets, might resemble the profile of the optic nerves and, posteriorly, of the pituitary gland. Nearby, the 2 souls hugging each other remind one of the brainstem’s profile. In addition, the outer profile of the composition does not resemble the exact shape that we have been used to seeing in the classical brain’s representation but appears more flattened. However, when we observe the fresh brain just removed from the cranium, we can see that it has flattened slightly. In contrast, dried and conserved sections will have a more convex surface. This feature could indicate, although not documented, that the artist could have directly seen a dissection of the human brain or at least could have obtained some drawings inspired from direct dissections, just as other contemporary artists had done. It is known that the younger Bastianino had worked for Michelangelo for some

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years in Rome. Therefore, he surely knew well the works of Michelangelo and probably also knew the hidden message of the brain in the creation of Adam. Bastianino returned to Ferrara in 1553, where he is known to have painted for the Canani family. At that time, Giovanni Battista Canani (1515e1579) was the Professor of Anatomy and very well known, because he had used artists to illustrate his textbooks, such as Girolamo da Carpi (1501e1556) who had painted for him the complex anatomy of the arm musculature in the “Musculorum humani corporis picturata dissection,” published in 1541. Moreover, only 4 universities in Europe had been given the Pope’s official permission to perform anatomical dissection: Bologna, Ferrara, Padua, and Paris. All such historical documentation makes it highly probable that Bastianino himself was in contact with the philosophical currents and anatomical studies that characterized the 15th and 16th centuries. Also, just as many other artists did, he could have used his painting to hide some references to the recent neuroanatomic acquisitions. In the absence of historical documents on the actual intentions of these painters, the knowledge of such commixture of medicine and art remains speculative but surely fascinating.

REFERENCES 1. Finger S. Minds Behind the Brain: A History of the Pioneers and Their Discoveries. Oxford: Oxford University Press; 2000. 2. Kemp M. Dissection and divinity in Leonardo’s late anatomies. J Warburg Courtauld Inst. 1972;XXXV: 200-225. 3. Kemp M. A drawing for the Fabrica and some thoughts on the Vesalius muscle-men. Med Hist. 1970;XIV:277-288. 4. Meshberger FL. An interpretation of Michelangelo’s creation of Adam based on neuroanatomy. JAMA. 1990;264:1837-1841. 5. Ian S, Rafael JT. Concealed neuroanatomy in Michelangelo’s Separation of Light From Darkness in the Sistine Chapel. Neurosurgery. 2010;66:851-861 [discussion: 860-861]. 6. Paluzzi A, Belli A, Bain P, Viva L. Brain “imaging” in Renaissance. J R Soc Med. 2007;100:540-543.

CONCLUSIONS However, no historical evidence is available that Bastianino intentionally used neuroanatomical models for his fresco Universal Judgement and no documented evidence is available regarding hidden messages in his masterpiece. Our theory is that the main body of the Universal Judgement, which he had painted in the apse of Ferrara Cathedral, represents a sagittal view of human brain, with Jesus located in the third ventricle. As a proof to corroborate this hypothesis, we hypothesized a possible connection among

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different disciplines such as philosophy, religion, medicine, and art. This interpretation can be found in other examples in the paintings of other artists from that period. Michelangelo and Gerard David, both placed God and/or Jesus in the middle portion of the brain (i.e., in the third ventricle), an anatomical region that was considered to be the abode of the highest intellectual faculties (i.e., rational thought).

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received 15 November 2018; accepted 28 March 2019 Citation: World Neurosurg. (2019) 127:486-489. https://doi.org/10.1016/j.wneu.2019.03.285 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved.

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