A New Book by Jameson Kısmet Bell: Performing the Sixteenth Century Brain

The wonder of people to see what is inside their bodies has a long history and the human brain is among the most mysterious parts of the human body. Jameson Kısmet Bell, Assistant Professor in the Department of Western Languages and Literatures at Bogazici University, takes the issue of the representation of brain from the juncture of history and literary criticism in his book Performing the Sixteenth-Century Brain: Beyond Word and Image Inscriptions. By re-examining two books, Hans von Gersdorff’s Fieldbook of Surgery (Feldtbuch der Wundtartzney) and Lorenz Fries’ Mirror of Medicine (Spiegel der Artzny) Kısmet Bell is shifting the focus from the images themselves to their production and interpretation in the early sixteenth century.

We interviewed with Jameson Kısmet Bell about the process of writing his book and its potential contributions to the interdisciplinary area of medical humanities.

You are examining two books, Hans von Gersdorffs’s Fieldbook of Surgery and Lorenz Fries’ Mirror of Medicine. How did you decide to examine these two books and what is the importance of these books in terms of the representations of brain?

Thank you for the questions and the opportunity to share a little about my new book, Performing the Sixteenth-Century Brain. Gersdorff’s Feldtbuch der Wundtartzney (Fieldbook of Surgery, 1517) and Fries’ Spiegel der Artzny (Mirror of Medicine, 1518) were accidental discoveries I made during research for my dissertation. In medical literature, these books are regularly cited as the first books to offer visually accurate representations of the brain. In one particular image that is reprinted in both books, one can see the convolutions of the cerebral cortex for the first time. In the history of medicine and surgery, the brain object we know today began with a shift that occurred in representation techniques used in these books.

However, as I poured over their words, I saw that they didn’t write much about the brain. They wrote about the head with great passion and took part in established rituals with rules and performances for the head, not the brain. They offered medical and surgical treatments, medicines, and rituals to perform the head better which they thought was the container of the soul. Gersdorff and Fries didn’t describe the image of the brain we see or recognize the object we know.  For my research then, I wanted to explore this difference: how could the first books that represented the brain with visual accuracy not write about the brain? What I found was fascinating, and it required more than just a history of medicine. It required a literary analysis of the language they used in relation to the images that were created.

You are rejecting the idea of an origin of the modern brain and focusing on the rituals related to the head and brain because, as we understood, the images in the books of Gersdorff and Fries are no longer available in modern books. So what is the origin of the images of the modern brain and what are the differences between the modern and old representations?

It’s not that the images of the brain are no longer available in contemporary books on the history of medicine and surgery. Quite the contrary, every book or article on the history of medicine, surgery, or the brain cites these images as the beginning of our “modern” understanding of the brain. What I’m rejecting, following Bruno Latour, is the sharp divide between the medieval and the modern: there are minute changes, shifts in how we record and thus represent the world.

These images of the brain I focus on represent the body and the brain printed realistically with three-dimensions on a sheet of paper. Since the image was created after one of the first public dissections to take place outside of Italy, we find visually accurate representations of the inside of the human body for the first time. This includes representations of the brain that were printed and spread around Europe. These three techniques—using linear perspective to draw three-dimensional objects in two-dimensional space, dissection, and print technologies—are techniques that are part of the contemporary tool box for knowledge. We recognize these images because we recognize the technologies that were used.

What I found perplexing is that very few secondary sources cited the words of these books, one written by Gersdorff, a practical surgeon who worked through many Central European wars, and the other by Fries, a medical doctor who attempted the first translation of Latin medicine into vernacular German. Neither of these professionals cited the brain in the image that is so obvious for modern readers to see.  I thought there must be more to the story and discovered there was.

The ancient and medieval understanding of the brain was based on an important assumption: the brain was part of the head and the head contained the intellectual soul, what we call the “mind” today. The mind was divided into parts—common sense and imagination in the front, reason in the middle, and memory in the back of the head—and these needed a location. They assumed the mind was located in three small chambers at the center of the brain, what we call the cerebral ventricles today. As you can see from this image of the head from da Carpi’s surgical book, images prior to and throughout the sixteenth century superimposed geometrical shapes on the head of a patient to represent the location of the soul. Elaborate rituals existed to perform imagination, reason and memory better; patients were given herbs and dietary regimens, taught logic and verbal games to improve reason, and mnemonic techniques to improve memory. There were also ways to diagnose improper brain functioning, illness, and treatments to restore the soul to its natural balance. Even surgery was used in case of illness, injury, or if non-invasive treatments were unsuccessful.

Whereas the medical doctor Fries rejected the importance of dissection and accurate images—favoring ancient knowledge, treatments, and rituals—Gersdorff was excited about the new techniques that a surgeon could use to treat patients. I’ll mention Fries later, but it is important to note that these images and dissection procedures are not neutral activities. Gersdorff describes a dissection procedure whereby the brain should be thrown away—a dissector should, step by step, cut through the skull, membranes, and cerebral matter—so one could find the three little chambers where the soul once resided. The image we see as the beginning of the modern brain is actually a guide on how to discard the brain to represent something that was invisible. It was only through a close reading of the words of the text in relation to the images that this procedure became clear.

“Every image is a construction based on specific assumptions about the world”

Why it is important to shift the focus from the images of body and brain to their production and interpretation? What are some mechanisms to produce and interpret these images and is there any mechanism of power in controlling these processes? 

Images are rhetorical: they present the appearance of knowledge without offering knowledge content. When one focuses on the images, one misses the detailed inscription process of how the images are constructed and the argument presented. If one pays attention to how the sensible world is represented and recorded in speech, paper and ink, printing, and now electrical and digital technologies—one sees a problem with the final product, or the image. No matter how realistic an image appears, it is a construction based on specific assumptions about the world.

The case of Lorenz Fries is revealing: as a medical doctor at the turn of the sixteenth century, Fries wanted to bring medical knowledge to the public by translating Latin to the language of the common man: German. Fries wrote that medical knowledge should not be limited to the nobility and wealthy; the “common man” should also have access to medicine. However, he wanted total control of the publication process, which was impossible with print technologies. The radical transformation of typography in the early sixteenth century meant that he wrote his book by hand and gave the manuscript to the printer. The printer worked with editors, typesetters, artists, and others at the print shop. The presentation of medical treatments transformed from his original manuscript to the final printed book.

This meant that in the first edition of Mirror of Medicine (1518), without Fries’ consent, the printer added the images of the body and brain that have become so popular. Nowhere in his book does he mention them, and when he mentions dissection and images at all, he does so disparagingly. The printer had borrowed the woodblock from the printer of Gersdorff’s book and included the images along with many others to sell more books. In a letter and dedication to a later edition, Fries called his book “a monster” and by 1532, the third edition, he had switched printers and removed all images from the book since he thought they distracted from the knowledge he was trying to teach.

As a rhetorical tool, the glitz of images is powerful. If we only look at the image, we would assume that it was Fries that put these images in the book and that he was a revolutionary figure for using these new techniques to represent the body. By engaging the process of the book’s production, however, we find a very different story. For Fries, knowledge was verbal and oral, and the radical techniques of dissection, visually accurate images, and printing disrupted the doctor patient relationship. When he inscribed his knowledge on paper and gave it to the printer, he did not realize until too late that he no longer had control.

“From the ancient world until the seventeenth century, the brain was trash”

You are claiming that brain was an unintended artifact that emerged through slight shifts in the codes of inscription, could you please tell your basis of this claim and what are these shifts happened in the codes of inscription?

As I mentioned above, from the ancient world until the seventeenth century, the brain was trash. “Trash” may be extreme, but Aristotle thought it was only a cooling mechanism for the heat produced in the heart and Plato described the head and brain as containers for the soul. Even forays into anatomy in the Roman period and Middle Ages were done by way of animals to show that the “seat of the soul” was the head, or where our inner senses were located.  For both Fries and Gersdorff, who inherited practices and knowledge from medieval surgeons and doctors, the most important part of the body was the head. As part of the head, the brain was no more or less important than one’s hair.

The concept of an “unintended artefact” comes from H.J. Rheinberger and B. Latour, a historian of science and sociologist. They write that practitioners of any science make inscriptions, which are recordings of what they are doing. In Europe in the sixteenth century, this record-making process shifted to include artists who represented the body, barber surgeons who cut the body during dissections, and printers who shared these records with a growing reading public. Doctors and surgeons had to communicate by speech, scribbling notes, or directing an ever-larger group of people. In taking part in the first public dissection in Strassburg in 1517, Hans von Gerdorff did not know he was creating the brain as an isolated object. Nor did he know the importance of the relationship between images and words when he described an anatomical organ. Yet slight shifts in the recording processes created the brain that we know today. 

The best example is a poem attached to the image, a part of which I’ve translated and can share here. The printer included this poem with the image on a broadside, or poster to advertise the book. It describes the dissection in rhyme with a common verse. After telling the surgeon how to saw off the top of the skull, the poem narrates how to find the brain, and the brain’s contents, the inner senses. They used the poetic verses as a memory device but also as  rhetorical flourish to sell more copies of the book. When we compare this poem with the image, we can see the numbered steps and read how the head and brain should be discarded piece by piece as one journeys toward the soul. The representation of this unintended artefact—that which should be thrown away—became then the focus of future studies on the brain in the sixteenth and seventeenth centuries: one man’s trash is another man’s treasure. 

A personal witness artistic and true [This image]

Tells how one divides the skull in two.

And saw through the roundest section/

Through two skins you’re almost on it

Therein find the brain deposit.

Its cell and holy marrow station

Common sense/imagination

In the front part does lower.

In the middle the thoughtful power

Memory would be housed in the rear.

“The brain that we know today is included in the idea of performance”

You are using the word “performing” in the title of the book. Could you tell why you decided to use this word rather than “representing” or “describing”? In other words, what is the reason to describe the 16th century brain as a performative object?

The concept of “performance” has a central place in contemporary critical theory, whether it be through language, the body, art, or broader cultural activities. When we perform, we are enacting particular codes that we and an audience recognize: an actor who performs a character must follow particular codes to disappear as an actor and re-appear as a character. The audience and actor accept this fiction. This performance assumes something about meaning: there is no “nature” or “natural” object that everyone everywhere knows and recognizes. What we have are particular sets of codes that we can recognize: when those codes are present, the object appears. When those codes are not present, the object disappears.

Performances are also only rational, or they only make sense, if you possess the codes by which to interpret them. Otherwise, the performance is irrational and makes little sense. The inability for contemporary medical historians to recognize the codes by which the brain was performed in the Early Modern Period is an example of this performance: certain codes are emphasized that we recognize and others that we don’t are ignored or we simply cannot see them. We recognize the visual codes of the image, the anatomy of the body, and the “book” quality of printed knowledge. However, what we don’t recognize are the strange rituals related to an invisible set of tools by which doctors, surgeons, patients, and artists enacted their bodies, heads, and brains. I wanted to bring these codes to our attention, codes that created the brain as a container for common sense, imagination, reason, and memory. This is a very different object than we have today because the epistemic performance is different.

Returning to the question, I could very well have used “representing” or “describing” the brain in the title, and I do elaborate on the importance of visual and verbal representations in the construction of this object. However, the concept of performance had more salience because representing and describing are included under the concept of inscription. When we inscribe something, Derrida writes that we are making a representation of something else. Every representation is a trace, or the “presence of absence.” A representation is a set of marks or traces that point to something that is not there. This emphasis on the representation takes one’s attention to the visual and verbal final product, as if the brain always already existed and we are re-presenting it.

Paradoxically, an object is created in a particular way by the codes of the representation itself. If we repeat a fiction long enough, the object becomes natural. The brain, or any represented object, only exists in a particular way at a particular time depending on the tools one has to inscribe it. The brain that we know today is also included in this idea of performance: the difference is that we inscribe it in a similar manner each time—visual accuracy, anatomical accuracy, and reproducibility of inscriptions—with only slight shifts in the codes of inscription. It is only after the fact that we can recognize how these slight shifts have radically changed the very nature of the object itself.

As we understood, again, you are using the method of close reading in examining two medicine books, what can this method add to our understanding to the medical representations of body and can your study be counted under the interdisciplinary area of medical humanities? Do you think that literary criticism can be used for other analyses in humanities? 

As an interdisciplinary book, it relies on knowledge from cultural criticism, history of medicine, anatomy, and even literary criticism. I would say this book could very well be categorized as medical humanities, but it also uses techniques of literary close reading to draw attention to details that a historian of medicine would miss. Whether we are visual artists, musicians, writers, or geneticists, we make inscriptions and these inscriptions are non-disciplinary. We frame the inscriptions within academic disciplines, but the inscriptions themselves make no such claim. A close reading follows these inscriptions as they cross disciplinary boundaries.

Without going into too much detail, close reading developed in the early twentieth century to train a new generation of literary critics to appreciate poetry. By the early 1980’s, “close reading” had shifted to include books and objects that are not necessarily “poetic” or “literary.” My close reading of medical and surgical books follows this trend. This expansion of potential research objects led me to other fields and forms of close reading that are actively practiced in anthropology, sociology, and history of science, even if they don’t use the term.

I was informed by sociologists B. Latour and S. Woolgar, as well as historians of science H.-J. Rheinberger and M. Hagner, and their approaches to close reading inscriptions in laboratory contexts. Scientists in laboratories constantly make inscriptions and the result is not what was envisioned at the beginning of the experiment. To understand the process of how experimentation occurs, one needs to follow the slight shifts in the codes of inscriptions and not be seduced by the rhetoric of the final product. These techniques of close reading from sociology and history of science draw attention to details of making inscriptions in a laboratory that a literary critic would miss or not recognize. My training as a literary critic made it possible to describe that which had gone unnoticed in the history of medicine and conversely, concepts from sociology and history of medicine allowed me to draw attention to what I would have missed as a literary critic.

Is there any chance to learn how brain studies differentiated in terms of gender issues during 16th century and onwards? And how 16th century medicine treated men and women (in some cases women with epilepsy treated as ‘witches’ etc.)  patients in this perspective?

Since gender was not the focus of the book, I can only point to some places where Fries and Gersdorff reference gender stereotypes in relation to performing the inner senses. However, like the concept of the brain was different in the sixteenth century, so was the concept of gender. Woman beneath the Skin performs such an analysis much better than I could convey.

The biological distinction between male and female, and more recent debates about the distinctions between biology and gender, did not appear until the nineteenth century. Here I can refer you to excellent studies that have approached the concepts of gender, the brain, and biology since the Middle Ages. For example, Katharine Park’s Secrets of Women focuses on the origins of anatomy in the Middle Ages in relation to gender and power issues; Londa Schiebinger’s The Mind Has No Sex offers a gender criticism of the relationship between gendered bodies and changing definitions of knowledge; finally, my thesis adviser, Michael Hagner, has written a trilogy of books on the brain from the Enlightenment to the present in relation many cultural, social, and scientific categories, one of which is gender. I could offer many more, but these would be good places to start.

“Today, it is impossible to not know about the brain”

And lastly, from a perspective looking to 16th century from 21th century, how do you think the rituals as brain performances have changed?

We understand the world based on the tools or technologies at hand. When the technologies change, so do knowledge practices, and thus the world.

The authority of medieval doctors was based on speech and memory. As embodied technologies, speech and memory defined how the brain could be performed and represented. This led to an emphasis on the immaterial over the material world, the invisible concept over the object. They created a very different brain through their knowledge rituals. For example, whatever a doctor said about the body was true based on the authority of speech. Even if the body contradicted the statements or diagnoses a doctor made, his speech was the authority.

The introduction of writing and print to record and share knowledge and treatments allowed for comparison, tests for accuracy, and a reversal of the effects of speech: doctors no longer had to memorize words and ideas and apply ancient knowledge. Rather, their speech changed in relation to written and printed texts, visual images, and just as important, the body itself. Doctors and surgeons began to talk about and write about inscriptions, thus unintentionally emphasizing the material world. For example, the growing number of anatomy books printed in the sixteenth century required a shift in knowledge performance: each new book inscribed the body with more visual and verbal detail, creating what Latour called an overwhelming cascade of new inscriptions. Even if one doubted the knowledge presented in certain books, one still had to print to make oneself known.

Mechanical and electrical inscriptions devices developed in the nineteenth and twentieth centuries also brought with them new rituals, procedures, and recording techniques. Digital imaging techniques in the late 20th and early 21st centuries continue this trend of creating ever smaller yet detailed inscriptions. This unprecedented advance in medical technologies has also brought with it a new concept of the brain that is different from previous versions and will be still different from how we know and represent it in the future.

A recent book on The Neuro-Turn in the Humanities offers a collection of essays on the role of the brain in 21st century critical discourse: whereas complex imaging and surgical technologies place knowledge in increasingly fewer experts hands, the dissemination of this knowledge becomes ever wider through the publication of the latest discoveries in academic articles, books, newspapers, television, and the internet. Prior to the sixteenth century, everyone could live without knowing about the brain. Today, it is impossible to not know about the brain. This knowledge affects how we imagine ourselves, our bodies, our friends, and our social interactions. As strange and irrational as sixteenth century brain rituals are to us, our own brain rituals would look very bizarre to someone unfamiliar with our knowledge practices.