Inside a circle, Bosch represents an operation to extract the stone of madness, which takes place in a broad landscape. Four persons occupy the scene. The surgeon stands, and the hapless patient sits. An assistant stands beside him while an old woman leans on the pedestal table with a book on her head.

The inscription in gothic lettering that frames the circle translates as: “Master, extract this stone from me soon, my name is Lubbert Das” [This name is sometimes translated as: “Castrated Badger”].

Bosch makes fun of the central character's attempt to cure his madness, which is understood to be stupidity or ignorance, a very common argument in several Flemish proverbs. The doctor's inverted funnel seems to imply that he is the true madman, while the woman with a book on her head, who looks on in amazement, seems to represent the weight of science. The tulip on the table represents the economic cost of the operation, symbolizing the surgeon's profit and casting him as a fraud.

In the sixteenth century, Felipe de Guevara owned a work on this subject, which was sold to Felipe II by his heirs. However, its size and format were different than the present work, which was first mentioned in 1745 in the Duke of Arco's country home, from which it entered the Royal Collection.