I’m not sure if that exact image is an original, but there is one remarkably similar found in Froissart’s Chronicles from the early 1470s: https://discardingimages.tumblr.com/post/58267835214/the-lute-player-and-the-harpist-froissarts

Search for “medieval marginalia” and you’ll find all kinds of similar weird stuff: https://www.ebaumsworld.com/pictures/the-most-bizarre-things-ever-to-be-found-hidden-in-medieval-art/84859940/?image=84859961 https://designyoutrust.com/2021/12/a-collection-of-medieval-marginalia-that-have-been-turned-into-memes/

There is also the painting “The Garden of Earthly Delights” by Hieronymus Bosch, which is entirely deranged: https://en.wikipedia.org/wiki/The_Garden_of_Earthly_Delights

On Reddit (and probably other places), “Linux distros” or “ISOs” was a roundabout way of referring to porn.

“Phantoms in the Brain” by V.S. Ramachandran.