Marco Aurelio Severino, De recondita abscessum, libri VIII…, 2nd ed. (Frankfurt: Caspar Rotelius for Johannes Beyer, 1643).
Francis A. Countway Library of Medicine, Rare Books 23.F.46
A patient with syphilis gazes at his physician-turned-viewer (fig. 1). On the adjacent page, we read of his condition:
First, for the wretched man, there appeared near the temples, projecting like a type of protruding “knot” and rising up from within the bone, what some have likened to gummi [the gum, or sap, secreted from trees]. Knots of this kind, and many others concealed beneath the skin along the right and left sides, had encircled the smooth head like a crown. Coming from the outermost region of the ears, then to the rising auricles, then to the weakened lobes, you could see them [the protrusions] amply scattered on his head. But at the episcenium—that is, at the eye, the brows, and the space in-between—one swollen lump, almost comparable to a hill, stood out such that the subgrundrium appeared huge from both sides. Beneath this, and beneath the verrucosis [or, rind-like skin], wart-covered and hairless eyelids were drawn back from the watery eyes by a large segment of dry flesh, which appeared like a type of fiber stained with blood. Between the eyes, more than half of the ridge of the nose had given way with the collapse of the bone-like tissue of the nasal septum, evidently caused by the swelling. The remainder of the nose, however, was covered all around by a flame-colored redness, and, I do not know how the philtrum [the groove above the upper lip and below the nose], along with the lips, was so sunken down by the moisture of the swellings. These things had altered his face to appear with a dolphin’s grin, or that of some kind of animal I cannot name. That scabrous excrescence—distended like a fist with the weight of infection—was dragging the jaw, the chin, and, accordingly, the entire face, downwards.
Flesh softened and sunken, a figure bodies forth. His tissue decays before our eyes—cartilaginous nose and ear having long since collapsed—as we trace, with the artist, his skin’s torturous folds. Like wax before flame, the man appears to melt. His flesh begins to “rupture from liquified bones.” Still, his body, as printed image, persists. The image is to be studied beside the physician’s description. As we turn between image and text, the man turns to his viewer. Gazing sidewards, his eye penetrates us from the tome within which it is set, to arouse, in the words of his first observer, horror. Such is the effect of Marco Aurelio Severino’s syphilitic image.
In 1632, Severino’s De recondita abscessuum natura libri VIII (On the Obscure Nature of Tumors, in Eight Books) was published to tremendous acclaim. One of Naples’ most famous medical figures, Severino had gained an international following as Professor of Anatomy and Surgery and as Chief Surgeon at the Ospedale degli Incurabili, or Hospital for the Incurables, in the city’s Spanish Quarter. (The English physician William Harvey, who numbered among his epistolary confidantes, visited him there.) Severino’s survey of the “abscess”—the diverse causes, manifestations, and treatments of all types of swellings and tumors—was hailed as a work of ingenio, or creative genius, proffering the revelations of new (and controversial) surgical procedures. In De recondita abscessuum natura, the body’s “obscurities” surface through images. The text features 20 engraved plates which appear, within the history of medicine and the history of art, “among the first to depict pathological lesions”—and to render them at the level of the afflicted organ and the individual patient alike.
The syphilitic man appears within the 23rd chapter of the fourth book, in a section dedicated to new observations of abscesses (novissime observatis abscessibus), and, more specifically, to those unsightly swellings produced by the sexually transmitted disease. Severino’s image captures the compounded effects of syphilis which he had witnessed at the Ospedale. Since its foundation in 1526 by Maria Llorença Llong, the hospital had numbered those suffering from the morbo gallico (or the “French disease,” as it was then popularly known) amongst its patients. Over a century later, Severino pronounced the illness by its “modern” name, syphilis. In addition to his observations, Severino’s chapter reproduces a fragment of Girolamo Fracastoro’s 1530 allegorical poem in which this diagnostic name first appeared: Syphilus, a shepherd in Fracastoro’s epic, is punished with the illness after his transgressions against Apollo.
Severino’s syphilitic image carries Fracastoro’s allegory into the present. The “Metamorphosis of Syphilis,” as Severino titled his figure, has a double function. The surgeon employs the “horrific” image as a warning. The figure before us is “one Neapolitan man who,” having been so afflicted, “has thus been able to warn many, the disease having—against every measure—taken away his external form as it progressed to the face.” The extent of this metamorphosis is rhetorically affective. Severino asks: “Would those who are unchanged upon seeing the disease’s progression step-by-step not feel a great shock if every type of distortion, of every part of the face, were brought together?”
Severino faces his former patient. Initial, moralized shock is set against the image’s primary function as a diagnostic site. Severino reflects, first, on the status of the syphilitic man as a reproduced image. “He ought to be recalled in my memory. […] If only the dexterity of my stylus were adequate, such that it might be able to express graphically that man I will describe, one way or another, by my own means.” Severino’s “means,” then, are simultaneously linguistic and pictorial. Reference to the graphic expression of the stylus implies that the image is the product of Severino’s hand and that the surgeon has created the original drawing (or disegno) from which the engraver will work. Moreover, Severino provides his own description of the engraved image. His ekphrasis remains as exacting as it is, to us, both tragic and disturbing.
Severino’s language activates the movements of decay. One senses his fascination with such strange metamorphoses. The body is transformed in text through the surgeon’s similitudes: the brow a hill, the skin a lemon, the mouth a dolphin’s grin. Swollen lumps resemble the knots of trees from which sap seeps. The surgeon’s poetics press into the complexities of description, signaled, too, by his neologisms, his use of Greek, and, most powerfully, his rhetorical silences (“I do not know…,” “I cannot name…”).
If the face is the final site of the disease’s progression, it is also the ultimate site of diagnostic and affective response. Severino continues:
But what remains of the horrors I speak, of those I now sketch (adumbro)? Further on, flesh ruptures from liquified bones, just as the muscles of the mouth convulse. Thus, the man appears to jest, laughing like a caricature, when he is, in fact, to be pitied. In turn, the rest of the body, gnawed away and plagued with scabrous and tuberous ulcers, was languid, suffering and painful, to the highest extreme, such that recalling and describing him fills me with horror.
As opposed to a purely physiognomic impression, the relation between interior and exterior are, here, as physiologically linked as they are psychologically distinct. The man grins, he laughs, but not of his own volition. This “caricature” wears a mask that may not be removed. His illness, in other words, may not be immediately moralized or—in Susan Sontag’s terms—metaphorized. Rather, the “monstrous” form of this metamorphosis insists on biological effects eliciting intervention, if not compassion.
Let us return in close to the “I now sketch” (adumbro) of the doctor’s final interrogative. Severino’s Latin is tied to the language of tonal painting. Adumbro—to “add” (ad) “shade” (umbra)—signals the enlivening act of illumination, of chiaroscuro (in Italian, “light-dark”). Indeed, the curves of the engraver’s metal burin spiral upon the copper plate to produce an image of dimensional presence. Severino’s image offers itself as a portrait to be studied and lamented. As Severino writes, he extends—he engraves—the presence of his former patient. Thus the syphilitic image remains: imprinted in Severino’s mind, imprinted before us.
I would like to thank Hannah Marcus, Felipe Pereda, and an anonymous peer reviewer for their insightful comments on an earlier version of this essay; and Craig Tichelkamp, Sandro-Angelo de Thomasis, and Katharine Liptak for their kind assistance with elements of the translation.
 “Primum enim homini misero, circa frontis utramque partem, quae temporibus respondet, projectura quaedam veluti nodosa, subsultantis inferne ossis, gummi dixerunt aliqui; cujusmodi & alia complura, sub cutem obducta, glabrum caput oblique dextra, levaque, coronae modo praecinxerant. In cujus capitis…, surgentium auricularum tum supremas pinnas, tum infirmos lobos vidisses, ample distractos. Sed episcenium, quod oculus attrahimus, cum deglabratis superciliis atque glabella, tuberculis uno quasi clivo confertis sic exstabat; ut subgrundium utrimque ingens appareret: sub quibus, & verrucosis, depilibusque palpebris occulebantur à nimia viscerum ariditate retracto oculi, fibras quibusdam veluti sanguineis tincti. Inter quos nasi jugum plus semisse desierat: nimirum ossis firmamento, quod interseptum vocant, per abscessum collapso. Caeterum autem nasi globus flammeo circum rubore obsitus, & ad philtrum humile depressus, cum labiis nescio quo madore turgentibus; rictum Delphini, vel nescio cujusmodi pecudum, efficiebant. Consonum etiam universo faciei vitio mentum, quod lichene scabrum & pugni modo praeturgidum, infesto pondero, maxillam ad infera detrahebat…” Marco Aurelio Severino, De recondita abscessum, libri VIII…, 2nd ed. (Frankfurt: Caspar Rotelius for Johannes Beyer, 1643), 250. I employ italics to preserve certain terms as they appear in Severino’s medical vocabulary. All translations are my own.
 “…liquatis circum carnibus exertisque pene ossibus.” Severino, De recondita abscessum, 249.
 The lack of identification for Severino’s ostensible patient remains an historical challenge. It is possible that the figure before us is “himself” a concatenation of multiple figures. However, given Severino’s insistence that this is a single individual, I have chosen to identify him as such. Out of respect for his (now, anonymous) personhood, I have emphasized the illustrated figure as a “syphilitic image,” rather than a “syphilitic man,” given that the latter would risk binding his identity to his medical condition alone.
 The 1632 edition was printed in Naples. Marco Aurelio Severino, De recondita abscessum natura, libri VIII… (Naples: Octavius Beltranus, 1632); see p. 122 for the syphilitic image. The second edition, which circulated more widely, was printed in Frankfurt in 1643; see note 2, above. The Harvard Libraries preserve two versions of the 1643 edition, at Countway Medical Library and at Houghton Library, and I refer to the second edition throughout this essay.
 Houghton Library preserves a remarkable document of this encounter: Harvey gifted Severino a copy of his manuscript, De motu cordis, which Severino read and annotated. Regarding his letters to Harvey and others, see C. B. Schmitt and C. Webster, “Harvey and M. A. Severino: A Neglected Medical Relationship,” Bulletin of the History of Medicine (1971): 49–75.
 Severino was called twice before the Inquisition for surgical procedures which were deemed “excessively cruel.” He was jailed once but ultimately acquitted both times; a treatise which he wrote in his own defense, Il medico a rovescio paradosso, survives in part. On the manuscript (Severino, Lancisiana, ms. 324), see Schmitt and Webster, “Harvey and M. A. Severino.” See also: Luigi Amabile, “Due artisti e uno scienziato: Gian Bologna, Jacomo Svanenburch, e Marco Aurelio Severino nel Santo Officio Napoletano,” Atti della Reale Accademia di Scienze Morali e Politiche (1891), 433–503.
 See Heirs of Hippocrates: The Development of Medicine in a Catalogue of History Books in the Hardin Library for the Health Sciences, the University of Iowa, 3rd ed., edited by Richard Eimas (Iowa City: University of Iowa Press, 1990), 166.
 Girolamo Fracastoro, Syphilis, sive morbus gallicus (Rome: Apud Antonium Bladum Asulanum, 1531), Book III. The unfolding of this origin myth occurs in America, where one cure for syphilis had emerged from guaiacum sanctum, or “holy wood.” Fracastoro used the name explicitly in describing the disease’s effects in his later medical text, Liber I de sympathia et antipathia rerum, de contagione et contagiosis morbis (Venice: Lucantonio Giunta, 1546). See G. L. Hendrickson, “The ‘Syphilis’ of Girolamo Fracastoro, with Some Observations on the Origin and History of the Word “Syphilis,” Bulletin of the Institute of the History of Medicine (1934): 515–546.
 “…unus Neapoli, qui potuit à multis adverti; praeter omnem modum ad hyrcinam speciem facie tenus abreptus.” Severino, De recondita abscessum, 249.
 “Quae cum singulatim immutata, tantum admirationis pariant: quid, cum omnia simul perversionum modos faciei partes singular coacervarint?” Ibid.
 “In memoriam autem revocandum est primum.” “Utinam autem par mihi styli dexteritas, quae graphice talem exprimere queat: utcunque illum ego meo modulo describam.” Ibid.
 The exact means of this procedure and the nature of Severino’s authorship are points I intend to investigate further in a forthcoming work. For now, I take Severino’s suggestion of his design, if not his manufacture, of the drawn (and later-printed) image at face value. Severino’s library includes working sketches and other drawings amidst his notes; see Maria Conforti, “Surgery, Medicine, and Natural Philosophy in the Library of Marco Aurelio Severino (1580–1656),” Bruniana & Campanelliana (2004): 283–29, 288. Additionally, Ottavio Beltrano’s publishing house, responsible for the 1632 edition, would certainly have had the means to translate the initial drawing into a reproducible plate.
 “Sed malas quas dico, vel quale nuns adumbro, cum reliquis partibus? Porro, liquatis circum carnibus exertisque pene ossibus; oris musculi convulsi, ut risum ludere videretur homo ridendus, quin vero miserandus; qui caetero corpore qua quidem abrosus, & phagedaenis infossus, que scaber ac tuberosus, languidus ad summum totus, squallens ac dolorosus, ut etiam commemorantem ac describentem me complet horror.” Severino, De recondita abscessum, 250.
 The reference to the dolphin’s grin recalls the work of Severino’s contemporary, Giambattista della Porta—whose physiognomies included comparison between human and nonhuman faces—only to refute it. See Della Porta, De humana physiognomonia libri IIII (Vico Equense: Giuseppe Cacchi, 1586).
 Susan Sontag, Illness as Metaphor and AIDS and its Metaphors (New York: Doubleday, 1990).
 As Eleanor Bulatkin notes, the Latin adumbrare (“to shadow forth,” “to portray”) traditionally refers to the act of portrayal via artistic means premised on illusionistic dimensionality. See Bulatkin, “The Italian Word Sfumatura,” PMLA (1957): 823–853, 831. See also, Gianfranco Folena, “Chiaroscuro leonardesco,” Lingua nostra (1951): 57–63.
 The status of such an image within the history of art remains unstable. The “portrait” (ritratto in the Italian) emphasizes the act of re-production as crucial to observation and replication. This may be opposed to the imagining of deformity which often characterizes the genre of the “grotesque,” and the exaggeration, or bodily extremes, associated with the “caricature.”