CSI: Italian Renaissance

Inside a lab in Pisa, forensics pathologist Gino Fornaciari and his team investigate 500-year-old cold cases

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[...] Some of the most compelling tales surround the dynasties of the Aragonese and Medici. Among Fornaciari’s most memorable “patients” is Isabella of Aragon, born in 1470, a shining star at the greatest courts of Italy, renowned for her intellect, beauty, courage in battle and remarkable fortitude. She knew Leonardo da Vinci; some art historians also believe she could have been the model for the Mona Lisa. She conducted famous love affairs with courtier Giosuč di Ruggero and condottiero Prospero Colonna, as well as, one scholar maintains, with Leonardo himself. Even an objective scientist such as Fornaciari isn’t immune to her charms. “Knowing that I had Isabella of Aragon in my laboratory, one of the most celebrated ladies of the Renaissance, who’d known Leonardo da Vinci—he’d made the magnificent theater backdrops for her wedding feast— all this raised certain emotions.”

All the more so when Fornaciari took a close look at Isabella’s teeth. The outer surfaces of those in the front of her mouth had been carefully filed—in some cases the enamel had been completely removed—to erase a black patina that still covered the teeth farther back. Electron microscopy revealed parallel striations on the front teeth, indicating abrasions made by a file. The black stain, it turned out, resulted from ingestion of mercury, in her day believed to combat syphilis. Proud Isabella, jealous of her celebrated beauty, had been attempting to hide the growing discoloration associated with her disease. “I imagine poor Isabella trying to preserve her privacy, not wanting to appear with black teeth because people would know she had venereal disease,” says Fornaciari.

His examination of Isabella’s grandfather, Ferrante I, King of Naples, born in 1431, also produced significant results. This great lord presided over a literary salon where leading humanist scholars converged, but he was also a gifted warrior, who with astuteness, courage and calculated—or, as his critics said, sadistic—savagery, maintained the independence of his kingdom against powerful enemies, both foreign and internal. No less a figure than Lorenzo the Magnificent de’ Medici traveled to Naples to kneel in submission before him. Ferrante died in 1494 at the age of 63, celebrated by contemporaries for maintaining his intellectual and physical vigor to the end of his life, although portraits completed during his later years showed that he had put on weight and occasionally appeared to be in pain.

Fornaciari debunked the myth of Ferrante’s enduring good health. Although the king’s mummified body had been lying in its cedar coffin for five centuries, and in 1509 had been badly damaged by a fire in the basilica, Fornaciari managed to recover a segment of Ferrante’s intestine, which when rehydrated showed a pattern of yellowish spots that looked sinisterly familiar to him from analyses of modern biopsies. Extracting DNA from mummified tissue, Fornaciari found mutation in the K-ras gene—clear proof that Ferrante had suffered from advanced colon cancer, most probably a colorectal adenocarcinoma. Fornaciari had made medical history, by identifying an oncogene mutation in an ancient tumor; his results offer potentially important data for studying the evolution of the disease.

Fornaciari subsequently analyzed bone collagen of King Ferrante and other Aragonese nobles, revealing a diet extremely reliant on red meat; this finding may correlate with Ferrante’s cancer. Red meat is widely recognized as an agent that increases risk for mutation of the K-ras gene and subsequent colorectal cancer. (As an example of Ferrante’s carnivorous preferences, a wedding banquet held at his court in 1487 featured, among 15 courses, beef and veal heads covered in their skins, roast ram in a sour cherry broth, roast piglet in vinegar broth and a range of salami, hams, livers, giblets and offal.)

Maria of Aragon, another famous beauty of the Renaissance, noted for her proud, fiery temperament, whose intellectual circle included Michelangelo, was found to have syphilitic lesions and human papillomavirus (HPV). Fornaciari’s identification of the latter in an ancient cadaver also offered new clues to the evolution of the virus.

King Ferrante II, who died young and surpassingly handsome at 28, shortly after the great Carpaccio painted his portrait, was found to have head lice, as well as poisoning from the mercury he used in an attempt to vanquish the infestation. An anonymous, richly dressed member of the Aragon family, about 27 years of age, had a fatal dagger wound in his left side, between the eighth and ninth ribs, with signs of massive bleeding.

Fornaciari also studied electron micrographs of tissue samples from an anonymous 2-year-old Aragonese child who died around 1570. He observed the lethal smallpox virus—which reacted to smallpox antibodies after centuries in the grave. Concerned that the virus could still be infectious, the Italian Ministry of Health threatened to close Fornaciari’s lab and impound the tiny cadaver, until Fornaciari reported that he had already sent samples for testing to the United States and Russia, where specialists pronounced the smallpox DNA biologically inert and therefore harmless.

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Fornaciari uncovered some of his most moving and detailed personal stories during exhumations of the Medici, begun in 2003. A driving force in the artistic, intellectual and economic life of the Italian Renaissance, the noble house helped to establish Florence as the cultural center of the Western world. The Medici were the patrons of Brunelleschi, Leonardo da Vinci, Michelangelo, Botticelli and Galileo Galilei. “You can’t really remain indifferent to someone like Cosimo I de’ Medici, one of the architects of the Renaissance,” Fornaciari says. An inexperienced teenager who suddenly came to power in Florence in 1537, Cosimo rescued the city-state of Florence, turning a foundering republic at the mercy of foreign powers into an independent duchy that was once more a major player on the European stage. He founded the Uffizi Gallery, freed Florentine territories from foreign armies and built a navy, which was instrumental in preventing the Ottoman takeover of the Mediterranean Sea during the Battle of Lepanto in 1571.

The wealth of biographical information available on Cosimo I allowed Fornaciari to synthesize contemporary testimony and forensic investigation. Documentation concerning Cosimo and his descendants is some of the most extensive in early modern history—the online database of the Medici Archive Project contains descriptions of some 10,000 letters and biographical records on more than 11,000 individuals. Portraits of Cosimo I in museums around the world depict his evolution from a shy, seemingly wary youth in 1538 to a bearded warrior in a polished suit of armor in 1565, and an elderly, corpulent and world-weary figure, gazing absently into space, toward the end of his life in 1574. Reports by court physicians and foreign ambassadors to the Florentine duchy recount Cosimo’s medical history in excruciating detail: He survived smallpox and “catarrhal fever” (likely pneumonia) in youth; suffered in later life from paralysis of his left arm, mental instability and incontinence; and had a painful condition of the joints described by contemporaries as gout.

Fornaciari found that Cosimo’s remains indicated he had been an extremely robust and active man, in whom Fornaciari also noted all of the “knightly markers”—sacro-lumbar arthritis, hypertrophy and erosion of certain parts of the femur, rotation and compression of the upper femur, and other deformations—typical of warriors who rode into battle on horseback. He noted nodes between Cosimo’s vertebrae, signs that as an adolescent, the young duke had worn heavy weights over his thorax, most probably suits of armor. Fornaciari also noticed pervasive arthritis and ossification between the sixth, seventh and eighth thoracic vertebrae, possible signs of diffuse idiopathic skeletal hyperostosis (DISH), a disease of the elderly linked to diabetes. “We see Cosimo getting fatter in his portraits, and the presence of DISH suggests he may have had diabetes, too,” says Fornaciari. “The diet of the Medici and other upper-class families often contained many sweets, which were a sort of status symbol, but often caused health problems.”