CSI: Italian Renaissance

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

Fornaciari’s analysis of an anonymous 13th- to 15th-century female skeleton showed evidence of severe anemia. (Dave Yoder)

Fornaciari’s analysis of an anonymous 13th- to 15th-century female skeleton showed evidence of severe anemia. (Dave Yoder)

High on the facade of Santa Maria Antica, among soaring Gothic spires and forbidding statues of knights in armor, pathologist Gino Fornaciari prepared to examine a corpse. Accompanied by workmen, he had climbed a 30-foot scaffold erected against this medieval church in Verona, Italy, and watched as they used hydraulic jacks to raise the massive lid of a marble sarcophagus set in a niche. Peering inside, Fornaciari found the body of a male in his 30s, wearing a long silk mantle, arms crossed on his chest. The abdomen was distended from postmortem putrefaction, although Fornaciari caught no scent of decomposition, only a faint waft of incense. He and the laborers eased the body onto a stretcher and lowered it to the ground; after dark, they loaded it into a van and drove to a nearby hospital, where Fornaciari began a series of tests to determine why the nobleman died—and how he had lived.

The victim, it appeared, had suffered from several chronic and puzzling conditions. A CT scan and digital X-ray revealed a calcification of the knees, as well as a level of arthritis in elbows, hips and lumbar vertebrae surprisingly advanced for anyone this young. A bronchoscopy showed severe anthracosis, similar to black lung, although he hadn’t been a miner, or even a smoker. Histological analysis of liver cells detected advanced fibrosis, although he had never touched hard liquor. Yet Fornaciari, a professor in the medical school at the University of Pisa, saw that none of these conditions likely had killed him.

Of course, Fornaciari had heard rumors that the man had been poisoned, but he discounted them as probable fabrications.“I’ve worked on several cases where there were rumors of poisonings and dark plots,” Fornaciari told me later. “They usually turn out to be just that, mere legends, which fall apart under scientific scrutiny.” He recited the victim’s symptoms in Latin, just as he had read them in a medieval chronicle: corporei fluxus stomachique doloris acuti . . . et febre ob laborem exercitus: “ diarrhea and acute stomach pains, belly disturbances . . . and fever from his labors with the army.”

Gino Fornaciari is no ordinary medical examiner; his bodies represent cold cases that are centuries, sometimes millennia, old. As head of a team of archaeologists, physical anthropologists, historians of medicine and additional specialists at the University of Pisa, he is a pioneer in the burgeoning field of paleopathology, the use of state-of-the-art medical technology and forensic techniques to investigate the lives and deaths of illustrious figures of the past.

Its practitioners worldwide are making startling discoveries. In December 2012, a team of scientists published results from an examination of the mummy of Pharaoh Ramses III, showing that he had died from having his throat slit, likely murdered in the so-called “harem conspiracy” of 1155 B.C. This May, Smithsonian anthropologist Douglas Owsley said he’d found evidence of cannibalism at Virginia’s Jamestown Colony, probably in the winter of 1609; cut marks on the skull and tibia of a newly exhumed 14-year-old girl’s remains indicated that her brain, tongue, cheeks and leg muscles were removed after her death. Scholars have reconstructed the faces of Renaissance figures including Dante and St. Anthony of Padua based on remains of their crania (Petrarch’s head, it emerged, had been swapped out at some point with that of a young woman). They are currently sifting the subsoil of a Florentine monastery for remains of Lisa Gherardini, a noblewoman believed by some art historians to be the model Leonardo da Vinci used when he painted the Mona Lisa.

But no one has made more important and striking finds than Gino Fornaciari. Over the past half-century, using tools of forensics and medical science as well as clues from anthropology, history and art, he and his colleagues have become detectives of the distant past, exhuming remains throughout Italy to scrutinize the lives and deaths of kings, paupers, saints, warriors and castrati opera stars. Fornaciari himself has examined entire noble populations, including the Medici of Florence and the royal Aragonese dynasty of Naples, whose corpses have been, in effect, archives containing unique clues to the fabric of everyday life in the Renaissance.

Such work is not without its critics, who brand scholars such as Fornaciari as little more than grave-robbers, rejecting their efforts as a pointless, even prurient, disturbance of the dead’s eternal rest. Yet paleo-sleuthing has demonstrated its value for the study of the past and future. As Fornaciari has solved some of history’s oldest riddles and murder mysteries, his work also holds life-and-death relevance. By studying modern killers such as malaria, tuberculosis, arteriosclerosis and cancer, whose telltale signs Fornaciari has found in ancient cadavers, he is helping to understand the origins of diseases and to predict the evolution of pathologies. “Gino Fornaciari and his team are prime movers in the field,” says bioarchaeologist Jane Buikstra of Arizona State University, author of The Global History of Paleopathology. “They’re shaping paleopathology in the 21st century and enriching discussion in a range of other fields, too.”

Fornaciari’s current “patient,” the nobleman interred at Santa Maria Antica, was Cangrande della Scala, warlord of Verona, whose family ruled the city and a swath of northeastern Italy with an iron hand seven centuries ago. They reigned at the beginning of the Italian Renaissance, that blaze of artistic creativity and new self-awareness that illumined the end of the Middle Ages and permanently altered human consciousness. Cangrande was a paradigmatic Renaissance man: Giotto painted his portrait, the poet Boccaccio celebrated his chivalry and Dante lauded him lavishly in the Paradiso as a paragon of the wise leader.

In July 1329, he had just conquered the rival town of Treviso and entered the city walls in triumph when he fell violently ill. Within hours he was dead. Several medieval chroniclers wrote that, shortly before his conquest, Cangrande had drunk at a poisoned spring, but Fornaciari doubted this hypothesis. “I’m always skeptical about claims of poisoning,” Fornaciari says. “Since Cangrande died in the summer, with symptoms including vomiting and diarrhea, I originally suspected that he’d contracted some sort of gastrointestinal disease.”

The answer to the puzzle was contained in Cangrande’s body, naturally mummified in the dry, warm air of his marble tomb, making it a treasure trove of information on Renaissance existence. His pathologies, unfamiliar today, made perfect sense for a 14th-century lord and warrior on horseback. The curious arthritis visible in Cangrande’s hips, knees, elbows and sacro-lumbar region indicates what Fornaciari terms “knightly markers,” disorders developed by cavalrymen during a lifetime in the saddle, wielding weighty weapons such as lances and broadswords. His liver disease may well have been caused by a virus, not alcohol, because hard liquor was unknown in Cangrande’s day. The knight’s respiratory ailments were likewise linked to life in a world lighted and warmed by fire, not electricity. Torch-lit banquet halls and bedchambers, where chimneys became widespread only a century later, and the smoky braziers used in army tents while on campaign, caused the kind of lung damage that today could be found in coal miners.

Strangest of all, however, were the results of pollen analysis and immunochemical tests conducted on Cangrande’s intestines and liver. Fornaciari isolated pollen from two plants: Matricaria chamomilla and Digitalis purpurea. “Chamomile,” he told me, “was used as a sedative; Cangrande could have drunk it as a tea. But foxglove? That shouldn’t have been there.” The plant contains digoxin and digitoxine, two potent heart stimulants, which in doses like those detected in Cangrande’s body can cause cardiac arrest. During the Middle Ages and the Renaissance, foxglove was used as a poison.

In fact, the symptoms mentioned by contemporary chroniclers—diarrhea, stomach pains and fever—matched those of digoxin and digitoxine poisoning. Hence, Fornaciari concluded, Cangrande had been murdered. As it happens, a contemporary chronicler reported that a month after Cangrande’s death, one of the nobleman’s doctors had been executed by Mastino II, Cangrande’s successor, suggesting the doctor’s possible involvement in a plot to kill his master. Who ultimately was responsible for the murder remains a mystery—an assertive fellow like Cangrande had plenty of enemies—although the ambitious Mastino II himself now emerges as a prime suspect.“I thought the poisoning story was just a legend, but sometimes the legends are true,” Fornaciari says. “Paleopathology is rewriting history!”

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Fornaciari trained as a medical doctor, and when I met him in his office at the department of oncology at the University of Pisa, he was applying his expertise to the present, peering through a microscope at samples from biopsies performed at the nearby university hospital. “I have to distinguish benign from malignant tissues,” he said, nodding to trays of samples stacked beside the microscope. “I have to be right, or there could be serious consequences for the patient—a surgeon could remove a healthy lung or breast, or leave a deadly malignancy in place.”

Now age 70, Fornaciari is an exemplar of that by now endangered species, the Italian university professor of the old school, who combines an almost fin de siècle formality with personal warmth and a disarming passion for his work. The son of factory workers in Viareggio, a coastal town near Pisa, Fornaciari earned his M.D. at the University of Pisa in 1971. He’s always been fascinated with the past, and from the outset of his medical training made forays into the health, quality of life and lifestyles of distant eras. During medical training he also took courses in archaeology and participated in excavations of prehistoric and Etruscan sites throughout Tuscany. In the early 1980s, the center of gravity of Fornaciari’s work began to shift from present to past, as he joined Vatican researchers charged with examining the remains of several prominent saints, including Pope Gregory VII and St. Anthony of Padua .

In 1984, Fornaciari agreed to lead an investigation of the most significant noble remains then to have been exhumed in Italy, the 38 naturally and artificially mummified bodies of the Aragonese royal family of Naples—major figures in the Italian Renaissance, buried in the Neapolitan basilica of San Domenico Maggiore. Fornaciari began to collaborate with scholars in Pisa and across Italy, who coalesced into an interdisciplinary team centered in Pisa. His investigators, here and in other parts of Italy, range from archaeologists to parasitologists and molecular biologists.

“Gino recognizes the fundamental importance of historical documentation and context in ways that I haven’t seen anyone else do,” says Clark Spencer Larsen of Ohio State University, a physical anthropologist who, with Fornaciari, co-directs a field project in Badia Pozzeveri, a medieval monastery and cemetery near Lucca. “He’s knowledgeable in many other areas as well. He’s pragmatic and interested in whatever answers the question, ‘How are we going to figure this out?’”

By now, Fornaciari had become the go-to guy for old bones in Italy, and was tackling an ever-growing range of centuries-old corpses, including an entire community overwhelmed by the Black Plague in Sardinia, and a cache of 18th- and 19th-century mummies in an underground crypt in northeastern Sicily. Then, in 2002, he and his team struck the mother lode of paleopathology when they were invited by the Italian minister of culture to investigate the 49 graves in the Medici Chapels in Florence, one of the most significant exhumation projects ever undertaken. Fornaciari still leads the ongoing investigation.