Gino Fornaciari
Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina. Sezione di Paleopatologia. Università di Pisa. Via Roma, 57 – 56126 Pisa.
Henry VII (? 1211 – Martirano 1242), eldest son of the emperor Frederick II and Constance of Aragon, was appointed king of Germany in 1220, when still a child.
At the age of majority, in 1229, he came into conflict with Frederick II in support of the German aristocracy and the claims of the Lombard Communes. Having headed a revolt in 1235, he was defeated and forced to submit. Thus he was confined in various fortresses of southern Italy and died on 10 February 1242, at the age of 31, falling into a precipice, perhaps committing suicide.
On 4 November 1998, a team of palaeopathologists led by Professor Gino Fornaciari of the Department of Oncology of Pisa University, in collaboration with Professor Pietro De Leo of the History Department of Calabria University, explored the tomb of Henry VII in the Cathedral of Cosenza.
Bone consolidation and restoration, carried out at the Laboratory of Human Palaeontology of Pisa University, directed by Professor Francesco Mallegni, made it possible to perform an accurate anthropological and palaeopathological study.
The extraordinary re-utilised Roman sarcophagus (Figure 1) contained the incomplete and fragmentary skeleton, in partial anatomic connection, of a vigorous adult male, aged 30-35 years. The individual, originally placed in supine position with the arms over the pubis, was around 1.66 centimetres high, a stature that is to be considered elevated for those times.

Figure 1 – The sarcophagus of Henry II in the cathedral of Cosenza.

The skeleton revealed the presence of numerous Schmorl’s intraspongy hernias, at the level of the dorso-lumbar rachis, as a result of traumas and/or excessive overloads during adolescence (De Sèze and Rickewaert 1979-1981), probably due to the practice of horse riding.
The study showed severe deformity of the left rotula, caused by considerable development of the lower apex, with extensive posterior periostitic reactions, while the left rotula appeared smaller and hypotrophic. X-ray examination showed good ossification of the left rotula and apex, while the right rotula presented diffused osteoporosis, confirming the macroscopic finding. It probably consisted in a secondary lesion following a severe trauma of the ligaments of the right knee occurred in generic amoxil otc, caused by a pull of the inferior tendon of the femoral quadriceps and resulting in hypofunctioning of the homolateral limb with consequent overload and functional involvement of the right inferior limb.
A missed regression – with abnormal ossification – of a subsidiary and inferior rotula nucleus (Sinding-Larsen-Johannson’s disease), sometimes following traumas or protracted overload (Köhler and Zimmer 1967) can also be hypothesised. However the lesion, primitive or secondary, seriously compromised the subject’s pace. The data agrees with what is known about the physical features of Henry VII, who had been assigned the nickname “the lame” (Kantorowicz, 1976).
The facial bones revealed total resorption of the anterior nasal spine with exposure of cancellous bone and partial cortical “capping”, evident remodelling of the lateral and inferior margins of the nasal aperture (Figure 2), numerous lesions in form of confluent pits and erosions in the mid-zone of the palatine processes on the oral surface, extended periostitis of the nasal surface of the palatine, with considerable enlargement of the naso-palatine duct, and bilateral periostitis of the zygomatic bones.

Fig. 2 – Total resorption of nasal spina with remodeling of margins of the nasal opening.

The individual shows all the pathognomonic stigmata of a rhinomaxillary syndrome (Andersen and Manchester 1992) also known as facies leprosa of Møller-Christensen (1983), caused by severe mucus-purulent chronic rhinitis typical of lepromatous leprosy.
The post-cranial skeleton presents extensive wide diaphyseal periostitis of the femurs, with bilateral diaphyseal remodelling and thinning, with subtotal resorption of the epiphyses, of the fourth metatarsals and proximal phalanxes (Figure 3).

Figure 3 – Bilateral thinning and subtotal resorption of the distal diaphyses of the fourth metatarsals and proximal phalanxes.

These aspects are characteristic of leprosy of the extremities, and in particular of the feet (Aufderheide and Rodriguez-Martin 1998).
We can conclude that this was a case of lepromatous leprosy, the most severe and diffused in the past, in quite advanced stage of development. The infection and clinical overture certainly started some years before the death and the disfiguring conditions of Henry VII must have obliged him to forced isolation, until his dramatic suicide.
On the basis of this scenario, not only does Frederick II appear less cruel, as a father, but he must also be absolved from the severe suspicion of his son’s murder.
Previously, there had been only two cases of mediaeval sovereigns affected by leprosy. The former was Baldovino IV (1160-1185), king of Jerusalem, known as the leprous king, whose disease is recorded only in historical sources (Mitchell 2000); the latter was the king Robert of Scotland (1274) whose illness, historically well known, was diagnosed directly on the skeletal remains, on the basis of the facies leprosa observed at the cranial level (Møller-Christensen 1983).
The case of Henry VII is important not only from a historical point of view, but also because it represents the first osteoarchaeological diagnosis of leprosy in Italy.

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