Gino Fornaciari,  Angelica Vitiello,  Sara Giusiani,
Valentina Giuffra,  Antonio Fornaciari*,  Natale Villari**

Department of Oncology, Transplants and Advanced Technologies in Medicine
Division of Paleopathology
University of Pisa, Italy
*Department of Archeology and History of Arts
Section of Medieval Archeology
University of Siena, Italy
**Department of Clinical Physiopathology
Section of Clinical Radiology
University of Florence, Italy


Within the framework of the Medici Project, a paleopathological team of experts from the University of Pisa, the University of Florence and the Superintendence for Florentine Museums, is carrying out a study on 49 tombs of some of the Medici family members  (16th-18th centuries) housed in the so-called Basilica of San Lorenzo in Florence. The project involves disciplines such as paleopathology, funerary archeology, physical anthropology, paleonutrition, parasitology, histology, histochemistry, immuno-histochemistry, electron microscopy, molecular biology, and identification of ancient pathogens. The most recent biomedical imaging technologies have been employed to obtain as much information as possible about the genetic make-up, eating habits, life styles and diseases of these important rulers of Renaissance Florence. The first anthropological and paleopathological results are presented here.

Key words: Medici, Florence, anthropology, paleopathology



Starting from the 14th century, the Medici gradually became one of the most powerful families of Italian Renaissance accumulating vast wealth through banking, commerce and skilful political ventures. This brought them to the forefront of social and political power in Tuscany and especially in Florence, which was the intellectual centre of the Western world. Lovers of literature and science, the Medici were patrons of several of the great artists of that period, such as Michelangelo, Leo­nardo da Vinci, Botticelli, Galileo, and Benvenuto Cellini.
The senior branch of the Medici family was that of Lorenzo the Magnificent (1446-1492), while the junior branch – that of the Grand Dukes of Tuscany – began with John of the Black Bands (1498-1526) and ended with Gian Gastone (1671-1737), the last Grand Duke. The most important members of this latter branch, less famous than the former, were buried under the vaults of the Basilica of San Lorenzo in Flor­ence1. In 2002, dr. Antonio Paolucci, Superintendent for the Florentine Museums, granted permission to examine 49 of the Medici family members buried in the church.
The Medici Project involves collaboration among scientists from the University of Pisa, the University of Florence and the Superinten­dence for Florentine Museums. The research programme includes paleopathology, funerary archeology, anthropol­ogy, paleonutrition, parasitology, pathology, histology, histochemistry, immunohistochemistry, electron microscopy, molecular biology, and identification of ancient pathogens. The most recent biomedical techniques  have been employed to obtain as much information as possible about the life style, health, and environment of these mighty rul­ers of Renaissance Florence2.
In order to conduct this study, a provisional laboratory was set up in the Lorena Chapel, which is the funerary crypt of the Grand Dukes of the Lorena dynasty, that ruled Florence and Tuscany after the Medici until 1859.
Some burials had already been explored during the Second World War3, so we decided to begin our examination with the intact tomb of Gian Gastone, the last Medici Grand Duke (1671-1737). The removal of a plain dark marble disk, considered a simple floor decoration, displayed a secret opening, with a small stone stair leading to an unknown hidden crypt. The small funerary crypt revealed a low raised plank supporting a large sarcophagus, and many small wooden coffins, which had collapsed to the floor, and were covered by a layer of dry mould, caused by the disastrous flood of 1966. Following the advice of the Opificio delle Pietre Dure in Florence, the famous Institute for the conservation of works of art, a special on-site climate-control chamber was built over the entrance of the crypt to face the problems of extreme dampness (90%) and high temperature (30°C) and to avoid additional damage to the coffins and bodies by the introduction of external air during the archaeologists’ examination.
The outer wooden sarcophagus of the Grand Duke Gian Gastone, apparently well preserved, was in fact very fragile, because of the high levels of humidity. The lid of the sarcophagus was badly damaged and had fallen inwards, displaying the inner leaden coffin, with a large Christian cross and six iron handles on the lid. The funerary deposition of the Grand Duke was intact:  he was still wearing his funerary crown in gold-plated copper and was covered by the silk Great Cape (Cappa Magna) of  Grand Master of Knights of the Order of  St. Stephen. He bore a small gold devotional medal in filigree at the neck and a silver crucifix on the chest; a large leaden tube, probably containing a parchment document celebrating his life, was near his right leg. On both sides of the Grand Duke’s head were two large medallions, masterpieces of the royal engraver Louis Siries (1686-1757). The obverse design shows a bust of the Duke on top of a monument be­tween two mountains. The figure of Securitas (Security) with two genii rejoicing in front of her can be seen below the monument. The Latin inscription reads "IO(HANNIS) GASTO(NIS) I ETR(URIAE) MAG(NUS) DUX VII”  (Gian Gastone I, VII Grand Duke of Tuscany). The design on the reverse shows a ruined Temple, with seated figures representing the Arts mourning the death of the Grand Duke, and the Latin inscription “AMPLIATORI ARTIUM” (to the Patron of Arts)3.

Fig. 4 – Severe scoliosis of the lumbar column, with deformity of the pelvis of
Giovanna d’Austria (1578).

Other small coffins collapsed to the floor or randomly distributed on the raised plank and containing  children’s bodies were visible in the crypt. Contrary to all expectations, several of the burials in the small wooden coffins were considerably well-preserved. For example, the elaborate clothes of a 5-year-old child, with shoes and sil­ver crown, showed an excellent state of preservation. The red silk jacket with a thin collar and buttons was adorned with silver gallons and large plus-fours in the same flowery fabric. The costume is very similar to the one worn by Don Filippino (1577-1582), a young son of the Grand Duke Francesco I, portrayed by Bizzelli (1586), where he appears with his mother, the Arch Duchess Joanna of Austria.
Other burials including the remains of an unknown child, about one-year-old, wearing a precious silk vest with silver cuffs, was less well preserved.

Fig. 1 – Column of Cosimo I (1519-1574): ossification of the anterior right vertebral ligament at the level of the 6th, 7th and 8th  thoracic vertebral bodies (DISH).



Fig. 2 – Rough horizontal craniotomy of the skull of Cosimo I, obtained with a bone saw and a large chisel (1574).



Fig. 3 – Skull of Giovanna d’Austria (1548-1578) with alveolar prognathism and amelogenesis imperfecta (detail).



Fig. 5 – Ossification of the anterior right vertebral ligament, at the level of the 5th -11th thoracic vertebral bodies (DISH) of the column of Ferdinando I (1609).



Study of the skeleton of Cosimo I  (1519-1574), 1st Grand Duke of Tuscany, revealed that he was 1.74 m tall, with an athletic body, estimated skeletal age of 50-60 years, medium-sized skull and narrow nose4. His well-developed muscular insertions (deltoid, great pectoral, great dorsal, biceps, forearm and thigh muscles) confirm the historical descriptions reporting on his great physical strength and robusticity5. Skeletal markers left by habitual horseback riding (lumbo-sacral arthritis; exostoses ed ovalization of acetabula; hypertrophy of femoral rectum muscle; strong hypertrophy of the: femoral biceps, great adductor, small gluteus, gluteal tuberosity, pectineus, lateral vastus and gastrocnemius; osteophyitosis of femoral head and fovea and trocantheric fovea; rotation and flattening of the small trochanter; very strong hypertrophy of the soleus muscle) are all present6, confirming his reputation as a highly skilled horseman. The presence of some Schmorl’s hernias reveals that, during adolescence, Cosimo carried heavy burdens on the thorax, probably the body armor of that period7. The clinical history of Cosimo I has been taken from the extremely rich archive data, which contain the reports of the ambassadors and court physicians. Cosimo I  survived several illnesses, including smallpox, malarial fevers at age 24 and 25, ‘gravel’ (renal or bladder calculi) at age 41-43, and bronchitis. Contemporary descriptions indicate that he also experienced severe early arteriosclerosis with paralysis of the left arm at age 48, right hemi-paresis, dyslalia, psychological instability, urinary incontinence, as well as aphasia and agraphia at the age of 54. He also suffered from an acute articular disorder of the right knee, named “gout” by the court physicians, at the age of 49 and 52-53. Finally, death was caused by ‘catarrhal fever’, probably bronchopneumonia, at the age of 558. The paleopathological study of the skeleton reveals that Cosimo’s vigorous physical activity was probably also responsible for his diffused arthritis in the lower thoracic/lumbar spine, sternum, shoulders, elbows, hips, knees and ankles9. Ossification of the anterior right vertebral ligament at the level of the 6th, 7th and 8th  thoracic vertebral bodies (Fig. 1) and the diffused ossifications of the articular ligaments demonstrate that he was affected by DISH  (Diffuse Idiopathic Skeletal Hyperostosis), an articular disease linked to diabetes and obesity10. Study of the teeth reveals a severe periodontal disease, with large abscess cavity and ante mortem loss of the first inferior right molar. At autopsy and embalming of the Grand Duke’s body 11 the court surgeon tried twice but with no success to cut open the skull at the level of the right parietal bone; only in the third attempt was he able to make a rough horizontal cut. The surgeon then opened the skull by inserting a large chisel, which caused damage to three different points of the skullcap (Fig. 2).


The study of the skeleton of Eleonora of Toledo (1522-1562), wife of Cosimo I, revealed a woman aged 36-46 years, 1.58 m tall, with a medium low skull, high orbits and narrow face and nose12. Her muscular insertions (deltoid, great dorsal, forearm muscles, thigh muscles and soleus muscle of the right leg) show a fairly good muscular activity13. The clinical history of Eleonora is characterized by eleven births which took place between the ages of 18 and 32. As a result of her many deliveries, at about 29 years of age she developed pulmonary tuberculosis which, together with an attack of pernicious malaria, killed her at the age of 4014. A famous portrait by Agnolo Bronzino exhibited in the Uffizi Gallery depicts a very thin, emaciated and ailing Eleonora, affected by phthisis.  The paleopathological study of Eleonora’s skeleton revealed that she had experienced a mild form of rickets during childhood, made evident by the curvature of her tibias15. It is not surprising that she presents the pelvic skeletal markers of her numerous deliveries, in the form of large pre-auricular grooves and retropubic foveae16. At the time of death, Eleonora suffered from severe dental disease with destructive caries, and was affected by slight arthritis in her lower spine and shoul­ders, elbows, hips, knees and ankles17.

The study of the skeleton of Cardinal Giovanni (1543-1562), second son of Cosimo I and Eleonora, revealed a young man with anthropological age of 19 years and stature of 1.75 m. The clinical history attests that he died from pernicious malaria after a visit to the swampy Maremma. The paleopathological study evidenced an advanced caries, with abscess of the left first upper molar and slight enamel hypoplasia, which suggests stress episodes at the age of 2 and 3 years. Some Schmorl’s hernias, present on the thoracic and lumbar vertebral bodies reveal that, during adolescence, the column of Giovanni had carried very heavy loads18.

The skeleton of Don Garzia (1547-1562), seventh son of Cosimo I and Eleonora, who died of pernicious malaria in the same way as his mother and brother, is that of a young 15/16 year-old-adolescent, 1.67 m tall. The paleopathological study reveals a non-penetrating caries of the left first upper molar and enamel hypoplasia, which indicates many stress episodes, at the ages of 2, 3 and 4 years.

The study of the skeleton of  Francesco I (1541-1587), 2nd Grand Duke of Tuscany, reveals that he was a vigorous man, with skeletal age of  40-50 years, a stature of 1.74 m, a medium-sized skull and a narrow nose19. The muscular insertions (deltoid, great  pectoral, great dorsal, biceps, forearm muscles) indi­cate a man of great physical strength 20. The skeletal markers associated with habit­ual horseback riding 21 already noticed for Cosimo I, are almost all present22. This new data changes completely the traditional view of Francesco I as an intel­lectual, sedentary scholar, nicknamed ‘the prince of the studiolo’ for his devotion to his humanistic and al­chemic studies. On the contrary, Francesco evidently led a physically active life23. According to the archival records we know that Francesco I survived several episodes of non-severe illness such as acute bronchitis at the age of 20 and bronchopneumonia at the age of 38. After putting on quite a lot of weight around the age of 35, and suffering from ‘gravel’ with colics at 44 and 45 years of age, he died of pernicious malaria at 4624. The Grand Duke was fascinated with applied sciences and developed a deeply rooted interest in alchemy, which he practiced with great success. He was able to fuse the rock crystal and to manufacture, in his laboratory in the Pitti Palace, a ware with a translucent body called ‘Medicean porce­lain’, very similar to the luxury wares imported from China25. As an alchemist, he certainly came into contact with chronic metallic poisons, and the toxicological study of his bone tissue will be important to establish to what extent he was exposed to the different sub­stances. The rumors according to which Francesco I and his second wife the Grand Duchess Bianca Capello were poisoned by arsenic compounds by the Grand Duke’s brother Ferdinando – who succeeded him on the throne – are certainly false26. Owing to the wide use that the surgeons of that time made of arsenical mixtures in both embalming and visceral processing27, it is probable that toxicology will be not able to verify this legend. The paleopathological study of the skeleton showed that Francesco I suffered from moderate vertebral and extra-vertebral arthritis28. Finally, the sectioning of the body of the sternum, clearly made in the course of autopsy29, is worth mentioning.

Fig. 9 – Vertebral block of the C6-C7 bodies with wedge-shaped collapse, fusion, and formation of an angular kyphosis (Pott’s disease), of the Cardinal Carlo (1666).


The Grand Duchess Giovanna d’Austria (1548-1578), first wife of Francesco I, was a very religious woman, as confirmed by the discovery of her well-preserved rosary, made in simple wood. Joan appears in numerous portraits and was considered an ugly woman and described as ‘hunchbacked’ by some contemporary reports. She survived six very difficult deliveries, but died in childbirth at the age of 30 after rupture of the uterus30. Study of the skeleton reveals that Giovanna was a woman with skeletal age of 25-35 years, a stature of 1.57 m, medium-low skull and orbits and narrow face and nose31. Her weak muscular insertions suggest that her physical activity was very limited. Her sternum had been sectioned during autopsy. The paleopathological examination of the skeleton was able to detect a large number of disorders:

  • prognathism: (anterior) projection of the mandible (the famous Habsburg jaw) (Fig. 3)
  • marked congenital hyperostosis (about 1 cm) of the cranial vault
  • amelogenesis imperfecta: congenital malformation of the dental crowns (Fig. 3, detail)32
  • severe scoliosis of the lumbar column with impressive deformity of the pelvis (Fig. 4), which well explains her difficult deliveries and death following rupture of the uterus
  • incomplete congenital dislocation of the hip33
  • clear signs of numerous and difficult deliveries, such as enormous retro-pubic foveae, and deep pre-auricular sulci34


Fig. 6 – Scoped-out defect at the interphalangeal joint of the hallux dorsum, with evident sclerotic margin (detail), by chronic gout, in the left foot of Ferdinando I (1609). .



Fig. 7 – Severe scoliosis of the lower thoracic and lumbar column of Cristina di Lorena (1565-1636).



Fig. 8 – Marked hypoplasia of the right mandibular corpus, with right deviation of the face, of the Cardinal Carlo (1595-1666).



What follows is the report of the death of Giovanna d’Austria and the results of her necropsy, as published by the obstetrician Resinelli in 1912 and cited by Pieraccini:
“…la Gran Duchessa come hebbe desinato, che erano circa diciassette hore, si levò da tavola con certe dogl(i)e, le quali non furono molto grandi, et alle 20 hore et 1/2, gettò gran copia d’acqua … et alle 4 hore in circa, apparve un braccio del putto vivo, et si battezz&ograv

Dipartimento di Ricerche Traslazionali e delle Nuove Tecnologie in Medicina e Chirurgia
Università di Pisa



Scuola Medica
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