Valentina Giuffra*,  Antonio Giuseppe Naccarato*, Davide Caramella**, Antonio Fornaciari°, Silvia Marvelli°°, Gino Fornaciari*

*Divisione di Paleopatologia, Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina, Università di Pisa; **Divisione di Radiologia Diagnostica ed Interventistica, Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina, Università di Pisa;
°Dipartimento di Archeologia e Storia delle Arti, Area di Archeologia Medievale, Università di Siena; °°Laboratorio di Palinologia – Laboratorio Archeoambientale, Centro Agricoltura Ambiente Giorgio Nicoli, San Giovanni in Persiceto, Bologna

Key words: artificial mummies, embalming, Italy, Renaissance, Siena
Palabras clave: momias artificiales, embalsamacion, Italia, Renacimiento, Siena

Two artificial mummies found in the hospital church of S. Maria della Scala in Siena (Tuscany, central Italy) and dated back to the end of the 15th century, were examined. The mummies, in good state of preservation and still wearing their Renaissance clothes, were identified as the rector of the hospital, named Salimbene Capacci, and his wife, Margherita Sozzini. Imaging studies, X-rays and CAT were performed. Autopsy made it possible to ascertain that the bodies had been eviscerated by a longitudinal cut from the neck to the pubis and that the thoracic and abdominal cavities had been filled with vegetable material. The pelvis was not eviscerated and the pelvic organs were conserved. The skull showed no traces of craniotomy or excerebration.

In the spring of 1999 restoration work was conducted in the Santissima Annunziata Church of Santa Maria della Scala Hospital in Siena. On this occasion a funerary chapel reappeared under the floor of the church, precisely under the altar of the hospital’s mythical founder, the blessed Sorore. It contained three mummified bodies which were very well-preserved, thanks to the favourable microclimatic conditions of the chapel, and were still wearing their original clothes. This finding aroused a large scientific interest, because “dressed” mummies in Italy dating back to the XV century are very rare.
More precisely, two of these mummies had already been discovered in 1678 and correctly identified with Salimbene Capacci, rector of the Hospital of Santa Maria della Scala in the second half of the XV century, and his wife, Margherita Sozzini. In fact, the discovery of the two mummified bodies during restoration of the floor inside the church is recorded in an archive document dating back to  1678. The description of the clothes and the burial place fits perfectly with the conditions encountered in 1999. The third body was not found in the chapel in 1678, but was added some time later.
The three mummies were then rediscovered during restoration work carried out in 1948, as attested by two handwritten pages contained in a lead tube placed in the interior of one coffin; the document was written on 8 September 1948 by Guido Tucci, supply officer of the Hospital. In the same period the Superintendent of Monuments Peleo Bacci carried out an investigation which established the identity of the two mummies, as confirmed later by an archive research. However, he erroneously identified the third body with a XV century painter, Lorenzo di Pietro, also known as “the Vecchietta”, and decided to close the chapel again. The mystery has been solved only recently and it has been ascertained that the third body belonged to Girolamo Macchi, who lived between 1648 and 1734 and worked as “major writer”, a sort of accountant for the Hospital. He was present when the corpses were discovered in 1678 and was so impressed by this finding that he wanted to be buried in that chapel after his death (Martellucci, 2002).
The XV century mummies were enclosed in rough coffins, decorated with a painted cross on the lid. The coffin of Margherita Sozzini was still closed at the moment of the finding, with the mummy of Salimbene Capacci deposed on the lid; on the contrary, the coffin of Girolamo Macchi was opened, with the lid leaning against the wall. He was wearing a white dress (gown), with a rosary in his hands and his feet tied up with a strip.
The present work focuses on the two mummies of the XV century, the most ancient and more interesting for the embalming process adopted, leaving the case of the 18th century mummy  for future study.

Historical Notes
The Hospital of Santa Maria della Scala, one of the most important Institutions in Siena, is a large  complex, deeply rooted in the history and traditions of the town. Positioned along the Via Fracigena, right opposite the cathedral, Santa Maria della Scala represented one of the first European examples of orphanage and hospital (Piccinni, 1996).
A popular tradition, now disproved, attributes its foundation to a modest shoemaker named Sorore, in 828 A.D. The first document witnessing the existence of the Hospital is dated back to 1195. The institution was first administered and managed by a religious order dedicated to works of charity. For many centuries the main activities of the Hospital consisted in helping the poor, curing the invalids, giving hospitality to the pilgrims and sheltering and bringing up the foundlings. A Rector, elected by the Church Chapter and confirmed by the Bishop and the Canons, was responsible for the direction of the Hospital. He was chosen among the richest families in Siena, and had to donate all his goods to the Institution before coming into office. Bequests of Friars and Sisters and donations of private citizens contributed to the growth and importance of the hospital. All these properties represented the first nucleus of the large agricultural estate, known as grances, representing a huge patrimony that was to become possession of the Hospital in the following centuries. Starting from the second half of the XIII century the Municipality of Siena became more and more interested in the activities of Santa Maria della Scala, and starting from the first years of the XV century the Rector was no longer elected by the Friars, but appointed by the Commune, to which the Hospital was more deeply connected, if not subjected (Banchi, 1877).
It is in this period that the lives of Salimbene Capacci and Margherita Sozzini are to be inserted in the Hospital events. The biographical and historical information about Salimbene Capacci comes from documents of the Santa Maria della Scala archive and from the volume on the Rectors of the Hospital drawn up by Luciano Bianchi in 1877. Salimbene, son of the notary Cristofano Capacci and of Biagia Piccolomini, was born in Siena in 1433. He married Margherita Sozzini, daughter of the famous jurisconsult Mariano, in 1459. He was elected Rector of the Hospital in February 1479, after 6 months in which the position had remained vacant, owing to a plague epidemic that affected the town in the summer of 1478.
In that period Siena was ravaged not only by the pestilence, but also by political fighting between the opposite factions of Riformatori and Noveschi. These contrasts were responsible for the expulsion of Salimbene, who was a Reformer, from the charge of Rector in July 1480, when he was deposed from office in favour of Cino di Cecco Cinughi, belonging to the faction of the Noveschi. Salimbene was then esiliated in Camerino, Marche, and only in February 1483 was he able to resume the direction of the Hospital, where he remained until 1497, the year of his death.
In 1484 the town of Siena sent Salimbene, together with three other ambassadors, on a religious and political mission to meet and pay obedience to the new Pope Innocenzo VIII. The mission was delicate, because the Sienese had to apologise for having forced him to flee from the town, where he had been sent as papal legate, owing to the repeated and violent disorders of that period.
The death of Salimbene occurred after a long period of infirmity in 1497 and solemn exequies were tributed to him. A detailed description of his death and of the funeral rites is reported in the Deliberations of the Chapter (tomo VI, c.49). He was buried in the church of the Hospital, in front of the altar of Santa Francesca, which no longer existed in the XIX century. An inscription placed near the door of the funerary Chapel recording the burial place, stated: “Sepulchrum – D. Salimbenis de Capaccis – Rectoris An. D. MCCCCXCVII – Die III novembris – Et d. Margheritae d. Mariani – De Sozzinis eius uxoris – A.D. MDXI die XV aprilis – Quod repertum fuit die – XXVI mens. Ian. MDCLXXVIII” (Banchi, 1877).
The life of Margherita Sozzini is closely linked to the Hospital events as well. During the second period of rectorship of her husband, begun in 1483, she was entrusted the responsibility and direction of the Institution’s female ward, including management of the foundlings. She also maintained her functions after the death of Salimbene, whom she outlived many years. She died in fact in 1511.

Materials and Methods
The imaging studies were performed at the Division of Diagnostic and Interventional Radiology of the University of Pisa using a CT scanner GE Sytec, Kv 120, MA 100, slice thickness 10 mm, field of view 42 cm. Although this was a third generation CT scanner, the tridimensional images obtained were acceptable. These exams were among the first Computer Tomography examinations carried out by the paleopathology team of Pisa; the classic stair-step artefact of the images is due to the fact that slice thickness was 10 mm, whereas slice thickness obtained using the most modern scanners is currently below 1 mm.
Autopsy was performed on both mummies. The presence of the arms folded across the lower thorax did not allow to open the bodies ventrally; they were then positioned on its stomach. The back was opened by cutting the skin layer with scalpel and scissors. Two openings were obtained at the sides of the spine from the shoulders to the lower thorax and the epidermis was folded externally. The ribs were exposed and then cut with shears to reach the thoracic cavity. Autopsy of the abdominal cavity was carried out by turning the mummies on their backs and opening the abdomen with a vertical cut from the region under the arms. In case of Siena 1 the head was detached from the body and opened by performing an horizontal cut passing through the foramen magnum with a saw.
Fragments of tissue belonging to different organs were sampled and rehydrated using Sandison’s solution (Sandison, 1955) and were submitted to routine histological processes.
The botanical analyses were carried out at the Palinology Laboratory of the Centro Agricoltura Ambiente Giorgio Nicoli, San Giovanni in Persiceto, Bologna. The samples were analysed at stereo- and light microscope. The samples for pollen analysis were processed according to standard techniques and analyzed at light microscope.

Siena 1
Macroscopic examination – The mummy of the man is lying on its back, with its arms folded across the lower thorax, the left forearm higher than the right forearm, and the legs extended (Fig.1). The skin is largely present on the body and well-preserved, except for the mandible, which is partly skeletonized. The hair of the mummy is well preserved. The nasal and auricular cartilages are absent. A cut, starting from the upper thorax and reaching the left side of the lower abdomen, was performed to eviscerate the body and was sutured with a rough thread (Fig.2a). The external genitalia are well preserved. Flattening of the buttocks may be attributed to the position of the corpse after deposition.

Imaging studies – CT – The scout-view evidenced a male skeleton with anthropological age of more than 50 years. Dentition suffered from intra-vitam tooth loss, in particular of the posterior teeth: the lower right second premolar, lower right and left molars, upper right third molar and two upper left molars are lost (Fig.2b).
A thick layer of post-mortal material is present in the sloping portion of the back. The spine and the joints are in good condition azithromycin online. Residual organs in the inferior abdomen, probably intestinal loops, are visible; prostate remains are also recognisable (Fig.2c). The penis is conserved.

AutopsyUnder the back epidermis a layer of dark-coloured material of earthy, powdery consistency, grouped in round-shaped clots, was evidenced under the skin (Fig.2d). This material, identifiable with the remains of muscular tissues and blood, was removed and sampled. The thoracic cavity appeared completely empty. This finding attested the removal of the thoracic organs during the embalming process, performed through an evisceration incision on the left of the thorax. The larynx, ribs and rib cartilage were sampled. The abdominal cavity had been filled with vegetal material, entirely sampled to be submitted to botanical analysis. Some visceral organs were still in situ; in particular, the remains of the bladder, prostate and  terminal segment of the intestinal tract were identified and sampled, as well as the femoral aorta and muscular bundles. The brain resulted powdered and assembled in little rounded masses of earthy consistency. The dura mater, a very rare finding in human mummified bodies, was very well-preserved and solidly attached to the internal table of the skull. The meninges and the hypophysis membrane were sampled.

Description of the samples and histology – The dura mater is intact and surprisingly well-preserved (Fig.3a). The big sickle is well recognisable and a large vessel, identifiable with the middle meningeal artery, is evidenced in the posterior region.
The larynx retains its typical structure, with its hyoid bone and thyroid, cricoid and tracheal cartilages (Fig.3b). Histological examination of the thyroid showed abundant tissue containing round follicles, filled with acidophil, colloid-like material (Fig.3c).
The femoral aorta is represented by the long tract of a large blood vessel, with calcific formations on the wall, divided into three branches in its inferior tract. The superior portion, which is the largest one, corresponds to the aorta, whereas the inferior tract is to be identified with the common iliac, with its two ramifications, external and internal iliac. The last one is then divided into two branches, the anterior and posterior trunk. The histological aspect of the external iliac shows the media tunic with a patterns of elastic tissue and lamellae.
The prostate is composed by a central fibrous structure, surrounded by perineal muscles (Fig.3d). Histology revealed dense fibrous tissue containing muscular fibers and roundish cavities of variable size.
The bladder is represented by a small fragment and the rectum by a short segment of the anal cavity.

Botanical analysis – Embalming materials used for Siena 1 are represented by macroremains of Rosemary (Rosmarinus officinalis), sage (Salvia) andfoxtail (Alopecurus).Flaxtows (Linum usitatissimum) were usedto fill the abdominal cavity.
Pollens were found of deciduous Oaks (Quercus deciduous: 3.5%), Olive (Olea europaea: 10.5%), Walnut (Juglans regia: 3.5%), Chenopodiaceae (29.8%), flax (Linum usitatissimum: 1.8), mint (Mentha: 1.8%), sage (Salvia: 1.8%), aloe (Aloe vera: 1.8%), dill (Anethum: 1.8%), felon herb (Artemisia: 7.0%), Caper (Capparis: 1.8%),chamomile (Matricaria chamomilla: 3.5%), hemp (Cannabis sativa: 5.3%).

Siena 3
Macroscopic examination – The mummy of the woman is lying on its back, with its arms folded across the lower thorax, the right wrist on the left one, and the legs extended (Fig.4). The head is flexed to the right. The skin is largely present, except for the head, which is partly skeletonized, and the thorax, the contents of which are partly exposed. The superficial tissues have been largely attacked by moths. The woman was probably obese, as attested by the large cutaneous folds. Staunching at the level of the neck was probably caused by the presence of a hat. The nasal cartilage is partly conserved; the nails are well preserved. The breasts have descended laterally. The evisceration incision was performed from the upper thorax to the pubis. In order to eviscerate the body and fill the thoracic cavity, the sternum was sectioned and the ribs opened. The decubitus caused flattening of the buttocks. The muscular bundles at the level of the calfs are well visible.

Imaging studies – CT – The mummy belongs to a woman whose skeletal age is more than 50 years. Considerable tooth loss is evidenced, especially in the area of the jaw; the remaining teeth show marked wear with crown flattening, in particular of the lower right molars (Fig.5a). A post-mortal fracture of the pubic symphysis on the right is documented. The woman suffered from right sacro-ileitis, with dense aspect of the ileum. The hip joint shows a slight bilateral arthritis. In the inferior abdomen tissue remains, probably intestinal loops and pelvic organs, are conserved.

Autopsy – The thoracic cavity resulted eviscerated and filled with vegetal materials (Fig.5b). The esophagus, sternum, rib cartilage and aorta, as well as the breast were sampled. Some pelvic organs had been left in situ; the pouch of Douglas, an extension of the peritoneal cavity between the rectum and posterior wall of the uterus, was sampled.
Embalming materials used for Siena 3 are represented by flax tows (Linum usitatissimum) to fill the cavity.
Description of the samples and histology – The breast is very well-preserved, with its adipose tissue; a duct and the nipple are recognisable (Fig.5c). At histology the breast appeared formed by fibrous and adipose tissue (Fig.5d). 
The pouch of Douglas is composed by long muscular and vascular structures, belonging to the posterior left abdominal wall, and by what seems to be the pelvic hole. In the anterior portion some hole structures are evidenced; the highest one could be identified with a transversally disposed intestinal ansa, the intermediate with the bottom of the uterus, whereas the infero-posterior structure could be the rectum. Histology shows that the uterus wall is formed by a fibrous myometrium.

Botanical analysis – In Siena 3 pollens were found of various Labiatae such as Rosemary (Rosmarinus officinalis: 26.3%), thyme (Thymus: 26.3%), mint (Mentha: 10.5%), sage (Salvia: 21.0%) and wheat (Triticum: 5.3%).


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Fig. 1. Siena 1 mummy


Fig. 2. Siena 1: fig.2a the sutured cut on the thorax; fig.2b scout-view; fig.2c CT scan of the inferior abdomen; fig.2d autopsy from the back


Fig. 3. Siena 1; fig.3a Dura mater; fig.3b the tyroid (black arrow) and the trachea (white arrow); fig. 3c histologic aspect of the tyroid tissue (EE 40×1); fig.3d the prostate (black arrow) surrounded by perineal muscles  


Fig. 4. Siena 3 mummy


Fig. 5. Siena 3: fig.5a Scout-view; fig.5b the eviscerated thoracic cavity and the filling with vegetal materials; fig.5c the brest; fig.5d the histologic aspect of the breast (EE 10×11)