Francesco Maria Fiorentini (1603-1673): An Italian physician in 'The Iron Century'

The aim of this paper is to shed light on the figure of Francesco Maria Fiorentini, a 17th-century physician from Lucca (Tuscany, Italy) and member of the Iatromechanical School, who distinguished himself for his role during the plague and the typhus epidemics that spread throughout Italy in the first half of that century. His work must be contextualized in a precise historical moment, which marked the gradual transition of Western medicine from the archaism of Galenic doctrine to that of the Iatromechanical School, when the foundations started to be laid for an experimental type of medicine that based its assumptions on the direct observation of phenomena concerning the human body. In this work, we mainly focus on the medical biography of Fiorentini and on the reasons why he enjoyed great social prestige among the most prominent figures of his time. However, Fiorentini should also be remembered as a multifaceted scholar, as evidenced by his numerous writings, which underline his erudition in disparate fields of knowledge.

A 14th century CE Brucella melitensis genome and the recent expansion of the Western Mediterranean clade

Brucellosis is a disease caused by the bacterium Brucella and typically transmitted through contact with infected ruminants. It is one of the most common chronic zoonotic diseases and of particular interest to public health agencies. Despite its well-known transmission history and characteristic symptoms, we lack a more complete understanding of the evolutionary history of its best-known species-Brucella melitensis. To address this knowledge gap we fortuitously found, sequenced and assembled a high-quality ancient B. melitensis draft genome from the kidney stone of a 14th-century Italian friar. The ancient strain contained fewer core genes than modern B. melitensis isolates, carried a complete complement of virulence genes, and did not contain any indication of significant antimicrobial resistances. The ancient B. melitensis genome fell as a basal sister lineage to a subgroup of B. melitensis strains within the Western Mediterranean phylogenetic group, with a short branch length indicative of its earlier sampling time, along with a similar gene content. By calibrating the molecular clock we suggest that the speciation event between B. melitensis and B. abortus is contemporaneous with the estimated time frame for the domestication of both sheep and goats. These results confirm the existence of the Western Mediterranean clade as a separate group in the 14th CE and suggest that its divergence was due to human and ruminant co-migration.

Exploring the effects of weaning age on adult infectious disease mortality among 18th-19th century Italians

OBJECTIVES

The developmental origins of health and disease (DOHaD) hypothesis describes how early childhood stress affects morbidity and mortality later in life. The role of early childhood stress in mortality from infectious disease is understudied. Stressors in early childhood that weaken the immune system may result in increased susceptibility to infectious disease in adulthood. Weaning is one of the earliest potential periods of significant stress in early childhood. This research investigates the effect of weaning after ~6 months of age on cholera mortality among 18th-19th-century Italian populations by determining if earlier breastfeeding cessation is associated with earlier mortality, analyzing childhood dietary variation and physiological stress markers, and determining if age-at-weaning completion differs between catastrophic and attritional populations.

METHODS

Serial dentin stable carbon and nitrogen isotope analyses from canines are compared between catastrophic (n = 45) and attritional groups (n = 23). Canines are sectioned serially from crown to apex, and the increment's δ¹⁵ N and δ¹³ C are used to estimate age-at-weaning completion.

RESULTS

Catastrophic and attritional groups exhibit similar age-at-weaning completion (~2.8 years). Seventy-four percent of individuals lack elevated δ¹⁵ N values in dentin that formed during infancy.

CONCLUSIONS

Age-at-weaning completion was not a predisposing factor in cholera mortality in adulthood in this sample. Age-at-weaning completion may not be significantly associated with infectious disease mortality because weaning completion likely occurred after infants had adapted to consuming contaminated weanling foods. Individuals without detectable weaning curves may represent infants who received supplementary foods since birth or were weaned before the age of 6-9 months.

Back to the Middle Ages: Entomological and Botanical Elements Reveal New Aspects of the Burial of Saint Davino of Armenia

The natural mummy of Saint Davino Armeno (11th century) is preserved in the church of Saint Michele in Foro in the city of Lucca (Tuscany, Central Italy). The body of Davino is one of the oldest Italian mummies of a Saint, and his paleopathological study was performed in 2018. In the present research, we investigated the arthropod fragments and botanical remains collected from the body, coffin, and fabrics of Saint Davino. Entomological analyses outlined the presence of 192 arthropod fragments. Among these, Diptera, Muscidae (Hydrotaea capensis and Muscina sp.), and Phoridae (Conicera sp.) puparia were the most abundant. Regarding Coleoptera, Ptinidae (Anobium punctatum) were the most frequent, followed by Cleridae (Necrobia sp.), Trogidae (Trox scaber), Curculionidae (Sitophilus granarius), and Histeridae (Gnathoncus). Cocoons of Tineidae and Pyralidae moths were found, along with a propodeum joined to the petiole and a mesopleuron of an Ichneumoninae parasitoid. Numerous metamera of Julida and three scorpion fragments were also found. Botanical samples indicated the presence of a quite broad botanical community, including gramineous species, olives, evergreen oaks, and grapevine. Overall, entomological data allow us to argue that Saint Davino was first buried into the soil, probably in a wooden coffin, thus supporting the historical-hagiographic tradition according to which he was buried sub divo in the cemetery of Saint Michele. The preservation of the body as a natural mummy may have been facilitated by burial in a coffin that prevented direct contact of the corpse with the earth. Botanical remains offer confirmation of a late medieval urban environment rich in horticultural areas and trees, giving us a landscape that is very different from the current Tuscan city.

Examining pathogen DNA recovery across the remains of a 14th century Italian friar (Blessed Sante) infected with Brucella melitensis

OBJECTIVE

To investigate variation in ancient DNA recovery of Brucella melitensis, the causative agent of brucellosis, from multiple tissues belonging to one individual MATERIALS: 14 samples were analyzed from the mummified remains of the Blessed Sante, a 14 ^th century Franciscan friar from central Italy, with macroscopic diagnosis of probable brucellosis.

METHODS

Shotgun sequencing data from was examined to determine the presence of Brucella DNA.

RESULTS

Three of the 14 samples contained authentic ancient DNA, identified as belonging to B. melitensis. A genome (23.81X depth coverage, 0.98 breadth coverage) was recovered from a kidney stone. Nine of the samples contained reads classified as B. melitensis (7-169), but for many the data quality was insufficient to withstand our identification and authentication criteria.

CONCLUSIONS

We identified significant variation in the preservation and abundance of B. melitensis DNA present across multiple tissues, with calcified nodules yielding the highest number of authenticated reads. This shows how greatly sample selection can impact pathogen identification.

SIGNIFICANCE

Our results demonstrate variation in the preservation and recovery of pathogen DNA across tissues. This study highlights the importance of sample selection in the reconstruction of infectious disease burden and highlights the importance of a holistic approach to identifying disease.

LIMITATIONS

Study focuses on pathogen recovery in a single individual.

SUGGESTIONS FOR FURTHER RESEARCH

Further analysis of how sampling impacts aDNA recovery will improve pathogen aDNA recovery and advance our understanding of disease in past peoples.

A 13th-century cystic echinococcosis from the cemetery of the monastery of Badia Pozzeveri (Lucca, Italy)

OBJECTIVE

To differentially diagnose a calcified formation recovered from a 13th century AD grave from the Tuscan monastery of Badia Pozzeveri, Lucca, Italy.

MATERIALS

A calcified formation from the thoraco-abdominal region of a skeleton buried in the monastery cemetery.

METHODS

Cone Beam Computed Tomography, Scanning Electron Microscope and Energy Dispersive X-Ray Spectroscopy.

RESULTS

A hollow, calcified ovoid formation was identified as typical of a hydatid cyst, permitting the diagnosis of cystic echinococcosis in a 35-45year-old female.

CONCLUSIONS

The study reveals the circulation of the parasite Echinococcus granulosus in the region of Lucca in late medieval Tuscany.

SIGNIFICANCE

This finding is the fourth case of cystic echinococcosis from an archaeological context in Italy and provides insight into environmental conditions that appear to have affected members of a community, irrespective of social status.

LIMITATIONS

Caution and the application of multiple analyses must be exercised in the differential diagnosis to discriminate among calcified formations.

SUGGESTIONS FOR FURTHER RESEARCH

Analysis of stable isotopes of the calcified formation, such as ¹⁵N and ¹³C, in order to compare them with isotopic values of the host individual and to further confirm the parasitic origin of the find.

A human MMTV-like betaretrovirus linked to breast cancer has been present in humans at least since the copper age

The betaretrovirus Mouse Mammary Tumor Virus (MMTV) is the well characterized etiological agent of mammary tumors in mice. In contrast, the etiology of sporadic human breast cancer (BC) is unknown, but accumulating data indicate a possible viral origin also for these malignancies. The presence of MMTVenv-like sequences (MMTVels) in the human salivary glands and saliva supports the latter as possible route of inter-human dissemination. In the absence of the demonstration of a mouse-man transmission of MMTV, we considered the possibility that a cross-species transmission could have occurred in ancient times. Therefore, we investigated MMTVels in the ancient dental calculus, which originates from saliva and is an excellent material for paleovirology. The calculus was collected from 36 ancient human skulls, excluding any possible mouse contamination. MMTV-like sequences were identified in the calculus of 6 individuals dated from the Copper Age to the 17^th century. The MMTV-like sequences were compared with known human endogenous betaretroviruses and with animal exogenous betaretroviruses, confirming their exogenous origin and relation to MMTV. These data reveal that a human exogenous betaretrovirus similar to MMTV has existed at least since 4,500 years ago and indirectly support the hypothesis that it could play a role in human breast cancer.

The 1918/19 Spanish Flu in Pisa (Tuscany, Italy): Clinical, Epidemiological and Autoptic Considerations

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemor agic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.

Insights on Funeral Practices and Insects Associated With the Tombs of King Ferrante II d'Aragona and Other Renaissance Nobles

The impressive Sacristy of the Basilica of San Domenico Maggiore contains 38 wooden sarcophagi with the bodies of 10 Aragonese princes and other Neapolitan nobles, who died in the 15th and 16th centuries. To improve the knowledge about the entomofauna associated with bodies in archaeological contexts, herein we provide insights on the funerary practices and the insect community associated to Ferrante II King of Naples and other Italian Renaissance mummies of the Aragonese dynasty buried in the Basilica of St. Domenico Maggiore. We identified 842 insect specimens: 88% were Diptera (Muscidae, Fanniidae, and Phoridae), followed by 9% Lepidoptera (Tineidae) and 3% Coleoptera (Dermestidae and Ptinidae). Ninety-seven percent of the specimens were collected from the coffin of Francesco Ferdinando d'Avalos, which was the best preserved. A lack of fly species characterizing the first colonization waves of exposed bodies was noted. The most common fly was the later colonizing muscid Hydrotaea capensis (Wiedemann); only a few Fanniidae (Fannia spp.) were retrieved. The lack of blowflies, coupled with recording H. capensis as the dominant fly, supports our hypothesis that corpses have been kept indoors for a long time under confined environmental conditions. Other explanations include odorous oils/balms having been used in the embalming process, causing the delay or stopping the arrival of first colonizer flies. Hermetically sealing of the coffin with bitumen may also have played a role in preventing access to the corpses. This scenario describes a historical context characterized by a well-advanced knowledge of body preparation, with specific burial techniques adopted for nobles.

Severe atherosclerosis in the natural mummy of Girolamo Macchi (1648-1734), "major writer" of Santa Maria della Scala Hospital in Siena (Italy)

BACKGROUND AND AIMS

A small crypt in the Santissima Annunziata Church of Santa Maria della Scala Hospital in Siena (Italy) contained three well-preserved mummies, two of which, dated back to the 15th-16th century, were identified as Salimbene Capacci (1433-1497), Rector of the Hospital, and his wife, Margherita Sozzini (?-1511). The third mummy, dressed in clothes of the 17th century, was not initially identified.

METHODS

Accurate bibliographical, taphonomic and anthropological studies allowed the identification of the mummy of Girolamo Macchi, who lived between 1648 and 1734 and worked as "major writer", an accountant, for the Hospital. He was present when the corpses of the Rector and his wife were discovered in 1678 and, impressed by this finding, wanted to be buried in the same chapel after his death, which occurred at the age of 86. A complete study, including macroscopic, radiological, isotopic and histological analyses, was performed on the natural mummy of Girolamo.

RESULTS

Macroscopic investigation showed a large inguinoscrotal hernia and a good preservation of the internal organs. The circulatory system revealed severe atherosclerosis, with multiple calcifications stenosing the lumen of the vessels, in particular of the lumbar aorta and the iliac arteries. The diagnosis was confirmed by imaging techniques (3D Cone Beam Scan) and by histology.

CONCLUSIONS

This case confirms that atherosclerosis is also a disease of ancient times. The presence of atherosclerosis in pre-contemporary individuals could suggest that the disease may not only be uniquely characteristic of a specific diet or lifestyle, but it could be also an inherent component of human ageing.

Gout in Duke Federico of Montefeltro (1422-1482): a new pearl of the Italian Renaissance

The article examines the truthfulness of historical accounts claiming that Renaissance Duke Federico of Montefeltro (1422-1482) suffered from gout. By direct paleopathological assessment of the skeletal remains and by the philological investigation of historical and documental sources, primarily a 1461 handwritten letter by the Duke himself to his personal physician, a description of the symptoms and Renaissance therapy is offered and a final diagnosis of gout is formulated. The Duke's handwritten letter offers a rare testimony of ancient clinical self-diagnostics and Renaissance living-experience of gout. Moreover, the article also shows how an alliance between historical, documental and paleopathological methods can greatly increase the precision of retrospective diagnoses, thus helping to shed clearer light onto the antiquity and evolution of diseases.

On the history of gout: paleopathological evidence from the Medici family of Florence

OBJECTIVES

Throughout history, gout has been referred to as the "disease of the kings", and has been clearly associated with the lifestyle of the aristocratic social classes. According to the written sources, several members of the famous Medici family of Florence suffered from an arthritic disease that contemporary physicians called "gout". A paleopathological study carried out on the skeletal remains of some members of the family, exhumed from their tombs in the Church of San Lorenzo in Florence, offered a unique opportunity to directly investigate the evidence of the arthritic diseases affecting this elite group.

METHODS

The skeletal remains of several members of the family were examined macroscopically and submitted to x-ray investigation.

RESULTS

The results of the study allowed us to ascertain that the so-called "gout of the Medici" should be considered the clinical manifestation of three different joint conditions: diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis and uratic gout. In particular, uric acid gout was diagnosed in the Grand Duke Ferdinand I (1549-1609). Recently, a new case of this disease was diagnosed in Anton Francesco Maria (1618-1659), a probable illegitimate member of the family.

CONCLUSIONS

With this new case, uratic gout was observed in 2 out of 9 adult males, leading to suppose that the disease should have been a common health problem within the family. The aetiology of the disease has to be searched in environmental factors, since both historical and paleonutritional studies demonstrated that the diet of this aristocratic court was rich in meat and wine.

THE MEDICI CHILDREN (FLORENCE, XVI-XVII CENTURIES): ANTHROPOLOGICAL STUDY AND PROPOSAL OF IDENTIFICATION

Exploration of the Medici chapels in San Lorenzo in Florence revealed the burials of nine infantile members of the Medici family. Eight children were found in the intact tomb of the last Grand Duke Giangastone (1671- 1737). The crypt contained several small coffins collapsed to the floor or randomly spread over a raised plank, as a result of the disastrous flood of the Arno river in 1966, which partly upset the tomb and left a layer of dry mould. The children's remains, mostly skeletonised, were found inside the coffins or scattered on the floor or on the plank, probably transported by the water. Another child was exhumed from the chapel of Grand Duke Ferdinand I (1549-1609) and Cristina from Lorena (1565-1636). The infantile remains were submitted to anthropological study, which allowed to establish the number of individuals buried in the crypt, and to estimate the age at death. The anthropological results were compared with information provided by archival documents, related to members of the family who died in infantile age. An identification of the children is proposed.

[Skeleton or mummy: practices and structures for secondary burial in southern Italy in modern and contemporary age]

The ancient concepts of death as duration and the practices of secondary burial,first analysed by Robert Hertz, still survive in many areas of southern Italy. According to these beliefs death was perceived not as a sudden event, but as a long-lasting process, during which the deceased person had to go through a transitory phase, passing from one state of existence to another. Recent archeological research documents the persistence of secondary burial rites in Southern Italy during the Modern Age. A survey conducted in the province of Messina in Eastern Sicily has identified two surviving architectural structures appointed for the treatment of the bodies: the 'sitting colatoio' aimed at favoring the skeletonisation and the 'horizontal colatoio' used to obtain mummification by dehydration. Both these structures controlled the corpse's decay and transformed the body in a stable and durable simulacra of the dead.

Rheumatoid arthritis, Klippel-Feil syndrome and Pott's disease in Cardinal Carlo de' Medici (1595-1666)

OBJECTIVE

A paleopathological study was carried out on the she skeletal remains of Cardinal Carlo de' Medici (1595-1666), son of the Grand Duke Ferdinando I (1549-1609) and Cristina from Lorraine (1565-1636), to investigate the articular pathology described in the archival sources.

METHODS

The skeletal remains of Carlo, buried in the Basilica of San Lorenzo in Florence, have been exhumed and submitted to macroscopic and radiological examination.

RESULTS

The skeleton of Carlo revealed a concentration of different severe pathologies. Ankylosis of the cervical column, associated with other facial and spine anomalies suggests a diagnosis of congenital disease: the Klippel-Feil syndrome. In addition, the cervical segment presents the results of the tuberculosis (Pott's disease) from which the Cardinal suffered in his infancy. The post-cranial skeleton shows an ankylosing disease, mainly symmetrical and extremely severe, involving the large as well as small articulations, and characterized by massive joint fusion, that totally disabled the Cardinal in his last years of life.

CONCLUSIONS

The final diagnosis suggests an advanced, ankylosing stage of rheumatoid arthritis.

The 'gout' of the Medici, Grand Dukes of Florence: a palaeopathological study

OBJECTIVE

According to the written sources several members of the famous Medici family of Renaissance Florence suffered from an arthritic disease, called 'gout' by contemporary physicians; a palaeopathological study allowed verification of the true nature of the 'gout of the Medici' referred by archive document data.

METHODS

The skeletal remains of the Grand Dukes and their families, buried in the Basilica of San Lorenzo in Florence, were examined macroscopically and submitted to X-ray investigation.

RESULTS

Out of 15 investigated individuals, two cases of diffuse idiopathic skeletal hyperostosis (DISH), with ossification of the anterior longitudinal ligament and massive hyperostotic changes of the extra-spinal ligaments, were detected in the skeletons of the Grand Dukes Cosimo I (1519-74) and his son Ferdinand I (1549-1609). The left foot of Ferdinand also revealed typical lesions of the uratic gout, confirming the archive data, which describe the disease in detail.

CONCLUSIONS

The association between DISH and elite status, highlighted in recent research, receives further confirmation in the present study, furnishing evidence to the significance of this disorder as a lifestyle indicator, linked specifically with a high-caloric diet, consequent obesity and type II diabetes mellitus. Furthermore, the coexistence between DISH and gout observed in Ferdinand represents the first documentation of this association in the palaeopathological literature.

The Medici Project first anthropological and paleopathological results of the exploration of the Medici tombs in Florence

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.

[The mummification in Sicily during the late Modern Age (XVIII-XIX century)]

Sicily is one of the Italian regions richest in mummified corpses. In addition to the Capuchin Catacombs of Palermo, a true unicum for their exceptional number of individuals, several other mummies collections, dated back to the late Modern Age, are present in many churches, convents and funerary chapels. The Sicilian mummies are the result of a particular treatment, obtained by drying the body in favourable microclimatic conditions without evisceration, a method which permitted equally to achieve a good state of preservation. The mummification was an extremely diffuse phenomenon in Sicily during the 18th and 19th centuries, not only among the privileged classes, but also among the middle-class. Besides the "Cappuccini Catacombs" of Palermo, at present the sites of Sicilian mummies known in scientific literature are restricted to Comiso (Ragusa) and Savoca (Messina); up to now in fact this historical-biological heritage has not been properly surveyed. In this article we present the first results of a survey carried out in the Messina's province during July 2005. The research enabled us to investigate this cultural phenomenon, to document the architectural structures appointed to the mummification process and to enrich the knowledge about the presence of mummified bodies in eastern Sicily during the Modern Age.

Effect of cumulative nearwork on accommodative facility and asthenopia

PURPOSE

To investigate quantitatively in young adults the relationship between long-term cumulative nearwork, degradation of dynamic accommodative ability and the presence of asthenopic symptoms.

METHODS

Subjects consisted of 87 young students and office workers between 18 and 31 years of age with uncorrected visual acuity of 20/30 or better in each eye. The amounts of nearwork, dynamic accommodative facility, and level of asthenopic symptoms were measured for each subject.

RESULTS

Total cumulative nearwork time was negatively correlated with accommodative facility and positively correlated with the number of asthenopic symptoms. Furthermore, significant correlations were found between total nearwork time and blurred vision, and blurred vision and reduced accommodative facility. Moreover, the sub-category of "hours spent reading over the years" was found to be significantly correlated with decreased accommodative facility.

CONCLUSIONS

The correlations suggest a relationship between cumulative amount of nearwork, decreased accommodative facility and asthenopia.

Isolation of mumps virus from vaginal secretions in association with oophoritis

Mumps virus was isolated from the cervico-vaginal secretions of a 31-year-old woman presenting with mild signs of oophoritis accompanied by xantholeucorrhoea. The serological finding of mumps-specific IgM antibodies was further evidence confirming the casual link between mumps virus and ovarian pathology. Rarely, ovarian involvement may be the only manifestation of mumps infection. The importance of this diagnosis and its relationship to the possible development of secondary oligomenorrhoea and early menopause is discussed.