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

CSI: Italian Renaissance

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

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Fornaciari explains the procedures used to solve historical puzzles. Researchers begin with a basic physical exam of bones and tissues, using calipers and other instruments. At the same time, he says, they create a context, exploring the historical landscape their subjects inhabited, consulting scholars and digging into archival records. For the past 15 years, they’ve used conventional X-ray and CT imaging at a nearby hospital to examine tissues and bones; conducted histological exams similar to those Fornaciari applies to living patients for a better understanding of tumors and other abnormalities; and relied on an electron microscope to examine tissues. More recently, they’ve employed immunological, isotopic and DNA analysis to coax additional information from their samples.

Work is done at many locations—here and at Fornaciari’s other Pisa laboratory, and in university labs throughout Italy, particularly Turin and Naples, as well as in Germany and the United States. On occasion, when examining illustrious, difficult-to-move corpses such as Cangrande della Scala or the Medici, Fornaciari cordons off an area of a church or chapel as an impromptu laboratory, creating kind of a field hospital for the dead, where he and his fellow researchers work under the gaze of curious tourists.

The laboratory, stacked with human bones, could easily seem grim— a murderer’s cave, a chamber of horrors. Instead, with its immaculate order and faint dry cedar-like scent, its soft bustle of conversation, this is a celebration of living. In the final analysis, it’s a laboratory of human experience, where anatomical investigation mingles with evidence from medicine, biography and portrait paintings to resurrect fully fledged life stories.

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Some of the most compelling tales surround the dynasties of the Aragonese and Medici. Among Fornaciari’s most memorable “patients” is Isabella of Aragon, born in 1470, a shining star at the greatest courts of Italy, renowned for her intellect, beauty, courage in battle and remarkable fortitude. She knew Leonardo da Vinci; some art historians also believe she could have been the model for the Mona Lisa. She conducted famous love affairs with courtier Giosuè di Ruggero and condottiero Prospero Colonna, as well as, one scholar maintains, with Leonardo himself. Even an objective scientist such as Fornaciari isn’t immune to her charms. “Knowing that I had Isabella of Aragon in my laboratory, one of the most celebrated ladies of the Renaissance, who’d known Leonardo da Vinci—he’d made the magnificent theater backdrops for her wedding feast— all this raised certain emotions.”

All the more so when Fornaciari took a close look at Isabella’s teeth. The outer surfaces of those in the front of her mouth had been carefully filed—in some cases the enamel had been completely removed—to erase a black patina that still covered the teeth farther back. Electron microscopy revealed parallel striations on the front teeth, indicating abrasions made by a file. The black stain, it turned out, resulted from ingestion of mercury, in her day believed to combat syphilis. Proud Isabella, jealous of her celebrated beauty, had been attempting to hide the growing discoloration associated with her disease. “I imagine poor Isabella trying to preserve her privacy, not wanting to appear with black teeth because people would know she had venereal disease,” says Fornaciari.

His examination of Isabella’s grandfather, Ferrante I, King of Naples, born in 1431, also produced significant results. This great lord presided over a literary salon where leading humanist scholars converged, but he was also a gifted warrior, who with astuteness, courage and calculated—or, as his critics said, sadistic—savagery, maintained the independence of his kingdom against powerful enemies, both foreign and internal. No less a figure than Lorenzo the Magnificent de’ Medici traveled to Naples to kneel in submission before him. Ferrante died in 1494 at the age of 63, celebrated by contemporaries for maintaining his intellectual and physical vigor to the end of his life, although portraits completed during his later years showed that he had put on weight and occasionally appeared to be in pain.

Fornaciari debunked the myth of Ferrante’s enduring good health. Although the king’s mummified body had been lying in its cedar coffin for five centuries, and in 1509 had been badly damaged by a fire in the basilica, Fornaciari managed to recover a segment of Ferrante’s intestine, which when rehydrated showed a pattern of yellowish spots that looked sinisterly familiar to him from analyses of modern biopsies. Extracting DNA from mummified tissue, Fornaciari found mutation in the K-ras gene—clear proof that Ferrante had suffered from advanced colon cancer, most probably a colorectal adenocarcinoma. Fornaciari had made medical history, by identifying an oncogene mutation in an ancient tumor; his results offer potentially important data for studying the evolution of the disease.

Fornaciari subsequently analyzed bone collagen of King Ferrante and other Aragonese nobles, revealing a diet extremely reliant on red meat; this finding may correlate with Ferrante’s cancer. Red meat is widely recognized as an agent that increases risk for mutation of the K-ras gene and subsequent colorectal cancer. (As an example of Ferrante’s carnivorous preferences, a wedding banquet held at his court in 1487 featured, among 15 courses, beef and veal heads covered in their skins, roast ram in a sour cherry broth, roast piglet in vinegar broth and a range of salami, hams, livers, giblets and offal.)

Maria of Aragon, another famous beauty of the Renaissance, noted for her proud, fiery temperament, whose intellectual circle included Michelangelo, was found to have syphilitic lesions and human papillomavirus (HPV). Fornaciari’s identification of the latter in an ancient cadaver also offered new clues to the evolution of the virus.

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