Stories of disease and care in the Museum of Pathological and Paleopathological Anatomy of Pisa

“If [...] rare affections of Viscera, or of Parts, morbid concretions, etc., are encountered, these pathological pieces shall be scrupulously collected, and prepared for preservation for the instruction of Physicians, and Surgeons. Thus, for example, if Bones are found badly united in the happened fractures [...] everything must be preserved, if it may be reputed by the Sector instructive for the Surgical School. So if any enormous vices are encountered in the Viscera, alterations that are not natural, and that would benefit Medical instruction, again these pieces shall be preserved, and prepared, or kept in such a way that they cannot perish.” So reads Article XIV of the Regulations proposed by the Medical College of the University of Pisa for the teaching ofPractical Anatomy, approved by grand ducal motu proprio on October 31, 1818. With this regulation, Grand Duke Ferdinand III of Tuscany of Lorraine ratified his support for research in the University of Pisa and in particular for the study of human anatomy, also initiating the collection of the Anatomical Cabinet, later remodeled into the Museum of Human Anatomy.

The pathology collections were so prominent in the Museum of Anatomy that Filippo Civinini, considered the father of the institute after which it is still named, questioned as early as 1841 the sufficiency of the definition of Anatomical Museum. In his opinion, in fact, it was limiting, since the collection “had to be, and was, and is in fact, Comparative Human Physio-Pathological, that is, composed of healthy and morbid organic pieces, as well as products of diseases.”

Ten years before the birth of the Museum of Pathology, a new course of study was inaugurated in the new premises of the Medical School of Pisa, which also saw the creation of a Chair of Pathological Anatomy and Histology, finally freed from that of Human Anatomy. With these premises, finally in 1884 the Museum of Pathological Anatomy was born, to whose direction the 37-year-old Professor Angiolo Maria Maffucci was called. The museum was refurbished in 2016 thanks to the interest of Professor Valentina Giuffra and her team, who retrieved the exhibits that had been placed in storage for more than a decade. Its premises are currently undergoing extensive renovation, and the collection can be enjoyed thanks to a temporary exhibition. Although the museum’s origins are late nineteenth century, part of its collections is much older thus constituting a heritage that combines medical interest with historical interest. Among the rarest sections is a collection of bladder stones, consisting of about fifty items of the most diverse shapes and sizes, measuring up to 9 centimeters. This collection was put together by Filippo Civinini as early as 1836, although it was originally intended to be much larger. Some were donated by Giorgio Regnoli, a clinical surgeon at the University and obtained by him through numerous surgical operations; others had flowed in from the Medici collections.

From the Museum of Natural History, on the other hand, came some animal “monstrosities,” which are now organized in the animal teratology collection. This is a selection of deformities and oddities, counting the remains of a six-legged dog, a bicephalic cat and a monocephalic bicorporeal cat, as well as a chick with two heads and one with four legs, and more. Other “monsters” - as they were called in the past - include twenty-five specimens of malformed infants, which Filippo Civinini diligently cataloged and studied. They show an almost complete sampling of all known congenital malformations, such as bicephaly, hydrocephaly caused by an excessive accumulation of cerebrospinal fluid resulting in increased cranial volume, cyclopia, or anencephaly, which is related to the failure of the encephalon and skull bones to develop. These conditions are fortunately being treated in time in the West today.

This selection, originally composed of many more exhibits, belonged to the Imperial and Royal Museum, and by the will of Grand Duke Leopold was donated to the museum curated by Civinini. Also belonging to the primitive Cabinet of Anatomy is the parasitological collection of helminths, worm-like organisms that live inside the body of another organism. These were donated by a famous naturalist from Padua, Professor Tommaso Antonio Catullo, who “made it a point to equip it with those rarer worms that it possessed, which if they were not worth completing the collection were at least enough to extend it greatly and in the meantime to make it ragguardevolissima.”

More confusing, however, are the origins of a small arachnological collection, which includes some specimens of venomous spiders. Other exhibits are the result of a continuous enrichment of the museum that has gone on for more than a century, bringing the museum collections to count more than 2,000 pieces of anatomo-pathological interest, taken during autopsies or surgeries.

The collection also includes pathological items from the cardiovascular, renal, nervous and lymphatic systems. Of particular note are a number of preparations testifying to the increased incidence of occupational diseases such as autopsy lungs of marble quarrymen, or of workers in the metallurgical and glassmaking sectors, suffering from silicosis, anthracosis or asbestosis. Such categories of workers in the past and unfortunately often still today are exposed to fine dust, such as silica and asbestos dust and other hazardous substances that, in the long run, damage the lungs and cause respiratory diseases. Quite recently, the museum has been enriched with two more sections: samples of forensic interest, from Forensic Medicine at the University of Pisa, of which in the case of homicides the murder weapon is sometimes preserved; and paleopathological exhibits.

Paleopathology is the discipline that studies disease through direct analysis of human remains from the past, whether skeletal or mummified, thus making it possible to reconstruct the health status of individuals and even entire ancient populations. Pisa is home to one of the few Italian laboratories specializing in paleopathology, thanks to which valuable artifacts have come to the museum. Here, bone paleopathology is the most represented, with evidence of fractures, often untreated, dating from the Paleolithic to the 18th century, as well as wounds of a violent type, probably inflicted in battle.

Also of interest is the collection of drilled skulls, a practice that was conducted as far back as the fifth millennium B.C., being in fact the oldest surgical operation ever attested in history. Drilling could be conducted for both therapeutic and magical-religious reasons; in fact, it was believed that malignant powers could dwell in the head. Specimens include a male skull dating from the 18th century, and found along with numerous mummies in the Chapel of the Dead in the church of Santa Maria della Grazia in Comiso near Ragusa. It shows four traumatic wounds and signs of drilling for surgical purposes, most likely performed in an attempt to reduce the edema caused by the injuries.

Also significant are ribs found in an Etruscan tomb dated to the 6th-5th centuries B.C.E., which show “nail-punch lesions,” or scars that form on the surface of the bones and testify to an individual suffering from a rare heart condition, aortic coarctation, which involves a narrowing of part of the aorta, the main blood vessel that carries blood from the heart to the rest of the body.

This finding is interesting because it provides us with historical evidence of a condition that, while rare, is also present in ancient populations. In other words, analysis of the bones of this individual has allowed archaeologists and paleopathologists to identify a heart condition that may have been present millennia ago, showing how certain vascular malformations were already recognizable clinical manifestations in antiquity.

Of equal historical importance is an artifact from the mummy of Ferrante I of Aragon, King of Naples, who died in 1494, which through diagnostic DNA investigations made it possible to identify a carcinoma of the colon. This finding is quite surprising because it actually refutes the commonly accepted hypothesis that cancer is a disease of the present world, caused by pollution or modern lifestyle.

Completing the exhibit is a pre-Columbian mummy, among the museum’s most representative pieces. Dated with radiocarbon surveys between 1420 and 1530, it shows the classic fetal position, typical of South American burials. This is a woman who was suffering from pneumonia, possibly the cause of death.

For several decades now, for practical and space reasons, the preparation of anatomical specimens has been replaced by slides of autopsy or surgical findings. This material, together with a rich collection of autopsy reports complete with anatomo-pathological diagnosis, is available for consultation.

The Museum of Anatomic Pathology and Paleopathology in Pisa continues to be an important resource for the study of disease through the ages, preserving evidence that tells the story of medicine and human health. Its collections, which combine science, history and culture, offer a rare opportunity to understand the evolution of disease and medical practices. Through its ongoing commitment to research and preservation, the museum remains a key reference point for scholars and anyone wishing to explore humanity’s medical past.

Stories of disease and care in the Museum of Pathological and Paleopathological Anatomy of Pisa

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