The children of the wealthy and powerful Medici family suffered from rickets as result of malnutrition and prolonged indoor life, a new paleopathological study has revealed.
Researchers at the University of Pisa made the discovery after analyzing nine skeletons taken from under the floor of the Medici Chapels in the Basilica of San Lorenzo in Florence.
The children's bones were found in 2004 after the discovery of a secret entrance in the intact tomb of Giangastone (1671–1737), the last Grand Duke of the clan that dominated the Florentine Renaissance.
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"The removal of a marble disc in the floor of the chapel, initially considered only a simple floor decoration, displayed a secret opening with a small stone stair leading to a hidden crypt," palaeopathologist Valentina Giuffra, Gino Fornaciari and colleagues of Pisa and Siena Universities, wrote in the International Journal of Osteoarchaeology.
In the crypt, a large sarcophagus contained the remains of Giangastone, while on the floor lay eight coffins and several scattered bones - the result of the Arno flooding of 1966. The ninth coffin was found in a nearby tomb.
Analysis of the bones revealed that the children's ages ranged from newborn to about 5 years old. Six out of nine showed the classic signs of rickets, such as curved arms and bow legs - a consequence of trying to crawl or walk on pathologically soft bones.
One of the children clearly identified, Filippo (1577-1582), the seventh child of Francesco I and Giovanna of Austria, also known as Don Filippino, had a slightly deformed skull. According to the researchers, rickets was the culprit.
A skeletal disorder characterized by a lack of vitamin D, rickets is usually associated with poor children living in heavily polluted cities where exposure to sunlight is limited.
"Diagnosis of a metabolic disease linked to vitamin D deficiency would appear unexpected in children brought up at the court of a Renaissance high social class family like the Medici of Florence," the researchers observed.
Rather than from defects in the metabolism, the disease originated from the Medicis' desire to protect their offspring, raising them according to the highest social standards for their times.
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"During the Renaissance, a common opinion prescribed that children were not to be weaned before the second year of life; for this reason, among the elite classes, wet nursing was a very widespread practice," the researchers wrote.
Indeed, the Medici princes were never weaned until they were at least 2; starting from eight to nine months, woman's milk was integrated with paps made of soft bread and apples. Cereals and breast milk are known to supply little vitamin D, while fruit contains none.
"With prolonged breast-feeding, vitamin D deficiency is highly expected to rise, in particular if the other main risk factor, inadequate sunlight exposition, is associated with a diet based on maternal milk," the researchers said.
They added that two hours per week is the required minimum period of exposure to sunlight for infants if only the face is exposed - something the Medici children did not enjoy.
At that time, skin color was a way to distinguish the upper class from peasants engaged in field work.
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"A pale ivory skin was considered a sign of health and elegance," the researchers wrote.
Kept indoors in large palaces where the opportunity of sunlight exposure was significantly reduced, the Medici children were also wrapped in many heavy layers. In keeping with the Renaissance customs, infants were heavily swaddled, leaving very little skin exposed.
Even two newborns showed signs of rickets, although they should have received vitamin D from their mothers through the placenta.
Rickets may have been the cause of death for these children or may have contributed to worsening other problems present at birth.
According to the researchers, the mothers also had a vitamin D deficiency. Heavy makeup, to prevent skin exposure to sunlight, and repeated childbearing - Eleanor of Toledo bore 11 children in 14 years - might have been the cause for their low-level vitamin D.
The researchers noted that the disease still strikes modern populations with cultural habits similar to the one adopted by the Medicis.
"A high incidence of rickets has been observed in modern sunny countries, such as Iran and Israel, where the same cultural practices, that is avoidance of sunlight and prolonged breast-feeding, documented for the Renaissance Medici family, are diffused," the researchers concluded.
Image: Don Filippino had a slightly deformed skull. Rickets was responsible for the condition. Credit: University of Pisa