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Still About Francesco de' Medici's Poisoning (1587)

      To the Editor:
      In 2010, Fornaciari et al
      • Fornaciari G.
      • Giuffra V.
      • Ferroglio E.
      • Bianucci R.
      Malaria was “the killer” of Francesco I de' Medici (1531-1587).
      detected Plasmodium falciparum in the skeletal remains of Francesco I de' Medici (1541-1587), Grand Duke of Tuscany. Francesco and his wife died within a few hours of each other, with the official report giving the cause as pernicious malaria. However, others suspected they had been poisoned by Francesco's brother and successor as Grand Duke, Ferdinando. The Fornaciari group argued that their findings confirmed the official explanation of Francesco's death and removed any suggestion of poisoning, although toxicologic studies published in 2006 had found arsenic concentrations within the lethal range in the remains of Francesco and his wife.
      • Mari F.
      • Polettini A.
      • Lippi D.
      • Bertol E.
      The mysterious death of Francesco I de' Medici and Bianca Cappello: an arsenic murder?.
      Information recently discovered in the Vatican Library now adds support to the conclusion of poisoning. Because Ferdinando was a Cardinal, he was required to report his activities to the Pope. The Vatican document includes his account of Francesco's death, which says among other things: “It is believed that his disease was caused by fungi and petechiae with pestilential fever… The Grand Duke was prone to disease, untidy and he had a swollen neck…” Skin eruptions (eg, petechiae), fever, and swelling are all symptoms of acute arsenic poisoning.
      Francesco's official autopsy reported postmortem signs of arsenic poisoning, such as velvety red congestion of the stomach, and an unofficial report by doctors who witnessed the autopsies of Francesco and his wife refers to a “poison which had corrupted their internal organs.”
      It is plausible that Francesco had malarial infection, then endemic in Tuscany. But the presence of malaria antigens in human remains does not establish that the person died of this disease, nor does it exclude the possibility that poison was used to ensure death when the malaria might have been nonfatal. On the other hand, the presence in human remains of arsenic concentrations at lethal levels does reliably identify acute arsenic poisoning as the cause of death. Autopsy descriptions and the Vatican document also support this conclusion.

      References

        • Fornaciari G.
        • Giuffra V.
        • Ferroglio E.
        • Bianucci R.
        Malaria was “the killer” of Francesco I de' Medici (1531-1587).
        Am J Med. 2010; 1232: 568-569
        • Mari F.
        • Polettini A.
        • Lippi D.
        • Bertol E.
        The mysterious death of Francesco I de' Medici and Bianca Cappello: an arsenic murder?.
        BMJ. 2006; 333: 1299-1301

      Linked Article

      • Malaria Was “the Killer” of Francesco I de' Medici (1531-1587)
        The American Journal of MedicineVol. 123Issue 6
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          The sudden deaths of Francesco I de' Medici (1531-1587), Second Grand Duke of Tuscany (Figure 1a), and his wife, Bianca Cappello (1548-1587), have been shrouded in mystery, and the cause of death has been debated for the past 4 centuries.
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      • The Reply
        The American Journal of MedicineVol. 128Issue 10
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          The finding of a document with a description of the conditions of Francesco I in the last moments of his life is of particular interest, as it allows us to further clarify the causes of the Grand Duke's death.
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