Family History of Type 2 Diabetes Mellitus

Both of Josephine Imperato’s parents had type 2 DM. Her father, Pasquale (Pascale) Foniciello (1 March 1837–15 May 1880), the fifth of seven children, died of the disease at 43 years of age. Her mother, Amalia Casertano (1 September 1849–7 July 1932), the fourth of five children, died of heart disease at the age of 82 years. However, she developed type 2 DM in her later years [1]. Thus, Josephine had a family history of both paternal and maternal type 2 DM.

Josephine’s genealogy is well documented, in part because many of her ancestors were among San Prisco’s leading citizens about whom considerable information is known. It was thus thought possible to attempt a familial aggregation study for type 2 DM among Josephine’s ancestors. The lineages from which she descended can be documented some six generations before her, back into the late seventeenth century. As with everyone, she had two parents, four grandparents, eight great grandparents, 16 great-great grandparents, 32 great-great-great grandparents, and 64 great-great-great-great grandparents. These six generations account for a total of 126 direct lineal ancestors, which double to 252 in the seventh generation, 504 in the eighth, and 1,008 in the ninth.

An attempt was made to examine these paternal and maternal generations to the sixth level beyond her. Oral accounts were very helpful for the early twentieth century and for the second half of the nineteenth century, and on occasion for earlier periods. These accounts did not necessarily identify diabetes mellitus per se, as in that time and place the disease may not have been known as such. Mild subclinical cases would not have been noted nor those that might have developed had people lived longer. What might have been observed was the triad of wasting, polyuria, and death. However, an obvious caveat must be raised here as wasting and death can be due to a variety of disease entities other than untreated severe clinical type 2 DM.

figure a

Antonia D’Orso Piazza (1899-1989), daughter of Maria Michela Foniciello (1876-1961) and Giovanni D’Orso (Courtesy of Michela and Angelo Stellato)

Josephine’s nine children, who survived to adulthood, were well educated. However, they knew little of her ancestry beyond that of her parents, Amalia Casertano and Pasquale Foniciello, her three sisters, Maria Michela, Angela Maria and Marianna, and their own maternal first cousins. The latter included Antonia and Silvio D’Orso, children of Maria Michela and Marianna (Naninelle) Ricciardi, daughter of Angela Maria. The latter died on 23 November 1901, following the death of her husband, Luigi Ricciardi.

figure b

Silvio D’Orso (1918-1969), son of Maria Michela Foniciello (1876-1961) and Giovanni D’Orso (Courtesy of Michela and Angelo Stellato)

Their daughter, Marianna, was thus orphaned at the age of 4 years. She was raised by her grandmother, Amalia Casertano, and eventually married Giovanni Ulini in Italy in 1932 in the presence of Josephine’s widower, Pasquale Imperato.

figure c

Wedding picture of Marianna Ricciardi and Giovanni Ulini, 1932 (Courtesy of the late Giovanni Ulini)

The heightened awareness that Josephine’s children had for their cousin Naninelle no doubt emanated from an earlier concern of their parents for her social and economic well-being as an orphan being raised by an elderly grandmother. In time, Josephine’s children spoke of their first cousin Naninelle to their own children in almost mythic terms. They recalled their own father’s visit to San Prisco, Italy in 1932, soon after Amalia’s death, and his essential role in assuring her marriage [2]. Thus, as is often the case, Josephine’s children had a genealogic knowledge base that extended back two generations (parents and grandparents), within their own generation, and forward to those of their own children and grandchildren. Thus, their span of knowledge essentially covered five generations. Their first cousin Naninelle, however, had the advantage of living with her grandmother for 28 years, and thus, not surprisingly, she was aware of people two generations back beyond her grandmother.

figure d

Marianna Ricciardi Ulini (1897-1985), daughter of Angela Maria Foniciello (1871-1901) and Luigi Ricciardi (Courtesy of the late Domenico Ulini)

Josephine’s paternal ancestors can be divided into two broad groups representing antecedents of her grandfather, Don Giuseppe Foniciello (1802–2 August 1854) and her grandmother, Donn’Angela Maria Valenziano (1809–16 June 1894). Don Giuseppe’s occupation at the time of his death at 52 years of age was that of possidente (property owner). This is a general term implying that someone has substantial possessions such as property [3]. Don Giuseppe owned a tannery, and was himself a tanner. His widow, Donn’Angela Maria Valenziano, survived him by 40 years, and died at the age of 85 years in 1894. She was also listed as possidente on her death certificate [4]. Donn’Angela Maria Valenziano was said to have died of “old age.” She in turn related that her husband, Giuseppe Foniciello, died of “fatigue.” This infers that he might have died of diabetes mellitus. However, this cannot be ascertained with any certainty. The death of Donn’Angela Maria Valenziano at 85 years of age does not necessarily imply that she did not have type 2 DM. However, there is no evidence to prove that she did.

The Valenziano, di Monaco, de Angelis, and Cipriano Lineages

Josephine’s grandmother, Donn’Angela Maria Valenziano, came from a Spanish lineage that had been in San Prisco only since the mid-eighteenth century. This lineage had begun with Gabriele Valenziano (1724–21 October 1761), who arrived in this area of Italy as a Spanish sub-lieutenant in the Royal Farnese Infantry Regiment of King Charles III, the newly installed King of Naples. On 17 March 1741, King Charles ordered a national registering of all real property and subsequent taxation of it. However, in San Prisco, this registration did not actually begin until 6 June 1754 [5]. Recently, Professor Luigi Russo has carefully researched the records of this registry and the taxes that were paid. As a result, he has documented many of the families then living in San Prisco, their possessions, and the amount of tax they paid [5: pp. 41–87].

figure e

Civil death record for Donn’Angela Maria Valenziano, 85 years of age, of the late Alessandro and Angela Rosa di Monaco, widow of Giuseppe Foniciello (1802-1854) and grandmother of Josephine Foniciello Imperato, 16 June 1894, San Prisco, Italy

At the time of the creation of this tax role, Gabriele Valenziano was recently married to Donna Teresa de Angelis, the sister of Bartolomeo de Angelis, a druggist, and Alessandro de Angelis. Their son, Francesco, named for Gabriele’s Spanish father, Francesco, was one year of age at the time. Bartolomeo operated the drug store owned by Don Francesco Antonio Ragucci [5: p. 54, 59]. Both Bartolomeo and his brother, Alessandro, paid the necessary dowry to Gabriele Valenziano when he married their sister, Teresa [6]. Being a Spaniard, Gabriele Valenziano had no known relatives in San Prisco. When he died on 21 October 1761, he was 37 years of age, and was a lieutenant in the cavalry posted in nearby Capua [7]. This was a young age at death, even for this period. His son, Don Francesco (1753–1807), and his wife, Donna Caterina Cipriano (1760–1820), had a son, Don Alessandro (13 January 1784–15 November 1820), who also died relatively young at the age of 36 years [8].

figure f

Baptismal record in Latin of Alessandro Giuseppe Valenziano of Don Francesco Valenziano of the late Gabriele and of Catarina Cipriano, 13 January 1784, Church of Santa Matrona, San Prisco, Italy

Don Alessandro Valenziano, Josephine Imperato’s great grandfather, was a druggist/merchant of medicines, a profession he perhaps adopted from his maternal great uncle, Don Bartolomeo de Angelis.

figure g

Civil death record for Don Alessandro Valenziano, 34 years of age, of the late Francesco and Donna Catarina Cipriano, 60 years of age, widower of Donn’Angela Rosa di Monaco, 15 November 1820, San Prisco, Italy

Don Alessandro Valenziano died 9 months after the death of his wife, Donn’Angela Rosa di Monaco, on 2 February 1820 [9]. They left five children, Angela Maria (born in 1809), who was Josephine Foniciello Imperato’s grandmother, Maria Teresa (born in 1810), Caterina (born in 1813), and Felice Gabriele (born in 1818). The poignancy of these five children being orphaned led the vital records clerk to note it on Don Alessandro’s death certificate [8].

figure h

Civil death record for Donn’Angela Rosa di Monaco, 30 years of age, of Don Nicola Maria di Monaco, 66 years of age, and Orsola Pasquale, 60 years of age, wife of Alessandro Valenziano, 34 years of age, 2 February 1820, San Prisco, Italy

The death of this couple at young ages and within a brief period of time could have been coincidental and due to diverse causes or else due to a common cause such as tuberculosis and perhaps even to type 2 DM. The death of Don Alessandro’s father Don Francesco at the age of 54 years, of his grandfather Don Gabriele at 37 years, and his own death at 36 years certainly raise the possibility of type 2 DM as the cause or else as a contributory cause in all three. However, there is no concrete evidence to support these assumptions. Little is known of Don Alessandro’s mother, Donna Caterina Cipriano (1760–1820), nor of her father, Don Natale Cipriano, and her grandfather, Don Francesco Cipriano. Thus, one cannot infer that any of these three generations suffered from type 2 DM.

figure i

Baptismal record in Latin of Don Gabriele Alessandro Valenziano of Don Francesco of the late Gabriele and Catarina Matrona Cipriano, 17 April 1782, Church of Santa Matrona, San Prisco, Italy

Don Alessandro Valenziano had an older borther, Don Gabriele Alessandro, who was born on 17 April 1782, and who became a priest. No death record was found for him in San Prisco. However, he may have died in another town to where he may have been assigned as a priest or pastor. On 8 March 1813, when he was 31 years of age, he served as a witness for the death of Andre Cornet, the 23-year-old head of the local branch of the Royal Treasury in San Prisco under King Joachim Murat, who then ruled the Kingdom of Naples on behalf of Napoleon. Don Alessandro also had a younger brother, Don Giuseppe, who was born in 1788, and who died in his seventh decade. Based on the information at hand, it is not possible to conclude that Don Alessandro’s brothers, Don Gabriele Alessandro and Don Giuseppe, suffered from type 2 DM.

figure j

Death record in Latin of Giuseppe Maria Paolo Valenziano, 4 years of age, of the late Gabriele and of Donna Teresa de Angelis, 25 December 1762, Church of Santa Matrona, San Prisco, Italy

Although orphaned, the five children of Don Alessandro and Donn’Angela Rosa di Monaco were the grandchildren on their mother’s side of one of the wealthiest couples in the town. These grandparents were Don Nicola Maria di Monaco (1754–3 December 1833), who was 66 years old at the time, and his wife, Orsola Pascale. Don Nicola Maria was a third-generation notary, the son of Don Francescantonio di Monaco, who was born in 1710, and the grandson of Don Nicola di Monaco and Faustina Riccardo, who were born in the seventeenth century. Don Nicola Maria di Monaco occupied a number of important civic positions in San Prisco and the surrounding district. He served as treasurer for both for a number of years, and in 1805–1806 was the Mayor of San Prisco [5: pp. 58–59, 163, 10].

The early deaths of Don Gabriele Valenziano at 37 years in 1761, of his son Francesco at 54 years in 1807, and his grandson Alessandro at 36 in 1820, raise the possibility of type 2DM, but cannot definitively prove it. By contrast, Don Gabriele’s daughter, Donna Caterina Valenziano (1757–21 July 1837), lived to be 80 years of age, and died at the peak of the 1837 cholera epidemic in San Prisco. At the time of her death, she was the widow of Don Gabriele Boccardi (born 1763), who came from one of San Prisco’s most prominent and wealthiest families, and who was the son of Dr. Don Saverio Boccardi, “Nobile ex Sanguine Patrizio Capuano.” The Boccardi family traced its roots to the fifteenth century in Nola, and later to nearby Capua. There is a high probability that Donna Caterina Valenziano died from cholera, which first arrived in San Prisco in 1837, where the peak of the epidemic occurred in the month of July when 99 deaths were recorded. This represented 54 percent of the total of 183 deaths for the year. While she may have also suffered from type 2 DM, there is no evidence to support this hypothesis.

figure k

Baptismal record in Latin of Francescantonio di Monaco of Nicola and Faustina Riccardi, 20 October 1710, Church of Santa Matrona, San Prisco, Italy

Not surprisingly, the di Monaco’s married women who also came from prominent affluent families. Don Francescantonio di Monaco married Marzia Messore, the daughter of Giovanantonio Messore, a physician who paid a large dowry on her behalf. Don Nicola Maria married Orsola Pascale (Pasquale) in August 1775. Her father, Felice Pascale, and his family paid a very large dowry of 3,220 ducats to Don Nicola Maria on this occasion. This compared to the dowry of 1,200 ducats paid by the brothers of Teresa de Angelis when she married Gabriele Valenziano in 1752 [5: p. 59, 6].

Don Nicola Maria di Monaco died in 1833 at the age of 83 years, and his wife, Orsola Pascale, a short time before him. Given their longevity, it would seem unlikely that they suffered from type 2 DM. Using longevity as a rough proxy for a disease such as type 2 DM, the principal possibilities in these lineages would seem to be the Valenzianos and the de Angelises, the latter based on Donna Teresa de Angelis’ death at 50 years of age in 1778. Yet, Josephine Foniciello Imperato’s grandmother, Donn’Angela Maria Valenziano, lived to be 85 years of age.

The Foniciello, de Paulis, Casaccia, Ventriglia, Peccerillo, and Meo Lineages

The Foniciello family has lived in San Prisco since at least the sixteenth century. A 1523 land registry (catasto) lists three families with this surname. However, all three were citizens of nearby Capua, then a large town compared to the Village of San Prisco, which then had only 294 inhabitants living in 55 households (fuochi). This evidence would seem to support the fact that the Foniciellos migrated from Capua to San Prisco [10: p. 22]. These three families were respectively headed by Angellus Fonicellus, Bernardinus Fonicello, and Joanes Jacobus Fonicello [11].

figure l

Baptismal record in Latin of Nicola Alessandro Foniciello of Fabio and Joanna Merola, 1 April 1696, Church of Santa Matrona, San Prisco, Italy

The spelling, Foniciello, was well established by the late seventeenth century as seen in the 1696 church registry of the baptism of Nicola Alessandro Foniciello on the first of April [12]. However, in the 19 March 1808 church death registry of Fabio Foninciello, Nicola’s son, the name is spelled Foninciello, in which an additional “n” has been added [13]. A variant of this spelling, Fonincello, appears for Nicola in the 1754 land and property registry initiated by King Charles III [5: p. 142].

The 22 March 1810 marriage record of another Fabio Foniciello, who was a tanner (conciatore), gives the spelling as Funicello [14]. This young man died 4 months later leaving behind a 2-month-old daughter, Angela. His 26 July 1810 death certificate gives the same Funicello spelling [2]. Thus, a “u” replaced the initial “o” and the “i” before the “e” was dropped. These marriage and death records provide some interesting social insights. Fabio, who was a grandson of Fabio Francesco Bartolomeo Pasquale Foniciello (25 August 1732–19 March 1808), and his wife, Angela Rosa Salemme, were married on 22 March 1810. Their daughter, Angela, was born on 18 May 1810, 2 months after their marriage.

figure m

Civil marriage record of Fabio Funicello, 20 years of age, of Crescenzo Funicello and Matrona Sorica (Soraco), and Angela Rosa Salemme, 18 years of age, of the late Tommaso Salemme and Matrona Valentino, 22 March 1810

Angela Rosa Salemme, was 18 years old at the time of her marriage, and Fabio 20 years. Their child was conceived out of wedlock, and a marriage obviously arranged before her birth. Fabio’s father, Crescenzo, had been a soldier in the Bourbon army of King Ferdinand IV of Naples, which in 1810 was defunct as the Kingdom of Naples was then under Napoleonic French rule.

figure n

Civil death record for Fabio Funicello, 22 years of age, of Crescenzo Funicello, soldier of the defunct army and Matrona Sorica (Soraco), husband of Angela Rosa Salemme, 26 July 1810, San Prisco, Italy

The Funicello spelling was used for Giuseppe Funicello on his death certificate on 12 August 1813. A brother of Fabio (1732–1808) and a son of Nicola and Giovanna Peccerillo, his mother’s surname, was mistakenly recorded as Russo by Francesco de Angelis, Mayor of Santo Prisco and Officer of Civil Vital Records [15].

figure o

Baptismal record in Latin for Fabio Francesco Pascale Bartolomeo Foniciello of Nicola of the late Fabio and Joanna Peccerillo, 25 August 1732, Church of Santa Matrona, San Prisco, Italy

In 1817, the death of Nicola Foniciello was recorded as Foniciello [16]. Yet the following year, Francesco de Angelis, Mayor and Officer of Civil Vital Records, recorded the deaths of two of Nicola’s siblings as Rosa Funiciello and Pasquale Foniciello [17, 18].

figure p

Death record in Latin of Fabio Foniciello, 78 years of age, husband of Marta Ventriglia, 19 March 1808, Church of Santa Matrona, San Prisco, Italy

The Foniciello spelling progressively became the standard except for occasional reversions to Funiciello (Table 1). Some outlier spellings occurred, as when Josephine Imperato immigrated to the United States. As was the practice then and now in Italy, women retained their maiden surnames. Josephine immigrated to the United States in 1897 as Maria Giuseppa Foniciello. However, on the List or Manifest of Alien Immigrants for the Commissioner of Immigration for the 19 November 1897 sailing of the S.S. Trojan Prince, she was listed as Maria Fumcillo. Her two sons, Clemente (later called Freeman) and Pasquale, four and 3 years of age respectively, were each simply listed as son [19]. She had always been formally known in Italy as Maria Giuseppa Foniciello, and by her husband, Pasquale Imperato, by her nickname, Peppinella. Thus, when an immigration official announced her name as Maria Fumcillo, her husband did not recognize any phonetic similarity to his own wife’s name. As a result, he did not respond to several calls by the immigration official to step forward. Burdened as she was with baggage and two small children, she tried to scan the crowd for her husband, but did not see him. She soon became panic-stricken, despite the fact that she was in the company of a 20-year-old distant relative, Giovanni Monaco, who was being met by his brother. Finally, when the immigration official called out her name along with those of their two sons, he came forward to greet them. He later claimed that he was listening for the name Peppinella Foniciello or Maria Giuseppa Foniciello. However, Josephine never forgot this experience and frequently chided her husband for having abandoned her and their sons at Ellis Island [20].

Table 1 Variations in the Spelling of the Surname Foniciello, 1523–1921
Full size table

Despite the lesson inherent in this anecdote, Josephine’s maiden surname was significantly distorted on her 1921 death certificate issued by the New York Hospital. There, her maiden surname is given as Fummgiello (Table 2) [21]. On her husband’s 1942 death certificate, her entire maiden name is incorrectly given as Concetta Funnicella. The informant is listed on the latter as Freeman P. Imperato, their eldest child [22]. Name misinformation on death certificates is not uncommon. It arises from recording being performed under adverse circumstances by clerks often unfamiliar with given names and surnames, and based on information provided by grief-stricken relatives who may have little familiarity with these surnames.

figure q

Civil birth record of Pascale Funiciello of Giuseppe, 34 years of age, and Donn’Angela Maria Valenziano, 28 years of age, 1 March 1837, San Prisco, Italy

Table 2 Josephine Foniciello Imperato’s Lineal Casertano ancestors and their ages at death
Full size table

A final comment on Josephine’s maiden surname is that her father, who was born Pascale Funiciello, always signed various records, including his 29 November 1868 marriage certificate, as Pasquale Funiciello, even when his name was recorded as Foniciello. He always did so with a very fluid hand. As is the custom in Italy, he sometimes put his last name first and given name second, thus signing as Funiciello Pasquale. Currently in San Prisco, both the Funiciello and Foniciello spellings are present. However, there are approximately four times as many people with the latter spelling compared to the former one.

As noted above, the Foniciello family has lived in San Prisco for a few centuries. Josephine Foniciello Imperato’s father, Pasquale Foniciello, is assumed to have died of type 2 DM. He had six siblings, Vincenzo (28 February 1830–21 November 1848), a cleric who died young at 18 years of age, Natale (27 February 1831–24 August 1831) who died in infancy, Maria Angela (b 27 May 1832), Domenico (b 29 May 1835), Giovanna Angela Viola (22 January 1843–2 October 1893), and Marianna (24 June 1851–21 February 1876). Marianna was married to Pasquale Possefiaccia and died at the age of 25 years, probably in childbirth. Her brother, Pasquale Foniciello, named his youngest daughter after her. This Marianna, born on 26 April 1880, 4 years after her aunt’s death, died at the age of 17 years on 2 February 1897. In her memory, Josephine Foniciello Imperato named her youngest daughter Marianne (7 April 1913–2 April 1996). Thus, this Marianne Imperato ultimately received her name from a great aunt, Marianna Foniciello, who died in 1876.

Pasquale Foniciello’s sister, Giovanna Angela Viola, died at 50 years of age, raising the possibility that she too suffered from type 2 DM.

Pasquale Foniciello’s father, Don Giuseppe Foniciello (1802–2 August 1854), who was a tanner, died at the age of 52 years. There is no information concerning his final illness except that he suffered from fatigue, according to his wife, Donn’Angela Maria Valenziano [23].

figure r

Civil death record of Pasquale Foniciello, 60 years of age, of the late Fabio and Marta Ventriglia, 25 July 1818, San Prisco, Italy

Don Giuseppe Foniciello’s sister, Donna Maria Vincenza (4 July 1815–22 January 1862), died at the age of 47 years, leaving behind her husband Don Raffaele de Paulis, a landowner from another very prominent family. One cannot infer anything about the cause of her death because no information concerning it has survived generation transfer.

figure s

Civil death record for Don Francesco Foniciello, 80 years of age, of the late Fabio and Marta Ventriglia and widower of Teresa de Paolis, 17 November 1837, San Prisco, Italy

Don Giuseppe Foniciello’s father, Don Francesco (1757–17 November 1837) died at the age of 80 years, his profession being given as that of estate manager probably because he had retired. However, for most of his life he was a carpenter. He died during the year of the first cholera outbreak to affect southern Italy, thus raising the possibility that this was the cause [24]. His wife, Teresa de Paulis (1778–23 April 1832) died at the age of 54 years, 5 years before him [25]. She was a member of another prominent San Prisco family, the daughter of Giacomantonio de Paulis and Isabella Casaccia (1731–12 March 1818) [26]. The members of the de Paulis family were judges, civil administrators, landowners, and clergy. Their name appears with several different spellings in eighteenth and nineteenth century documents, including delli Paulis, de Paulis, and di Paolis.

figure t

Civil death record for Don Giuseppe Foniciello, 54 years of age, of the late Francesco and Teresa de Paolis, husband of Donn’Angela Maria Valenziano, 2 August 1854, San Prisco, Italy

As stated, Don Francesco Foniciello’s wife, Teresa de Paulis, died at 54 years of age, but nothing is known of the circumstances of her death. Her sister, Alessandra delli Paulis, died on 16 April 1811 at the age of 33 years, leaving behind her widower husband, Pasquale di Monaco, and three children, Constantino, Clemente, and Michelangelo [27]. Again, nothing is known of the cause of her death, but death in childbirth is a possibility. The de Paulis sisters also had a brother, Reverend Vincenzo de Paulis, who was a priest and pastor of the Mother Church of Santa Matrona in San Prisco, and who died at the young age of 41 years in 1814 [28]. The deaths of these three siblings at relatively young ages, 54, 33 and 41 years respectively, certainly raise the possibility of type 2 DM. Their remaining surviving brother, Natale de Paulis, died at 70 years of age on 18 April 1821, leaving behind his widow, Maddalena Matrioti. Listed as a property owner on his death certificate, he was the longest surviving child of Giacomantonio de Paulis and Isabella Casaccia [29].

Nothing is known of the cause of death of the father of these four siblings, Giacomantonio di Paulis, who probably died in the late eighteenth or early nineteenth century.

figure u

Civil death record for Donna Teresa de Paulis, 54 years of age, of the late Giacomantonio de Paulis and Isabelle Casaccia, wife of Francesco Foniciello, 76 years of age, 23 April 1832, San Prisco, Italy

Giacomantonio de Paulis’ wife, Isabella Casaccia (1731–12 March 1818), died at 87 years of age, reasonably precluding the possibility that she was suffering from type 2 DM [30]. Her parents, Natale Casaccio (Casaccia) and Ovidia (Lidia) Monaco (di Monaco) were respectively born in 1702 and 1707. Natale Casaccio was listed in the 1754 tax rolls (Catasto Onciario) as a “Napolitano Privilegiato” from the nearby town of Capua. He was a tanner who also owned a house in San Prisco. In addition to his wife, Ovidia Monaco, who was 47 years of age at the time, he had a son, Paoloantonio, 11, and two daughters, Isabella, 17, and Barbara, 15 [5: p. 147]. Nothing is known of the causes of death of Natale Casaccia and Ovidia Monaco, which most likely took place in Capua in the latter half of the eighteenth or early part of the nineteenth century.

figure v

Civil death record for Isabella Casaccia, 87 years of age, of the late Natale and Lidia de Monaco and widow of Giacomantonio delli Paoli, 12 March 1818, San Prisco, Italy

Don Francesco Foniciello had five siblings who lived to adulthood, Crescenzo (1756–21 November 1831), Pasquale (1758–25 July 1818), Giovanna (1760–10 August 1840), Nicola (1772–26 August 1817), and Rosa (1783–20 June 1818). Crescenzo, who died at 75 years of age, was a soldier in the army of the Bourbon Kingdom of Naples. As described above, his young son Fabio, who was a tanner, had to marry Angela Rosa Salemme 2 months before she gave birth to their daughter, Angela, on 18 May 1810. Unfortunately, Fabio died 2 months later [14, 31]. The remaining two brothers, Pasquale and Nicola, were blacksmiths, a profession they inherited from their father, Fabio Foniciello. Pasquale and a sister, Rosa, who was married to Gregorio di Monaco, died within a month of one another on 25 July 1818 and 20 June 1818 respectively [32, 33]. In addition, their brother, Nicola, died the previous year on 26 August 1817 [34]. The deaths of these three siblings, Nicola, Rosa and Pasquale, at the respective ages of 44, 35 and 60, and in such close temporal proximity, could reflect an infectious disease such as typhoid fever, typhus or smallpox. On the other hand, it could also reflect type 2 DM. A final conclusion is not possible because no oral accounts of their deaths have survived generation transfer, and the death certificates of this period gave no cause of death. Their sister, Giovanna Foniciello, died on 10 August 1840, at the same age as her brother, Francesco.

figure w

Civil death record for Marta Ventriglia, 80 years of age, of the late Nicola and Orsola Meo and widow of Fabio Funiciello, 30 December 1814

At the level of the next oldest generation, Josephine Foniciello Imperato’s great-great grandparents, were Fabio Francesco Pascale Bartolomeo Foniciello (25 August 1732–19 March 1808) and Marta Ventriglia (1730–30 December 1814). Fabio, who was San Prisco’s master blacksmith, lived to be 76 years of age, while his wife, Marta Ventriglia, lived to be 84. Fabio died on 19 March 1808 [13]. Fabio was the son of Nicola Alessandro Foniciello (1 April 1696–1769) and Giovanna Peccerillo, born in 1698. Their causes of death are unknown, as are those of Nicola’s parents, also a Fabio Foniciello and Joanna Merola, born in the mid-seventeenth century. The parents of Fabio’s wife, Marta Ventriglia, were Nicola Ventriglia and Orsola Meo, who were probably born in the late seventeenth century.

figure x

Descendants of Angela Maria Foniciello and Maria Giuseppa Foniciello (Josephine Imperato), San Prisco, Italy, July 1984. Front row, left to right: Luciano Ulini and Gavin Imperato. Back row, left to to right: Giovanni Ulini, Pascal James Imperato, Anna Maria Ulini, Domenico Ulini, Gianni Ulini, Alison Imperato, Antonio Ercolano with Federica and Anna Ercolano with Austin Imperato

At the time of the 1754 tax roll, Nicola Foniciello (1696–1769) was listed as “stroppio e inabile a fatica” (disabled and unable to work) [5: p. 60]. Yet, his net worth was among the highest in San Prisco, there being only ten others wealthier than he in the town [5: p. 46, 142]. His affluence was further validated by the fact that his second son, Priscantonio, born in 1738, was a seminarian studying for the priesthood in 1754, and his youngest son, Giuseppe, born in 1741, was a student at the School of Letters. Their sister, Matrona, who was 18 at the time of the 1754 tax role, was then a spinster [5: p. 60].

figure y

Descendants of the three surviving daughters of Pasquale Foniciello and Amalia Casertano, Sant’Angelo in Formis, Italy, 1989. Included are the four granddaughters of Maria Michela Foniciello D’Orso: Angelina, Laura, Rachele, and Michela. On the extreme left is Giovanni Ulini and on the right Pascal James Imperato, Domenico Ulini, Antonio Ercolano, and Maria di Pasquale D’Orso

The three sons of Nicola Foniciello (1696–1769) were prominent citizens of San Prisco. Priscantonio became the pastor of the Church of Santa Matrona, while Fabio and Giuseppe, both blacksmiths, played important roles in civic life. Giuseppe was one of the administrators of the Chapel of Santa Matrona, and one of the conveners of a public parliament in 1779 [5: p. 121]. In 1787, Fabio and Giuseppe Foniciello, along with Antonio Sorbo, forged a new iron clapper for the bell of Santa Matrona [5: pp. 123–124].

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The four daughters of Silvio D’Orso and Maria di Pasquale: Angela, Laura, Rachele, and Michele with their spouses, children and a grandson, and Pascal James Imperato (left), Sant’Angelo in Formis, 2008

The Casertano, Vaccarella, Zibella, Monaco, and Palmiero Lineages

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A portion of the civil birth record of Amalia Casertano, daughter of Domenico Casertano, 30 years of age, and Maria Michela Vaccarella, 30 years of age, 1 September 1849, San Prisco, Italy

Josephine Foniciello Imperato’s mother, Amalia Casertano, developed type 2 DM late in life. She was the daughter of Maria Michela Vaccarella (3 May 1819–2 June 1902), who died at 83 years of age [35, 36], and Domenico Casertano (27 January 1823–1863), who died young at the age of 40 years [37]. Amalia, who was born on 1 September 1849 [38], was the fourth of five children. The others were Adelina Maria Filomena (born 1 April 1844), Luigi (14 January 1846–15 August 1846), Luigia (19 October 1847–28 September 1916), and Giuseppe (17 October 1851–7 December 1927).

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Death record in Latin of Domenico Casertano, 46 years of age, of the late Andrea, 12 June 1765, Church of Santa Matrona, San Prisco, Italy

When Amalia Casertano and Pasquale Foniciello married on 29 November 1868, they were both listed on the marriage record as possidente or property owners [39]. He was 31 years of age, and she 19 years. At the time of her birth in 1849, her father Domenico’s occupation was given as that of a bottler [38]. However, at the time of Domenico’s birth on 27 January 1823, his father Giuseppe was listed as a bracciale, or laborer [37]. Yet Giuseppe Casertano was listed as a possidente (property owner) when he died on 10 August 1867, 44 years later, indicating a considerable improvement in his economic status.

Amalia’s father Domenico’s early death at 40 years raises the possibility at least of type 2 DM. His brother, Antonio (26 October 1825–15 October 1892), lived to 67 years of age. Domenico’s wife, Maria Michela Vaccarella, lived to the age of 83 years, although her death certificate incorrectly states that she was 80 years of age [36]. It seems unlikely that her death was due to type 2 DM. She later married Marcello Alessandro and survived him.

Amalia delivered her first child, Maria Giuseppa (Josephine) on 5 July 1869, slightly more than 7 months after her marriage. Given her young age at the time and her ultimate longevity, it seems unlikely that this was a premature birth due to type 2 DM. While a 7-month pregnancy cannot be ruled out, it is also possible that Josephine was conceived before the marriage.

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Death record in Latin of Giuseppe Casertano, 30 years of age, husband of Catarina Pasquariello, 11 October 1780, Church of Santa Matrona, San Prisco, Italy

Domenico Casertano’s father, Giuseppe, died on 10 August 1867 at the age of 65 years, and 4 years after his son’s 1863 death [40]. While one cannot infer a type 2 DM death, this diagnosis remains a possibility. His wife, Maria Rosalia Zibella (1804–19 October 1886), lived to be 82 years of age. She died in a house on a small street, Vico Primo, off of San Prisco’s main street, Via Michele Monaco [41]. Given her age, it is unlikely that type 2 DM was causative in her death.

Amalia Casertano’s maternal great grandfather, Aniello Vaccarella, was San Prisco’s “mastro d’ascia” (master cabinet maker). In July 1788, he built a chestnut cabinet for the storage of the arms of the military on the orders of Captain Francesco Gianfrotta [5: pp. 125–126]. The cabinet with these weapons was then placed in the town clock tower, originally built in 1776 by Matteo Iannotta of the late Paduano and Francesco Salemme of the late Giacomo, master masons of San Prisco and Antonio di Lillo of the late Ortenzio, master mason of Casapulla [5: p. 120]. Matteo Iannotta was a great-great grandfather of Pasquale Imperato, Josephine’s husband.

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Civil death record for Domenico Casertano, 50 years of age, of the late Giuseppe and Lucia di Felice, and husband of Matrona Monaco, 1 January 1821, San Prisco, Italy

In March 1789, Aniello Vaccarella built a document cabinet of poplar wood for the local government offices [5: p. 128]. His son, Biase (Biagio) Vaccarella, Amalia Casertano’s maternal grandfather and a carpenter, was born in 1774 and died on 24 July 1854 at the age of 80 years [42].

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Civil death record for Biase Vaccarella, 80 years of age, of the late Aniello and Lucia Petricione, and husband of Arcangela Palmiero, 24 July 1854, San Prisco, Italy

Although Aniello Vaccarella’s dates are not currently known nor those of his wife, Lucia Petricione, and her father Paolo, and her grandfather Crescenzo, given the longevity of Biase Vaccarella (80 years) and his daughter, Maria Michela Vaccarella (83 years), it is unlikely that type 2 DM descended in this line. Biase Vaccarella’s wife, Maria Arcangela Palmiero (1786–31 January 1861), died at 75 years of age [43]. She was not from San Prisco, but from the nearby town of Casanova. Nothing is currently known of her ancestry, except the name of her father, Giuseppe Palmiero.

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Civil birth record for Maria Michela Vaccarella, daughter of Biase Vaccarella, 46 years of age, and Arcangela Palmiero, 34 years of age, 3 May 1819

As previously noted, Amalia Casertano’s father, Domenico Casertano, died at 40 years of age in 1863, while his wife, Maria Michela Vaccarella, died at 83 years on 2 June 1902 at 26 Via Constantinopoli in the center of the town. She survived her first husband, Domenico Casertano, by 39 years and later married Alessandro Marcello whom she also survived [36].

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Civil death record for Maria Michela Vaccarella, 83 years of age, of the late Biase Vaccarella and Arcangela Palmiero, and widow of Alessandro Marcello, 2 June 1902, San Prisco, Italy

Maria Rosalia Zibella (1804–19 December 1886), widow of Giuseppe Casertano (1802–10 August 1867), died at 82 years of age as noted above [41]. Amalia Casertano’s paternal grandmother, Rosalia Zibella, came from a line of long-lived ancestors. Her father, Antonio Zibella (1778–5 August 1854), lived to be 76 years of age [44]. His father, Carmine Zibella (1756–19 January 1814), lived to 58 years of age [45], and was first married to Antonio’s mother, Lucia Capuano, about whom nothing is known, and then to Felicia Pina who survived him [45]. Nothing is known of Carmine’s parents, Giuseppe Zibella and Maria di Caprio, who lived in the eighteenth century.

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Civil death record for Carmine Zibella, 58 years of age, of the late Giuseppe Zibella and Maria di Caprio, and wife of Felicia Pina, 19 January 1814, San Prisco, Italy

Rosalia Zibella’s mother, Alessandra Santoro (1777–11 January 1853) lived to be 76 years of age [46]. Nothing is known at present of her parents, Saverio Santoro and Rosalina Foniciello. On the 1815 tax rolls for San Prisco, Antonio Zibella was listed as a bracciante (laborer) who paid 2.80 ducats in taxes, while the estate of his father, Carmine Zibella, paid 11.9 ducats [5: Appendix XXXIV]. Carmine, who was a campagnuolo (farmer) had died the previous year.

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Civil death record for Antonio Zibella, 76 years of age, of the late Carmine and Lucia Capuano, widower of Alessandra Santoro, 5 August 1854, San Prisco, Italy

Amalia’s great grandfather, Domenico Casertano, like his son, Giuseppe, and his grandson, Domenico, died fairly young at the age of 50 years (1771–1 January 1821). Unlike his son, Giuseppe, and his grandson, Domenico, who were respectively a possidente (property owner) and a bottler, Domenico was a compire (finisher) [47]. Domenico was married to Maddalena Monaco (1767–16 June 1867), who outlived him by 46 years and who reached 100 years of age [48]. She also outlived a second husband, Domenico Sbardono. Nothing is known at this time of her parents, Pasquale Monaco and Orsola Galluccio. However, Amalia Casertano’s Casertano ancestors can be traced back three additional generations beyond her great grandfather, Domenico Casertano (1771–1 January 1821). The latter’s father was Giuseppe Casertano (1750–11 October 1780). He was married first to Lucia di Felice, his son Domenico’s mother, and then to Caterina Pasquariello, who survived him when he died at 30 years of age [49]. Giuseppe’s father, also called Domenico, was born in 1719 and died on 12 June 1765 at the age of 46 years [50]. His father, Andrea Casertano, was a shoemaker who paid 14 ducats in taxes during the 1753–1754 tax collection [5: p. 135].

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Civil birth record for Domenico Casertano, son of Giuseppe Casertano, 21 years of age, and Rosalia Zibella, 19 years of age, 27 January 1823, San Prisco, Italy

The Casertano lineage of Josephine Imperato (Maria Giuseppa Foniciello) includes six previous generations whose ages at death are known. Except for the first generation before her, represented by her mother, Amalia Casertano, who lived to 83 years of age, most of those in the other four generations all died fairly young. Given that her mother, Amalia Casertano (1849–1932), developed type 2 DM in old age, there is a high index of suspicion that some or all of the Casertanos before her also had type 2 DM. As shown in Table 2, the ages at death of Josephine Imperato’s lineal Casertano ancestors, exclusive of her mother Amalia, ranged from 30 to 65 years across the five generations who lived from 1719 to 1863. While Josephine’s great-great grandfather, Giuseppe Casertano (1802–1867), lived to 65 years of age, the others in the four remaining generations for whom vital data are available died at 40, 50, 30 and 46 years respectively. These are relatively young ages at death even in the context of those times. This raises the possibility that they may have died from type 2 DM or else from some other inherited disease.

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Civil death record for Alessandra Santoro, 76 years of age, daughter of the late Saverio and Rosalina Foniciello, and wife of Antonio Zibella, 11 January 1853, San Prisco, Italy

All of the above said, Josephine’s mother, Amalia, had two siblings who lived to advanced adulthood age. They were Luigia (19 October 1847–28 September 1916), who lived to 69 years of age, and Giuseppe (17 October 1851–7 December 1927), who lived to 76 years of age. While they too may have developed type 2 DM in adulthood, there is no firm evidence that they indeed had the disease.

Conclusions

Josephine Imperato (Maria Giuseppa Foniciello) died in diabetic ketoacidosis at the age of 52 years on 14 November 1921, 10 months before commercial insulin became available. Through ongoing genealogical research, it has been possible to examine vital records for some twenty of her paternal and maternal lineages going back from four to seven generations. The absence of documented causes of death in eighteenth and nineteenth century death records was not unexpected. Also, the diagnosis of clinical type 2 DM would not have been possible in those centuries in the then rural town of San Prisco, Italy. Except for Josephine Imperato’s parents, Pasquale Foniciello and Amalia Casertano, both of whom had type 2 DM, there were no reliable oral family histories indicating the possible presence of the disease among her many ancestors, except for that of her grandfather, Giuseppe Foniciello (1802–1854).

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Civil marriage record of Maria Giuseppa Foniciello, 22 years of age, of the late Pasquale and of Amalia Casertano and Pasquale Imparato, 22 years of age, of Clemente and of Concetta Caruso, 10 May 1891, San Prisco, Italy

Despite the limitations placed on this research by the absence of reliable medical histories or documented diagnoses, it was possible to establish lineage-based possibilities for the presence of type 2 DM. This is especially so with lineages in which the adults in successive generations died young. There is clearly surmise in this approach as the deaths of younger adults in the 200 years under investigation could have been due to a variety of infectious and non-infectious diseases such as typhoid fever, typhus, tuberculosis, rheumatic heart disease, chronic renal disease, and many others. However, the early deaths of successive generations over more than a century would not tend to support an infectious cause of death. Rather, such evidence would tend to support an inheritable disease such as type 2 DM, passed on from one generation to another, but not necessarily expressed as clinical death in every member of a generation.

Among Josephine Imperato’s ancestral lineages, there are a few in which early adult death occurred over multiple generations. The three lineages where this phenomenon is prominent are the Valenzianos, Josephine Imperato’s Spanish ancestors, the Foniciellos, and the Casertanos. While the first two are paternal lineages, the latter is a maternal one in which early adult death occurred in four of six Casertano generations as shown in Table 2.

Josephine Imperato’s delli Paulis ancestor, Teresa de Paulis (delli Paulis), and her siblings are an example of intra-generational early adult demise. The wife of Don Francesco Foniciello, Josephine Imperato’s great grandmother, Teresa de Paulis, died at 54 years of age. Her sister Donn’ Alessandra died at 33 years of age, and her brother Don Vincenzo at 41 years of age. The early deaths of the delli Paulis siblings in 1811, 1814, and 1832 raise the possibility that all three died from type 2 DM. That said, however, there is no firm evidence to support this suspicion. In the case of Donn’ Alessandra, complications of childbirth may have been the cause of her death.

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Portion of a letter from Pasquale Imparato (Imperato) to his oldest son, Clement (Freeman) Imparato (Imperato), San Prisco, Italy, 10 August 1922. He returned for a visit to San Prisco the year following his wife’s death and after an absence of almost 30 years

The population of San Prisco was 294 in 1523. By 1788, the population had grown almost ten-fold to 2,261 [10: p. 22, 28]. However, by 1881, prior to major emigration to the United States, the population had only grown to 4,033. While the population has grown to some 10,000 today, most of this growth represents in-migration from the city of Naples as San Prisco progressively becomes a suburban community. Given the small population of San Prisco in the eighteenth and nineteenth centuries and the tendency of people there to marry locally, it is reasonable to conclude that the allele pool in the population of the town in those centuries was a restricted one. Thus, many were biologically related to one another, even if they did not think so, based on social and family histories that are often vulnerable to the risks inherent in generation transfer. Therefore, genetic templates for type 2 DM may well have been present in many lineages in this town, and not just in those under consideration here.

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Giovanni Ulini (26 January 1906 – 27 July 1991), husband of Marianna Ricciardi Ulini (15 October 1897 – 5 March 1985) (Courtesy of the late Domenico Ulini)

What is more certain, based on fairly reliable medical histories, is that both of Josephine Foniciello Imperato’s parents had type 2 DM from which her father died in 1880. There is also strong evidence that her paternal grandfather, Giuseppe Foniciello, died from the disease in 1854, and that several generations of her maternal Casertano lineage might have died from the disease. Given this strong family history, it is not surprising that she eventually acquired the disease, which in the pre-insulin era could not have been successfully treated.

Among Josephine Imperato’s nine children who survived to adulthood, four developed type 2 DM. However, except for one who died in an automobile accident at the age of 54, the other three lived to the advanced ages of 89, 95, and 83. Her remaining five children, who did not develop type 2 DM, died at the ages of 75, 75, 98, 86, and 98. Josephine had 25 grandchildren of whom only four have thus far developed type 2 DM.