The Second World Cholera Pandemic (1826–1849) in the Kingdom of the Two Sicilies with Special Reference to the Towns of San Prisco and Forio d’Ischia

Abstract

The second world cholera pandemic in Europe (1829–1849) was significant because of its geographic extent and the enormous numbers of people who fell ill or died. It was also singularly important because it demonstrated the profound levels of ignorance in both Europe and North America concerning the cause, modes of transmission, and treatment of cholera. This paper discusses the pandemic in the Kingdom of the Two Sicilies in great detail. Even though medical and public health authorities in this kingdom had several years to prepare for cholera’s eventual arrival in 1836–1837, their elaborate preventive and therapeutic measures proved no more successful than elsewhere. Despite their efforts, it was estimated that there were 32,145 cases of cholera in the city of Naples by July 1837. Some 19,470 people were estimated to have died among the city’s then 357,283 population. This amounted to a cholera-specific mortality rate of 54.5/1000 population. Sicily was also severely affected by the epidemic. It was estimated that 69,000 people died of cholera in Sicily, 24,000 of them in the city of Palermo. Two rural towns in the kingdom, San Prisco and Forio d’Ischia, were selected for in-depth epidemiologic study. The former had a population of 3700 in 1836–1837, while the latter had a population of 5500. The economic basis of both towns was agriculture. However, because Forio is located on an island, fishing and sea transport were then also important industries. Cholera appeared in San Prisco in July 1837 and quickly swept through the population. By August, the epidemic was essentially over. It is estimated that some 109 people died from cholera in San Prisco for a disease-specific mortality rate of 29.5/1000 population. The age range of those who died from cholera was 1 to 90 years. The majority of deaths (60.6 %) were among women. The first cases of cholera appeared in Forio d’Ischia in June 1837. The epidemic then peaked in July. It is estimated that approximately 316 people died from cholera in Forio out of a population of 5500. This resulted in a cholera-specific mortality rate of 57.5/1000 population. Among the first 42 fatal cases in whom the disease was documented on their death certificates, ages ranged from 15 to 88 years. The mean age was 52.4 years. The majority of deaths (57.1 %) were among women. We reached beyond the statistics of this epidemic by presenting an in-depth study of the first person to die from cholera in Forio d’Ischia, Nicola Antonio Insante. By focusing on him, we were able to develop a broad account of the social and economic consequences of his death on his family. At the same time, our research demonstrated the resiliency of his immediate and distant descendants. Similarly, we discuss the D’Ambra and Scola families of Forio d’Ischia, and the Caruso and Valenziano families of San Prisco, among whom a number died from cholera in 1837.

Introduction

The second world cholera pandemic, like the first one (1817–1823), arose in Bengal, India. Its importance was due not only to the extent of its geographic spread, but to other issues which arose as it invaded Europe and North America. It demonstrated the serious inadequacies of western medicine’s therapeutic capabilities and the futility of the public health measures implemented to contain its spread. Cholera carried a high morbidity and mortality, and coupled with quarantine efforts to contain it, caused significant social, political, and economic disruptions [1].

Beginning in 1826 in the Ganges River Delta of Bengal, this pandemic quickly moved into Russia by 1827. From there, it was eventually imported into Poland in 1831 by Russian soldiers sent into put down a revolt. It quickly spread the same year to Berlin, Vienna, England, and Wales. By 1832, it had infected London, Ireland, and France. The various sanitary barriers erected across Europe and enforced by well-armed military failed to halt its spread. Similarly, quarantine measures also failed.

In 1832, Irish immigrants carried cholera into Canada, where outbreaks quickly developed in Quebec and Montreal. Shortly thereafter, on 26 June, cholera was identified in Irish immigrants in New York City [2]. Panic immediately set in as soon as word got out that cholera was in the city. This resulted in a mass exodus of affluent people to areas believed unassailable by the disease.

It was not long before people observed that the spread of cholera was not always rapid and inexorable. Witness the six-year period that elapsed between its appearance in Moscow in 1830 and its reaching the Kingdom of the Two Sicilies in southern Italy in 1836–1837. They also observed that there were periods of explosive epidemics followed by others when few or no cases occurred. This cycle of disease absence followed by recrudescence became a well established phenomenon. Low prevalence and disease-free periods varied in length as was the case when recurrences occurred in Poland and Prussia in 1837, after a period of several years. Recrudescences occurred in other parts of Europe and the Americas as well as in other parts of the world. Thus, the second world cholera pandemic, unlike its predecessor, was global in its geographic reach, and temporally very prolonged.

During the second pandemic, there was a widespread belief that cholera arose among the morally unfit, and in circumstances characterized by poverty, filth, misery, and vice. This “localist” belief was strengthened by the fact that in many parts of Europe and North America, the highest morbidity and mortality rates occurred among day laborers, paupers, beggars, artisans, sailors, boatmen, fishermen, and small traders. Thus, the wealthier levels of society perceived that they were invulnerable to the disease since they were not in proximity to the miasmas that arose from filth rotting in the streets. In point of fact, the poor were more vulnerable to cholera because of their proximity to unsafe local water supplies, a fact that became more apparent during later pandemics [3]. The poor for their part often thought that the wealthy had in some way supposedly contaminated their water supplies. Subsequent pandemics in which both rich and poor alike were affected altered causation beliefs in miasmas so prominent in the second world cholera pandemic [4].

Cholera and the Kingdom of the Two Sicilies

Cholera arrived in the city of Naples, the capital of the Kingdom of the Two Sicilies, on 2 October 1836. It was to remain there for slightly more than a year until 24 October 1837. By the time the epidemic ceased, it is estimated that there were 32,145 cases and 19,470 deaths in the city. This represented a mortality rate of 65 % and 54.5 deaths per 1000 population among Naples’ 357,283 inhabitants [5].

An understanding of the second world cholera pandemic in southern Italy is aided by a brief overview of the Kingdom of the Two Sicilies, its history, and that of the political units that preceded it. The Kingdom of the Two Sicilies, which occupied the lower half of the Italian peninsula and Sicily, was ruled by an autocratic Spanish Bourbon monarchy which, like previous regimes in this area of Italy, kept most of the population hostage to both ignorance and poverty.

This region of Italy came under direct Spanish rule in 1504, and the kings of Spain ruled through viceroys. Consequently, southern Italy and Sicily (for varying periods) were in effect European colonies of Spain. This Spanish colonial status continued for two centuries, and was largely characterized by political repression and economic exploitation. The War of the Spanish Succession (1700–1715) resulted in the conquest of the area by the Austrians in 1707. They remained in control of southern Italy for 27 years, until the War of the Polish Succession (1733–1738) resulted in the creation of the Kingdom of Naples. Don Carlos, infante of Spain and son of King Philip V, defeated the Austrians at Bitonto in 1734, and became King Charles VII of the Kingdom of Naples. After a 25-year reign, he succeeded to the Spanish throne as King Charles III and abdicated the throne of the Kingdom of Naples in favor of his young son who became Ferdinand IV [6].

Under Ferdinand, most in the kingdom continued to live in degrading poverty while the aristocracy and clergy led privileged lives. Forty years after becoming king (1799), Ferdinand and his family were forced to flee from Naples to Palermo when French forces arrived and supported the new Parthenopean Republic. Less than a year later, however, Ferdinand was restored by popular support and the military intervention of a British fleet under Horatio Nelson [6].

Soon thereafter, in 1806, Napoleon’s forces under his brother, Joseph Bonaparte, invaded the Kingdom of Naples, and Ferdinand and his family again fled to Palermo in Sicily. Joseph Bonaparte ruled as king until 1808, when he became King of Spain. Napoleon then gave the Kingdom of Naples to his brother-in-law, Joachim Murat, who ruled as king until 1815. Napoleon’s defeat at Waterloo in 1815 and Murat’s at Tolentino by the Austrians effectively ended French domination of the Kingdom of Naples. During these years, referred to by Italians as the Decennio, the French abolished feudalism, confiscated ecclesiastical properties and the land holdings of the aristocracy, promoted the development of a middle class, created civil vital records, and revamped the army and the navy. Ferdinand was restored for a second time in 1815, and became Ferdinand I, King of the Kingdom of the Two Sicilies, as the Kingdom of Naples was now called under the terms of the Congress of Vienna [6].

At the time of the 1836–1837 cholera epidemic, Ferdinand I’s grandson, Ferdinand II, was king. Having become king in 1830, he and his government made extensive and elaborate administrative and medical preparations for the possible arrival of cholera in the kingdom.

Efforts to Prevent and Treat Cholera

Francesco Leoni has detailed the administrative and medical structures created by the Bourbon government to both prevent the disease from entering the kingdom, to contain its spread, to manage cases, and to disinfect houses occupied by those with cholera. These included the creation of a Supreme Council of Health with sweeping powers to formulate policies concerning quarantines, sanitary cordons, therapeutic regimens for cholera patients, disinfection of presumed contaminated environments, and the establishment of special hospitals or portions of hospitals for caring for the ill [7]. A separate Supreme Council of Health was also created in Sicily [8].

Most preventive and therapeutic efforts were concentrated in Naples and other large towns and cities where a long history of civil unrest and rebellion always posed potential threats to the Bourbon monarchy. The highest priority was given to protecting the royal family, and for this purpose a strict sanitary cordon was thrown up around the Royal Palace in the city of Naples [7]. High levels of protection were also given to the military and the police which were essential for maintaining the king and his government in power.

Dr. Salvatore De Renzi, who was from Avellino, was Director of the Hospital of Santa Maria di Loreto in Naples. He and other leading physicians participated in elaborating guidelines for the medical management of cases of cholera by degree of severity. Most of the therapeutic recommendations were those that had already been widely used in other parts of Europe. Medical leaders in Naples were aware of all the preventive and therapeutic measures that had been implemented for cholera over the four-year period as it had spread through Europe. Not surprisingly, they too used calomel, opiates, a variety of substances applied externally to the abdomen, purgatives, mercury, and blood letting. However, De Renzi and his colleagues experimented with what became known as an anti-choleric wine [7]. This mixture, derived in part from a herbal preparation, was administered to patients at De Renzi’s Hospital of Santa Maria di Loreto, where he claimed it produced excellent therapeutic results [7]. De Renzi, like other institutional directors and medical practitioners, was required to report all cases of cholera to the government. Wealthy families tended not to report cases, while the poor often reported as cases people who had died of other causes in the interests of obtaining a free burial [5].

The elaborate preventive and therapeutic plans of the government proved largely futile. Cholera raged through the kingdom. Disinfection efforts at the homes of victims, such as burning all furnishings or treating houses with chlorine or sulphur gases, were resisted, and only encouraged people to hide cases and deaths. Despite the deficiencies of case and death reporting, data for the city of Naples and other large cities and towns in the kingdom were meticulously gathered. In her exhaustive study of data for Naples, Messina was able to analyze cases and deaths for a number of towns near Naples, and especially for Naples itself. She was also able to analyze data for several of the kingdom’s provinces, recognizing that there were significant flaws in the available information. In essence, the epidemic in the city of Naples extended from 2 October 1836 to 8 March 1837 and from 13 April 1837 to 24 October 1837, with a five-week lull between the two acute phases [5].

The epidemic was equally severe in Sicily where 69,000 people died, 24,000 of them in Palermo alone [8]. Given the deficiencies in case and death reporting, it is likely that these figures are conservative. Adding to the problem of counting cases was that of the general absence of cause of death recording on civil death certificates. Prior to the French occupation of the Kingdom of Naples, death, birth, and marriage registries were maintained by the church. One of the major Napoleonic reforms was the establishment of civil vital records in all cities and towns. These were continued by King Ferdinand I following his restoration in 1815. However, causes of death were not generally recorded in these civil records, except in cases of suicide or homicide. As Messina has noted, deaths from cholera were often assumed to have occurred at times of epidemics. Thus, mortality data for the 1836–1837 epidemic are often inferential in nature [5].

There were of course other sources for morbidity and mortality data such as those from hospitals. Based on his own experience at the Hospital of Santa Maria di Loreto, De Renzi wrote a detailed account of the 1836–1837 cholera epidemic. He estimated that the total number of cases in the city of Naples was on the order of 30,000 by the end of July 1837. Undercounting of cases occurred both because the government tried to minimize the number for political reasons, and because mild cases went unreported. Similarly, the government initially made a concerted effort to minimize the number of deaths out of concerns for possible civil disorder and even outright rebellion [5].

A detailed examination of cholera data from two towns in the Kingdom of the Two Sicilies illustrates the inconsistencies in mortality recording. These available data also demonstrate the necessity for deducing the epidemic curves based on comparisons with pre- and post-cholera mortality levels. This approach is similar to that currently used in tracking influenza epidemic curves. Here, pneumonia mortality levels are used to infer the level of influenza cases 2 weeks previously [9].

Cholera data were examined for San Prisco and Forio d’Ischia. The former was then a relatively small town situated between the larger towns of Capua and Caserta to the northwest of Naples, then the capital of the kingdom. Forio was a much larger town situated on the west coast of the volcanic island of Ischia in the Bay Naples (Fig. 1).

Fig. 1

Location of the towns of San Prisco and Forio d’Ischia in Italy (Drawn by Frank Fasano)

Vital Records Sources

There are two major sources of historical vital records for towns in southern Italy. The earliest are church records which were generally initiated in the sixteenth and seventeenth centuries following the Council of Trent. Many of these records are currently located in the churches where they were originally created or else have been moved to diocesan archives. A few are currently in the regional holdings of Italy’s Archivio di Stato (state archives). The information for births, deaths, and marriages in these ecclesiastical records is often very summary in nature.

Following the Napoleonic conquest of the Kingdom of Naples in 1806, government vital records systems were instituted in towns throughout the kingdom. The start date for these records varies from one town to another. However, in general, many began around 1809 and 1810. At the same time, ecclesiastical records continued to be created by churches.

With the restoration of the Bourbon monarchy in 1815, King Ferdinand I and his successors continued the system of municipal vital records. Over the course of the ensuing century, the basic forms used for registering births, deaths, and marriages physically changed several times with concurrent changes in the information included in them. These changes continued after the Kingdom of the Two Sicilies formally became part of the Kingdom of Italy in 1861. However, changes in vital record forms, reflecting standardization throughout Italy, were not uniformly implemented until a few years following Italian unification.

From their inception in the towns of San Prisco and Forio d’Ischia in 1810 and 1809 respectively, two copies of municipal vital records were created. One copy was kept by the vital records officer in the town hall, and another was respectively sent to the Tribunale in Capua or Naples. Most of the latter for the nineteenth century are now in local collections of the Archivio di Stato, while the former are archived in a town’s vital records office. The microfilms and digitized copies of these municipal vital records created by the Church of Jesus Christ of Latter Day Saints during the past few decades reflect the original Tribunale holdings. Over time, portions of records have been lost from both local vital records offices and Tribunale holdings as well as from ecclesiastical archives.

For the purpose of this and other studies, we have carefully examined both church and municipal vital records in situ in both towns. In addition, we have studied the Tribunale holdings in the Archivio di Stato in Caserta, Italy. The municipal vital records for San Prisco for the period 1810–1929 were microfilmed by the Church of Jesus Christ of Latter Day Saints. We carefully studied these for several years at the church’s Family History Center in Plainview, New York. These microfilm copies were produced from records in the Tribunale holdings of the Archivio di Stato in Caserta. More recently, the church digitized the Tribunale copies of vital records for the town of Forio d’Ischia for the period 1809–1915 from the Archivio di Stato holdings in Naples. We have examined these records in detail online through www.Familysearch.org.

Reading ecclesiastical records requires a working knowledge of Latin. One of us (PJI) possesses this ability, having studied Latin for 4 years. We were also greatly aided by Eleanor M. Imperato (wife and mother), who studied Latin for 7 years. The authors are reasonably fluent in Italian, and were greatly aided by Eleanor M. Imperato, who is a fluent Italian speaker.

Data Collection and Analysis

This study began with the observation that there was a dramatic increase in deaths in both towns in 1837. These increases occurred in San Prisco in July and in Forio d’Ischia in June and July. We were already familiar with the second world cholera pandemic, and at the outset knew that this was the probable cause of these dramatic spikes in mortality.

San Prisco was and is a much smaller town than Forio d’Ischia, and its historical vital records, both ecclesiastical and municipal, are locally well organized. Similarly, the microfilmed municipal records are well organized with deaths (morti) comprising an easily identifiable category. These death certificates are chronologically organized by year and by date within a given year. For some early nineteenth century years, indices were created. However, these were generally organized alphabetically by first name and not by surname. An additional challenge in all vital records of this era is in deciphering the calligraphy of some vital records officials as well as the orthography they used for personal names and surnames.

The vital records for Forio present additional challenges. In the Forio vital records office, birth, death, and marriage records are separately bound in annual volumes and stored on shelves. Within each volume, certificates are chronologically filed by date. By comparison, the Tribunale records on file in the Archivio di Stato in Naples, and digitized by the Church of Jesus Christ of Latter Day Saints, are not so consistently organized. Concerning death records, for certain years such as 1821 and 1823–1836, they are filed under the category Diversi (diverse documents). However, within the Diversi category, usually reserved for a variety of other types of documents, death certificates were annually filed chronologically under a Morti section. In some years, an index is also included, organized alphabetically by first name.

The Tribunale death certificates for Forio for 1837, the year of the cholera epidemic, are separately listed under Morti and not submerged in the Diversi section. However, only death certificates from the period 1 January–15 October are included. The remaining certificates for the last two-and-a-half months of the year are missing. Also, the actual death certificates for 2–18 July are missing. These deficiencies are partially compensated for by the fact that within the 1837 Diversi section there is an impressive 26-page alphabetical listing of deaths by first names for 1837. This document lists the victims’ names, paternity, and day and month of death. In addition, the calligraphy in this document is of superior quality making for easy reading of its content.

Stillbirths and the deaths of Forio residents outside of the town were not included in this study given their lack of relevance to the 1837 cholera epidemic in Forio. Overall, their numbers for all years in this general period were small.

To the south of Forio is Panza, which historically was a hamlet. While records for Panza were managed by the vital records officer of Forio, they were kept separate and apart, and not comingled with those of Forio. The population of Panza in the early nineteenth century was very small, and only a few births and deaths were annually reported. For the purposes of this study, mortality data for Panza were not included.

Calculating Cholera-Specific Mortality Rates

Causes of death were not generally recorded. As discussed below, there was an exception to this practice when the vital records official for Forio recorded cholera or suspected cholera on the death certificates for the first 42 cases. Calculating the total or crude mortality rates for 1837 for San Prisco and Forio was relatively easy. These rates simply consist of the total annual number expressed as deaths per 1000 population. However, we also wished to calculate cholera-specific mortality rates for the two towns for 1837. This was achieved by first averaging the annual number of deaths for years both before and after 1837 for each town. For San Prisco, this was 74, and for Forio it was 130 deaths. These numbers were then respectively subtracted from the total number of 1837 deaths for San Prisco and Forio. This resulted in an approximate number of excess deaths, assumed to be due to cholera.

Thus, while the total number of deaths for 1837 in San Prisco was 183, subtracting the average of 74 annual deaths for other adjacent years produced 109 probable deaths due to cholera. For Forio, the average number of deaths for years before and after 1837 was 130. This number, when subtracted from the total number of 446 deaths for 1837, resulted in 316 probable deaths due to cholera. Once these approximate numbers were calculated, it was possible to determine the disease-specific mortality for cholera for each town based on its 1837 population.

These calculations respectively resulted in crude mortality rates of 49.5/1000 and 81.1/1000 for San Prisco and Forio respectively, and cholera-specific mortality rates of 29.5/1000 and 57.5/1000 respectively.

Cholera in San Prisco

San Prisco today is now a town of some 10,000 people that lies to the northwest of Naples and to the west of Caserta in the current Province of Campania. Originally a hamlet of the town of Capua to the west, the town lies at the foot of Mount Tifata, an important peak in the Apennine range of mountains [10, 11]. In the early sixteenth century, the town had a population of some 300 people. However, by 1800, this population had grown to 2400 people [12].

The economy of San Prisco was based on agriculture, especially the cultivation of olives, grains, and grapes. During the nineteenth century, San Prisco was located in the Province of Terra di Lavoro, a name that signifies “fruitful land.” This province was so called because it was a highly productive agricultural area. However, the economy of the town also greatly benefited from the construction of the nearby Royal Palace at Caserta by King Charles VII (later King Charles III of Spain) between 1752 and 1774.

Throughout most of its existence, the town was called Santo Prisco. However, toward the latter half of the nineteenth century, the name Santo was truncated in official records to San, which also came into popular use. Interestingly, late nineteenth century immigrants to the United States from the town and their children continued to refer to it as Santo Prisco even into the 1960s (Fig. 2).

Fig. 2

The center of San Prisco, 2008

At the time of the 1836–1837 cholera epidemic, there were about 3700 people living in San Prisco. The average number of deaths annually ranged between 65 and 86 in the years before and after the epidemic. The annual mortality rate reflected these absolute numbers, ranging from 17.8/1000 population in 1835 to 23.2/1000 population in 1838 (Table 1).

Table 1 Comparative total annual registered deaths and crude mortality rates, 1833–1843, Town of San Prisco, Province of Terra di Lavoro, Kingdom of the Two Sicilies

In 1837, cholera arrived in San Prisco. The total number of annual deaths that year reached 183. This was more than double the number in any of the other years between 1833 and 1838. This amounted to a crude mortality rate for 1837 of 49.5/1000 population, more than double that of any of the comparison years. The approximate cholera-specific mortality rate was 29.5/1000 population. This cholera-specific mortality rate of 29.5/1000 population was much lower than the cholera-specific mortality rate of 54.5/1000 population reported for the same time period in the city of Naples [5].

Some sources give the annual number of deaths in San Prisco for 1837 as 187. However, we have used the 183 figure as it reflects the number of death certificates that appear in the Registro di Morti for that year. More significant than this small disparity in the total number of deaths is the distribution of deaths by month. For eleven of the twelve months of 1837, the number of deaths in San Prisco ranged from two to fifteen per month. However, in July, when cholera appeared in the town, the total number of deaths for that month dramatically rose to 99 (Table 2).

Table 2 Total registered deaths, by month, Town of San Prisco, Province of Terra di Lavoro, Kingdom of the Two Sicilies, 1837

This is the month that other town records indicate that cholera appeared. As shown in Table 3, the epidemic in San Prisco began suddenly, the second week of July, and continued for the remainder of the month. Thirty-six people died during the third week of July alone, and 31 during the remainder of the month. A total of 99 people died in July in the town, more than the total number who annually died in the years before and after 1837. By August, the epidemic had essentially run its course because in that month, only 13 people died.

Table 3 Deaths during the month of July 1837 by week, Town of San Prisco, Province of Terra di Lavoro, Kingdom of the Two Sicilies

A close examination of all the death certificates for San Prisco revealed that in no case was any cause of death listed, including cholera or suspected cholera. There is nothing exceptional about this finding because in most instances at this time and for decades before and afterwards, causes of death were generally not recorded on death certificates. There are no data on the number of cholera cases that occurred in San Prisco during the epidemic. Mild cases could have been overlooked, even by the victims themselves, and moderately severe cases may not have been reported to the authorities. As Messina has pointed out, data for deaths from cholera during this epidemic are to a great extent inferential for many localities, and that certainly holds true for San Prisco [5].

One of those who succumbed to cholera in San Prisco at the height of the epidemic on 17 July 1837 was Alessandro Caruso, who was 80 years of age. He was a retired gardener and shop owner. He was respectively a fourth paternal great-grandfather of the senior author, PJI, and a fifth paternal great-grandfather of GHI and ACI. Alessandro was the son of Andrea Caruso and Lucia Fiorillo, who lived in the eighteenth century. He was also the father of Prisco Caruso (1776–1828), grandfather of Antonio Caruso (1805–1850), and great-grandfather to Concetta Caruso (1830–1910). She married Clement Imperato (1840–1923) in 1863, and their second son, Pasquale Imperato (1869–1942) was respectively the grandfather and great-grandfather of the authors, PJI, GHI, and ACI [13].

Another probable victim of the epidemic was Donna Caterina Valenziano (1757–21 July 1837). She was the daughter of Don Gabriele Valenziano (1724–21 October 1761) and Donna Teresa de Angelis (1728–28 August 1778). Don Gabriele Valenziano was a Spanish Sub-Lieutenant in the Royal Farnese Infantry Regiment, and posted at nearby Capua. He later became a Lieutenant in the Royal Cavalry at Capua. He was brought into the then Kingdom of Naples by the Spanish Bourbon King Charles VII, later King Charles III of Spain. He married Donna Teresa de Angelis in 1754. She came from one of San Prisco’s leading families. Her brothers, Bartolomeo de Angelis, a druggist, and Alessandro de Angelis, paid her dowry [14].

Donna Caterina Valenziano was born in 1757 into San Prisco’s upper socio-economic stratum. She eventually married Don Gabriele Boccardi (b. 1743), the son of Don Saverio Boccardi (b. 1700), a physician and one of the wealthiest men in the town, who was originally from nearby Capua. Donna Caterina Valenziano’s older brother, Don Francesco Valenziano (1753–1807), was respectively a fourth great-grandfather of the senior author, and a fifth great-grandfather of GHI and ACI. Thus, she was respectively a fifth and a sixth great-aunt of the authors. If Donna Caterina Valenziano did indeed die from cholera, her death would indicate that the disease also affected even the wealthiest residents of the town. For at the time of her death, she was a major property owner in San Prisco [14].

As shown in Table 4, the mean age of those who died in the month of July 1837 in San Prisco was 41.5 years. The ages of those who died ranged from 1 to 90 years of age. The majority of deaths (60.6 %) occurred among women. Thus, there were 1.5 female deaths for every male one.

Table 4 Demographic characteristics of the ninety-nine people who died in the month of July 1837, Town of San Prisco, Province of Terra di Lavoro, Kingdom of the Two Sicilies

There are a few caveats concerning the age data for San Prisco. Municipal clerks often recorded the ages of those who died to a nearest round number, such as 50, 55, 60, 65, 70, 75, etc. This was because most people, except for those from the higher socio-economic levels, were often unsure of their precise ages or dates of birth. Children who died young were often listed as infants, without a precise age being provided. The data in Table 4 also reflect a decision by the vital records official to assign 1 year of age to the seven children who died during the month of July, regardless of their actual age.

Prior to the cholera epidemic of 1836–1837, most of the dead were buried beneath the churches. In San Prisco, these burials usually took place in the crypts of the Church of Santa Matrona, referred to as the town’s “mother church.” However, because of the large number of deaths from cholera, victims were soon buried in cemeteries created for this purpose. An additional reason for burying cholera victims in cemeteries was to prevent spread of the disease. Following the cholera epidemic of 1836–1837, burial in cemeteries became increasingly common in southern Italy.

Burial customs in the Kingdom of the Two Sicilies were complex and encompassed an initial interment in a shallow grave, usually beneath a church. This was followed a few years later by disinterment, the scraping of residual tissues from the skeleton, and the placement of the bones in a niche or a common ossuary. There were many variations to these rites, including replacement of clothing on the dead after exhumation. Even today in southern Italy, the dead are placed in shallow graves in cemeteries for about 2 years. Thereafter, the remains are removed and cleaned of residual tissues. The bones are then placed in a family niche or else placed in a common ossuary. The beliefs upon which this custom of secondary burial is based are very complex, and have been described by Fornaciari, Giuffra, and Pezzini [15].

Well before the cholera epidemic of 1836–1837, the Supreme Magistrate of Health for the city of Naples became extremely concerned about the unhygienic nature of secondary burials because of the exposure of people to putrefaction [15]. Once cholera arrived in the kingdom, the Supreme Council of Health ordered that the dead be buried in permanent graves in cemeteries. This led to the creation of cemeteries in many locations. However, popular belief in the necessity of exhumation after a time and reburial of the bones of the deceased has continued to this present day.

Cholera in Forio d’Ischia

Ischia is a volcanic island in the Tyrrhenian Sea that lies some 19 miles from the city of Naples. It has a roughly rectangular shape, and is approximately six miles east to west and four miles north to south. It has a 24-mile coastline, and because it is of volcanic origins is extremely mountainous. The highest peak is Mount Epomeo, which is currently dormant. Two severe earthquakes occurred in Ischia in 1881 and 1883. Centered in the town of Casamicciola, both caused extensive damage. However, the earthquake of 28 July 1883 was the most severe in historical memory. It virtually destroyed the town of Casamicciola, known even then for its thermal baths, and also affected the nearby town of Forio where 345 people died. In Casamicciola, 1784 people died, while the total number of deaths for the five towns on the island affected by this earthquake was 2313. After Casamicciola, Forio suffered the greatest loss of life [16, 17].

Forio occupies the most western portion of the island of Ischia. Historically, its economy was based on agriculture, fishing, and shipping. Its vineyards were and still are famous for the quality of the wines they produce, in part because of the richness of the volcanic soil in which the grapes are grown. Today, Forio’s economy is based on a thriving tourist industry. By the late twentieth century, there were some 70 hotels in Forio accommodating large numbers of international tourists drawn to the town by its miles of excellent beaches and thermal baths (Figs. 3, 4).

Fig. 3

Forio d’Ischia from the Bay of Naples, 1989

Fig. 4

The center of Forio d’Ischia

In 1837, the population of Forio was 5500. The first cases of cholera were diagnosed in June 1837. As shown in Table 5, there were 446 deaths in Forio in 1837, making for a crude mortality rate of 81.1/1000 population. This rate exceeded the crude mortality rate of 57.5/1000 population for San Prisco. The calculated cholera-specific mortality rate for Forio was 45.1/1000.

Table 5 Comparative total registered deaths and mortality rates, 1 January through 31 December, for selected years, Town of Forio di Ischia, Province of Naples, Kingdom of the Two Sicilies

As also shown in Table 5, the annual crude death rates for Forio between 1830 and 1844, with the exception of 1837, ranged from 21.3/1000 population (1838) to 25.6/1000 population (1840). No mortality data for Forio are available in the Tribunale records for 1841 and 1842. These gaps in information reflect the status of vital records filed with the Tribunale in Naples and not those on file in the town of Forio. Record loss because of natural disasters and war was surprisingly infrequent. However, it nonetheless did occur. In order to prevent total loss of a given record, two copies were usually created in towns in southern Italy during the nineteenth century. One was kept in the vital records office of the town and the other was filed with the Tribunale in the provincial capital.

As alluded to above, the death records for the town of Forio for the years under consideration are incomplete. However, they are the ones that were digitized by the Church of Jesus Christ of Latter Day Saints from files that were originally in the Tribunale in Naples, and which are now in the Archivio di Stato there.

As already noted, complete death registration certificates for 1837 are only extant in the Tribunale records for the period 1 January through 15 October. However, there is a 26-page alphabetical listing by first name of all deaths for 1837 filed in the Diversi (diverse documents) section of the original Tribunale holdings. As shown in Table 6, the epidemic began in Forio in the month of June, when 55 deaths were recorded. It peaked in July when 255 deaths were registered. In tabulating these data, an assumption was made that most of these July deaths were due to cholera. As in the case of San Prisco, we realize that some of these deaths were due to other causes.

Table 6 Total registered deaths, by month, 1 January–31 December 1837, Town of Forio d’Ischia, Province of Naples, Kingdom of the Two Sicilies

It is noteworthy that the first 42 deaths from cholera or suspected cholera were documented as such on the death certificates for the period of 19 June, when the epidemic began, through 1 July 1837 (Table 7). Listing the cause of death on death certificates was never really done in southern Italy either before 1837 or for decades afterwards. There was a twofold reason for this. First, there were no widely accepted diagnostic mortality standards. People often died of fevers and internal pain that could have been due to a variety of causes. Second, death certificates were not completed and signed by physicians, but rather by the ufficiale dello stato civile (vital records officer) of a town, who was often the mayor. Even suicides or homicides were sometimes not listed per se on death certificates. Instead, a notation was made on the certificate or a statement attached to it indicating that an inquest was held, and a report of its findings created.

Table 7 The first forty-two documented deaths from cholera in the Town of Forio d’Ischia, Province of Naples, Kingdom of the Two Sicilies, 20 June–1 July, 1837

The vital records official for Forio at the beginning of the epidemic was Nicola Castellaccio, who was also the town mayor. He recorded cholera or suspected cholera on the death certificates of 42 individuals who died between 19 June and 1 July. His term of office expired on 2 July 1837. He was succeeded by Bartolomew Castaldi in both offices. Castaldi noted on all the death certificates that he signed that he was the elected mayor, a clear departure from the standard practice of just stating mayor as his title. However, no mention was made on any death certificate of cholera or suspected cholera once he took office. Although direct evidence is lacking, it is probable that higher government authorities were not pleased with Castellaccio listing cholera or suspected cholera as the cause of death and instructed his successor, Castaldi, not to do so.

Thanks to Castellaccio, it was possible to document the age, gender, occupation, and date of death of the first 42 cases of cholera in Forio, which occurred between 19 June and 1 July. As shown in Table 8, the mean age of the victims was 52.4 years. The oldest victim was 88 years, and the youngest 15 years. There were 1.3 female victims for every male (Table 8). In San Prisco, the ratio of female to male victims was similar at 1.5.

Table 8 Demographic characteristics of the first forty-two documented deaths from cholera, 19 June–1 July 1837, Town of Forio d’Ischia, Province of Naples, Kingdom of the Two Sicilies

It is of interest that the disease affected all strata of society from laborers to property owners. This may have been due to contaminated water supplies shared by all socio-economic levels of the town. The preponderance of deaths among older adults speaks to greater disease severity, which may have had its origins in lower levels of gastric acidity. It is also of interest that the first two deaths occurred among mariners, Nicola Insante and Antonio La Monica. The former was respectively a maternal second and third great-grandfather of the authors, PJI, GHI, and ACI, and thus much is known about him and his family. Even a brief overview of him and his familial connections humanize him as a person.

It should be noted that on 25 February 1837, well before the epidemic began, that the conscientious Castellaccio recorded a possible case of cholera. The person in question was Cristoforo Di Colantonio, a 54-year-old laborer who died the day before on 24 February “of a disease suspicious of sporadic cholera.” On 6 March, Castellaccio recorded that on the previous day, Carmela Di Colantonio, Cristoforo’s 12-year-old daughter, died of “a suspicious disease.”

The third case in this cluster was Cristoforo’s 48-year-old wife, Candida Carneglia, who also died on 6 March of “an illness suspicious of spurious cholera.” No other cases of cholera were reported until 19 June, three-and-a-half months later.

Castellaccio was obviously aware of the cholera epidemic then in progress in Naples. However, since no clinical details were provided for this family cluster of three cases, it is not possible to conclude with certainty that they died from cholera. If they did, the deaths of the mother and daughter on 6 March, 10 days after the father’s passing, would indicate that he was the index case. They most probably became simultaneously infected by caring for him during his illness, if indeed cholera was the cause of all their deaths.

Castellaccio was cautious in his statements on these death certificates using such grammatical qualifiers such as “suspected,” “sporadic,” and “spurious.” This indicates that he himself was not absolutely sure that they died of cholera. There is obviously the possibility that they did. However, the failure of the disease to immediately spread to others raises serious questions about the diagnosis. For cholera did not become epidemic in Forio for almost three-and-a-half months after the deaths of the mother and daughter. Because of this epidemiologic evidence, we have not included these three cases among those who died in the 1837 cholera epidemic in Forio.

A Profile of Nicola Antonio Vincenzo Insante Who was the First Person to Die from Cholera in Forio d’Ischia During the 1837 Epidemic

Nicola Antonio Insante came from a family of mariners. He also came from a family whose surname was often transformed in written vital records because of phonetic interpretation by church clergy and town clerks. These various spellings spanning some 300 years include Ansaldo, Ansaldi, Santi, Zante, Ansante, Assante, and Insante. The last name persisted in the late nineteenth century, into the twentieth century, and continues today.

Nicola was born in Forio on 14 May 1782 as Nicola Antonio Vincenzo Ansaldi to Pietro Paolo Andrea Ansaldi (Zante) (14 May 1749–March 1812), a mariner, and Anna Maria Iodice (Fig. 5). His grandfather, Cristoforo Gaetano Ansaldi (31 October 1711–14 March 1784), was also a mariner, and was married to Caterina Esposito. His great-grandparents were Filippo Antonio Ansaldo (b. 30 October 1684) and Lucrezia Sferratore, who were married in Forio on 21 July 1709. Filippo Antonio Ansaldo was a mariner, and it is believed by some that his parents, Nicola Ansaldo and Apollonia Camelera, came to Ischia from Genoa (Fig. 6).

Fig. 5

Baptismal record written in Latin for Nicola Antonio Vincenzo Ansaldi (Insante), 14 May 1782

Fig. 6

Death record written in Latin for Cristoforo Gaetano Ansaldi (Insante), 14 March 1784

Because of a reliance of vital records officials on the phonetic interpretation of names, Nicola Insante’s family surname alternated even for the same person. Sometimes, the surnames recorded on the birth and death certificates for someone were vastly different. For example, Nicola was listed as Nicola Ansaldi on his birth certificate (1782), but as Nicola Insante on his death certificate (1837). Nicola’s father, Pietro Paolo Andrea, was listed as Zante on his 14 May 1749 birth certificate. His father, Cristoforo Gaetano, was listed in turn as Ansaldi on his 31 October 1711 birth certificate and as Zante on his 14 March 1784 death certificate. Further complicating matters is the fact that when Nicola was born, his father, Pietro Paolo Andrea, was listed as Ansaldi. Yet, Pietro Paolo Andrea’s own birth record lists him as Zante (Fig. 7).

Fig. 7

Baptismal record written in Latin for Pietro Paolo Andrea Zante (Insante), son of Cristoforo Zante (Insante) and Catarina Esposito, 14 May 1749

On 19 December 1814, Nicola Insante, who was 32 years of age, married Maria Lauro (1795–13 May 1857), who was 19 years of age. She was the daughter of Gaetano Lauro, who was also a mariner, and Loreta Carneglia. There is an interesting notation on this marriage record that states that Nicola was the son of the late Pietro Paolo, who died at sea in the month of March in the year 1812. Thus, Nicola’s father met a tragic death at the age of 63 years. Nicola’s mother, Anna Maria Iodice, was still alive at the time of his marriage [18]. However, she was deceased at the time of his death in 1837.

Nicola and Maria had several children including: Pietro Paolo (11 November 1815–12 September 1816), Pietro Paolo (19 November 1817–28 March 1897), Loreta Angela (1 April 1820–?), Gaetano Stanislaso (15 August 1821–15 November 1822), Gaetano Francesco Pasquale (21 April 1824–31 December 1876), Antonio Francesco Paolo (26 August 1828–2 December 1878), and Anna Maria Luigi (30 December 1830–19 September 1890). All of Nicola’s three adult sons became mariners, and Pietro Paolo rose to the rank of ship’s captain. Pietro Paolo was 19 years of age when his father died, Gaetano was 11, and Antonio (later Antoine) was nine. Their sister, Anna Maria Luigi, was only 7 years of age.

Nicola Insante died of cholera at 3:30 AM on 19 June 1837 at his home on Strada Marina in Forio. His death was not reported to the mayor and vital records officer, Nicola Castellaccio, until 2:00 PM the following day, 20 June (Fig. 8).

Fig. 8

Civil death record for Nicola Insante, 44 years of age, son of the late Pietro Paolo and the late Anna Maria Iodice, and husband of Maria Lauro, 19 June 1837, Forio d’Ischia, Province of Naples, Kingdom of the Two Sicilies

It is noteworthy that the other cholera victim who died on 19 June did so at 7:30 a.m. His death was reported at 2:00 p.m. the same day. Thus, from a temporal perspective, Nicola Insante was the first person to die of cholera in Forio, followed 4 h later by a fellow mariner, Antonio La Monica who lived on Strada San Giovanni. It is difficult to account for the almost day-and-a-half delay that occurred in reporting Nicola’s death to the civil authorities. However, such delays in death reporting were not unusual at that time whatever the cause. What is not known, of course, in Nicola’s case, is if any members of his immediate family also came down with cholera at the same time. If they did, they all recovered because their deaths were not recorded on the 1837 mortality list.

The Fate of Nicola Insante’s Family

When Nicola Insante died, he left a widow and several young children, all of whom must have known that he died of cholera. In an era when there was no form of government support for a family in these circumstances, all the children had to find employment. Antonio (Antoine) became a mariner and sailed widely throughout the Mediterranean. On 7 August 1858, he married Maddalena (Madeleine) Scola (29 April 1840–4 December 1911). In 1870, Antonio (Antoine) emigrated from Forio to Philippeville in French Algeria, where his youngest son, Vincent, was born on 27 November 1873 (Fig. 9).

Fig. 9

Birth certificate, written in French, for Vincent Santi (Insante), son of Antoine Santi (Insante) and Madeleine Scola, 27 November 1873, Philippeville, Algeria

Vincent and his siblings, Nicola (19 February 1865–10 June 1926), Maria Libera (4 January 1868–26 May 1956), and Angela (1871–9 November 1880), grew up in Philippeville, Algeria speaking French. Both Vincent and Angela were French citizens. Vincent Insante was born on 27 November 1873 at Numero 5 Rue du Troisieme Bataillon in Philippeville. His birth certificate, number 420 for that year, lists his name as Vincent Santi [19]. When he was baptized on 14 December 1873, his name again was recorded as Vincent Santi [20]. Thus, yet again, the surname was transformed. His father Antoine died at the Hôpital Militaire in Philippeville on 2 December 1878 under the name Antoine Insanté [21]. The cause of death was not stated on his death certificate. However, his death was witnessed by two male nurses, François Perge and Pierre Allegnon. Antoine’s death certificate was signed by Philippeville’s mayor, Alexandre Ricoux (Fig. 10).

Fig. 10

Death certificate, written in French, for Antoine Insanté, 2 December 1878, Philippeville, Algeria

Life in Algeria

It is estimated that Antoine and his family lived in Philippeville, Algeria for some 10 years. Many decades later, his daughter, Maria Libera Insante Verde, recounted fragments of their life there. She recalled that salt was mined nearby and that her father took her to see the mountains of salt piled up at the mine. He would also fill a small cloth bag with salt to bring home. She also recalled suffering from typhoid fever and losing all her hair. She was hospitalized at the Hôpital Militaire, which she accurately described as an enormous physical facility. It was indeed a very large facility since it served the French military forces in that part of North Africa. While a patient in the hospital, she recalled being cared for by French nuns.

Maria Libera Insante Verde also recalled attending a convent school in Philippeville where she learned a number of French children’s songs, including “Les Bons Bons.” The lines of this song were: “Les bons bons. Les bons bons. Tous les belles filles dissent les bons bons, les bons bons. Tous les filles dissent les bons bons.” The girls sang this song as they lined up, licked their index fingers, and then in turn dipped them into a bowl of multi-colored nonpareils. Needless to say that this practice was highly unhygienic, and could have facilitated the transmission of a number of diseases.

Maria Libera Insante Verde remembered a childless French couple who gave her a doll and proposed adopting her. She also remembered suffering a fracture of the lower portion of her right tibia when a carriage wheel rolled over her as she sat in the street playing.

Maria Libera Insante Verde always mentioned that Philippeville was near Bône and Constantine, nearby towns more familiar to most Italians since there were large colonies of them there [22]. A number of people had immigrated to Algeria from Forio in the 1860s and 1870s because of a depressed economy in the town. This depressed economy was due to a fungal infection of grapes, thus affecting the export of Forio’s principal export crop, which was wine [23]. Mariners were especially adversely affected since they transported the barrels of wine to the mainland.

Following Antoine Insante’s death, his wife eventually returned to Forio after an absence of a decade. Her children, who were both French and Italian speaking, now had to integrate themselves into the life of a town that was essentially alien to them. Madeleine, now once again Maddalena, and her daughter, Maria, set up a dressmaking shop on the Via San Vito in the quarter of the same name, which they maintained for the next three decades (Fig. 11). Around 1882, Maddalena gave birth to a son who was sent to the Real Casa Santa dell’Annunziata, a foundling home and orphanage in Naples.

Fig. 11

Building which housed Maddalena (Madeline) Scola Insante’s dress shop on the Via San Vito, Forio d’Ischia, Italy, as depicted in a painting by Roberto Pollio in 1984

Nicola, Maddalena’s oldest son, suffered from severe congenital scoliosis, and throughout life was limited in work opportunities. His sister, Maria Libera, incorrectly but intentionally maintained that his physical condition was due to a work accident in which a wooden barrel rolled off of a wagon onto his back.

Maddalena did receive some help from her Scola relatives, but her relations with her husband’s older brother, Pietro Paolo Insante, were always cool. He had remained behind in Forio when his younger brother, Antonio, went to Algeria. However, even in Forio, personal tragedy entered his life. None of his three sons lived into adult life. Of his six daughters, only two, Marianna and Libera, lived into adult life and moved to Naples after they married.

In 1880, Angela Insante, Maddalena’s second daughter, died at the age of 9 years. Based on descriptions of her sister, Maria Libera, many decades later, she probably died of rheumatic heart disease. She frequently suffered from tachyarrhythmias which even her mother observed in her carotid pulse.

On 28 July 1883, a devastating earthquake struck Ischia. Centered in the nearby town of Casamicciola, it caused 2313 deaths on the island of Ischia, of which 345 were in Forio [17]. Maddalena Insante suffered from severe hearing loss, and thus did not hear the subterranean roar from the earthquake. However, she felt the severe movement of the floor of her shop and the lurching of the chair on which she was seated. According to accounts given by her daughter, Maria Libera, decades later, she fled into the street exclaiming: “Terramoto. Terramoto.” She and her daughter saw the side of the nearby church of San Vito move. However, it did not collapse. King Umberto II of Italy later visited Forio. Maddalena rushed up to him saying, “Maesta grazia. Maesta grazia,” which literally translated means “Majesty, a favor.” The town mayor told the king not to pay any attention to her as she was deaf, a widow, and crazy. The king dismissed his remarks and directed one of his aides to provide her with a document entitling her to aid (Fig. 12).

Fig. 12

Damage from the 1883 earthquake along a main street of the town of Lacco Ameno (In H.S. Johnston-Lavis)

The rhythm of life for Antoine’s family continued for decades. Vincent, now called Vincenzo, became a carroziere (coachman) with his own coach and horse.

The Marriage of Maria Libera Insante and Pietro Paolo Michele Verde

On 26 April 1904, Maria Libera Insante (4 January 1868–26 May 1956) married Pietro Paolo Michele Verde (8 May 1878–19 September 1933). He was 25 years of age, and she was 36 years of age. A stone mason and also an avid gardener, he had served for 3 years in the 74th Infantry Division of the Italian Army from 20 March 1899 to 22 April 1902 [24]. Literate and possessing an elementary level of education, his life began tragically when his mother, Emmanuela Filomena Nicolella (5 May 1838–14 May 1878), died 6 days after his birth. In all probability, her death was due to either post-partum infection or another complication of delivery. She was the daughter of Antonio Nicolella (1796–28 October 1867), a mariner who was deceased, and Anna Maria Amalfitano (b. 1796) who was still living (Fig. 13).

Fig. 13

Military discharge papers from the Italian army for Pietro Paolo Verde, 1902

Complicating this tragedy was the death of Pietro Paolo’s father, Francesco Paolo Verde (26 April 1834–27 May 1878), thirteen days after his wife died. He was only 44 years of age, while his wife, Emmanuela, was 40 years of age. Francesco was a builder who belonged to a large patronymic group in Forio. His parents were Giuseppe Verde (b. 1803) and Maria Grazia Veglianti (1792–2 October 1881). His maternal grandparents were Pasquale Veglianti and Maria Giovanna Verde who lived most of their lives in the eighteenth century.

At the time of their deaths, Emmanuela Nicolella’s mother, Anna Maria Amalfitano, and Francesco Verde’s mother, Maria Grazia Veglianti, were still living. However, both of these grandmothers were quite advanced in age, and thus were not able to care for their grandson, Pietro Paolo Michele Verde. Thus, he was orphaned in less than a month after he was born. He and his seven siblings were raised by different foster families in the town. These older siblings included his sister, Teresa, who was a spinster, and who eventually immigrated to the United States where she settled in Brooklyn, New York. His sister, Maria Grazia Verde (16 May 1866–22 August 1897), was 15 years older than him. She became the second wife of Bernardo Scola, a brother to Maddalena Scola Insante, and an uncle to Maria Libera Insante. After marrying Pietro Paolo Verde, Maria Libera Insante became an aunt-in-law to Bernardo Scola and Maria Grazia Verde’s children, Vincenzo, Antonio, and Concetta, to whom she was biologically a first cousin. She also became a sister-in-law to her uncle, Bernardo Scola. This complex relationship of cousin by birth and then respectively aunt and sister-in-law through marriage was often confusing to subsequent generations.

Maria Libera Insante always identified with her mother’s Scola family and not with her patronymic Insante relatives, who were very few in number. The latter consisted of her father’s brother and his family. The Scolas, on the other hand, were by then a large family comprised of her mother’s five siblings, their spouses, and children (Fig. 14).

Fig. 14

Maddalena (Madeleine) Scola Insante in 1908

Maria Libera Insante and her husband were childless because in adult life she was subjected to a total hysterectomy for vaginal bleeding. Whether such a radical surgical intervention was really necessary remains an open question. Without any children of their own, they insisted that her brother, Vincenzo, bring his five-year-old daughter, Madalynne Marguerite, to the United States when he left Naples on 24 May 1911 aboard the Duca di Genova. Pietro Paolo Verde had sailed from Naples on 27 April 1909 aboard the Cretic, and his wife had followed him in 1910, arriving in New York on 27 April aboard the Koenig Albert (Fig. 15). She traveled with a large wooden trunk made by her uncle, Antonio Scola (1846–1922), a cabinet maker. This trunk is currently in the possession of the senior author (PJI).

Fig. 15

Kingdom of Italy passport for Pietro Paolo Verde, 1909

Pietro Paolo Verde settled in Canton, Ohio, to where his nephew, Ciro Verde, had been recruited by a labor recruiter known among Italian immigrants of that time as padrone. These labor recruiters worked closely with steamship agents to supply the railroads, mines, and factories with large numbers of unskilled labor. There were different types of padrone, and some actually lent the money for ship passage to immigrants at high interest rates that kept some of the latter indentured to them for long periods of time [25].

Vincenzo Insante had originally intended to settle in Canton, Ohio and then send for his wife and other daughter, Angela. However, he did not care for working for the Pennsylvania Railroad, and after visiting his first cousin, Bernardo Scola, his aunt, Nicolette Balsofiore, and brother-in-law, Gennaro D’Ambra, in Providence, Rhode Island, returned to Forio where he died in the Spanish Influenza epidemic of 1918. His wife, Marianna D’Ambra, was very upset when she learned that he had left their oldest daughter, Madalynne, in Canton, Ohio with his sister. Madalynne vividly remembered decades later her father’s departure from Canton, Ohio. Her aunt told her to hide under the bed, and being but 5 years of age, she obeyed. From there, she could only see her father’s shoes (Fig. 16).

Fig. 16

Left to right: Pietro Paolo Verde, Madalynne Marguerite Insante, and Maria Libera Insante Verde, Canton, Ohio, 1913

Maria Libera Insante and Pietro Paolo Verde took excellent care of their niece, lavished all that they could on her as permitted by their means, and supported her attending McKinley High School from where she graduated in 1924 (Fig. 17).

Fig. 17

Madalynne Marguerite Insante, a great-granddaughter of Nicola Antonio Vincenzo Insante, on her graduation from McKinley High School in Canton, Ohio, June 1924

Pietro Paolo Verde had seven older siblings. These included Ciro Paolo (1862–1943) who, along with some family members, was killed on 9 September 1943, when American planes mistakenly bombed the San Vito quarter of Forio during World War II. He remarried after the death of his first wife, Rachele Cigliano. His two sons by his first marriage were Francesco Vito Vincenzo (b. 11 June 1892) and Vincenzo Emmanuele (4 August 1896–1962). The former moved to Lacco Ameno, a town near Forio, after his marriage. Vincenzo immigrated to the United States in 1921, following his military service in the Italian navy, and settled in the East New York section of Brooklyn. A plasterer by profession, he often used the surname Green, the English translation of Verde. Mr. Green spoke flawless formal Italian and excellent English. Gregarious by nature, he also tended to be very talkative. He passed away from metastatic prostate cancer at St. Rose’s Home in Manhattan in 1962.

Ciro Paolo had three sons with his second wife, Concetta. They were: Pietro, Salvatore, and Ciro. The last named was also killed in the American bombing of Forio on 9 September 1943.

Vincenzo Paolo (b. 6 November 1863) was the second child of Francesco and Emmanuela. His son, Ciro Francesco Giovanni Verde (30 January 1888–31 October 1960), immigrated to the United States in 1907, and at first settled in Canton, Ohio. He later settled in the East New York section of Brooklyn, New York along with his sister, who was married to John Mattera, and his aunt, Teresa Verde (2 May 1872–1957). His own sister died young from tuberculosis, leaving her widower husband, John Mattera, and a son. Ciro Verde was a building contractor, and had eight children.

Maria Grazia Verde (16 May 1866–22 August 1897) married Bernardo Scola (20 May 1851–29 January 1904) following the death of his first wife, Concetta Amalfitano (14 September 1857–22 March 1888). Fifteen years his junior, Maria Grazia had three children who survived to adulthood, Vincenzo (30 January 1890–29 July 1956), Antonio Vito (22 March 1894–1979), and Concetta (18 June 1896–14 January 1985). Maria Grazia was accidentally killed at home when she moved an upright rifle stored on a staircase. The rifle belonged to her husband. An inquest was conducted and a judicial review held in the nearby town of Lacco Ameno. Both concluded that her death was accidental.

The fourth child of Francesco Paolo Verde and his wife, Emmanuela Nicolella, was Vito (b. 31 July 1868), and the fifth, Anna Maria (17 June 1870–9 September 1943). She also died in the American aerial bombardment of Forio in 1943. She was married to Ciro D’Abundo. Their son, Francesco D’Abundo, immigrated to the United States, where he became a tailor. He lived near his other Verde relatives in the East New York section of Brooklyn, New York. He and his wife later retired to Naples, Italy.

Teresa Verde (2 May 1872–1957), who was a spinster and the sixth child, settled in Brooklyn, New York, and for a time lived with her nephew, Ciro Verde. The seventh child was Maria Fernia Concetta (b. 17 November 1875), who remained in Italy. More distant relatives of this Verde family also settled near them in Brooklyn, New York. These included Filippo Del Deo, a tailor, who immigrated to the United States in 1903, and his wife, Julia, who arrived in 1905. Julia Del Deo was the Matron of Honor at the wedding of Madalynne Marguerite Insante and James Anthony Imperato on 4 June 1927 at Saint Agnes Church in the Carroll Gardens section of Brooklyn, New York. Filippo and Julia Del Deo were life-long friends of the Imperato family, and their daughter, Maria, continues to be so to this day.

The Marriage of Vincenzo Insante and Marianna D’Ambra

Soon after, Maria Libera Insante married, her younger brother, Vincenzo, married Marianna D’Ambra on 22 February 1905. He was 31, and she was 20 years of age. One of eight children of Giuseppe D’Ambra and Maria Emmanuela Di Maio, she was a member of a large patronymic group in Forio. By comparison, the members of the Insante and Scola families were few in number.

Marianna D’Ambra was the third of eight children, three of whom were girls. One of her five brothers, Saverio, died when he was in his seventh year in 1899. Of the four sons who lived to adulthood, two immigrated to the United States. Francesco settled in Brooklyn, New York, and Gennaro in Providence, Rhode Island. The former had two daughters, Emmanuela and Lucia, and a son, Joseph. Gennaro had no children. Francesco returned to Forio in his retirement years, and died there on 12 April 1968. His wife, Angela Maria Di Maio D’Ambra, died in New York City on 18 November 1969.

Marianna D’Ambra came from a family of farmers. Her parents were not keen on her marrying the son of a mariner who himself was a coachman, even though he had his own horse and carriage. Men in both of these occupations were perceived as possibly wayward since their opportunities for doing so were frequent. In addition, Marianna D’Ambra’s parents viewed Vincenzo Insante as being spoiled by his mother and sister, and given to being easy going and care free.

Not surprisingly, the Scola relatives of Maddalena Scola had viewed her husband, Antonio Insante, in the same light. Even as late as 1957, John Sacchetti, the son of Maddalena Scola’s sister, Carmela Scola Sacchetti, who lived in Philadelphia, Pennsylvania, expressed a negative opinion about Antonio Insante as a mariner who took his family off to Algeria. When one of us (PJI) asked him about Antonio at the wake of Vincenzo Scola (1890–1956), he replied: “Oh, that one,” inferring a negative opinion handed down from their mother. Although Antonio Insante had been dead for almost 80 years, negative attitudes about him remarkably persisted among his wife’s nephews and on another continent (Fig. 18). In large measure, these originated in Antonio Insante’s decision to immigrate to Algeria where two of his children were born.

Fig. 18

John Sacchetti (left) and his mother, Carmela Scola Sacchetti (right), Philadelphia, Pennsylvania, 1920

Marianna D’Ambra’s direct lineage was spared deaths during the 1837 cholera epidemic. His own father, Giuseppe (1842–1925), died from congestive heart failure as evidenced by dyspnea on exertion and anasarca. His wife, Maria Emmanuela Di Maio, died at the age of 80 years of heart disease. Her parents, Gioacchino Pasquale Di Maio (1 July 1811–7 November 1891), and Lucia Candida Sferratore (11 December 1814–22 March 1894), lived to be 80 years of age. Maria Emmanuela Di Maio’s sister, Teresa Di Maio, had a daughter, Assunta, whose son, Joseph Longo (Luongo), and his wife, Francesca, lived in New York City. They later retired to Forio, where they both eventually died. They had no children. When Maria Emmanuela Di Maio died, her remains had to stay overnight at home before burial the following day.

Cholera and the Extended D’Ambra Family

Although cholera spared Marianna D’Ambra’s lineal ancestors, it took a considerable toll on members of this extended family. A dozen members of the D’Ambra family died during the peak weeks of the 1837 cholera epidemic, beginning in the last 2 weeks of June and extending into the first week of August. While this is a large number, it should be noted that the D’Ambras were at that time one of the largest extended families in the town. Consequently, one would expect a higher attack rate for cholera among them.

Of the dozen members of the D’Ambra family who presumably died from cholera, the actual diagnosis was recorded on the death certificate of only one, Gaetano D’Ambra. He was a laborer who died on 30 June, a time when the mayor and vital records official, Nicola Castellaccio, was recording either cholera or suspected cholera on death certificates. A prominent member of the D’Ambra family, Don Antonio D’Ambra, a priest, died from the disease on 13 July. His death at the peak of the cholera epidemic underscored the fact that mortality from the disease was not restricted to the poor.

In the Kingdom of the Two Sicilies, the honorific Don for men and Donna for women was used for the clergy, landlords (proprietario), and property and business owners (possidente). Today, the honorific is sometimes and informally used for the clergy and as a form of compliment for prominent people. In 1837, there were few families in Forio who qualified for these honorifics. However, their relative wealth and higher standard of living did not protect them from a disease such as cholera, spread by the fecal-oral route. During the 1837 epidemic, several individuals with the honorific Don or Donna died of the disease. Prominent among them was Donna Maria Loreta Milone, who died on 20 July. She was the daughter of Don Giovan Giuseppe Milone and Donna Orsola Maltese, and the wife of Don Bartolomeo Schiappa. All four were identified as property owners. The Milone family villa, Villa Milone, was then as now on the Via San Vito in Forio, and was for sale in 2008.

The Milones were one of Forio’s most prominent families. Maddalena Scola Insante and her family lived across the street from the Villa Milone. Even into her late eighties in the 1950s, her daughter, Maria Libera Insante Verde, recalled them as they were in the late nineteenth and early twentieth centuries. The then head of the family traveled through the town in a fine horse and carriage, and maintained a beautiful garden across the street from the villa. He frequently spoke with Maria Libera and her mother, Maddalena (Fig. 19).

Fig. 19

The Villa Milone (right) and garden (left) as they appeared in 2008. The Church of San Vito is in the background

Cholera and the Scola Family

The 1837 cholera epidemic affected many families in Forio. Among these was the Scola family of which Maddalena Scola was a member. The members of this patronymic group were not numerous in Forio until the mid-nineteenth century. However, they were present in the town throughout the eighteenth century and probably earlier. Most Scola men were bakers, and they and their families tended to live in the San Vito quarter of Forio on the Strada Casa Capezza (now the Via Casa Capezza) or the Via San Vito near the church of San Vito named for the patron saint of the town (Fig. 20).

Fig. 20

The house at 58 Via San Vito in Forio d’Ischia where Maddalena (Madeleine) Scola Insante (1840–1911) died, and where Madalynne Marguerite Insante Imperato (1906–1970) was born

On 13 January 1837, Antonio Scola, the son of the late Nicola Scola and the late Restituta Calise, died at the age of 64 years. Both he and his father were bakers, as was his son, Vincenzo (1810–1864). Antonio Scola was married to Maddalena Mogera after whom his granddaughter, Maddalena Scola (1840–1911), who married Antonio Francesco Paolo Insante (1828–1878), would be named.

Antonio Scola’s death was the first recorded in Forio for the calendar year 1837. His death was recorded by Nicola Castellaccio, the mayor and vital records official. Castellaccio distinguished himself in part by recording cholera or suspected cholera on the death records of 42 cases between 19 June and 1 July 1837. This was especially noteworthy at a time when causes of death were not specified on death certificates. Castellaccio also recorded a possible familial cluster of cholera cases in late February and early March of 1837 consisting of a husband, wife, and their 12-year-old daughter.

It is of course an open question as to whether or not Antonio Scola died of cholera on 13 January 1837. If so, he would have been the first to die of the disease in the town. However, what is certain is that his widow, Maddalena Mogera Scola, died some six months later on 11 July 1837 at the peak of the cholera epidemic. Thus cholera also touched the Scola family in a major way.

However, Maddalena Mogera Scola’s children were all adults, and thus not subjected to the vicissitudes of being juvenile orphans. This is in sharp contrast to the situation with Nicola Insante, the first person to die of cholera in Forio on 19 June 1837. His four surviving children were all minors at the time of his death. His son, Antonio Francesco Paolo Insante (1828–1878), was 9 years old at the time of his father’s death. On 7 August 1858, he married Maddalena Scola (1840–1911), a granddaughter of both Antonio Scola and Maddalena Mogera Scola, after whom she was named. Thus, the Insante and Scola families came to be joined through marriage, and shared a common experience of losing relatives in the cholera epidemic of 1837.

Later History of the Insante, Scola, and D’Ambra Families

The Insante family in Forio remained small because only Vincenzo, who was born in Algeria to Antonio Insante and Maddalena Scola, had descendants who carried the surname. Following the death of his father in Algeria 1878, Vincenzo returned to Forio with his mother and three siblings. While his paternal uncle, Pietro Paolo Insante, and his family were there, he and his siblings were drawn to his mother’s Scola Family. She had three sisters and two brothers, all of whom eventually had a significant number of children, thus enlarging Vincenzo Insante’s world of matrilineal cousins.

His Scola aunts included Restituta Scola Impagliazzo (1844–1922), Carmela Scola Sacchetti (1849–1928), who emigrated to the United States and settled in Philadelphia, Pennsylvania, and Nicoletta Scola Balsofiore (1854–1931) who also immigrated to the United States and settled in Providence, Rhode Island. She was widowed at the age of 28 years and gave birth to her son, Nicola, after her husband’s death. One of the Balsofiore men was a member of the Bersaglieri, a division of shock troops of the Italian army.

Vincenzo Insante’s Scola uncles included Antonio (1846–1922), who was a cabinet maker, and Bernardo (1851–1904), who married twice. A stone mason, Bernardo’s second marriage was to Maria Grazia Verde (1863–1897), an older sister of Pietro Paolo Verde, who married Vincenzo Insante’s sister, Maria Libera Insante. Maria Grazia was accidentally killed by a blast from her husband’s rifle as it discharged as she moved it on a stairway. Bernardo was exonerated of any negligence by an official inquest. He died of pneumonia 7 years later, leaving behind several orphans from two marriages.

Antonio Scola (1846–1922) did not immigrate to the United States. He was an expert cabinet maker who also made coffins. He made the large wooden trunk in which his niece, Maria Libera Insante Verde, stored her possessions when she immigrated to the United States in 1910. Antonio was very gregarious and personable (Fig. 21).

Fig. 21

Antonio Scola (1846–1922) (Courtesy of Bernard Vincent Scola)

Antonio’s two sons, Vincenzo Paolo (1875–1941) and Bernardo (1880–1967), immigrated to Providence, Rhode Island. Vincenzo’s son, Aristide William Anthony (1908–2000), developed a keen interest in magic, and frequently performed before various groups. Bernardo had eight children, one of whom, Francis Joseph (1909–1975), became a Dominican priest.

Bernardo Scola eventually became the head of a large extended family in Providence. He was highly respected and esteemed not only by members of the Scola family in Providence, but also by his relatives elsewhere in the United States. His descendants established Scola Enterprises Inc., a leading manufacturer of jewelry. For many years, the company’s president was a grandson, Bernard Vincent Scola, who also conducted extensive genealogic research on the Scola family (Fig. 22).

Fig. 22

Some members of Bernardo Scola’s family in the 1930s. Seated left to right: Luisa Calise Scola, Margaret, and Bernardo. Standing left to right: Vito, Mary, and Joseph

The four Scola sisters and their two brothers lost their father, Vincenzo Filippo Scola (1810–1864) when most were very young, ranging in age from 24 years (Maddalena) to 10 years (Nicoletta). Based on descriptions provided in the 1950s by his granddaughter, Maria Libera Insante, he died from the effects of Parkinson’s disease. He developed motor rigidity and bradykinesia. The latter eventually became very severe with the development of a frozen gait. His family members and others would push him, and even forcefully kick him in the buttocks in attempts to initiate locomotion. His wife, Angela Maria D’Ambra (1817–1873) eventually developed some form of dementia as evidenced by her not recognizing people and throwing the contents of a night commode onto the floor.

The economic opportunities presented by the labor markets of the United States drew large numbers of Italian immigrants in the late nineteenth and early twentieth centuries. As a result, a number of members of these families immigrated to the United States. The places where they settled varied, and were often determined by job offerings. Initial Scola immigrants settled in Philadelphia, Pennsylvania, Providence, Rhode Island, and Vineland, New Jersey. Early D’Ambra immigrants went to Brooklyn, New York or to Providence Rhode Island.

Maria Libera Insante followed her husband, Pietro Paolo Verde, to Canton, Ohio in 1910, where her brother, Vincenzo Insante, later joined her, but for only a brief time before returning to Italy. His daughter, Madalynne Marguerite Insante, was left in Canton under the care of her aunt and uncle who raised her. Once she graduated McKinley High School in 1924, they re-located to Brooklyn, New York, where her uncle, Pietro Paolo Verde, had some relatives.

Selling their house in Canton to the DiMinnos, their neighbors, they lived for a few years at 1268 Blake Avenue in the New Lots section of Brooklyn. In 1929, following the 1927 marriage of their niece, Madalynne Marguerite Insante, to James A. Imperato, they moved to a new home in a suburban development of Tudor-style brick houses in southwestern Queens County called Tudor Village [26]. Graced with lawns, large backyards, and tree-lined streets, this area represented a significant change for Pietro Paolo Verde and his family. An avid gardener, he enhanced his property with flowering shrubs, rose bushes, and hedges. In the summers, he planted an extensive vegetable garden. He enjoyed long walks through the nearby fields with his white terrier, “Prince,” who unfortunately disappeared 1 day, perhaps stolen. Both he and his wife, Maria Libera, loved animals. In Canton, Ohio they had a part collie called “Dick” and in Forio, she had a white cat named “Bellina.” He was not satisfied with the slightly twisted trunks of the sycamore saplings planted by the builder in front of his house and next door. So he removed them and obtained two saplings with perfectly straight trunks from the builder and planted them himself. These 88-year-old trees were still standing at the time of this writing. Four generations of their family lived in the Tudor Village home, including two of the authors, PJI and GHI. It was sold in 1983 after being in the same family for 54 years (Fig. 23).

Fig. 23

The Tudor Village home of Pietro Paolo Verde and his wife, Maria Libera Insante Verde (standing in the rear). Left to right: Pascal James Imperato, Josephine Ann Imperato, and Elissa Dolores Imperato, 1938

Pietro Paolo Verde and his wife, Maria Libera Insante, opposed the marriage of their niece, Madalynne Marguerite, to James A. Imperato, then an architectural student at Cooper Union. In fact, Pietro Paolo Verde boycotted the wedding, which took place on 4 June 1927 at which Vincenzo Scola from Philadelphia gave the bride away. He was a first cousin to Madalynne Marguerite’s father, Vincenzo Insante, then deceased. In later years, Madalynne Marguerite recounted that her uncle and aunt wanted her to marry one of his grand-nephews. Despite this difficulty, Madalynne and James Imperato also moved into the three-bedroom Tudor Village home in January 1929, where they eventually raised six children. Pietro Paolo Verde died in this home from an acute myocardial infarction on 19 September 1933. Aggravated by an electric company bill, he was putting on his tie preparing to go to the company’s office in Jamaica, Queens County. His wife was sewing on her pedal-operated Singer sewing machine and had her back to him as he put on his tie. He then said in the dialect of Forio, “Vecchia, mow viene,” which literally translated means “Old one, now it is coming.” Vecchia was his nickname for his wife who was 10 years older than him. Thinking their chow dog, Babo, was coming up the stairs, she turned around just in time to see him collapse into a chair, staring forward at a large colored lithograph of the Holy Family on the wall. She called to her niece, Madalynne, who was out on the front stoop with her one-year-old daughter, Josephine Ann, but by the time she arrived, he was dead. The fact that he died at the age of 55 years and his father at 40 years of age, indicates that there was probably a familial predisposition to coronary artery disease. Although the Scola family had been dispersed in the United States, relatives came from Philadelphia and Providence to attend his funeral.

Maria Libera Insante lived in this home until her death on 26 May 1956, surrounded by her niece’s family who called her Atsie, an Americanized version of the Italian, la zia, meaning aunt. She helped to raise her niece’s six children, taught them French songs she had learned as a child in Philippeville, Algeria, and their evening prayers in Italian. During the summers, she took them on regular trips to visit Caroline Sferratore Esposito’s small farm, a mile away on Eldert Lane adjacent to the tidal marshes of Jamaica Bay. Caroline and her husband, Bartolomeo, were immigrants from Forio, she from the Citara quarter and he from Monterrone. Their house and farm stood in a rural landscape now covered by high-rise buildings [27].

Maria Libera Insante Verde’s multilingual abilities were also reflected in her ability to recite the mass from memory in Latin. She also regularly used nasal snuff which she kept in a small air-tight wooden snuff box, equipped with a hinged lid. It had been hand carved by her uncle, Antonio Scola. She kept a large supply of snuff in a storage bottle in which there was a small spoon for transferring the snuff to the box she carried. Having acquired the snuff habit in Italy, she purchased an imported Italian brand called, “Tabac di San Antonino.” On occasion, she would yield to demands from her nieces and nephews to use it, and was greatly amused when it produced a beginner’s bout of sneezing.

She purchased this snuff from Donna Concetta, who operated a small grocery store on the northwest corner of Drew Street and Blake Avenue in Brooklyn, New York. Her store and home were in a small wooden house behind which was a grape arbor where she and visitors would sit in the shade on warm summer days.

This neighborhood that had been settled by Italian immigrants in the early twentieth century was semi-rural with unpaved roads. Many farmed small plots of land there and also raised livestock. This area was eventually transected by two major roads, the Sunrise Highway and Linden Boulevard. Installed at an artificially higher elevation to conform to the desired municipal grade level, these roads and the rail yards of New York’s Independent Subway System to the west, placed most of the neighborhood in depressions some ten feet below the new municipal grade level. In later years, many left the area, and it was despairingly referred to as “The Hole” both because of its lower elevation and the economically disadvantaged population that continued to live there.

Marianna D’Ambra, Vincenzo Insante’s wife, never immigrated to the United States. However, she did come for a brief visit in 1953–1954. In the 1920’s, her brother-in-law, Pietro Paolo Verde, suggested she come to the United States with her children. He sent her the funds for the voyage for all of them, and she purchased the tickets. However, shortly before the departure date, she had a dream in which she was told not to go. As a result, she cancelled the trip.

Two of her brothers, however, did immigrate to the United States. Gennaro (1890–1966) traveled to New York in 1914 aboard the Berlin when he was 23 years of age, and settled in Providence, Rhode Island. As was common among Italian immigrants at that time, he returned to Italy for a visit and then came back to the United States in 1920 aboard the Patria when he was 28 years of age. His brother, Francesco (1888–1968), settled in Brooklyn, New York, but also made return trips to Italy. He finally retired to Forio where he died on 12 April 1968.

Marianna D’Ambra’s older sister, Lucia (1878–1957), married Davide Monti from the nearby town of Lacco Ameno, where she settled. Because of where she lived, her Forio-based relatives referred to her in their dialect by the moniker, “Luchi ou Lac,” meaning Lucia of Lacco. In this way, they quickly distinguished her from other women with the same first name.

Vincenzo Insante’s Immigration to the United States

From the surviving correspondence, it is clear that Vincenzo Insante was not keen about leaving Forio for the United States. His mother, Maddalena Scola, who was 71 years of age, was very ill, suffering from a uterine tumor from which she regularly had vaginal bleeding. His brother, Nicola, was also disabled. However, his sister, Maria Libera Insante, and her husband insisted that he come and that he bring his daughter, Madalynne Marguerite, with him.

Vincenzo invoked various excuses for delaying his departure. On 5 May 1911, he wrote to say that his daughter had a fever and was only slightly better [28]. Earlier, on 7 March 1911, he wrote to say that he had obtained passports for himself and his daughter, but that he was in need of some financial support. He also said that once he was definite about coming, he had to sell his horse and carriage, and that then there was no going back on the travel decision. Yet, in the same letter, he said to his sister that his daughter was delighted every day with the idea of going to America. However, in the next sentence, he said that he was frightened of the ocean [29].

This ambiguity about his leaving was also expressed by his mother, Maddalena Scola, in a letter that she wrote to her daughter in Ohio on 27 March 1911 [30]. In this letter, she complained to her daughter that she was debilitated to the point that she could not walk. Thus, she was confined to bed. She did, however, confirm receipt of 20 Lira that her daughter had sent from the United States.

Finally, on 21 May 1911, Vincenzo wrote his brother-in-law, Pietro Paolo Verde, to say that they were going to sail from Naples on the Duca di Genova, and that the trip would take 13 days [31]. In this same letter, his mother added a note, again asking for financial help (Fig. 24).

Fig. 24

Front page of a letter from Vincenzo Insante to Pietro Paolo Verde, 21 May 1911, Forio d’Ischia, Italy

The Duca di Genova sailed from Naples on 24 May 2011, and arrived in New York on 6 June. Vincenzo and his daughter traveled Cabin Class and not in steerage. As a result, they did not have to pass through Ellis Island. His daughter’s only memory of the trip was seeing flying fish through a porthole on the ship. On arrival, he gave as his destination the home of his brother-in-law, Pietro Paolo Verde, at 818 Madison Street in Canton, Ohio (Fig. 25).

Fig. 25

Pietro Paolo Verde (1878–1933), husband of Maria Libera Insante (1868–1956)

At the end of June, Vincenzo’a wife, Marianna, wrote to update him on what was happening at home. In particular, she reported that his brother, Nicola, started a fierce argument with his mother just after he left, and that the arguing had become a daily occurrence. She even stated that in the heat of these arguments, Nicola had grabbed his mother by the throat. In this same letter, she cautioned him to take care of his health and to be watchful of their daughter. She also thanked him for the postcard that he had sent her on 8 June 1911, and sent him love and kisses from her parents, herself, and their other children, Angela, Antonio, and Giuseppe [32].

Vincenzo Insante’s Return to Italy and Subsequent Tragedy

Back in Italy, Vincenzo was re-united with his wife and three other children. During the next several years, he and his wife had four additional children. By 1918, their seven children in Italy were Angela (b 1908), Antonio (b 1909), Giuseppe (b 1910), Pietro Paolo (b 1913), Vito (b 1914), Maria Libera (b 1916), and Luigi (b 1918). Departing from the usual naming practices, Vincenzo had named his second daughter, Angela, after his deceased sister. However, he followed the established custom of naming his first daughter after his mother. He then named his first son, Antonio, after his father, and his third son after his brother-in-law, Pietro Paolo Verde. He named his third daughter, Maria Libera, after his sister. The usual custom was to name the second son and second daughter after the mother’s parents, a practice that he did not follow. He probably did so to demonstrate his love and respect for his sister and brother-in-law.

In November 1918, the Spanish Influenza struck Italy. The first to fall ill was their oldest son, Antonio, who was 9 years of age. At first, his mother, Marianna D’Ambra, thought it was diphtheria because he had choking episodes. When the doctors on Ischia could do no more to treat him, Vincenzo decided to take him to the hospital in Naples. When he arrived in Naples, he found the city streets jammed with people celebrating. It was 11 November, and an armistice had just been signed ending World War I. There were no taxis anywhere, and so he set off on foot, making his way to the hospital with his dying son in his arms. On the way, Antonio died.

But worse was to come. Eight days later, their youngest son, Luigi, who was 1 month old, also died of influenza. The next month, Vincenzo and his two-and-a-half-year-old daughter, Maria Libera, fell ill with the disease. Delirious from fever, he told his wife that he would die and that Maria Libera would soon follow him. He died on 27 December, followed 2 days later by little Maria Libera. In 6 weeks, Marianna D’Ambra had lost her husband and three of her eight children.

Left a widow with no pension and four young children, she struggled to keep her family together. While remittances from her in-laws in Ohio helped, she took in laundry, watched other children, and wove wicker seats for chairs which she often carried for miles by foot from Forio to Porto d’Ischia. Eventually, all of the children had to work. As her son, Giuseppe Insante, said to one of us (PJI) in 1989, “We always worked.”

Realizing that her son, Vito, was studious, she allowed the Franciscan friars to take him to Palestine to study. He was ordained a Franciscan priest at the Basilica of the Getsemani in Jerusalem on 18 May 1940, and had a subsequent distinguished ministry and teaching career in the Middle East (Fig. 26).

Fig. 26

Vincenzo Insante’s surviving family. Left to right: Angela, Marianna D’Ambra Insante (his widow), Vito, Giuseppe, and Pietro Paolo, 1919

The War Years

The outbreak of World War II interrupted Marianna D’Ambra’s correspondence with her daughter, Madalynne, now married with children. In 1944, however, after having requested help from the American Red Cross in 1942, Madalynne heard from her mother: “Dear Daughter. I heard your good news with pleasure. We are all well. Write often. Embraces. Your mother, Marianna D’Ambra.”

The war years were very difficult in Forio because food and medicines were in very short supply. Once the war was over, one of Marianna’s sons, Pietro Paolo Insante, immigrated to Argentina in 1947. That left Marianna with only two of her original eight children in Forio. During these years, she was greatly helped by remittances from her daughter, Madalynne, who also sent flour-sack “CARE” packages full of clothing, coffee, bags of sugar, and bars of chocolate.

Reunited

In 1952, Madalynne Marguerite Imperato began the long process of having her mother come to the United States. In April 1953, Marianna D’Ambro arrived in New York on the Andrea Doria. It had been 42 years since mother and daughter had seen one another. After a stay of 17 months, she returned to Italy aboard the Cristoforo Colombo (Fig. 27).

Fig. 27

Madalynne Marguerite Insante Imperato (left) seeing her mother, Marianna D’Ambra Insante (right), off to Italy aboard the Cristoforo Colombo, September 1954

In 1957, Madalynne visited Forio, and for the first time in 46 years met her sister Angela and brother Giuseppe. A few weeks later, she met her brother Vito, who had come home on leave from Israel [33]. During the subsequent decades, the descendants of Nicola Insante, who died of cholera in 1837, have visited one another many times. Dispersed in Italy, Argentina, and the United States, they have remained in fairly close contact (Fig. 28).

Fig. 28

The family of Pietro Paolo Insante in Buenos Aires, Argentina, late 1960s. Front row, left to right: Andrea, Anna Maria, Vincenzo, and Carolina. Rear left to right: Loreta Impagliazzo Insante and Pietro Paolo Insante

The Reverend Vito Insante

The son of Vincenzo Insante and Marianna D’Ambra, Father Vito Insante, OFM (1914–1967), is esteemed as having been a leading scholar, linguist, theologian, philosopher, educator, and administrator. A great-grandson of Nicola Insante, who was the first person to die from cholera in 1837 in Forio, he had an illustrious career spent mainly in the Middle East. Aware of his passion for learning, his mother was agreeable to his leaving Forio in 1927 and joining the Franciscan Fathers in Palestine. Their role there was to oversee sites considered holy to Christians and to educate young men. Vito Insante was named after Forio’s patron saint, Saint Vitus (Fig. 29).

Fig. 29

Eighteenth century silver and gold statue of Saint Vitus, the patron saint of Forio d’Ischia, in its shrine in the church named for him, 2008

On arrival in Palestine, Vito Insante entered the College of Emmaus. During his 4 years there, he excelled in his studies and then entered the Franciscan novitiate in Nazareth. In Nazareth, he became fully familiar with the Franciscan way of life [34].

Following his studies at the novitiate, he went on to study at Ain Karen, then for 3 years in Bethlehem, where his studies were focused on philosophy. He then studied theology at the Convent of San Salvatore in Jerusalem. During the course of his studies, he acquired fluency in French, Arabic, and English which he later taught in various Franciscan educational institutions. On 18 May 1940, he was ordained a Franciscan priest at the Basilica of the Getsemani in Jerusalem. Following his ordination, he spent 3 years at Emmaus.

It was not until the spring of 1946 that he was able to return to Forio to see his mother and family after an absence of 19 years. Thereafter, he was able to return home on leave every 5 years (Fig. 30).

Fig. 30

Reverend Vito Insante, OFM (1914–1967)

During his almost 40 years in the Middle East, he served as the Superior and Rector of the Franciscan College in Aleppo, Syria, and Superior of the Franciscan houses in Emmaus, Getsemani, Bethlehem, and Rome. He had a great love for art, literature, and poetry. He especially admired the poems of the nineteenth century Italian poet, Giosuè Carducci, and his contemporary, Giacomo Leopardi, who was also a philosopher and essayist. He enjoyed reading the laudi of the thirteenth century Franciscan, Jacopone da Todi. Father Insante’s own poems were often modeled on those of these poets and others. His novel, Un mio amici del 4000 D.C. (A Friend of Mine of 4000 A.D.), which was probably written in the 1940s, has not yet been published.

Endowed with a superb interpersonal skills and scholarly brilliance, he served as an excellent mentor to both students and to those studying for the priesthood. His appointment to positions of great responsibility reflected both his leadership skills and his ability to get on well with others.

In 1967, Father Insante requested and received a transfer to the Franciscan Institute in Rome in order to be geographically closer to his mother, Marianna D’Ambra, who was then 83 years of age and in poor health. However, on 8 December 1967, he unexpectedly passed away in his sleep at the age of 53 years, most likely from an acute myocardial infarction. His brother, Pietro Paolo Insante, had died of renal failure in Argentina less than 2 months before on 19 October 1967. Given her fragile health, Father Vito’s mother was never told of his passing [35]. Her relatives even took the precaution of taking her away from Forio the day of his funeral. They did so in case she asked about the large crowds of people gathered in the center of the town and the tolling of all the church bells as her son’s bier was carried in procession from the port to the church. She herself only lived another 2 months before passing away on 27 February 1968.

On 25 September 2008, the town of Forio d’Ischia held a ceremony to name a square in honor of Father Vito Insante [36]. His nieces, Anna Insante Mattera, who lives in Forio, and Ana Maria Insante de Olivan, who lives in Argentina, and his grand-niece, Dott. Dina Verde, who lives in Forio, initiated efforts to have a town square named in his honor (Fig. 31).

Fig. 31

The mayor of Forio d’Ischia, Dott. Franco Regine, dedicating the Father Vito Insante Square. Left to right: Reverend Fedele Mattera, OFM, Mayor Regine, Dott. Dina Verde Di Maio, Anna Insante Mattera, Ana Maria Insante Olivan, Joyce Elaine Imperato Monteleone, and Dr. Pascal James Imperato, 25 September 2008

Presided over by the town mayor, Dott. Franco Regine, and the Reverend Fedele Mattera, OFM, participants included descendants of Nicola Insante from three continents. These included his numerous descendants in Forio, two of his descendants from Argentina, Ana Maria Insante de Olivan and her brother, Vincenzo Insante, and Dr. Pascal James Imperato and Joyce Elaine Imperato Monteleone from the United States (Fig. 32).

Fig. 32

Twelve great-great-grandchildren of Nicola Antonio Vincenzo Insante (1782–1837) from Argentina, Italy, and the United States, at the dedication of a square in honor of his great-grandson, Reverend Vito Insante, OFM, 25 September 2008. Left to right: Vincenzo Calise, Anna Calise Patalano, Ana Maria Insante Olivan, Pietro Calise, Ventura (Regina) Calise Schiano, Joyce Elaine Monteleone Imperato, Vincenzo Insante, Rosa Calise Verde, Davide Calise, Paola Calise Tufano, Dr. Pascal James Imperato, and Anna Insante Mattera

This square, called Largo Padre Vito Insante (Father Vito Insante Square) is located in the town center off of its main thoroughfare, the Via Giovanni Castellaccio, and not far from the Strada Marina where Father Vito Insante’s great-grandfather, Nicola Insante, died from cholera in 1837. The plaque on this square also has a subtitle, Rettore in Terrasanta (Rector in the Holy Land) and his dates, 1914–1967 (Fig. 33).

Fig. 33

Plaque commemorating Father Vito Insante Square in Forio d’Ischia, Italy

The above account provides a view of the humanity that is present behind a mortality statistic. Nicola Insante’s descendants were able to overcome the terrible consequences of his tragic death from cholera at a relatively young age in 1837, as well as numerous other vicissitudes of life that ensued over the next century and three quarters. Neither he nor his immediate family could have foreseen that a second great-grandson (PJI) and two-third great-grandsons (GHI and ACI) would write about his death 178 years later.

Discussion

Although the second world cholera pandemic reached Great Britain and North America in 1832, it did not reach the southern Italian Kingdom of the Two Sicilies until 1836. Public health and medical leaders as well as the political rulers of this kingdom were very familiar with the preventive and therapeutic measures that had been employed elsewhere in Europe. The government of King Ferdinand II placed a high priority on quarantines, sanitary cordons, the isolation of cases, and disinfection of the homes of cholera victims. They hoped that these preventive measures would keep the disease out of the kingdom and under control if it appeared [7]. King Ferdinand’s government also put into place very elaborate administrative structures to deal with the epidemic were it to arrive in the kingdom. His Supreme Health Council was given sweeping authorities to create policies concerning prevention strategies, the reporting of cases and deaths, the isolation of cases, and treatment regimens to be used for those who fell ill with the disease. A high priority was placed on protecting the royal family, and for that purpose, a sanitary cordon was thrown up around the Royal Palace in Naples [7]. The military and the police, the principal guardians of the country’s autocratic monarchy, were also given the highest possible levels of protection.

Despite all these measures, the disease arrived in the city of Naples on 2 October 1836, and before long swept through the entire kingdom. It was almost predictable that several years of planning, using ineffective preventive measures and an inadequate armamentarium of therapies, would fail.

Based on field research in Italy of existing archival records, and a study of records available in the United States, we were able to elucidate the epidemiology of the 1837 cholera epidemic in two separate towns in the kingdom, San Prisco and Forio d’Ischia. Despite efforts by the central government to standardize death registrations for cholera, we found that there were significant disparities in this regard between these two towns. Forio is a maritime town on the island of Ischia. There, cholera or suspected cholera cases were initially stated as the cause of death on death certificates, probably because the mayor was conscientious about documenting its presence. However, early in the epidemic, there was a change in mayoral administrations. The new mayor, like the previous one, was also the vital records official. Once the change in administration occurred, there was no further listing of cholera or suspected cholera on death certificates. It is possible that the new mayor received orders not to record cholera or suspected cholera on these certificates. This is not surprising because, as Messina noted, the central government initially suppressed the reporting of the disease [5]. This was done out of concerns that the true scope of the epidemic and the government’s inability to control it could lead to civil disorder and even rebellion as it had elsewhere in Europe.

In San Prisco, cholera was never listed as a cause of death during the epidemic. However, this is not surprising as causes of death were not generally recorded on death certificates. As Messina suggests, the presence of cholera often had to be deduced by a sudden spike in deaths well above the normal level, and by contemporary records indicating it was present in a locality [5].

The estimated 1837 cholera-specific mortality rates for San Prisco and Forio were not comparable. That for San Prisco was 29.5/1000 population while that for Forio was 57.5/1000 population. By comparison, the rate for the city of Naples was 54.5/1000 [5]. It may be that Forio’s maritime location in the Bay of Naples may have facilitated the spread of the disease through greater population movements. This possibility is given some credence by the fact that the first two deaths from cholera in Forio on 19 June 1837 were among mariners who may have contracted the disease outside of the town. Some caution is required in interpreting the cholera-specific mortality rate of 54.5/1000 for Naples. This calculation is based on an assumed population of some 360,000 people. However, the city at that time probably had a much larger population. If so, then the disease-specific mortality rate of 54.5/1000 would have been much lower. On the other hand, the number of cholera cases may have been greatly under reported. What is somewhat more certain is that some 59.2 % of those who contracted cholera died [5].

The calculated 1837 cholera-specific mortality rates for smaller towns such as San Prisco would tend to be more accurate than those for large cities. This is because the base populations of large cities tended to represent broad estimates while those of small towns were fairly accurate. Also, mortality numbers in large cities were sometimes inflated by the poor, who reported deaths from other causes as due to cholera in the interests of free government burials. Consequently, caution is required in attempting to compare cholera-specific mortality rates between small towns such as San Prisco and Forio, and large cities such as Naples.

The first person who died from cholera in Forio on 19 June 1837 was Nicola Antonio Vincenzo Insante, a 44-year-old mariner who lived close to the sea. An ancestor of the authors, he left behind a widow and several young children. We have presented a portrait of him, his immediate family, and his descendants so as to humanize the statistics that usually characterize epidemics of this kind. We have also presented information on deaths during this cholera epidemic among the D’Ambra and Scola families that were either then or in the future related to the Insante family. Prominent among these deaths were that of Maddalena Mogera Scola on 11 July 1837 and the possible death of her husband, Antonio Scola, from cholera on 13 January 1837. The extended D’Ambra family suffered almost a dozen deaths during this epidemic (Fig. 34).

Fig. 34

Five descendants of Nicola Antonio Vincenzo Insante. Left to right: Rosa Calise Verde (a great-great-granddaughter), Anna Insante Mattera (a great-great-granddaughter), Anna Calise Patalano (a great-great-granddaughter), Eleanor M. Imperato, Pascal James Imperato (a great-great-grandson), and Austin C. Imperato (a great-great-great-grandson), Forio d’Ischia, Italy, 1989

In San Prisco, Alessandro Caruso, respectively a fourth and fifth paternal great-grandfather of PJI and GHI and ACI, died during the epidemic. In addition, Donna Caterina Valenziano, respectively a fifth and sixth great-aunt of PJI and GHI and ACI, also died during the epidemic in San Prisco. Both were 80 years of age. As was the case with Nicola Insante in Forio d’Ischia, their descendants eventually overcame the adverse impacts of their deaths from cholera.

This present study has established the essential epidemiologic characteristics of the epidemic for the towns of San Prisco and Forio d’Ischia. In addition, it has explored in detail the fate and resilience of the immediate family members of specific cholera victims who died during the epidemic. Furthermore, the present study has attempted to humanize those who died from the disease by presenting them, their social, economic and cultural contexts, as well as their extended families and multi-generational descendants. In the case of Nicola Antonio Vincenzo Insante, who was the first to die from cholera in Forio d’Ischia in 1837, these descendants are now spread across three continents (Fig. 35).

Fig. 35

American descendants of Nicola Antonio Vincenzo Insante. Seated left to right: Joyce Elaine Imperato Monteleone, Madalynne Marguerite Insante Imperato, and Josephine Ann Imperato Di Nardo. Standing left to right: Francis Paul Imperato, Pascal James Imperato, and Gerard Anthony Imperato, 1967

During the course of this research, we interviewed numerous descendants who had been born in the mid and late nineteenth century. In no instance did anyone know that one of their remote ancestors had died from cholera in 1837. While some knew the names of these ancestors, their occupations, and other anecdotes about them, most did not know their causes of death. Either this information had never been passed on to them or else they had forgotten it. This lack of knowledge of death causation from cholera was just as common among those who were educated and literate as among those who were not. Most interviewed were two to three generations removed from the 1837 epidemic and thus there is a strong possibility that the information was never passed on to them. This demonstrates the risks inherent in generation transfer of knowledge through primarily oral means.

Among those Insante family members born in the twentieth century, none were familiar with the fact that Nicola Antonio Vincenzo Insante had died from cholera. In fact, none, except Madalynne Marguerite Insante Imperato, knew his name. A great-granddaughter of his, she took a great interest in her ancestry. In 1989, a memorial was installed in the Forio cemetery in her honor by her children, all of whom were born in the United States [36].

A significant finding of this study is that many more women than men died from cholera in these two towns. In San Prisco, based on the 99 people who died in the month of July, 1.5 women died for every man. In Forio, there were 1.3 female deaths for every male one, based on the first 42 deaths registered as either cholera or suspected cholera. In studying the early phase of cholera in late 1836 in the city of Naples, Messina found that there were 1.3 female deaths for every male one [5]. This figure is identical to that for the town of Forio. Messina also found that this female preponderance also held for reported cases in the city of Naples. Among 2037 cases, 59 % were among women while 41 % were among men. Thus, there were 1.4 female cases for every male one [5]. Unfortunately, case numbers are not available for the two towns under study, San Prisco and Forio d’Ischia (Fig. 36).

Fig. 36

Memorial to Madalynne Marguerite Insante Imperato (1906–1970) installed in the Forio d’Ischia cemetery in 1989 (Courtesty of Captain Agostino Mazzella)

The obvious question is why were women more likely to contract cholera and to die from it once they did. The higher numbers of cases and deaths among women cannot be accounted for on demographic grounds. In both San Prisco and Forio, the proportions of women to men in the population were virtually equal. Messina noted the same for the city of Naples [5].

Messina also noted that the larger proportion of cases and deaths among women was especially marked among the poorer groups in Naples which constituted the majority of the population [5]. However, these major gender differences in cholera morbidity and mortality between women and men faded among the leisure classes. She hypothesized that the greater proportion of cholera cases and deaths among poor women as compared to poor men was due to their hard life which rendered them less able to resist infection [5]. While there may be some merit to this hypothesis, we believe that another factor significantly contributed to more women contracting the disease and dying from it.

Cholera cases were generally cared for at home. Those who nursed and cared for victims and who cleaned up the vomitus and diarrheal excreta they produced were the women of a family. As a result, they were at a much higher risk than men of contracting the disease. In addition, their exposure to large inoculums of the organism capable of escaping gastric acid destruction was considerable. Thus, they were in effect more vulnerable than men of contracting cholera directly from family victims and of ingesting large inoculums capable of causing severe disease and a higher risk of death. This conclusion is supported by the fact that Messina found virtually no female-to-male differences in morbidity and mortality among the leisure classes in Naples [5]. This is not surprising, as the care of cholera victims in such families was relegated to servants.

In the final analysis, the public health and medical sciences of the Kingdom of the Two Sicilies did not possess the necessary means to either prevent the spread of cholera or to effectively treat patients severely affected by it at the time of the second world pandemic. Advances in environmental sanitation, including potable water supplies, safe food sources, and closed sewer systems, would eventually make the prevention and control of cholera possible in many parts of the world. The final acceptance of oral rehydration therapy in the late twentieth century for treating cholera patients has greatly reduced mortality from the disease.

Appendices

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Appendix 10

Appendix 11

Appendix 12

Appendix 13

Appendix 14

Appendix 15

Appendix 16

Appendix 17

Appendix 18

Appendix 19

Appendix 20

Appendix 21

Appendix 22

Appendix 23

Appendix 24

Appendix 25

Appendix 26

Appendix 27