MESSINA, Sicily — Mafia gangsters suffer worse stress than top businessmen and are as likely to die from that as from a bullet, according to a top Sicilian pathologist.
Prof. Francesco Aragona, who has spent 40 years examining their insides, says Mafiosi are likely to have thickened arteries, kidney failure, stomach ulcers, sterility and mental illness.
Their livers are yellowish, fatty and chronically short of glucose, says Aragona, a professor of forensic medicine at the University of Messina.
"The strains of a violent criminal life lead to internal conflict and the individual can become extremely disturbed, both physically and mentally," he said.
"They become incapable of responding to any stimulus and can die from heart attacks or strokes just as easily as a shotgun blast."
Gang warfare in and around Reggio Calabria, Italy's most violent city just across the Straits of Messina, has provided a steady supply of corpses for his research and he and his team perform hundreds of autopsies each year.
"Many of the victims have been in a state of extreme agitation and alarm for a long time," Aragona said. As a result their bodies are constantly pumping out adrenaline, reducing blood sugar and increasing pressure on the heart.
After a while all hormone-producing organs such as the thyroid, pituitary and adrenal glands are weakened, altering the whole metabolism.
"Take this case of a 32-year-old man killed in his car in Reggio Calabria," said Aragona, of a victim of a sawed-off shotgun blast.
"His organs show clear signs of stress."
Pictures of his adrenal gland seen under a microscope show that instead of the normal black clump of hormone there are a few shrivelled, gray globules.
"The production of (the hormone) cortisone is almost completely exhausted. If the process had gone on much longer he could have died anyway," Aragona said.
In many ways the effects are similar to "executive stress," suffered by people in more conventional but nevertheless high-pressure jobs.
"The difference is that these people show the classic symptoms of stress at a very young age. The heart attacks and strokes businessmen get aged 50 or 60, the Mafia get under 30," Aragona said.
"Look at this slide. He was only 27 years old but has the brain of an old man."
Anyone on the run either from the police or from Mafia hit men is likely to suffer from acute stress. Aragona said they were often pale, thin, ate irregularly and were invariably sterile.
But such problems do not trouble many senior Mafia bosses, figures commanding huge respect, who usually remain above the killing and gang war for drugs and building rackets, leaving the fighting to their men.
"They often live quietly at home, eat well and have lots of children," Aragona said.
Considering the frequency and violence of Mafia "hits" it is easy to understand the anxieties.
One man studied by Aragona had a screwdriver rammed into his skull. Reggio Calabria province, which regularly tops Italy's homicide league, had 165 murders last year.
Occasionally murderers will leave ritual symbols, such as a cork in the mouth of an informer.
The preferred murder method by gang members in Calabria, however, is by sawed-off shotgun, which leaves the skull practically unrecognizable.
"I'm convinced that when gang members carry out the crime the damage is far worse. They try to make the body completely unrecognizable," Aragona said. "When it's a hired assassin, often one bullet will do."