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The physician and the dance of death

As part of our end-of-life care series RCP rare books and special collections librarian Katie Birkwood explores the dance of death, an artistic genre that offers fascinating insight into mortality during the Late Middle Ages.

A 16th-century man in a fur robe and hat sits at a desk beside a window. He’s reading from a large book resting on a lectern, next to which sits an hourglass. Weighty tomes in heavy bindings and a rounded bottle of liquid rest on a shelf high above his head. The man looks up to see a leering skeleton walking into the room, leading an aged man, poorly dressed and wearily hobbling slowly forward with the aid of a stick. The skeleton holds out a glass vessel, and the seated man reaches forward to take it.

This macabre and captivating image (right) comes from the famous series of ‘Dance of death’ illustrations designed by the artist Hans Holbein the younger (c.1497–1543), in a reproduction published in March 1832. The well-dressed man seated at the desk is a physician. The flask is a uroscopy flask, the standard visual symbol of a physician in the medieval and Renaissance eras when the examination of the colour, texture and smell of a patient’s urine sample was one of a physician’s primary diagnostic tools. The skeleton represents death, the great leveller who visits us all, regardless of rank or expertise.

Death taunts the physician by bringing him an elderly and incurable patient, thereby proving the uselessness of the physicians’ knowledge and experience.

Danse macabre

The dance of death – also known as the danse macabre – is a reflection and commentary on mortality and society that was popular for more than six centuries. The earliest known dance of death poem is the Spanish Dança general de la muerte, thought to have been composed around the year 1400. In 1425 the earliest known pictorial dance mural was painted at the Paris Cemetery of the Holy Innocents.

The dance of death spread quickly across the continent, reaching as far as the Baltic and Scandinavia. Text for an English version painted at the old St Paul’s Cathedral was translated into Middle English by the poet John Lydgate (c.1370–c.1450). In it, death taunts the physician by describing how nothing can win out against death: ‘Good leche is he / that can hym self recure’ (‘It’s a good doctor who can cure himself’). The physician agrees that despite all his hard work studying medicine and his attempts to find ways to treat the plague, ‘Agens dethe / is worth no medicyne’ (‘No medicine has value against death’).

Dance of death design for a dagger sheath ascribed to Hans Holbein the younger.

In the dance of death on the cemetery wall of St John’s Church, Basel, the flask full of urine has fallen to the ground, and the physician is left asking ‘But who will mine inspect, I pray? / Now that Death calls myself away.’ These public dance of death murals were a kind of ‘illustrated sermon’, instructing the viewers in an appropriately pious and accepting attitude towards death, and to prepare themselves properly for an end that could come at any time, but which would be eased for the faithful through the grace of God.

The murals took the form of a painted procession snaking around a cloister or courtyard, in which each figure is linked to the next in an unbroken line or chain of dancers. Death, always in the figure of a skeleton, dances its way from person to person, taking each by the hand and leading them wildly and remorselessly on. 

Social and religious rank

The characters in the dance of death were usually arranged in order of social and religious rank, beginning with the pope and the emperor, and proceeding through the ranks of nobility and the church, the professions and trades, labourers, the poor, the old, and the young. A doctor or physician is almost always included, usually somewhere in the middle of the sequence alongside sailors, priests and nuns. The different characters respond to death in different ways: the knight fights death with a sword, the businessman is too busy to notice the ghoulish figure sneaking up on him, the old farm labourer welcomes death’s release and a family is distraught as a toddler is dragged away from the hearth…

Katie Birkwood is the RCP rare books and special collections librarian. You can follow her on Twitter at @Girlinthe.

The full article appears in February’s 'end-of-life care' themed Commentary magazine.