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Monday, December 19th, 2005, 04:44 PM
BMJ 2003;327:215-218 (26 July), doi:10.1136/bmj.327.7408.215

URL: http://bmj.bmjjournals.com/cgi/conte...l/327/7408/215 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215)

Dead body with mourners: medical reflections on the entombment of Christ

Johan P Mackenbach
1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands j.mackenbach@erasmusmc.nl (http://us.f302.mail.yahoo.com/ym/Compose?To=j.mackenbach@erasmusmc.nl)

Illness and early death were common in the Middle Ages, and in the absence of effective medical treatment religion was important in helping people cope with the harshness of life. Meditation on depictions of Jesus's suffering stimulated compassion and may thereby have helped lay the foundations for modern health care

Sculptures of the burial of Christ were popular throughout western Europe in the 15th and 16th centuries. The genre was part of a more general obsession with death that partly arose from the poor health conditions. The sculptures provided an ideal of dignified behaviour for mourners and may have helped replace the popular taste for the macabre with the positive force of compassion, not only towards Jesus but towards sick and dying people generally.

Depiction of the entombment
The entombment of Christ is one of several standard representations of Jesus's suffering and death at the hands of the Romans. Other frequently painted or sculpted scenes include the flagellation, man of sorrow (Jesus sitting with the crown of thorns on his head), crucifixion, deposition from the cross, and pietŕ (the dead Jesus lying on Mary's knees).1 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF1) The genre of the entombment is thought to have originated in Flanders in the early 15th century, from where it spread to the north east of France (Burgundy and Lorraine) and then to other parts of western Europe. Three hundred and eighty seven monumental entombments have been documented in France, 28 in Belgium, over 20 in Germany, about 60 in Italy, and 25 in Spain.2 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF2) 3 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF3)
One of the best examples of a sculpture of an entombment is in Chaource, a small town in the Champagne region of France. The old church has a crypt that can be entered through a small door flanked by two, more than full size, Roman soldiers. Dim light flows from a small window on the left and faintly illuminates a group of men and women slightly bent over the dead body of Jesus (fig 1 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#FIG1)). The sculpture was done in 1515, at a time when renaissance art was flourishing in Italy and spreading through France. It is gothic in style and combines dignity with realism. The women with their faces half hidden below layers of cloth, the sad postures of the men with their exotic hats, the stone hard body of Jesus, the iron spears of the friendly soldiers—this is a presence that cannot be ignored and that on closer scrutiny reveals some interesting aspects of medical history.

http://bmj.bmjjournals.com/content/vol327/issue7408/images/small/macj17616.f1.gif Fig 1 Entombment of Christ in Chaource. From Martin3 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF3) Credit: M AMELOT

Prevalence of death and cult of the passion
The popularity of depicting entombments is probably part of a more general obsession with death in the late Middle Ages. According to Huizinga, "No other epoch has laid so much stress as the expiring Middle Ages on the thought of death... Since the thirteenth century, the popular preaching of the mendicant orders had made the eternal admonition to remember death swell into a sombre chorus ringing throughout the world."4 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF4) The obsession with death is shown by the many "dances of death." These originated in the first quarter of the 15th century in response to plague epidemics and usually consisted of a series of poems illustrated by a procession of the living and dead (fig 2 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#FIG2)). The dead are portrayed as corpses or skeletons, in a macabre, awe inspiring fashion. The dances were intended as an illustrated sermon summoning the faithful to do penance for their sins before dying unexpectedly.5 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF5) 6 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF6)

http://bmj.bmjjournals.com/content/vol327/issue7408/images/small/macj17616.f2.gif Fig 2 Dance of death: scene of death and physician in Knoblochtzer's Doten Dantz mit Figuren, from Kaiser G. Der Tanzende Tod. Frankfurt: Suhrkamp Verlag, 1983

Entombments are not macabre. Many have a beauty and intimacy that raise the opposite type of emotion. Nevertheless, the macabre obsession and the passion cult are probably related to the same underlying phenomenon. Strong experiences of suffering were common in the late Middle Ages, and death was present all the time. Normal life expectancy was under 40 years, and frequent hunger, epidemics, and wars gave rise to deep anxiety and despair. Using parish registers, historical demographers have shown that mortality crises, defined as at least a doubling of the death rate, occurred several times each century.7 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF7) 8 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF8)
Identification with the suffering of Jesus seems to have comforted people frightened by the prospect of an unexpected and untimely death. Throughout western Europe, popular devotion books contained instructions for meditation on Jesus's blood and other signs of his martyrdom, and small diptychs and other objects with representations of passion scenes were used in private devotion.9 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF9) Testimonies by followers of the modern devotion, a 15th century spiritual lay movement in the low countries, show that their intense contemplation of Jesus's suffering and its signs helped them put their own lives into a grander perspective: the ultimate salvation of humankind.10 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF10)
The introduction of the cult of the passion could even have been a clever theological move that helped give the death cult a more positive slant. The popular taste for the macabre was turned into a commiseration with the suffering Jesus, and cynicism about the miseries of earthly life was replaced by the hope for resurrection. In a time without effective treatment of disease, this could have been an effective psychological coping strategy. In addition, prayer may have been considered an effective remedy.

Iconography of a burial
Typically, entombment scenes contain eight people: Jesus, John of Arimathea, Nicodemus, Jesus's mother Mary, the disciple John, and three other women. Jesus's body is usually represented as that of a sleeping person (still, stretched out, perhaps a little stiff), with just a hint at his wounds (such as a little blood streaming out of the stab between his ribs). Sculptors must have hesitated to add macabre signs of decay to a body that was believed to be resuscitated a few days later. Only a few entombments have details directly suggesting death, such as contraction of the face, protruding ribs, and caved-in stomach.
According to the canonical bible stories of Matthew, Mark, and Luke, it was John of Arimathea who buried Jesus. John's gospel adds Nicodemus. Mary Magdalen and "the other Mary" (the mother of one of Jesus's followers) are mentioned as spectators, sitting in front of the grave. Early representations of the burial therefore did not include any women or John, Jesus's favourite disciple.
At some stage in the development of the entombment scene, the original story of Jesus's burial must have merged with that of the embalming of his body. Two days after his death, the two Mary's and Salomé went to the grave to embalm Jesus's body but found the grave empty. This merging of two stories must have added theological meaning: the presence of the women embalmers announces Easter morning and reminds viewers that although Jesus's body is dead, he will soon be resurrected.2 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF2)
It is less easy to explain the presence of the mother of Jesus and the disciple John. No bible story suggests that they were present at or after the burial, although John's gospel mentions that both were present at the crucifixion. This could be explained by assuming that the sculptor intended to represent not the bible stories but a tableau vivant, the final scene of a theatrical performance of the passion narrative in which all actors in their costumes gathered together silently.11 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF11)

_Expression of emotion
Real life mourning must have contrasted starkly with the restrained emotion of Jesus's family and friends as it was depicted in the entombments. Emotions like anger or despair are not represented at all, and the artists use minimal means to suggest the feelings of the mourners—a head bent forward, John's hand lightly touching Mary, a slip of cloth used to wipe away some tears. One striking example is that of the entombment in Carennac (Dordogne, France), where you can see, but only with appropriate lighting, that below Mary's shawl John's hand rests on her shoulder as an almost invisible sign of his emotional support.
By providing an example of dignified behaviour, entombments may have played a part in development of self restraint by mourners, just as the artes moriendi of the same period provided guidance on the behaviour of the dying.12 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF12) It is only after about 1540 that a more vivid, baroque style developed and that _expression of emotion became less restrained. In later entombments, body movements are more vehement, hands are lifted in the air, Mary faints, and mouths open to cry (fig 3 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#FIG3)).3 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF3)

http://bmj.bmjjournals.com/content/vol327/issue7408/images/small/macj17616.f3.gif Fig 3 Entombment of Christ in Joinville. From Martin3 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF3)

To some extent, the entombment scene must have been perceived as a symbol for all burials. Shrouds were still used in medieval times, and the whole scene would have been familiar to medieval Christians, for whom burying was the seventh work of mercy.13 (http://bmj.bmjjournals.com/cgi/content/full/327/7408/215#REF13) In the late Middle Ages, special brotherhoods for burying were founded, in the spirit of Jesus's words, "as you did it to one of the least of these my brothers, you did it to me" (Matthew 25;40).

Summary points Many sculptures of the entombment of Christ were done in western Europe in the 15th century
Their popularity reflects a general obsession with death at a time without medical treatment for disease
The emotions of mourners are restrained and physical signs of suffering are rare
Reflecting on such images may have helped develop compassion for sick and dying people