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Accepted Sign Of Death

In classical antiquity, the absence of a heartbeat was the accepted sign of death. The heart was the seat of life: the first organ to live and the last one to die. Breathing was considered just a regulator of the heat of the heart. There was an awareness that the brain influenced reason and sensation, but the brain's actions were still deemed dependent on the existence of a functional heart. Aristotle taught that a person was an integral combination of body and soul; the soul could not exist without a body, and the death of the body meant the death of the soul. He recognized three parts of the soul with different actions: the vegetative soul regulated bodily vitality, the animative soul controlled motion and sensation, and the rational soul, or the mind, governed the higher mental faculties. The rational soul might die without affecting the vitality of the body; indeed, animals could subsist their entire lives without one. The death of the vegetative soul always caused bodily death, however. Relatively little is known about what criteria of death were actually used in classical antiquity: one would presume that feeling the pulse had a central part, given the emphasis on the action of the heart as the divider between life and death. Immobility, coldness, and incipient putrefaction probably also played a role. Actually, when the classical physician spoke of "signs of death," he meant the physical signs in Hippocrates' Prognostikon that death was inevitable; the presence of these signs indicated that the doctor's work was done. According to the Hippocratic medical ethics, a doctor should then forecast the impending demise, collect his fee, and withdraw from the case. The actual diagnosis of death was left to the nonmedical attendants, often the patient's own family and relations.

There is evidence that already in classical antiquity some observers were aware that the criteria of death might sometimes be fallible. The seventh book of Pliny's Natural History contains a section on the signs of death among the Romans. Rather pessimistically, Pliny wrote that the signs of death are innumerable, but that there are no signs that health is secure. Although many in number, these death signs were not always reliable. Shockingly, the consul Acilius Aviola and the praetor Lucius Lamia had both awakened on their flaming funeral pyres after being falsely declared dead, and the attendants could save neither of them from a most horrible death. Another Roman worthy, Gaius Aelius Tubero, managed to show signs of life while actually on the pyre, fortunately before it was too late. Pliny also mentioned several instances where people had been carried out on a bier to be buried, but returned on foot. He concluded, "Such is the condition of humanity, and so uncertain is men's judgment, that they cannot determine even death itself." Plutarch told of a man who had fallen from a precipice and who lay motionless for three days before returning to life as his friends carried him to the grave. In Plato's Republic can be found the tale of an Armenian soldier named Er who was slain in battle. Ten days later, the surviving soldiers returned to bury the dead and were surprised to find that even though all other bodies were corrupted, that of Er was still intact. This finding did not weaken their conviction that he was dead, however, and they put him on a funeral pyre, where, to the great surprise of all those present, he returned to life and was saved. The very influential Greek physician Galen recommended great caution in certain diseases, like hysteria, asphyxia, coma, and catalepsy, since the signs of life could be suspended for weeks without affecting the chance for recovery. In his De locis affectis, he commented on a case report given by Heraclides of Pontus, concerning a woman who had collapsed from "uterine suffocation" and was without a perceivable pulse or respiration for thirty days, before reviving. Galen was also aware that some people who died from excessive joy or grief were known to recover; moreover, he considered it unwise to consign to the grave too hastily those who had died from intoxication with alcohol or soporific drafts. In his De medicina, the influential Roman physician Aurelius Cornelius Celsus agreed, stating that the art of medicine was conjectural, and the signs of death not always totally reliable.' As evidence, he repeated the tale of Asclepiades of Prusa, who discovered that the "corpse" carried along in a funeral cortege was not really dead. But he also wrote that a sign should not be rejected if it was deceptive in just 1 out of 1,000 instances, if it held good in the other 999 patients. This controversy will recur again and again in the debate about the uncertainty of the signs of death. Celsus knew of cases where medical attendants had deserted their patients, after making a gloomy prognosis, only to find that the patients had recovered without their help. It was rumored, he wrote, that some people had even shown signs of life when carried to their funerals. There exists a manuscript of declamations attributed to Fabius Quintilien, but which is probably by a later Roman author, which contains some interesting observations concerning the reasons for delayed funerals in ancient Rome.' The pseudoQuintilien wrote, "For what purpose do you imagine that long-delayed interments were invented? Or, on what account it is that the mournful pomp of funeral solemnities is always accompanied by sorrowful groans and piercing cries? Why, for no other reason, but because we have seen people return to life after they were about to be laid in the grave as dead."

Some interesting information about how the ancients viewed the reliability (or lack of its of their procedures for declaring people dead can be found in some ancient Greek and Arabic novels and stories. In the anonymous Greek novel Apollonius, Prince of Tyre, a physician finds a floating coffin with the corpse of a young woman in it. Some money has been put in the coffin, with a note stating that half of it should be used for a decent funeral pyre for the corpse, and the other half as a fee for the individual who found the coffin. The physician orders a funeral pyre to be prepared, but one of his apprentices actually manages to revive the presumed corpse by rubbing her body with ointment and oil; she makes her resurrection known by saying, "Doctor, please do not touch me in any way that is not proper. For I am the wife of a king and the daughter of a king." She turns out to be the wife of Prince Apollonius of Tyre, who was mistakenly buried at sea; it was equally fortunate and unrealistic that the coffin was not submerged by the waves. In a medieval Arabic tale, a baker eats a large meal of apricots and hot bread and falls lifeless to the ground shortly thereafter. The local doctor declares him dead from overeating, but fortunately the famous doctor Yabrudi passes by as the funeral procession is on the way to the burial yard. Yabrudi examines the baker and demands to know exactly what caused his death. He then prepares a powerful laxative, which soon has the desired effect; after a volcanic emptying of the bowels, the gourmandizing baker revives and is able to walk back to his shop.

A very long-lived and powerful literary motif is that of the heroine who is buried alive, but saved by a robber. The first incarnation of this legendary figure is to be found in the novel Charieas and Callirhoè, by Chariton of Aphrodisias, a Greek writer active between the first and second century A.D. The heroine Callirhoe one day annoys her jealous husband, Charieas, who is ungallant enough to kick her so violently in the stomach that she falls unconscious. She presents all signs of death and is promptly buried in a vault. Poor Callirhoe awakens in the tomb, however, breaks free from her shroud, and cries, "I am alive! Help me!" But no one can hear her, and she laments, "Alas, what misfortune! I am buried alive, through no fault of my own, and I will die a very long death!" But some pirates have decided to break into the vault to plunder it; they save Callirhoe and later sell her as a slave. The same theme recurs in the novel The Ephiesians, by Xenophon of Ephesos, a Greek writer active at about the same period. The heroine Antheia is to marry a certain Perilaos, but she considers this a fate worse than death and procures poison from a physician. On the morning of her supposed wedding day, she swallows it. The physician abided by the Hippocratic oath enough to be unwilling to participate actively in the suicide of one of his patients, however, and substituted a sleeping potion for the poison. Less valorously, the elderly practitioner did not mention this substitution to anyone, and when Antheia awakens, it is in the tomb. At that moment, however, a band of robbers breaks into the vault to steal her valuable jewelry, with which she has been buried, and she is saved from her premature burial and later reunited with her husband. These stories certainly imply that the fear of being buried alive, after having been mistaken for dead in a comatose state, and of awakening in the tomb, is a deep-seated one; the tale of the prematurely buried Callirhoe, and her pathetic lamentation in the dark and lonely vault, must have been listened to with a frisson of horror.

Much of the medical knowledge of antiquity was forgotten in medieval times, and there are fewer sources pertaining to the signs of death, and to the concerns about premature burial, from this period.' A remarkable anecdote tells that King Louis IX (Saint Louis) of France fell ill in 1244 with some kind of enteritis: he was severely weakened by the incessant diarrhea, and his doctors considered him to be dead. But when mass was said over the king's dead body, he moved and gave some other signs of life. Louis IX recovered completely, and in order to give thanks for what he regarded as a divine intervention to save his life, he equipped and led a crusade to Egypt.' Another curious story of uncertain origin (and doubtful veracity) tells that Thomas a Kempis, who died in 1471, was denied canonization because splinters of wood from the coffin lid were found embedded underneath his fingernails when the coffin was opened; why, if he had been worthy of becoming a saint, had he made such desperate efforts to postpone his meeting with his Maker?' The fact that some fourteenth-century English aristocrats, like Elizabeth de Burgh and John, duke of Lancaster, made bequests stipulating that their bodies be left above ground for several weeks without being embalmed, has by some observers been attributed to a fear of premature burial, but this was not mentioned in any of the actual bequests as the reason for these extraordinary delays.' It has also been suggested that uncertainty about the moment of death, and fear of a live burial, caused some medieval funerals to be long, drawn-out affairs, and that the religious custom of holding a candle near the mouth of the person in extremis was a crude test of death, since a breath would cause the flame to flicker." Quite a few excavations of early cemeteries show that the most common burial positions were either with the arms by the sides of the body, the hands over the pelvis, or the arms crossed over the chest.' But there are both Danish and British examples of skeletons found in gruesome, contorted positions,' suggesting that the person was either killed violently and dumped into the grave face down or buried alive by accident or as a punishment."

The seventeenth century was the age of the old monster medicine, a time when medical science was immersed in a rich subculture of pagan myths, religious legends, and popular superstitions. Death was defined as a state where life was extinct and the soul had left the body; a person could be either dead or alive, and no concept existed of a process of dying. Death was regarded as a wholly supernatural, obscure phenomenon, outside the limits of rational analysis. The resemblance between death and sleep was stressed: in both these states, the soul was considered to be concentrated outside the body, thereby capable of communicating with God. Another important observation concerned the mummies, which were believed still to have elements of life within them as long as the embalming preparations preserved them from corruption. Life was thus an exception from nature: a mystic force that could be retained in a cadaver by artificial means. The seventeenth-century scholars who wanted to study the phenomenon of death more closely did so by collecting observations concerning the dead body. They often preferred the popular, superstitious belief that the cadaver still had some degree of life and sensibility to the Christian dogma that the union and separation of body and soul accounted for creation and death.

At this time, curious anecdotes, legends, and folklore about the dead body abounded. Why did the body of a murdered man start to bleed profusely when the murderer entered the room, and why was a ghostly rattle of the bones from the tomb of Pope Sylvester II always heard just before the death of a pope? Why did the hair and nails of some cadavers keep growing after death, and why did some of them even cut new teeth? Who are the more happy, the dead or the living, and are all humans, even the most hideous monsters, resurrected in heaven? These were some of the questions addressed in Dr. Heinrich Kornmann's curious book De miraculis mortuorum, a treatise on the miracles of the dead, first published in 1610. Among the sections on incorruptible saints, screaming corpses, speaking skulls, and jumping specters in Kornmann's book is to be found a brief note concerning a certain Cardinal Andreas, who died in Rome and was to be buried in a cathedral, where the pope and a body of clergy attended a service to honor his memory. But during the service the cardinal groaned and sat up in his coffin. This was looked on as a miracle and ascribed to the influence of Saint Jerome, to whom the cardinal was greatly attached. Another note describes the death of Archbishop Geron of Cologne, who was prematurely buried in a tomb in his own cathedral, and expired in the most lamentable manner; his sad fate was deemed just as miraculous as the phenomena discussed earlier.

Jan Bondeson. . W.W. Norton & Company. 2001.


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