UNEQUAL IN DEATH

Dances of death, occupational mortality statistics, and social critique

^a Department of Public Health, Erasmus University, PO Box 1738, 3000 DR Rotterdam, Netherlands

In the late middle ages and early renaissance dances of death were a popular art form. Despite important differences in outlook, the moral messages of these art forms and of modern analyses of socioeconomic inequalities in mortality overlap considerably. This theme has survived in modern dances of death, which are popular in certain parts of Europe, especially in Germany and other German speaking countries in central Europe, and are clearly inspired by the late medieval and early renaissance examples. In the modern dances of death, however, unlike their historical counterparts, social critique (crtiticism of social inequality) is almost absent, although they include representations of differences between people in social position. Remarkably, references to socioeconomic inequalities in mortality, which have been documented extensively, are also uncommon in the modern examples. This raises important questions about public perception of social inequality in general and socioeconomic inequalities in mortality in particular, and it suggests that modern Western society has not developed the cultural means of conveying the moral message that follows from research into socioeconomic inequalities in health.

Dances of death were once an immensely popular art form throughout Europe.^{1 2 3 4 5 6 7} The two most common types were mural paintings in churches or cemeteries and wood cuts in books. Some of the mural paintings can still be found, especially in France (where they are called danses macabres) and in the German speaking part of central Europe (Totentanze). The most important British example was a mural painting in Pardon Churchyard, near St Paul's Cathedral in London. This was an imitation of one of the earliest and most famous dances of death, the now lost danse macabre of the Saints Innocents cemetery in Paris, which was painted in 1424-5. The London version was executed by an unknown painter around 1430 and destroyed in 1549. Only the poems, translations from the French by the monk and poet John Lydgate, were preserved.² A few other British dances of death have partially survived--for example, the one at Hexham Abbey.

These dances of death usually consisted of a series of poems illustrated by a procession of the living and dead. The order in which the living are portrayed follows their social standing, and all are accompanied by a corpse or skeleton (fig 1). In the dialogue between the living and dead, which is represented in the poems, the dead point out the sins which the living have committed, and the living are then forced to join them in a dance--a euphemism for death. "Sagt Ja Sagt Nein, Getanzt Muess Sein" ["Whether you say yes or no, you must dance"] is the motto of a dance of death painted in Fuessen, southern Bavaria, in 1602.

View larger version (160K): [in this window] [in a new window]   Fig 1--"Death and the Monk, Death and the Usurer:" one of Guyot Marchant's wood cuts (published 1485). In the poems accompanying the wood cuts (not reproduced) the monk admits that he has not done enough penance for his sins, and the usurer is reproached for his avarice. Reproduced with permission from Kaiser7

The genre was probably invented by a Dominican monk, somewhere in the fourteenth century and was intended as an illustrated sermon summoning the faithful to do penance for their sins before suffering an untimely death.^{4 5 7 8} This call was directed at people of all ranks, not only because all men are mortal but also because, according to the belief of the time, higher demands would be made of higher placed people at the Last Judgment.⁷

Social inequality then and now: dances of death and occupational mortality statistics

In their representation of the social hierarchy dances of death offer an interesting view of the perception of social stratification in late medieval and early renaissance times.^{9 10} The box shows the social hierarchy of the London "Daunce of Machabray." The basic structure is one in which religious and secular positions alternate, but Lydgate has added a few characters to the original which introduce irregularities (princess, abbess, gentlewoman, tregetour [fool], juror).² In a sense, these dances of death prefigure modern occupational mortality statistics, such as the decennial supplements on occupational mortality in England and Wales.¹¹ Of course, the structure of society has changed dramatically, but social inequality, largely based on occupational achievement, is still a penetrating characteristic of society. Furthermore, in the dances of death each occupation had its characteristic sins, and these in a way correspond to the occupational mortality risks identified in modern statistics.

Below the vaguely similar surface, however, there are profound differences. The most important is that occupational mortality statistics are compiled to highlight differences, whereas dances of death argued the equality of all in the face of death. The latter was primarily understood in an existential sense, but the executors of these works of art probably also had no awareness at all of inequality in the risk of dying prematurely. Even if the authors of dances of death had known that mortality was lower among the rich than among the poor, as it is now,^{12 13 14} they probably would not have cared. They were concerned with the afterlife, and who would care about a few years more or less of life expectancy in the face of a choice between an eternal stay in heaven or in hell?

 Order of social positions in Lydgate's
 dance of death for St Paul's, London

   Pope; emperor; cardinal; king; patriarch; consta-
 ble; archbishop; baron; princess; bishop; squire;
 abbot; abbess; bailiff; astronomer (addressed
 "master"); burgess; canon secular; merchant;
 carthusian; sergeant; monk; usurer and poor man;
 physician; amorous squire; gentlewoman; man of
 law; Mr John Rykill, tregetour[fool]; person
 [parson]; juror; minstrel; labourer; friar minor;
 child; young clerk; hermit

   Source: Kurtz.1

At this deeper level of understanding, however, one is again struck by a certain similarity. In dances of death the equality of all before death is used as an exhortation to do penance for one's sins, and, consequently, to carry out acts of mercy and not to abuse one's social position. Often, therefore, elements of criticism of social inequality--in short, social critique--are included, in which those who hold high social positions, such as the rich and the powerful, are criticised vigorously for their lack of concern for the poor and the weak. This moral message may even have helped to mitigate the effects of social inequality.^{7 10 15} Likewise, occupational mortality statistics have been used to show the existence and even widening of the mortality gap between rich and poor^{16 17} and to argue the defects of a society in which those who have less of everything also die younger.

Survival of death dances and disappearance of social critique DEATH, THE GREAT LEVELLER

Late medieval and early renaissance dances of death, with their images of grimacing skeletons and cadavers with slit bellies inflicting death on their victims with cruel or ironical gestures, have captured artists' imaginations throughout the centuries. As late as the nineteenth and even in the twentieth century many works of art have been made which clearly were inspired by dances of death. These range from drawings, wood cuts, and paintings to plays, operas, and instrumental music.^{18 19} Sometimes the artist cites the death dance theme only subtly, but sometimes complete modern versions of dances of death have been created--for example, Grieshaber's cycle of wood cuts entitled Totentanz von Basel (1966)²⁰ and Honegger's instrumental work Danse Macabre (1939). Often these modern dances of death include representations of different social positions, but social critique is quite rare--probably rarer than in late medieval and early renaissance dances of death. It is also amazing that references to socioeconomic inequalities in mortality, which have been frequently documented for more than a century, are almost completely lacking.

The theme was and is particularly popular in Germany and other German speaking countries in central Europe. The survival of the death dance theme in these countries is probably at least partly due to the experience of two world wars. Many artists have used and transformed a traditional dance of death to express their horror for the loss of so many innocent lives. After the second world war the threat of mass destruction by nuclear warfare inspired several artists to create a dance of death. Death here is still the great equaliser: nobody, whatever his or her social position, escapes the ravages of war. Not surprisingly, most of the time no social critique is implied at all, and it is only for the sake of visual clarity that the representation of some social positions may include references to social inequality.

Gerd Arntz, a graphic artist from Germany who has lived as an expatriate in the Netherlands since 1934, created his linocut Dodendans in 1950 as a reaction to the Korean war.²¹ It depicts the devastating effects of nuclear warfare and portrays several social groups--namely, scientists, rulers (fig 2), artists, traders, employees, and labourers. Although the cartoon-like representation includes class conscious cliches such as a factory manager studying his rising profits and a lackey sacrificing himself, it is unlikely that the artist intended this as criticism of social inequality as such. There is criticism here, but it relates to the role of scientists and rulers in creating and using the threats of nuclear warfare.

View larger version (81K): [in this window] [in a new window]   Fig 2--Upper part of Gerd Arntz's linocut "Dodendans" (1950). The blast of a nuclear explosion smashes a window and kills scientists (left) and rulers (right). Reproduced with permission from Broos21

PERSONAL CONFRONTATION WITH DEATH

A second motif that often recurs in modern dances of death is personal confrontation with death. Many artists discovered the death dance theme after a personal loss, such as the death of a father or mother, and have used the theme as a vehicle for representing the experience of death in a person's life. Portraying death offers good opportunities for projecting all kinds of properties to it--from cruelty to mercy, and from being a sudden attacker to being a lifelong companion. Also, in the portraits of the people who are taken away by death all the different reactions can be represented. Again, social critique is almost never implied, and the artist may even refrain from portraying social positions at all and choose to focus on different personal circumstances. If social positions are portrayed, it is not important whether these are modern or antique: any representation will do.

Recently, an Austrian painter named Herwig Zens painted a Basler Totentanz (1990), inspired like Grieshaber's by the dance of death that once adorned the walls of the Dominicans' monastery in Basle (created around 1445, destroyed 1805). Figure 3 reproduces a part of this huge cycle of paintings. The main message of this dance of death seems to relate to the cruelty of death, and to depict this the old social positions apparently seemed good enough.

View larger version (144K): [in this window] [in a new window]   Fig 3--Excerpt from "Der Basler Totentanz" (1990) by Herwig Zens. Death asks the fool for a dance. Reproduced with permission from Herwig Zens

SOCIAL CONDITIONS AND DEATH

It is only in the modern dances of death that have been inspired by a third motif that one sometimes finds elements of straightforward social critique. In several nineteenth and twentieth century versions of the dance of death the artists have tried to bring out the connection between a person's behaviour or living conditions and his or her death. Late nineteenth and early twentieth century dances of death contain many simple, perhaps even pathetic, examples of this. An infant living in miserable circumstances whom death grabs from the cradle, death disguised as a building speculator witnessing a fatal accident on a construction site (fig 4), a quarryman embraced by death in his stone pit--these examples even suggest that the artists were aware of the link between material living and working conditions and mortality and used it to emphasise their moral message on social inequality.

View larger version (162K): [in this window] [in a new window]   Fig 4--Wood cut from "Ein neuer Totentanz in achtzehn Bilder" (A new dance of death in 18 pictures) (1904) by Jentzsch. Death, disguised as a building speculator, witnesses a fatal accident at a construction site and says: "Now you have your day off." Reproduced with permission from the Graphiksammlung "Mensch und Tod" of the Heinrich-Heine-Universitat in Dusseldorf, Germany

This awareness seems to have faded away again during this century because more recent dances of death with this third motif refer only to the behavioural or attitudinal characteristics of the people occupying various social positions--the modern equivalent of the sins as they were represented in older dances of death. An example can be found in the work of Fritz Moser and Hans-Jorg Modlmayr. Their Totentanz (1964) consists of a series of 10 wood cuts, each accompanied by a poem, and was made for a church in Emsdetten in Germany.²² The social positions portrayed include a playboy (fig 5), a girl, a married couple, a convict and his judge, an army commander, war camp prisoners, and mothers. These do not represent positions in the social stratification system of modern societies, and there can therefore be no clearcut social critique in this dance of death. The criticism is of a different and perhaps more subtle nature--for example, in the descriptions of the playboy (who is reproached for the accidents and the environmental pollution he causes with his fast car), the married couple (rich, happy, and self contained), and the convict and his judge (the judge inflicts the death punishment on the convict, but because of his lack of mercy he will himself be killed by the impersonation of death, which here seems to protect the weak). By their behaviours and attitudes these people inflict death on others, but death turns against them.

View larger version (107K): [in this window] [in a new window]   Fig 5--Death reproaches the playboy for "chasing children and chamoises into the abyss. Beyond life, he whizzes right into the oil-polluted sea." Reproduced with permission from Moser and Modlmayr22

The moral of this history

My comparison of late medieval or early renaissance dances of death with modern occupational mortality statistics has shown vague similarities and profound differences. Despite all the differences in outlook, however, the moral messages of both seem to overlap to a considerable degree. Unfortunately for those who fight social inequality in our time the strong link with mortality which more than a century of research has documented has never produced images as powerful as the old dances of death. With the exception of some late nineteenth and early twentieth century dances of death, modern versions largely ignore social inequality, let alone socioeconomic inequalities in mortality. One wonders why: is it because social inequality has lost the spectacular visibility which it still had in the nineteenth century? Is it impossible to translate the more subtle forms of modern social inequality into powerful visual images? This seems unlikely, because modern dances of death have successfully been used to express quite abstract and complex messages. The lack of social critique is more likely to be because among the cultural elites themes other than social inequality are perceived to be more important. Over the past decade the threat of nuclear warfare has considerably diminished, but political instability and destruction of the environment continue to be major concerns. Also, self fulfilment is highly valued, and there is widespread awareness of the importance of the microsocial environment and of behaviours and attitudes for health and wellbeing. Much of this is just as strongly dependent on socioeconomic factors as material living and working conditions--the only problem is that this connection is not nearly as easily discerned by people in society. The lesson to be learnt is that it is of strategic importance for those who pursue social equality to show the link between socioeconomic factors and these other concerns.

Finally, it is likely that the lack of attention to socioeconomic inequalities in mortality is also due to a lack of public awareness of this phenomenon. Despite the repeated demonstration of these inequalities the general public in most countries is still largely unaware. This may be an important impediment to efforts to reduce socioeconomic inequalities in health because these would require the involvement of many sectors of society.²³ Developing a cultural means of conveying the moral message which follows from research into socioeconomic inequalities in health could be instrumental in raising public awareness. But where is the artist who is prepared to face this challenge?

I thank Dr E Schuster, Heinrich-Heine Universitat, Dusseldorf, Germany, for help in obtaining some of the information and illustrations used in this paper.

Funding: None. Conflict of interest: None.

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