How could medieval people determine whether someone had died without modern medical technology? Lorris Chevalier explores the physical signs of death recognised in the Middle Ages, from the absence of a pulse to changes in skin colour, and how families, midwives, and physicians made these judgements.
By Lorris Chevalier
In the Middle Ages, there was no single, universally defined medical test for determining whether a person was dead. Medieval ideas about death were strongly influenced by ancient authorities, particularly Aristotle and the Galenic medical tradition. Life was understood through the functioning of the body, especially the heart, which was regarded as central to life and the source of the body’s vital heat. The brain and other organs also had important roles in the medical understanding of life, but the heart remained particularly important in discussions of life, death, and the pulse.
This meant that death was not necessarily established through one specific examination. Instead, people looked for a combination of signs: the absence of breathing or a pulse, coldness of the body, changes in skin colour, unconsciousness, immobility, changes in the eyes and mouth, and other physical signs. Fifteenth-century Italian sources show that both ordinary people and medical practitioners could recognize these signs.
These sources also show that determining death could be a collective judgement. In many cases, witnesses described the person as dead because everyone present agreed that death had occurred. In the canonization process of Bernardino of Siena, for example, in fifteen of the twenty-nine cases involving death, the determination was made by all those present. Family members, friends, physicians, and other witnesses could all observe the body and interpret its condition.
A particularly interesting example is the case of Johannes, a seriously ill boy. His father described him as quasi mortuus, meaning “almost dead”; his mother considered him tamquam mortuus, “as if dead”; while his eighteen-year-old brother stated that he fuit mortuus, “was dead.” The three witnesses had seen the same child, but they did not use exactly the same expressions. This suggests that people could distinguish between being close to death and being definitively dead.
Recognizing death therefore depended heavily on experience and observation. A person did not necessarily need to be a physician to recognize that someone had died, although physicians had an important authority in difficult cases. The evidence from fifteenth-century Italy shows several recurring physical signs that people associated with death. This article draws on the research of Jyrki Nissi, particularly his study “Quomodo Scit Quod Mortuus Erat? Signs of Death in 15th-Century Italy.”
Pulse
Woodcut: physician at patient’s bedside, taking his pulse. Wellcome Images
The pulse was one of the important ways of determining whether life remained in the body. Because ancient medical thought placed such importance on the heart, the absence of a pulse could be taken as a powerful indication of death. However, the sources show that the pulse was normally considered alongside other signs rather than being the sole test.
In the process of Bernardino of Siena, the absence of a pulse is mentioned in four of the twenty-nine cases involving death. In the miracles of James of the Marches, it appears even more frequently, in eleven cases. One particularly clear example concerns Jacoba, who had been struck by falling wood and stones. Witnesses said that she had been dead for about a quarter of an hour. They found no pulse, no breathing, rolled-back eyes, and cold limbs. Her condition was therefore described through several signs at once rather than through the pulse alone.
Another example concerns a three-year-old girl. She was considered dead because her pulse could not be found on her hands or feet. This is especially useful for understanding how a medieval witness might physically examine someone: the pulse was not necessarily sought only at one location, but could be checked at the extremities.
The sources concerning newborns also mention pulse examination. A midwife named Bucia examined a newborn by placing her hand near the child’s heart. In another case, the caregiver Anthonia tried to find a pulse at the baby’s throat and limbs. She found none, and the baby was not breathing and had cold limbs.
These examples demonstrate that the absence of a pulse was not simply a theoretical medical concept. People actually touched the body and searched for evidence of circulation.
Breathing
British Library Add MS 37049, fol. 38v
Breathing was another important sign of life. A person who no longer appeared to breathe could be considered dead, but the sources do not suggest that medieval witnesses always treated breathing and pulse as exactly the same test. They could be mentioned separately, indicating that both were recognized as signs of life.
In the Bernardino material, breathing is mentioned in eight cases, while the miracles of James of the Marches contain eleven cases in which breathing is used as a sign.
The case of Jacoba, struck by falling wood and stones, again provides a particularly clear example. Witnesses said that she had no pulse and was not breathing, in addition to having cold limbs and eyes rolled back.
Another child was considered dead because witnesses could find neither breathing nor a pulse anywhere in the body. The combination of the two signs was especially significant because it suggested that the body no longer displayed the basic signs of life.
A similar example concerns an eight-month-old boy in the miracles of James of the Marches. His family believed that he was completely dead because he was not breathing and no pulse could be detected anywhere in his body.
Breathing was also especially important in cases involving newborn children. A newborn’s cry could be interpreted as evidence that the child was alive. Conversely, the absence of crying could be interpreted as a sign of death. Thus, breathing and vocalization were closely connected to the recognition of life in infants.
The Last Breath
13th-century Italian manuscript miniature of Jaufre Rudel dying in the arms of Hodierna of Tripoli, Bibliotheque Nationale Française, Manuscrits Français 854, fol. 121
The sources also contain descriptions of what could be interpreted as the final breaths of a dying person. In one case, Jacobus was lying on his back with his eyes rolled upward, and witnesses observed three tractus, or final breaths.
These final movements were significant because they represented the transition between life and death. Nissi notes that the expression tractus facere could refer to the final breath of a dying person.
The description of three final breaths is also interesting because medieval Christian traditions sometimes associated the departure of the soul with three final utterances or movements. Thus, the observation of breathing could have both a physical and religious meaning.
This shows that determining death was not purely a medical process. Physical observations could also be interpreted through religious ideas about the moment when the soul left the body.
Coldness of the Body
The temperature of the body was another important sign. A living body was expected to possess warmth, while a corpse gradually became cold. Medieval witnesses therefore used touch as part of their assessment. In the Bernardino process, coldness is mentioned seven times. In the miracles of James of the Marches, it appears eighteen times, making it the second most frequently mentioned sign after black colouring.
One striking example concerns a drowned boy whose body was described as being cold like ice. His mother also noticed that his body was black and swollen, that his tongue was black and hanging from his mouth, and that he was not breathing. Two other women touched different parts of his body and confirmed that he was extremely cold.
Another case concerns Tadeus Bucii, who touched his seriously ill son during the night. The father found the boy cold from head to toe. He also noticed drops of sweat around the boy’s forehead and two tears in his eyes, which he interpreted as signs that death was approaching.
The sources therefore demonstrate that coldness was something people could determine directly through touch. Unlike skin colour, which could simply be seen, temperature required physical contact with the body.
The sources also show that warmth could be used in attempts to revive or assist people who were believed to be dying. In one case, a two-year-old child suffering from plague became extremely cold, and heated clothes were used to warm his body.
An even more unusual example concerns an eight-month-pregnant woman named Violante. She had not felt the child moving for three days, and her abdomen became cold. Her husband, who was a physician, tried different methods, including heated clothes, baths, and ointments, but her abdomen remained cold. This shows that medieval observers could associate the temperature of the mother’s body with the condition of an unborn child.
Changes in Skin Colour
The death of Llywelyn the Great, Prince of Wales, with his sons Gruffydd and Dafydd at his bedside. Illustration by Matthew Paris, 13th century, from the Chronica Majora (Corpus Christi College, Cambridge, MS 16).
Changes in skin colour were among the most frequently described signs of death. The miracles of James of the Marches contain twenty-one cases in which the body or part of the body became black. The Bernardino process contains five such cases.
One particularly striking example concerns a three-year-old boy who fell from a high place. Witnesses described him as having become black, having lost his speech, and having no pulse. Some people wanted a physician to be called, while others considered this unnecessary because they believed that the child was already dead.
Another case concerns Gentilesca, a four-year-old girl who was accidentally swept away by water while walking with her sister. She was covered by water and mud and appeared dead when she was rescued. A witness later described her as having closed eyes and a black face, which reinforced the impression that she was dead.
The case of Pompeo, a young boy who fell from a window, provides another example. He suffered a severe head injury, and his head and face became swollen and black. His condition was so severe that those present believed he could not survive.
The meaning of this black colour should be treated cautiously. From a modern perspective, some descriptions may partly correspond to changes that occur after death, such as post-mortem lividity, although the medieval descriptions do not allow every case to be identified precisely with a modern medical process. The article also points out that blackness carried strong symbolic associations with death, sin, and hell in medieval culture.
Other colours were also recorded. Some bodies were described as livid, while others were pale. In one case, two witnesses described the same drowned boy differently: one described his face as black, while another described it as livid. This difference demonstrates that witnesses could perceive or remember the same physical condition differently.
The Eyes
12th century mosaic Basilica di San Pietro. Museo Barracco, Roma
The eyes could provide another visible indication that a person was dead or dying. The sources mention closed eyes four times and rolled-back eyes three times. The case of Jacoba is again particularly clear: after being struck by falling material, she was found with her eyes rolled back, together with an absent pulse, absent breathing, and cold limbs.
Another case concerns Jacobus Anthonius, who became seriously ill after injuring himself with a black thorn. When his condition worsened, he asked to be placed on the ground. His wife and two other witnesses then observed several signs of death. His eyes were rolled back, he was lying on his back, and he made three final breaths.
The position of the eyes was therefore not considered independently. It became meaningful when combined with other physical signs.
The eyes could also be important in cases involving children. One three-year-old girl was considered dead because she had no pulse, black teeth, rolled-back eyes, and cold limbs. Once again, several signs were interpreted together.
The Mouth, Teeth, and Tongue
The mouth and teeth could also change in appearance or become difficult to move. Nissi records descriptions involving dead lips, black tongues, black teeth, and stiff or closed mouths.
In one case, a one-year-old boy named Troiano was considered dead because his eyes were closed, his teeth were described as serati, and his pulse had disappeared. The description suggests that the teeth appeared clenched or closed, or perhaps “waxy.” Another case describes an eight-day-old baby whose mouth had become closed or stiff, while his body was beginning to become cold.
The sources also describe cases in which the tongue or throat became black. One woman suffering from a severe fever was described as having a tongue and throat that had become black like coal. Her physicians had given up hope of recovery.
Teeth could also become black. In the case of a three-year-old girl, her mother used several signs to establish that the child was dead: the absence of a pulse, black teeth, rolled-back eyes, and cold extremities.
These examples are particularly interesting because they show that medieval observers paid close attention to parts of the body that modern observers would not necessarily consider primary indicators of death.
Lips
The lips could also be interpreted as signs of death. In one miracle account, a mother observed that her baby’s lips were described as “dead,” although we do not know exactly what the mother meant by this expression. However, it compares the description with older medical traditions in which loose, hanging, pale, or livid lips could indicate that death was approaching.
The phrase therefore demonstrates how ordinary physical observations could acquire a specific association with death. A particular appearance of the lips could be recognized as part of a larger pattern of dying.
Tongue and Throat
The tongue and throat were also examined. This was not surprising because medieval physicians already used the tongue as an important source of information about illness.
For example, the famous physician Gentile da Foligno used observations of the pulse, tongue, and urine when making a prognosis for a plague patient. Thus, examining the tongue was part of a broader medical practice.
In the hagiographical material, however, the tongue could become a sign of death when it was described as black. A black tongue or throat could indicate that the person’s condition had become extremely serious.
Speechlessness
The inability to speak was another sign associated with death. In several cases, witnesses described a person as unable to speak before declaring that the person was dead or almost dead.
For example, the three-year-old boy who fell from a height became black, lost his speech, and had no detectable pulse. The combination of these signs convinced some witnesses that there was no need to call a physician because they believed that the boy had already died.
Speechlessness was particularly significant in children because crying could indicate life. In several cases involving newborns, the absence of crying was used as evidence that the baby was dead. Thus, sound itself could become part of the examination of the body: a cry suggested life, while complete silence could suggest death.
Immobility and Unconsciousness
A dead person was also characterized by a complete lack of movement or response. Unconsciousness, speechlessness, and immobility appear among the signs used in the sources to describe someone as dead or close to death. The example of the three-year-old boy who fell from a height is particularly useful. He had become black, had lost his ability to speak, and had no pulse.
Another case concerns a man called Caramello, who collapsed and was treated by two physicians. The physicians tried several remedies and even bloodletting, but the man remained without sensation, appearing like a corpse. Interestingly, however, he still had a weak pulse. This example is important because it shows that a person could appear dead while still displaying one sign of life.
The case therefore demonstrates the uncertainty involved in medieval determinations of death. Not every apparently dead person was necessarily considered completely beyond recovery.
Body Position
The position of the body could also contribute to the identification of death. In one case, Jacobus was deliberately placed on the ground because he wished to die there. Lying on the ground was connected with the Christian practice of preparing for death.
Similarly, witnesses could interpret a person lying on their back as a sign associated with dying because they had seen other dying people adopt the same position. Another witness described a drowned boy whose head hung downward and whose face was low and black. His rigid limbs, closed eyes, and lack of movement reinforced the impression of death.
This demonstrates that medieval people did not only examine isolated body parts. They also interpreted the overall posture of the body.
Wounds and Injuries
Gruffudd’s fall from the Tower of London – British Library MS Royal 14 C VII f. 136r
Physical injuries could also indicate that death was approaching. In 1446, a boy named Micutius suffered a serious fall from a high portico. Physicians examined his head and concluded that it was severely damaged and that an operation was necessary.
Another case concerns Leonettus, who fell from a horse and suffered serious wounds to his head and chest. Physicians and surgeons treated him for several days. His injuries were so severe that the physicians concluded that there was little or no hope for a natural recovery.
The case demonstrates that wounds were not necessarily signs that someone was already dead. Instead, severe injuries could be interpreted as signs that death was imminent.
Bleeding
Bleeding could likewise be associated with a fatal condition. A particularly striking example is Loysi Bisbano, a three-year-old boy who fell from a height of more than four canne. He was found without crying, speaking, or breathing. Blood was coming from his mouth, nose, eyes, and ears, while his body had become swollen, black, and cold.
The combination of massive bleeding, lack of movement, lack of speech, absence of breathing, and changes in colour led physicians and witnesses to regard his condition as hopeless.
Again, bleeding alone was not necessarily proof of death. It was its combination with several other signs that made the condition appear fatal.
Pain and the “Sweat of Death”
Even pain could be interpreted as a sign that death was approaching. In one case, a person experienced such severe pain that he lost his senses and developed what the source calls the “sweat of death.”
Another remarkable case concerns a dying boy whose father observed drops of sweat around his forehead and two tears in his eyes. The father interpreted these bodily changes as signs that death was approaching.
These examples are especially interesting because modern people do not normally regard tears or sweat as direct signs of death. In the fifteenth-century sources, however, they could form part of the visual vocabulary of dying.
Tears
The presence of tears was therefore not always understood as an emotional response. It could also be interpreted as a physical sign associated with the final stages of life.
In the case of Tadeus Bucii’s son, the father saw two tears around the boy’s eyes at the same time as he observed coldness and sweat. These signs together convinced him that his son’s death was approaching. This is a good example of how medieval witnesses combined several observations: temperature, sweat, tears, and the general appearance of the patient.
Death During Childbirth
The recognition of death was particularly important during childbirth, because midwives had to determine whether a newborn was alive and whether an emergency baptism was possible.
In five cases from the Bernardino process, midwives determined whether babies were alive or dead. These women had considerable practical experience. One midwife, Bucia, stated that she had seen more than 140 babies and could compare the newborn in front of her with previous cases.
One difficult case involved a breech birth in which the baby’s feet appeared first. The midwife initially believed that the baby was dead and asked the women around her to help pull the child out. Once the baby was delivered, she examined the child and confirmed what she believed to be death.
Another case demonstrates how uncertain such observations could be. A baby was thought to be dead after a difficult birth and was placed on the ground. However, when the midwife later bathed the child, she noticed movement. The child was therefore alive and could be baptized.
This example is particularly important because it demonstrates that apparent death was not necessarily irreversible.
Who Could Recognize Death?
Miniature of a physician treating a man lying in a bed.
Determining death was not exclusively the responsibility of physicians. The fifteenth-century evidence shows that family members, friends, neighbours, midwives, physicians, surgeons, pharmacists, and other people present at the scene could all participate in recognizing whether someone was dead.
In many cases, people physically examined the body themselves. They touched the arms, legs, chest, throat, and other parts of the body. They placed an ear near the chest or mouth to listen for breathing. They looked at the eyes, skin, tongue, teeth, and lips.
The example of Jacoba’s death is particularly revealing because several different people participated in the observation. Her husband and other people present interpreted her physical condition, while an apothecary and his students were also involved.
The sources therefore present death as a collective event, rather than as something determined exclusively by a professional.
Physicians and Surgeons
Physicians had a particularly important authority when the circumstances were difficult or when serious injuries were involved. In the Bernardino material, physicians confirmed death in approximately one third of the cases involving death. Their authority came from their knowledge of the human body and their experience in dealing with illness and injury.
One example is Leonettus, who fell from a horse and suffered serious injuries to his head and chest. Physicians and surgeons treated him, and the physician Carolus later observed what he described as numerous “signs of death” in Leonettus’ head.
Three physicians were associated with the case, including Baverio Maghinardo Bonetti, a highly educated physician who had taught medicine at Bologna. The presence of several physicians demonstrates the importance that could be attached to professional medical judgement.
Medical authority therefore did not replace observation of the body. Instead, physicians interpreted the same physical signs — pulse, breathing, temperature, appearance, injuries, and other bodily changes — with the authority of their medical knowledge.
Apothecaries
The article also provides an example in which apothecaries became involved in recognizing death. Jacoba, after being struck by falling wood and stones, was found by an apothecary named Dominicus and his students. They encountered her lying on the ground and considered her dead.
This example is important because it shows that knowledge relevant to recognizing death extended beyond physicians. People working with medicines and treating illness could also possess enough practical knowledge to judge the condition of a body.
Midwives and Newborns
Midwives had particular expertise in determining whether a newborn was alive or dead, especially when a child was born in difficult circumstances. The sources describe midwives using experience and physical examination to distinguish a living child from one that appeared dead.
One midwife, Bucia, stated that she had attended more than 140 births. She used this experience as evidence that she could recognize when a newborn differed from children she had previously seen, including babies who had died during childbirth.
Another woman, Dea, explained that she had given birth to several children herself and had also seen older children die. She therefore believed that her experience allowed her to recognize the signs of death in a newborn.
These examples show that practical female experience could constitute a form of expertise even though women did not normally have access to university medical education.
Death Was Determined by Several Signs
The most important point from these fifteenth-century sources is that death was generally recognized through a combination of physical signs.
A person might have:
no pulse;
no breathing;
a cold body or cold limbs;
black, pale, or livid skin;
rolled-back or closed eyes;
a stiff or closed mouth;
unusual or black teeth;
a black tongue or throat;
dead-looking lips;
no movement;
no speech or response;
severe wounds;
bleeding;
tears or sweat;
unusual final breaths;
a characteristic position of the body.
The cases in the article repeatedly demonstrate this accumulation of evidence. Jacoba, for example, was described as having no pulse, no breathing, rolled-back eyes, and cold limbs. Similarly, the three-year-old boy who fell from a height was described as black, unable to speak, and without a pulse.
The drowned boy examined by Lucas and Jacob provides another particularly detailed example. Lucas observed closed eyes, a blackened face, rigid limbs, and a lowered head. Jacob added that the boy did not move or breathe, had a livid face, and had a cold body.
The medieval recognition of death was therefore not simply a matter of finding one sign and declaring someone dead. It was an interpretation of the whole condition of the body.
A Note of Caution
These examples come primarily from fifteenth-century Italian hagiographical and canonization materials, rather than from modern medical records. The witnesses often described events after they had happened, their testimony was recorded and sometimes translated into Latin, and the cases were collected precisely because they involved miraculous recoveries.
There is therefore an important methodological limitation: in the sources used by the article, the people described as dead ultimately recovered. This means that some individuals may not have been biologically dead according to modern medical criteria. They were people whom witnesses believed to be dead or almost dead.
The testimonies may also have been influenced by the purpose of the canonization process. Witnesses were trying to establish that a miracle had genuinely occurred, which could encourage them to emphasize how severe the person’s condition had been.
Nevertheless, the material is particularly valuable because witnesses were specifically asked how they knew that a person was dead. It therefore preserves unusually detailed descriptions of the physical signs that ordinary people and medical practitioners associated with death in late medieval Italy.
The sources therefore provide an important insight into medieval understandings of the body. They show that although medieval people did not possess modern definitions of biological death, they had developed detailed ways of observing, interpreting, and discussing the physical signs associated with dying and death.
Dr Lorris Chevalier, who has a Ph.D. in medieval literature, is a historical advisor for movies, including The Last Duel and Napoleon. Click here to view his website.
How could medieval people determine whether someone had died without modern medical technology? Lorris Chevalier explores the physical signs of death recognised in the Middle Ages, from the absence of a pulse to changes in skin colour, and how families, midwives, and physicians made these judgements.
By Lorris Chevalier
In the Middle Ages, there was no single, universally defined medical test for determining whether a person was dead. Medieval ideas about death were strongly influenced by ancient authorities, particularly Aristotle and the Galenic medical tradition. Life was understood through the functioning of the body, especially the heart, which was regarded as central to life and the source of the body’s vital heat. The brain and other organs also had important roles in the medical understanding of life, but the heart remained particularly important in discussions of life, death, and the pulse.
This meant that death was not necessarily established through one specific examination. Instead, people looked for a combination of signs: the absence of breathing or a pulse, coldness of the body, changes in skin colour, unconsciousness, immobility, changes in the eyes and mouth, and other physical signs. Fifteenth-century Italian sources show that both ordinary people and medical practitioners could recognize these signs.
These sources also show that determining death could be a collective judgement. In many cases, witnesses described the person as dead because everyone present agreed that death had occurred. In the canonization process of Bernardino of Siena, for example, in fifteen of the twenty-nine cases involving death, the determination was made by all those present. Family members, friends, physicians, and other witnesses could all observe the body and interpret its condition.
A particularly interesting example is the case of Johannes, a seriously ill boy. His father described him as quasi mortuus, meaning “almost dead”; his mother considered him tamquam mortuus, “as if dead”; while his eighteen-year-old brother stated that he fuit mortuus, “was dead.” The three witnesses had seen the same child, but they did not use exactly the same expressions. This suggests that people could distinguish between being close to death and being definitively dead.
Recognizing death therefore depended heavily on experience and observation. A person did not necessarily need to be a physician to recognize that someone had died, although physicians had an important authority in difficult cases. The evidence from fifteenth-century Italy shows several recurring physical signs that people associated with death. This article draws on the research of Jyrki Nissi, particularly his study “Quomodo Scit Quod Mortuus Erat? Signs of Death in 15th-Century Italy.”
Pulse
The pulse was one of the important ways of determining whether life remained in the body. Because ancient medical thought placed such importance on the heart, the absence of a pulse could be taken as a powerful indication of death. However, the sources show that the pulse was normally considered alongside other signs rather than being the sole test.
In the process of Bernardino of Siena, the absence of a pulse is mentioned in four of the twenty-nine cases involving death. In the miracles of James of the Marches, it appears even more frequently, in eleven cases. One particularly clear example concerns Jacoba, who had been struck by falling wood and stones. Witnesses said that she had been dead for about a quarter of an hour. They found no pulse, no breathing, rolled-back eyes, and cold limbs. Her condition was therefore described through several signs at once rather than through the pulse alone.
Another example concerns a three-year-old girl. She was considered dead because her pulse could not be found on her hands or feet. This is especially useful for understanding how a medieval witness might physically examine someone: the pulse was not necessarily sought only at one location, but could be checked at the extremities.
The sources concerning newborns also mention pulse examination. A midwife named Bucia examined a newborn by placing her hand near the child’s heart. In another case, the caregiver Anthonia tried to find a pulse at the baby’s throat and limbs. She found none, and the baby was not breathing and had cold limbs.
These examples demonstrate that the absence of a pulse was not simply a theoretical medical concept. People actually touched the body and searched for evidence of circulation.
Breathing
Breathing was another important sign of life. A person who no longer appeared to breathe could be considered dead, but the sources do not suggest that medieval witnesses always treated breathing and pulse as exactly the same test. They could be mentioned separately, indicating that both were recognized as signs of life.
In the Bernardino material, breathing is mentioned in eight cases, while the miracles of James of the Marches contain eleven cases in which breathing is used as a sign.
The case of Jacoba, struck by falling wood and stones, again provides a particularly clear example. Witnesses said that she had no pulse and was not breathing, in addition to having cold limbs and eyes rolled back.
Another child was considered dead because witnesses could find neither breathing nor a pulse anywhere in the body. The combination of the two signs was especially significant because it suggested that the body no longer displayed the basic signs of life.
A similar example concerns an eight-month-old boy in the miracles of James of the Marches. His family believed that he was completely dead because he was not breathing and no pulse could be detected anywhere in his body.
Breathing was also especially important in cases involving newborn children. A newborn’s cry could be interpreted as evidence that the child was alive. Conversely, the absence of crying could be interpreted as a sign of death. Thus, breathing and vocalization were closely connected to the recognition of life in infants.
The Last Breath
The sources also contain descriptions of what could be interpreted as the final breaths of a dying person. In one case, Jacobus was lying on his back with his eyes rolled upward, and witnesses observed three tractus, or final breaths.
These final movements were significant because they represented the transition between life and death. Nissi notes that the expression tractus facere could refer to the final breath of a dying person.
The description of three final breaths is also interesting because medieval Christian traditions sometimes associated the departure of the soul with three final utterances or movements. Thus, the observation of breathing could have both a physical and religious meaning.
This shows that determining death was not purely a medical process. Physical observations could also be interpreted through religious ideas about the moment when the soul left the body.
Coldness of the Body
The temperature of the body was another important sign. A living body was expected to possess warmth, while a corpse gradually became cold. Medieval witnesses therefore used touch as part of their assessment. In the Bernardino process, coldness is mentioned seven times. In the miracles of James of the Marches, it appears eighteen times, making it the second most frequently mentioned sign after black colouring.
One striking example concerns a drowned boy whose body was described as being cold like ice. His mother also noticed that his body was black and swollen, that his tongue was black and hanging from his mouth, and that he was not breathing. Two other women touched different parts of his body and confirmed that he was extremely cold.
Another case concerns Tadeus Bucii, who touched his seriously ill son during the night. The father found the boy cold from head to toe. He also noticed drops of sweat around the boy’s forehead and two tears in his eyes, which he interpreted as signs that death was approaching.
The sources therefore demonstrate that coldness was something people could determine directly through touch. Unlike skin colour, which could simply be seen, temperature required physical contact with the body.
The sources also show that warmth could be used in attempts to revive or assist people who were believed to be dying. In one case, a two-year-old child suffering from plague became extremely cold, and heated clothes were used to warm his body.
An even more unusual example concerns an eight-month-pregnant woman named Violante. She had not felt the child moving for three days, and her abdomen became cold. Her husband, who was a physician, tried different methods, including heated clothes, baths, and ointments, but her abdomen remained cold. This shows that medieval observers could associate the temperature of the mother’s body with the condition of an unborn child.
Changes in Skin Colour
Changes in skin colour were among the most frequently described signs of death. The miracles of James of the Marches contain twenty-one cases in which the body or part of the body became black. The Bernardino process contains five such cases.
One particularly striking example concerns a three-year-old boy who fell from a high place. Witnesses described him as having become black, having lost his speech, and having no pulse. Some people wanted a physician to be called, while others considered this unnecessary because they believed that the child was already dead.
Another case concerns Gentilesca, a four-year-old girl who was accidentally swept away by water while walking with her sister. She was covered by water and mud and appeared dead when she was rescued. A witness later described her as having closed eyes and a black face, which reinforced the impression that she was dead.
The case of Pompeo, a young boy who fell from a window, provides another example. He suffered a severe head injury, and his head and face became swollen and black. His condition was so severe that those present believed he could not survive.
The meaning of this black colour should be treated cautiously. From a modern perspective, some descriptions may partly correspond to changes that occur after death, such as post-mortem lividity, although the medieval descriptions do not allow every case to be identified precisely with a modern medical process. The article also points out that blackness carried strong symbolic associations with death, sin, and hell in medieval culture.
Other colours were also recorded. Some bodies were described as livid, while others were pale. In one case, two witnesses described the same drowned boy differently: one described his face as black, while another described it as livid. This difference demonstrates that witnesses could perceive or remember the same physical condition differently.
The Eyes
The eyes could provide another visible indication that a person was dead or dying. The sources mention closed eyes four times and rolled-back eyes three times. The case of Jacoba is again particularly clear: after being struck by falling material, she was found with her eyes rolled back, together with an absent pulse, absent breathing, and cold limbs.
Another case concerns Jacobus Anthonius, who became seriously ill after injuring himself with a black thorn. When his condition worsened, he asked to be placed on the ground. His wife and two other witnesses then observed several signs of death. His eyes were rolled back, he was lying on his back, and he made three final breaths.
The position of the eyes was therefore not considered independently. It became meaningful when combined with other physical signs.
The eyes could also be important in cases involving children. One three-year-old girl was considered dead because she had no pulse, black teeth, rolled-back eyes, and cold limbs. Once again, several signs were interpreted together.
The Mouth, Teeth, and Tongue
The mouth and teeth could also change in appearance or become difficult to move. Nissi records descriptions involving dead lips, black tongues, black teeth, and stiff or closed mouths.
In one case, a one-year-old boy named Troiano was considered dead because his eyes were closed, his teeth were described as serati, and his pulse had disappeared. The description suggests that the teeth appeared clenched or closed, or perhaps “waxy.” Another case describes an eight-day-old baby whose mouth had become closed or stiff, while his body was beginning to become cold.
The sources also describe cases in which the tongue or throat became black. One woman suffering from a severe fever was described as having a tongue and throat that had become black like coal. Her physicians had given up hope of recovery.
Teeth could also become black. In the case of a three-year-old girl, her mother used several signs to establish that the child was dead: the absence of a pulse, black teeth, rolled-back eyes, and cold extremities.
These examples are particularly interesting because they show that medieval observers paid close attention to parts of the body that modern observers would not necessarily consider primary indicators of death.
Lips
The lips could also be interpreted as signs of death. In one miracle account, a mother observed that her baby’s lips were described as “dead,” although we do not know exactly what the mother meant by this expression. However, it compares the description with older medical traditions in which loose, hanging, pale, or livid lips could indicate that death was approaching.
The phrase therefore demonstrates how ordinary physical observations could acquire a specific association with death. A particular appearance of the lips could be recognized as part of a larger pattern of dying.
Tongue and Throat
The tongue and throat were also examined. This was not surprising because medieval physicians already used the tongue as an important source of information about illness.
For example, the famous physician Gentile da Foligno used observations of the pulse, tongue, and urine when making a prognosis for a plague patient. Thus, examining the tongue was part of a broader medical practice.
In the hagiographical material, however, the tongue could become a sign of death when it was described as black. A black tongue or throat could indicate that the person’s condition had become extremely serious.
Speechlessness
The inability to speak was another sign associated with death. In several cases, witnesses described a person as unable to speak before declaring that the person was dead or almost dead.
For example, the three-year-old boy who fell from a height became black, lost his speech, and had no detectable pulse. The combination of these signs convinced some witnesses that there was no need to call a physician because they believed that the boy had already died.
Speechlessness was particularly significant in children because crying could indicate life. In several cases involving newborns, the absence of crying was used as evidence that the baby was dead. Thus, sound itself could become part of the examination of the body: a cry suggested life, while complete silence could suggest death.
Immobility and Unconsciousness
A dead person was also characterized by a complete lack of movement or response. Unconsciousness, speechlessness, and immobility appear among the signs used in the sources to describe someone as dead or close to death. The example of the three-year-old boy who fell from a height is particularly useful. He had become black, had lost his ability to speak, and had no pulse.
Another case concerns a man called Caramello, who collapsed and was treated by two physicians. The physicians tried several remedies and even bloodletting, but the man remained without sensation, appearing like a corpse. Interestingly, however, he still had a weak pulse. This example is important because it shows that a person could appear dead while still displaying one sign of life.
The case therefore demonstrates the uncertainty involved in medieval determinations of death. Not every apparently dead person was necessarily considered completely beyond recovery.
Body Position
The position of the body could also contribute to the identification of death. In one case, Jacobus was deliberately placed on the ground because he wished to die there. Lying on the ground was connected with the Christian practice of preparing for death.
Similarly, witnesses could interpret a person lying on their back as a sign associated with dying because they had seen other dying people adopt the same position. Another witness described a drowned boy whose head hung downward and whose face was low and black. His rigid limbs, closed eyes, and lack of movement reinforced the impression of death.
This demonstrates that medieval people did not only examine isolated body parts. They also interpreted the overall posture of the body.
Wounds and Injuries
Physical injuries could also indicate that death was approaching. In 1446, a boy named Micutius suffered a serious fall from a high portico. Physicians examined his head and concluded that it was severely damaged and that an operation was necessary.
Another case concerns Leonettus, who fell from a horse and suffered serious wounds to his head and chest. Physicians and surgeons treated him for several days. His injuries were so severe that the physicians concluded that there was little or no hope for a natural recovery.
The case demonstrates that wounds were not necessarily signs that someone was already dead. Instead, severe injuries could be interpreted as signs that death was imminent.
Bleeding
Bleeding could likewise be associated with a fatal condition. A particularly striking example is Loysi Bisbano, a three-year-old boy who fell from a height of more than four canne. He was found without crying, speaking, or breathing. Blood was coming from his mouth, nose, eyes, and ears, while his body had become swollen, black, and cold.
The combination of massive bleeding, lack of movement, lack of speech, absence of breathing, and changes in colour led physicians and witnesses to regard his condition as hopeless.
Again, bleeding alone was not necessarily proof of death. It was its combination with several other signs that made the condition appear fatal.
Pain and the “Sweat of Death”
Even pain could be interpreted as a sign that death was approaching. In one case, a person experienced such severe pain that he lost his senses and developed what the source calls the “sweat of death.”
Another remarkable case concerns a dying boy whose father observed drops of sweat around his forehead and two tears in his eyes. The father interpreted these bodily changes as signs that death was approaching.
These examples are especially interesting because modern people do not normally regard tears or sweat as direct signs of death. In the fifteenth-century sources, however, they could form part of the visual vocabulary of dying.
Tears
The presence of tears was therefore not always understood as an emotional response. It could also be interpreted as a physical sign associated with the final stages of life.
In the case of Tadeus Bucii’s son, the father saw two tears around the boy’s eyes at the same time as he observed coldness and sweat. These signs together convinced him that his son’s death was approaching. This is a good example of how medieval witnesses combined several observations: temperature, sweat, tears, and the general appearance of the patient.
Death During Childbirth
The recognition of death was particularly important during childbirth, because midwives had to determine whether a newborn was alive and whether an emergency baptism was possible.
In five cases from the Bernardino process, midwives determined whether babies were alive or dead. These women had considerable practical experience. One midwife, Bucia, stated that she had seen more than 140 babies and could compare the newborn in front of her with previous cases.
One difficult case involved a breech birth in which the baby’s feet appeared first. The midwife initially believed that the baby was dead and asked the women around her to help pull the child out. Once the baby was delivered, she examined the child and confirmed what she believed to be death.
Another case demonstrates how uncertain such observations could be. A baby was thought to be dead after a difficult birth and was placed on the ground. However, when the midwife later bathed the child, she noticed movement. The child was therefore alive and could be baptized.
This example is particularly important because it demonstrates that apparent death was not necessarily irreversible.
Who Could Recognize Death?
Determining death was not exclusively the responsibility of physicians. The fifteenth-century evidence shows that family members, friends, neighbours, midwives, physicians, surgeons, pharmacists, and other people present at the scene could all participate in recognizing whether someone was dead.
In many cases, people physically examined the body themselves. They touched the arms, legs, chest, throat, and other parts of the body. They placed an ear near the chest or mouth to listen for breathing. They looked at the eyes, skin, tongue, teeth, and lips.
The example of Jacoba’s death is particularly revealing because several different people participated in the observation. Her husband and other people present interpreted her physical condition, while an apothecary and his students were also involved.
The sources therefore present death as a collective event, rather than as something determined exclusively by a professional.
Physicians and Surgeons
Physicians had a particularly important authority when the circumstances were difficult or when serious injuries were involved. In the Bernardino material, physicians confirmed death in approximately one third of the cases involving death. Their authority came from their knowledge of the human body and their experience in dealing with illness and injury.
One example is Leonettus, who fell from a horse and suffered serious injuries to his head and chest. Physicians and surgeons treated him, and the physician Carolus later observed what he described as numerous “signs of death” in Leonettus’ head.
Three physicians were associated with the case, including Baverio Maghinardo Bonetti, a highly educated physician who had taught medicine at Bologna. The presence of several physicians demonstrates the importance that could be attached to professional medical judgement.
Medical authority therefore did not replace observation of the body. Instead, physicians interpreted the same physical signs — pulse, breathing, temperature, appearance, injuries, and other bodily changes — with the authority of their medical knowledge.
Apothecaries
The article also provides an example in which apothecaries became involved in recognizing death. Jacoba, after being struck by falling wood and stones, was found by an apothecary named Dominicus and his students. They encountered her lying on the ground and considered her dead.
This example is important because it shows that knowledge relevant to recognizing death extended beyond physicians. People working with medicines and treating illness could also possess enough practical knowledge to judge the condition of a body.
Midwives and Newborns
Midwives had particular expertise in determining whether a newborn was alive or dead, especially when a child was born in difficult circumstances. The sources describe midwives using experience and physical examination to distinguish a living child from one that appeared dead.
One midwife, Bucia, stated that she had attended more than 140 births. She used this experience as evidence that she could recognize when a newborn differed from children she had previously seen, including babies who had died during childbirth.
Another woman, Dea, explained that she had given birth to several children herself and had also seen older children die. She therefore believed that her experience allowed her to recognize the signs of death in a newborn.
These examples show that practical female experience could constitute a form of expertise even though women did not normally have access to university medical education.
Death Was Determined by Several Signs
The most important point from these fifteenth-century sources is that death was generally recognized through a combination of physical signs.
A person might have:
The cases in the article repeatedly demonstrate this accumulation of evidence. Jacoba, for example, was described as having no pulse, no breathing, rolled-back eyes, and cold limbs. Similarly, the three-year-old boy who fell from a height was described as black, unable to speak, and without a pulse.
The drowned boy examined by Lucas and Jacob provides another particularly detailed example. Lucas observed closed eyes, a blackened face, rigid limbs, and a lowered head. Jacob added that the boy did not move or breathe, had a livid face, and had a cold body.
The medieval recognition of death was therefore not simply a matter of finding one sign and declaring someone dead. It was an interpretation of the whole condition of the body.
A Note of Caution
These examples come primarily from fifteenth-century Italian hagiographical and canonization materials, rather than from modern medical records. The witnesses often described events after they had happened, their testimony was recorded and sometimes translated into Latin, and the cases were collected precisely because they involved miraculous recoveries.
There is therefore an important methodological limitation: in the sources used by the article, the people described as dead ultimately recovered. This means that some individuals may not have been biologically dead according to modern medical criteria. They were people whom witnesses believed to be dead or almost dead.
The testimonies may also have been influenced by the purpose of the canonization process. Witnesses were trying to establish that a miracle had genuinely occurred, which could encourage them to emphasize how severe the person’s condition had been.
Nevertheless, the material is particularly valuable because witnesses were specifically asked how they knew that a person was dead. It therefore preserves unusually detailed descriptions of the physical signs that ordinary people and medical practitioners associated with death in late medieval Italy.
The sources therefore provide an important insight into medieval understandings of the body. They show that although medieval people did not possess modern definitions of biological death, they had developed detailed ways of observing, interpreting, and discussing the physical signs associated with dying and death.
Dr Lorris Chevalier, who has a Ph.D. in medieval literature, is a historical advisor for movies, including The Last Duel and Napoleon. Click here to view his website.
Click here to read more from Lorris Chevalier
Further Reading:
Nissi, Jyrki, “Quomodo Scit Quod Mortuus Erat? Signs of Death in 15th-Century Italy,” SVMMA: Revista de Cultures Medievals, no. 7 (2016).
Top Image: Beinecke MS.229 fol. 267v
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