On the Physical Death of Jesus Christ
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Special Communication
On the Physical Death of Jesus Christ
William D. Edwards, MD; Wesley J. Gabel, MDiv; Floyd E. Hosmer, MS, AMI
· Jesus of Nazareth underwent Jewish and Roman trials, was flogged,
and was sentenced to death by crucifixion. The scourging produced deep
Talmud, and by the Jewish historian
Flavius Josephus, although the au-
stripelike lacerations and appreciable blood loss, and it probably set the thenticity of portions of the latter is
stage for hypovolemic shock as evidenced by the fact that Jesus was too problematic.26
weakened to carry the crossbar (patibulum) to Golgotha. At the site of The Shroud of Turin is considered
crucifixion his wrists were nailed to the patibulum, and after the patibulum by many to represent the actual buri-
was lifted onto the upright post, (stipes) his feet were nailed to the stipes. al cloth of Jesus,22 and several public-
The major pathophysiologic effect of crucifixion was an interference with cations concerning the medical as-
normal respirations. Accordingly, death resulted primarily from hypovolemic pects of his death draw conclusions
shock and exhaustion asphyxia. Jesus’ death was ensured by the thrust of a from this assumption.5,11 The Shroud
soldier’s spear into his side. Modern medical interpretation of the historical of Turin and recent archaeological
evidence indicates that Jesus was dead when taken down from the cross. findings provide valuable information
(JAMA 1986; 255:1455-1463) concerning Roman crucifixion prac-
tices.22-24 The interpretations of mod-
ern writers, based on a knowledge of
THE LIFE and teachings of Jesus of credibility of any discussion of Jesus’ science and medicine not available in
Nazareth have formed the basis for a death will be determined primarily by the first century, may offer addition-
major world religion, (Christianity) the credibility of one’s sources. For al insight concerning the possible
have appreciably influenced the this review, the source material mechanisms of Jesus’ death.2-17
course of human history, and, by includes the writings of ancient When taken in concert certain
virtue of a compassionate attitude Christian and non-Christian authors, facts—the extensive and early testi-
toward the sick, also have contributed the writings of modern authors, and mony of both Christian proponents
to the development of modern medi- the Shroud of Turin.1-40 Using the and opponents, and their universal
cine. The eminence of Jesus as a legal-historical method of scientific acceptance of Jesus as a true histori-
historical figure and the suffering, investigation,27 scholars have estab- cal figure; the ethic of the gospel
and controversy associated with his lished the reliability and accuracy of writers, and the shortness of the time
death has stimulated us to investi- the ancient manuscripts.26,27,29,31 interval between the events and the
gate, in an interdisciplinary manner, The most extensive and detailed extant manuscripts; and the confir-
the circumstances surrounding his descriptions of the life and death of mation of the gospel accounts by
crucifixion. Accordingly it is our Jesus are to be found in the New historians and archaeological find-
intent to present not a theological Testament gospels of Matthew, Mark, ings26-27—ensure a reliable testimony
treatise but rather a medically, and Luke, and John.1 The other 23 books from which a modern medical interpret-
historically accurate account of the of the New Testament support but do tation of Jesus’ death may be made.
physical death of the one called Jesus not expand on the details recorded in
GETHSEMANE
Christ. the gospels. Contemporary Christian,
Jewish, and Roman authors provide After Jesus and his disciples had
SOURCES additional insight concerning the observed the Passover meal in an
The source material concerning first-century Jewish and Roman legal upper room in a home in southwest
Christ’s death comprises a body of systems and the details of scourging Jerusalem, they traveled to the Mount
literature and not a physical body or and crucifixion.5 Seneca, Livy, Plu- of Olives, northeast of the city (Fig 1).
its skeletal remains. Accordingly, the tarch, and others refer to crucifixion (Owing to various adjustments in the
practices in their works.8,28 Specifical- calendar, the years of Jesus’ birth and
From the Departments of Pathology (Dr. Edwards) ly, Jesus (or his crucifixion) is men- death remain controversial.29 How-
and Medical Graphics (Mr. Hosmer), Mayo Clinic, tioned by the Roman historians Cor- ever, it is likely that Jesus was born
Rochester, Minn; and the Homestead United Meth-
odist Church, Rochester, Minn, and the West Bethel nelius Tacitus, Pliny the Younger, in either 4 or 6 BC and died in 30
United Methodist Church, Bethel, Minn (Pastor and Suetonius, by non-Roman histori- AD.11,29 During the Passover observ-
Gabel).
Reprint requests to Department of Pathology, ans Thallus and Phlegon, by the satir- ance in 30 AD, the Last Supper would
Mayo Clinic, Rochester, MN 55905 (Dr Edwards). ist Lucian of Samosata, by the Jewish have been observed on Thursday,
JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al 1455To Sychem N
and Damascus
W E
0 500 1,000 1,500 S
Feet
Meters Fortress of
Possible Antonia
0 250 500
Golgotha
Garden of
Gethsemane
To Joppa
7 4
Traditional 5 Mount of Olives
Golgotha
Suburb To Bethany
(Calvary)
6
Herod Antipas’ Temple
Palace
Herod’s 2
Palace 3
Upper City
Lower City Kidron Valley
Caiaphas’
Residence
Upper 1
Room
Hinnom Valley
To Bethlehem
and Hebron
To Salt Sea
Fig 1.—Map of Jerusalem at time of Christ. Jesus left Upper Room and walked with disciples to Mount of Olives
and Garden of Gethsemane (1), where he was arrested and taken first to Annas and then to Caiaphas (2). After
first trial before political Sanhedrin at Caiaphas’ residence, Jesus was tried again before religious Sanhedrin,
probably at Temple (3) Next, he was taken to Pontius Pilate (4), who sent him to Herod Antipas (5). Herod
returned Jesus to Pilate (6), and Pilate finally handed over Jesus for scourging at Fortress of Antonia and for
crucifixion at Golgotha (7). (Modified from Pfeiffer et al.30)
April 6 [Nisan 13], and Jesus would have suggested that hematidrosis ably at the temple (Fig l), Jesus was
have been crucified on Friday, April 7 produced hypovolemia, we agree with tried before the religious Sanhedrin
[Nisan 14].29) At nearby Gethsemane, Bucklin5 that Jesus’ actual blood loss (with the Pharisees and the Saddu-
Jesus, apparently knowing that the probably was minimal. However, in cees) and again was found guilty of
time of his death was near, suffered the cold night air,1 it may have pro- blasphemy, a crime punishable by
great mental anguish, and, as de- duced chills. death.1,5
scribed by the physician Luke, his
TRIALS Roman Trials
sweat became like blood.1
Although this is a very rare phe- Jewish Trials Since permission for an execution
nomenon, bloody sweat (hematidrosis Soon after midnight, Jesus was had to come from the governing
or hemohidrosis) may occur in highly arrested at Gethsemane by the tem- Romans,1 Jesus was taken early in the
emotional states or in persons with ple officials and was taken first to morning by the temple officials to the
bleeding disorders.18-20 As a result of Annas and then to Caiaphas, the Praetorium of the Fortress of Anton-
hemorrhage into the sweat glands, Jewish high priest for that year (Fig ia, the residence and governmental
the skin becomes fragile and tender.2,11 1).1 Between 1 AM and daybreak, Jesus seat of Pontius Pilate, the procurator
Luke’s description supports the diag- was tried before Caiaphas and the of Judea (Fig 1). However, Jesus was
nosis of hematidrosis rather than political Sanhedrin and was found presented to Pilate not as a blas-
eccrine chromidrosis (brown or yel- guilty of blasphemy.1 The guards then phemer but rather as a self-appointed
low-green sweat) or stigmatization blindfolded Jesus, spat on him, and king who would undermine the Ro-
(blood oozing from the palms or else- struck him in the face with their man authority.1 Pilate made no
where).18-21 Although some authors fists.1 Soon after daybreak, presum- charges against Jesus and sent him to
1456 JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et alDirection of
Whip Against
Victim’s Back
Small Bone
Leather (Pieces)
WoodenThongs Metal Balls Roman
Handle
Legionnaire
Flagrum
MAYO
©1985
Flogging
Top View Direction of Whip Marks
Victim
Fig 2.—Scourging. Left, Short whip (flagrum) with lead balls and sheep bones tied into leather thongs. Center
left, Naked victim tied to flogging post. Deep stripelike lacerations were usually associated with considerable
blood loss. Center right, View from above, showing position of lictors. Right, Inferomedial direction of wounds.
Herod Antipas, the tetrarch of Ju his closest friends (the disciples), and (lictors) or by one who alternated
dea.1 Herod likewise made no official a physical beating (after the first positions.5,7,11,28 The severity of the
charges and then returned Jesus to Jewish trial). Also, in the setting of a scourging depended on the disposition
Pilate (Fig 1).1 Again, Pilate could traumatic and sleepless night, he had of the lictors and was intended to
find no basis for a legal charge been forced to walk more than 2.5 weaken the victim to a state just
against Jesus, but the people persist- miles (4.0 km) to and from the sites of short of collapse or death.8 After the
ently demanded crucifixion. Pilate the various trials (Fig 1). These phys- scourging, the soldiers often taunted
finally granted their demand and ical and emotional factors may have their victim.11
handed over Jesus to be flogged rendered Jesus particularly vulnera-
(scourged) and crucified. (McDowell25 ble to the adverse hemodynamic Medical Aspects of Scourging
has reviewed the prevailing political, effects of the scourging. As the Roman soldiers repeatedly
religious, and economic climates in struck the victim’s back with full
Jerusalem at the time of Jesus’ death, SCOURGING
force, the iron balls would cause deep
and Bucklin5 has described the vari- Scourging Practices contusions, and the leather thongs
ous illegalities of the Jewish and and sheep bones would cut into the
Flogging was a legal preliminary to
Roman trials.) skin and subcutaneous tissues.7 Then,
every Roman execution,28 and only
women and Roman senators or sol- as the flogging continued, the lacera-
Health of Jesus
diers (except in cases of desertion) tions would tear into the underlying
The rigors of Jesus’ ministry (that were exempt.11 The usual instrument skeletal muscles and produce quiver-
is, traveling by foot throughout Pal- was a short whip (flagellum or flagel- ing ribbons of bleeding flesh.2,7,25 Pain
estine) would have precluded any lum) with several single or braided and blood loss generally set the stage
major physical illness or a weak gen- leather thongs of variable lengths, in for circulatory shock.12 The extent of
eral constitution. Accordingly, it is which small iron balls or sharp pieces blood loss may well have determined
reasonable to assume that Jesus was of sheep bones were tied at intervals how long the victim would survive on
in good physical condition before his (Fig 2).5,7,11 Occasionally, staves also the cross.8
walk to Gethsemane. However, dur- were used.8,12 For scourging, the man
Scourging of Jesus
ing the 12 hours between 9 PM Thurs- was stripped of his clothing, and his
day and 9 AM Friday, he had suffered hands were tied to an upright post At the Praetorium, Jesus was
great emotional stress (as evidenced (Fig 2).11 The back, buttocks, and legs severely whipped. (Although the se-
by hematidrosis), abandonment by were flogged either by two soldiers verity of the scourging is not dis-
JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al 14575 to 6 ft (1.5 to 1.8 m)
75 to 125 lb (34 to 57 kg)
Titulus
Patibulum
6 to 8 ft
Stipes
Sedile (1.8 to 2.4 m)
MAYO
©1985
Stipes
Fig 3.—Cross and titulus. Left, victim carrying crossbar (patibulum) to site of upright post (stipes). Center Low
Tau cross (crux commissa), commonly used by Romans at time of Christ. Upper right, Rendition of Jesus’ titulus
with name and crime—Jesus of Nazareth, King of the Jews—written in Hebrew, Latin, and Greek. Lower right
Possible methods for attaching tittles to Tau cross (left) and Latin cross (right).
Variations in Crosses and struck him on the head with the mum pain and suffering.10,17 It was one
Used for Crucifixion wooden staff.1 Moreover, when the of the most disgraceful and cruel
Latin
soldiers tore the robe from Jesus’ methods of execution and usually was
Designation Characteristics back, they probably reopened the reserved only for slaves, foreigners,
Infelix lignum Tree scourging wounds.7 revolutionaries, and the vilest of
Crux simplex, Upright post The severe scourging, with its criminals.3,25,28 Roman law usually pro-
Crux acuta
intense pain and appreciable blood tected Roman citizens from crucifix-
Crux composita Stipes and patibulum
Crux humilis Low cross loss, most probably left Jesus in a ion,5 except perhaps in the ease of
Crux sublimis Tall cross preshock state. Moreover, hematidro- desertion by soldiers.
Crux commissa T-shaped (Tau) cross sis had rendered his skin particularly In its earliest form in Persia, the
Crux immissa †-shaped (Latin) tender. The physical and mental victim was either tied to a tree or was
cross
Crux capitata †-shaped (Latin)
abuse meted out by the Jews and the tied to or impaled on an upright post,
cross Romans, as well as the lack of food, usually to keep the guilty victim’s feet
Crux decussata X-shaped cross water, and sleep, also contributed to from touching holy ground.8,11,30,34,38
his generally weakened state. There- Only later was a true cross used; it
fore, even before the actual crucifix- was characterized by an upright post
cussed in the four gospel accounts, it ion, Jesus’ physical condition was at (stipes) and a horizontal crossbar
is implied in one of the epistles [1 least serious and possibly critical. (patibulum), and it had several varia-
Peter 2:24]. A detailed word study of tions (Table).11 Although archaeology-
the ancient Greek text for this verse CRUCIFIXION cal and historical evidence strongly
Crucifixion Practices indicates that the low Tau cross was
indicates that the scourging of Jesus
was particularly harsh.33) It is not Crucifixion probably first began preferred by the Romans in Palestine
known whether the number of lashes among the Persians.34 Alexander the at the time of Christ (Fig 3),2,7,11
was limited to 39, in accordance with Great introduced the practice to crucifixion practices often varied in a
Jewish law.5 The Roman soldiers, Egypt and Carthage, and the Romans given geographic region and in ac-
amused that this weakened man had appear to have learned of it from the cordance with the imagination of the
claimed to be a king, began to mock Carthaginians.11 Although the Ro- executioners, and the Latin cross and
him by placing a robe on his shoul- mans did not invent crucifixions they other forms also may have been
ders, a crown of thorns on his head, perfected it as a form of torture and used.28
and a wooden staff as a scepter in his capital punishment that was designed It was customary for the con-
right hand.1 Next, they spat on Jesus to produce a slow death with maxi- demned man to carry his own cross
1458 JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al? in
(1 cm)
Flexor Retinaculum
Ulnar Nerve and Artery
Median Nerve
Radial Artery
Flexor Pollicus
Longus Musculus
MAYO
©1985
5 to 7 in
(13 to 18 cm)
Radial Artery
Nail in
Patibulum
Ulnar Artery
Flexor Retinaculum
Median Nerve
Fig 4.—Nailing of wrists. Left, Size of iron nail. Center, Location of nail in wrist, between carpals and radius. Right, Cross
section of wrist, at level of plane indicated at left, showing path of nail, with probable transection of median nerve and
impalement of flexor pollicis longus, but without injury to major arterial trunks and without fractures of bones.
from the flogging post to the site of by ropes.10,11,30 To prolong the crucifix- After both arms were fixed to the
crucifixion outside the city walls.8,11,30 ion process, a horizontal wooden block crossbar, the patibulum and the vic-
He was usually naked, unless this was or plank, serving as a crude seat tim, together, were lifted onto the
prohibited by local customs.11 Since (sedile or sedulum), often was at- stipes.11 On the low cross, four sol-
the weight of the entire cross was tached midway down the stipes.3,11,16 diers could accomplish this relatively
probably well over 300 lb (136 kg), Only very rarely, and probably later easily. However, on the tall cross, the
only the crossbar was carried (Fig than the time of Christ, was an soldiers used either wooden forks or
3).11 The patibulum, weighing 75 to additional block (suppedaneum) em- ladders.11
125 lb. (34 to 57 kg),11,30 was placed ployed for transfixion of the feet.9,11 Next, the feet were fixed to the
across the nape of the victim’s neck At the site of execution, by law, the cross, either by nails or ropes. Ossua-
and balanced along both shoulders. victim was given a bitter drink of ry findings and the Shroud of Turin
Usually, the outstretched arms then wine mixed with myrrh (gall) as a suggest that nailing was the pre-
were tied to the crossbar.7,11 The pro- mild analgesic.7,17 The criminal was ferred Roman practice.23,24,30 Although
cessional to the site of crucifixion was then thrown to the ground on his the feet could be fixed to the sides of
led by a complete Roman military back, with his arms outstretched the stipes or to a wooden footrest
guard, headed by a centurion.3,11 One along the patibulum.11 The hands (suppedaneum), they usually were
of the soldiers carried a sign (titulus) could be nailed or tied to the crossbar, nailed directly to the front of the
on which the condemned man’s name but nailing apparently was preferred stipes (Fig 5).11 To accomplish this,
and crime were displayed (Fig 3).3,11 by the Romans.8,11 The archaeological flexion of the knees may have been
Later, the titulus would be attached to remains of a crucified body, found in quite prominent, and the bent legs
the top of the cross.11 The Roman an ossuary near Jerusalem and dating may have been rotated laterally (Fig
guard would not leave the victim until from the time of Christ, indicate that 6).23-25,30
they were sure of his death.9,11 the nails were tapered iron spikes When the nailing was completed,
Outside the city walls was perma- approximately 5 to 7 in (13 to 18 cm) the titulus was attached to the cross,
nently located the heavy upright long with a square shaft 3/8 in (1 cm) by nails or cords, just above the
wooden stipes, on which the patibu- across.23,24,30 Furthermore, ossuary victim’s head.11 The soldiers and the
lum would be secured. In the case of findings and the Shroud of Turin civilian crowd often taunted and
the Tau cross, this was accomplished have documented that the nails com- jeered the condemned man, and the
by means of a mortise and tenon monly were driven through the wrists soldiers customarily divided up his
joint, with or without reinforcement rather than the palms (Fig 4).22-24,30 clothes among themselves11,25 The
JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al 1459Medical Aspects of Crucifixion
With knowledge of both anatomy
and ancient crucifixion practices, one
may reconstruct the probable medical
aspects of this form of slow execution.
Each wound apparently was intended
to produce intense agony, and the
contributing causes of death were
numerous.
Weight-Bearing The scourging prior to crucifixion
Direction served to weaken the condemned man
of Body
Placement and, if blood loss was considerable, to
5 4 3 2 of Nail produce orthostatic hypotension and
1
even hypovolemic shock.8,12 When the
1 Metatarsals victim was thrown to the ground on
his back, in preparation for transfix-
ion of the hands, his scourging
wounds most likely would become
torn open again and contaminated
Medial View Frontal View with dirt.2,16 Furthermore, with each
respiration, the painful scourging
wounds would be scraped against the
rough wood of the stipes.7 As a result,
blood loss from the back probably
would continue throughout the cruci-
fixion ordeal.
With arms outstretched but not
Right Foot taut, the wrists were nailed to the
patibulum.7,11 It has been shown that
Metatarsal 1 the ligaments and bones of the wrist
can support the weight of a body
hanging from them, but the palms
Deep cannot.11 Accordingly, the iron spikes
Stipes MAYO
Peroneal Nerve probably were driven between the
©1985
Medial radius and the carpals or between the
Plantar Nerve two rows of carpal bones,2,10,11,30 either
Metatarsal 5
proximal to or through the strong
Lateral Plantar Nerve bandlike flexor retinaculum and the
various intercarpal ligaments (Fig 4).
Fig 5.—Nailing of feet. Left, Position of feet atop one another and against stipes. Upper right, Although a nail in either location in
Location of nail in second intermetatarsal space. Lower right, Cross section of foot, at plane
the wrist might pass between the
indicated at left, showing path of nail.
bony elements and thereby produce
no fractures, the likelihood of painful
length of survival generally ranged for burial, after obtaining permission periosteal injury would seem great.
from three or four hours to three or from the Roman judge.11 Furthermore, the driven nail would
four days and appears to have been Since no one was intended to sur- crush or sever the rather large senso-
inversely related to the severity of vive crucifixion, the body was not rimotor median nerve (Fig 4).2,7,11 The
the scourging.8,11 However, even if the released to the family until the sol- stimulated nerve would produce ex-
scourging had been relatively mild, diers were sure that the victim was cruciating bolts of fiery pain in both
the Roman soldiers could hasten dead. By custom, one of the Roman arms.7,9 Although the severed median
death by breaking the legs below the guards would pierce the body with a nerve would result in paralysis of a
knees (crurifragium or skelokopia).8,11 sword or lance.8,11 Traditionally, this portion of the hand, ischemic contrac-
Not uncommonly, insects would had been considered a spear wound to tures and impalement of various liga-
light upon or burrow into the open the heart through the right side of ments by the iron spike might pro-
wounds or the eyes, ears, and nose of the chest—a fatal wound probably duce a clawlike grasp.
the dying and helpless victim, and taught to most Roman soldiers.11 The Most commonly, the feet were fixed
birds of prey would tear at these Shroud of Turin documents this form to the front of the stipes by means
sites.16 Moreover, it was customary to of injury.5,11,22 Moreover, the standard of an iron spike driven through the
leave the corpse on the cross to be infantry spear, which was 5 to 6 ft first or second intermetatarsal space,
devoured by predatory animals.8,11,12,28 (1.5 to 1.8 m) long,30 could easily have just distal to the tarsometatarsal
However, by Roman law, the family reached the chest of a man crucified joint.2,5,8,11,30 It is likely that the deep
of the condemned could take the body on the customary low cross.11 peroneal nerve and branches of the
1460 JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et alSternocleidomastoid
Muscle
Scalenus Musculi
Parasternal
Intercartilaginous
Pectoralis
Muscles
Musculus
(Major)
External
Intercostal
Muscles Internal
Intercostal
Muscles
Inhalation
Active: Normal Breathing
Passive: Crucified Victims External
Oblique
Muscle
Internal
Oblique
Rectus Muscle
MAYO Abdominus
Transverse
©1985
Musculus
Abdominus
Musculus
Exhalation
Passive: Normal Breathing
Active: Crucified Victims
Fig 6—Respirations during crucifixion. Left, Inhalation. With elbows extended and shoulders abducted,
respiratory muscles of inhalation are passively stretched and thorax is expanded. Right, Exhalation. With elbows
flexed and shoulders adducted and with weight of body on nailed feet, exhalation is accomplished as active,
rather than passive, process. Breaking legs below knees would place burden of exhalation on shoulder and arm
muscles alone and soon would result in exhaustion asphyxia.
medial and lateral plantar nerves contractions, due to fatigue and most prominent causes probably were
would have been injured by the nails hypercarbia, would hinder respiration hypovolemic shock and exhaustion
(Fig 5). Although scourging may have even further.11 asphyxia.2,3,7,10 Other possible contrib-
resulted in considerable blood loss, Adequate exhalation required lift- uting factors included dehydration,7,16
crucifixion per se was a relatively ing the body by pushing up on the feet stress-induced arrhythmias,3 and con-
bloodless procedure, since no major and by flexing the elbows and adduct- gestive heart failure with the rapid
arteries, other than perhaps the ing the shoulders (Fig 6).2 However, accumulation of pericardial and per-
deep plantar arch, pass through the this maneuver would place the entire haps pleural effusions.2,7,11 Crucifrac-
favored anatomic sites of transfix- weight of the body on the tarsals and ture (breaking the legs below the
ion.2,10,11 would produce searing pain.7 Further- knees), if performed, led to an
The major pathophysiologic effect more, flexion of the elbows would asphyxic death within minutes.11
of crucifixion, beyond the excruciate- cause rotation of the wrists about the Death by crucifixion was, in ev-
ing pain, was a marked interference iron nails and cause fiery pain along ery sense of the word, excruciating
with normal respiration, particularly the damaged median nerves.7 Lifting (Latin, excruciatus, or “out of the
exhalation (Fig 6). The weight of the of the body would also painfully cross”).
body, pulling down on the out- scrape the scourged back against the
Crucifixion of Jesus
stretched arms and shoulders, would rough wooden stipes.2,7 Muscle cramps
tend to fix the intercostal muscles in and paresthesias of the outstretched After the scourging and the mock-
an inhalation state and thereby hin- and uplifted arms would add to the ing, at about 9 AM, the Roman soldiers
der passive exhalation.2,10,11 According- discomfort.7 As a result, each respire- put Jesus’ clothes back on him and
ly, exhalation was primarily dia- tory effort would become agonizing then led him and two thieves to be
phragmatic, and breathing was shal- and tiring and lead eventually to crucified.1 Jesus apparently was so
low. It is likely that this form of asphyxia.2,3,7,10 weakened by the severe flogging that
respiration would not suffice and that The actual cause of death by cruci- he could not carry the patibulum
hypercarbia would soon result. The fixion was multifactorial and varied from the Praetorium to the site of
onset of muscle cramps or tetanic somewhat with each case, but the two crucifixion one third of a mile (600 to
JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al 1461Aorta
Esophagus
LA
Right Lung RA Left Lung
LV
RV
MAYO
©1985
Right Sternum Left Pleural Cavity
Ventricular
Wall Pericardial
Perietal Cavity
Pericardium
Fig 7.—Spear wound to chest. Left, Probable path of spear. Right, Cross section of thorax, at level of plane
indicated at left, showing structures perforated by spear. LA indicates left atrium; LV, left ventricle; RA, right
atrium; RV, right ventricle.
650 m) away.1,3,5,7 Simon of Cyrene was taunted Jesus throughout the cruci- namely, the nature of the wound in his
summoned to carry Christ’s cross, fixion ordeal, and the soldiers side4,6 and the cause of his death
and the processional then made its cast lots for his clothing.1 Christ spoke after only several hours on the
way to Golgotha (or Calvary), an seven times from the cross.1 Since cross.13-17
established crucifixion site. speech occurs during exhalation, The gospel of John describes the
Here, Jesus’ clothes, except for a these short, terse utterances must piercing of Jesus’ side and emphasizes
linen loincloth, again were removed, have been particularly difficult and the sudden flow of blood and water.1
thereby probably reopening the painful. At about 3 PM that Friday, Some authors have interpreted the
scourging wounds. He then was Jesus cried out in a loud voice, bowed flow of water to be ascites12 or urine,
offered a drink of wine mixed with his head, and died.1 The Roman sol- from an abdominal midline perfora-
myrrh (gall) but, after tasting it, diers and onlookers recognized his tion of the bladder.15 However, the
refused the drink.1 Finally, Jesus and moment of death.1 Greek word (πλευρα, or pleura)32,35,36
the two thieves were crucified. Al- Since the Jews did not want the used by John clearly denoted later-
though scriptural references are bodies to remain on the crosses after ality and often implied the ribs.6,32,36
made to nails in the hands,1 these are sunset, the beginning of the Sabbath, Therefore, it seems probable that the
not at odds with the archaeological they asked Pontius Pilate to order wound was in the thorax and well
evidence of wrist wounds, since the crucifracture to hasten the deaths of away from the abdominal midline.
ancients customarily considered the the three crucified men.1 The soldiers Although the side of the wound was
wrist to be a part of the hand.7,11 The broke the legs of the two thieves, but not designated by John, it traditional-
titulus (Fig 3) was attached above when they came to Jesus and saw that ly has been depicted on the right
Jesus’ head. It is unclear whether he was already dead, they did not side.4 Supporting this tradition is the
Jesus was crucified on the Tau cross break his legs.1 Rather, one of the fact that a large flow of blood would
or the Latin cross; archaeological soldiers pierced his side, probably be more likely with a perforation of
findings favor the former11 and early with an infantry spear, and produced the distended and thin-walled right
tradition the latter.38 The fact that a sudden flow of blood and water.1 atrium or ventricle than the thick-
Jesus later was offered a drink of Later that day, Jesus’ body was taken walled and contracted left ventricle.
wine vinegar from a sponge placed on down from the cross and placed in a Although the side of the wound may
the stalk of the hyssop plant1 (approx- tomb.1 never be established with certainty,
imately 20 in, or 50 cm, long) strongly the right seems more probable than
DEATH OF JESUS
supports the belief that Jesus was the left.
crucified on the short cross.6 Two aspects of Jesus’ death have Some of the skepticism in accepting
The soldiers and the civilian crowd been the source of great controversy, John’s description has arisen from
1462 JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et althe difficulty in explaining, with med- cried out in a loud voice and then supports this interpretation. The ac-
ical accuracy, the flow of both blood bowed his head and died suggests the tual cause of Jesus’ death, like that of
and water. Part of this difficulty has possibility of a catastrophic terminal other crucified victims, may have
been based on the assumption that event. One popular explanation has been multifactorial and related pri-
the blood appeared first, then the been that Jesus died of cardiac rup- marily to hypovolemic shock, exhaus-
water. However, in the ancient Greek, ture. In the setting of the scourging tion asphyxia, and perhaps acute
the order of words generally denoted and crucifixions with associated hypo- heart failure.2,3,5-7,10,11 A fatal cardiac
prominence and not necessarily a volemia, hypoxemia, and perhaps an arrhythmia may have accounted for
time sequence.37 Therefore, it seems altered coagulable state, friable non- the apparent catastrophic terminal
likely that John was emphasizing the infective thrombotic vegetations event.
prominence of blood rather than its could have formed on the aortic or Thus, it remains unsettled whether
appearance preceding the water. mitral valve. These then could have Jesus died of cardiac rupture or of
Therefore, the water probably dislodged and embolized into the cor- cardiorespiratory failure. However,
represented serous pleural and pericardi- onary circulation and thereby pro- the important feature may be not
al fluid,5-7,11 and would have preceded duced an acute transmural myocar- how he died but rather whether he
the flow of blood and been smaller in dial infarction. Thrombotic valvular died. Clearly, the weight of historical
volume than the blood. Perhaps in the vegetations have been reported to and medical evidence indicates that
setting of hypovolemia and impend- develop under analogous acute trau- Jesus was dead before the wound to
ing acute heart failure, pleural and matic conditions.39 Rupture of the left his side was inflicted and supports
pericardial effusions may have devel- ventricular free wall may occur, the traditional view that the spear,
oped and would have added to the though uncommonly, in the first few thrust between his right ribs, proba-
volume of apparent water.5,11 The hours following infarction.40 bly perforated not only the right lung
blood, in contrast, may have origin- However, another explanation may but also the pericardium and heart and
nated from the right atrium or the be more likely. Jesus’ death may have thereby ensured his death (Fig 7).
right ventricle (Fig 7) or perhaps been hastened simply by his state of Accordingly, interpretations based on
from a hemopericardium.5,7,11 exhaustion and by the severity of the the assumption that Jesus did not die
Jesus’ death after only three to six scourging, with its resultant blood on the cross appear to be at odds with
hours on the cross surprised even loss and preshock state.7 The fact that modern medical knowledge.
Pontius Pilate.1 The fact that Jesus he could not carry his patibulum
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JAMA March 21, 1986—Vol 255, No. 11 Death of Christ—Edwards et al 1463You can also read
