On the Physical Death of Jesus Christ

William D. Edwards, MD; Wesley J. Gabel, MDiv; Floyd E. Hosmer, MS, AMI

(in "JAMA", Journal of the American Medical Association, Vol. 255, n. 11, March 21, 1986, pp. 1455-1463)

pp. 1461-1463

Crucifixion of Jesus

After the scourging and the mocking, at about 9 AM, the Roman soldiers put Jesus’ clothes back on him and then led him and two thieves to be crucified. Jesus apparently was so weakened by the severe flogging that he could not carry the patibulum from the Praetorium to the site of crucifixion one third of a mile (600 to 650 m) away. Simon of Cyrene was summoned to carry Christ’s cross, and the processional then made its way to Golgotha (or Calvary), an established crucifixion site.

Here, Jesus’ clothes, except for a linen loincloth, again were removed, thereby probably reopening the scourging wounds. He then was offered a drink of wine mixed with myrrh (gall) but, after tasting it, refused the drink. Finally, Jesus and the two thieves were crucified. Although scriptural references are made to nails in the hands, these are not at odds with the archaeological evidence of wrist wounds, since the ancients customarily considered the wrist to be a part of the hand. The titulus (Fig 3) was attached above Jesus’ head. It is unclear whether Jesus was crucified on the Tau cross or the Latin cross; archaeological findings favor the former and early tradition the latter. The fact that Jesus later was offered a drink of wine vinegar from a sponge placed on the stalk of the hyssop plant (approximately 20 in, or 50 cm, long) strongly supports the belief that Jesus was crucified on the short cross.

The soldiers and the civilian crowd taunted Jesus throughout the crucifixion ordeal, and the soldiers cast lots for his clothing. Christ spoke seven times from the cross. Since speech occurs during exhalation, these short, terse utterances must have been particularly difficult and painful. At about 3 PM that Friday, Jesus cried out in a loud voice, bowed his head, and died. The Roman soldiers and onlookers recognized his moment of death.

Since the Jews did not want the bodies to remain on the crosses after sunset, the beginning of the Sabbath, they asked Pontius Pilate to order crucifracture to hasten the deaths of the three crucified men. The soldiers broke the legs of the two thieves, but when they came to Jesus and saw that he was already dead, they did not break his legs. Rather, one of the soldiers pierced his side, probably with an infantry spear, and produced a sudden flow of blood and water. Later that day, Jesus’ body was taken down from the cross and placed in a tomb.

DEATH OF JESUS

Two aspects of Jesus’ death have been the source of great controversy, namely, the nature of the wound in his side and the cause of his death after only several hours on the cross.

The gospel of John describes the piercing of Jesus’ side and emphasizes the sudden flow of blood and water. Some authors have interpreted the flow of water to be ascites or urine, from an abdominal midline perforation of the bladder. However, the Greek word (πλευρα, or pleura) used by John clearly denoted laterality and often implied the ribs. Therefore, it seems probable that the wound was in the thorax and well away from the abdominal midline.

Although the side of the wound was not designated by John, it traditionally has been depicted on the right side. Supporting this tradition is the fact that a large flow of blood would be more likely with a perforation of the distended and thin-walled right atrium or ventricle than the thick-walled and contracted left ventricle. Although the side of the wound may never be established with certainty, the right seems more probable than the left.

Some of the skepticism in accepting John’s description has arisen from the difficulty in explaining, with medical accuracy, the flow of both blood and water. Part of this difficulty has been based on the assumption that the blood appeared first, then the water. However, in the ancient Greek, the order of words generally denoted prominence and not necessarily a time sequence. Therefore, it seems likely that John was emphasizing the prominence of blood rather than its appearance preceding the water.

Therefore, the water probably represented serous pleural and pericardial fluid, and would have preceded the flow of blood and been smaller in volume than the blood. Perhaps in the setting of hypovolemia and impending acute heart failure, pleural and pericardial effusions may have developed and would have added to the volume of apparent water. The blood, in contrast, may have originnated from the right atrium or the right ventricle (Fig 7) or perhaps from a hemopericardium.

Jesus’ death after only three to six hours on the cross surprised even Pontius Pilate. The fact that Jesus cried out in a loud voice and then bowed his head and died suggests the possibility of a catastrophic terminal event. One popular explanation has been that Jesus died of cardiac rupture. In the setting of the scourging and crucifixions with associated hypovolemia, hypoxemia, and perhaps an altered coagulable state, friable non-infective thrombotic vegetations could have formed on the aortic or mitral valve. These then could have dislodged and embolized into the coronary circulation and thereby produced an acute transmural myocardial infarction. Thrombotic valvular vegetations have been reported to develop under analogous acute traumatic conditions. Rupture of the left ventricular free wall may occur, though uncommonly, in the first few hours following infarction.

However, another explanation may be more likely. Jesus’ death may have been hastened simply by his state of exhaustion and by the severity of the scourging, with its resultant blood loss and preshock state. The fact that he could not carry his patibulum supports this interpretation. The actual cause of Jesus’ death, like that of other crucified victims, may have been multifactorial and related primarily to hypovolemic shock, exhaustion asphyxia, and perhaps acute heart failure. A fatal cardiac arrhythmia may have accounted for the apparent catastrophic terminal event.

Thus, it remains unsettled whether Jesus died of cardiac rupture or of cardiorespiratory failure. However, the important feature may be not how he died but rather whether he died. Clearly, the weight of historical and medical evidence indicates that Jesus was dead before the wound to his side was inflicted and supports the traditional view that the spear, thrust between his right ribs, probably perforated not only the right lung but also the pericardium and heart and thereby ensured his death (Fig 7). Accordingly, interpretations based on the assumption that Jesus did not die on the cross appear to be at odds with modern medical knowledge.

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