jama_255_11_025

7/31/2019 jama_255_11_025

1/9

On the Physical Death of Jesus ChristWilliam 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 deepstripelike lacerations and appreciable blood loss, and it probably set thestage for hypovolemic shock, as evidenced by the fact that Jesus was tooweakened to carry the crossbar (patibulum) to Golgotha. At the site ofcrucifixion, his wrists were nailed to the patibulum and, after the patibulumwas lifted onto the upright post (stipes), his feet were nailed to the stipes.The major pathophysiologic effect of crucifixion was an interference withnormal respirations. Accordingly, death resulted primarily from hypovolemic

shock and exhaustion asphyxia. Jesus' death was ensured by the thrust of asoldier's spear into his side. Modern medical interpretation of the historicalevidence indicates that Jesus was dead when taken down from the cross.

(JAMA 1986;255:1455-1463)

THE LIFE and teachings of Jesus ofNazareth have formed the basis for amajor world religion (Christianity),have appreciably influenced thecourse of human history, and, byvirtue of a compassionate attitudetoward the sick, also have contributedto the

developmentof modern medi

cine. The eminence of Jesus as ahistorical figure and the sufferingand controversy associated with hisdeath have stimulated us to investigate, in an interdisciplinary manner,the circumstances surrounding hiscrucifixion. Accordingly, it is ourintent to present not a theologicaltreatise but rather a medically andhistorically accurate account of thephysical death of the one called JesusChrist.

SOURCES

The source material concerningChrist's death comprises a body ofliterature and not a physical body orits skeletal remains. Accordingly, the

credibility of any discussion of Jesus'death will be determined primarily bythe credibility of one's sources. Forthis review, the source materialincludes the writings of ancientChristian and non-Christian authors,the writings of modern authors, andthe Shroud of Turin.'40

Usingthe

legal-historical method of scientificinvestigation," scholars have established the reliability and accuracy ofthe ancient manuscripts.2622,293'

The most extensive and detaileddescriptions of the life and death ofJesus are to be found in the NewTestament gospels of Matthew, Mark,Luke, and John.' The other 23 booksof the New Testament support but donot expand on the details recorded inthe gospels. Contemporary Christian,Jewish, and Roman authors provide

additional insight concerning thefirst-century Jewish and Roman legalsystems and the details of scourgingand crucifixion.5 Seneca, Livy, Plutarch, and others refer to crucifixionpractices in their works.828 Specifically, Jesus (or his crucifixion) is mentioned by the Roman historians Cornelius Tacitus, Pliny the Younger,and Suetonius, by non-Roman historians Thallus and Phlegon, by the satirist Lucian of Samosata, by the Jewish

Talmud, and by the Jewish historianFlavius Josephus, although the authenticity of portions of the latter isproblematic.26

The Shroud of Turin is consideredby many to represent the actual burial cloth of Jesus,22 and several publications concerning the medical aspects of his death draw conclusions

from this assumption."' The Shroudof Turin and recent archaeologicalfindings provide valuable informationconcerning Roman crucifixion practices.2224 The interpretations of modern writers, based on a knowledge ofscience and medicine not available inthe first century, may offer additional insight concerning the possiblemechanisms of Jesus' death.2"17

When taken in concert, certainfactsthe extensive and early testimony of both Christian proponentsand

opponents,and their universal

acceptance of Jesus as a true historical figure; the ethic of the gospelwriters, and the shortness of the timeinterval between the events and theextant manuscripts; and the confirmation of the gospel accounts byhistorians and archaeological findings2627ensure a reliable testimonyfrom which a modern medical interpretation of Jesus' death may be made.

GETHSEMANE

After Jesus and his disciples had

observed the Passover meal in anupper room in a home in southwestJerusalem, they traveled to the Mountof Olives, northeast of the city (Fig 1).(Owing to various adjustments in thecalendar, the years of Jesus' birth anddeath remain controversial.2' However, it is likely that Jesus was bornin either 4 or 6 BC and died in 30AD."2'' During the Passover observance in 30 AD, the Last Supper wouldhave been observed on Thursday,

From the Departments of Pathology (Dr Edwards)and Medical Graphics (Mr Hosmer), Mayo Clinic,Rochester, Minn; and the Homestead United Meth-odist Church, Rochester, Minn, and the West BethelUnited Methodist Church, Bethel, Minn (PastorGabel).

Reprint requests to Department of Pathology,Mayo Clinic, Rochester, MN 55905 (Dr Edwards).

wnloaded From: http://jama.jamanetwork.com/ on 06/05/2012

7/31/2019 jama_255_11_025

2/9

To Sychem N. and Damascus t

o 500 1,000 1,500 Vi .^^^nv" n\ S'

''

I

'' ^Meters Jrpossib|e\ Frtress of \\

0 250 500 y/\ HT \ AntoniaSS v, Golgotha \,/ \\nX s' II x\/jj^AW-^^^i\ GethsemaneTo Joppa \\ y^ //^1| J^jFx.

^S./? Traditional l/>^>\lC@ 9^^^%.M"nt of olives^y/ Golgotha II

.

J T l\Il 111 \^ I^5^\\ i^7 ^ >JASuburtx\ VMa. T I VV~L==To Bethany

7/31/2019 jama_255_11_025

3/9

Fig 2.Scourging. Left, Short whip (flagrum) with lead balls and sheep bones tied into leather thongs. Centerleft, Naked victim tied to flogging post. Deep stripelike lacerations were usually associated with considerableblood loss. Center right, View from above, showing position of lictors. Right, Inferomedial direction of wounds.

Herod Antipas, the tetrarch of Ju-dea.' Herod likewise made no officialcharges and then returned Jesus toPilate (Fig 1).' Again, Pilate couldfind no basis for a

legal chargeagainst Jesus, but the people persistently demanded crucifixion. Pilatefinally granted their demand andhanded over Jesus to be flogged(scourged) and crucified. (McDowell25has reviewed the prevailing political,religious, and economic climates inJerusalem at the time of Jesus' death,and Bucklin5 has described the various illegalities of the Jewish andRoman trials.)

Health of Jesus

The rigors of Jesus' ministry (thatis, traveling by foot throughout Palestine) would have precluded anymajor physical illness or a weak general constitution. Accordingly, it isreasonable to assume that Jesus wasin good physical condition before hiswalk to Gethsemane. However, during the 12 hours between 9 pm Thursday and 9 am Friday, he had sufferedgreat emotional stress (as evidencedby hematidrosis), abandonment by

his closest friends (the disciples), anda physical beating (after the firstJewish trial). Also, in the setting of atraumatic and sleepless night, he hadbeen forced to walk more than 2.5miles (4.0 km) to and from the sites ofthe various trials (Fig 1). These physical and emotional factors may haverendered Jesus particularly vulnerable to the adverse hemodynamiceffects of the scourging.

SCOURGINGScourging Practices

Flogging was a legal preliminary toevery Roman execution,28 and onlywomen and Roman senators or soldiers (except in cases of desertion)were exempt." The usual instrumentwas a short whip (flagrum or flagel-lum) with several single or braidedleather thongs of variable lengths, inwhich small iron balls or sharp piecesof sheep bones were tied at intervals(Fig 2).-'" Occasionally, staves alsowere used.8'2 For scourging, the manwas stripped of his clothing, and hishands were tied to an upright post(Fig 2)." The back, buttocks, and legswere flogged either by two soldiers

(lictors) or by one who alternatedpositions.'7"28 The severity of thescourging depended on the dispositionof the lictors and was intended toweaken the victim to a state

justshort of collapse or death.8 After thescourging, the soldiers often tauntedtheir victim."

Medical Aspects of ScourgingAs the Roman soldiers repeatedly

struck the victim's back with fullforce, the iron balls would cause deepcontusions, and the leather thongsand sheep bones would cut into theskin and subcutaneous tissues.7 Then,as the flogging continued, the lacerations would tear into the underlying

skeletal muscles and produce quivering ribbons of bleeding flesh.272' Painand blood loss generally set the stagefor circulatory shock.'2 The extent ofblood loss may well have determinedhow long the victim would survive onthe cross."

Scourging of JesusAt the Praetorium, Jesus was

severely whipped. (Although the severity of the scourging is not dis-


7/31/2019 jama_255_11_025

4/9

Fig 3.Cross and titulus. Left, Victim carrying crossbar (patibulum) to site of upright post (stipes). Center, LowTau cross (crux commlssa), commonly used by Romans at time of Christ. Upper right, Rendition of Jesus' titulus,with name and crimeJesus of Nazareth, King of the Jewswritten in Hebrew, Latin, and Greek. Lower right,Possible methods for attaching titulus to Tau cross (left) and Latin cross (right).

Variations in CrossesUsed for Crucifixion

Latin

Designation CharacteristicsInfelix lignum

Crux simplex,crux acuta

Crux compositaCrux humilisCrux sublimisCrux commissaCrux immissa

Crux capitata

Crux decussata

Tree

Upright post

Stipes and patibulumLow crossTall crossT-shaped (Tau) cross

t-shaped (Latin)cross

t-shaped (Latin)cross

X-shaped cross

cussed in the four gospel accounts, itis implied in one of the epistles [1Peter 2:24]. A detailed word study of

the ancient Greek text for this verseindicates that the scourging of Jesuswas particularly harsh.33) It is notknown whether the number of lasheswas limited to 39, in accordance withJewish law.5 The Roman soldiers,amused that this weakened man hadclaimed to be a king, began to mockhim by placing a robe on his shoulders, a crown of thorns on his head,and a wooden staff as a scepter in hisright hand.' Next, they spat on Jesus

and struck him on the head with thewooden staff.' Moreover, when thesoldiers tore the robe from Jesus'back, they probably reopened thescourging wounds.7

Thesevere

scourging, with itsintense pain and appreciable bloodloss, most probably left Jesus in apreshock state. Moreover, hematidrosis had rendered his skin particularlytender. The physical and mentalabuse meted out by the Jews and theRomans, as well as the lack of food,water, and sleep, also contributed tohis generally weakened state. Therefore, even before the actual crucifixion, Jesus' physical condition was atleast serious and possibly critical.

CRUCIFIXIONCrucifixion Practices

Crucifixion probably first beganamong the Persians.34 Alexander theGreat introduced the practice toEgypt and Carthage, and the Romansappear to have learned of it from theCarthaginians." Although the Romans did not invent crucifixion, theyperfected it as a form of torture andcapital punishment that was designedto produce a slow death with maxi-

mum pain and suffering.""7 It was oneof the most disgraceful and cruelmethods of execution and usually wasreserved only for slaves, foreigners,revolutionaries, and the vilest of

criminals.32528Roman law

usually protected Roman citizens from crucifixion,5 except perhaps in the case ofdesertion by soldiers.

In its earliest form in Persia, thevictim was either tied to a tree or wastied to or impaled on an upright post,usually to keep the guilty victim's feetfrom touching holy ground.8"3034'38Only later was a true cross used; itwas characterized by an upright post(stipes) and a horizontal crossbar(patibulum), and it had several variations (Table)." Although archaeological and historical evidence stronglyindicates that the low Tau cross waspreferred by the Romans in Palestineat the time of Christ (Fig 3),27"crucifixion practices often varied in agiven geographic region and in accordance with the imagination of theexecutioners, and the Latin cross andother forms also may have beenused.28

It was customary for the condemned man to carry his own cross


7/31/2019 jama_255_11_025

5/9

Fig 4.

Nailing of wrists. Left, Size of iron nail. Center, Location of nail in wrist, between carpis and radius. Right, Crosssection of wrist, at level of plane indicated at left, showing path of nail, with probable transectlon of median nerve andimpalement of flexor pollicis longus, but without injury to major arterial trunks and without fractures of bones.

from the flogging post to the site ofcrucifixion outside the city walls.8"'30He was usually naked, unless this wasprohibited by local customs." Since

the weight of the entire cross wasprobably well over 300 lb (136 kg),only the crossbar was carried (Fig3)." The patibulum, weighing 75 to125 lb (34 to 57 kg),"30 was placedacross the nape of the victim's neckand balanced along both shoulders.Usually, the outstretched arms thenwere tied to the crossbar.7" The processional to the site of crucifixion wasled by a complete Roman militaryguard, headed by a centurion.3" Oneof the soldiers carried a sign (titulus)on which the condemned man's name

and crime were displayed (Fig 3).3"Later, the titulus would be attachedto the top of the cross." The Romanguard would not leave the victim untilthey were sure of his death.'"

Outside the city walls was permanently located the heavy uprightwooden stipes, on which the patibulum would be secured. In the case ofthe Tau cross, this was accomplishedby means of a mortise and tenon

joint, with or without reinforcement

by ropes.10"30 To prolong the crucifixion process, a horizontal wooden blockor plank, serving as a crude seat(sedile or sedulum), often was at

tached midway down the stipes.3"16Only very rarely, and probably laterthan the time of Christ, was anadditional block (suppedaneum) employed for transfixion of the feet."'

At the site of execution, by law, thevictim was given a bitter drink ofwine mixed with myrrh (gall) as amild analgesic.717 The criminal wasthen thrown to the ground on hisback, with his arms outstretchedalong the patibulum." The handscould be nailed or tied to the crossbar,but nailing apparently was preferredby the Romans.8" The archaeologicalremains of a crucified body, found inan ossuary near Jerusalem and datingfrom the time of Christ, indicate thatthe nails were tapered iron spikesapproximately 5 to 7 in (13 to 18 cm)long with a square shaft % in (1 cm)across.232430 Furthermore, ossuaryfindings and the Shroud of Turinhave documented that the nails commonly were driven through the wristsrather than the palms (Fig 4).222430

After both arms were fixed to thecrossbar, the patibulum and the victim, together, were lifted onto thestipes." On the low cross, four sol

diers could accomplish this relativelyeasily. However, on the tall cross, thesoldiers used either wooden forks orladders."

Next, the feet were fixed to thecross, either by nails or ropes. Ossuary findings and the Shroud of Turinsuggest that nailing was the preferred Roman practice.23243" Althoughthe feet could be fixed to the sides ofthe stipes or to a wooden footrest(suppedaneum), they usually werenailed directly to the front of thestipes (Fig 5)." To accomplish this,flexion of the knees may have beenquite prominent, and the bent legsmay have been rotated laterally (Fig

23-25.30

When the nailing was completed,the titulus was attached to the cross,by nails or cords, just above thevictim's head." The soldiers and thecivilian crowd often taunted and

jeered the condemned man, and thesoldiers customarily divided up hisclothes among themselves."25 The

6)


7/31/2019 jama_255_11_025

6/9

Fig 5.Nailing of feet. Left, Position of feet atop one another and against stipes. Upper right,Location of nail in second intermetatarsal space. Lower right, Cross section of foot, at planeindicated at left, showing path of nail.

length of survival generally rangedfrom three or four hours to three orfour days and appears to have beeninversely related to the severity of thescourging.8" However, even if thescourging had been relatively mild,the Roman soldiers could hasten

death by breaking the legs below theknees (crurifragium or skelokopia).8 "

Not uncommonly, insects wouldlight upon or burrow into the openwounds or the eyes, ears, and nose ofthe dying and helpless victim, andbirds of prey would tear at thesesites." Moreover, it was customary toleave the corpse on the cross to bedevoured by predatory animals.8"1228However, by Roman law, the familyof the condemned could take the body

for burial, after obtaining permissionfrom the Roman judge."

Since no one was intended to survive crucifixion, the body was notreleased to the family until the soldiers were sure that the victim wasdead. By custom, one of the Roman

guards would pierce the body with asword or lance.8" Traditionally, thishad been considered a spear wound tothe heart through the right side ofthe chesta fatal wound probablytaught to most Roman soldiers." TheShroud of Turin documents this formof injury.5"22 Moreover, the standardinfantry spear, which was 5 to 6 ft(1.5 to 1.8 m) long,30 could easily havereached the chest of a man crucifiedon the customary low cross."

Medical Aspects of Crucifixion

With a knowledge of both anatomyand ancient crucifixion practices, onemay reconstruct the probable medicalaspects of this form of slow execution.Each wound apparently was intendedto produce intense agony, and thecontributing causes of death werenumerous.

The scourging prior to crucifixionserved to weaken the condemned manand, if blood loss was considerable, toproduce orthostatic hypotension andeven hypovolemic shock.812 When thevictim was thrown to the ground onhis back, in preparation for transfixion of the hands, his scourgingwounds most likely would becometorn open again and contaminatedwith dirt.2" Furthermore, with eachrespiration, the painful scourgingwounds would be scraped against therough wood of the stipes.7 As a result,blood loss from the back probablywould continue throughout the crucifixion ordeal.

With arms outstretched but nottaut, the wrists were nailed to thepatibulum.7" It has been shown thatthe ligaments and bones of the wristcan support the weight of a bodyhanging from them, but the palmscannot." Accordingly, the iron spikesprobably were driven between theradius and the carpis or between thetwo rows of carpal bones,210"30 either

proximal to or through the strongbandlike flexor retinaculum and thevarious intercarpal ligaments (Fig 4).Although a nail in either location inthe wrist might pass between thebony elements and thereby produceno fractures, the likelihood of painfulperiosteal injury would seem great.Furthermore, the driven nail wouldcrush or sever the rather large senso-rimotor median nerve (Fig 4).27" Thestimulated nerve would produce excruciating bolts of fiery pain in botharms.7' Although the severed mediannerve would result in paralysis of aportion of the hand, ischmie contractures and impalement of various ligaments by the iron spike might produce a clawlike grasp.

Most commonly, the feet were fixedto the front of the stipes by meansof an iron spike driven through thefirst or second intermetatarsal space,

just distal to the tarsometatarsaljoint.258"30 It is likely that the deepperoneal nerve and branches of the


7/31/2019 jama_255_11_025

7/9

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 elbowsflexed 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 armmuscles alone and soon would result in exhaustion asphyxia.

medial and lateralplantar

nerves

would have been injured by the nails(Fig 5). Although scourging may haveresulted in considerable blood loss,crucifixion per se was a relativelybloodless procedure, since no majorarteries, other than perhaps thedeep plantar arch, pass through thefavored anatomic sites of transfixion.210"

The major pathophysiologic effectof crucifixion, beyond the excruciating pain, was a marked interferencewith normal respiration, particularly

exhalation (Fig 6). The weight of thebody, pulling down on the outstretched arms and shoulders, wouldtend to fix the intercostal muscles inan inhalation state and thereby hinder passive exhalation.210" Accordingly, exhalation was primarily diaphragmatic, and breathing was shallow. It is likely that this form ofrespiration would not suffice and thathypercarbia would soon result. Theonset of muscle cramps or tetanic

contractions,due to

fatigueand

hypercarbia, would hinder respirationeven further."

Adequate exhalation required lifting the body by pushing up on the feetand by flexing the elbows and adduct-ing the shoulders (Fig 6).2 However,this maneuver would place the entireweight of the body on the tarsals andwould produce searing pain.7 Furthermore, flexion of the elbows wouldcause rotation of the wrists about theiron nails and cause fiery pain alongthe damaged median nerves.7 Lifting

of the body would also painfullyscrape the scourged back against therough wooden stipes.27 Muscle crampsand paresthesias of the outstretchedand uplifted arms would add to thediscomfort.7 As a result, each respiratory effort would become agonizingand tiring and lead eventually toasphyxia.23'7'10

The actual cause of death by crucifixion was multifactorial and variedsomewhat with each case, but the two

most

prominentcauses

probablywere

hypovolemic shock and exhaustionasphyxia.23710 Other possible contributing factors included dehydration,7"stress-induced arrhythmias,3 and congestive heart failure with the rapidaccumulation of pericardial and perhaps pleural effusions.27" Crucifrac-ture (breaking the legs below theknees), if performed, led to anasphyxie death within minutes."Death by crucifixion was, in every sense of the word, excruciating(Latin, excruciatus, or "out of the

cross").Crucifixion of Jesus

After the scourging and the mocking, at about 9 am, the Roman soldiersput Jesus' clothes back on him andthen led him and two thieves to becrucified.1 Jesus apparently was soweakened by the severe flogging thathe could not carry the patibulumfrom the Praetorium to the site ofcrucifixion one third of a mile (600 to


7/31/2019 jama_255_11_025

8/9

Fig 7.Spear wound to chest. Left, Probable path of spear. Right, Cross section of thorax, at level of planeindicated at left, showing structures perforated by spear. LA indicates left atrium; LV, left ventricle; RA, rightatrium; RV, right ventricle.

650 m) away.1'357 Simon of Cyrene wassummoned to carry Christ's cross,and the processional then made itsway to Golgotha (or Calvary), anestablished crucifixion site.

Here, Jesus' clothes, except for alinen loincloth, again were removed,thereby probably reopening thescourging wounds. He then wasoffered a drink of wine mixed withmyrrh (gall) but, after tasting it,refused the drink.' Finally, Jesus andthe two thieves were crucified. Although scriptural references aremade to nails in the hands,' these arenot at odds with the archaeologicalevidence of wrist wounds, since theancients customarily considered thewrist to be a part of the hand.7" Thetitulus (Fig 3) was attached above

Jesus' head. It is unclear whetherJesus was crucified on the Tau crossor the Latin cross; archaeologicalfindings favor the former" and earlytradition the latter.38 The fact thatJesus later was offered a drink ofwine vinegar from a sponge placed onthe stalk of the hyssop plant' (approximately 20 in, or 50 cm, long) stronglysupports the belief that Jesus wascrucified on the short cross."

The soldiers and the civilian crowd

taunted Jesus throughout the crucifixion ordeal, and the soldiers castlots for his clothing.' Christ spokeseven times from the cross.' Sincespeech occurs during exhalation,these short, terse utterances musthave been particularly difficult andpainful. At about 3 pm that Friday,Jesus cried out in a loud voice, bowedhis head, and died.' The Roman soldiers and onlookers recognized hismoment of death.'

Since the Jews did not want thebodies to remain on the crosses aftersunset, the beginning of the Sabbath,they asked Pontius Pilate to ordercrucifracture to hasten the deaths ofthe three crucified men.' The soldiersbroke the legs of the two thieves, butwhen they came to Jesus and saw that

he was already dead, they did notbreak his legs.' Rather, one of thesoldiers pierced his side, probablywith an infantry spear, and produceda sudden flow of blood and water.'Later that day, Jesus' body was takendown from the cross and placed in atomb.'

DEATH OF JESUS

Two aspects of Jesus' death havebeen the source of great controversy,

namely, the nature of the wound inhis side4" and the cause of his deathafter only several hours on thecross.'3'7

The gospel of John describes thepiercing of Jesus' side and emphasizesthe sudden flow of blood and water.'Some authors have interpreted theflow of water to be ascites'2 or urine,from an abdominal midline perforation of the bladder.15 However, theGreek word (irXevpcx, or pleura)323536used by John clearly denoted laterally and often implied the ribs.63236Therefore, it seems probable that thewound was in the thorax and wellaway from the abdominal midline.

Although the side of the wound wasnot designated by John, it traditionally has been depicted on the rightside.4 Supporting this tradition is thefact that a large flow of blood wouldbe more likely with a perforation ofthe distended and thin-walled rightatrium or ventricle than the thick-walled and contracted left ventricle.Although the side of the wound maynever be established with certainty,the right seems more probable thanthe left.

Some of the skepticism in acceptingJohn's description has arisen from


7/31/2019 jama_255_11_025

9/9

the difficulty in explaining, with medical accuracy, the flow of both bloodand water. Part of this difficulty hasbeen based on the assumption thatthe blood appeared first, then thewater. However, in the ancient Greek,the order of words generally denotedprominence and not necessarily atime sequence.1' Therefore, it seems

likelythat John was

emphasizingthe

prominence of blood rather than itsappearance preceding the water.

Therefore, the water probably represented serous pleural and pericardi-al fluid,'7" and would have precededthe flow of blood and been smaller involume than the blood. Perhaps in thesetting of hypovolemia and impending acute heart failure, pleural andpericardial effusions may have developed and would have added to thevolume of apparent water.5" Theblood, in contrast, may have origi

nated from the right atrium or theright ventricle (Fig 7) or perhapsfrom a hemopericardium.'7"

Jesus' death after only three to sixhours on the cross surprised evenPontius Pilate.' The fact that Jesus

cried out in a loud voice and thenbowed his head and died suggests thepossibility of a catastrophic terminalevent. One popular explanation hasbeen that Jesus died of cardiac rupture. In the setting of the scourgingand crucifixion, with associated hypo-volemia, hypoxemia, and perhaps analtered coagulable state, friable non-infective thrombotic

vegetationscould have formed on the aortic ormitral valve. These then could havedislodged and embolized into the coronary circulation and thereby produced an acute transmural myocar-dial infarction. Thrombotic valvularvegetations have been reported todevelop under analogous acute traumatic conditions." Rupture of the leftventricular free wall may occur,though uncommonly, in the first fewhours following infarction.4"

However, another explanation maybe more likely. Jesus' death may havebeen hastened simply by his state ofexhaustion and by the severity of thescourging, with its resultant bloodloss and preshock state.7 The fact thathe could not carry his patibulum

References

Supports this interpretation. The actual cause of Jesus' death, like that ofother crucified victims, may havebeen multifactorial and related primarily to hypovolemic shock, exhaustion asphyxia, and perhaps acuteheart failure.2'3'7'"" A fatal cardiacarrhythmia may have accounted forthe apparent catastrophic terminalevent.

Thus, it remains unsettled whetherJesus died of cardiac rupture or ofcardiorespiratory failure. However,the important feature may be nothow he died but rather whether hedied. Clearly, the weight of historicaland medical evidence indicates thatJesus was dead before the wound tohis side was inflicted and supportsthe traditional view that the spear,thrust between his right ribs, probably perforated not only the right lungbut also the pericardium and heart

and thereby ensured his death (Fig 7).Accordingly, interpretations based onthe assumption that Jesus did not dieon the cross appear to be at odds withmodern medical knowledge.

1. Matthew 26:17-27:61, Mark 14:12-15:47,Luke 22:7-23:56, John 13:1-19:42, in The HolyBible (New International Version). Grand Rap-ids, Mich, Zondervan Bible Publishers, 1978.

2. Lumpkin R: The physical suffering ofChrist. J Med Assoc Ala 1978;47:8-10,47.

3. Johnson CD: Medical and cardiologicalaspects of the passion and crucifixion of Jesus,the Christ. Bol Assoc Med PR 1978;70:97-102.

4. Barb AA: The wound in Christ's side. JWarburg Courtauld Inst 1971;34:320-321.

5. Bucklin R: The legal and medical aspects ofthe trial and death of Christ. Sci Law 1970;10:14-26.

6. Mikulicz-Radecki FV: The chest wound inthe crucified Christ. Med News 1966;14:30-40.

7. Davis CT: The crucifixion of Jesus: Thepassion of Christ from a medical point of view.Ariz Med 1965;22:183-187.

8. Tenney SM: On death by crucifixion. AmHeart J 1964;68:286-287.

9. Bloomquist ER: A doctor looks at crucifix-ion. Christian Herald, March 1964, pp 35, 46-48.

10. DePasquale NP, Burch GE: Death by cru-cifixion. Am Heart J 1963;66:434-435.

11. Barbet P: A Doctor atCalvary:

The Pas-sion of Our Lord Jesus Christ as Described by aSurgeon. Earl of Wicklow (trans). Garden City,NY, Doubleday Image Books, 1953, pp 12-18,37-147, 159-175, 187-208.

12. Primrose WB: A surgeon looks at thecrucifixion. Hibbert J, 1949, pp 382-388.

13. Bergsma S: Did Jesus die of a brokenheart? Calvin Forum 1948;14:163-167.

14. Whitaker JR: The physical cause of thedeath of our Lord. Cath Manchester Guard1937;15:83-91.

15. Clark CCP: What was the physical cause ofthe death of Jesus Christ? Med Rec 1890;38:543.

16. Cooper HC: The agony of death by cruci-fixion. NY Med J 1883;38:150-153.

17. Stroud W: Treatise on the Physical Cause

of the Death of Christ and Its Relation to thePrinciples and Practice of Christianity, ed 2.London, Hamilton & Adams, 1871, pp 28-156,489-494.

18. Allen AC: The Skin: A ClinicopathologicalTreatise, ed 2. New York, Grune & Stratton Inc,1967, pp 745-747.

19. Sutton RL Jr: Diseases of the Skin, ed 11.St Louis, CV Mosby Co, 1956, pp 1393-1394.20. Scott CT: A case of haematidrosis. Br Med

J 1918;1:532-533.21. Klauder JV: Stigmatization. Arch Derma-

tol Syphilol 1938;37:650-659.22. Weaver KF: The mystery of the shroud.

Natl Geogr 1980;157:730-753.23. Tzaferis V: Jewish tombs at and near

Giv'at ha-Mivtar, Jerusalem. Israel Explor J1970;20:18-32.

24. Haas N: Anthropological observations onthe skeletal remains from Giv'at ha-Mivtar.Israel Explor J 1970;20:38-59.

25. McDowell J: The Resurrection Factor. SanBernardino, Calif, Here's Life Publishers, 1981,pp 20-53, 75-103.

26. McDowell J: Evidence That Demands aVerdict: Historical Evidences

forthe Christian

Faith. San Bernardino, Calif, Here's Life Pub-lishers, 1979, pp 39-87, 141-263.

27. McDowell J: More Than a Carpenter.Wheaton, Ill, Tyndale House Publishers, 1977,pp 36-71, 89-100.

28. Hengel M: Crucifixion in the AncientWorld and the Folly of the Message of the Cross,Bowden J (trans). Philadelphia, Fortress Press,1977, pp 22-45, 86-90.

29. Ricciotti G: The Life of Christ, ZizzamiaAI (trans). Milwaukee, Bruce Publishing Co,1947, pp 29-57, 78-153, 161-167, 586-647.

30. Pfeiffer CF, Vos HF, Rea J (eds): WycliffeBible Encyclopedia. Chicago, Moody Press, 1975,pp 149-152, 404-405, 713-723, 1173-1174, 1520\x=req-\1523.

31. Greenleaf S: An Examination of the Testi-mony of the Four Evangelists by the Rules ofEvidence Administered in the Courts of Justice.Grand Rapids, Mich, Baker Book House, 1965,p 29.

32. Hatch E, Redpath HA: A Concordance tothe Septuagint and the Other Greek Versions ofthe Old Testament (Including the ApocryphalBooks). Graz, Austria, Akademische Druce UVerlagsanstalt, 1975, p 1142.

33. Wuest KS: Wuest Word Studies From theGreek New Testament for the English Reader.Grand Rapids, Mich, WB Eerdmans Publisher,1973, vol 1, p 280.

34. Friedrich G: Theological Dictionary of theNew Testament, Bremiley G (ed-trans). GrandRapids, Mich, WB Eerdmans Publisher, 1971, vol7, pp 572, 573, 632.

35. Arndt WF, Gingrich FW: A Greek-EnglishLexicon of the New Testament and Other EarlyChristian Literature. University of ChicagoPress, 1957, p 673.

36. Brown F, Driver SR, Briggs CA: A Hebrewand English Lexicon of the Old Testament Withan Appendix Containing the Biblical Aramaic.

Oxford, England,Clarendon

Press, 1953,pp

841,854.37. Robertson AT: A Grammar of the Greek

New Testament in Light of Historical Research.Nashville, Tenn, Broadman Press, 1931, pp 417\x=req-\427.

38. Jackson SM (ed): The New Schaff-HerzogEncyclopedia ofReligious Knowledge. New York,Funk & Wagnalls, 1909, pp 312-314.

39. Kim H-S, Suzuki M, Lie JT, et al: Nonbac-terial thrombotic endocarditis (NBTE) and dis-seminated intravascular coagulation (DIC): Au-topsy study of 36 patients. Arch Pathol Lab Med1977;101:65-68.

40. Becker AE, van Mantgem J-P: Cardiactamponade: A study of 50 hearts. Eur J Cardiol1975;3:349-358.

wnloadedFrom: http://jama jamanetwork com/on 06/05/2012

Documents

jama_255_11_025