(William D. Edwards, MD, Department of Pathology, Mayo Clinic, Rochester, MN; Wesley J. Gabel, MDiv, West Bethel United Methodist Church, Bethel, MN.; Floyd E Hosmer, MS, AMI, Dept of Medical Graphics, Mayo Clinic, Rochester, MN; Homestead United Methodist Church, Rochester, MN; review of article and excerpts from On The Physical Death of Jesus Christ, JAMA, March 21, 1986 – Vol 255, No. 11). (The medical terms in this article have been edited into layman’s terminology by: Carol R. Ritchie; TNCC, MSN, RN, CNOR.)
Flogging was a legal preliminary to every Roman execution, and only women and Roman senators or soldiers (except in cases of desertion) were exempt. The usual instrument was a short whip with several single or braided leather thongs of variable lengths, in which small iron balls or sharp pieces of sheep bones were tied at intervals. For scourging, the man was stripped of his clothing, and his hands were tied to an upright post. The back, buttocks, and legs were flogged either by two soldiers (lictors) or by one who alternated positions. The severity of the scourging depended on the disposition of the lictors and was intended to weaken the victim to a state just short of collapse or death. As the Roman soldiers repeatedly struck the victim’s back with full force, the iron balls would cause deep contusions, and the leather thongs and sheep bones would cut into the skin and subcutaneous tissues. Then, as the flogging continued, the lacerations would tear into the underlying skeletal muscles and produce quivering ribbons of bleeding flesh. Pain and blood loss generally set the stage for circulatory shock. The extent of blood loss may well have determined how long the victim would survive on the cross. After the scourging, the soldiers often taunted their victim.
Although the Romans did not invent crucifixion, they perfected it as a form of torture and capital punishment that was designed to produce a slow death with maximum pain and suffering. It was one of the most disgraceful and cruel methods of execution and usually was reserved only for slaves, foreigners, revolutionaries, and the vilest of criminals. Roman law usually protected Roman citizens from crucifixion, except perhaps in the case of desertion by soldiers.
(The cross) was characterized by an upright post and a horizontal crossbar, and it had several variations. It was customary for the condemned man to carry his own cross from the flogging post to the site of crucifixion outside the city walls. He was usually naked, unless this was prohibited by local customs. Since the weight of the entire cross was probably well over 300 lb. (136 kg), only the crossbar was carried. The crossbar, weighing 75 to 125 lb. (34 to 57 kg), was placed across the nape of the victim’s neck and balanced along both shoulders. Usually, the outstretched arms then were tied to the crossbar. The processional to the site of crucifixion was led by a complete Roman military guard, headed by a centurion. One of the soldiers carried a sign on which the condemned man’s name and crime were displayed. Later, the sign would be attached to the top of the cross. The Roman guard would not leave the victim until they were sure of his death.
Outside the city walls was permanently located the heavy upright wooden post, on which the crossbar would be secured. To prolong the crucifixion process, a horizontal wooden block or plank, serving as a crude seat, often was attached midway down the post.
At the site of execution, by law, the victim was given a bitter drink of wine mixed with myrrh (gall) as a mild pain reliever. The criminal was then thrown to the ground on his back, with his arms outstretched along the crossbar. The hands could be nailed or tied to the crossbar, but nailing apparently was preferred by the Romans. The nails were tapered iron spikes approximately 5 to 7 in (13 to 18 cm) long with a square shaft 3/8 in (1 cm) across. The nails commonly were driven through the wrists rather than the palms.
After both arms were fixed to the crossbar, the crossbar and the victim, together, were lifted onto the post. Next, the feet were fixed to the cross, either by nails or ropes. Nailing was the preferred Roman practice. Although the feet could be fixed to the sides of the post or to a wooden footrest, they usually were nailed directly to the front of the post. To accomplish this, flexion of the knees may have been quite prominent, and the bent legs may have been rotated outward.
When the nailing was completed, the sign was attached to the cross, by nails or cords, just above the victim’s head. The soldiers and the civilian crowd often taunted and jeered the condemned man, and the soldiers customarily divided up his clothes among themselves. The length of survival generally ranged from three or four hours to three or four days and appears to have been inversely related to the severity of the scourging. However, even if the scourging had been relatively mild, the Roman soldiers could hasten death by breaking the legs below the knees.
Not uncommonly, insects would light upon or burrow into the open wounds or the eyes, ears, and nose of the dying and helpless victim, and birds of prey would tear at these sites. Moreover, it was customary to leave the corpse on the cross to be devoured by predatory animals. However, by Roman law, the family of the condemned could take the body for burial, after obtaining permission from the Roman judge.
Since no one was intended to survive crucifixion, the body was not released to the family until the soldiers were sure that the victim was dead. By custom, one of the Roman guards would pierce the body with a sword or lance. Traditionally, this had been considered a spear wound to the heart through the right side of the chest—a fatal wound probably taught to most Roman soldiers. Moreover, the standard infantry spear, which was 5 to 6 ft (1.5 to 1.8 m) long could easily have reached the chest of a man crucified on the customary low cross.
Medical Aspects of Crucifixion
With a 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.
The scourging prior to crucifixion served to weaken the condemned man and, if blood loss was considerable, to produce conditions leading to a severe drop in blood pressure, fainting, and even organ failure. When the victim was thrown to the ground on his back, in preparation for transfixion of his hands, his scourging wounds most likely would become torn open again and contaminated with dirt. Furthermore, with each respiration, the painful scourging wounds would be scraped against the rough wood of the post. As a result, blood loss from the back probably would continue throughout the crucifixion ordeal.
It has been shown that the dense fibrous tissue connecting the bones together, and bones of the wrist, can support the weight of a body hanging from them, but the palms cannot. Accordingly, the iron spikes probably were driven between the radius, the heavier of the two forearm bones, and the carpals, the eight wrist bones. Another probability for placement of the spikes could be between the row of carpal bones nearest the radius, or through the strong fibrous band-like tissue that covers the carpals, which forms a tunnel for the various fibrous bands connecting the eight carpal bones. The nail driven at this location would crush or sever the rather large median nerve. This nerve provides sensation and movement, particularly to the 2nd and 3rd fingers. Damage to the median nerve results in a contracture or a claw-like deformity of the hand. The damaged nerve would also produce excruciating bolts of fiery pain in both arms.
It is likely that the deep peroneal nerve, extending to the front of the ankle, and branches of the medial and lateral plantar nerves, would have been injured by the nails driven through the feet. Although scourging may have resulted in considerable blood loss, crucifixion per se was a relatively bloodless procedure, since no major arteries, other than perhaps the deep plantar arch, a confluence of arteries in the foot, pass through the favored anatomic sites of transfixion.
The crucial effect of crucifixion, beyond the excruciating pain, was a marked interference with normal respiration, particularly exhalation. The weight of the body, pulling down on the outstretched arms and shoulders, would tend to fix the chest muscles used for breathing in an inhalation state and thereby hinder passive exhalation. Accordingly, exhalation would require using the abdominal muscles rather than the chest muscles, and breathing would be shallow. It is likely that this form of respiration would not suffice and that a high level of carbon dioxide in the bloodstream would soon result. The onset of muscle cramps or tetanic contractions, due to fatigue and the high levels of carbon dioxide in the blood, would hinder respiration even further.
Adequate exhalation required lifting the body by pushing up on the feet and by flexing the elbows and pulling the shoulders inward. However, this maneuver would place the entire weight of the body on the bones in the feet, and would produce searing pain. Furthermore, flexion, or bending of the elbows would cause rotation of the wrists about the iron nails and cause fiery pain along the damaged median nerves. Lifting of the body would also painfully scrape the scourged back against the rough wooden post. Muscle cramps and loss of feeling in both the outstretched and uplifted arms would add to the discomfort. As a result, each respiratory effort would become agonizing and tiring, further reducing the oxygen levels in the blood, and lead eventually to asphyxia.
The actual cause of death by crucifixion was multifactorial and varied somewhat with each case, but the two most prominent causes probably were shock from inadequate perfusion of critical organs due to blood loss and inadequate oxygen levels in the blood due to inability to breathe properly. Other possible contributing factors included dehydration, stress-induced arrhythmias of the heart, and congestive heart failure with the rapid accumulation of fluid around the heart and in lungs. Death by crucifixion was, in every sense of the word, excruciating (Latin, excruciatus, or "out of the cross").
Scourging of Jesus
At the Praetorium, Jesus was severely whipped. (Although the severity of the scourging is not discussed in the four Gospel accounts, it is implied in one of the epistles (1 Peter 2:24). A detailed word study of the ancient Greek text for this verse indicates that the scourging of Jesus was particularly harsh.) It is not known whether the number of lashes was limited to 39, in accordance with Jewish law. The Roman soldiers, amused that this weakened man had claimed to be a king, began to mock him by placing a robe on his shoulders, a crown of thorns on his head, and a wooden staff as a scepter in his right hand. Next, they spat on Jesus and struck him on the head with the wooden staff. Moreover, when the soldiers tore the robe from Jesus’ back, they probably reopened the scourging wounds.
The severe scourging, with its intense pain and appreciable blood loss, most probably left Jesus in a preshock state. Moreover, bleeding from the skin particularly from the capillaries around the sweat glands from severe stress had rendered his skin particularly tender. The physical and mental abuse meted out by the Jews and the Romans, as well as the lack of food, water, and sleep, also contributed to his generally weakened state. Therefore, even before the actual crucifixion, Jesus’ physical condition was at least serious and possibly critical.
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 fluid from the lining inside abdomen or urine, from an abdominal midline perforation of the bladder. However, the Greek word used by John (pleura) clearly denoted laterality and often implied the ribs. Therefore, it seems probable that the wound was in the chest 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 heart near 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. The water probably represented fluid draining from the tissues lining the lung and heart and would have preceded the flow of blood and been smaller in volume than the blood. Perhaps in the setting of low blood volume and impending acute heart failure, lung and heart tissue drainage due to cellular imbalances may have developed and would have added to the volume of apparent water. The blood, in contrast, may have originated from the right atrium or the right ventricle or perhaps from a collection of blood from the lining around the heart.
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.
The actual cause of Jesus’ death, like that of other crucified victims, may have been multifactorial and related primarily to shock from low blood volume, exhaustion asphyxia, and perhaps acute heart failure. A fatal cardiac arrhythmia may have accounted for the apparent catastrophic terminal event.
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.*
*Editor’s Note: From Scripture there is reason to believe that the spear that was thrust into Jesus side was the cause of His death. In the Gospel of John, the parallel account reads: “And so, when Jesus had received the vinegar, He said, ‘It is finished.’ And bowing His head, He yielded up His spirit. The Jews therefore, so that the bodies might not remain on the cross on the Sabbath, because it was apreparation day (for that Sabbath was a high day), requested of Pilate that their legs might be broken and the bodies be taken away. Then the soldiers came and broke the legs of the first one, and the legs of the other who was crucified with Him. But when they came to Jesus and saw that He was already dead, they did not break His legs; but one of the soldiers had pierced His side with a spear, and immediately blood and water had come out” (John 19:30-34).
The Greek verb enuzen enuzen is an aroist past tense verb of nusswnusso. Therefore, this aroist verb enuzen enuzen clearly indicates that the soldier had pierced Jesus’ side with the spear in the immediate past, that is just prior to the time that the other soldier came to break Jesus’ legs, but found that He was dead already.
When the missing part of Matthew 27:49 is restored, it is clear that the final cause of Jesus’ death was from the spear that the soldier had thrust into His side. This full verse reads: “But the rest said, ‘Let Him alone! Let us see if Elijah comes to save Him.’ Then another took a spear and thrust it into His side, and out came water and blood.”
The latter half of this verse, which includes the words “...Then another took a spear and out came water and blood,” has been omitted from the King James Version. However, some ancient manuscripts contain this part of the verse. The latter part of the verse is also found in other manuscripts that are designated by letter (L, T, Z) and by number (33, 49, 892 and 1241). Older translations which contain the complete verse are the Moffatt translation and the Fenton translation. Newer translations generally footnote this portion of Matthew 27:49 rather than including it in the text. The weight of evidence indicates that the latter half of the verse is an authentic part of the Greek text and should be included in translations of the New Testament. The veracity of this portion of Matthew 27:49 is substantiated by the records in John 19:34 and 20:27.