Crucifixion from a Medical Standpoint

Good Friday is often a time in which people reflect on the Passion of Christ.  As a physician, the effects on the body from crucifixion are particularly insightful.  A look into the medical aspects of crucifixion will hopefully be interesting to all and give further understanding of the agony and suffering endured by Jesus of Nazareth.

Crucifixion was a widespread punishment in the ancient world predominantly for those individuals who were deemed a threat to peace.   This form of torture and execution was first described by the Persians in the 6th century BC and continued until the 4th century AD when it was banned by Emperor Constantine the Great of Rome, who was the first Christian emperor, in reverence to Jesus Christ.  It was perfected by the Romans and carried out against individuals who were not considered members of society.  The most detailed account of anyone’s crucifixion is that of the death of Jesus of Nazareth from biblical passages, so reference to this account of the Passion of Christ is necessarily included in this discussion. 

Some consider the beginning of the Passion as the Garden of Gethsemane, where some interpret Luke 22:44, that Jesus sweated blood.  KJV states, “. . . his sweat was as it were great drops of blood falling down to the ground.”  Although it does not specifically state that Jesus sweated blood, there is a rare condition called hematohidrosis where this happens.  It is caused by bleeding into sweat glands. 

After his arrest, he was subjected to multiple beatings (including blows to his head while blindfolded), mocking, and humiliations.  The psychological effect of this on top of the false trials should not be underemphasized.  Although presuming Jesus was in good physical condition, with this and being walked to and from Herod’s, he was likely exhausted, bruised, and beginning to get dehydrated even before the flogging.

Crucifixion under Roman authority usually began with flogging.  Flogging involved a flagrum, which was a short-handled whip with multiple leather thongs to which here attached small pieces of bone and metal balls.  Designed to catch and tear flesh, this was usually performed on the bareback and legs of the victim.  Sometimes resulting in the exposure of the underlying bone and leaving long ribbons of bleeding flesh hanging.  The result was further bleeding and blood loss.  Jewish law limited their floggings to 40 lashes.  The Pharisees, being legalistic, limited their lashes to 39, so they would not be guilty of breaking the law if they miscounted.  Romans had no limitation, and the biblical account suggests the scourging of Jesus was particularly severe. 

After the scourging, Jesus was made to stand and dressed in a robe, which would act as a dressing and help stop the bleeding.  He was further mocked and crowned with a band of twisted thorny twigs and struck on the head.  The face and scalp have a great blood supply and when cut or punctured, bleed profusely.  After this, the robe was torn off Jesus’ back, causing pain and the wounds on his back to re-open.  This further would further weaken Jesus from blood loss and dehydration.

Following this the victim was given the cross, or a portion of it, to carry to the site of the crucifixion. This was frequently the patibulum, or cross-arm of the cross, and could weigh between 75 and 125 pounds, depending on the size and wood.  The rough wood beam was carried on his back, still raw and bleeding from the flogging.  It is estimated Jesus carried His cross approximately 600 yards before Simon carried the cross the final way.

Jesus arrived at Golgotha for crucifixion.  He has already been beaten, mocked, falsely accused; tried, flogged, and was physically exhausted.  He likely has not slept, had anything to eat or drink since the Last Supper, was dehydrated, suffering from stages of hypovolemic shock (shock from blood loss), physically in pain from the beatings and flogging.  Any one of these events would be trauma enough but taken together are incomprehensible.  Interestingly, artistic paintings and renderings of Jesus at crucifixion fail to show his actual physical state.  Isaiah 52:14 prophesized, “Just as many were astonished at you, So His visage was marred more than any man, And His form more than the sons of men.”

Also contrary to artistic representations of Jesus’ crucifixion, the heavy square iron spikes (about 6 inches long and between ¼ and ½ inch wide) were likely driven between the radius and ulna bones of the forearm, rather than the hands which would not support the weight of the body.  This location on the wrist where the spikes were driven would traumatize the median nerve, and cause searing pain and paralysis of the hand.  The victim was then raised and the patibulum (cross beam) was attached to the stipes (base of the cross often buried to provide support for the cross).  The result is that within a few minutes, the weight of the body on the joints of the upper extremity would cause dislocation of the shoulders and elbows, extending the length of each arm 6-9 inches. In addition to this, the open wounds from the scourging of the back rubbing against the rough wood of the stipes, from even the simple act of breathing, would be painful and contribute to further bleeding.

The feet were then positioned flat over each other against the stipes a bend of each knee approximating 90 degrees to drive the spike through the arch of each foot.  Alternatively, the feet could be fixed to the side of the stipes with nails through the ankles or on top of a footrest in front of the stipes.  The awkward positioning of the legs would result in the victim supporting the weight of his body with the thigh muscles.  The difficulty of this can be experienced by trying to stand with bent legs and no other support. 

Looking at the physiologic effect of crucifixion, hemorrhagic shock caused by blood loss from the beatings and scourging would result in a rapid heart rate to try to maintain the circulation of the remaining blood to vital organs.  This would increase the demand on the heart muscle.  The position of the body and the dislocation of the arms would transfer considerable weight to the chest wall.  The result would be to trap air in the lungs during inhalation and make it difficult to exhale.  The victim would have to pull up against the nailed arms and push up against the nailed feet, raking the scourged back against the rough timber, just to raise themselves up to exhale.  Over time there would be a decrease in oxygen intake and a buildup of carbon dioxide.  The physiologic consequences of this would be a further strain on the heart to beat faster, and the chest cavity filling up with fluid around the heart and lungs causing them to collapse which further compromises oxygen intake and delivery.  The heart begins to fail with further accumulation of fluid around the lungs and heart. 

The actual cause of death would be multifactorial and would vary with each individual depending on the health of the victim.  Exhaustive asphyxia (suffocation) and hypovolemic shock (shock due to blood loss) would be the leading causes.  Contributing factors include stress-induced arrhythmias (abnormal and potentially fatal heart rhythms), congestive heart failure, and fluid around the heart and lungs constricting their movement.  The practice of breaking the legs below the knees (crucifracture) was performed to hasten the death by preventing the victim from pushing up to breathe.  This could also potentially result in a type of pulmonary embolism (clot or obstruction of arteries in the lung). 

Concerning the crucifixion of Jesus, some have suggested that he was not dead at all, citing the relatively short time on the cross and the events of the resurrection after.  The purpose of this article is not to debate the resurrection of Jesus Christ, but to look at the medical aspects.  With that said, the victims who were crucified had committed capital crimes, and were crucified until dead.  The Roman Centurions responsible were battle-hardened soldiers well acquainted with death, and quite able to recognize it.  They were responsible for carrying out the execution.  Failure to do so would result in their own punishment and even death.  The Roman soldier who saw that Jesus was dead pierced his right side with a spear.  This location where the spear was inserted was a target known from the soldiers training to be a fatal blow resulting in the rapid death of their enemies.  The weapon would pierce the heart and lungs.  The account in John 19:34 of this during Jesus’ crucifixion reports that blood and water flowed out from the wound.  This is likely the blood left in the heart and the fluid around the heart and lungs which would appear clear like water.

The torture and agony of crucifixion are unimaginable.  In fact, it is frequently described as excruciating.  The word excruciate is derived from Latin.  “Ex-” meaning “out of, from” and “crux” meaning cross.  Quite literally it means from the cross, referring to “torture, torment, inflict very severe pain on, as if by crucifying.”  From a medical standpoint, the Gospel’s description of the torture and death of Jesus Christ is credible and offers evidence of  both the authenticity of the account and accuracy of the physiologic process of crucifixion

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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