In recent years, the crucifixion of Jesus Christ(as) has stimulated considerable interest. The inspiration received from the masterpiece of the Promised Messiah, Hadhrat Mirza Ghulam Ahmad(as), Jesus in India, stimulated this author to conduct an interdisciplinary investigation on the circumstances surrounding the crucifixion and to present a historical-cum-medical accurate account as to why Jesus Christ(as) went into a state of swoon and the circumstances that led to his recovery, and to explore the differential diagnosis of other clinical conditions put forward by doctors. There is a range of evidence on the process of crucifixion in literature. However, the credibility of any discussion will be determined primarily by the credibility of the source material. For this ‘theory’, the source material includes the extensive and detailed descriptions of the process of flogging and crucifixion found in the New Testament Gospels, and contemporary Christian and non-Christian authors. The interpretations of modern writers, based on the knowledge of science and medicine, may offer additional insight into this.
Jesus Christ(as) was arrested past midnight at Gethsemane and taken to the high priest where he was found guilty of blasphemy. Soon after daybreak he was blindfolded, spat on the face and struck on the face with fists. There is no mention of any blood loss nor does blood loss of any significance occur with such an assault. Further, it is reasonable to assume that Jesus Christ(as) was in good physical condition.
Scourging (Flogging) Practices
At the praetorium, Jesus Christ(as) was flogged – a preliminary to almost every Roman execution. The instrument was a short whip with several single or braided leather thongs of variable length, in which small iron balls or sharp pieces of sheep bones were tied at intervals.[4,7,8] The victim was stripped of his clothing, and his hands were tied to an upright post. He was then struck on the back with the whip encircling the side and part of the front of the chest. (see image below) The iron balls of the whips resulted in deep contusion, and sharp piece of sheep bones caused deep cuts into the skin and subcutaneous tissue.[4,7,8] The extent of blood loss may well have determined how long the victim would survive on the cross. In the case of Jesus Christ(as), scourging was mild and blood loss minimal. Also, the severity of scourging is not discussed in the four Gospel accounts and it is not known whether the number of lashes was limited to thirty nine, in accordance with the Jewish Law.
Survival length on the cross generally averaged three days (with a range of two to five days).[8,9] Jesus Christ(as) did not carry the crossbar from the flogging post to the site of crucifixion (as was customary for condemned men), one third of a mile (600 to 650 m) away.[3,4,7,8,9,13] At Golgotha, the crucifixion site, after twelve noon that Friday, Jesus Christ(as) cried out in a loud voice, bowed his head, and swooned.[3,15] He remained on the cross for only about two hours until the sixth hour on Friday, just before sunset, because the next day was the Sabbath and according to Jewish custom it was unlawful to keep anyone on the cross on the Sabbath, or the night previous. The soldiers broke the leg of the two thieves, but not that of Jesus Christ(as), as they mistook his being in a state of swoon for being dead. Instead, one of the soldiers pierced his chest, with an infantry spear, most probably into the pericardial cavity, producing a sudden flow of blood and water. After the dust storm and violent earthquake, many people had dispersed.[3,15] Christ(as) having been taken for dead, his body was handed over to Joseph of Arimathea.[3,15,8] Nicodemus, a very learned physician who knew the secrets of ‘Therapents’ – a term for therapeutics, saw the wound with blood and water flowing, which is not seen in the dead, and spoke in a low tone: ‘Dear friends, be of good cheer, and let us to work. Jesus is not dead. He seems so only because his strength is gone.’ Having carefully laid the body of Jesus Christ(as) on the ground, Nicodemus spread strong spices and healing salves, making out that he was doing so to keep the body from decaying. These spices and salves had great healing power and were used at that time. Both Joseph and Nicodemus ‘blew into him their own breath’ as if providing mouth-to-mouth artificial respiration. Nicodemus also ‘believed that it was not best to close up the wound in Jesus’ side, because he considered the flow of blood and water was helpful to respiration and beneficial in the renewing of life’. This is a well-known practice in patients with cardiac tamponade (bleeding within the pericardial cavity) where after aspiration with a wide bore needle the blood is allowed to drain to avoid recollection. At the suggestion of Pilate, Jesus Christ(as) was then placed in a nearby inconspicuous house, built like a tomb.
Medical Aspects of Crucifixion Of Jesus Christ(as)
Scourging of Jesus Christ(as)
The severity of scourging depended on the disposition of the lictors (Romans soldiers) and was intended to humiliate and weaken the victim. In the case of Jesus Christ(as), scourging was mild due to the seemingly favourable attitude of Pilate. The iron balls caused contusion and the sheep bones cut into the skin and subcutaneous tissues, thus the blood loss was minimal. The sharp pieces of sheep bones probably injured the pericardial sac resulting in slow accumulation of blood within the pericardial cavity. If the rate of blood accumulation had been fast, this would have most likely caused severe injury, as the faster rate would have interfered with the adequate functioning of the heart. The rate of blood accumulation may well have determined the time Jesus Christ(as) lapsed into a state of coma.
Crucifixion of Jesus Christ(as)
With the arms outstretched, the wrists were nailed to the cross. It has been shown that the ligaments and bones of the wrist can support the weight of the body but the palms cannot.[8,11,16,17] The nail in the wrist might pass between the bony elements and thereby produce no fractures, the likelihood of painful periosteal injury, i.e. injury to the outer layers of bones, which are rich in nerves and hence very sensitive to pain, wound seem great.[7,8,16] (see image below).
Most commonly, the feet were fixed to the front of the cross by means of an iron spike driven through the first or second intermetatarsal space, (space between the first and second toe), just distal to the tarsometatarsal joint.[4,8,9,16,17] Thus, crucifixion per se was a relatively bloodless procedure since no major arteries pass through the favoured anatomic sites of transfixion.[8,11,16] (see image below) .
The actual cause of death varied with each case. It mainly depended on the initial health of the victim including mental health, the duration on the cross, dehydration, excruciating pain, exhaustion, asphyxia (on account of prolonged interference of normal respiration), blood loss with hypovolaemia (excess blood loss), and crurifracture – the act of breaking someone’s legs so as to ease their pain by speeding along their death in crucifixion. Jesus Christ(as), he was in good health and in excellent mental state. He remained on the cross for a significantly short time with less exhaustion, dehydration and asphyxia. The blood loss was minimal both during scourging and crucifixion making the possibility of shock due to the loss of a large volume of blood unlikely. No bones were broken in order to hasten death. The injury to the chest with a spear can result in pleural effusion but the blood congeals in a dead man with poor flow with blood clots and pleural fluid. It is most probable that the infantry spear came to the rescue of Jesus Christ(as) when it pierced the pericardial cavity and revived the encaged heart as ‘blood and water gushed out’ (see image below). It is only in a beating heart of a living person that blood gushes out. Skepticism has arisen in explaining with medical accuracy, the flow of both blood and water. In ancient Greek, the order of words generally denoted prominence and not necessarily a time sequence. therefore; it seems likely that John was emphasising the prominence of blood following the injury with a spear.
A popular but medically unacceptable explanation has been that Jesus Christ(as) died of cardiac rupture. It is mentioned that in the setting of scourging and crucifixion, an altered coagulable state may have resulted in thrombotic vegetation over the aortic and mitral valves which could have embolised in the coronary circulation resulting in myocardial infarction, rupture and death,[19,20] meaning that blood becomes more prone to clotting, leading to a congealed mass of blood on the structures on the left side of the heart. These congealed masses may have broken off from the heart and gotten to the blood supply of the heart, resulting in the condition. This is a very naïve explanation that is hardly, if ever, seen in medical practice. The altered coagulable state (when blood congeals inside the body, rather than readily flowing) is uncommon with scourging or crucifixion. When it does develop, it takes many hours, and presents primarily as bleeding from the wound. The patient usually dies of blood loss over the next few days. These detached broken off clots mainly block the small arteries such as kidneys. The small arteries of the heart are seldom involved but if the small arteries are ever involved, myocardial infarction is extremely unlikely as the main coronary arteries are spared. If ever a heart attack does occur, rupture of the infracted segment (deadened part of the heart), usually takes five to seven days. Thus, the explanation does not find cardiological acceptance. Another explanation put forward is the state of exhaustion on account of scourging, blood loss and pre-shock state. The fact that Jesus Christ(as) did not carry his crossbar is given in support of this interpretation. However, one should not forget the compassionate attitude of Pilate who never wanted Jesus(as) to be crucified in the first place. In the case of Jesus Christ(as), scourging was mild and no mention is given in the four Gospel account. The above explanation thus, is untenable. It has been postulated that perhaps Jesus Christ(as) died of acute heart failure with terminal fatal cardiac arrhythmia, i.e. serious problems with the rhythm of the heart.[4,6-8,11,13,16] This explanation in a man like Jesus Christ(as) without previous history of any medical ailment makes the above diagnosis unlikely. Jesus Christ(as) has been described by some to have suffered from an extremely rare medical disorder of bloody sweat (heamatidrosis). This may have occurred in highly emotional state in which he was in and could have resulted in hypervolemia (loss of blood volume) contributing to his death. It is rather odd to think of such rare disorder in a healthy man with a loss of a substantial volume of blood in sweat on a cold night of early April. Also it is very unlikely that a noble Prophet of God would have succumbed under emotional stress.
Thus, with knowledge of both anatomy and ancient crucifixion practices, it is not difficult to reconstruct the probable medical aspects of crucifixion from a cardiologist’s perspective. It is extremely likely that Jesus Christ(as) sustained an injury to the pericardium during the process of scourging. The sharp pieces of sheep bones in the whip caused deep cuts in the pericardium. This resulted in accumulation of blood in the pericardial cavity. While on the cross, the process of blood accumulation continued. This resulted in cardiac tamponade with hemodynamic disturbance, a condition that caused the heart to struggle, as it was unable to pump blood against free blood in the coverings of the heart, leading to low blood pressure and pulse. In such a predicament, the cardiac output dropped and the brain was deprived of oxygen. It was most likely at this critical stage of hemodynamic disturbance, i.e. low blood pressure and heart rate that Jesus Christ(as) cried out in a loud voice, bowed his head and became unconscious. The piercing of the spear in the chest aimed at the heart created a rent in the outer layer of the pericardium. This resulted in decompression of the heart ‘as blood and water gushed out.’ The increase in cardiac output as the heart was decompressed resulted in improvement of oxygen to the brain. The arrival of Joseph of Arimethia and Nicodemus, an experienced physician, further lend support that Jesus(as) survived the ordeal of crucifixion. The application of strong spices and salves at this stage was essential to prevent the wounds from infection and relief of pain. They probably employed artificial respiration when they ‘blew into him their own breath’ after Jesus(as) was brought down from the cross. Also, the wound of the spear was left open to drain, as ‘Nicodemus believed that it was best not to close up the wound in Jesus’(as) side because he considered that flow of blood and water from there was helpful to respiration in the renewing of life.’ This practice is well known amongst cardiologists to prevent reaccumulation of blood in the pericardial cavity. Clearly, the weight of historical and medical evidence indicates that Jesus Christ(as) did not die on the Cross but was delivered alive and then treated.
Professor M M H Nuri MBBS, FCPS, MRCP, FACC is Chief Executive and Chief Cardiologist of Tahir Heart Institute (THI) Rabwah Pakistan. THI is a state of the art, not-for-profit, partly charitable, heart hospital in the most impoverished region of Punjab, Pakistan.
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