A Critical Review of the Medical Literature
Professor Amtul Razzaq Carmichael, UK
Crucifixion was designed to bring about a slow, painful and agonising death, and used as a punishment in ancient Rome, with its most famous victim being Jesus Christ (as). But what if it was medically plausible for Jesus (as) to have survived this gruelling ordeal?
In order to survive the events of crucifixion, firstly, Jesus (as) must have been taken to be dead by the Roman soldiers when he was taken down from the cross. Secondly, Jesus (as) would have needed to have been resuscitated back to life. Thirdly, someone must have seen Jesus (as) alive after the events of the crucifixion. We aim to address these important issues from a scientific perspective, by critically assessing the scientific evidence regarding premature diagnosis of death, detailing the practise of crucifixion, and then analysing medically plausible ways in which Jesus (as) could have been resuscitated after the trauma of crucifixion.
Is an Incorrect Diagnosis of Death Medically Plausible?
Is it even imaginable that experienced Roman soldiers, who had mastered the art of crucifixion, made a mistake in diagnosing the death of one of their most important victims? In other words, is it possible that someone who is actually alive could wrongly be declared dead? The medical literature clearly shows that such incidents are possible. For example, one highly publicised incident in 2020 from the United States involves a female patient who was diagnosed as dead after being seen by paramedics and first responders; however, she was discovered to be alive, with her eyes open, when workers at the funeral home unzipped her body bag. 
Historical records show plenty of cases of people being buried prematurely.  In the early 1900s, in response to some high profile cases of premature burial, including the narrow escape of a child found in Regent’s Park, London, a book entitled Premature Burial And How It May Be Prevented was published.  One of the authors, Dr. Vollum, was a medical inspector for the US Army, who had himself narrowly avoided interment after a near-drowning incident. 
Nor was this the only treatise on premature burial at the time: several years earlier, Dr. Franz Hartmann had also addressed this problem in Buried Alive: an Examination into the Occult Causes of Apparent Death, Trance, and Catalepsy. And the subject was also tackled in another book published in the late 1800s, Absolute Signs of Death, which outlines several cases of premature burial because of an incorrect death diagnosis. One of the cases is quoted from the Paris edition of the New York Herald, May 14, 1895: ‘A woman, belonging to the village of Laterie, died, to all appearance at least, a few days ago. After the body had been placed in a coffin, it was transported to the village church. On the way the bearers heard sounds proceeding from it, and at once sent for the mayor, who ordered it to be opened. The woman was found to be suffering from eclampsia, which had been mistaken for death by her relatives.’ 
Indeed, the problem of premature burial was so prevalent that a variety of innovations arose to prevent it. For example, coffins were designed that would open at the faintest movements. And at a mortuary in Munich, bells were attached to a corpse’s finger for a few days before burial, so that if the diagnosis of death were incorrect, the ‘corpse’ could ring the bell to summon help.
More recently, The Lancet published an eyewitness account of a patient who had been declared dead by the physician, only to sit up and ask for a cup of tea well after his diagnosis.  A similar case has been described by a doctor in The Annals of Internal Medicine. This doctor saw a patient come to life after he had declared him dead and completed the paperwork for the death certificate. 
A variety of news reports show many cases around the world of people being incorrectly diagnosed as dead, even after these patients were seen by multiple healthcare professionals. [8,9,10,11,12]
All of the above cases go to show that even in the most experienced hands, a mistaken diagnosis of death can be made in patients who are still alive. Hence, it is quite plausible that the Roman soldiers made a mistake in declaring Jesus (as) dead after the events of the crucifixion. Even if the Roman guards were professionals in diagnosing death, as we can see above, even professionals can be mistaken.
Before addressing the question how is it even possible that Jesus (as) survived the events of the crucifixion, we need to understand the prevalent practice of crucifixion at that time and how the victims of crucifixion died.
The Practice of Crucifixion
Crucifixion was one of the most horrible, cruel, and terrifying forms of punishment that was ever devised and was the height of ‘man’s inhumanity to man.’ [13,14,15] Crucifixion was a punishment where executioners had full rein to practice maximal sadism, and inflict pain, discomfort, suffering, and torture on their victims.[16,17]
The Assyrians, Babylonians, and Persians widely used crucifixion as a mean of torture and persecution. With the arrival of Alexander the Great, crucifixion was introduced as a punishment to Eastern Mediterranean countries. Death on the cross was the most dreadful of all others, both for the shame and the pain of it; and so scandalous that it was inflicted as the last mark of detestation upon the vilest of people.  The Latin historian, Quintus Curtius Rufus, records that Alexander had two thousand Tyrians hung on crosses along the shoreline of Tyre.  Romans refined the technique of crucifixion to maximise pain and prolong the suffering of the victim, mainly slaves, military enemies, and violent criminals.  It is recorded that on Pompey’s order 6000 risen slaves were crucified along the Appian Way after the defeat of Spartacus.
Crucifixion generally began with the scourging of the condemned and was administered by the soldiers. The condemned person was usually tied to a column and whipped with a flagrum, three or four leather whips attached to a handle, and tied to the end of each tail of the flagrum were pieces of bone and bits of lead. Scourging caused intense pain, bruising, external bleeding, exposed flesh, and rib fractures that could cause internal bleeding and lung injury. Roman law required that the victim die on the cross and not die from scourging. 
The cross consisted of two parts – a movable horizontal beam and a fixed vertical part. The condemned man would be nailed to the cross beams with his hands. The wound caused by this method would damage the median nerve of the hand, which would lead to excruciating pain. Once fixed to the crossbeam, the condemned was hoisted and attached to the vertical part. The feet were placed on top of one another and nailed to the upright beam with a single nail about 7 inches long. The injuries sustained during the process of crucifixion were not immediately life-threatening as the sharp nails passed through soft tissue without damaging any major blood vessels, main muscles or bones.  The outstretched arms, the bent knees and the trunk sagging forward on the cross caused the entire body weight of the victim to be supported by their wrists and hands.
Victims were kept on the cross until they passed away. Usually, they generally lasted for three days on the cross if left undisturbed and died of exposure, thirst, starvation, and exhaustion. In some victims, Roman soldiers had to expedite death by breaking the bones in their legs. At other times, Roman soldiers would create smoke with a fire at the bottom of the cross to suffocate the victims to death.  After they had died, the horizontal bar of the cross would be removed, and the bodies were left at the site. The corpses were generally not claimed for burial and left to decompose, exposed to attacks from birds of prey and wild dogs. Thus, crucifixion sites were generally open, away from residential areas and near a well-travelled road so that the victims could be seen as an example for passers-by.  There are many theories about how people died after crucifixion. The victims of crucifixion were exposed to multiple factors that contributed to their death, including shock due to excess blood loss, trauma and asphyxia.
Crucifixion causes a profound disruption in the victim’s ability to breathe because, when someone is suspended from the cross, their chest wall is stretched. While suspended, the chest wall stays fixed in a position where the lung is full. In other words, victims would have to lift their bodies just to exhale and allow the air that was trapped in their lungs out in order to draw a fresh breath.
At the same time, the victims suffered from intense thirst, severe muscle cramps, and traumatic injuries to the nerves, bones and soft tissues of the feet and wrists, rendering their bodies progressively weaker. Over time, because of this weakness, they would no longer be able to lift their bodies to exhale, which eventually led to a drop in oxygen and a rise in carbon dioxide levels, leading to coma and ultimately death. This form of death was slow and very agonising.
Eyewitness testimony and experiments surrounding crucifixion also shed some light on this aspect. Eyewitness testimony of a form of crucifixion reports that after about an hour of hanging, victims would draw up their legs more and more frequently to facilitate breathing, but that these efforts also became progressively feebler. Asphyxia set in, progressively and finally. This was evident from the fact that the thoracic frame was swelled out to its maximum, while the epigastric (the upper part of the abdomen) hollow was extremely concave. 
In a study conducted in 1948, healthy medical students who were hung by their wrists showed signs both of respiratory distress and very low blood pressure.  The subjects relied on their diaphragm for breathing, and when they were allowed to use their legs to lift the torso against gravity, their symptoms of respiratory distress improved. It is suggested that this was why the Romans broke the legs of victims to hasten death – so that they would be unable to lift themselves to breathe. This would expedite death by asphyxia and external or internal bleeding. Pathologist Dr Frederik Zugibe has proposed that victims died of cardiac and respiratory failure resulting from hypovolaemic shock caused by excessive blood loss during scourging.  Other suggested causes of death are cardiac embolism, ruptured heart, or excessive external bleeding and disorders of blood clotting.  It is recognised that no one can say definitively the exact mechanism of death in any particular crucifixion; we can only suggest the causes that may qualify for consideration. 
The duration that the victims had to endure on the cross before death was variable and was determined by the age, state of nutrition, amount of blood and volume loss and the incumbent weather. While it is postulated that the usual duration of death on the cross was 24 to 36 hours, in some people, this duration could be longer – even as much as 10 days. 
Medical Debate About the Cause of Death of Jesus (as)
While there were no autopsies and no formal records or medical accounts at that time, there are several hypotheses about the possible cause of death of Jesus (as). Whereas the medical community agrees that the death of Jesus (as) on the cross was atypical for happening so quickly, as generally it took days for the victims of crucifixion to die, there is no consensus about the exact cause of death.  Postulated mechanisms for the sudden and unexpectedly premature death of Jesus (as) include asphyxia, ruptured heart, acute dilatation of the stomach, suspension trauma, coagulopathy, and shock. [32,33,34,35] While any of these could be the cause of death, there is no universal consensus or any clear evidence for the definite cause of death. [36,37]
How Could Jesus (as) Have Survived the Events of the Crucifixion?
There is a proposed alternate hypothesis in that Jesus (as) did not die on the cross at all and survived the events of the crucifixion. [38,39,40] Medical evidence supports the possibility that crucifixion victims can be resuscitated.  For many years, Catholic devotees re-enact the practice of crucifixion and are placed on the cross, with their arms and feet nailed to the cross after enduring a period of flagellation.  It is reported that, after being administered basic first aid, a volunteer, who had had 8cm spikes driven through each of his hands and feet before being placed on a wooden cross by assistants costumed as Roman centurions, nonchalantly walked back home.  Devotees say their wounds can take up to two weeks to heal.  While these re-enactments are only a pale imitation of the real thing – participants are able to rest their feet on a small wooden plank, for example – they offer some indication of the effects of the wounds on victims.
Scientific evidence suggests several ways that explain how Jesus (as) could have survived the events of crucifixion. Among these are auto-resuscitation, hypothermia, shock and collapse and cardiac tamponade.
Autoresuscitation: Lazarus Syndrome
First described in 1982, Lazarus syndrome is a phenomenon where patients survive after an attempt at resuscitation has seemingly failed.  This is called auto-resuscitation, in which blood circulation resumes spontaneously a few minutes after an attempt at resuscitation has been abandoned. This phenomenon is underreported and has been seen by up to 50% of intensive care or prehospital emergency physicians.  Since about 30% of such patients make a good recovery, it is recommended to monitor the patient for at least ten minutes after stopping resuscitation and before declaring death.
How exactly auto-resuscitation takes place is not fully understood, with several theories proposed.  One possible mechanism that has been suggested for how auto-resuscitation works is ‘auto-PEEP,’ or auto-positive-end-expiratory-pressure. [48,49,50] This is described as, ‘During CPR, dynamic hyperinflation may develop in a patient with obstructive airway disease because of hyperventilation and inadequate exhalation time. Cessation of ventilation relieves the hyperinflation and the excessive intrathoracic pressure, thus allowing cardiac filling and permitting the spontaneous return of cardiac function.’  In other words, the over-inflated lungs are relieved, bringing down the excessive intrathoracic pressure and allowing the heart to fill and pump the blood again to resume circulation, leading to auto-resuscitation.
We present a novel hypothesis that Jesus (as), who was in a state of deep coma, experienced ‘spontaneous return of circulation’ when he was placed in a horizontal position after being taken down from the cross. As has been explained above, during the process of crucifixion, the lungs get hyper-inflated (overfilled with air) as breathing requires more and more effort. In the position of crucifixion, the large muscle on the front of the chest wall is stretched upwards and outwards. This makes it much harder to exhale. To facilitate exhalation, the victim had to straighten his knees, bend his elbow, pull the shoulders in and push his body upwards on the nail-impaled wrists.  The more time spent on the cross, the weaker this effort became, and the lungs got more and more overfilled with air, leading to respiratory distress.
Respiratory distress caused by crucifixion closely resembles a severe asthma or emphysema attack, where the lungs are over-inflated. 
While on the cross, the lungs of Jesus (as) would have become gradually distended with increasing efforts to exhale. The increasing pressure caused by the over-filled lungs inside the chest wall would have hindered the return of blood to the heart. This would have been compounded by hypovolaemia, thirst and blood loss caused by flagellation, all of which would have further reduced the return of blood to the heart – leading to circulatory compromise, syncope, or deep coma. As inhalation was relatively easy during crucifixion, vital tissues would have remained oxygenated adequately, keeping them alive. Presumed dead, Jesus (as) was taken off the cross and was placed in a horizontal position. The horizontal position would have helped him to exhale. This would have allowed the lungs to deflate, decrease the pressure inside the chest wall, allowing the blood flow to the heart to increase, facilitating the pumping action of the heart and would have led to a return of circulation, completing the process of auto-resuscitation. Thus, it is medically plausible that Jesus (as) experienced ‘spontaneous return of circulation’ as overinflation of the lungs was relieved by his being placed in a horizontal position.
The Journal of the Norwegian Medical Association published an alternative hypothesis suggesting that Jesus (as) was alive at the time he was taken down from the cross. At a body temperature of less than 25°C, a person may appear lifeless even to experienced medical personnel. It is possible to resuscitate people at this body temperature or even lower than this.  At times, these people can come to life spontaneously. It is argued that the circumstances of the crucifixion of Jesus (as) suggest that he might have been suffering from hypothermia on the cross. Therefore, it is conceivable that at the time Jesus (as) was taken down from the cross, he was not dead, but was perceived to be dead and placed in the sepulchre. 
Jerusalem, being 500 metres above sea level, can be quite cold in the spring. It is possible that the cold weather, storm or eclipse, and a period of being on the cross with minimal clothing may have caused hypothermia. It is also possible that Jesus (as) was completely exhausted before he was nailed to the cross.  He had been starved, he had not slept, he had been severely tortured in the morning, and he was forced to carry a heavy cross until he retreated under the burden. Jesus (as) was only on the cross for a short time, a time too short to bring about death on the cross. A combination of exhaustion and hypothermia due to cold weather may have made Jesus (as) appear dead to bystanders. It is quite possible that soldiers also made this mistake.  It is recorded that the soldiers stabbed Jesus (as) with a spear and blood and water came out. But dead people do not bleed.  The body of Jesus (as) was surrendered to Joseph of Arimathea. Nicodemus, a physician and secret follower of Jesus (as), also accompanied Joseph to the sepulchre. It is quite possible and plausible that Jesus (as), in a natural way, had come to consciousness again, and that he had left the burial ground alone or by friends’ help. Modern emergency medicine has shown that with appropriate treatment, patients with severe hypothermia can survive. A study showed that two-thirds of patients with hypothermia (the mean core body temperature on admission was 20.6°C) survived when treated with re-warming.
Shock and Collapse
An alternative hypothesis has been presented in The Journal of the Royal College of Physicians of London in 1991. Dr Margaret Lloyd Davies put forward the hypothesis that Jesus (as) collapsed and was in a state of shock when taken down from the cross and was resuscitated rather than resurrected after the events of the crucifixion. She gives an account of the injuries sustained by Jesus (as), including flogging, that might have inflicted significant superficial injuries, which would have been painful but not life-threatening. No eyewitness account of the flagellation has been recorded in the Gospels. Dr Lloyd Davies states that the onset of shock could not have been long delayed. Indeed, the intense pain would cause pooling of blood in the vascular bed and the slowing of the heart rate. The blood pressure and pulse pressure would be low, and some loss of blood would result from the wound on his back. During this period, Jesus (as) went through an agonising ordeal of having to struggle to breathe against gravity. After having been on the cross for three hours or possibly slightly longer, Jesus (as) appeared dead to the bystanders. Dr Lloyd Davies points out that there is a major gap in the description of the events of the crucifixion. There is no account whatsoever of Jesus (as) being removed from the cross. Of the four Gospels, only John records the incident of the spear thrust into Jesus’ (as) side when blood and water came out. There is no doubt in the assertion of the medical science that a corpse does not bleed. Therefore, it is hypothesised that Jesus (as) was weakened, tired, thirsty and had endured flagellation and a blow to the head. This can plausibly account for the collapse of Jesus (as) on the cross. Jesus (as) was in shock and hypotensive, lost consciousness because of diminished blood supply to the brain. His ashen skin and immobility made others believe that Jesus (as) had died. It is argued that the oxygen supply to the brain remained minimal, but above a critical level to sustain life. When Jesus (as) was taken down from the cross and laid on the ground, it restored circulation. A chill during the eclipse of the sun might have helped to maintain blood pressure and cold extremities may have suggested to the guards that Jesus (as) was dead. Dr Lloyd Davies suggests that Jesus (as) was taken away and tended by his followers as he showed signs of life.
WB Primrose, a senior anesthetist at Glasgow Royal Infirmary and Princess Louise Scottish Hospital in Bishopton argued in 1949 that Jesus (as) was alive at the time he was taken off the cross.  He cites the evidence of bleeding from the spear wound, as clearly showing that despite the appearance of death, circulation was still present. Active bleeding generally stops after the cessation of a heartbeat. Primrose argued that those who were present at the site of crucifixion of Jesus (as) were convinced that he appeared dead since he had collapsed and was in a state of shock. This resulted in Jesus (as) ending up collapsing in a deep coma. In this condition, the victim is unconscious, has an ashen grey complexion and is cold to the touch; all signs that may be mistaken for death. However, he could have maintained a low-grade circulation that is not readily detectable but is adequate to keep the vital organs alive. Primrose argued that this is what happened to Jesus (as). Hence, it is quite plausible that Jesus (as) was later resuscitated and recovered. Primrose remarked that, ‘such conditions of low vitality are well known to the anesthetists of today’. The author concludes that a detailed analysis of the events of crucifixion as described in the Gospels, in light of modern knowledge, are not sufficient to pronounce with absolute certainty that Jesus (as) was actually dead when his body was removed from the cross.
One suggested theory is that Jesus (as) developed cardiac tamponade during the process of scourging and crucifixion. This hypothesis has been discussed in detail elsewhere. ‘Cardiac tamponade (bleeding within the pericardial cavity) [is] where after aspiration with a wide bore needle the blood is allowed to drain to avoid recollection’ (see The Review of Religions March 2012 edition). It is argued that 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’. It is only in a beating heart of a living person that blood gushes out.
There is objective clinical evidence to demonstrate that it is possible to make a mistake in the diagnosis of death in living people, even in expert trained hands. Experienced and trained Roman soldiers cannot be considered immune from making such a mistake.
Moreover, in the medical literature, there is consensus that death within a few hours on the cross was unexpected and premature. There is no categorical proof or evidence confirming the death of Jesus (as) during the process of crucifixion. Alternatively, there are several proposed scientific mechanisms that support the hypothesis that Jesus (as) survived the events of crucifixion and that resuscitation is a medical possibility. Therefore, based on the current evidence, it is medically plausible that Jesus (as) survived the events of the crucifixion, and perhaps that is why Jesus (as) was seen by his disciples days afterwards, who witnessed his injuries. 
About the Author: Professor Amtul Razzaq Carmichael MD, M Ed, FRCS (Gen Surg.), MBBS, is a consultant. She qualified in 1987 with gold medals for academic excellence and undertook her surgical training at major teaching hospitals in London, Edinburgh and Philadelphia. She has authored many articles for major peer-reviewed scientific journals. She is a senior member of The Review of Religions Editorial Board as well as Assistant Manager.
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