Therefore, the water probably represented serous pleural and pericardial fluid, (5-7,11) and would have preceded the flow of blood and been smaller in volume than the blood. Perhaps in the setting of hypovolemia and impending acute heart failure, pleural and pericardial effusions may have developed and would have added to the volume of apparent water. (5,11) The blood, in contrast, may have originated from the right atrium or the right ventricle or perhaps from a hemopericardium. (5,7,11)

Jesus' death after only three to six hours on the cross surprised even Pontius Pilate. (1) 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. One popular explanation has been that Jesus died of cardiac rupture. In the setting of the scourging and crucifixion, with associated hypovolemia, hypoxemia, and perhaps and altered coagulable state, friable non-infective thrombotic vegetations could have formed on the aortic or mitral valve. These then could have dislodged and embolized into the coronary circulation and thereby produced an acute transmural myocardial infarction. Thrombotic valvular vegetations have been reported to develop under analogous acute traumatic conditions. (39) Rupture of the left ventricular free wall may occur, though uncommonly, in the first few hours following infarction. (40)

However, another explanation may be more likely. Jesus' death may have been hastened simply by his state of exhaustion and by the severity of the scourging, with its resultant blood loss and preshock state. (7) The fact that he could not carry his patibulum supports this interpretation. The actual cause of Jesus' death, like that of other crucified victims, may have been multifactorial and related primarily to hypovolemic shock, exhaustion asphyxia, and perhaps acute heart failure. (2,3,5-7,10,11) A fatal cardiac arrhythmia may have accounted for the apparent catastrophic terminal event.

Thus, it remains unsettled whether Jesus died of cardiac rupture or of cardiorespiratory failure. However, the important feature may be not how he died but rather whether he died. 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. Accordingly, interpretations based on the assumption that Jesus did not die on the cross appear to be at odds with modern medical knowledge.

From the Departments of Pathology (Dr. Edwards) and Medical Graphics (Mr. Hoamer), Mayo Clinic, Rochester, Minn.; and the Homestead United Methodist Church, Rochester, Minn., and the West Bethel United Methodist Church, Bethel, Minn. (Pastor Gabel).


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

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

3. Johnson CD: Medical and cardiological aspects 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. "J Warbury Courtauld Inst" 1971;34:320-321.

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

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

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

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

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

10. DePasquale NP, Burch GE: Death by crucifixion. "Am Heart J" 1963;6:434-435.

11. Barbet P: "A Doctor at Calvary: The Passion of Our Lord Jesus Christ as Described by a Surgeon", 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 the crucifixion. "Hibbert J" 1949, pp 382-388.

13. Bergsma S: did Jesus die of a broken heart? "Calvin Forum" 1948;14:163-167.

14. Whitaker JR: The physical cause of the death of our Lord. "Cath Manchester Guard" 1937;15:83-91.

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

16. Cooper HC: The agony of death by crucifixion. "NY Med J" 1883:38:150-153.

17. Shroud W: "Treatise on the Physical Cause of the Death of Christ and Its Relation to the Principles and Practice of Christianity" ed 2. London, Hamilton & Adams, 1871, pp 28-156, 489-494.

18. Allen AC: "The Skin: A Clinicopathological Treatise", 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 Dermatol 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 J" 1970;20:38-59.

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

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

26. McDowell J: "Evidence That Demands a Verdict: Historical Evidence for the Christian Faith." San Bernardino, Calif, Here's Life Publishers, 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 Ancient World 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" Zizzamia AI (trans). Milwaukee, Bruce Publishing Co, 1947, pp 29-57, 78-153, 161-167, 586-647.

30. Pfeiffer CF, Vos HF, Rea J (eda): "Wycliffe Bible Encyclopedia." Chicago Moody Press, 1975, pp 149-152, 404-405, 713-723, 1173,1174, 150-1523.

31. Greenleaf S: "An Examination of the Testimony of the four Evangelists by the Rules of Evidence Administered in the Courts of Justice." Grand Rapids, Mich, Baker Book House, 1965, p. 29.

32. Hatch E, Redpath HA: "A Concordance to the Septuagint and the Other Greek Versions of the Old Testament (Including the Apocryphal Books) Graz, Austria, Akademische Druce U Verlagsanstalt, 1975, p 1142.

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

34. Friedrich G: "Theological Dictionary of the New Testament", Bremiley G (ed-trans). Grand Rapids, Mich. WB Eerdmans Publisher, 1971, vol 7, pp 572,573,632.

35. Aradt WF, Gingrich FW: "A Greek-English Lexicon of the New Testament and Other Early Christian Literature." University of Chicago Press, 1057, p 673.

36. Brown F, Driver SR, Briggs CA: "A Hebrew and English Lexicon of the Old Testament With an 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 417-427.

38. Jackson SM (ed): "The New Schaff-Herzog Encyclopedia of Religious Knowledge." New York, Funk & Wagnalls, 1909, pp 312-314.

39. Kim H-S, Suzuki M, Lie JT, et al: Nonbacterial thrombotic endocarditis (NBTE) and disseminated intravascular coagulation (DIC): Autopsy study of 36 patients. "Arch Pathol Lab Med" 1977;101:65-68.

40. Becker AE, van Mantgem J-P: Cardiac tamponade: A study of 50 hearts. "Eur J Cardiol" 1975;3:349-358.

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

Copyright 1986, American Medical Association

By Permission of Mayo Foundation

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