By Dr. W. Reid Litchfield

Editor’s Note:  To get Dr. Litchfield’s full article as well as an Easter-themed photo essay of the holy land, order BYU Studies vol. 37:4.  To subscribe to BYU Studies, click here. 

The physical cause of the death of our Lord has occupied the minds and fueled the pens of medical theorists and theologians for centuries. The search for the answer to this diagnostic dilemma has left a windfall of literature and theories that is of tremendous interest to students of the life of Jesus Christ. This essay will review some of the more prominent theories on the physical cause of the death of Christ … Each of these theories has its merits, along with its probable flaws.

The Ruptured Heart Theory

The ruptured heart theory is, without doubt, the most well-known theory on the cause of Christ’s death. It is certainly the one most familiar to the Latter-day Saint community as a result of its endorsement by James E. Talmage. Dr. William Stroud popularized this theory in 1847, and it was on Stroud’s work that Elder Talmage based many of his conclusions.

Understanding cardiac rupture can be conceptually difficult without a basic knowledge of how the heart works. At the simplest level, the heart is a hollow pump surrounded by an inflexible fibrous sac called the pericardium. The heart and its vast network of arteries and veins represent a self-contained system that circulates blood to nourish the organs of the body. In a cardiac rupture, a hole in the wall of the heart causes blood to leak into the pericardial sac, which quickly stops the pumping action of the heart. This phenomenon, known as cardiac tamponade, is rapidly fatal. When cardiac tamponade strikes, many victims will cry out loudly, quickly lose consciousness, and then die — all reminiscent of the way Jesus died.

Stroud’s theory is based on the incident described in John 19:34: “But one of the soldiers with a spear pierced his side, and forthwith came there out blood and water.” John’s observation contradicts the maxim that “a corpse does not bleed” and places special significance on the emergence of both blood and water from the wound. Stroud’s theory is relatively simple: The intensity of Jesus’ suffering on the cross caused his heart to rupture, resulting in his rapid and dramatic death from cardiac tamponade. The blood in the pericardium then separated into clot and serum and emerged under pressure as separate components when the soldier’s javelin penetrated the pericardium.

It is certainly true that when blood is left to sit in a test tube it will eventually separate into an amber-colored serum and dark red clot. Nevertheless, with few exceptions, blood does not clot in the pericardium after cardiac tamponade. Even if this were a possibility, the one or two hours at most that intervened between death and the spear thrust would have been insufficient for the separation to occur. Finally, it is difficult to understand how a blood clot, which has the consistency of gelatin, could flow from the wound. In all likelihood, the accounts describing the presence of blood and water, which seemed to Stroud to pinpoint the cause of Christ’s death, led him to an erroneous conclusion.

A more likely explanation for the emergence of both blood and water from the wound assumes separate sources for the fluids — the blood emerging from the heart and clear fluid emerging from either the pericardium or the chest cavity. In the case of the clear fluid, there is normally a small amount of watery fluid in the spaces that surround the lung (pleural cavity) and the heart (pericardial space). Excessive and pathologic accumulation of this fluid is nonspecific and can occur in a variety of conditions such as heart failure, chest trauma, and shock. In the Lord’s case, the ordeals of crucifixion could have caused an accumulation of pericardial or pleural fluid. A javelin thrust could penetrate the pleural cavity, the lung, the pericardial space, and the heart itself, resulting in the drainage of the separate fluids under the influence of gravity. The biblical record suggests that the wound was large enough for this kind of drainage to occur; remember that Thomas was able to thrust his hand into Christ’s side (see John 20:27).

Cardiac tamponade is known to occur in other settings. Dr. David Ball suggests that Christ could have died as a result of traumatic cardiac tamponade and cites several case studies to support the theory. He argues that Christ’s numerous falls during his walk to Calvary could have been the source of the chest trauma that caused the syndrome. With his arms tied to the crossbar, Jesus could not shield his body and would have fallen forward to the cobblestone road under the weight of the load. In this type of trauma, the heart is compressed between the breastbone (sternum) and the spinal column. Ball suggests that this trauma weakened the wall of the heart and caused it to rupture.

The problem with Ball’s theory, like Stroud’s, relates to time. The theory would require cardiac rupture to occur only six to seven hours following the trauma. The modern experience with these injuries suggests that traumatic cardiac rupture occurs most often at the time of injury or, less commonly, days following the injury. The six- to seven-hour time frame simply does not fit well. Although the various cardiac rupture theories may have great appeal from a sentimental view, supporting a traditional broken heart symbolism, modern medical thinking does not substantiate that particular physical diagnosis.

The Asphyxia Theory

Virtually every medical treatise on the subject of crucifixion and most of the experiments that simulate crucifixion in healthy volunteers agree that crucifixion causes a profound disruption of the victim’s ability to breathe. This knowledge has led many medical theorists to postulate asphyxia as the cause of Christ’s death.

This disruption of breathing relates to the way the chest wall is stretched when the victim is suspended from the cross. In a normal person, the act of inhaling, or inspiration, occurs with the coordinated contraction of the diaphragm and outward expansion of the chest wall. When the chest and diaphragm relax, the chest spontaneously deflates.

In the cruciarius (the Latin term for a victim of crucifixion), the chest was stretched into the same position that it assumed during normal inspiration. Expiration could not occur spontaneously because the chest was held in the inspiration position by the weight of the body pulling on the arms. In essence, the positioning of the body on the cross transformed the normally effortless act of breathing into something that required tremendous energy. Incomplete emptying of the chest could occur by contracting the muscles of the abdominal wall to force air out of the chest; the diaphragm will only work for inspiration. Adequate expiration could not occur without lifting the body up either by pulling up with the arms or pushing up on the nailed feet.

While hanging by the hands, the victim’s breathing would be shallow, rapid, and inefficient. With time, oxygen levels in the blood would fall and carbon dioxide levels would rise. Intense air hunger would ensue and prompt a heroic effort on the part of the cruciarius to lift the body up to facilitate normal breathing. A period of frantic, gasping respiration would rescue the victim from suffocation. Then with time, the legs would fatigue and force the cruciarius to hang by the arms, thereby ushering in another period of tortured breathing and air hunger.

The rhythmic cycle of breathing would continue for many hours or even days. To the experienced eye of the executioner, this cycle served as a useful barometer of the overall condition of the condemned and could probably be used to predict the time of death. To the onlooker, it was a powerful visual deterrent of criminal conduct and a sober reminder that the ruling authorities would not tolerate disruptions that threatened their political or religious order.

The agonies exacted by this form of capital punishment were unspeakable. They resulted not only from the air hunger and respiratory distress already mentioned, but also from multiple other factors: intense thirst, severe muscle cramping, and traumatic injury to the nerves, bones, and soft tissues of the feet and wrists caused by the nails. Death came slowly, and only then after the victims were so weak that they could no longer lift the body to rescue themselves from asphyxia. As the victims weakened, they lifted themselves less frequently. In time, carbon dioxide levels rose and oxygen levels fell, and the victims gradually slipped into a coma. Death, when it finally came, was quiet and peaceful.

It should now be apparent why the practice of breaking the legs of the cruciarius was an effective means of accelerating death. This maneuver would make it impossible for the crucified to “stand up” and breathe, even if the victim still had sufficient strength to do so.

With this background in mind, it is now possible to critically analyze the asphyxia theory in light of the details provided by the Gospel narrators’ accounts of Christ’s crucifixion. Although none of the Gospel narratives give a direct description of Christ’s physical condition on the cross, they do so indirectly. All four writers agree that Jesus spoke from the cross. Since vocalization is only possible during expiration, he had to have sufficient strength to lift his body and speak out above the clamor that surrounded him. On each of the seven occasions where his words were recorded, he spoke deliberately and used the occasion as a teaching moment. Perhaps the point is best illustrated by reviewing the words Christ spoke immediately prior to his death. Matthew, Mark, and Luke all describe them as being uttered forcefully and relate that they were quickly followed by his death (see Matt. 27:50, Mark 15:37, and Luke 23:46). These words were not the final whispers of a near-comatose man in the terminal stages of asphyxia.

Asphyxia caused by crucifixion closely resembles a severe asthma or emphysema attack. Normally, patients are restless, panicky, and feel like they cannot get enough air. They may be extremely agitated initially, but as the condition worsens, they become more sedated and do not speak. Every effort is devoted to breathing. Finally, victims gradually become drowsy, slip into a coma, and die quietly if the process is not reversed.

Although victims of crucifixion are very similar to asthmatic or emphysema patients in some ways, they were different in one very important respect: they could reverse their inability to fully exhale by pushing down on the nails in the feet, easing the pull on the chest that paralyzes normal respiration. This maneuver allowed normal respiratory mechanics to ensue and temporarily rescue the victim from impending coma and death.

Death from asphyxia and the cardiovascular instability caused by slow suffocation were probably the cause of death in the vast majority of the men and women who died by crucifixion. However, it could not have been the cause of Christ’s death. Although obviously weakened and suffering from his great ordeal, he still had sufficient strength to lift himself, speak out, and be heard above the din of his enemies who encircled the cross. His sudden and unexpected death bears little resemblance to the gradual decline and quiet passing of one that dies by slow asphyxia.

The Cardiovascular Collapse Theory

The most prevalent modern theory on the cause of Christ’s death is that of cardiovascular collapse. The numerous supporters of this theory suggest that Jesus died of profound shock. The scourging, the beatings, and the fixing to the cross would have left Jesus dehydrated, weak, and critically ill. Add to these insults the tremendous energy expenditure that crucifixion exacted for things as simple as breathing, and the conclusion is intuitive. The stage was set for a complex interplay of physiological insults to be present simultaneously: dehydration, massive trauma and soft tissue injury (especially from the prior scourging), inadequate respiration, and strenuous physical exertion. All acted together to initiate a vicious cycle of incremental and irreversible decline. Eventually the severity of the shock would be such that blood pressure would fall below levels required to perfuse the brain, and coma would result. In fact, cardiovascular collapse is inseparably connected with the abnormalities that accompany gradual asphyxia. This theory supposes only that the cause of coma was the metabolic complications of shock rather than those of asphyxia.

For this reason, the contentions used to renounce the asphyxia theory are exactly the same as those used to question the cardiovascular collapse theory. Again, the biblical account of Christ’s death clearly describes a sudden, unexpected death that was immediately preceded by a loud cry and a statement to the onlookers surrounding the cross. Jesus showed none of the hallmark signs of one dying from profound shock.

The Lord’s Death in Perspective

The assertion that the exact cause of Christ’s death really does not matter is, of course, valid. It is a detail that could be omitted from the story without significantly changing the importance of the overall message. When this line of reasoning is taken to an extreme, the same could be said of almost everything we know about the Lord. The only details of his life that are of primal significance are that he did live, that he did atone for us, and that he was resurrected. These few details tell us he fulfilled his part in the plan of salvation.

However, the exercise of studying the nuances of details transforms ancient manuscripts into living words of counsel. It is the details that bring long-dead men and women to life in our minds. The intimacy of our relationship with the Lord is in large part predicated upon our study of the details of his life and teachings. In this context, any question that serves to deepen our understanding of the Lord’s life is of great value to all those who seek to know him and understand him.

A separate line of reasoning argues that the exact cause of the Lord’s death is a moot concept since Jesus alone determined the timing and nature of his death and reminds us that Jesus himself stated, “No man taketh it [my life] from me, but I lay it down of myself. I have power to lay it down, and I have power to take it again” (John 10:18). Christ’s unique ancestry made him at once both a man and a God and left him in full control throughout the entire ordeal. This point is critical to the entire discussion and should not be overlooked.

Yet I believe it is reasonable to assume that the Creator of this world and God of heaven and earth would abide by the same laws that maintain and govern his creation. Jesus’ mortal body would therefore be subject to the same laws that govern all mortals. Once Christ suspended his godly power to maintain his life under the lethal weight of an eternal atonement, standard physiological principles and laws would be operative. After all, it is Christ’s human side rather than his immortal side with which we most closely relate. We cannot fully identify with the death of the God that died on Good Friday, yet it is much more within our reach to identify with the man.

More important than all of that is the way that the exercise increases our understanding of Christ’s atonement, death, and resurrection. As we study and ponder all that we can about our Savior, our hearts swell with gratitude for his condescension and his infinite love. Our empathy for the Lord fulfills the pleadings of a familiar hymn: “More tears for his sorrows, More pain at his grief.” Once this change has occurred, our perspective is dramatically altered, and the quest for the answer to the question of how Jesus died becomes, above all, the medium through which our appreciation for the Lord’s sacrifice is greatly deepened.

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Sources

James E. Talmage, Jesus the Christ (Salt Lake City: Deseret Book, 1981), 668–69.

William Stroud, Treatise on the Physical Death of Jesus Christ and its Relation to the Principles and Practice of Christianity (London: Hamilton and Adams, 1847), 73–156.

Origen (a.d. 185–254), cited in John Wilkinson, “The Incident of the Blood and Water in John 19:34,” Scottish Journal of Theology 28 (1975), 159-60.

Pierre Barbet, A Doctor at Calvary: The Passion of Our Lord Jesus Christ as Described by a Surgeon (Garden City, New York: Image Books, 1963), 139–42.

Frederick T. Zugibe, “Death by Crucifixion,” Canadian Society of Forensic Science Journal 17 (1984): 4.

Doron Zahger and Eliyahu Milgalter, “Clinical Problem Solving: A Broken Heart,” New England Journal of Medicine 334 (1996): 319–21.

David A. Ball, “The Crucifixion and Death of a Man Called Jesus,” Journal of the Mississippi State Medical Association 30 (1989): 80–82.

C. Truman Davis, “The Crucifixion of Jesus: The Passion of Christ from a Medical Point of View,” Arizona Medicine 22 (1965): 187.

W. D. Edwards, W. J. Gabel, and F. E. Hosmer, “On the Physical Death of Jesus Christ,” Journal of the American Medical Association 255 (1986): 1463.

J. E. Holoubek and A. B. Holoubek, “Execution by Crucifixion: History, Methods and Cause of Death,” Journal of Medicine 26 (1995): 11–15.

 A. A. Le Bec, “The Death of the Cross: A Physiological Study of the Passion of Our Lord Jesus Christ,” Catholic Medical Guardian 3 (1925): 126–32.

R. Lumpkin, “The Physical Suffering of Christ,” Journal of the Medical Association of the State of Alabama 47 (1978): 8–10.

S. M. Tenney, “On Death by Crucifixion [letter],” American Heart Journal 68 (1964): 286–87.

J. R. Whitaker, “The Physical Cause of the Death of Our Lord,” Catholic Medical Guardian 13 (1935): 87–88.

Hugh J. Schonfield, The Passover Plot: New Light on the History of Jesus (New York: Bantam, 1965).

J. G. Bourne, “The Resurrection of Christ: A Remarkable Medical Theory,” [London] Sunday Times (January 24, 1965).

C. C. P. Clark, “What Was the Physical Cause of the Death of Jesus Christ?” Medical Record 38 (1890): 543.

 W. B. Primrose, “A Surgeon Looks at the Crucifixion,” Hibbart Journal 47, no. 4 (1949): 382–88.

Margaret Lloyd Davies and Trevor A. Lloyd Davies, “Resurrection or Resuscitation?” Journal of the Royal College of Physicians of London 25 (April 1991): 167–70.

“More Holiness Give Me,” in Hymns of The Church of Jesus Christ of Latter-day Saints (Salt Lake City: The Church of Jesus Christ of Latter-day Saints, 1985), no. 131.