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 Two aspects of Jesus' death have been the source of great controversy, namely, the nature of the wound in his side 4, 6 and the cause of his death after only several hours on the cross.13-17 The gospel of John describes the piercing of Jesus' side and emphasizes the sudden flow of blood and water.1 Some authors have interpreted the flow of water to be ascites 12 or urine, from an abdominal midline perforation of the bladder.15 However, the Greek word plvra, or pleura) 32, 35, 36 used by John clearly denoted laterality and often implied the ribs.6, 32,36 Therefore, it seems probable that the wound was in the thorax and well away from the abdominal midline.

 Although the side of the wound was not designated by John, it traditionally has been depicted on the right side.4 Supporting this tradition is the fact that a large flow of blood would be more likely with a perforation of the distended and thin-walled right atrium or ventricle than the thick-walled and contracted left ventricle. Although the side of the wound may never be established with certainty, the right seems more probable than the left.

 Some of the skepticism in accepting John's description has arisen from the difficulty in explaining, with medical accuracy, the flow of both blood and water. Part of this difficulty has been based on the assumption that the blood appeared first, then the water. However, in the ancient Greek, the order of words generally denoted prominence and not necessarily a time sequence.37 Therefore, it seems likely that John was emphasizing the prominence of blood rather than its appearance preceding the water.

 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 (Fig. 7) or perhaps from a hemoperieardium.5, 7, 11

 Jesus' death after only three to six hours on the cross surprised even Pontius Pilate. 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 crucifixions with associated hypovolemia, hyperemia, and perhaps an 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 hypovolemie shock, exhaustion asphyxia, and perhaps acute heart failure2, 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 (Fig 7). Accordingly, interpretations based on the assumption that Jesus did not die on the cross appear to be at odds with modern medical knowledge.

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A Physician Analyzes The Crucifixion, by Dr. C. Truman Davis
Medical Aspects Of The Crucifixion Of Jesus Christ, Compiled by David Terasaka, M.D.
If Dr. Seuss wrote the Crucifixion in the Bible

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1. Matthew 26:17-27:61, Mark 14:12-15:47, Luke 22:7-23:56, John 13:1-19:42, in The Holy Bible (New International Version). Grand Rapids, Mieh, Zondervan Bible Publishers, 1978. 18. Allen AC: The Skin: A Clinicopathological Treatise, ed 2 New York, Grune & Stratton Inc. 1967, pp 745-747- 35. Arndt WF, Gingrich FW: A Greek-English Lexicon of the New Testament and Other Early Christian Literature. University of Chicago Press, 1957, p 673
2. Lumpkin R: The physical suffering of Christ. J Med. Assoc Ala 1978,47:8-10,47. 19. Sutton RL Jr: Diseases of the Skin, ed 11. st Louis, CV Mosby Co. 1956, pp 1393-1394. 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.
3 Johnson CD: Medical and cardiological aspects of the passion and crucifixion of Jesus, the Christ. Bol Assoc. Med. PR 1978;70:97-102. 20. Scott CT: A case of haematidrosis. Br Med. J 1918;1:532-533. 37. Robertson AT: A Grammar of the Greek New Testament in Light of Historical Research. Nashville, Tenn, Broadman Press, 1931, pp 417-427.
4. Barb AA: The wound in Christ's side. J Warburg Courtauld Inst. 1971;34:320-321. 21. Klauder JV: Stigmatization. Arch DermatoI Syphilol 1938;37:650-659. .38. Jackson SM (ed): The New Schaff-Herzog Encyclopedia of Religious Knowledge. New York, Funk & Wagnalls, 1909, pp 312-314..
5. Bucklin R The legal and medical aspects of the trial and death of Christ. Sci Law 1970; 10:14-26. 22. Weaver KF: The mystery of the shroud. Natl Geogr 1980;157:730-753. 39. Kim H-S, Suzuki M, Lie JT, et al: Nonbacterial thrombotic endocarditis (NBTE) and dis-seminated intravascular coagulation (DIC): Autopsy study of 36 patients. Arch Pathol Lab Med 1977;101:65-68.
6. Mikulicz-Radeeki FV: The chest wound in the crucified Christ. Med News 1966;14:30-40. 23. Tzaferis V: Jewish tombs at and near Giv'at ha-Mivtar, Jerusalem. Israel Explor J 1970;20:18-32. 40. Becker AE, van Mantgem J-P: Cardiac tamponade: A study of 50 hearts. Eur J Cardiol 1975;3:349-358.
7. Davis CT: The crucifixion of Jesus: The passion of Christ from a medical point of view. Ariz Med 1965;22:183-187. 24. Haas N: Anthropological observations on the skeletal remains from Giv'at ha-Mivtar. Israel Explor J 1970;20:38-59.
8. Tenney SM: On death by crucifixion Am Heart J 1964;68:286-287. 25. McDowell J: The Resurrection Factor. San Bernardino, Calif, Here's Life Publishers, 1981 pp 20-53, 75-103.
9. Bloomquist ER: A doctor looks at crucifixion. Christian Herald, March 1964, pp 35, 46-48. 26. McDowell J: Evidence That Demands a Verdict: Historical Evidences for the Chnstian Faith. San Bernardino, Calif, Here's Life Publishers, 1979, pp 39-87, 141-263.
10. DePasquale NP, Burch GE: Death by crucifixion. Am Heart J 1963;66:434-435. 27. McDowell J: More Than a Carpenter. Wheaton, III, Tyndale House Publishers, 1977 pp 36-71, 89-100.
11. Barbet P: A Doctor at Calvary: The Passion of Out Lold 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. 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.
12. Primrose WB: A surgeon looks at the crucifixion. Hibbert J. 1949, pp 382-388.


29. Ricciotti G: The Life of Christ, Zizzamia AI (trans). Milwaukee, Bruce Publishing Co 1947, pp 29-57, 78-153, 161-167, 586-647.
13. Bergsma S: Did Jesus die of a broken heart? Calvin Forum 1948;14:163-167. 30. Pfeiffer CF, Vos HF, Rea J (eds): Wycliffe Bible Encyclopedia. Chicago, Moody Press, 1975 pp 149-152, 404-405, 713-723, 1173-1174, 1520-1523.
14. Whitaker JR: The physical cause of the death of our Lord. Cath Manchester Guard 1937;15:83-91 . 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, p29.
15. Clark CCP: What was the physical cause of the death of Jesus Christ? Med Rec 1890;38:543. 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.
16. Cooper HC: The agony of death by crucifixion. NY Med J 1883;38:150-153. 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.
17 Stroud W: Treatise on the Physical Cause of the Death of Chlist and Its Relation to the Principles and Practice of Christianity, ed 2. London, Hamilton & Adams, 1871, pp 28-156, 489-494. 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