INTRODUCTION
Crucifixion
may be defined as a method of execution by which a person is hanged,
usually by their arms, from a cross or similar structure until dead. It
has been used in many parts of the world and in many time periods; but
is perhaps best known today as a cruel method of social control and
punishment in the Roman Empire around 2000 years ago1
(pp 22-3). In modern times, the medical profession has shown
considerable interest in crucifixion. The typical aim of articles by
this group has been to determine how crucified individuals actually
died; and they often focus on the case of Jesus of Nazareth. Since
Stroud's book of 1847,2 at least 10 different theories have been proposed (Table 1), and many more articles have been published suggesting various combinations of these theories. The 10 examples referenced in Table 1
have been chosen merely as representing the wide difference of opinion
in the published literature: it is not an exhaustive list of all
articles published on the subject. The postulated causes of death
include cardiovascular, respiratory, metabolic, and psychological
pathology. Some authors have even argued that in a limited proportion of
cases the victim only appeared to die, and recovered consciousness once
brought down from the cross.
Table 1
A representative selection of medical hypotheses for the cause of death of Jesus, or crucifixion in general
| Cause of death | Background of author | Reference |
|---|---|---|
| Cardiac rupture | Physician | Stroud 1847 (Ref 2) |
| Heart failure | Physician | Davis 1965 (Ref 15) |
| Hypovolaemic shock | Forensic pathologist | Zugibe 2005 (Ref 12) |
| Syncope | Surgeon | LeBec 1925 (Ref 16) |
| Acidosis | Physician | Wijffels 2000 (Ref 17) |
| Asphyxia | Surgeon | Barbet 1963 (Ref 18) |
| Arrhythmia plus asphyxia | Pathologist | Edwards 1986 (Ref 19) |
| Pulmonary embolism | Haematologist | Brenner 2005 (Ref 20) |
| Voluntary surrender of life | Physician | Wilkinson 1972 (Ref 21) |
| Didn't actually die | Physician | Lloyd-Davies 1991 (Ref 22) |
When
a large number of theories are proposed for a problem in any scientific
discipline, this often demonstrates that there is no clear evidence
indicating the answer. Here we investigate why there are over 10
completely different theories described in the medical literature.
METHOD
An
extensive search for publications on crucifixion was undertaken. These
were divided into three groups by main profession of the author, be they
physicians, archaeologists or historians. Over 40 articles and books by
physicians that discussed the medical causes of death in crucifixion
were studied. The publications by historians and archaeologists were
used to provide background information on crucifixion. Early printed
editions of Latin texts dating from the Roman period, held in the
British Library, were consulted for passages describing crucifixion. The
replica model of the only archaeological case of crucifixion yet found
(from Giv'at ha-Mivtar) was studied during a visit to
Jerusalem. This case was discussed in detail with an osteoarchaeologist
in Israel who examined the original bones prior to their reburial.
A
summary of the available historical, archaeological and re-enactment
evidence was constructed. This was compared with the evidence discussed
in each of the publications by medical authors, in order to determine
the breadth of information consulted prior to the proposal of their
hypothesis as to how crucifixion victims died.
HISTORICAL EVIDENCE
Written
evidence for the details of crucifixion has been limited to eyewitness
accounts and other related written texts. No Roman period instructions
for those performing crucifixion have been preserved as far as we are
aware. The most detailed accounts of any one particular crucifixion are
the biblical passages covering the death of Jesus of Nazareth; but we
should not assume that this was by any means representative of all
crucifixions. Indeed, the precise details may well have varied between
regions, evolved over time, or even depending upon the social status of
the victim and the crime he allegedly committed. Flavius Josephus
(37-c.100CE) wrote of the hundreds of Jewish prisoners crucified at
Jerusalem in 70 CE, during an uprising against the Romans.
`They were first whipped and then tormented with all sorts of tortures, before they died, and were crucified before the wall of the city... the soldiers, out of wrath and hatred they bore the Jews, nailed those they caught to the crosses in different postures, by way of jest'.3
Lucius Anneus Seneca (4BCE-65CE) recorded another mass crucifixion and noted:
`I see crosses there, not just of one kind but made in many different ways: some have their victims with their head down to the ground, some impale their private parts, others stretch out their arms'.4
In Roman times a common starting point was to be whipped across the back, buttocks and legs with a flagrum.
This was a short whip with sharp objects interweaved into the thongs.
The victim was then often obliged to carry part of their cross to the
place of execution, outside the city walls. The weight of this would
obviously vary depending upon the region and the type of wood used. Once
at the place of crucifixion, the hands and feet of the prisoner were
fixed to the cross with either nails or cords, and the cross erected in
any one of a range of orientations. If crucified head up, the victim's
weight may also have been supported on a small seat. This was believed
to prolong the time it took a man to die. Victims in the head up
position could spend several days on the cross before they died. One
technique used by the Romans to hasten death was to break the legs below
the knee with a blunt instrument1
(p. 25). Modern interpretation in the medical literature as to how this
might work includes blood loss from the fracture site or respiratory
failure from fat embolism. In those positioned head up then respiratory
failure might also ensue as a consequence of the inability to inflate
the chest sufficiently, since the legs could no longer be used to
support the weight of the body. However, it is unknown which of these
three widely stated hypotheses is correct, since crucifixion is not
employed as a modern legal method of execution.
Analysis
of the clinical literature suggests that there has been suboptimal use
of these historical sources in post publications. Over 40 such articles
have been reviewed for this study, although only a proportion of these
have specifically been quoted in the reference list as they highlight
particular points. The vast majority of articles do not refer to texts
in the original languages that describe the details of crucifixion,
which are mostly in Latin and Greek. At best there is occasional
reference to the few Roman period texts that have been published in
English translation.5,6
However, most papers do not even discuss the translations of these
texts, but chose to quote previous publications by other medical authors
for their historical information.7,8 In some cases the result is a series of misquotes that bear limited resemblance to the actual surviving evidence.
ARCHAEOLOGICAL EVIDENCE
There
has been just one archaeological case of crucifixion published to our
knowledge. Cases are rare, as most crucified people were not formally
buried, but left on a rubbish dump to be eaten by wild dogs and hyenas.
The one case we do have was a young Jewish man buried during the Roman
Period, in a tomb near Giv'at ha-Mivtar in Israel.9
The inscription on the ossuary suggests his name was probably Yehohanan
ben Hagkol. The skeletal remains were only available for study for a
few weeks before being given a Jewish burial, although a model of this
calcaneus and nail have been exhibited in the Israel Museum in
Jerusalem. The excavated remains were fragmentary and incomplete, but
were unmistakably a case of crucifixion. The initial osteoarchaeological
interpretation of the remains10
was of poor quality, and somewhat misleading. A much more expert
analysis of these remains was published in 1985 by Zias and Sekeles.11
They described how an 11.5cm iron nail had been hammered through the
body of the right calcaneus from lateral to medial, and was still in situ (Figure 1).
The tip of the nail was bent, suggesting that during its insertion it
had perhaps met a hard knot of wood or pre-existing nail left from an
earlier crucifixion. The remains of a flat piece of olive wood were
found to be located between the lateral aspect of the calcaneus and the
head of the nail. Its use may have been to prevent the crucifixion
victim freeing his foot by forcing it laterally over the head of the
nail. It seems that, at least in this case, the heels were nailed to the
sides of the cross. There was no evidence for nail insertion through
the bones of the wrist or forearm, although this is widely stated in
medical articles. The appearance of the tibial fragments was suggestive
of post mortem damage due to the decomposition process, and not ante
mortem fractures to hasten death. However, several medical articles
incorrectly state that they were ante mortem. We also have no idea as to
whether this particular victim was positioned head up, head down, or in
any other orientation.
Calcaneus transfixed by an iron nail, from a first century AD Jewish tomb at Giv'at ha-Mivtar.
Excavated bone on the right, model reconstruction on left. [Reproduced
with the kind permission of Dr Joe Zias, Israel.] (In colour online.)
Every
carving of Jesus' crucifixion that we have ever seen in Catholic or
Protestant churches have a nail passing through both feet from front to
back. This religious stereotype has influenced the views of many
researchers over the years. However, there is no evidence that
crucifixion was actually carried out in this way in classical times.
EVIDENCE FROM RE-ENACTMENT
Over
the years a number of researchers have tried to test both the
physiology and the symptomatology of crucifixion. Zugibe has been the
most recent, and the most thorough, with his humane experimental
recreation of certain aspects of crucifixion.12
The volunteers were attached to the cross in a safe and temporary way,
were carefully monitored, and the study terminated at the time of their
request. The fact that none of the re-enactment research has actually
crucified people means that these studies have only limited relevance to
genuine cases. The absence of whipping, carrying a heavy cross, being
nailed to it, the dehydration from water deprivation and hot sun, and
the anxiety of their imminent death might all have resulted in somewhat
different findings in the modern groups and crucifixion victims 2000
years ago. Furthermore, re-enacted crucifixions have typically placed
their volunteers in the head up position displayed in Christian
churches, and not in the wide variety of positions recorded in the
written records from Roman times.
Zugibe
attached the hands of his volunteers to a cross with leather gloves.
The legs were placed with the knees and hips flexed and with the plantar
surface of the feet flush with the anterior aspect of the cross
upright. They were attached to the upright using a belt that ran over
the dorsum of the feet. This choice of foot position seems to have been
influenced by images in churches, but is at odds with the archaeological
evidence and, to our knowledge, is not supported by historical evidence
either. Zugibe's aim was to establish the cause of death of Jesus of
Nazareth, and he tested many physiological variables in a systematic
manner. He concluded that hypovolaemic shock caused Jesus' death, and
the asphyxiation theory had been overwhelmingly disproved12
(p. 121). However, the conclusion was not based on any positive
evidence for the shock theory (which was not tested), but rather upon
negative evidence for the asphyxiation theory. It seems that none of the
volunteers suffered significant difficulty breathing while on the
replica cross. However, the longest time any were left on the cross
seems to have been limited, on account of the physical discomfort of
being on the cross. Since it was extremely rare for anyone in Roman
times to die on a cross within the first few hours, it could be argued
that the time scale of the study cannot disprove the asphyxiation
theory. Furthermore, much of Zugibe's arguments are based on evidence
from the Turin Shroud. This appears to be a medieval forgery dating from
between 1260 and 1390CE, since fibres have been radiocarbon dated by
three separate laboratories.13 While some claim that the carbon date merely reflects the date of a medieval repair to the material,14
we would argue that there is still no firm evidence to suggest that the
shroud of Turin can be used as part of an impartial scientific study.
DISCUSSION
We
have highlighted 10 theories put forward by medical practitioners who
have investigated the medical cause of death by crucifixion. They
include forensic pathologists, physicians, and surgeons with outstanding
pedigrees from around the world. At first glance, their medical
arguments appear plausible. However, our principal finding is that on
more detailed examination most of these hypotheses regarding crucifixion
are unsubstantiated by the available data. The evidence for crucifixion
that we have discussed here includes archaeological, historical, and
re-enactment. Very few of the past medical publications in the field
show awareness of this full range of evidence. Many are limited to those
few written sources that have been translated into English. The
arguments of these earlier papers often rely on the Turin Shroud for
evidence, despite the fact that there is fair evidence to suggest that
it is a forgery. Many articles just quote earlier medical publications,
without discussing original sources themselves. The archaeological
evidence, namely the crucified man from Giv'at ha-Mivtar, is
often ignored. This is a crucial point, as it is arguably the most
important and reliable evidence for crucifixion that exists. Very few
papers show any sign of input from historians or osteoarchaeologists in
order to expand upon the medical expertise of the authors.
The
strengths of this study are that it provides an impartial assessment of
past work in the field. It gives credit to good published research, but
highlights major problems where they appear. The authors possess the
necessary linguistic, medical and archaeological skills to undertake
such a study. We have not engaged in humane re-enactment research
ourselves, so have no preferred cause of death that we wish to champion.
The weaknesses of the study perhaps include the fact that, since we
have not performed humane re-enactment research ourselves, it could be
argued we are in a less knowledgeable position from which to comment on
the usefulness of the re-enactment research that has been undertaken.
Neither do we claim to have first hand experience of the challenges and
difficulties associated with developing a humane and ethical research
protocol.
Our conclusion is that, at
present, there is insufficient evidence to safely state exactly how
people did die from crucifixion in Roman times. It is quite likely that
different individuals died from different physiological causes, and we
would expect that the orientation in which they were crucified would be
crucial in this respect. Until new archaeological or textual evidence
comes to light then it is only through more realistic humane
re-enactment research that we may move closer to an answer. However, the
difficulty in creating a research method that is more realistic, while
ensuring that it remains humane, ethical and painless may be quite a
challenge. Most importantly, future publication of articles in the
medical literature should be restricted to those that consider the full
range of historical and archaeological evidence. This may well require a
collaborative team approach including historians and archaeologists as
well as physicians.
Notes
Acknowledgments
We are most grateful to Dr Joe Zias (formerly Curator for Physical
Anthropology, Israel Antiquities Authority) for discussing the
archaeological evidence with us, and for allowing us to reproduce his
images of the calcaneus and crucifixion nail.
Competing interests None declared.
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