Part 3: Medical Aspects of Crucifixion

With a knowledge of both anatomy and ancient crucifixion practices, one may reconstruct the probable medical aspects of this form of slow execution. Each wound apparently was intended to produce intense agony, and the contributing causes of death were numerous.

The scourging prior to crucifixion served to weaken the condemned man and, if blood loss was considerable, to produce conditions leading to a severe drop in blood pressure, fainting, and even organ failure. When the victim was thrown to the ground on his back, in preparation for transfixion of his hands, his scourging wounds most likely would become torn open again and contaminated with dirt. Furthermore, with each respiration, the painful scourging wounds would be scraped against the rough wood of the post. As a result, blood loss from the back probably would continue throughout the crucifixion ordeal.

It has been shown that the dense fibrous tissue connecting the bones together, and bones of the wrist, can support the weight of a body hanging from them, but the palms cannot. Accordingly, the iron spikes probably were driven between the radius, the heavier of the two forearm bones, and the carpals, the eight wrist bones. Another probability for placement of the spikes could be between the row of carpal bones nearest the radius, or through the strong fibrous band-like tissue that covers the carpals, which forms a tunnel for the various fibrous bands connecting the eight carpal bones. The nail driven at this location would crush or sever the rather large median nerve. This nerve provides sensation and movement, particularly to the 2nd and 3rd fingers. Damage to the median nerve results in a contracture or a claw-like deformity of the hand. The damaged nerve would also produce excruciating bolts of fiery pain in both arms.

It is likely that the deep peroneal nerve, extending to the front of the ankle, and branches of the medial and lateral plantar nerves, would have been injured by the nails driven through the feet. Although scourging may have resulted in considerable blood loss, crucifixion per se was a relatively bloodless procedure, since no major arteries, other than perhaps the deep plantar arch, a confluence of arteries in the foot, pass through the favored anatomic sites of transfixion.

The crucial effect of crucifixion, beyond the excruciating pain, was a marked interference with normal respiration, particularly exhalation. The weight of the body, pulling down on the outstretched arms and shoulders, would tend to fix the chest muscles used for breathing in an inhalation state and thereby hinder passive exhalation. Accordingly, exhalation would require using the abdominal muscles rather than the chest muscles, and breathing would be shallow. It is likely that this form of respiration would not suffice and that a high level of carbon dioxide in the bloodstream would soon result. The onset of muscle cramps or tetanic contractions, due to fatigue and the high levels of carbon dioxide in the blood, would hinder respiration even further.

Adequate exhalation required lifting the body by pushing up on the feet and by flexing the elbows and pulling the shoulders inward. However, this maneuver would place the entire weight of the body on the bones in the feet, and would produce searing pain. Furthermore, flexion, or bending of the elbows would cause rotation of the wrists about the iron nails and cause fiery pain along the damaged median nerves. Lifting of the body would also painfully scrape the scourged back against the rough wooden post. Muscle cramps and loss of feeling in both the outstretched and uplifted arms would add to the discomfort. As a result, each respiratory effort would become agonizing and tiring, further reducing the oxygen levels in the blood, and lead eventually to asphyxia.

The actual cause of death by crucifixion was multifactorial and varied somewhat with each case, but the two most prominent causes probably were shock from inadequate perfusion of critical organs due to blood loss and inadequate oxygen levels in the blood due to inability to breathe properly. Other possible contributing factors included dehydration, stress-induced arrhythmias of the heart, and congestive heart failure with the rapid accumulation of fluid around the heart and in lungs. Death by crucifixion was, in every sense of the word, excruciating (Latin, excruciatus, or “out of the cross”).

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