The Case against Asphyxiation

Why did someone subjected to crucifixion die? Due mainly to the influential writings of the French surgeon Pierre Barbet, the prevailing theory until recently was that the usual cause of death was asphyxiation (strangulation) (1). This theory is based on the facts of respiration. Inhalation is active, whereas exhalation is passive. To breathe in requires muscular effort to expand the chest, producing a vacuum that air rushes in to fill. Breathing out requires the same muscles to relax, so that the chest will collapse and force out the air admitted to the lungs moments earlier.

Barbet supposed that in a typical crucifixion, the victim ascended the cross with his arms stretched out along a nearly horizontal line, but gravity soon made him slump downward into a cramped position. There, with gravity straining his torso downward and his arms straining it upward, he could breathe in, but he could not relax the muscles of the rib cage enough to breathe out. Thus, to exhale, he had to push himself up, using mainly his legs. In time, overcome by weakness, he was not able to raise himself for another breath, and he died of suffocation (2).

The theory seems to have important evidence in its favor.

  1. It explains why some victims were able to fight off death for two or more days (3). A strong man could persevere a long while in the exertion necessary to stave off strangulation.
  2. It explains why crucifixion was regarded as the ultimate torture. The agonies of a victim who was desperately struggling to raise himself time after time so that he could continue breathing would have been prolonged and ghastly.
  3. Barbet verified that the cause of death when the Nazis hanged prisoners by their arms was strangulation (4).
  4. The theory explains why, at least in some cases, nails were inserted through the upper forearms. The victim must have pulled against the nails as he sought to raise his body for another breath. But nails through the palms would not have supported the additional weight created by this effort (5). They would have torn out the flesh between the fingers and come loose.
  5. It explains also why the victim's legs were broken to hasten death. If he had to push up in order to breathe, the crippling of his legs would have brought the onset of death within minutes.

But the evidence for strangulation does not stand up to scrutiny.

  1. Other fatal processes might also require a protracted period before ending in death. It might take hours or days of continuing trauma to produce death by shock, for example.
  2. Any other cause of death would have made crucifixion no less agonizing and no less a spectacle of human depravity.
  3. The Nazi victims were hung from a single upright with their hands attached directly overhead. Their feet had no support (6). Although suspension in this manner kills by strangulation, the victims of crucifixion had their feet supported and their arms extended to the side. Many were also held aloft by a sedile. In his experiments, Frederick Zugibe showed that an unseated suspended person with his feet supported and his arms outstretched at 65º from the vertical line suffered no respiratory distress whatever. Thus, for any condemned man hung from a cross in this fashion, strangulation was not a possible cause of death (7). Moreover, Zugibe found that his volunteers who assumed the posture of a crucified man were wholly unable to pull themselves up. So, even if this posture cramped the victim severely enough to stop his breathing, he would have died immediately, not after prolonged exertions (8).
         The posture Zugibe chose probably reproduced Roman practice, but we do not know for sure. It would take more experiments to determine exactly how far the angle of alignment could be diminished from 65º before risking strangulation. On occasions when the Romans hung victims at less than the critical angle, strangulation reemerges as the likely cause of death. Often when undertaking mass executions, for example, the Romans affixed their victims to a single upright, probably leaving their bodies suspended from hands overhead (9).
  4. We have shown already that the likely need for lower insertion of the nails was to prevent the hands from ripping apart when the victim was raised into position.
  5. Breaking the legs probably hastened death for another reason. The consequence of leg fractures is instant and severe loss of blood (10). Why this would quickly snuff out life is evident when we consider the true ordinary cause of death by crucifixion.

We see then that the evidence for strangulation as a cause of death does not pass muster. Our skepticism grows when we consider that the Romans found it easy to kill people by hanging them in a variety of postures, not just in the upright posture which suffocation theory assumes.

As Zugibe has argued most persuasively, a typical victim of crucifixion probably died of shock, which is the shutting down of bodily tissues when they are deprived of the blood service necessary to sustain life (11). To put it simply, insufficient blood flow leads to death. The shock suffered by Jesus and others who were crucified was probably compounded of two kinds: traumatic shock (curtailing of circulation by the brain's response to unbearable pain) and hypovolemic shock (depletion of body fluids). In the final stage of shock, the heart and lungs are so weakened by deoxygenation and so overwhelmed by the growing burden of a dying body that they cannot continue functioning. The proximate cause of death is cardiac and respiratory arrest (12).

The Trauma Jesus Endured

There is no doubt in Jesus’ case that His ordeal was traumatic to an unbearable degree.

  1. Before being arrested, He spent the night in agonizing prayer so full of grief and apprehension and dread that He sweated drops of blood (Luke 22:44). Zugibe has assembled abundant evidence that Luke is referring to an authentic medical condition known as hematidrosis, generally arising from extreme fear or distress (13).
  2. After Jesus was condemned by an illegal session of the Sanhedrin serving as the highest Jewish court, His enemies spit upon Him, smote Him with their fists, blindfolded Him and slapped Him across the face, mocked Him, dared Him to prove that He was God by naming His attackers, and made Him the butt of many other crude blasphemies (Matt. 26:67; Mark 14:65; Luke 22:63-64). This frenzy of violence was absolutely in violation of Jewish law.
  3. In the hope of placating the Jewish leaders who were demanding Jesus’ death, Pilate sent Jesus to be scourged (Matt. 27:26; Mark 15:15; John 19:1). The horrors of Roman scourging have been described by many writers (14). The instrument of torture was a flagrum, a vicious implement consisting of several long leather thongs studded with bone or metal. The chief injury came not from the impact of the blows but from the cutting of the thongs as they swept across the back. Jesus’ suffering under the lash did not equal His suffering on the cross, but it was torment of a kind so extreme that we can scarcely imagine the pain Jesus endured. The Jews also practiced scourging, but the law of Moses permitted no more than forty strokes. To avoid giving too many by accident, as a result of an error in counting, the Jews stopped at thirty-nine. But the Romans observed no limit. Their usual object was to bring the victim as near death as possible. They continued until his back was torn to shreds of quivering flesh and his bleeding was profuse. Some victims were left with their bowels exposed (15).
  4. After finishing the bloody work of lashing Jesus, the soldiers dressed Him up in a purple robe, purple being the color that the Romans associated with royalty. They took a thorny vine and wove it into a crown and placed it on His head. They gave Him a scepter also, but it was not gold. It was just a common reed. They bowed in jest before Him and hailed Him as king of the Jews. But simple ridicule was not enough (Matt. 27:29-30; John 19:2-3). As a sign of their complete contempt for the man, they spit upon Him. Yet they were still not satisfied. They wanted to see more blood. So, they seized the reed in His hands and flailed it on His head to drive the thorns deeper into His skull. Then they struck Him with their hands. Yet in the light of prophecy we know that the abuse went still further: “I gave my back to the smiters, and my cheeks to them that plucked off the hair: I hid not my face from shame and spitting” (Isa. 50:6). The soldiers in their fury must have pulled the hair from His cheeks and chin. The combined effect of all these assaults was to leave His visage so marred that He no longer looked like a man (Isa. 52:14).
         The penetration of the skull and upper face by stout thorns could have precipitated a condition that Zugibe names major trigeminal neuralgia, generally associated with paroxysms of stabbing pain, in some cases so severe that it has been called one of the worst pains known to man (16). The effect of many penetrating thorns was probably comparable to multiple simultaneous toothaches.
  5. Before conducting Jesus to the cross, the soldiers ripped off the scarlet robe and replaced it with His own garment (Matt. 27:31; Mark 15:20). No doubt by then the kingly garb was firmly stuck to the freshly clotted wounds on His back. Pulling it away and reopening the wounds must have been excruciating.
  6. The soldiers required Jesus to carry the patibulum of His own cross to the place of execution, but before He had gone very far, they enlisted another man to take up the load (Matt. 27:31-32; Mark 15:20-21; Luke 23:26). We surmise that they resorted to getting help only because Jesus stumbled and fell, perhaps repeatedly. Whether He had one hand free to catch Himself, we do not know. Even if He did not, coming to the ground was perhaps a minor blow compared with the earlier blows of whip and fist, yet it was further jostling of nerves already in extreme pain.
  7. Upon arrival at Calvary, the soldiers took off His garment again, freshly aggravating the wounds on His back and shoulders.
  8. They nailed His hands and His feet to the cross. Here was probably the worst of all torments He was required to bear. The upper nails may have injured the median nerves, and the lower may have done similar damage to the plantar nerves (17). Such damage is known as causalgia, a condition that can induce a severe pain commonly described as searing (18). To suffer this condition in only one extremity may be traumatic enough to produce shock (19). Yet Jesus may have suffered it in all four extremities, and He could obtain no relief. Hanging in a splayed-out manner on a rough upright timber put the puncture wounds under unremitting tension, continually renewing the victim’s anguish and despair. Perhaps the nails alone were horrifically painful to an extent that they could bring on death. The feature that accounted for the brutal efficiency of Roman crucifixion in its most common form was likely the nails.
  9. The last insult to both Jesus’ humanity and deity was to lift Him upon the cross, so that He might be a public spectacle. If He were dragged upward by arms already nailed to the patibulum, the ruthless pain would surely have caused many men to lose consciousness. But Jesus kept His mind alert, although at the price of extreme agony.

Jesus’ Loss of Body Fluids

There is also no doubt that Jesus’ ordeal brought Him to a state of acute dehydration.

  1. His last meal and perhaps his last drink were during the last evening before His death.
  2. In the Garden, He sweated profusely, and the emission included drops of blood.
  3. The blows to His face and the buffeting perhaps elsewhere on His body doubtless caused both superficial and internal bleeding.
  4. The plucking of His beard caused bleeding all across His lower face.
  5. The flagrum inflicted multiple wounds, including visible lacerations, bruises, and weals. Internally He suffered hemorrhaging and fluid accumulation in his lung cavity (pleural effusion). The loss of fluids must have been severe (20).
  6. More bleeding followed when the crown of thorns was implanted on His head.
  7. The ripping off of His garment on two occasions freshened wounds and restarted the bleeding.
  8. The piercing of His hands and feet with thick spikes may have been the worst work of blood-letting. The continual pull of gravity on the extremities, causing pressure at the point of the wounds, must have disturbed clotting, so that the bleeding never stopped.
  9. The rigid vertical position of Jesus on the cross inhibited adequate blood flow to the upper parts of His body.
  10. Several authors have supposed that Jesus’ exposure to the sun was another factor increasing dehydration (21). Undoubtedly it was, but we must take into account that darkness fell after three hours.

A full consideration of what Jesus suffered leaves no doubt that shock was the probable cause of death. It is remarkable not that He died so soon, only after six hours, but that He survived so long.

The Seepage from Jesus’ Side

We gain some insight on Jesus' bodily state at the time of death by looking at the postmortem evidence. Shortly after He gave up His spirit, a Roman soldier made sure He was dead by dealing Him a wound that would have been fatal had He still been alive. The soldier thrust a spear upward into His side, undoubtedly into His heart cavity. John reports that from the wound emerged a mixture of blood and water (John 19:34).

What caused the bloody flow from the wound in Jesus' side? Various explanations have been proposed over the years, but the most recent comments by medical experts show an emerging consensus. They agree that the scourging Jesus received doubtless caused severe injury to the chest region. In consequence, fluid steadily accumulated in the sac surrounding the lungs. Such an accumulation, known as pleural effusion, is clear or yellowish in color, and in Jesus’ case the quantity could have been substantial (22). A spear thrust directly toward the heart would have passed through the lung (pleural) cavity before penetrating the heart (pericardial) cavity (23). When the soldier abruptly withdrew the spear, a small amount of blood from the heart cavity would have been dragged out by the spear point, and this red seepage would have been followed by some seepage of clear fluid from the pleural cavity (24).

Zugibe maintains that the red seepage was blood released by penetration of the heart itself (25). Marinella thinks, however, that it was a clear pericardial effusion tinged with blood, a mixture others have named hemopericardium. He states that a fluid of this composition can collect in the pericardial sac as a result of injury to the chest wall or heart muscle, and he supposes that the cause in Jesus’ case was trauma previously sustained by the heart, whether during His scourging or during His fall on the road to Golgotha (26). Zugibe, a cardiologist, views hemopericardium as probable only after rupture of the heart or aorta (27). While Edwards et al. believe that a hemopericardium due to heart rupture might have provided the red seepage, they agree with Zugibe that it more likely came from a spear puncture of the heart: specifically, the right atrium or ventricle (28). They conjecture moreover that a clear and watery pericardial effusion might have developed in the course of Jesus’ ordeal, augmenting the watery portion of what John saw flowing from Jesus’ side (29). Zugibe replies that pericardial effusion "is too small in volume and would be immediately mixed with the blood from the right atrium of the heart as a consequence of the piercing action of the spear" (30).

Many writers in the past have insisted that the flow of blood and water was a clear sign of a ruptured heart (31). When reviewing autopsies performed on several who died after their hearts ruptured, Stuart Bergsma stated, "The pericardial cavity was occupied by approximately 500 cc's of fluid and freshly clotted blood" (32). In his view, the water reported by John was the watery fluid normally present in the heart cavity. To this was added blood leaking from the torn wall of the heart.

But it is unlikely that Jesus suffered a broken heart from strictly natural causes. The usual cause of a ruptured heart is a heart attack, produced either by arteriosclerosis (heart disease) or a blood clot. The shut-off of circulation to the heart causes death of tissue (a condition known as infarction), and over a period of days the dead tissue softens and becomes prone to rupturing (33). My own father, for instance, died when his heart ruptured three days after he suffered a mild heart attack caused by a blood clot.

But it is unlikely that Jesus suffered from heart disease. There may have been clots circulating in His bloodstream, but these would more likely have lodged in His lungs (34). Edwards raises the possibility that the trauma Jesus suffered led to formation of noninfective thrombotic vegetations (clotlike lesions) on His heart valves. These are known to develop as a result of severe trauma. Moreover, these can break loose and clog circulation, producing an infarction (35). The question remains, however, whether rupturing due to any cause could happen within the time frame of Jesus’ crucifixion. He died within a few hours, not days after the onset of His ordeal.

Following an acute infarction, can rupturing occur sooner than a lapse of days? Edwards cites research showing that rupturing can occur, although rarely, within hours (36). But given Jesus’ perfect genetic endowment, His youth, and His sinless life, we doubt that His susceptibility to any pathological condition would have placed Him among the weakest rather than the strongest. No, His heart tissue would not have deteriorated so quickly to the point of rupture.

The Cause of Jesus’ Death

Jesus' death cannot be attributed to any physical cause. He taught His disciples,

17 Therefore doth my Father love me, because I lay down my life, that I might take it again.

18 No man taketh it from me, but I lay it down of myself. I have power to lay it down, and I have power to take it again. This commandment have I received of my Father.

John 10:17-18

In other words, He could live or die as He willed. Even when His body reached a condition that would have been fatal to other men, He had the power to go on living. The Gospel accounts show clearly that He died only when He chose to die. His next to last saying was, "Father, into thy hands I commend my spirit" (Luke 23:46). Matthew declares that His death came when He "yielded up the ghost [that is, 'spirit']" (Matt. 27:50). John uses a similar expression, translated "gave up the ghost [that is, 'spirit']" (John 19:30). It was impossible that God Incarnate should die apart from His own consent. Yet when His body could no longer function without supernatural help, He did not cling to life. Instead, He willingly commended His spirit to the Father and breathed no more (Luke 23:46).

Just as the cause of Jesus’ death is beyond medical analysis, so also is the exact sequence of internal processes before His death and the exact condition of His body at the time of death. Some have supposed that anyone approaching death on a cross was too debilitated to speak except in a halting and mumbling fashion (37). Yet Jesus cried out with a loud voice, and the centurion was so amazed that he was willing to call Jesus the Son of God (Mark 15:37-9). In other words, until the very end, Jesus had access to supernatural strength and wielded supernatural control of His own body.

We may not therefore dismiss the possibility that He suffered a broken heart. The strongest evidence for it comes from prophecy. In the psalm giving an uncannily correct foreglimpse of what Jesus would suffer on the cross, the victim on the threshold of death says, "My heart is like wax; it is melted in the midst of my bowels" (Psa. 22:14). The imagery is meaningless if it does not describe a real crisis in heart function. Melting is apt language if it speaks of a heart disintegrating and releasing fluid. The melt likely refers to blood seeping into the heart cavity after the heart has ruptured.

Many readers assume that the psalmist is casting Jesus’ experience into poetic language employing hyperbole (that is, deliberate exaggeration to express feelings that exceed the capacity of ordinary language). Support for this interpretation looks to the previous statement. The man on the cross cries out, "All my bones are out of joint." A plausible line of reasoning goes like this. However terrible crucifixion was, nothing like a general disconnection of bones took place. Thus, judging from the context, we should view the victim's account of His experience as subjective rather than literal truth. More precisely, we should view the melting of the man’s heart as a figure whose details do not necessarily prophesy real facts. Yet the fallacy in this reasoning is its starting point: an unfortunate translation. "Out of joint" is better rendered "spread apart" (38) or simply "separated" (39). The grotesque stretching of Jesus' body on the cross must truly have produced a sensation of extreme pressure on His joints. How the victim describes his ordeal is exactly correct. We return therefore to the possibility that the melting of His heart speaks of heart rupture.

It would be wrong to say that Jesus died from a broken heart. Rather, He died with a broken heart. We may suppose that heart rupture could be the result of anything drastically raising the internal pressure. It is possible that violent irregular contractions induced by severe emotional and physical stress so squeezed the blood inside the heart that internal pressure rose to bursting strength, especially if the heart had indeed been wounded in the course of Jesus’ ordeal. Jesus' broken heart could, in fact, have been caused by His tremendous agony of soul, as He bore our sins and felt the infinite weight and coldness of the Father's wrath. The muscular exertion required to burst Jesus’ heart may have been humanly impossible, perhaps even for a healthy man, but it was within the power of the divine man. So, we see as plausible the position taken by Arthur Custance. He said that the last assault on Jesus’ body was not a pathological event within the normal experience of mankind, but an unprecedented heart-rending grief swelling within the infinite dimensions of His own soul (40).


  1. Zugibe, 101-2.
  2. Barbet, 74-7.
  3. Tzaferis, 49-50; Arthur Custance, "Did the Lord Die of Heart Rupture?" in The Virgin Birth and the Incarnation, vol. 5 of The Doorway Papers (Grand Rapids, Mich.: Zondervan Publishing House, 1976), 303-4; Zugibe, 57.
  4. Barbet, 76, 174.
  5. Ibid., 77-8.
  6. Ibid., 174; Zugibe, 103.
  7. Ibid., 108-116.
  8. Ibid., 116-8.
  9. Ibid., 40
  10. Ibid., 106.
  11. Ibid., 135.
  12. Ibid., 130-5.
  13. Ibid., 7-15.
  14. Ibid., 17-25; Barbet, 47-8, 83-4; McDowell, 43-4; Kiehl, 113-6; Mark A. Marinella, Died He for Me: A Physician’s View of the Crucifixion of Jesus Christ (Ventura, CA: Nordskog Publishing, 2008), 49-58; Hunt, 109-112.
  15. Eusebius Church History 4.15.
  16. Zugibe, 33-7.
  17. Ibid., 92, 97, 133.
  18. Ibid.
  19. Ibid., 92.
  20. Ibid., 130, 132.
  21. Marinella, 72-3; Zugibe, 133.
  22. Zugibe, 139-140; Marinella, 76-7; William D. Edwards, Wesley J. Gabel, and Floyd E. Hosmer, “On the Physical Death of Jesus Christ,” Journal of the American Medical Association 255:11 (March 21, 1986): 1455-63 (p. 1463).
  23. Zugibe 140; Marinella 79, 91; Edwards et al., 1462-3.
  24. Zugibe, loc. cit.
  25. Ibid.
  26. Marinella, 78-9, 90-1.
  27. Zugibe, 139.
  28. Edwards et al., loc. cit.
  29. Edwards et al., 1463.
  30. Zugibe, 143.
  31. Custance, 303-305; McDowell, 48-9.
  32. Stuart Bergsma, "Did Jesus Die of a Broken Heart?" The Calvin Forum, March 1948, 165, quoted by McDowell, 48.
  33. Zugibe, 123-6.
  34. Marinella, 78.
  35. Edwards et al., op. cit.
  36. Ibid.
  37. Marinella, 87-8, 92
  38. Green, 2:1402.
  39. Francis Brown, S. R. Driver, and Charles A. Briggs, The New Brown-Driver-Briggs Hebrew and English Lexicon with an Appendix Containing the Biblical Aramaic (n.p., 1906; repr., Peabody, Mass.: Hendrickson Publishers, 1979), 825.
  40. Custance, 308-14.