Next, the feet were fixed to the cross, either by nails or ropes. Ossuary findings and the Shroud of Turin suggest that nailing was the preferred Roman practice.23, 24, 30 Although the feet could be fixed to the sides of the stipes or to a wooden footrest (suppedaneum), they usually were nailed directly to the front of the stipes (Fig 5).11 To accomplish this, flexion of the knees may have been quite prominent, and the bent legs may have been rotated laterally (Fig 6) 23 -25, 30
Fig 5.Nailing of feet. Left, Position of feet atop one another and against stipes. Upper right, Location of nail in second intermetatarsal space. Lower right, Cross section of foot, at plane indicated at left, showing path of nail.
When the nailing was completed, the titulus was attached to the cross, by nails or cords, just above the victim’s head.11 The soldiers and the civilian crowd often taunted and jeered the condemned man, and the soldiers customarily divided up his clothes among themselves 11, 25 The length of survival generally ranged from three or four hours to three or four days and appears to have been inversely related to the severity of the scourging.8, 11 However, even if the scourging had been relatively mild, the Roman soldiers could hasten death by breaking the legs below the knees (erurifragium or skelokopia).8, 11
Not uncommonly, insects would light upon or burrow into the open wounds or the eyes, ears, and nose of the dying and helpless victim, and birds of prey would tear at these sites.16 Moreover, it was customary to leave the corpse on the cross to be devoured by predatory animals..8, 11, 12, 28 However, by Roman law, the family of the condemned could take the body for burial, after obtaining permission from the Roman judge.11
Since no one was intended to survive crucifixions the body was not released to the family until the soldiers were sure that the victim was dead. By custom, one of the Roman guards would pierce the body with a sword or lance.8, 11 Traditionally, this had been considered a spear wound to the heart through the right side of the chest — a fatal wound probably taught to most Roman soldiers.11 The Shroud of Turin documents this form of injury.5, 11, 22 Moreover, the standard infantry spear, which was 5 to 6 ft (1.5 to 1.8 m) long,lø could easily have reached the chest of a man crucified on the customary low cross.”
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 orthostatie hypotension and even hypovolemie shock.8, 12 When the victim was thrown to the ground on his back, in preparation for transfixion of the hands, his scourging wounds most likely would become torn open again and contaminated with dirt.2, 16 Furthermore, with each respiration, the painful scourging wounds would be scraped against the rough wood of the stipes. 7 As a result, blood loss from the back probably would continue throughout the crucifixion ordeal.
With arms outstretched but not taut, the wrists were nailed to the patibulum.7, 11 It has been shown that the ligaments and bones of the wrist can support the weight of a body hanging from them, but the palms cannot.11 Accordingly, the iron spikes probably were driven between the radius and the carpals or between the two rows of carpal bones, 2, 10, 11, 30 either proximal to or through the strong bandlike flexor retinaeulum and the various interearpal ligaments (Fig 4). Although a nail in either location in the wrist might pass between the bony elements and thereby produce no fractures, the likelihood of painful periosteal injury would seem great. Furthermore, the driven nail would crush or sever the rather large sensorimotor median nerve (Fig 4).2, 7, 11 The stimulated nerve would produce excruciating bolts of fiery pain in both arms.7, 9 Although the severed median nerve would result in paralysis of a portion of the hand, isehemie eontraetures and impalement of various ligaments by the iron spike might produce a clawlike grasp.
Fig 6. Respirations during crucifixion. Left, Inhalation. With elbows extended and shoulders abducted, respiratory muscles of inhalation are passively stretched and thorax is expanded. Right, Exhalation. With elbows flexed and shoulders adducted and with weight of body on nailed feet, exhalation is accomplished as active, rather than passive, process. Breaking legs below knees would place burden of exhalation on shoulder and arm muscles alone and soon would result in exhaustion asphyxia.
Most commonly, the feet were fixed to the front of the stipes by means of an iron spike driven through the first or second intermetatarsal space, just distal to the tarsometatarsal joint.2, 5, 8, 11, 30 It is likely that the deep peroneal nerve and branches of the medial and lateral plantar nerves would have been injured by the nails (Fig 5). 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, pass through the favored anatomic sites of transfixion. 2, 10, 11
The major pathophysiologic effect of crucifixion, beyond the excruciating pain, was a marked interference with normal respiration, particularly exhalation (Fig 6). The weight of the body, pulling down on the outstretched arms and shoulders, would tend to fix the intercostal muscles in an inhalation state and thereby hinder passive exhalation. 2, 10, 11 Accordingly, exhalation was primarily diaphragmatic, and breathing was shallow. It is likely that this form of respiration would not suffice and that hypercarbia would soon result. The onset of muscle cramps or tetanic contractions, due to fatigue and hypercarbia, would hinder respiration even further.11
Adequate exhalation required lifting the body by pushing up on the feet and by flexing the elbows and adducting the shoulders (Fig 6) 2 However, this maneuver would place the entire weight of the body on the tarsals and would produce searing pain.7 Furthermore, flexion of the elbows would cause rotation of the wrists about the iron nails and cause fiery pain along the damaged median nerves.7 Lifting of the body would also painfully scrape the scourged back against the rough wooden stipes. 2, 7 Muscle cramps and paresthesias of the outstretched and uplifted arms would add to the discomfort. 7 As a result, each respiratory effort would become agonizing and tiring and lead eventually to asphyxia. 2, 3, 7, 10, 11
The actual cause of death by crucifixion was multifactorial and varied somewhat with each ease, but the two most prominent causes probably were hypovolemie shock and exhaustion asphyxia.2, 3, 7, 10 Other possible contributing factors included dehydration, 7, 16 stress-induced arrhythmias,3 and congestive heart failure with the rapid accumulation of pericardial and perhaps pleural effusions. 2, 7, 11 Crucifracture (breaking the legs below the knees), if performed, led to an asphyxic death within minutes.11 Death by crucifixion was, in every sense of the word, excruciating (Latin, excruciatus, or “out of the cross”).
Crucifixion of Jesus
After the scourging and the mocking, at about 9 AM, the Roman soldiers put Jesus’ clothes back on him and then led him and two thieves to be crucified.1 Jesus apparently was so weakened by the severe flogging that he could not carry the patibulum from the Praetorium to the site of crucifixion one third of a mile (600 to 650 m) away.1, 3, 5, 7 Simon of Cyrene was summoned to carry Christ’s cross, and the processional then made its way to Golgotha (or Calvary), an established crucifixion site.
Here, Jesus’ clothes, except for a linen loincloth, again were removed, thereby probably reopening the scourging wounds. He then was offered a drink of wine mixed with myrrh (gall) but, after tasting it, refused the drink.1 Finally, Jesus and the two thieves were crucified. Although scriptural references are made to nails in the hands,1 these are not at odds with the archaeological evidence of wrist wounds, since the ancients customarily considered the wrist to be a part of the hand.7, 11 The titulus (Fig 3) was attached above Jesus’ head. It is unclear whether Jesus was crucified on the Tau cross or the Latin cross; archaeological findings favor the former 11 and early tradition the latter.38 The fact that Jesus later was offered a drink of wine vinegar from a sponge placed on the stalk of the hyssop plant1 (approximately 20 in, or 50 em, long) strongly supports the belief that Jesus was crucified on the short cross.6
The soldiers and the civilian crowd taunted Jesus throughout the crucifixion ordeal, and the soldiers east lots for his clothing. 1 Christ spoke seven times from the cross.’ Since speech occurs during exhalation, these short, terse utterances must have been particularly difficult and painful. At about 3 PM that Friday, Jesus cried out in a loud voice, bowed his head, and died.1 The Roman soldiers and onlookers recognized his moment of death.1
Since the Jews did not want the bodies to remain on the crosses after sunset, the beginning of the Sabbath, they asked Pontius Pilate to order erueifraeture to hasten the deaths of the three crucified men.1 The soldiers broke the legs of the two thieves, but when they came to Jesus and saw that he was already dead, they did not break his legs.1 Rather, one of the soldiers pierced his side, probably with an infantry spear, and produced a sudden flow of blood and water.1 Later that day, Jesus’ body was taken down from the cross and placed in a tomb.1
Fig 7.Spear wound to chest. Left, Probable path of spear. Right, Cross section of thorax, at level of plane indicated at left, showing structures perforated by spear. LA indicates left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
DEATH OF JESUS
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 failure.2, 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.
 an incorporating a Alexander the Greats Greek culture, language and philosophy
 Isaiah 48:2-5 For they call themselves after the holy city, And lean on the God of Israel; The Lord of hosts is His name: 3 “I have declared the former things from the beginning; They went forth from My mouth, and I caused them to hear it. Suddenly I did them, and they came to pass. 4 Because I knew that you were obstinate, And your neck was an iron sinew, And your brow bronze, 5 Even from the beginning I have declared it to you; Before it came to pass I proclaimed it to you, Lest you should say, ‘My idol has done them, And my carved image and my molded image Have commanded them.’
 2 Peter 1:19-21 And so we have the prophetic word confirmed, which you do well to heed as a light that shines in a dark place, until the day dawns and the morning star rises in your hearts; 20 knowing this first, that no prophecy of Scripture is of any private interpretation, 21 for prophecy never came by the will of man, but holy men of God spoke as they were moved by the Holy Spirit.