Emergency Care of the Crucifixion Victim

Accident and Emergency Nursing (2002) 10, 235–239 ª 2002 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0965-2302(02)00127-3, available online at http://www.idealibrary.com on Emergency care of the crucifixion victim Scott L DeBoer, Charles L Maddow ... of all punishments, it is the most cruel and most terrifying Cicero, first century A.D. Of all the terrible ways to die, most people say that death by fire or death by drowning are the worst. If you lived 2000 years ago however, you most certainly would disagree. Throughout world history, one of the most feared deaths was that of crucifixion. This article will guide you through the medical, psychological, and emotional aspects of crucifixion. The death of the man called Jesus Christ will be used to illustrate the use of a punishment that was unequalled in its cruelty and depth of suffering. This article will review not only the injuries associated with crucifixion, as well as current medical archaeological theories relating to the suffering and eventual death on a cross, but Scott L DeBoer also using the introduction case study, the initial assessment and resuscitation of a crucifixion RN,MSN,CEN,CCRN, CFRN Flight Nurse victim will be addressed. Regardless of religious beliefs, this article will give attendees a Educator: UCAN, deeper awareness of ‘‘and they crucified him’’. ª 2002 Elsevier Science Ltd. All rights University of Chicago Hospitals, reserved. Owner: Peds-R-Us Medical Education, Chicago, Illinois USA Charles L Maddow ... MD, Senior Medic 101 to County General We are en route it still is being performed as evidenced by the Instructor of with a 33-year old male who was the victim of a current practice in areas of the Philippines, Emergency crucifixion. He is in traumatic arrest, intubated where volunteers undergo crucifixion Medicine, University of Rochester School and 100% oxygen is being administered. We have (complete with scourging and nailing to a of Medicine and two IV’s with LR wide open and will be at your cross, though not to the point of death) during Dentistry, ER in 2 minutes. Lent each year as penance and to show their Rochester, New York, USA devotion to Jesus Christ (Discovery Channel When one considers the ‘‘worst ways to Video 2001). This article will review the injuries Correspondence to: die’’, typical responses include death by and causes of death associated with crucifixion, Scott DeBoer, 2301 drowning and death by fire. However, as detailed by archaeologists, theologians, and Flint Court, Dyer, IN throughout history, a much more feared death medical professionals. 46311, USA. Tel.: +1-219-865- was that of death by crucifixion. Even though In the previous paramedic report, you are 9380; Fax: +1-219- crucifixion was ‘‘outlawed’’ as a method of told that in 2 minutes, a victim of crucifixion 865-9271; execution by Constantine early in the fourth will be arriving at your ER. Simply put, this E-mail: pedsrusscott @cs.com century, several descriptions of victims being will be a trauma patient like no other. The crucified are found throughout subsequent Romans did not invent the idea of crucifixion; Manuscript history. More recently, several forensic science however they did perfect it. Crucifixion was received: and mystery novels have also ‘‘resurrected’’ created with the simple concept of maximum 24 January 2002 accepted: crucifixion as the way that unfortunate victims torture and shame for as long as a person could 17 May 2002 are tortured and later killed. Though quite rare, survive. As a rule, victims were not allowed ª 2002 Elsevier Science Ltd. All rights reserved. Accident and Emergency Nursing (2002) 10, 235–239 235 Emergency care of the crucifixion victim medical treatment after crucifixion, but this It is difficult, but not impossible to breathe patient is about to arrive at your door. as the victim hangs on the cross. However, as To understand the injuries associated with the lungs begin to fill with fluid, the end crucifixion, one must first remember that the quickly draws near. Pleural effusions develop process starts long before one is ‘‘nailed’’ to a due the effects of the traumatic scourging and cross. In Roman times, scourging or flogging irreversible shock ensues. Soldiers at the cross was a legal prerequisite to all crucifixions. A offer a sip of vinegar wine as an effort to person was tied nude to a post, while one or deaden the pain, however, it is too little, too two soldiers utilized leather straps with bones late. As a result of the continuing blood loss, or pieces of metal at the ends to attempt to respiratory failure, dehydration and shock, remove every piece of flesh from the back. finally, mercifully, the crucifixion victim dies. Called the ‘‘half-death’’, the idea was to bring In an effort to assure the death of the victim, the person to be crucified ‘‘one stroke away soldiers pierce a lance through the right chest, from death’’. Though scourging could be used perforating the heart and lungs, as evidenced as a form of execution, the real punishment by the flow of ‘‘ blood and water’’ (Edwards was yet to come (Edwards et al. 1986; Zugibe et al. 1986; Zugibe 1988). 1988). Now remember that a victim of these similar After surviving the scourging, the victim tortures is being brought to your ER. Despite had to ‘‘carry their own cross’’ to the place of gruesome and distracting injuries, care of this execution. Paintings have portrayed Jesus and all major trauma patients should follow Christ and others carrying the entire cross, the same pathway, with attention to the however this probably was not the case. The immediate life threats and necessary critical stipes, or vertical post, was permanently fixed actions. A patient sustaining the injuries at the place of execution and the victim carried associated with scourging and crucifixion only the patibulum or cross-beam. As a would likely deserve endotracheal intubation patibulum would weigh as much as 50–125 and mechanical ventilation. All patients in pounds, this was no easy task, especially after cardiac arrest should be immediately surviving the brutal scourging. Throughout the intubated. The patient not in arrest should be ‘‘parade of shame’’, the victim carried a sign intubated for depressed mental status detailing their name and crimes, while (classically, Glasgow Coma Score of 6 8), spectators mocked the victim (Edwards et al. absence of gag and other protective airway 1986; Zugibe 1988). When arriving at the reflexes, ineffective oxygenation or ventilation, designated site, the crucifixion truly begins. or reasonable expectation of any of the above. Though ropes were occasionally used, the Most theories of the exact causes of death by Romans preferred nailing as the method of crucifixion have focused on respiratory failure, choice for fixing people to the cross. The person with the body’s weight rapidly fatiguing the was thrown onto the ground and a group of intercostal muscles. This leaves the diaphragm soldiers proceeded to drive a nail (similar to a as the sole muscle driving ventilation. As the railroad spike) through the hands/wrists/ diaphragm tires, exhalation, dependant on forearms to attach them to the patibulum. intercostal muscles and opposed by the body’s Then, the person was lifted onto the stipes weight expanding the chest cage, is impaired, (vertical post) and the feet, individually or resulting in progressive CO2 retention in an together, were nailed to the cross. There is obstructive pattern similar to the severe asthma relatively minimal blood loss from the nails, or COPD patient (Edwards et al. 1986). however the loss from the scourging was Other theories suggest that the scourging substantial. As the victim is now suspended by prior to the actual crucifixion brings on death the nails in the hands and feet, pain beyond all due to effects of blunt chest trauma. A high comprehension ensues as the nails rub against likelihood of painful rib fractures or even flail the great nerves. The taking of each breath chest would lead to inefficient respiratory involves moving the hands and feet against the mechanics. Hemothorax from intercostal nails and rubbing the bloody flesh against the arteries lacerated by shards of bone, and rough wood (Edwards et al. 1986). transudative pleural effusion from contused 236 Accident and Emergency Nursing (2002) 10, 235–239 ª 2002 Elsevier Science Ltd. All rights reserved. Emergency care of the crucifixion victim muscles, further embarrass respiratory decompress a right tension pneumothorax, mechanics (Edwards et al. 1986; Zugibe 1988). must be also be assumed to have hit major Larger amounts of force could have led to thoracic vessels and potentially the heart itself pulmonary contusions and haemorrhage, (Stern & Bobek 2001; Colucciello & Ferrera which as edema progresses, increasingly 2001). impair oxygenation. In any case, the likelihood The sudden loss of vital signs following is great that even were the patient removed penetrating chest trauma, if it occurs within from the cross with an intact mental status and 5–10 min of medical care is an indication for an protecting his airway, the nature of his emergent thoracotomy or ‘‘cracking the chest’’. multiple injuries would necessitate One could not know for certain if this patient endotracheal intubation and mechanical was truly dead at the time of this injury or ventilation with 100% oxygen and PEEP. simply moribund due to the lethal, though Lastly, the concept of shock as the cause of potentially reversible, processes discussed death is one that must be examined. Ongoing above. The goals of emergent thoracotomy are studies done by Dr. F. Zugibe (Zugibe 1988) in simple: to identify life threatening injuries and which healthy medical student volunteers were address those injuries in such a fashion that suspended on a cross, while monitoring of labs, will allow patients to survive until definitive vital signs, and cardiopulmonary statuses were surgical care is available.

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