Updated: Mar 22, 2021
By William Lynes
Lazarus is a man of the new testament, living in the time of Jesus Christ in the city of Bethany. He was the brother of two of Christ’s followers, sisters Mary and Martha. Bethany sat less than 2 miles south of Jerusalem in Israel. The story of Lazarus’ death and Christ’s rising from the dead, is depicted in John 11:1-45.
What are the details of Lazarus’ illness and subsequent reappearance?
As only a physician would, when I read this story I ask what disease Lazarus suffered from, did Lazarus truly die or was he just ill, and therefore only healed of his illness. The following discusses this story in a manner that might fit nicely in a Clinical Pathologic Conference such as those reported in the New England Journal of Medicine.
What Caused Lazarus’ Illness?
Lazarus did not die suddenly as Jesus was sent word that he was sick, implying some length of illness (v 11:3). Therefore, he had a progressive illness which led to a mortal condition. This progressive illness could be from an overwhelming infection such as pneumonia or a plague-like illness. The infection leads to sepsis (infection in the bloodstream) and the syndrome of septic shock, systemic collapse, and death.
Septic Shock is the end result of overwhelming infection. In addition, in death due to chronic illness such as cancer, it is a very common final pathway leading to death. The mechanisms of septic shock or sepsis are very complicated but three major effects of overwhelming infection lead to septic shock and subsequent death.
1. Bacterial products in the bloodstream have adverse effects on lung gas exchange, leading to hypoxia or oxygen starvation ie. Less oxygen in bloodstream.
2. Blood flow is shunted by toxic factors that stop the regulation of blood vessel tone. This results in shunting more blood to areas not in need, and less blood to areas that are in need. This results in hypoxia of all tissues, of which the kidneys and liver are perhaps the most important in maintaining life.
3. Brain stem hypoxia leads to less stimulus to breath, leading to reduced ventilation and worsening of hypoxia.
Lazarus on the other hand, may have suffered from a chronic disease such as cancer, coronary artery disease, and heart failure, or other chronic illness responsible for deaths. Death in these states may occur by wasting and nutritional effects, but in such a chronic illness the last pathway is often infection leading to sepsis.
Was Lazarus dead, or severely ill?
Importantly, Lazarus was deathly ill. His illness was such that the sisters sent word to Jesus, considered “Lord” by Mary and Martha (V3). This supports the severity and deathly nature of his illness. Jesus waited to come to Bethany for over two days (v 6) and eventually 4 days (v 39), allowing this deathly state to progress to what was reported to Jesus as Lazarus’ death (v 21). We know that Lazarus was dead, as determined by many at the scene. In addition, not only Mary and Martha reported that he was dead, but many others said the same to Christ after his arrival in Bethany (v 37). This included the most educated of the day, Jewish Pharisees (v46). Evidence includes the fact that he was placed in a tomb, wrapped in grave clothes, and the opening closed off with a stone (v 44); an act only performed on the absolutely dead. Those who witnessed the events worried that the decay process of death, over the now 4 days, would have resulted in a “bad odor” when the stone was rolled away from his grave (v39).
Decomposition occurs only in the dead.
A bad odor occurs due to irreversible (except during resurrection) cell death as follows:
Mechanism of cell death
Respiration and circulation stops-tissue oxygen levels drop- cell metabolism ceases and energy sources are depleted. This leads to cell injury and irreversible cell death
Hypoxia leads to lactic acidosis and decreased pH, which results in inhibition of enzyme function and protein synthesis
Cellular effect of cell injury- primarily due to lack of energy sources
Membrane permeability leads to cellular swelling.
Nuclear chromosomes, containing DNA, clump and the nuclear membrane swells.
Lysosomes, which store digestive enzymes, leak these into cells through their leaky membranes. The lysosome eventually swells and eventually rupture. This, dumping of lysosome contents, is thought to signify a point of no return
As with the nucleus and lysosome, mitochondria, which produce and store energy, rupture, destroying this necessary cellular organelle.
Cell death depends on the magnitude of cell injury and the type of organ
In general, the point of no return occurs within 8 hours of the onset of sepsis.
1. Kidney 15 minutes 2. Liver 30-45 minutes 3. Heart 24 hours 4.Brain 4-5 mins 5. Miscellaneous tissues decay- normal bacteria invade dead tissue- ? how long? A dirty wound occurs after 24 hours.
The appearance of the body.
Lazarus would have appeared to the witnesses as follows:
– Pallor- pale skin – Cold – Rigid- rigor mortis – Turgidity- bruising of dependent parts of the body ex. Buttocks if died on back -Cyanosis- blueness of areas normally pink due to prominent blood flow- ex blue lips and nail beds
The appearance of organs when dead
1.Kidney- enlarged/pale/yellow 2. Liver- enlarged/yellow/soft/greasy 3. Heart- yellow/flabby 4. Brain- pale/swollen/loss of wrinkles (sulci/ gyri) 5. Pupils fixed and dilated
Lazarus was dead, decomposing for four days, and raised from the dead to live another day.
So Lazarus was dead. We know this because many witnessed his death. In addition, he was entombed and placed in grave clothes, something never done in the case of maybe dead. We know as well that he lay in this state for four days. His death at four days would have been accompanied by tremendous cellular death, decomposition, and a horrible stench.