There are good reasons Saint John reported water and blood flowed from Jesus’ side after the Roman soldier pierced him with a spear. The medical explanation is called pericardial tamponade – a condition usually resulting from major chest trauma.
Many NT scholars believe Jesus suffered from this condition in his final moments. Basically, it is a condition where water fills the sac surrounding the heart (called the pericardium). Since we know Jesus was flogged and beaten, this is where he could have suffered the chest trauma. Pastor Mark Driscoll, Marshill Church, said he believes it was either this, or that Jesus fell under his cross beam when he was carrying it. Cross beams could way more than 100 pounds (like a railroad tie) and would crush a man's chest if he fell under it. This would explain why John's gospel mentions Jesus carried his own cross, but the synoptic gospels claim Simon carried it. One could mend this surface contradiction by holding that Jesus began by carrying his cross beam, but weakened from his flogging, fell underneath the weight and was crushed, and from that point being unable to carry the beam, thus needing Simon's help.
With that kind of chest trauma, fluid would build around the heart causing massive heart failure and death. This would explain why blood and water came out when his side was pierced with a spear. This would also debunk the swoon theory, which states that Jesus merely passed out on the cross, and the Romans, (who were professional executioners) mistook him for being dead. If water came from his side, chances are he surely died from massive heart failure.
Here's why it was significant enough for Saint John to record it. Water and blood played significant roles in the ritual cleansing of a person. Baptism was a very common ritual, and the law required baptism for a number of situations. For example, a woman who finished her menstrual cycle would need to be immersed in water before being clean again. Another example is seen with the high priest, who was baptized five times before entering the Most Holy Place on Yom Kippur (the Day of Atonement).
Also, we know that blood atones for sin, and "without the shedding of blood there is no forgiveness of sins" (Heb. 9:22). In fact, in many cleansing rituals, blood and water were used together. For example, in order for a leper who had been healed, to be pronounced ceremonially clean, he needed to be (among other things) sprinkled with blood and water together, then baptized (Lev. 14:1-9, Heb. 9:19-20). The blood is necessary for atonement because the wages of sin is death, (Rom. 6:23) and the life of a creature is in its blood (Lev. 17:14). Water (I suppose) is significant because it is the one base substance needed for all kinds of cleaning – so blood for the life, and water for the cleansing. These things don't evoke very much imagery in our culture because we are so far removed from animal sacrifices (which required blood and lots of water). But to the first-century Jew, blood and water together evoked graphic imagery of death, substitution and purification. 1 John hammers on this: "This is he who came by water and blood - Jesus Christ; not by the water only but by the water and the blood" (5:6a). Additionally, water in the near east has always been a symbol of life. Consider that Jesus referred attaining eternal life through “living water” (John 4:14).
This is also why the Christian sacraments (baptism and communion) are symbols of water and blood. The third element is the Spirit, where Jesus will "baptize us in spirit and fire" (Luke 3:16). Further along in 1 John 5, the spirit is mentioned as the third witness (verses 6-9). So, water blood and the Spirit are major themes for us. One could even argue our baptism is a picture of the great flood from Gen. 6, and our immersion with the spirit a picture of how God will one day immerse the earth in fire (Rev. 8) - both having cleansing properties. We see all three elements at the cross right at the point of Jesus’ death. His last words were "Father, into your hands I commit my spirit!" Then, water and blood flowed from his side. Water, blood, spirit.
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