Let us examine some aspects of heart rupture as a physiological phenomenon in general, and as one circumstance involved in the sufferings of our Lord.
It should be noted, in passing, that during the last century postmortems were much more common (at least in Europe) than they are today.
For one thing, in those days it was not necessary to obtain permission either beforehand from the deceased or afterwards from the nearest of kin.
Today it is, and as a consequence it is far less often carried out.
Thus although instances of heart rupture in circumstances such as those considered below may, in fact, be more frequent than present literature indicates, they are not recognized as such.
In many of the cases which follow, heart rupture was reported because postmortems had been carried out.
Heart rupture may occur in response to either great agony of soul or great joy.
In the latter case it may be that rather than joy it is an experience of tremendous relief which overwhelms the heart.
Dr. Stroud referred to a lady who, being suddenly told of the return of her son from the Indies, a return which she had feared would never occur, was so overwhelmed that she suffered a rupture of the heart which proved fatal.
He referred in the same place to another lady who was so extremely affected with sorrow at the departure of her son for Turkey that she died suddenly at the very moment she was about to withdraw her hand from the parting farewell.(12)
Historians present us with many instances of the fatal effects of excess joy, but the circumstances often reveal that it was relief from great anxiety which really overwhelmed the individual's emotional system.
Pliny, for example, informed us that Chilo, the Lacedemonian, died upon hearing that his son had gained a prize in the Olympic Games. (13)
Valerius Maximus has told us that Sophocles, the tragic writer, in a contest of honour, died in consequence of a decision being pronounced in his favour. (14)
Alus Gellius mentioned a remarkable example in the sudden death of Diagoras, whose three sons were crowned the same day as victors in the Olympic Games, the one as a pugilist, the second as a wrestler, and the third in both capacities. (15)
Livy also mentioned the case of an aged mother who, while she was in the depths of distress from the tidings of her son having been slain in battle, died in his arms from excess of joy on his safe return. (16)
According to Dr. Thomas Cogan, all these are probably examples of rupture due to emotion. (17)
We do not, of course, have any positive proof, since no autopsy was reported in any of these cases.
On the other hand, J. G. Zimmermann noted that Philip V of Spain died suddenly on being told that the Spaniards had been defeated; and an autopsy showed that his heart had ruptured. (18)
According to Stroud, a Dr. Hope in a work published in London in 1839 entitled On the Diseases of the Heart and Great Vessels
, stated, "Rupture of the heart or great vessels into the pericardium is not always immediately fatal, as a solid coagulum or a fibrinous concretum has in several instances been known to arrest the hemorrhage for a few hours. Of the ten cases mentioned by one authority, eight died instantly, one in about two hours, and another in fourteen hours." (19)
Stroud also mentioned a case recorded by a German physician, Dr. Daniel Fischer, who wrote as follows: (20)
A gentleman, aged 68, and apparently possessing every claim to longevity, was, after having spent many years at court, compelled to quit it and retire to a country residence. . . . Toward the close of life his attention was occupied by an unpleasant business, which, as interfering with the indulgence of his propensity for solitude, had the effect of aggravating his melancholy. . . . On the 16th of October, 1817, he was seized, while walking, with a severe pain, which he supposed to be cramp at the stomach. The pain, after returning repeatedly, attended with violent agitation and agony, proved fatal on the evening of the 20th (i.e., four days later). On examination of the body 18 hours after death, the only morbid condition of any importance was rupture of the heart.
On puncturing the pericardium, which had the appearance of being distended by a substance of a dark blue colour, a quantity of reddish fluid escaped, and afterwards florid blood to the amount of two or three pounds. The membrane was then slit up, and the heart was found to be surrounded by a coagulum more than three pounds in weight. When this was cleared away, a rupture was discovered in the left ventricle, which extended upwards from the apex about one and a half inches on the external surface. The internal wound was found to be about half an inch in length. . . .
Owing to the smallness of the aperture, the fatal consequences of this rupture had evidently been protracted.
A word is necessary about the probable course of events, considered purely from a physiological point of view, which lead to the actual rupture of the heart. According to Allan Burns in his Diseases of the Heart
, this is what happens: (21)
The immediate cause is a sudden and violent contraction of one of the ventricles, usually the left, on the column of blood thrown into it by a similar contraction of the corresponding auricle.
Prevented from returning backward by the intervening valve, and not finding sufficient outlet forward in the connecting artery, the blood reacts against the ventricle itself which is consequently torn open at the point of greatest distention, or least resistance.
A quantity of blood is hereby discharged into the pericardium, and having no means of escape from that capsule, stops the circulation by compressing the heart from without and induces almost instantaneous death. In young and vigorous subjects, the blood thus collected in the pericardium soon divides into its constituent parts, namely, a pale watery liquid called serum, and a soft clotted substance of a deep red colour termed crassamentum.
As pointed out by Krumbhaar and Crowell, (22)
most cases of spontaneous rupture of the heart recorded in modern times are considered to be due primarily to coronary disease which has produced infarction and partial or complete aneurysm.
Death is then said to be due to hemopericardium, i.e., effusion of blood into the pericardial sac. Karsner says that in hemopericardium from rupture of the heart wall, the intraventricular pressure is communicated directly to the pericardial sac. (23)
This compresses intrapericardial pulmonary veins and also inhibits cardiac diastole. The result is usually rapidly fatal. When compression of the heart results from hemorrhage into the pericardium, usually occurring after rupture of the heart, it is referred to as cardiac tamponade.
Conversation with some of my medical friends indicates that very little attention is given nowadays to the possibility of actual heart rupture as the result of great emotional stress.
It is common enough to speak of heart failure or stroke, etc., but apparently actual rupture, except in cases of known disease or aneurysms, is not often recognized.
More frequent autopsy might reveal that true heart break occurs more often than is supposed.
It is a reflection of comparative medical disinterest in such a possibility that even Hans Selye of Montreal, one of the world's greatest authorities on human stress in any form, does not refer to heart rupture due to stress in his monumental annual reviews on the subject.
Stroud gave many other similar case histories, and made frequent reference to the fact that if the rupture occurred a sufficient time before actual death the blood which leaked into the pericardium was found to have separated into a coagulum and a serious fluid.
There is little doubt that this composite would have been referred to by a non-medical observer as "blood and water": in the Lord's case the spear of the centurion, piercing the pericardium, allowed this blood and water to escape.
This circumstance strongly suggests that heart break had not occurred immediately prior to the infliction of the wound but some time previously. And we are given in Scripture some intimation as to how long previously this rupture had actually taken place.
We are told in Luke 22:44 that in the Lord's agony in the Garden of Gethsemane great drops of sweat were seen pouring down His face, with the appearance not of the normal watery fluid which comprises ordinary human sweat in times of stress but "as it were great drops of blood."
Now, sweat water is drawn by the glands from the blood, and the blood is thereby concentrated.
This filtrate from the blood is almost perfectly pure water. When sweating first breaks out, the fluid contains a number of substances including salt, but altogether these substances amount to less than one percent of the fluid which is otherwise pure water.
Indeed, in a man acclimatized to the heat, the water expressed to the surface by the glands within a few minutes after the onset of sweating becomes the purest watery fluid in the whole body.
However, under very great emotional stress accompanied by a marked rise in blood pressure, red blood cells may find their way into the glomerulus and the sweat then appears on the skin surface as "bloody."
The appearance of coloured as opposed to clear watery sweat is referred to technically as chromidrosis.
Shelley and Hurley in reviewing the subject, concluded that it is a function only of the sweat glands which are termed apocrine. (24)
The activity of these particular sweat glands is related to the emotional side of man's nature and does not normally relate to the mechanism whereby he maintains his body temperature. In the cases referred to by these authors, the coloured droplets were turbid and appeared at the follicular or hair openings in the axillary vault or armpit. They mentioned two cases.
In the first, coloured sweat occurred in the armpit, a typical site for normal emotional sweating; but in the second of their two cases, chromidrosis appeared on the forehead.
Although there is no evidence of apocrine glands in this area, there are eccrine glands there, which respond to mental or emotional stimuli as the apocrine glands in the armpit do.
Sweating does indeed occur in the forehead in response to a rise in body temperature, but it also occurs in this area due to mental stress, to anxiety, to fear, and to other stimuli whichper se have nothing to do with a rise in body temperature.
Thus two distinct sweating mechanisms exist in this one area.
It also happens that a similar situation exists in the palmar and plantar regions of the hands and feet.
It is in these regions, therefore, that one might expect to find bloody sweat under great emotional or mental stress: namely, in the forehead, the palms, and the soles of the feet.
Shelley and Hurley properly observed that the possible relationship of the phenomenon of chromidrosis to hysterical stigmata or localized hematidrosis ("bloody sweat") is worthy of wider exploration. And Rothman pointed out, (25)
palmar "bleeding" was reported in the case of Theresa of Konnersreuth, an individual whose medical history was examined at some length by W. Kroner in 1927.
Now and then one reads of similar cases in recent times, but I am not aware that any extended reports have been written on them.
However, in his work on The Siberian Chukchee
, Bogoras does note that a Shaman, or priest, when called upon by a "spirit" to go into a "proper state" of ecstasy for the performance of his ritual, may sweat blood if he resists the spirit.
Instead of the proscribed behaviour he begins to act like a madman or an epileptic, and has to be forcibly restrained. (26)
Now Stroud referred to a number of works from the 16th to the 19th century in which are to be found case histories of men who, being condemned to death under unexpected circumstances, broke out into a bloody sweat. (27)
One young boy is referred to who, having taken part in a crime for which two of his elder brothers were hanged, was exposed to public view under the gallows at the time and was thereupon observed to sweat blood from his whole body.
In a Commentary on the Four Gospels
published in 1639 in Paris, Joannes Maldonatus referred to a robust and healthy man who had shortly before, on hearing of sentence of death passed upon him, been bathed in a bloody sweat.
In 1743, J. Schenck, (28)
in a work titled Medical Observations
, referred to the case of a nun who, falling into the hands of soldiers threatening her with instant death, was so terrified that "she discharged blood from every part of her body and died of hemorrhage in the sight of her assailants."
In 1800, S. A. D. Tissot, in a work on the nervous system, (29)
referred to a sailor who was so alarmed by a storm that he collapsed, sweating blood from his face continuously throughout the whole storm.
He mentioned that the bloody sweat renewed itself like ordinary sweat as fast as it was wiped away. Charles IX of France, a monarch of great cruelty but also great energy, both in mind and body, died of a similar cause in his 25th year. (30)
According to Voltaire, he suffered fatal hemorrhage, the blood flowing from the pores of his skin.
Voltaire noted that this malady was not without previous example, and he expressed the opinion that it is usually the result of either excessive fear or great passion.
In his Histoire d'France
, the historian de Mezeray referred to the same circumstance, noting that it was about the 8th of May, 1574. (31)
He said that in his last illness near the end, Charles was found on one occasion "bathed in a bloody sweat."
The blood need not reach the skin surface only by way of the sweat gland tubules, but directly through the skin itself, a phenomenon which is a special form of diapedesis.
There has been some question about the veracity of this form of generalized cutaneous transpiration of blood, but the phenomenon has been referred to continuously from the time of Theophrastus, Aristotle, and Lucan right down to modern times, and it seems unlikely that all these reports are fabrications.
That the sweat glands themselves are usually involved seems likely, because some of those who have experienced bloody sweat have reportedly noticed a tingling sensation in the skin immediately before the bloody sweat has showed on the surface.
In our own laboratory where sweat measurements are made with highly sophisticated equipment that allows us to determine within one second when sweating is about to occur, we have found that after a few days most subjects on a treadmill are able to anticipate quite precisely when sweating is about to break out by an awareness of this overall tingling sensation.
As already noted by Rothman, very powerful emotion associated with strong religious feelings may by some unknown psychomotor process lead to bleeding in the hands and feet, and sometimes on the forehead, a phenomenon which superstition has tried to link supernaturally with the wounds of the Lord.
But it may in fact be related rather to the activity of a special class of eccrine sweat glands which, unlike the rest of the eccrine sweat glands in the body serving the purpose of the maintenance of body temperature by evaporative cooling, are related to what Walter Cannon so aptly termed "the fight or flight" reaction.
These particular glands respond not to a rise in body temperature, but to a sudden increase in emotional stress.
The response is, in fact, exceedingly specific and very prompt, and quite precisely related to the level of stress.
As already noted, these glands are found in the forehead region and in the palmar and plantar regions.
The great beads of sweat which appeared to those who were present like drops of blood falling from the Lord's forehead certainly indicate a tremendous emotional battle.
I think that it would be quite wrong to attribute to the Lord a terrible fear of what was to be faced, but there is no question that He must have had a terrible horror.
It is difficult to know with certainty exactly what He meant when He cried that the cup might pass from Him.
But He must have been able to anticipate what it was going to mean to take upon Himself personal responsibility for all of man's terrible human wickedness, as though He Himself were the cause of it all.
He must have known that He was being called upon to assume this burden not in some kind of "as if" way, but in actual fact so truly that even His Father would condemn Him as guilty and accountable.
He could not dismiss His life, if He was to fulfill this task, until He had indeed assumed this responsibility.
And for this reason He endured the Cross rather than escaping from it -- which He could easily have done by dismissing His spirit at any time, for He had the power to do so (John 10:18).
I think there may be some justification in supposing that it was in the Garden of Gethesmane that the Lord's heart was ruptured, thereby allowing the blood which leaked from it to accumulate slowly in the pericardial sac.
The centurion's spear subsequently punctured this sac and allowed the blood in its separated form to escape via the wound.
In Psalm 69:20 these words seem to be prophetic: "Reproach hath broken my heart; and I am full of heaviness: and I looked for some to take pity, but there was none; and for comforters, but I found none."
Surely the second part of this utterance was as literally fulfilled as the first part, for in Mark 14:37 we are given a picture of what happened when the Lord did look for comfort from His companions.
It is written, "And he cometh, and findeth them sleeping, and saith unto Peter, Simon, sleepest thou? couldest not thou watch one hour?" (Mark 14:37).
The physical suffering which preceded and accompanied the Crucifixion, appalling though it was, can have been nothing really in comparison with the agony of soul that was to be faced on the Cross when the moment came for the Father to lay upon Him the iniquity of us all and, in the doing of it, to turn away from His beloved Son as One vile and condemned and unforgivable, for on what grounds could He have been forgiven?
He bore our iniquity and paid our debt in full.
In those terrible hours the Father condemned His Son as responsible for our wickedness, and His Son in the agony of His soul accepted full responsibility.
His anguish allowed no accounting of the mere three hours marked off on our clocks.
In times of extreme torture men have commonly stated that all sense of time is entirely lost, that in fact eternity takes over.
The actual period of torture may be a matter only of seconds, but the interval is experienced as unending. While our clocks ticked over the minutes until they showed the passing of three hours, to the Lord Himself the period of torment under condemnation must undoubtedly have been experienced as an eternity, and because He was who He was, He must have known beforehand something of what the experience was going to entail.
It is, therefore, all the more wonderful that during the first three hours on the Cross His thoughts were only for others, for the forgiveness of His tormentors, and for the care of His mother.
Then judgment fell, and darkness.
It was only after the darkness and judgment suddenly came to an end, and the horror and the loneliness were terminated as the sense of fellowship with His Father was restored, that He could cry exultingly, "It is finished" (John 19:30).
Then, and then only, was He free to dismiss His spirit at will.
But in the Garden of Gethsemane the agony in anticipation of all that was to come -- the trial, the mockery, and the desertion by His Father -- had already broken His heart.
It was not the cause of His death, but it did accompany it.
He died with a broken heart; and the centurion's spear became the instrument in the hand of God, which bore witness to the uniqueness of the Lord's death and to the ordeal which had preceded it.