Abstract

Table of Contents

Part I

Part II

Part III

Part IV

Appendixes


     

     Did the Lord Jesus die from a broken heart?
     Not a few commentators of recent years have suggested that He did, and the evidence adduced in such a work as that by Dr. William Stroud carries considerable weight. (263) Yet I believe it is important to distinguish between dying with a broken heart and dying from, or as a result of, a broken heart. In the Lord's case the former, I am persuaded, may be a sad truth but the latter is a profound error. I believe that the circumstantial evidence from the Gospels lends some support to the view that the Lord's heart was broken, ruptured in the most literal sense, when He died. But I am also persuaded that this was not the cause of his dying, nor even a contributing factor in it. But this, in turn, means it must be possible for a man with a ruptured heart to continue an active life. It means that heart rupture is not necessarily immediately fatal. Is this the case? Can a man survive for any length of time after the heart has ruptured, and what would be the symptoms during that survival time? And what are the known causes of heart rupture in the first place?
     Poets speak of a broken heart without meaning that the organ itself is physiologically ruptured: and we commonly speak of men and women (and upon occasion of pets, too) as having died of a broken heart in consequence of bereavement or very great disappointment. History also shows that great and unexpected joy can be fatal in a strikingly similar manner. Commonly, we suppose that such an experience is so emotionally overwhelming that the rhythm of the pulse is severely disturbed causing a fatal malfunction of the vagus nerve which regulates the beat. We do not necessarily mean the actual rupture of the walls of the heart's chambers. It is as though the engine were "stalled," rather as a car engine may be stalled by feeding it too strong a mixture of fuel.
     But actual heart rupture is well known in medical histories and if autopsies were performed as frequently and as routinely today as they were during the last century, we might well find as frequent reference in current medical literature to it as there was a century ago, especially in Europe. However, there are still many accounts of death by heart rupture, verified by post mortem examination. And in a surprising number of instances rupture was not immediately fatal. From some quite extensive accounts it is clear that a man may live for some

263. Stroud, William, The Physical Cause of the Death of Christ, New York, Appleton, 1871, 422 pp.

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hours and, though in great discomfort, may continue the daily round of activities until, suddenly, there comes a dramatic end � sometimes in great pain, but sometimes quietly during sleep.
     Is this, then, the cause of the death of the Lord Jesus? Personally, I do not think so: but let us look at some of the evidence which has led not a few commentators to assume that heart rupture was indeed the immediate cause of the Lord's death. It is a view which has a certain sentimental appeal and should therefore be examined all the more carefully.

     Before embarking on a brief historical summary of the evidence regarding heart rupture, it will be proper to note a fact which helps to account for the comparative paucity of medical reports on the subject in the enormous literature of the present day. One is hard put, in fact, to find many references in current medical literature guides such as Index Medicus, and one may note also that the world famous authority on human stress, Dr. Hans Selyc of Montreal, scarcely even mentions the subject in his very extended bibliographies. Is this because heart rupture is now so rare and therefore seldom considered a likely cause of premature death, and is therefore unrecognized because not expected? One contributing factor may be that post mortems, so common formerly at least in Europe, are now somewhat rarer because it is necessary today to obtain permission either beforehand from the patient or afterwards from the nearest of kin, whereas previously this was not a requirement. As a consequence such post mortems are less often carried out, especially since the rather general term 'heart failure' seems to be accepted as a sufficient description of the cause of death.
     The literature of antiquity and the medical literature of the last century or two abounds in detailed accounts which we have no reason to suppose are not authentic and quite correctly diagnosed.
     In a recent study of this aspect of medical diagnosis, Dr. George L. Engel of Strong Memorial Hospital, New York, published the results of a survey of 275 newspaper reports of sudden death attributed to heart failure due to traumatic shock. (264) He commences by saying, "Few folklore notions have enjoyed as widespread and persistent popularity as those that ascribe sudden death to emotional shock. As far back as written records exist, people are described as dying suddenly while in the throes of fear, rage, grief, humiliation, or joy." He notes that physicians writing before 1900 often ascribe sudden deaths to intense emotion, but with the coming of the germ theory of disease in the late nineteenth century which cast doubts on much folklore about medical matters, such notions fell into disfavor. "In the eighteenth and nineteenth centuries medical

264. Engel, George L., "Sudden and Rapid Death During Psychological Stress," Annals of Internal Medicine, vol.74, no.5, 1971, p.771�783 with extensive bibliography.

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writings abounded in such accounts. . . .  Since then consideration of the relationship between emotion and sudden death has virtually disappeared from the medical literature." Yet he adds: "Many physicians in private conversations are quite ready to recount from their own practices examples of patients who apparently died suddenly under precisely such circumstances."
     Engel gives a breakdown of his findings, stating that of the 275 reports studied, clearly the most common cause (in 135 deaths) was an exceptional traumatic disruption of a close human relationship, whether actual or anticipated, or confrontation with events of great emotional consequence impossible to escape. He observes that in experiments with animals this was most likely to occur with already damaged hearts, but it was not a hard and fast rule. Animals with undamaged hearts also suffered heart rupture under certain conditions of stress. And as to humans, an 88 year old man without known heart disease was reported to have developed acute pulmonary edema after receiving tragic news, dying just as the doctor reached the house. A similar report of an otherwise healthy 27 year old captain is also noted.
     As to the cause: it frequently appears to be the result of severe derangement of the cardiac rhythm � particularly in the case of humans. Certain hormonal substances are secreted in excess during stress which predispose the heart to lethal arrhythmias.
     Engel comments: "We can only speculate about the mechanism of death in such cases. Most would agree that effective cardiac arrest, whether caused by ventricular asystole or by ventricular tachyarrhythmias, is probably responsible for the death of those who die within a few minutes. . . But such are not present in all cases. . . Some of the lethal influences may involve rapid shifts between sympathetic and parasympathetic cardiovascular effects."
     Such shifts back and forth can be invoked experimentally in animals and the usual consequence is sudden death for no other accountable reason. This has been demonstrated in squirrel monkeys. Engel therefore concludes: "Certainly, the use of 'folklore' or 'old wives' tales' as pejorative labels, as some skeptics are wont to do, is hardly compatible with the scientific attitude requisite for the study of natural phenomena involving life and death."
     It is curious that there seem to be as many reports from antiquity of death from heart rupture caused by sudden joy as there are by sudden grief! Later reports tend in the opposite direction.
     Valerius Maximus (c. 30 A.D.) tells us that Sophocles, the writer of Greek tragedies, had died in 405 B.C. in consequence of a decision being pronounced in his favour in a contest concerning his honour. (265) The Roman

265. Valerius Maximus, Factorum et Dictorum, Memorabilium, Bk. IX. 12.

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historian Livy, writing about the same time, mentions the case of an aged mother, who while she was in the depths of distress due to tidings of her son having been slain in battle, died in his arms from excess of joy on his safe return. (266) Pliny, writing somewhere around 100 A.D., informs us that the Lacedemonian, Chilo, died upon hearing that his son had won a prize in the Olympic Games. (267) The Greek physician, Galen (about 175 A.D.), mentions death from joy, commenting that the emotion of joy is more dangerous to the heart than anger. (268) Aulus Gellius (second century A.D.) mentions the remarkable example of such in the case of the Greek poet Diagoras of Melos whose three sons were crowned the same day as victors in the Olympic Games, one as a pugilist, the second as a wrestler, and the third in both roles. (269)
     Among the fragmentary remains of a kind of official Journal of contemporary events authorized by the Roman Emperors and known under the title Ephemerides, there are instances of death from sudden joy. Similar reports are also known from Marcellus Donatus (1586) and other writers. (270) In recent times Gould and Pyle, speaking of this fact, observed that heart rupture is known to have occurred from sudden joy by post mortem examination; in one particular case the pericardium (the sac around the heart) being filled with blood as a consequence. (271) The general assumption made by these writers is that rupture resulted from the sudden and excessive increase in cardiac output. (272) Such medical histories seem to bear out not only that excessive joy is as damaging to the heart as excessive grief but that the damage is likely to be more immediately fatal. Perhaps this is a reflection of the fact that we are less accustomed to joy than to grief and therefore build up a greater capacity to sustain the shocks of the latter. At any rate, it seems as though the individual may survive heart rupture caused by an excessive disappointment for several hours, or even for days. Nor is heart rupture from external injury always immediately fatal either.
     If not all, at least the great majority, of instances of heart rupture are probably because the heart tissue has already been weakened by fatty degeneration or some other damage such as infarct, for example, due to strain, although a surprising number of post mortems of the last century were unable to demonstrate any such predisposing condition, the walls of the organ being firm and healthy at the time of actual rupture.

266. Titus Livius, History of Rome, Bk. XXII. 7.
267. Gaius Pliny, Bk. VII (on Man), § 7.
268. Galen: quoted by Gould and Pyle, Anomalies and Curiosities of Medicine, New York, Julian Press, 1966, 6th printing, p.524.
269. Aulus Gellius, Noctes Atticae, (130�180 A.D.), Bk. 111.15.
270. Donatus, Marcellus, De Medica Historia Mirabili, Libri Sex. 4, Mantua, 1586.
271. Gould, G. M. and W. L. Pyle, Anomalies and Curiosities of Medicine, New York, Julian Press, 1966, 6th printing, p.524.
272. Gould, G. M. and W. L. Pyle, ibid., p.625.

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     As we have already noted, one of the most complete studies vis-a-vis the death of the Lord Jesus is that undertaken by William Stroud. Stroud quotes from many sources, especially during the nineteenth century when such interest in the subject of heart rupture was evidenced by the numerous reports in the medical literature. Thereafter, interest seems to have declined, partly as a result of the greater restrictions imposed upon post mortem examination. Today, however, there is renewed concern. MD of Canada recently had the following note under the title, "Subacute Heart Rupture": (273)

     Rupture of the heart has now become the second major cause of death in the coronary care unit, second only to myocardial failure. Investigation by Dr. Michael O'Rourke of Sydney, Australia, (274) shows that in some instances heart rupture is not sudden and dramatic but subacute. If recognized early, this rupture can be repaired surgically.

     Perhaps two factors have contributed to this resurgence of interest: life is more hectic and heart failure of one kind or another has become more common. At the same time, the tremendous advances in heart surgery technique, and perhaps the temptation of surgeons to prove their own skills, has improved chances of survival by corrective measures.
     In the meantime, it is now rather well established that rupture can be sustained for a remarkable length of time without fatal consequences though not without severe pain. It is not at all impossible, therefore, that Jesus may have indeed suffered some form of subacute heart rupture in Gethsemane and yet have sustained the subsequent abuse at the hands of the soldiers and the final torture of crucifixion some hours later, without succumbing to the effects of the rupture itself. We have some well authenticated instances of survival for several days after severe heart rupture which were later fully confirmed by a post mortem examination. But it must still be borne in mind that such examination generally suggested previous tissue degeneration, a circumstance which it is difficult to admit in Jesus' case.
     A German physician, Dr. Daniel Fischer, whose chief interest was heart pathology, in the December, 1817, issue of the Journal der Prachschen Heilkunde, reported such a case in some detail. (275) A summary statement of the case is given herewith.
     A gentleman, aged 68 (his initials only are given as V.K.), in apparently robust health, was forced by an

273. MD of Canada, vol.14, no.10, Oct., 1973, p.62.
274. O'Rourke, Michael, reporting in Lancet, 21 July, 1973, p.124.
275. Fischer, Daniel, The London Medical Repository, vol.XI, p.422�427.

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unfortunate circumstance to retire from a prominent position in the German court. The experience proved excessively burdensome to his sensitive nature. On the 16th of October, 1817, he was suddenly seized with a violent pain while walking, which he supposed to be a stomach cramp. He reached home half a mile distant only with great difficulty, but after some medication (Hoffman's Anodyne) he quickly recovered and did not complain further that day.
     On the 17th, after a good night, he felt so fully recovered that he visited a neighbour travelling by carriage, there held a conference, and returned home again later on foot accompanied by his coachman. During the return trip, however, he sustained another attack of pain so violent that he had to be entirely supported by his servant. Arriving home he rested, soon recovered, had supper, and slept as usual.
     On the morning of the 18th, he sent a note to his physician, Dr. Fischer, and gave him an account of his health, requesting his advice. His appetite and digestion, he said, were quite unimpaired. Dr. Fischer prescribed a diaphoretic mixture to relieve what appeared to be gas, and the rest of the day and the succeeding night were spent comfortably.
     On the 19th, he went to church and exerted himself in singing with the congregation. He then returned home, and almost at once experienced a dreadful pain in the region of his stomach. Dr. Fischer was called and arrived within one hour to find the paroxysm had almost completely subsided, but he noted that circulation was poor as evidenced by coldness of the extremities. In the afternoon the patient seemed improved, and by evening he felt so much better that he wanted to get up and join his family for dinner.
     Early on the 20th, Dr. Fischer learned that his patient had passed a fairly good night, and that body functions seemed to have responded to the medication prescribed for his stomach. The patient, however, after sending off the messenger with this report, got out of bed, smoked a pipe, and began to walk about. The pain instantly returned accompanied by a paroxysm "with the rapidity of lightning." The doctor was at once called, arriving about ten o'clock. The patient's suffering subsided slowly and the doctor left at 11:30 � but he was at once re-summoned to find his patient in an awful agony "roaring for relief or death." After several heroic attempts to relieve his suffering, some of which were partially successful, the doctor again left. But the next morning, the 21st, he received the unexpected news that his patient had died very suddenly during the night.
     Eighteen hours after death a post mortem examination was carried out. The sternum being removed, and the pericardium punctured, it having the appearance of being distended by a substance of dark blue colour, a

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quantity of reddish fluid escaped followed by bright red blood to the amount of two or three pounds. The pericardium was then opened up completely and the heart itself was found to be surrounded by a coagulum of more than three pounds in weight. When this was cleared away, a rupture was disclosed in the aortic ventricle. The heart was then removed entirely and the rupture was found to extend upwards about an inch and a half on the external surface while the internal rupture was about half an inch in length. This indicated that rupture was caused by excess pressure from the inside. According to the methods of tissue analysis then available, the heart tissue itself was otherwise found to be firm and healthy.
     Whether this conclusion would be accepted in the light of present diagnostic technique is difficult to say. However, the subsequent discussion which followed the publication of Fischer's report showed that other similar cases of heart rupture were known where the heart tissue was in no way pathological. (276) A Dr. Portal is quoted as stating in two medical reports dated 1784 and 1794 that the aortic ventricle "commonly bursts without any previous weakening of the substance of the heart." And in the second of these reports, Portal quotes a certain Dr. Whytt as "having seen the heart burst from protracted grief" and therefore "not regarding the term broken heart in the light of a mere metaphor." (277) Dr. Portal also notes some authorities who do not believe that heart rupture can occur unless the heart has been subject to insidious inflammation or overburdened with excess adipose tissue. Heart rupture would then be the fatal termination of a previously existing morbid state. But as Dr. Fischer observed, such was clearly not the case in the instance of his report. Possibly rupture is not therefore fatal at once in a healthy heart but only in a diseased one. Fischer reported in this case "no morbid state of heart capable of diminishing its cohesive properties."
     Survival for some hours or even some days would thus seem to be quite possible, though undoubtedly accompanied by considerable pain. Moreover, the protracted survival of Fischer's patient must be viewed in the light of his mature age (68 years), and we must assume therefore that in the case of the Lord Jesus who was still in the prime of life, emotional stress and not a diseased condition could have caused rupture if indeed rupture did occur. Fischer believed on the basis of all the evidence that rupture had "occurred gradually" over the previous few days. The first pains felt on the 16th he believed to have been due to the violent extension or aneurysm rather than actual rupture. Actual rupture probably occurred at the first devastating attack of pain while the subject was out  

276. The London Medical Repository, vol. XII, 1819, p.164�168.
277. Portal: quoting Dr. Baillie, "Treatise on Morbid Anatomy," Anatomie des Krankhaften, Baucs, etc., Berlin, 1794, translated by by Soemmering.

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walking on the 17th. That would mean that this particular individual survived heart rupture with a surprising amount of activity in the interval for about three days.
     A number of other cases established by post mortem examination are cited in the follow-up of Dr. Fischer's article, in one of which the left ventricle was found to have ruptured in three places. Heart rupture was also reported as having occurred during sleep, although severe pain in the area had been experienced for some time previously.
     From current literature one gathers that most authorities would now attach greater importance to pathological conditions than to sudden emotional stress, and in view of Stroud's fascinating conclusions regarding the case of Jesus, I think this fact has to be kept in mind. Krumbhaar and Crowell attribute rupture to coronary disease which has produced infarction and partial or complete aneurysm. Death is then said to be due to haemopericardium, i.e., infusion of blood into the pericardial sac. (278) Karsner observes that in haemopericardium from rupture of the heart wall, the intraventricular pressure is communicated directly to the pericardial sac. (279) This compresses intrapericardial pulmonary veins and also inhibits cardiac diastole. The result is usually rapidly fatal. It is referred to as cardiac tamponade. History is replete with cases of men who have died from this form of heart failure in their prime upon hearing shocking news. J. G. Zimmerman noted that Philip V of Spain died suddenly on learning of a major defeat of his army: and autopsy showed that his heart had ruptured in this way. (280) It seems highly likely that there are other examples if we had an adequate medical history of every individual whose death has been attributed to some form of heart failure.
     Charles K. Friedberg, in his Diseases of the Heart, observes that rupture of the heart is "one of the commoner causes of sudden death" but only in the first two weeks after acute myocardial infarction. (281) Nearly 5% of one thousand consecutive cases of acute myocardial infarction confirmed at autopsy indicated death due to rupture. Much higher percentages (up to 19%) were reported by other investigators in 1960. In all such cases, rupture occurs at the point of infarction and usually while the infarcted area is still soft and freshly damaged. After some weeks it hardens somewhat and the patient is then likely to survive for some time. In mental institutions where hypertension is frequent, the incidence of rupture in acute myocardial infarction has been recorded as high as 73%, but this high relationship between hypertension and rupture has not been observed

278. Krumbhaar, E. B. and C. Crowell, "Spontaneous Rupture of the Heart, A Clinical Pathological Study," American Journal of Medical Science, vol.170, 1928, p.828f.
279. Karsner, Howard T., Human Pathology, Philadelphia, Lippincott, 1938, p.379.
280. Zimmerman, J. G., On Experience in Physic (translated from German), London, 1782, vol.II, p.268f.
281. Friedberg, Charles K., Diseases of the Heart, Philadelphia, Saunders, 1966, p.854f.

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in a normal population. In all cases it is a general rule that rupture occurs only when previous degeneration of the heart tissue has occurred.
     A suffusion of blood is commonly found in the pericardium in various amounts depending upon time of death, severity of rupture, and level of activity. It may exceed one liter (2.2 lbs.) but averages 250 c.c. (about 0.5 lbs.). Death may occur within a few minutes, but occasionally there is a survival period of a half hour to several hours. However, mention is made of survival in one instance for more than five years due to the formation over the rupture of fibrous pericardial adhesions.
     While older reports seem to indicate cases of rupture in healthy hearts, the general consensus of opinion at the present time is that rupture only occurs where previous degeneration of heart tissue exists. The issue is crucial, if this is really the case, for it implies either that the Lord's heart had in this sense already "degenerated" and the Lamb was not therefore without blemish, or that the phenomenon of bloody sweat and the escape of "water and blood" from the wound on the cross must be explained in some other way. That the rule is not hard and fast, however, is suggested by Friedberg's remarks under a general heading Traumatic Heart Disease. (282) He observes: "There are instances of so-called spontaneous rupture, perforation or tear of a cardiac structure, in which physical strain may be a significant contributory factor." Yet if applied in the Lord's case, this would still not be the cause of death but merely an accompaniment. In other words, the Lord died with a broken heart perhaps but, in my view, not from it. To my mind the distinction is a real one and one of great importance.
     The actual course of events in the case of rupture, considered from the purely physiological point of view, was many years ago very ably described by a Dr. Allan Burns who shows what happens to the blood escaping from the rupture into the enveloping pericardium. Newer, more recent, knowledge has not required any essential change of this descriptive paragraph. (283)

     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 resuming backward by the intervening valve, and not finding a 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 thereby 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 constituents parts, namely, a pale watery liquid called serum, and a soft clotted substance of a deep red colour termed crassamentum.

282. Friedberg, Charles K., ibid., p.1691f.
283. Burns, Allan, On Diseases of the Heart, Edinburgh, 1809, p.181.

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     Now we are told in Luke 22:44 that in Gethsemane the agony of spirit which anticipation of the horror of the pending ordeal brought upon the Lord was so severe that, as it were, great drops of blood burst like sweat from his forehead and poured down his face. Luke, the physician, was the one who obtained this piece of information from some eye witness to the event. The disciples may not have been asleep at the beginning of Jesus' spiritual struggle but had fallen asleep by the time He returned to them after it was over. Luke may have received his information from one of them, for he certainly records it as though it was an eye witness account. He makes no effort to explain the phenomenon.
     In Hebrews 5:7 we seem almost certainly to have a further reference to this event. We are told here that in the days of his flesh, the Lord offered up prayers and supplication: evidently under the stress of pending death and was heard and preserved at that time. This clearly cannot refer to his death a few hours later on the cross, since He could not possibly be spared from this if man was to be redeemed. What prospect of immediate death was He then preserved from if not death by heart rupture?
     Certainly the Greek verb sodzo appearing here in the phrase "able to save him," often means "to preserve." Probable instances of this meaning in other places where the same word occurs will be found as follows: 1 Timothy 2:15, the preservation of the woman in childbearing; 1 Timothy 4:10, the Lord who preserves all men but takes particular care of the redeemed; 2 Timothy 4:18, Paul is preserved against every evil device brought against him. One might argue, therefore, that in Gethsemane the Lord's heart suffered a subacute rupture, and that the Lord Himself was fully aware of what had happened within his body. Certainly the form and functions of the human body were of his design in the first place and He was Himself the master Physician. There is no reason at all why He may not have correctly recognized the symptoms in his own case. It could be, therefore, that the trauma of anticipation of what was to be truly an awful spiritual and physical agony, was sufficient to rupture his otherwise perfectly sound heart, with fatal consequences to Himself and to his mission if death ensued prematurely as a result. He would have recognized this only too well.
     The question then arises as to whether, if weakened by this serious internal wound, his frame would be able to sustain the ordeal that it was about to undergo. We have to remember that although He was made with the potential of unending life, that life could still be destroyed. If such an internal wound should prove fatal now, the whole plan of salvation � for which the Universe was created as a setting and to which all history had moved up to this moment � would have aborted.

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      Many commentators have habitually associated Hebrews 5:7 with the events of Gethsemane, as Barnes does for example, though he does not indicate any awareness of the possibility of heart rupture. (284) In response to the Lord's cry for help, an angel came to strengthen Him (Luke 22:43), a circumstance which suggests that the prayer was indeed for physical support, since it is most unlikely that He would appeal for spiritual help from an angel. Almost immediately after this appeal, the bloody sweat broke out on his forehead as though in confirmation of the internal injury which may have prompted his cry for help.

     The significance of "sweating" blood as a physiological phenomenon is not clear, although a great deal is known about the sweating mechanism itself. It is referred to technically as haematridrosis. It has, however, been observed to be always associated with deep emotional stress. It was reported frequently enough in antiquity, during the Middle Ages, and even in modern times.
     When a man's body overheats, several automatic corrective measures are at once initiated. These include an increased flow of blood through the vascular bed just below the skin surface, causing a sudden reddening or flushing, and resulting in a much greater transport of deep body heat via the blood fluid to the skin surface where it is radiated away if conditions permit. If this proves insufficient and body temperature continues to rise, then the sweat glands are triggered into activity. A very pure water, filtered from the blood vessels, is expressed via about two million sweat glands onto the skin surface where it evaporates and in so doing removes a quite remarkable store of heat very efficiently, provided that the surrounding air has the requisite capacity to absorb the water vapour. In conditions of high humidity it is therefore characteristically difficult to keep cool.
     This filtrated water is one of the purest fluids in the body, since it contains a total of less than 1% of other substances such as uric acid, lactic acid, etc. Under normal circumstances this exudate contains no other blood components than water. However, under very great emotional stress, perhaps in part due to a rise in pulse rate and blood pressure, red blood cells may find their way into individual sweat glands, chiefly those which are under the control of the sympathetic nervous system � which the majority of sweat glands are not. The areas particularly involved here are the forehead, the axillary vaults (the arm pits), and some areas of the hands. The forehead region is especially involved, being for some reason highly supplied with sweat glands that are particularly active.
     According to Shelley and Hurley, such coloured sweat does not relate normally to a rise in body temperature

284. Barnes, Albert, Notes on the New Testament, Grand Rapids, Kregel, 1962, p.1260, loc. sit.

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but only to emotional stress. (285) The coloured droplets are turbid and they suggest a possible connection with hysterical stigmata in the hands. Rothman, in his classic work on the biochemistry and physiology of the skin, believes that this form of sweating (which may also be found in the palm of the hand) probably accounts for the phenomenon associated with the well-known Theresa of Konnersreuth. (286) Bloody sweat has been reported also among primitive people, especially shamans from Siberia when seeking a state of ecstasy, as reported by Bogoras. (287) William Stroud refers to a number of works from the sixteenth to the nineteenth centuries in which are to be found case histories of men who, being condemned to death under unexpected circumstances, have broken out into a bloody sweat. (288) One young boy is mentioned who, having taken part in a crime for which two of his older brothers were hanged, was exhibited to public view under the gallows at the time and was thereupon observed to sweat blood from the exposed parts of his body (presumably his hands and his face). In a Commentary on the Four Gospels published in 1639 in Paris, Joannes Maldonatus refers to a robust and healthy man who had, on hearing a sentence of death passed upon him, been bathed in a bloody sweat. (289) In 1743 J. Schenck, in a work entitled 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." (290) In 1800 S. A. D. Tissot, in a work on the nervous system, referred to a sailor who was so alarmed by a storm that he collapsed, sweating blood from his face continuously throughout the whole episode. He mentions that the bloody sweat renewed itself like ordinary sweat as fast as it was wiped away. (291)
     One of the best known and most famous examples is that of Charles IX of France, a monarch of great cruelty but also of great energy both in mind and body, who died of a similar cause in his 25th year. According to Voltaire, he suffered a fatal hemorrhage, the blood flowing from the pores of his skin. He expressed the opinion that it is usually the result either of excessive fear or of great passion. (292) In his Histoire d'France, the

285. Shelley, W. B. and H. J. Hurley, "Methods of Exploring Human Apocrine Sweat Gland Physiology," Archives of Dermatology and Syphilis, vol.66, 1952, p.156�161.
286. Rothman, Stephen, Physiology and Biochemistry of the Skin. Chicago University Press, 1955, p.187.
287. Bogoras: quoted by Alexander Goldenweiser, Anthropology, New York, Crofts, 1945, p.251.
288. Stroud, William, The Physical Causes of the Death of Christ, New York, Appleton, 1871, p.97.
289. Maldonatus, Joannes, Commentary on the Four Gospels, Paris, 1639, p.601.
290. Schenck, Joannes, Rarer Medical Observations (Observ. Medicae Rariores), Frankfort, 1609, Bk. III, p.458.
291. Tissot, S. A. D., Traites des Nerfs, Avignon, 1800, p.279, 280.
292. Voltaire, F. M., Complete Works, Baslc, 1785, vol.18, p.531�-532.

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historian de Mezeray, refers to the same circumstance noting that it was on the 8th of May, 1574. (293) He says that in his last illness near the end, Charles was found on one occasion bathed in bloody sweat. There is an interesting discussion of this subject, from a purely medical point of view, in the work by Gould and Pyle to which reference has already been made. (294)

     I would conclude, then, that while heart rupture may not have been the cause of the bloody sweat on the Lord's brow, extraordinary emotional stress might have been the common cause which lay behind both phenomena. The agony of Gethsemane was the agony of anticipation of the events which were about to transpire, and the effect of that agony upon the Lord's body may have been sufficient to cause both subacute heart rupture and bloody sweat. But I would go further and say also that heart rupture was, nevertheless, not the cause of the Lord's death on the cross. In Gethsemane his cry for help was heard and this injury was not permitted in the interval between Gethsemane and his death to anticipate the sacrifice of his life which He was to make voluntarily and in his own time.
     Adding enormously as it must have done to the ordeal of all that He endured from the evening of his arrest to the moment when He dismissed his spirit by an act of will, and no doubt contributing largely to the sheer physical impossibility of carrying the crossbar of his own instrument of death to the place of execution, the Lord Jesus still did not succumb to death � did not die � because of heart rupture. He died perhaps with, but not because of, a broken heart, for the circumstance of the outflow of 'blood and water' (John 19:34) seems to indicate that the pericardium had indeed been pierced by the soldier's spear. Extravasated blood, which had escaped through what was perhaps a very small rupture, had accumulated and separated out into coagulum and serum. This could possibly account for a phenomenon which Scripture has seen fit to include in the record as a circumstance of significance. But his death was entirely of his own doing, not forced upon Him because of the failure of his heart. Sentiment might favour such a supposition, but I believe that theology demands recognition of something of greater consequence.
     His death was in no sense a final collapse of the life support system of his body, but a glorious triumph of will, of spirit over body. On this supernatural fact Scripture has spoken unequivocally and with beautiful precision, as we have seen in Part IV, Chapter 32. These signs of possible rupture may serve perhaps to give us

293. de Mezeray, Histoire d'France, Paris, 1685, vol.III, p.306.
294. Gould, G. M. and W. L. Pyle, Anomalies and Curiosities of Medicine, New York, Julian Press, 1966, 6th printing, p.388�391.

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some idea of the awful prospect the Lord faced and the unimaginable burden it placed upon his nervous system and therefore also upon his heart. It could have been a literal fulfillment of Psalm 69:20, "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." "Could ye not watch with Me one hour?" (Matthew 26:40). 

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