Casey, Thomas F.

Laforet, Eugene G.

English

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The Linacre QuarterlyVolume 22 | Number 1 Article 22-1-1955Medical Aspects of the Holy Eucharist: APhysiological and Canonical StudyEugene G. LaforetThomas F. CaseyFollow this and additional works at: https://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationLaforet, Eugene G. and Casey, Thomas F. (1955) "Medical Aspects of the Holy Eucharist: A Physiological and Canonical Study," TheLinacre Quarterly: Vol. 22 : No. 1 , Article 2.Available at: https://epublications.marquette.edu/lnq/vol22/iss1/2parents' will? The moral conse­quence of these considerations isthat although there is per se anobligation to adm inister  such atransfusion, there may often be anexcuse from it in practice-at leastin those cases where physiciansand hospital administrators are no•protected by a court order. N.B. Part III on LEGAL LIABIL IT\and Part  IV on P UB LICPoucY will fo l low in th,next issue  o f  LINACRLQUARTERLY. "THE OLDEST medical manuscript in Ireland appears to be one copied in 1352. The Irish mss. of the 13th-18th century, preserved in the libraries of Dublin, London, an_d Oxfo�d form a collection of medical literature which is probably the largest in existence rn any one tongue. There are eighty of these medica l mss., some of which hove been published in the Royal Irish Academy, Dublin. The prefa ce to the ms. of 1352 breathes a spirit worthy of the best tra ditions of the medical faculty: 'May the merciful God have mercy on us all. I have here collected practical rules from several works, for the honor of God, for the benefit of the Irish people, for the instruction of my pupils, and for the love of my friends and of my. kindred. I have translated them from latin into gaelic from the authority of Galen 1n the last book of his Practical Pantheon, and from the Book of thePrognostics of Hippocrates ... I pray God to bless those doctors who will use this book; and I lay it on their souls a s an injunction, that they extract not spar­ingly from it; that they fail not on account of neglecting the practical rules (herein contained); and more especially that they do their duty devotedly in ca ses where they receive no pay (on account of the poverty of the patients). I implore every doctor that before he begins his trea tment he remember God, the Father of health, to the end that his work may be finished prosperousl·y. Moreover, let him not be in mortal sin, and let him implore the patient to be also free from grievous sin. Let him offer up a secret prayer for the sick person, and implore the Heavenly Father, the Physician and Balm-giver for all mankind, to prosper the work he is entering upon and to save him from the shame and discredit of failure.'" 10 Reprinted from the Handbook of the Sixth International Congr�ss of Catholic Doctors LINACRE QUARTERLYMedical Aspects of the Holy Eucharist: A Physiological and Canonical Study by EUGENE G. LAFORET, M.D.and REV. THOMAS F. CASEYN NO OTHER Sacrament is Divin­} ity so intimately perfused inmaterial substance as in the HolyEucharist, and in no other Sacra­ment is the union of the recipientwith his Creator physical as well.as spiritual. The physical and es­pecially the physiological as�ectsof t h i s  Sacrament render 1t ofunique importance to the p�ysi�ian.The object of this paper 1s brieflyto summari;?:e medically pertinentcanonical regulations related to theSacrament and to examine experi­mental data concerning time-rela­tionships of the human digestiveprocess.The practical aspect of the re­ception of Holy Eucharist by apatient often presents multiple �ac­ets to the physician. The patientmay require an indwelling Levintube with constant W angensteen­type suction. Vomiting m�y b_eintractable. Death may be 1mm1-nent. Severe diarrhea may super­vene in a patient with an ileostomy.In addition, the performance of anautopsy upon a person who hasrecently received Viaticum posesfurther related questions. In gen­eral, theological opinion holds thatthe Divine Presence remains aslong as the physical form of thehost is incorrupt "ac c ording tocommon estimation." The crux ofFEBRUARY, 1955the problems suggested above l!esin the time required for physio­logical alteration ("corruption"}·of the host by the human digestivesystem.Generally speaking, alteration or"corruption" of the ingested wa.fer(starch) is dependent upon bothmechanical and chemical factors.Deglutition and gastric peristalsiscontribute to the physical disrup­tion of the host. Chemical or enzy­matic degradation proceeds pari passu due to the ac�ion of_ thesalivary enzyme, ptyalm. Salivarydigestion is influenced by (a) theamount of ptyalin in the saliva, ( b) the thoroughness of mecha n icalmixture of ptyalin and substrate,and ( c) the time during which theenzyme is allowed to act.1 Sincethe optimal pH for ptyalin activityis in the range 6.6 - 6.8, it isevident that high gastric aciditymay effectively neutralize its amy­lolytic action.In an effort to estimate the ap­proximate time required for c�r­ruption of the host under ".ary�ngconditions; a series of fifty in vitroexperiments was conducted.1 Bard, P. (ed.): Macleod's Physiology in Modern Medicine, 9th ed., St. Loms, The C. V. Mosby Company, 1941.p. 964. 11-N z )o (') :,:, ttl 0 C: )o :,:, ..-j tI1 :,:, t"' -< 'Tl tI1 0:, :,:, C: )o -\.II \.II Age 40 63 53 26 56 31 40 64 65 32 58 62 57 35 57 64 60 62 55 58 67 -\.,,) 6 5 5 3 4 4 3 5 4 ) � ) l i 4 7 2 0 0 ,6 ;5 11 !8;914574734645642383367613738 TABLE I. RELATIONSHIP OF pH TO DISSOLUTION TIMES. Free Diagnosis. pH Acid Agitation Beginning dissolution duodenal ulcer 7.3 no 10" 15"gastric ulcer 1.8 yes 1' 5'30"post-op. subtotal gastrectomy 7.1 no 30" 3 1 post-op. subtotal gastrectomy 7.1 no none 10"post-op. subtotal gastrectomy 5.2 no none 10"post-op. subtotal gastrectomy 5.5 no none 30"post-op. subtotal gastrectomy 7.0 no none 10"post-op. subtotal gastrectomy 6.9 no 30" 30"post-op. subtotal gastrectorriy 6.9 no 30" 30" hiatus hernia 1.9 yes 30" 10' bleeding duodenal ulcer l. 7 yes none 10' post-op. subtotal gastrectomy 5.3 no none 2 1 hiatus hernia 1.5 yes 30" 2' post-op. subtotal gastrectomy 3.3 yes 30" 2' post-op. subtotal gastrectomy 7.7 no 30" 2' hiatus hernia 7.4 no 30" 2' hiatus hernia 1.5 yes 30" 18' duodenal ulcer 2.75 yes 30" 3' hiatus hernia 2.5 yes 30" 13' hiatus hernia 6.8 no none 1' gastric ulcer 2.4 yes 30" 2 130" .,.. obstructed duodenal ulcer2.4 yes 3011 31 post-op. subtotal gastrectomy6.7 no none 15"post-op. subtotal gastrectomy7.0 no none 15"post-op. subtotal gastrectomy5.0 no none 15"post-op. subtotal gastrectomy .6.6 · no none 15"post-op. subtotal gastrectomy2.1 yes 30" 41duodenal ulcer 1.9 yes 30" 51 duodenal ulcer 1.5 yes 30" 61 duodenal ulcer 1.3 yes 3011 2 1 duodenal ulcer 2.3 yes 30" 3 1 gastric ulcer 6.8 no 10" 2 1 hiatvs hernia 7.5 no 10" 2 1 post-op. subtotal gastrectomy7.2 no none 2130"chron. cholecysti tis: gas tr. ulcer7.7 no none 30"duodenal ulcer 1.8 yes 30" 7 1 duodenal ulcer 1.6 yes 3011 5 1 bleeding duodenal ulcer1.5 yes . 3011 6 1 hiatus hernia 3.4 yes none 11 post-op. subtotal gastrectomy7.5 no none 15 11 post-op. hiatus herniorrhaphy7.3 no none 1011 duodenal ulcer 6.5 no none 3011 gastric ulcer 2.7 yes none 301  duodenal ulcer 1.6 yes none 1 13011 pre-pyloric ulcer 2.4 yes 3011 30"post-op. subtotal gastrectomy6.8 no 1511 301  post-op. subtotal gastrectomy6.8 no 1511 301  duodenal ulcer 1.5 yes 45" 81 post-op. subtotal gastrectomy3.3 yes 3011 . 2 130"post-op. subtotal gastrectomy7.5 no 1011 30"TIME Wafer U nrecogniz-able but not Complete completely dissolution dissolved 30" 1'30"6' 7' 3'30" 4 1 30" 1 130" 1'30" 2' 2' 3 1 30" 1' 1'30" 2' 2' 2 13011 11 1 14' 18' 20' 8 1 101 17 1 20 1 6 1 8' 8' 10' 10 1 14' 21' .. 3'30" 4 1 15' .. 1'30" 2 1 4' f, I 413011 .. 3011 1' 30" 11 30" 1 130"30" 21 5 1 .. 12 1 .. 1313011 .. 5 1 .. 6 1 91 31 4 1 31 41 31 3130"1130" 213011 301 .. 7 1 9'3011 11' 14' 2 1 31 3011 1 1 201  30"1 1 1130111 13011 21 2' 213012 1 31 1' 21 1' 113011 111 .. 4 1 5' 1 1 21 Method: With the patient in thefasting state the stomach was aspi­rated by means of a Levin tube.The pH of the recovered specimenwas determined with a Beckmanelectrometric pH-meter. A 5 cc.sample was placed in a water-bathat 37oc. One-quarter of a stand­ard-sized ( 2.8 cm. diameter) un­consecrated host was mixed with�aliva intra-orally and then placedm �he sample of gastric juice. Agi­tat10� with a wooden spatula forvarymg periods was occasionallyused to simulate the mechanicaleffect of peristalsis. Three end-�oints were deter�iped: (a) th,time required for beginning disso l�tion to become apparent; ( b) th,time required for the host to become unrecognizable as such, bunot �ompletely dissolved, and ( c;the t�me required for complete dis solut10n. These end-points wendependent upon the judgment 0the observer ( "according to com,mon estimation"), in the absenC(of a feasible chemical test. All th(subjects were male and the ag,range was from 26 to 81 yearsTable I summarizes the results ob­tained in this study.FIGURE I 15 u �13 �12 ........ 1J.<:: JO �9 � 8c::: �7 c,.; ' 5 .,. 143 2 J ............... o------o X-·-·-·XBEGINNING l)/SSOLUT/ON UNliEC06NIZABLE DISSOLUTION COl1PLETE -· I I ,.i x·. i I ,. I . I I I I • I I I f ! I I • I I ' X : ''I ,o I I I ,• ---.-;---d __ , ... ."'.,.l_ ..... l -- -- - -- -- .ti ---o---- / .�/ - ······················ ··················fl,, �--·lt'-'.A-' ········ :.�::.::.:.'. .. ··•········· ····· ·•····1.S 7. 0 6.S 6.0 S. S S.O �.r +. 0 J.S 3. 0 2..5 2.0 /.S f.�pH LINACRE QUARTERLY It is evident that rapidity of dis­solution varies inversely with theacidity of the specimen, due prin­cipally to the inhibition of ptyalinin an acid medium. Several repre­sentative determinations illustrat­ing this relationship are presentedgraphically in Figure I. Regardless of the pH. in only 9of the 50 patients did the time re­quired for the wafer to become un­recognizable ("corrupt" ) , thoughnot completely dissolved, exceed10 minutes, and in the majority itwas considerably less. In these 9individuals, all of whom showed alow pH. the times ranged from 1,1minutes to 21 minutes. It is likelythat all of the recorded timeswould have been shorter if in vivoperistalsis could have been moreeffectively simulated. CANON LAW ANDTHEOLOGICAL OPINIONThe Code of Canon Law2 com­mands that Holy Viaticum for t4esick be not unduly postponed, andthose who have the care of soulsare enjoined to watch with care sothat patients may be refreshed withViaticum while fully in commandof their faculties. In many fatalillnesses the hours previous to them oment of death are not consciousones. Some patients may be irra­tional or comatose. Others, whileconscious, may exper i e nce diffi­culty in swallowing in the hourspreceding death because of vomit­ing or the necessity of employingnasogastric suction.* Thus in such2 Codex Juris Canonici, canon. 865, New-man, Westminster, Maryland, 1942. p.290. 3 Malboeuf. Rev. Rene P.: personal com­munication. FEBRUARY, 1955cases there is little possibility ofViaticum being administered in thefinal minutes of life with deathensuing immediately after swallow­ing of the Sacred Host. However,there are some types of deathwhich could conceivably occur im­mediately after the reception ofCommunion. The incident of aman suffering a fatal coronary oc­clusion or cerebral vascular acci­dent in or near church after receiv­ing Communion, the execution ofa condemned criminal soon afterhis last Communion, or the suddendeath of an accident victim ar.epossible instances in which ·com­munion may have been receivedwithin a very short time beforedeath. Should an autopsy be per­formed promptly there arises theproblem that the Sacred Host maynot have been digested and maystill be incorrupt in the stomach .Digestion is known to continuepost mortem since the digestiveenzymes already secreted at thetime of somatic death retain theirpotency. The chemical inter11ctionof the enzymes and stomach con­tent does not cease immediatelyalthough . the d e c l i n i n g  environ­mental temperature tends to retardthe rate of digestion. The potencyof enzymes already secreted at thetime of death is readily manifestby autolysis. Most autopsies areperformed s e v e r a l  hours afterdeath, which would appear to al­low sufficient time for the corrup­tion of the Host in the cadaver bythe action of the enzymes present.* It has been observed3 that patients withindwelling Levin tubes on constant suc­tion may swallow the Species morereadily if the tube is compressed withthe fingers during the act of deglutition.15 However, it is frequently advisablethat n ecropsy be  performedpromptly on patients dying of cer­tain diseases, such as brain tumorand blood dyscrasias, especiallythe leukemias, in order that thehistopathology be altered as littleas possible by post mortem degen­eration. If such an autopsy is per­formed shortly after death ( as mayalso be done in the case of anexecuted criminal), there exists thepossibility that the Sacred Host isstill incorrupt. If the doctor per­forming the post mortem examina­tion must examine the stomach andfinds the Host still recognizable itwould seem proper that he takehold of It with forceps, place It ina clean cloth, and request a priestto take It for disposition. In thisevent the priest would be guidedby the prescriptions of the RomanMissal4 which require that theHost be placed in a holy placeuntil It corrupts. What remains isthen to be put into the sacrarium.ty minutes. This estimate is madeof the healthy, for in the sick hesays the Species remains severalhours or even a day. Canon Duri­eux 6 states, "A sick stomach some­times takes two or three hours todigest a small Host." Capellmann 7 thinks a space of a half-hour to bethe minimum needed. CappelloScites Gasparri 9 who quotes theopinion of two physicians 10 that aminimum of one-half hour is re­quired for the digestion of a smallHost except in the case of the sick.They state that, "Other than thefew ulcerous stomachs which maydigest a small Host in ten or twentyminutes an afflicted stomach willneed two or three hours to act onthe small Host." If the post mortem procedure doe·snot necessitate opening the stom­ach enzymatic action will disposeof the Host in due time. The timereq.uired for digestion and corrup­tion of the Sacred Species is notuniformly estimated by all theolo­gians. (The manuals do not treatof post i:nortem digestion but mere­ly discuss the length of time thatthe Species remains incorrupt inthe stomach of the communicant.) Merkelbach  5 observes that thecommon estimate is fifteen minutesalthough some writers require thir-4 Miss�le Romanum, Tit. 10, De Defecti-bus, n. 14., Mame, Turin, 1951. p. 50. 5 Merkelbach: Summa Theologiae Mora­lis, 2nd ed., ( 3 vols.), Desclee, Paris,1936. Vol. III, p. 212.16 DISCUSSIONAs far as could be determined,the most recent medical estimateregarding the minimum time re­quired for corruption of the in­gested Host has been that ofGeorge and Core 10 in 1893. Thesewriters agreed on a minimum ofone half hour for the digestion orcorruption of a small Host by ahealthy stomach. They state that"the few ulcerous stomachs" maydigest a small Host in l O or 20minutes. It is evident that the"ulcerous stomachs" mentioned by6 Durieux: Th e E u c h a r i s  t ( Law andPractice) , translated by Dolphin, Don­nelly, Chicago, 1926. p. 184. 7 Capellmann: Medicina Pastoralis, 7thed., Barth, Aachen, 1890. p. 187.8 Cappello: De Sacramentis, (5 .vols.),Marietti, Turin and Rome, 1949-1953.· Vol. I, p. 327. 9 Gasparri: De Eucharistia, ( 2 vols.),Delhome and Briquet, Paris, 1897. Vol.II, pp. 407 -408. 10 George and Core: L'Universite Cath­o!ique, December, 1893.LINACRE QUARTERLYthe write r s  m u s t  refer �o theachlorhydric stomachs of mal�n�r tgastric ulcer and not th1 �g �acid stomachs of benign uo ena ulcer. d S. nowhere was encountere mce . . an estimate of wafer -d1g�st1o nbased on experimental evidence,the present study was undertaken.The results indicate that corrup­tion of the ingested host may pr?dress at a considerably more rap1;ate than heretofore believed,fanhd . 'b the pH o t e that, cetens pan us, . . gastric content's is a dec1s1ve �actf r.In general. the speed ?f d1sso Htion varies inversely with the I1. of the gastric secretions. �ven ��the few subjects whose time .digestion was prolonged, the maxi-time for the ingested host to:e�:me unrecognizable did not ex­ceed 21 minutes. It would appear,therefore, that the previously . acdce ted values should be revised p d On a practical plane,ownwar . . h it would seem that except m t emost unusual circumstan�es no un­due concern about poss1b�e dese-t. . of the Sacred Species needera 10n t is be entertained when an au opsy . conducted on a recent commum­cant. Intractable vomit!ng would,of course, militate agamst recep­tion of the Sacrament. However,even a patient requiring nasogas­tric suction may receive Commu�­ion, particularly if there is no 1:1edi­cal contraindication to the .m;erf ruption of suction for a pen_o o 20 to 30 minutes after reception ofFEBRUARY, 1955 the Host. The use of a Mill�r­Abbott tube on constant suctionshould constitute no deterrent t?the reception of the Sacrame�t !fthe advancing end of the tube is I� or beyond the duodenum. It isalmost a certainty that a Host �e-. d by an ileostomy patient with ce1ve d severe diarrhea would be corru�te long before It reached the te_rmmal·1 Apart from mental mcom-1 eum. . petence. defective sensonum, orintractable vomiting• there . ap�earto be few medical contraindicationsto the reception of Holy C?mmun­ion by the ill. In general. it w?uldseem that the Grace to be gamedb reception of the Sacrament out­:eighs any risk of irrever�nce tothe Sacred Species if such irrever-. less than certain to follow.ence 1s CONCLUSIONS Experimental data here!n pre­nted indicate that the time �e­s:ired for corruption of the i�­q sted host is briefer than pr�v1-��sly believed. The rap id� t yt�!digestion varies inversely _with H. Apart from mental 11:compe-p defecfive sensor1um, ortence, h ear intractable vomiting, t ere . ap� . t b few medical contraindications,_o e f H 1 Commun-to the reception o o y bl . ion by the ill: In debata e m-·t would seem that thestances I t· ofGrace to be gained by rec�p ion the Holy Eucharist outweighs an_Y.. k f . verence if the latter isns o irre less than certain to follow.17 

Medical Aspects of the Holy Eucharist: A Physiological and Canonical Study

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Medical Aspects of the Holy Eucharist: A Physiological and Canonical Study

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