The Importance of Intinction.
By Gardiner Mumford Day.
New York: Episcopal Evangelical Fellowship, 1945.
The Origin of Intinction
At the close of the last century one of the deacons of a Presbyterian Church in Rochester, New York, who happened to be a physician, became greatly concerned because the Church was encouraging the spread of disease through the use of the Common Cup in the Communion service. Under his persuasion this Church abandoned the use of the Common Cup and adopted the arrangement of having individual Communion cups. This custom spread rapidly until now practically all Protestant Churches as well as the Synagogue have abandoned officially the use of the Common Cup except the Lutheran and Protestant Episcopal Churches.
When the epidemic of infantile paralysis broke out in the eastern part of our country in 1916 and in many communities the Churches were requested to remain closed for several Sundays during the most severe part of the epidemic, many parishes temporarily abandoned the use of the Common Cup and instituted the use of intinction (which means that instead of drinking from Common Cup the edge of the wafer is dipped in the wine). Intinction was adopted by these parishes rather than individual Communion Cups in the first place, from the practical point of view, because there were not sufficient individual cups immediately available, and in the second place, because it was felt that by dipping the wafer into a single chalice, the emphasis on the corporate aspect of the Communion was retained.
After the epidemic, while some parishes returned to the use of the Common Cup, others continued the use of intinction. Still other parishes retained the use of intinction but allowed those so desiring to drink from a Common Cup.
Where intinction alone is used, the priest ordinarily carries a combined paten and chalice and after dipping the wafer in the wine, places it either on the tongue or on the palm of the hand of the communicant. Where the optional method is allowed, the priest delivers the wafer according to the traditional method to the communicant and then carries two chalices, one of which is for those who wish to drink from the Cup and the other for those who wish to dip the wafer into the wine. As a rule, the intinction chalice is somewhat smaller and contains but little wine, so that the communicant can easily avoid any possibility of touching the wine with his fingers. Technically speaking, of course, this was not provided for in the rubric, but in view of our modern knowledge of bacteriology, can certainly be said to keep the rubric in spirit. It should be noted also that at the time of the above epidemic, some parishes instituted the Roman custom and administered the Communion in one kind, that is, administered only the Bread to the laity. This is obviously a direct violation of the rubric as well as the historic stand of Protestantism that our Lord instituted the Communion in two kinds for all people. This is made clear in Article 30 in the Articles of Religion printed in the back of the Book of Common Prayer.
Since 1916 the number of parishes in the Episcopal Church using intinction has increased steadily, but unfortunately, slowly. This pamphlet is written because an increasing number of Episcopalians believe that the Church should lead both in applying the best modern hygienic knowledge in its practice and obeying the laws of public health rather than consistently breaking them, as so many of our parishes do at present. Furthermore, in view of this, intinction should be definitely authorized by the Church and the necessary changes made in the rubrics to relieve anyone who conscientiously feels restrained by the present rubrics from adopting intinction. It is for this reason that the Episcopal Evangelical Fellowship, meeting in Richmond in 1944, declared its belief that one of the present imperatives of legislation in our Church is the authorization of intinction as permissive use.
It is hoped that the material in this pamphlet will help in bringing this matter to the attention of the clergy and laity of our Church and assist them in understanding the importance of encouraging action in this matter.
Dr. Chadwick's Statement
No one is more competent to speak on this matter than Dr. Henry D. Chadwick, former Health Commissioner of Massachusetts and nationally known expert in the field of public health, particularly tuberculosis. Therefore, we print the following letter which appeared in The Living Church of July 14, 1946.
To the Editor: From many years' work in the field of public health and as a specialist in tuberculosis, I am keenly aware of the danger of a well person contracting this disease by intimate contact with a tuberculous individual if the sputum contains tubercle bacilli. No more direct way of transferring these germs can be devised than by drinking from the same cup. That the cup happens to be used in church does not alter this fundamental fact as germs are no respectors of persons or places.
To make the type of service optional would protect the well-informed but would not prevent the uninformed or thoughtless person from possible infection by lip to lip transfer of tubercle bacilli smeared on the cup by a preceding tuberculous communicant. To argue that the percentage of alcohol in the sacramental wine would kill any tubercle bacilli that adhere to the edge of the cup is fallacious for two reasons : first, the contact is too brief and the alcohol content too low for disinfection; second the wine does not come in contact with the outer lip of the cup which is more likely to be contaminated.
States have recognized the danger by enacting legislation prohibiting the use of the common drinking cup in public places. These laws are obeyed by all the Churches except the Lutheran and Episcopal denominations. Why should any Church be a law breaker or expect exemption from compliance with a law passed to protect the health of all the people?
Bishop Ivins' article published in The Living Church in the October 8, 1944, issue reviews the history of administering Holy Communion from the early days of the Church and the different methods used. He advances as evidence to prove that tuberculosis is not a menace to communicants who use the common cup that "Every priest who administers the Holy Communion consumes all that may be left in the chalice after all have communicated from it, and cleanses the chalice with his lips" and that "In spite of this, the clergy remain a 'preferred' risk by life insurance companies." It is a fact that clergymen have a longer life expectancy than other professional men, but lawyers and physicians lead a more strenuous life and are exposed to more physical hazards. Furthermore, a very small percentage of the total number of ministers considered in determining the "risk" on a professional basis ever have any contact with the common cup, as most American Churches do not use it in their form of administration of the Sacrament. The clergy are not immune to tuberculosis, as we all know. I have recently had two clergymen with tuberculosis under my care.
Bishop Ivins quotes from a report made by Burrows and Hemmens published in the Journal of Infectious Diseases, 73: 180-190, 1943, of their study of the use of a silver chalice and the possibility of spreading disease thereby. Their problem was to determine whether there was a bactericidal action of the silver surface of the chalice on bacteria in a saliva solution allowed to remain thereon for a given time. They found that after five minutes the number of streptococci recovered from the infected surface was reduced 55% while on the glass slide the reduction was 20%. Even after the rim was wiped with a sterile cloth appreciable numbers could be recovered. They also state "that in the case of tubercle bacilli the time interval was extended to as long as 40 minutes. Guinea pigs were inoculated and in all cases tuberculosis developed. It was clear, therefore, that an infective dose remained viable over the entire period of observation." Unfortunately, Bishop Ivins did not include this paragraph in his abstract, although that is the most significant finding in their entire report and the one that should most concern us.
I would like also to call attention to the fact that the Rev. David R. Cochran in his three articles on the administration of the Holy Communion, published by The Living Church in the spring of 1945 and subsequently reprinted in pamphlet form, not only overlooks the part of the Burrows and Hemmens report which shows that they were not able to demonstrate the same bactericidal action when dealing with tubercle bacilli, but goes so far as to claim, on the basic of the Burrows and Hemmens test, that "the possibility of spreading of infection with a silver chalice, when a purificator is used and the chalice rotated would seem to be negligible." On the other hand I would rather agree with the judgment of Dr. Joseph H. Pratt in a letter to The Living Church, September 2, 1945, in which he stated, "So far as tuberculosis is concerned, their (Burrows and Hemmens) work supports the warning of the National Tuberculosis Association regarding the danger of transmitting this disease by the common cup!'
Dr. Paul E. Rutledge of Kirkwood, Mo., has made experiments under natural conditions in the United States Public Health Laboratory at Clayton, Mo. From his report I quote: "I have repeatedly demonstrated the presence of pathological bacteria on the Communion Cup, the cultures being made within ten minutes after the use of the cup by the last communicant. The organisms recovered are: Staphylococcus aureus and albus, streptococcus non hemolyticus, diphtheroids, micrococcus catarrhalis, micrococcus tetragenous, bacillus subtilis, and an unidentified yeast. I feel that these organisms represent such a wide range of cultural characteristics that it is fair to say that practically any disease which attacks through the nose and throat may be transmitted by the Communion Cup."
Furthermore, Bishop Ivins notes another objection to the use of the common cup, as follows: "There is another reason against the reception of the chalice and that is the use of lipstick by women, even when they come to Holy Communion. This is no place to comment on the practice itself, but so long as it continues in vogue the reception of the chalice is an unpleasant experience for everyone and a rather revolting one for a priest who cleanses it. This is a rather awful thing to have to say about receiving Holy Communion, but so long as so many women are so unthoughtful of others in regard to this practice it would seem that the only alternative would be Communion in one kind for many. It would further seem that those who should deny themselves the use of the chalice should be those who use lipstick. But it is probably too much to expect most of these women to do so of their own volition and therefore others will have to do so."
When several people drink from the same cup they defy the germ theory and the teachings of Pasteur, Koch, and sanitarians throughout the world.
Quite recently in a Massachusetts town four young women, members of the same choir, developed tuberculosis. Investigation indicated that the infection was passed from one to the other, as there were no cases of tuberculosis in the families of any of these patients. Just how this infection took place is not susceptible of proof, as it might have occurred in one of several ways. These young women were in close contact in all of the activities of the choir. In singing or coughing, the germs of tuberculosis could have been transferred from one tuberculous person to others with whom she was in intimate contact, but drinking from a common cup would be an even more direct method of conveying infection. This hazard applies as much to the chalice used in the Communion service as it does to a common drinking cup used by different individuals.
I cannot believe that any clergyman would knowingly pass a cup used by a person with pulmonary tuberculosis to other communicants. However, even if all the persons conscious of having tuberculosis refrained from participating in the Communion service, this is bound to happen when the common cup is used, as X-ray surveys show that about 1% of all adults have some evidence of pulmonary tuberculosis.
I was present recently at Communion in an Episcopal church where the communicants were given the choice of two methods of receiving Communion. I noticed that about one-half requested the intinction method, the others used the common cup and thereby exposed themselves to infection with tuberculosis and such other communicable diseases as may be spread through mouth to mouth contact. The Church should take the lead in promoting hygiene and not merely because of tradition actively oppose progress or assume a neutral attitude in this important matter. The dead hand of tradition should be lifted and not be permitted to stunt the growth of the living Church. Henry D. Chadwick, M.D.
National T. B. Association
The resolution of the National Tuberculosis Association to which Dr. Chadwick refers is as follows:
Whereas, It is a well established fact that one case of tuberculosis comes from another; that the infectious agent, the tubercle bacillus, is contained in the sputum of those who have the disease and that this bacillus may be conveyed from mouth to mouth through the use of a common drinking cup;
Whereas, This menace to health has been recognized in most, if not all the states, by legislation prohibiting the use of the common drinking cup but notwithstanding certain church organizations continue to use the common communion cup in their services; Therefore, be it
Resolved, that the Board of Directors of the National Tuberculosis Association at the Annual Business Meeting held in St. Louis, May 6, 1943, respectively call the attention of the governing heads of the church organizations which use the common communion cup to the danger of transmitting communicable diseases in this way, and recommend that they adopt some method of administering the sacrament that is in conformity with our knowledge of good hygiene and public health practice.
An Avoidable Conflict
An Episcopalian who is preparing himself for work in the important field of public health and is studying at one of the best schools of public health in the country was recently given a reading assignment which included the following passage from a standard work entitled Preventive Medicine and Public Health by a Professor at Cornell Medical College, Dr. Wilson G. Smillie, who, it is interesting to notice, like Dr. Chadwick is also an Episcopalian.
"The regulations concerning individual drinking cups and sanitary drinking fountains that have been imposed by the Federal Government upon interstate carriers have had a most beneficial influence upon the adoption of these regulations by state and local health departments.
"In relatively recent times, the tin cup chained to the water bucket was standard equipment in schools, offices, trains, markets, and other public places. It was difficult to prove that respiratory disease may be spread in this manner, and the aesthetic arguments were overwhelmed by the obvious advantages of simplicity and economy. There is a traditional and probably apocryphal story that the national legislation for abolition of the common drinking cup resulted from an accidental infection with syphilis, following the use of a common drinking cup on a mid western train. She had noticed that the person who used the cup just before her had "a brownish rash on the face." This tragedy resulted in a crusade by her husband for sanitary drinking facilities on interstate carriers that has extended to all parts of the nation, and is now a matter of almost universal practice in schools, offices, stores, and all other public places. Practically the only exception to this rule is the stubborn ... continuation of the use of the common communion cup in church services by a few of the more conservative religious sects."
The Status of Intinction
In view of the foregoing a natural question is: What is the status of intinction in our Church? The answer is that intinction has never been authorized by General Convention. At three successive General Conventions, however, the House of Deputies passed by a large majority a resolution authorizing intinction as a permissive use, but each time the House of Bishops has failed to concur. In 1943 the vote was by orders with the clerical delegations from forty-five dioceses voting in the affirmative to thirty in the negative, while forty-nine lay delegations voted in the affirmative to only twelve in the negative. It is also noteworthy that in an informal straw vote taken in the House of Bishops at the Convention in 1943 a majority of the Bishops present voted in favor of either intinction or Communion in one kind when the permission of the Bishop was first secured. Nevertheless, at the same Convention the House of Bishops by resolution referred the matter to the Lambeth Conference of the Bishops of the Anglican Communion for counsel and advice declaring that "although the method of intinction and Communion in one kind in the administration of the Holy Communion are already widely used, this house believes it unwise to take constitutional action upon it at this time."
The Lambeth Conference is scheduled to meet in the summer of 1948 and it is our hope that it will give its approval to the use of intinction where it is desired in order that the Church may adopt methods of administration of the Holy Communion which conform to the best knowledge of modern hygiene and enable the Church to obey the laws of public health.
The Church's Practice
New prayers, new services, and new practices are not simply conceived in someone's mind and then placed in the Book of Common Prayer. Ordinarily a new practice is introduced into a parish. If it proves helpful, other parishes adopt it, and thus, it spreads through a considerable part of the Church and may even be authorized by the Bishop in one or more dioceses. For example, in the service of Morning Prayer, many parishes years ago adopted the practice of encouraging the congregation to join with the minister in saying the General Thanksgiving in unison, although such a practice was not authorized by the rubrics. Consequently, in the 1928 revision we find the practice authorized by the rubric on page 19 of the Prayer Book: "Note, That the General Thanksgiving may be said by the Congregation with the Minister."
Thus, the Book of Common Prayer has grown and still grows through experimentation and experience. If no prayer, service, or usage that had not been authorized by rubric or by General Convention was ever put into practice, the Book of Common Prayer would long since have become a dead book. In reality, it is a living Book because most of its prayers, services and usages have been tried out and tested in experience long before they were actually authorized by the Church.
Sometimes such practices are employed in individual parishes with neither the explicit consent nor disapproval of the Bishop. The latter may feel he has no authority to approve and yet may be glad to have the practice tested in experience in order to determine whether or not it successfully meets a need. Frequently, such practices are permitted or authorized by a Bishop for his diocese, as is the case with intinction and Communion in one kind, in the belief that such questions come within the jurisdiction of the diocesan Bishop. In some cases the use of intinction or Communion in one kind has become so prevalent in a diocese that were the Bishop to forbid its use, he would "excommunicate" a vast number of communicants. For example, a young communicant who came from a parish where intinction is an alternate usage, attended a Provincial Conference recently where only the Common Cup was offered. She asked the Chaplain whether she had to drink from the Common Cup as she had never drunk from one in her life and the idea was repellant to her. Naturally the Chaplain informed her that while there was no special cup reserved for intinction, she could dip her wafer in the Common Cup, which, although only a make shift from the hygienic standpoint, at least made Communion in both kinds possible for her.
While as strong an aversion as this may be rare, there are far more people in our pews who agree with this young girl than ever say so. Rather than to raise what might be embarrassing questions regarding the practice of a parish, the communicant who is repelled by the Common Cup will often simply absent himself from communicating, or even from the Communion service. Anyone who has used intinction, for example, as an alternate method as the writer has for some twenty years, will have people continually saying to him: "I'm very happy that you have intinction in this parish because my husband is a dentist and while he is confirmed, our Rector at home will not allow intinction, and this morning was the first time he has been willing to receive Communion with me." Or, "I was delighted to be at Communion this morning as I had not realized that it could be administered by intinction so reverently. Our Rector at home has always said it was a 'sloppy' method, but now I know better." I believe that general experience indicates that in parishes where intinction has been employed over a period of years and proper instruction given in confirmation class, the number of those receiving Communion has considerably increased.
It may be well to note also that it can be fairly contended that some methods of using intinction are unrubrical when the rubrics are interpreted "by the letter rather than the spirit," but self-intinction when the communicant is given the wafer and himself dips it into the Cup is generally interpreted as within the scope of the rubric. The priest delivers the Bread and the Cup to the communicant as required by the rubrics. (See pages 82 and 83 in the Prayer Book).
Owing to the fact, however, that some clergy feel constrained to allow only the use of the Common Cup until the use of other methods is definitely authorized, and in view of the increasingly widespread use of alternate methods, and the ever increasing desire upon the part of the laity for them, it is to be hoped that the Lambeth Conference will give the most careful consideration to this matter. There is little doubt that the point of view contained in the following resolution coming from several groups of clergy to the General Convention in 1937 would receive today not less but greater backing, especially from the laity of our Church:
Whereas, Medical research has proved that many diseases are transmitted through labial contacts with vessels used consecutively by many people, and,
Whereas, The knowledge of such facts has caused many communicants to become troubled, and has also, we believe, interfered with their devotional enjoyment of the great service of the Church, therefore, be it
Resolved, That it be respectfully and earnestly urged that some action be taken by General Convention allowing permissive use of Administration of the Holy Communion by Intinction. (Journal of the General Convention, 1937, page 274)
Similarly, we respectfully and earnestly urge that the Lambeth Conference approve the use of such alternate methods for the administration of Communion as will bring the Church's practice into conformity with the best modern hygienic knowledge. May the Anglican Communion no longer lag behind in this matter, but rather, join with other Churches in stressing the spirit rather than the letter in the administration of Holy Communion.