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Sacrament Of Anointing The Sick

Anointing Of The Sick (Extreme Unction)

A sacrament of the New Law instituted by Christ to give spiritual aid and comfort and perfect spiritual health, including, if need be, the remission of sins, and also, conditionally, to restore bodily health, to Christians who are seriously ill; it consists essentially in the unction by a priest of the body of the sick person, accompanied by a suitable form of words. The several points embodied in this descriptive definition will be more fully explained in the following sections into which this article is divided: I. Actual Rite of Administration; II. Name; III. Sacramental Efficacy of the Rite; IV. Matter and Form; V. Minister; VI. Subject; VII. Effects; VIII. Necessity; IX. Repetition; X. Reviviscence of the Sacrament.


As administered in the Western Church today according to the rite of the Roman Ritual, the sacrament consists (apart from certain non-essential prayers) in the unction with oil, specially blessed by the bishop, of the organs of the five external senses (eyes, ears, nostrils, lips, hands), of the feet, and, for men (where the custom exists and the condition of the patient permits of his being moved), of the loins or reins; and in the following form repeated at each unction with mention of the corresponding sense or faculty: "Through this holy unction and His own most tender mercy may the Lord pardon thee whatever sins or faults thou hast committed [quidquid deliquisti] by sight [by hearing, smell, taste, touch, walking, carnal delectation]". The unction of the loins is generally, if not universally, omitted in English-speaking countries, and it is of course everywhere forbidden in case of women. To perform this rite fully takes an appreciable time, but in cases of urgent necessity, when death is likely to occur before it can be completed, it is sufficient to employ a single unction (on the forehead, for instance) with the general form: "Through this holy unction may the Lord pardon thee whatever sins or faults thou hast committed." By the decree of 25 April, 1906, the Holy Office has expressly approved of this form for cases of urgent necessity.

In the Eastern Orthodox (schismatical) Church this sacrament is normally administered by a number of priests (seven, five, three; but in case of necessity even one is enough); and it is the priests themselves who bless the oil on each occasion before use. The parts usually anointed are the forehead, chin, cheeks, hands, nostrils, and breast, and the form used is the following: "Holy Father, physician of souls and of bodies, Who didst send Thy Only- Begotten Son as the healer of every disease and our deliverer from death, heal also Thy servant N. from the bodily infirmity that holds him, and make him live through the grace of Christ, by the intercessions of [certain saints who are named], and of all the saints." (Goar, Euchologion, p. 417.) Each of the priests who are present repeats the whole rite.


The name Extreme Unction did not become technical in the West till towards the end of the twelfth century, and has never become current in the East. Some theologians would explain its origin on the ground that this unction was regarded as the last in order of the sacramental or quasi-sacramental unctions, being preceded by those of baptism, confirmation, and Holy orders; but, having regard to the conditions prevailing at the time when the name was introduced (see below, VI), it is much more probable that it was intended originally to mean "the unction of those in extremis", i.e. of the dying, especially as the corresponding name, sacramentum exeuntium, came into common use during the same period.

In previous ages the sacrament was known by a variety of names, e.g., the holy oil, or unction, of the sick; the unction or blessing of consecrated oil; the unction of God; the office of the unction; etc. In the Eastern Church the later technical name is euchelaion (i.e. prayer-oil); but other names have been and still are in use, e.g. elaion hagion (holy), or hegismenon (consecrated), elaion, elaiou Chrisis, chrisma, etc.


A. Catholic Doctrine

The Council of Trent (Sess. XIV, cap. i, De Extr. Unct.) teaches that "this sacred unction of the sick was instituted by Christ Our Lord as a sacrament of the New Testament, truly and properly so called, being insinuated indeed in Mark [vi, 13] but commended to the faithful and promulgated" by James [Ep., v, 14, 15]; and the corresponding canon (can. i, De Extr. Unct.) anathematizes anyone who would say "that extreme unction is not truly and properly a sacrament instituted by Christ Our Lord, and promulgated by the blessed Apostle James, but merely a rite received from the fathers, or a human invention". Already at the Council of Florence, in the Instruction of Eugene IV for the Armenians (Bull "Exultate Deo", 22 Nov., 1439), extreme unction is named as the fifth of the Seven Sacraments, and its matter and form, subject, minister, and effects described (Denzinger, "Enchiridion", 10th ed., Freiburg, 1908, no. 700--old no. 595). Again, it was one of the three sacraments (the others being confirmation and matrimony) which Wycliffites and Hussites were under suspicion of contemning, and about which they were to be specially interrogated at the Council of Constance by order of Martin V (Bull "Inter cunctas", 22 Feb., 1418.--Denzinger, op. cit., no. 669--old no. 563). Going back farther we find extreme unction enumerated among the sacraments in the profession of faith subscribed for the Greeks by Michael Palæologus at the Council of Lyons in 1274 (Denzinger, no. 465--old no. 388), and in the still earlier profession prescribed for converted Waldenses by Innocent III in 1208 (Denzinger, no. 424--old no. 370). Thus, long before Trent--in fact from the time when the definition of a sacrament in the strict sense had been elaborated by the early Scholastics-- extreme unction had been recognized and authoritatively proclaimed as a sacrament; but in Trent for the first time its institution by Christ Himself was defined. Among the older Schoolmen there had been a difference of opinion on this point, some--as Hugh of St. Victor (De Sacram., Bk. II, pt. XV, c. ii), Peter Lombard (Sent., IV, dist. xxiii), St. Bonaventure (Comm. in Sent., loc. cit., art. i, Q. ii), and others--holding against the more common view that this sacrament had been instituted by the Apostles after the Descent of the Holy Ghost and under His inspiration. But since Trent it must be held as a doctrine of Catholic faith that Christ is at least the mediate author of extreme unction, i.e., that it is by His proper authority as God-Man that the prayer-unction has become an efficacious sign of grace; and theologians almost unanimously maintain that we must hold it to be at least certain that Christ was in some sense the immediate author of this sacrament, i.e., that He Himself while on earth commissioned the Apostles to employ some such sign for conferring special graces, without, however, necessarily specifying the matter and form to be used. In other words, immediate institution by Christ is compatible with a mere generic determination by Him of the physical elements of the sacrament.

The teaching of the Council of Trent is directed chiefly against the Reformers of the sixteenth century. Luther denied the sacramentality of extreme unction and classed it among rites that are of human or ecclesiastical institution (De Captivit. Babylonicâ, cap. de extr. unct.). Calvin had nothing but contempt and ridicule for this sacrament, which he described as a piece of "histrionic hypocrisy" (Instit., IV, xix, 18). He did not deny that the Jacobean rite may have been a sacrament in the Early Church, but held that it was a mere temporary institution which had lost all its efficacy since the charisma of healing had ceased (Comm. in Ep. Jacobi, v, 14, 15). The same position is taken up in the confessions of the Lutheran and Calvinistic bodies. In the first edition (1551) of the Edwardine Prayer Book for the reformed Anglican Church the rite of unction for the sick, with prayers that are clearly Catholic in tone, was retained; but in the second edition (1552) this rite was omitted, and the general teaching on the sacraments shows clearly enough the intention of denying that extreme unction is a sacrament. The same is to be said of the other Protestant bodies, and down to our day the denial of the Tridentine doctrine on extreme unction has been one of the facts that go to make up the negative unanimity of Protestantism. At the present time, however, there has been a revival more or less among Anglicans of Catholic teaching and practice. "Some of our clergy", writes Mr. Puller (Anointing of the Sick in Scripture and Tradition, London, 1904), "seeing the plain injunction about Unction in the pages of the New Testament, jump hastily to the conclusion that the Roman teaching and practice in regard to Unction is right, and seek to revive the use of Unction as a channel of sanctifying grace, believing that grace is imparted sacramentally through the oil as a preparation for death" (p. 307). Mr. Puller himself is not prepared to go so far, though he pleads for the revival of the Jacobean unction, which he regards as a mere sacramental instituted for the supernatural healing of bodily sickness only. His more advanced friends can appeal to the authority of one of their classical writers, Bishop Forbes of Brechin, who admits (Exposition of the XXXIX Articles, vol. II, p. 463) that "unction of the sick is the Lost Pleiad of the Anglican firmament. . .There has been practically lost an apostolic practice, whereby, in case of grievous sickness, the faithful were anointed and prayed over, for the forgiveness of their sins, and to restore them, if God so willed, or to give them spiritual support in their maladies".

Previous to the Reformation there appears to have been no definite heresy relating to this sacrament in particular. The Albigenses are said to have rejected it, the meaning probably being that its rejection, like that of other sacraments, was logically implied in their principles. The abuses connected with its administration which prevailed in the twelfth and thirteenth centuries and which tended to make it accessible only to the rich, gave the Waldenses a pretext for denouncing it as the ultima superbia (cf. Preger, Beiträge zur Gesch. der Waldenser im M.A., pp. 66 sqq.). That the Wycliffites and Hussites were suspected of contemning extreme unction is clear from the interrogatory already referred to, but the present writer has failed to discover any evidence of its specific rejection by these heretics.

B. Proof of Catholic Doctrine from Holy Scripture

In this connection there are only two texts to be discussed--Mark, vi, 13, and James, v, 14, 15--and the first of these may be disposed of briefly. Some ancient writers (Victor of Antioch, Theophylactus, Euthymius, St. Bede, and others) and not a few Scholastics saw a reference to this sacrament in this text of St. Mark, and some of them took it to be a record of its institution by Christ or at least a proof of His promise or intention to institute it. Some post-Tridentine theologians also (Maldonatus, de Sainte-Beuve, Berti, Mariana, and among recent writers, but in a modified form, Schell) have maintained that the unction here mentioned was sacramental. But the great majority of theologians and commentators have denied the sacramentality of this unction on the grounds: (1) that there is mention only of bodily healing as its effect (cf. Matt., x, 1; Luke, ix, 1, 2); (2) that many of those anointed had probably not received Christian baptism; (3) that the Apostles had not yet been ordained priests; and (4) that penance, of which extreme unction is the complement, had not yet been instituted as a sacrament. Hence the guarded statement of the Council of Trent that extreme unction as a sacrament is merely "insinuated" in St. Mark, i.e. hinted at or prefigured in the miraculous unction which the Apostles employed, just as Christian baptism had been prefigured by the baptism of John.

The text of St. James reads: "Is any man sick among you? Let him bring in the priests of the Church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith shall save [sosei] the sick man: and the Lord shall raise him up [egerei]: and if he be in sins, they shall be forgiven him." It is not seriously disputed that there is question here of those who are physically ill, and of them alone; and that the sickness is supposed to be grave is conveyed by the word kamnonta and by the injunction to have the priests called in; presumably the sick person cannot go to them. That by "the priests of the church" are meant the hierarchical clergy, and not merely elders in the sense of those of mature age, is also abundantly clear. The expression tous presbyterous, even if used alone, would naturally admit no other meaning, in accordance with the usage of the Acts, Pastoral Epistles, and I Peter (v); but the addition of tes ekklesias excludes the possibility of doubt (cf. Acts, xx, 17). The priests are to pray over the sick man, anointing him with oil. Here we have the physical elements necessary to constitute a sacrament in the strict sense: oil as remote matter, like water in baptism; the anointing as proximate matter, like immersion or infusion in baptism; and the accompanying prayer as form. This rite will therefore be a true sacrament if it has the sanction of Christ's authority, and is intended by its own operation to confer grace on the sick person, to work for his spiritual benefit. But the words "in the name of the Lord" here mean "by the power and authority of Christ", which is the same as to say that St. James clearly implies the Divine institution of the rite he enjoins. To take these words as referring to a mere invocation of Christ's name--which is the only alternative interpretation--would be to see in them a needless and confusing repetition of the injunction "let them pray over him". But is this rite recommended by St. James as an operative sign of grace? It may be admitted that the words "the prayer of faith shall save the sick man; and the Lord shall raise him up", taken by themselves and apart from the context, might possibly be applied to mere bodily healing; but the words that follow, "and if he be in sins, they shall be forgiven him", speak expressly of a spiritual effect involving the bestowal of grace. This being so, and it being further assumed that the remission of sins is given by St. James as an effect of the prayer-unction, nothing is more reasonable than to hold that St. James is thinking of spiritual as well as of bodily effects when he speaks of the sick man being "saved" and "raised up".

It cannot be denied that in accordance with New Testament usage the words in question (especially the first) are capable of conveying this twofold meaning, and it is much more natural in the present context to suppose that they do convey it. A few verses further on the predominating spiritual and eschatological connotation of "saving" in St. James's mind emerges clearly in the expression, "shall save his soul from death" (v, 20), and without necessarily excluding a reference to deliverance from bodily death in verse 15, we are certainly justified in including in that verse a reference to the saving of the soul. Moreover, the Apostle could not, surely, have meant to teach or imply that every sick Christian who was anointed would be cured of his sickness and saved from bodily death; yet the unction is clearly enjoined as a permanent institution in the Church for all the sick faithful, and the saving and raising up are represented absolutely as being the normal, if not infallible, effect of its use. We know from experience (and the same has been known and noted in the Church from the beginning) that restoration of bodily health does not as a matter of fact normally result from the unction, though it does result with sufficient frequency and without being counted miraculous to justify us in regarding it as one of the Divinely (but conditionally) intended effects of the rite. Are we to suppose, therefore, that St. James thus solemnly recommends universal recourse to a rite which, after all, will be efficacious for the purpose intended only by way of a comparatively rare exception? Yet this is what would follow if it be held that there is reference exclusively to bodily healing in the clauses which speak of the sick man being saved and raised up, and if further it be denied that the remission of sins spoken of in the following clause, and which is undeniably a spiritual effect, is attributed to the unction by St. James. This is the position taken by Mr. Puller; but, apart from the arbitrary and violent breaking up of the Jacobean text which it postulates, such a view utterly fails to furnish an adequate rationale for the universal and permanent character or the Apostolic prescription. Mr. Puller vainly seeks an analogy (op. cit., pp. 289 sqq.) in the absolute and universal expressions in which Christ assures us that our prayers will be heard. We admit that our rightly disposed prayers are always and infallibly efficacious for our ultimate spiritual good, but not by any means necessarily so for the specific temporal objects or even the proximate spiritual ends which we ourselves intend. Christ's promises regarding the efficacy of prayer are fully justified on this ground; but would they be justified if we were compelled to verify them by reference merely to the particular temporal boons we ask for? Yet this is how, on his own hypothesis, Mr. Puller is obliged to justify St. James assurance that the prayer-unction shall be efficacious. But in the Catholic view, which considers the temporal boon of bodily healing as being only a conditional and subordinate end of the unction, while its paramount spiritual purpose--to confer on the sick and dying graces which they specially need--may be, and is normally, obtained, not only is an adequate rationale of the Jacobean injunction provided, but a true instead of a false analogy with the efficacy of prayer is established.

But in defense of his thesis Mr. Puller is further obliged to maintain that all reference to the effects of the unction ceases with the words, "the Lord shall raise him up", and that in the clause immediately following, "and if he be in sins, they shall be forgiven him", St. James passes on to a totally different subject, namely, the Sacrament of Penance. But unless we agree to disregard the rules of grammar and the logical sequence of thought, it is impossible to allow this separation of the clauses and this sudden transition in the third clause to a new and altogether unexpected subject-matter. All three clauses are connected in the very same way with the unction, "and the prayer of faith. . .and the Lord. . .and if he be in sins. . .", so that the remission of sins is just as clearly stated to be an effect of the unction as the saving and raising up. Had St. James meant to speak of the effect of priestly absolution in the third clause he could not have written in such a way as inevitably to mislead the reader into believing that he was still dealing with an effect of the priestly unction. In the nature of things there is no reason why unction as well as absolution by a priest might not be Divinely ordained for the sacramental remission of sin, and that it was so ordained is what every reader naturally concludes from St. James. Nor is there anything in the context to suggest a reference to the Sacrament of Penance in this third clause. The admonition in the following verse (16), "Confess, therefore, your sins one to another", may refer to a mere liturgical confession like that expressed in the "Confiteor"; but even if we take the reference to be to sacramental confession and admit the genuineness of the connecting "therefore" (its genuineness is not beyond doubt), there is no compelling reason for connecting this admonition closely with the clause which immediately precedes. The "therefore" may very well be taken as referring vaguely to the whole preceding Epistle and introducing a sort of epilogue.

Mr. Puller is the latest and most elaborate attempt to evade the plain meaning of the Jacobean text that we have met with; hence our reason for dealing with is so fully. It would be an endless task to notice the many other similarly arbitrary devices of interpretation to which Protestant theologians and commentators have recurred in attempting to justify their denial of the Tridentine teaching so clearly supported by St. James (see examples in Kern, "De Sacramento Extremæ Unctionis", Ratisbon, 1907, pp. 60 sq.). It is enough to remark that the number of mutually contradictory interpretations they have offered is a strong confirmation of the Catholic interpretation, which is indeed the only plain and natural one, but which they are bound to reject at the outset. In contrast with their disregard of St. James's injunction and their hopeless disagreement as to what the Apostle really meant, we have the practice of the whole Christian world down to the time of the Reformation in maintaining the use of the Jacobean rite, and the agreement of East and West in holding this rite to be a sacrament in the strict sense, an agreement which became explicit and formal as soon as the definition of a sacrament in the strict sense was formulated, but which was already implicitly and informally contained in the common practice and belief of preceding ages. We proceed, therefore, to study the witness of Tradition.

C. Proof from Tradition

(1) State of the Argument

Owing to the comparative paucity of extant testimonies from the early centuries relating to this sacrament, Catholic theologians habitually recur to the general argument from prescription, which in this case may be stated briefly thus: The uninterrupted use of the Jacobean rite and its recognition as a sacrament in the Eastern and Western Churches, notwithstanding their separation since 869, proves that both must have been in possession of a common tradition on the subject prior to the schism. Further, the fact that the Nestorian and Monophysite bodies, who separated from the Church in the fifth century, retained the use of the unction of the sick, carries back the undivided tradition to the beginning of that century, while no evidence from that or any earlier period can be adduced to weaken the legitimate presumption that the tradition is Apostolic, having its origin in St. James's injunction. Both of these broad facts will be established by the evidence to be given below, while the presumption referred to will be confirmed by the witness of the first four centuries.

As to the actual paucity of early testimonies, various explanations have been offered. It is not sufficient to appeal with Binterim (Die Vorzüglichsten Denkwürdigkeiten der christkathol. Kirche, vol. VI, pt. III, p. 241) to the Discipline of the Secret, which, so far as it existed, applied equally to other sacraments, yet did not prevent frequent reference to them by writers and preachers of those ages. Nor is Launoi's contention (Opera, vol. I, pt. I, pp. 544 sq.) well founded, that recourse to this sacrament was much rarer in early ages than later. It is more to the point in the first place to recall the loss, except for a few fragments, of several early commentaries on St. James's Epistle (by Clement of Alexandria, Didymus, St. Augustine, St. Cyril of Alexandria, and others) in which chiefly we should look for reference to the unction. The earliest accurately preserved commentary is that of St. Bede (d. 735), who, as we shall see, is a witness for this sacrament, as is also Victor of Antioch (fifth century), the earliest commentator on St. Mark. Second, it is clear, at the period when testimonies become abundant, that the unction was allied to penance as a supplementary sacrament, and as such was administered regularly before the Viaticum. We may presume that this order of administration had come down from remote antiquity, and this close connection with penance, about which, as privately administered to the sick, the Fathers rarely speak, helps to explain their silence on extreme unction. Third, it should be remembered that there was no systematic sacramental theology before the Scholastic period, and, in the absence of the interests of system, the interests of public instruction would call far less frequently for the treatment of this sacrament and of the other offices privately administered to the sick than would subjects of such practical public concern as the preparation of catechumens and the administration and reception of those sacraments which were solemnly conferred in the church. If these, and similar considerations which might be added, are duly weighed, it will be seen that the comparative fewness of early testimonies is not after all so strange. It should be observed, moreover, that charismatic and other unctions of the sick, even with consecrated oil, distinct from the Jacobean unction, were practiced in the early ages, and that the vagueness of not a few testimonies which speak of the anointing of the sick makes it doubtful whether the reference is to the Apostolic rite or to some of these other usages.

It should finally be premised that in stating the argument from tradition a larger place must be allowed for the principle of development than theologians of the past were in the habit of allowing. Protestant controversialists were wont virtually to demand that the early centuries should speak in the language of Trent--even Mr. Puller is considerably under the influence of this standpoint--and Catholic theologians have been prone to accommodate their defense to the terms of their adversaries' demand. Hence they have undertaken in many cases to prove much more than they were strictly bound to prove, as for instance that extreme unction was clearly recognized as a sacrament in the strict sense long before the definition of a sacrament in this sense was drawn up. It is a perfectly valid defense of the Tridentine doctrine on extreme unction to show that St. James permanently prescribed the rite of unction in terms that imply its strictly sacramental efficacy; that the Church for several centuries simply went on practicing the rite and believing in its efficacy as taught by the Apostle, without feeling the need of a more definitely formulated doctrine than is expressed in the text of his Epistle; and that finally, when this need had arisen, the Church, in the exercise of her infallible authority, did define for all time the true meaning and proper efficacy of the Jacobean prayer-unction. It is well to keep this principle in mind in discussing the witness of the early ages, though as a matter of fact the evidence, as will be seen, proves more than we are under any obligation to prove.

(2) The Evidence

(a) Ante-Nicene Period.--The earliest extant witness is Origen (d. 254), who, in enumerating the several ways of obtaining remission of sins, comes (seventhly) to "the hard and laborious" way of (public) penance, which involves the confession of one's sins to the priest and the acceptance at his hands of "the salutary medicine". And having quoted the Psalmist in support of confession, Origen adds: "And in this [in quo] is fulfilled also what St. James the Apostle says: if any one is sick, let him call in the priests of the Church, and let them lay hands on him, anointing him with oil in the name of the Lord, and the prayer of faith shall save the sick man, and if he be in sins they shall be remitted to him" (Hom. ii, in Levit., in P.G., XII, 419). We might be content to quote this as a proof merely of the fact that the injunction of St. James was well known and observed in Origen's time, and that the rite itself was commonly spoken of at Alexandria as "a laying on of hands". But when it is urged that he here attributes the remission of sins of which the Apostle, speaks not to the rite of unction but to the Sacrament of Penance, it is worth while inquiring into the reasons alleged for this interpretation of the passage. Some would have it that Origen is allegorizing, and that he takes the sick man in St. James to mean the spiritually sick or the sinner, thus changing the Apostolic injunction to the following: If anyone be in sins, let him call in the priest. . .and if he be in sins, they shall be remitted to him. But we cannot suppose the great Alexandrian capable of such illogicalness on his own account, or capable of attributing it to the Apostle. According to Mr. Puller (op. cit., pp. 42 sqq.), Origen, while quoting the whole text of St. James, means in reality to refer only to the fulfillment of the concluding words, "and if he be in sins", etc. But if that be so, why quote the preceding part at all, which, in Mr. Puller's, and ex hypothesi in Origen's, view, has nothing to do with the subject and can only lead to confusion; and why, above all, omit the words of St. James immediately following, "Confess your sins one to another", which would have been very much to the point and could not have caused any confusion? The truth is that the relation of the Jacobean rite to penance is very obscurely stated by Origen; but, whatever may have been his views of that relation, he evidently means to speak of the whole rite, unction and all, and to assert that it is performed as a means of remitting sin for the sick. If it be held on the obscurity of the connection that he absolutely identifies the Jacobean rite with penance, the only logical conclusion would be that he considered the unction to be a necessary part of penance for the sick. But it is much more reasonable and more in keeping with what we know of the penitential discipline of the period--Christian sinners were admitted to canonical penance only once--to suppose that Origen looked upon the rite of unction as a supplement to penance, intended for the sick or dying who either had never undergone canonical penance, or after penance might have contracted new sins, or who, owing to their "hard and laborious" course of satisfaction being cut short by sickness, might be considered to need just such a complement to absolution, this complement itself being independently efficacious to remit sins or complete their remission by removal of their effects. This would fairly account for the confused grouping together of both ways of remission in the text, and it is a Catholic interpretation in keeping with the conditions of that age and with later and clearer teaching. It is interesting to observe that John Cassian, writing nearly two centuries later, and probably with this very text of Origen before him, gives similar enumeration of means for obtaining remission of sins, and in this enumeration the Jacobean rite is given an independent place (Collat., XX, in P.L., XLIX, 1161).

Origen's contemporary, Tertullian, in upbraiding heretics for neglecting the distinction between clergy and laity and allowing even women "to teach, to dispute, to perform exorcisms, to undertake cures [curationes repromittere], perhaps even to baptize" (De Præscript., c. xli, in P.L., II, 262), probably refers in the italicized clause to the use of the Jacobean rite; for he did not consider charismatic healing, even with oil, to be the proper or exclusive function of the clergy (see "Ad Scapulam", c. iv, in P.L., I, 703). If this be so, Tertullian is a witness to the general use of the rite and to the belief that its administration was reserved to the priests.

St. Aphraates, "the Persian Sage", though he wrote (336-345) after Nicæa, may be counted as an Ante-Nicene witness, since he lived outside the limits of the empire and remained in ignorance of the Arian strife. Writing of the various uses of holy oil, this Father says that it contains the sign "of the sacrament of life by which Christians [baptism], priests [in ordination], kings, and prophets are made perfect; [it] illuminates darkness [in confirmation], anoints the sick, and by its secret sacrament restores penitents" (Demonstratio xxiii, 3, in Graffin, "Patrol. Syriaca", vol. I, p. lv). It is hardly possible to question the allusion here to the Jacobean rite, which was therefore in regular use in the remote Persian Church at the beginning of the fourth century. Its mention side by side with other unctions that are not sacramental in the strict sense is characteristic of the period, and merely shows that the strict definition of a sacrament has not been formulated. As being virtually Ante-Nicene we may give also the witness of the collection of liturgical prayers known as the "Sacramentary of Serapion". (Serapion was Bishop of Thmuis in the Nile Delta and the friend of St. Athanasius.) The seventeenth prayer is a lengthy form for consecrating the oil of the sick, in the course of which God is besought to bestow upon the oil a supernatural efficacy "for good grace and remission of sins, for a medicine of life and salvation, for health and soundness of soul, body, spirit, for perfect strengthening". Here we have not only the recognition in plain terms of spiritual effects from the unction but the special mention of grace and the remission of sins. Mr. Puller tries to explain away several of these expressions, but he has no refuge from the force of the words "for good grace and remission of sins" but to hold that they must be a later addition to the original text.

(b) The Great Patristic Age: Fourth to Seventh Century.-- References to extreme unction in this period are much more abundant and prove beyond doubt the universal use of the Jacobean unction in every part of the Church. Some testimonies, moreover, refer specifically to one or more of the several ends and effects of the sacrament, as the cure or alleviation of bodily sickness and the remission of sins, while some may be said to anticipate pretty clearly the definition of extreme unction as a sacrament in the strict sense. As illustrating the universal use of the Jacobean unction, we may cite in the first place St. Ephraem Syrus (d. 373), who in his forty-sixth polemical sermon (Opera, Rome, 1740, vol. II, p. 541), addressing the sick person to whom the priests minister, says: "They pray over thee; one blows on thee; another seals thee." The "sealing" here undoubtedly means "anointing with the sign of the cross", and the reference to St. James is clear [see Bickell, Carmina Nisibena, Leipzig, 1866, pp. 223, 4, note, and the other passage (seventy-third carmen) there discussed]. Next we would call attention to the witness of an ancient Ordo compiled, it is believed, in Greek before the middle of the fourth century, but which is preserved only in a fragmentary Latin version made before the end of the fifth century and recently discovered at Verona ("Didascaliæ Apostolorum" in "Fragmenta Veronensia", ed. Hauler, Leipzig, 1900), and in an Ethiopic version. This Ordo in both versions contains a form for consecrating the oil for the Jacobean rite, the Latin praying for "the strengthening and healing" of those who use it, and the Ethiopic for their "strengthening and sanctification". Mr. Puller, who gives and discusses both versions (op. cit., p. 104 sq.), is once more obliged to postulate a corruption of the Ethiopic version because of the reference to sanctification. But may not the "strengthening" spoken of as distinct from "healing" be spiritual rather than corporal? Likewise the "Testamentum Domini", compiled in Greek about the year 400 or earlier, and preserved in Syriac (published by Rahmani), and in Ethiopic and Arabic versions (still in MSS.) contains a form for consecrating the oil of the sick, in which, besides bodily healing, the sanctifying power of the oil as applied to penitents is referred to (see "The Testament of Our Lord", tr. Cooper and Maclean, 1902, pp. 77, 78). From these instances it appears that Serapion's Sacramentary was not without parallels during this period.

In St. Augustine's "Speculum de Scripturâ" (an. 427); in P.L., XXXIV, 887-1040), which is made up almost entirely of Scriptural texts, without comment by the compiler, and is intended as a handy manual of Christian piety, doctrinal and practical, the injunction of St. James regarding the prayer-unction of the sick is quoted. This shows that the rite was a commonplace in the Christian practice of that age; and we are told by Possidius, in his "Life of Augustine" (c. xxvii, in P.L., XXXII, 56), that the saint himself "followed the rule laid down by the Apostle that he should visit only orphans and widows in their tribulation (James, i, 27), and that if he happened to be asked by the sick to pray to the Lord for them and impose hands on them, he did so without delay". We have seen Origen refer to the Jacobean rite as an "imposition of hands", and this title survived to a very late period in the Church of St. Ambrose, who was himself an ardent student of Origen and from whom St. Augustine very likely borrowed it (see Magistretti, "Manuale Ambrosianum ex Codice sæc. XI", etc., 1905, vol. I, p. 79 sq., 94 sq., 147 sq., where three different Ordines of the eleventh and thirteenth centuries have as title for the office of extreme unction, impositio manuum super infirmum). It is fair, then, to conclude from the biographer's statement that, when called upon to do so, St. Augustine himself used to administer the Jacobean unction to the sick. This would be exactly on the lines laid down by Augustine's contemporary, Pope Innocent I (see below). St. Ambrose himself, writing against the Novatians (De Poenit., VIII, in P.L., XVI, 477), asks: "Why therefore do you lay on hands and believe it to be an effect of the blessing [benedictionis opus] if any of the sick happen to recover?. . .Why do you baptize, if sins cannot be remitted by men?" The coupling of this laying-on of hands with baptism and the use of both as arguments in favor of penance, shows that there is question not of mere charismatic healing by a simple blessing, but of a rite which, like baptism, was in regular use among the Novatians, and which can only have been the unction of St. James. St. Athanasius, in his encyclical letter of 341 (P.G., XXV, 234), complaining of the evils to religion caused by the intrusion of the Arian Bishop Gregory, mentions among other abuses that many catechumens were left to die without baptism and that many sick and dying Christians had to choose the hard alternative of being deprived of priestly ministrations--"which they considered a more terrible calamity than the disease itself"--rather than allow "the hands of the Arians to be laid on their heads". Here again we are justified in seeing a reference to extreme unction as an ordinary Christian practice, and a proof of the value which the faithful attached to the rite. Cassiodorus (d. about 570) thus paraphrases the injunction of St. James (Complexiones in Epp. Apostolorum, in P.L., LXX, 1380): "a priest is to be called in, who by the prayer of faith [oratione fidei] and the unction of the holy oil which he imparts will save him who is afflicted [by a serious injury or by sickness]."

To these testimonies may be added many instances of the use of extreme unction recorded in the lives of the saints. See, e.g., the lives of St. Leobinus (d. about 550; Acta SS., 14 March, p. 348), St. Tresanus (ibid., 7 Feb., p. 55), St. Eugene (Eoghan), Bishop of Ardsrath (modern Ardstraw, in the Diocese of Derry; d. about 618; ibid., 23 Aug., p. 627). One instance from the life of an Eastern saint, Hypatius (d. about 446), is worthy of particular notice. While still a young monk and before his elevation to the priesthood, he was appointed infirmarian in his monastery (in Bithynia), and while occupying this office he showed a splendid example of charity in his care of the sick, whom he sought out and brought to the monastery. "But if the necessity arose", says his disciple and biographer, "of anointing the sick person, he reported to the abbot, who was a priest (en gar presbyteros), and had the unction with the blessed oil performed by him. And it often happened that in a few days, God co-operating with his efforts, he sent the man home restored to health" (Acta SS., 17 June, p. 251). It appears from this testimony that the Jacobean unction was administered only to those who were seriously ill, that only a priest could administer it, that consecrated oil was used, that it was distinct from charismatic unction (which the saint himself used to perform, while still a layman, using consecrated oil), and finally that bodily healing did not always follow and was not apparently expected to follow, and that when it did take place it was not regarded as miraculous. It is, therefore, implied that other effects besides bodily healing were believed to be produced by the Jacobean unction, and these must be understood to be spiritual.

As evidence of the use of the unction by the Nestorians we may refer to the nineteenth canon of the synod held at Seleucia in 554 under the presidency of the Patriarch Joseph, and which, speaking of those who have been addicted to various diabolical and superstitious practices, prescribes that any such person on being converted shall have applied to him, "as to one who is corporally sick, the oil of prayer blessed by the priests" (Chabot, Synodicon Orientale, 1902, p. 363). Here, besides the legitimate use of the Jacobean unction, we have an early instance of an abuse, which prevails in the modern Orthodox (schismatical) church, of permitting the euchelaion to be administered, on certain days of the year, to people who are in perfect health, as a complement of penance and a preparation for Holy Communion [see below VI, (3)]. That the Monophysites also retained the Jacobean unction after their separation from the Catholic Church (451) is clear from the fact that their liturgies (Armenian, Syrian, and Coptic) contain the rite for blessing the oil. There is reason to suppose that this portion of their liturgies in its present form has been borrowed from, or modelled upon, the Byzantine rite of a later period (see Brightman in "Journal of Theological Studies", I, p. 261), but this borrowing supposes that they already possessed the unction itself. It has nowadays fallen into disuse among the Nestorians and Armenians, though not among the Copts.

Many testimonies might be quoted in which the Jacobean unction is recommended specifically as a means of restoring bodily health, and the faithful are urged to receive it instead of recurring, as they were prone to do, to various superstitious remedies. This is the burden of certain passages in Procopius of Gaza [c. 465-525; "In Levit.", xix, 31, in P.G., LXXXVII (1), 762 sq.], Isaac of Antioch (b. about 350; Opp., ed. Bickell, Pt. I, pp. 187 sq.), St. Cyril of Alexandria (De Adorat. in Spiritu et Veritate, VI, in P.G., LXVIII, 470 sq.), St. Cæsarius of Arles (Serm. cclxxix, 5, "Append ad sermm. Augustini"in P.L., XXXIX, 2273), and John Mandakuni (Montagouni), Catholicos of the Armenians from 480 to 487 (Schmid, Reden des Joannes Mandakuni, pp. 222 sq.). This particular effect of the prayer-unction is the one specially emphasized in the form used to this day in the Orthodox Eastern Church (see above, I).

Mention of the remission of sins as an effect of the Jacobean rite is also fairly frequent. It is coupled with bodily healing by St. Cæsarius in the passage just referred to: the sick person will "receive both health of body and remission of sins, for the Holy Ghost has given this promise through James". We have mentioned the witness of John Cassian, and the witness of his master, St. Chrysostom, may be given here. In his work "On the Priesthood" (III, vi, in P.G., XLVIII, 644) St. Chrysostom proves the dignity of the priesthood by showing, among other arguments, that the priests by their spiritual ministry do more for us than our own parents can do. Whereas our parents only beget our bodies, which they cannot save from death and disease, the priests regenerate our souls in baptism and have power, moreover, to remit post-baptismal sins; a power which St. Chrysostom proves by quoting the text of St. James. This passage, like that of Origen discussed above, has given rise to no little controversy, and it is claimed by Mr. Puller (op. cit., pp. 45 sqq.) as a proof that St. Chrysostom, like Origen, understood St. James as he (Mr. Puller) does. But if this were so it would still be true that only clinical penance is referred to, for it is only of the sick that St. James can be understood to speak; and the main point of Mr. Puller's argument, viz., that it is inconceivable that St. Chrysostom should pass over the Sacrament of Penance in such a context, would have lost hardly any of its force. We know very little, except by way of inference and assumption, about the practice of clinical penance in that age; but we are well acquainted with canonical penance as administered to those in good health, and it is to this obviously we should expect the saint to refer, if he were bound to speak of that sacrament at all. Mr. Puller is probably aware how very difficult it would be to prove that St. Chrysostom anywhere in his voluminous writings teaches clearly and indisputably the necessity of confessing to a priest: in other words, that he recognizes the Sacrament of Penance as Mr. Puller recognizes it; and in view of this general obscurity on a point of fundamental importance it is not at all so strange that penance should be passed over here. We do not pretend to be able to enter into St. Chrysostom's mind, but assuming that he recognized both penance and unction to be efficacious for the remission of post-baptismal sins--and the text before us plainly states this in regard to the unction--we may perhaps find in the greater affinity of unction with baptism, and in the particular points of contrast he is developing, a reason why unction rather than penance is appealed to. Regeneration by water in baptism is opposed to parental generation, and saving by oil from spiritual disease and eternal death to the inability of parents to save their children from bodily disease and death. St. Chrysostom might have added several other points of contrast, but he confines himself in this context to these two; and supposing, as one ought in all candor to suppose, that he understood the text of St. James as we do, in its obvious and natural sense, it is evident that the prayer-unction, so much more akin to baptism in the simplicity of its ritual character and so naturally suggested by the mention of sickness and death, supplied a much apter illustration of the priestly power of remitting post-baptismal sins than the judicial process of penance. And a single illustrative example was all that the context required.

Victor of Antioch (fifth century) is one of the ancient witnesses who, in the general terms they employ in speaking of the Jacobean unction, anticipate more or less clearly the definition of a sacrament in the strict sense. Commenting on St. Mark, vi, 13, Victor quotes the text of St. James and adds: "Oil both cures pains and is a source of light and refreshment. The oil, then, used in anointing signifies both the mercy of God, and the cure of the disease, and the enlightening of the heart. For it is manifest to all that the prayer effected all this; but the oil, as I think, was the symbol of these things" (Cramer, Caten. Græc. Patrum, I, p. 324). Here we have the distinction, so well known in later theology, between the signification and causality of a sacrament; only Victor attributes the signification entirely to the matter and the causality to the form (the prayer). This was to be corrected in the fully developed sacramental theory of later times, but the attribution of sacramental effects to the form (the prayer, the word, etc.) is characteristic of patristic suggestions of a theory. Victor clearly attributes both spiritual and corporal effects to the prayer-unction; nor can the fact that he uses the imperfect tense (energei, "effected"; hyperche, "was") be taken to imply that the use of the unction had ceased at Antioch in his day. The use of the present tense in describing the signification of the rite implies the contrary, and independent evidence is clearly against the supposition. In the passage from John Mandakuni, referred to above, the prayer-unction is repeatedly described as "the gift of grace", "the grace of God", Divinely instituted and prescribed, and which cannot be neglected and despised without incurring "the curse of the Apostles"; language which it is difficult to understand unless we suppose the Armenian patriarch to have reckoned the unction among the most sacred of Christian rites, or, in other words, regarded it as being what we describe as a sacrament in the strict sense (cf. Kern, op. cit., pp. 46, 47).

There remains to be noticed under this head the most celebrated of all patristic testimonies on extreme unction, the well-known passage in the Letter of Pope Innocent I (402-417), written in 416, to Decentius, Bishop of Eugubium, in reply to certain questions submitted by the latter for solution. In answer to the question as to who were entitle to the unction, the pope, having quoted the text of St. James, says: "There is no doubt that this text must be received or understood of the sick faithful, who may be [lawfully] anointed with the holy oil of chrism; which, having been blessed by the bishop, it is permitted not only to priests but to all Christians to use for anointing in their own need or that of their families." Then he diverges to point out the superfluous character of a further doubt expressed by Decentius: "We notice the superfluous addition of a doubt whether a bishop may do what is undoubtedly permitted to priests. For priests are expressly mentioned [by St. James] for the reason that bishops, hindered by other occupations, cannot go to all the sick. But if the bishop is able to do so or thinks anyone specially worthy of being visited, he, whose office it is to consecrate the chrism, need not hesitate to bless and anoint the sick person." Then, reverting to the original question, he explains the qualification he had added in speaking of "the sick faithful": "For this unction may not be given to penitents [i.e. to those undergoing canonical penance], seeing that it is a sacrament (quia genus sacramenti est]. For how is it imagined that one sacrament [unum genus] may be given to those to whom the other sacraments are denied?" The pope adds that he has answered all his correspondent's questions in order that the latter's Church may be in a position to follow "the Roman custom" (P.L., XX, 559 sq., Denzinger, no. 99--old no. 61). We do not, of course, suggest that Pope Innocent had before his mind the definition of a sacrament in the strict sense when he calls the Jacobean unction a sacrament, but since "the other sacraments" from which penitents were excluded were the Holy Eucharist and certain sacred offices, we are justified in maintaining that this association of the unction with the Eucharist most naturally suggests an implicit faith on the part of Pope Innocent in what has been explicitly taught by Scholastic theologians and defined by the Council of Trent. It is interesting to observe that Mr. Puller, in discussing this text (op. cit., pp 53 sqq.), omits all reference to the Holy Eucharist, though it is by far the most obvious and important of "the other sacraments" of which Innocent is speaking, and diverts his reader's attention to the eulogia, or blessed bread (pain bénit), a sacramental which was in use in many churches at that time and in later ages, but to which there is not the least reason for believing that the pope meant specially to refer. In any case the reference is certainly not exclusive, as Mr. Puller leaves his reader to infer. What Pope Innocent, following the "Roman custom", explicitly teaches is that the "sacrament" enjoined by St. James was to be administered to the sick faithful who were not doing canonical penance; that priests, and a fortiori bishops, can administer it; but that the oil must be blessed by the bishop. The exclusion of sick penitents from this "sacrament" must be understood, of course, as being subject to the same exception as their exclusion from "the other sacraments", and the latter are directed to be given before the annual Easter reconciliation when danger of death is imminent: "Quando usque ad desperandum venerit, ante tempus paschæ relaxandum [est] ne de sæculo [ægrotus] absque communione discedat." If the words of Innocent--and the same observation applies to other ancient testimonies, e.g. to that of Cæsarius of Arles referred to above--seem to imply that the laity were permitted to anoint themselves or members of their household with the oil consecrated by the bishop, yet it is clear enough from the text of St. James and from the way in which Pope Innocent explains the mention of priests in the text, that this could not have been considered by him to be identical with the Jacobean rite, but to be at most a pious use of the oil allowable for devotional, and possibly for charismatic, purposes. But it would not be impossible nor altogether unreasonable to understand the language used by Innocent and others in a causative sense, i.e. as meaning not that the laity were permitted to anoint themselves, but that they were to have the blessed oil at hand to secure their being anointed by the priests according to the prescription of St. James. We believe, however, that this is a forced and unnatural way of understanding such testimonies, all the more so as there is demonstrative evidence of the devotional and charismatic use of sacred oil by the laity during the early centuries.

It is worth adding, as a conclusion to our survey of this period, that Innocent's reply to Decentius was incorporated in various early collections of canon law, some of which, as for instance that of Dionysius Exiguus (P.L., LXVII, 240), were made towards the end of the fifth or the beginning of the sixth century. In this way Innocent's teaching became known and was received as law in most parts of the Western Church.

(c) The Seventh Century and Later.--One of the most important witnesses for this period is St. Bede (d. 735), who, in his commentary on the Epistle of St. James, tells us (P.L., XCIII, 39) that, as in Apostolic times, so "now the custom of the Church is that the sick should be anointed by the priests with consecrated oil and through the accompanying prayer restored to health". He adds that, according to Pope Innocent, even the laity may use the oil provided it has been consecrated by the bishop; and commenting on the clause, "if he be in sins they shall be remitted to him", after quoting I Cor., xi, 30, to prove that "many because of sins committed in the soul are stricken with bodily sickness or death", he goes on to speak of the necessity of confession: "If, therefore, the sick be in sins and shall have confessed these to the priests of the Church and shall have sincerely undertaken to relinquish and amend them, they shall be remitted to them. For sins cannot be remitted without the confession of amendment. Hence the injunction is rightly added [by James], `Confess, therefore, your sins one to another.'" St. Bede thus appears to connect the remission of sins in St. James's text with penance rather than the unction, and is therefore claimed by Mr. Puller as supporting his own interpretation of the text. But it should be observed that in asserting the necessity of confessing post-baptismal sins, a necessity recognized in Catholic teaching, Bede does not deny that the unction also may be efficacious in remitting them, or at least in completing their remission, or in remitting the lighter daily sins which need not be confessed. The bodily sickness which the unction is intended to heal is regarded by St. Bede as being, often at any rate, the effect of sin; and it is interesting to notice that Amalarius of Metz, writing a century later (De Eccles. Offic., I, xii, in P.L., CV, 1011 sq.), with this passage of Bede before him, expressly attributes to the unction not only the healing of sickness due to the unworthy reception of the Eucharist, but the remission of daily sins: "What saves the sick is manifestly the prayer of faith, of which the sign is the unction of oil. If those whom the unction of oil, i.e. the grace of God through the prayer of the priest, assists are sick for the reason that they eat the Body of the Lord unworthily, it is right that the consecration [of the oil] of which there is question should be associated with the consecration of the Body and Blood of the Lord, which takes place in commemoration of the Passion of Christ, by Whom the author of sin has been eternally vanquished. The Passion of Christ destroyed the author of death; His grace, which is signified by the unction of oil, has destroyed his arms, which are daily sins."

The confusing way in which St. Bede introduces penance in connection with the text of St. James is intelligible enough when we remember that the unction was regarded and administered as a complement of the Sacrament of Penance, and that no formal question had yet been raised about their respective independent effects. In the circumstances of the age it was more important to insist on the necessity of confession than to discuss with critical minuteness the effects of the unction, and one had to be careful not to allow the text of St. James to be misunderstood as if it dispensed with this necessity for the sick sinner. The passage in St. Bede merely proves that he was preoccupied with some such idea in approaching the text of St. James. Paschasius Radbertus (writing about 831) says from the same standpoint that "according to the Apostle when anyone is sick, recourse is to be had in the first place to confession of sins, then to the prayer of many, then to the sanctification of the unction [or, the unction of sanctification]" (De Corp. et Sang. Domini, c. viii, in P.L., CXX, 1292); and the same writer, in what he tells us of the death of his abbot, St. Adelhard of Corbie, testifies to the prevalence of an opinion that it was only those in sins who had need of the unction. The assembled monks, who regarded the holy abbot as "free from the burdens of sins", doubted whether they should procure the Apostolic unction for him. But the saint, overhearing the debate, demanded that it should be given at once, and with his dying breath exclaimed: "Now dismiss thy servant in peace, because I have received all the sacraments of Thy mystery" (P.L., CXX, 1547).

As proving the uninterrupted universality during this period of the practice of the Jacobean rite, with a clear indication in some instances of its strictly sacramental efficacy, we shall add some further testimonies from writers, synods, and the precepts of particular bishops. As doubts may be raised regarding the age of any particular expression in the early medieval liturgies, we shall omit all reference to them. There is all the less need to be exhaustive as the adversaries of Catholic teaching are compelled to admit that from the eighth century onwards the strictly sacramental conception of the Jacobean rite emerges clearly in the writings and legislation of both the Eastern and the Western Churches. Haymo, Bishop of Halberstadt (841-853), in his Homily on Luke, ix, 6 (P.L., CXVIII, 573), and Amulo. Bishop of Lyons (about 841), in his letter Theobald (P.L., CXVI, 82), speak of the unction of the sick as an Apostolic practice. Prudentius, Bishop of Treves (about 843- 861), tells how the holy virgin Maura asked to receive from his own hands "the Sacraments of the Eucharist and of Extreme Unction" (P.L., CXV, 1374; cf. Acta SS., 21 Sept., p. 272); and Jonas, Bishop of Orléans, in his "Institutio Laicalis" (about 829), after reprobating the popular practice of recurring in sickness to magical remedies, says: "It is obligatory on anyone who is sick to demand, not from wizards and witches, but from the Church and her priests, the unction of sanctified oil, a remedy which [as coming] from Our Lord Jesus Christ will benefit him not only in body but in soul" (III, xiv, in P.L., CVI, 122 sq.). Already the Second Council of Châlon-sur-Saône (813), in its forty-eighth canon, had prescribed as obligatory the unction enjoined by St. James, "since a medicine of this kind which heals the sicknesses of soul and of body is not to be lightly esteemed" (Hardouin, IV, 1040). The Council of Aachen in 836 warns the priest not to neglect giving penance and unction to the sick person (once his illness becomes serious), and when the end is seen to be imminent the soul is to be commended to God "more sacerdotali cum acceptione sacræ communionis" (cap. ii, can. v, ibid., 1397). The First Council of Mainz (847), held under the presidency of Rhabanus Maurus (cap. xxvi), prescribed in the same order the administration of penance, unction, and the Viaticum (Hardouin, V, 13); while the Council of Pavia (850), legislating, as seems clear from the wording of the capitulary (viii), according to the traditional interpretation of Pope Innocent's letter to Decentius (see above), directs preachers to be sedulous in instructing the faithful regarding "that salutary sacrament which James the Apostle commends. . .a truly great and very much to be desired mystery, by which, if asked for with faith, both sins are remitted and as a consequence corporal health restored" (ibid., III, 27; Denzinger, Freiburg, 1908, no. 315).

The statutes attributed to St. Sonnatius, Archbishop of Reims (about 600-631), and which are certainly anterior to the ninth century, direct (no. 15) that "extreme unction is to be brought to the sick person who asks for it", and "that the pastor himself is to visit him often, animating and duly preparing him for future glory" (P.L., LXXX, 445; cf. Hefele, Conciliengesch., III, 77). The fourth of the canons promulgated (about 745) by St. Boniface, the Apostle of Germany (see Hefele, III, 580 sq.), forbids priests to go on a journey "without the chrism, and the blessed oil, and the Eucharist", so that in any emergency they may be ready to offer their ministrations; and the twenty-ninth orders all priests to have the oil of the sick always with them and to warn the sick faithful to apply for the unction (P.L., LXXXIX, 821 sq.). In the "Excerptiones" of Egbert, Archbishop of York (732-766), the unction is mentioned between penance and the Eucharist, and ordered to be diligently administered (P.L., LXXXIX, 382). But no writer of this period treats of the unction so fully as, and none more undeniably regards it as a true sacrament in the strict sense that, Theodulf, Bishop of Orleans, and with him we will conclude our list of witnesses. A long section of his second Capitulare, published in 789, is taken up with the subject (P.L., CV, 220 sq.): "Priests are also to be admonished regarding the unction of the sick, and penance and the Viaticum, lest anyone should die without the Viaticum." Penance is to be given first, and then, "if the sickness allow it," the patient is to be carried to the church, where the unction and Holy Communion are to be given. Theodulf describes the unction in detail, ordering fifteen, or three times five, crosses to be made with the oil to symbolize the Trinity and the five senses, but noting at the same time that the practice varies as to the number of anointings and the parts anointed. He quotes with approval the form used by the Greeks while anointing, in which remission of sins is expressly mentioned; and so clearly is the unction in his view intended as a preparation for death that he directs the sick person after receiving it to commend his soul into the hands of God and bid farewell to the living. He enjoins the unction of sick children also on the ground that it sometimes cures them, and that penance is (often) necessary for them. Theodulf's teaching is so clear and definite that some Protestant controversialists recognize him as the originator in the West of the teaching which, as they claim, transformed the Jacobean rite into a sacrament. But from all that precedes it is abundantly clear that no such transformation occurred. Some previous writers, as we have seen, had explicitly taught and many had implied the substance of Theodulf's doctrine, to which a still more definite expression was later to be given. The Scholastic and Tridentine doctrine is the only goal to which patristic and medieval teaching could logically have led.


(For the technical meaning of these terms in sacramental theology see SACRAMENTS.)

(1) The remote matter of extreme unction is consecrated oil. No one has ever doubted that the oil meant by St. James is the oil of olives, and in the Western Church pure olive oil without mixture of any other substance seems to have been almost always used. But in the Eastern Church the custom was introduced pretty early of adding in some places a little water, as a symbol of baptism, in others a little wine, in memory of the good Samaritan, and, among the Nestorians, a little ashes or dust from the sepulchre of some saint. But that the oil must be blessed or consecrated before use is the unanimous testimony of all the ages. Some theologians, however, have held consecration to be necessary merely as a matter of precept, not essential for the validity of the sacrament, e.g. Victoria (Summ. Sacramentorum, no. 219), Juénin (Comm. hist. et dogm. de Sacram., D. vii, q. iii, c. i), de Sainte-Beuve (De Extr. Unct., D. iii, a. 1), Drouven (De Re Sacramentariâ, Lib. VII, q. ii, c. i, 2); indeed Berti, while holding the opposite himself, admitted the wide prevalence of this view among the recent theologians of his day. But considering the unanimity of tradition in insisting on the oil being blessed, and the teaching of the Council of Trent (Sess. XIV) that "the Church has understood the matter [of this sacrament] to be oil blessed by the bishop", it is not surprising that by a decree of the Holy Office, issued 13 Jan., 1611, the proposition asserting the validity of extreme unction with the use of oil not consecrated by the bishop should have been proscribed as "rash and near to error" (Denzinger, no. 1628--old no. 1494), and that, to the question whether a parish priest could in case of necessity validly use for this sacrament oil blessed by himself, the same Holy Office, reaffirming the previous decree, should have replied in the negative (14 Sept., 1842; ibid., no. 1629--old no. 1495). These decisions only settle the dogmatic question provisionally and, so far as they affirm the necessity of episcopal consecration of the oil, are applicable only to the Western Church. As is well known it is the officiating priest or priests who ordinarily bless the oil in the Eastern Orthodox Church, and there is no lack of evidence to prove the antiquity of this practice (see Benedict XIV, De Synod. Dioec., VIII, i, 4). For Italo-Greeks in communion with the Holy See the practice was sanctioned by Clement VIII in 1595 and by Benedict XIV (see ibid.) in 1742; and it has likewise been sanctioned for various bodies of Eastern Uniats down to our own day (see "Collect. Lacensis", II, pp. 35, 150, 582, 479 sq.; cf. Letter of Leo XIII, "De Discipl. Orient. conservandâ" in "Acta S. Sedis", XXVII, pp. 257 sq.). There is no doubt, therefore, that priests can be delegated to bless the oil validly, though there is no instance on record of such delegation being given to Western priests. But it is only the supreme authority in the Church that can grant delegation, or at least it may reserve to itself the power of granting it (in case one should wish to maintain that in the absence of reservation the ordinary bishop would have this power). The Eastern Uniats have the express approbation of the Holy See for their discipline, and, as regards the schismatical Orthodox, one may say either that they have the tacit approbation of the pope or that the reservation of episcopal power does not extend to them. In spite of the schism the pope has never wished or intended to abrogate the ancient privileges of the Orthodox in matters of this kind.

The prayers for blessing the oil that have come down to us differ very widely, but all of them contain some reference to the purpose of anointing the sick. Hence, at least in the case of a bishop, whose power is ordinary and not delegated, no special form would seem to be necessary for validity, provided this purpose is expressed. But where it is not at all expressed or intended, as in the forms at present used for blessing the chrism and the oil of catechumens, it appears doubtful whether either of these oils would be valid matter for extreme unction (cf. Kern, op. cit., p. 131). But in the nature of things there does not seem to be any reason why a composite form of blessing might not suffice to make the same oil valid matter for more than one sacrament.

(2) The proximate matter of extreme unction is the unction with consecrated oil. The parts anointed according to present usage in the Western and Eastern Churches have been mentioned above (I), but it is to be observed that even today there are differences of practice in various branches of the Orthodox Church (see Echos d'Orient, 1899, p. 194). The question is whether several unctions are necessary for a valid sacrament, and if so, which are the essential ones. Arguing from the practice with which they were acquainted and which they assumed to have existed always, the Scholastics not unnaturally concluded that the unctions of the five organs of sense were essential. This was the teaching of St. Thomas (Suppl., Q. xxxii, a. 6), who has been followed pretty unanimously by the School and by many later theologians down to our own day (e.g. Billot, De Sacramentis, II, p. 231) who set the method and tradition of the School above positive and historical theology. But a wider knowledge of past and present facts has made it increasingly difficult to defend this view, and the best theologians of recent times have denied that the unction of the five senses, any more than that of the feet or loins, is essential for the validity of the sacrament. The facts, broadly speaking, are these: that no ancient testimony mentions the five unctions at all, much less prescribes them as necessary, but most of them speak simply of unction in a way that suggests the sufficiency of a single unction; that the unction of the five senses has never been extensively practiced in the East, and is not practiced at the present time in the Orthodox Church, while those Uniats who practice it have simply borrowed it in modern times from Rome; and that even in the Western Church down to the eleventh century the practice was not very widespread, and did not become universal till the seventeenth century, as is proved by a number of sixteenth- century Rituals that have been preserved (for details and sources see Kern, op. cit., p. 133 sq.). In face of these facts it is impossible any longer to defend the Scholastic view except by maintaining that the Church has frequently changed the essential matter of the sacrament, or that she has allowed it to be invalidly administered during the greater part of her history, as she still allows without protest in the East. The only conclusion, therefore, is that as far as the matter is concerned nothing more is required for a valid sacrament than a true unction with duly consecrated oil, and this conclusion may henceforth be regarded as certain by reason of the recent decree of the Holy Office already referred to (I), which, though it speaks only of the form, evidently supposes that form to be used with a single unction. Besides the authority of the Scholastic tradition, which was based on ignorance of the facts, the only dogmatic argument for the view we have rejected is to be found in the instruction of Eugene IV to the Armenians [see above, III (A)]. But in reply to this argument it is enough to remark that this decree is not a dogmatic definition but a disciplinary instruction, and that, if it were a definition, those who appeal to it ought in consistency to hold the unction of the feet and loins to be essential. It is hardly necessary to add that, while denying the necessity of the unctions prescribed in the Roman Ritual for the validity of the sacrament, there is no intention of denying the grave obligation of adhering strictly to the Ritual except, as the Holy Office allows, in cases of urgent necessity.

(3)The forms of extreme unction from the Roman Ritual and the Euchologion have been given above(I). However ancient may be either form in its substance, it is certain that many other forms substantially different from the present have been in use both in the East and the West (see Martène, "De Antiquis Eccl. Rit.", I, vii, 4; and Kern, op. cit., pp. 142-152); and the controversy among theologians as to what precise form or kind of form is necessary for the validity of the sacrament has followed pretty much the same lines as that about the proximate matter. That some form is essential, and that what is essential is contained in both the Eastern and Western forms now in use, is admitted by all. The problem is to decide not merely what words in either form may be omitted without invalidating the sacrament, but whether the words retained as essential must necessarily express a prayer--"the prayer of faith" spoken of by St. James. Both forms as now used are deprecatory, and for the West the Holy Office has decided what words may be omitted in case of necessity from the form of the Roman Ritual. That the form, whether short or long, must be a prayer-form, and that a mere indicative form, such as "I anoint thee" etc., would not be sufficient for validity, has been the opinion of most of the great Scholastics and of many later theologians. But not a few Scholastics of eminence, and nearly all later theologians who have made due allowance for the facts of history, have upheld the opposite view. For the fact is that the indicative form has been widely used in the East and still more widely in the West; it is the form we meet with in the very earliest Church Orders preserved, viz., those of the Celtic Church (see Warren, "Liturgy and Ritual of the Celtic Church", e.g. p. 168: "I anoint thee with sanctified oil in the name of the Trinity that thou mayst be saved for ever and ever"; cf. p. 223). Among contemporary theologians Kern (op. cit., pp. 154 sq.), who is followed by Pohle (Lehrbuch der Dogmatik, 3d ed., Paderborn, 1908, III, 534) suggests a compromise by holding, on the one hand, that at least a virtual prayer-form is required by the text of St. James and, on the other hand, that the indicative forms that have been used are virtually deprecatory. But this seems to be only a subtle way of denying the raison d'être of the controversy; one might argue on the same principle that the forms of baptism, penance, and confirmation are virtually prayer-forms. Some of the so-called indicative forms may be reasonably construed in this way, but in regard to others we may say, with Benedict XIV, that "we do not know how a prayer can be discovered in certain other forms published from very many ancient Rituals by Ménard and Martène, in which there is used merely the words `I anoint thee' without any thing else being added from which a prayer can be deduced or fashioned" (De Synod. Dioec., VIII, ii, 2). If it be insisted that prayer as such must be in some way an element in the sacrament, one may say that the prayer used in blessing the oil satisfies this requirement. What has been said in regard to the matter is to be repeated here, viz., that the dogmatic controversy about the form does not affect the disciplinary obligation of adhering strictly to the prescriptions of the Ritual, or, for cases of urgent necessity, to the decree of the Holy Office.


(1) The Council of Trent has defined in accordance with the words of St. James that the proper ministers (proprios ministros) of this sacrament are the priests of the Church alone, that is bishops or priests ordained by them (Sess. XIV, cap. iii, and can. iv, De Extr. Unct.). And this has been the constant teaching of tradition, as is clear from the testimonies given above. Yet Launoi (Opp., I, 569 sq.) has maintained that deacons can be validly delegated by the bishop to administer extreme unction, appealing in support of his view to certain cases in which they were authorized in the absence of a priest to reconcile dying penitents and give them the Viaticum. But in none of these cases is extreme unction once mentioned or referred to, and one may not gratuitously assume that the permission given extended to this sacrament, all the more so as there is not a particle of evidence from any other source to support the assumption. The Carmelite Thomas Waldensis (d. 1430) inferred from the passage of Innocent I [see above, under III (C), (2), (b)] that, in case of necessity when no priest could be got, a layman or woman might validly anoint (Doctrinale Antiq. Fidei, II, clxiii, 3), and quite recently Boudinhon (Revue Cath. des Eglises, July, 1905, p. 401 sq.) has defended the same view and improved upon it by allowing the sick person to administer the sacrament to himself or herself. This opinion, however, seems to be clearly excluded by the definition of the Council of Trent that the priest alone is the "proper" minister of extreme unction. The word proper cannot be taken as equivalent merely to ordinary, and can only mean "Divinely authorized". And as to the unction of themselves or others by lay persons with the consecrated oil, it is clear that Pope Innocent, while sanctioning the pious practice, could not have supposed it to be efficacious in the same way as the unction by a priest or bishop, to whom alone in his view the administration of the Jacobean rite belonged. This lay unction was merely what we call today a sacramental. Clericatus (Decisiones de Extr. Unct., decis. lxxv) has held that a sick priest in case of necessity can validly administer extreme unction to himself; but he has no argument of any weight to offer for this opinion, which is opposed to all sacramental analogy (outside the case of the Eucharist) and to a decision of the Congregation of Propaganda issued 23 March, 1844. These several singular opinions are rejected with practical unanimity by theologians, and the doctrine is maintained that the priests of the Church, and they alone, can validly confer extreme unction.

(2) The use of the plural in St. James--"the priests of the Church"--does not imply that several priests are required for the valid administration of the sacrament. Writing, as we may suppose, to Christian communities in each of which there was a number of priests, and where several, if it seemed well, could easily be summoned, it was natural for the Apostle to use the plural without intending to lay down as a matter of necessity that several should actually be called in. The expression used is merely a popular and familiar way of saying: "Let the sick man call for priestly ministrations", just as one might say, "Let him call in the doctors", meaning, "Let him procure medical aid". The plural in either case suggests at the very most the desirability, if the circumstances permit, of calling in more than one priest or doctor, but does not exclude, as is obvious, the services of only one, if only one is available, or if for a variety of possible reasons it is better that only one should be summoned. As is evident from several of the witnesses quoted above (III), not only in the West but in the East the unction was often administered in the early centuries by a single priest; this has been indeed at all times the almost universal practice in the West (for exceptions cf. Martène, op. cit., I, vii, 3; Kern, op. cit., p. 259). In the East, however, it has been more generally the custom for several priests to take part in the administration of the sacrament. Although the number seven, chosen for mystical reasons, was the ordinary number in many parts of the East from an earlier period, it does not seem to have been prescribed by law for the Orthodox Church before the thirteenth century (cf. Kern, op. cit., p. 260). But even those Oriental theologians who with Symeon of Thessalonica (fifteenth century) seem to deny the validity of unction by a single priest, do not insist on more than three as necessary, while most Easterns admit that one is enough in case of necessity (cf. Kern, op. cit., p. 261). The Catholic position is that either one or several priests may validly administer extreme unction; but when several officiate it is forbidden by Benedict XIV for the Italo-Greeks (Const. "Etsi Pastoralis", 1742) for one priest merely to anoint and another merely to pronounce the form, and most theologians deny the validity of the unction conferred in this way. The actual practice, however, of the schismatical churches is for each priest in turn to repeat the whole rite, both matter and form, with variations only in the non-essential prayers. This gives rise to an interesting question which will best be discussed in connection with the repetition of the sacrament (below, IX).


(1) Extreme Unction may be validly administered only to Christians who have had the use of reason and who are in danger of death from sickness. That the subject must be baptized is obvious, since all the sacraments, besides baptism itself, are subject to this condition. This is implied in the text of St. James: "Is any man sick among you?" i.e. any member of the Christian community; and tradition is so clear on the subject that it is unnecessary to delay in giving proof. It is not so easy to explain on internal grounds why extreme unction must be denied to baptized infants who are sick or dying, while confirmation, for instance, may be validly administered to them; but such is undoubtedly the traditional teaching and practice. Except to those who were capable of penance extreme unction has never been given. If we assume, however, that the principal effect of extreme unction is to give, with sanctifying grace or its increase, the right to certain actual graces for strengthening and comforting and alleviating the sick person in the needs and temptations which specially beset him in a state of dangerous illness, and that the other effects are dependent on the principal, it will be seen that for those who have not attained, and will not attain, the use of reason till the sickness has ended in death or recovery, the right in question would be meaningless, whereas the similar right bestowed with the character in confirmation may, and normally does, realize its object in later life. It is to be observed in regard to children, that no age can be specified at which they cease to be incapable of receiving extreme unction. If they have attained sufficient use of reason to be capable of sinning even venially, they may certainly be admitted to this sacrament, even though considered too young according to modern practice to receive their First Communion; and in cases of doubt the unction should be administered conditionally. Those who have always been insane or idiotic are to be treated in the same way as children; but anyone who has ever had the use of reason, though temporarily delirious by reason of the disease or even incurable insane, is to be given the benefit of the sacrament in case of serious illness.

(2) Grave or serious bodily illness is required for the valid reception of extreme unction. This implied in the text of St. James and in Catholic tradition (see above, III), and is formally stated in the decree of Eugene IV for the Armenians: "This sacrament is not to be given except to the sick person, of whose death fears are entertained" (Denzinger, no. 700--old no. 595), and in the teaching of the Council of Trent that "this unction is to be administered to the sick, but especially to those who seem to be at the point of death [in exitu vitæ]" (Sess. XIV, cap. iii, De Extr. Unct.). It is clear from these words of Trent that extreme unction is not for the dying alone, but for all the faithful who are seriously ill with any sickness as involves danger of death (discrimen vitæ, ibid.), i.e. as may probably terminate fatally. How grave must be the illness or how proximate the danger of death is not determined by the council, but is left to be decided by the speculations of theologians and the practical judgment of priests directly charged with the duty of administering the sacrament. And there have been, and perhaps still are, differences of opinion and of practice in this matter.

(3) Down to the twelfth century in the Western Church the practice was to give the unction freely to all (except public penitents) who were suffering from any serious illness, without waiting to decide whether danger of death was imminent. This is clear from many testimonies quoted above (III). But during the twelfth and thirteenth centuries a change of practice took place, and the sacrament came to be regarded by many as intended only for the dying. The causes contributing to this change were: (a) the extortionate demands of the clergy on the occasion of administering the unction which prevented the poor or even those of moderate means from asking for it except as a last resource; (b) the influence of certain popular superstitions, as, for instance, that the person anointed could not, in case of recovery, use the rights of marriage, eat flesh meat, make a will, walk with bare feet, etc.; and (c) the teaching of the Scotist School and of other theologians that, as the principal effect of the sacrament was the final remission of venial sins, it should not be given except to those who could not recover, and were no longer able or at least likely to fall again into venial sin (St. Bonaventure, "Breviloquium", P. VI, c. xi; Scotus, "Report. Parisien.", dist. xxiii, Q. unica). It was doubtless under the influence of this teaching that one or two provincial synods of the sixteenth century described the subject of extreme unction as "the dangerously sick and almost dying" (Hardouin, X, 1848, 1535); and the neglect of the sacrament induced by these several causes resulted, during the disturbances of the sixteenth century, in its total abandonment in many parts of Germany and especially of Bavaria (Knöpfler, "Die Kelchbewegung in Bayern unter Herzog Albrecht V.", pp. 61 sq.; and on this whole matter see Kern, op. cit., pp. 282 sq.). In view of these facts, the oft-repeated accusation of the Eastern schismatics, that the Latins gave the sacrament only to the dying and withheld it from the seriously ill who were capable of receiving it, is not without foundation (Kern, op. cit., p. 274); but they were wrong in assuming that the Western Church as a whole or the Holy See is responsible for abuses of this kind. Church authority earnestly tried to correct the avarice of the clergy and the superstitions of the people, while the Scotist teaching, regarding the chief effect of the unction, was never generally admitted in the schools, and its post-Tridentine adherents have felt compelled to modify the practical conclusion which St. Bonaventure and Scotus had logically drawn from it. There still linger in the popular mind traces of the erroneous opinion that extreme unction is to be postponed till a sickness otherwise serious has taken a critical turn for the worse, and the danger of death become imminent; and priests do not always combat this idea as strongly as they ought to, with the result that possibly in many cases the Divinely ordained effect of corporal healing is rendered impossible except by a miracle. The best and most recent theological teaching is in favor of a lenient, rather than of a severe, view of the gravity of the sickness, or the proximity of the danger of death, required to qualify for the valid reception of extreme unction; and this is clearly compatible with the teaching of the Council of Trent and is supported by the traditional practice of the first twelve centuries.

But if the Easterns have had some justification for their charge against the Westerns of unduly restricting the administration of this sacrament, the Orthodox Church is officially responsible for a widespread abuse of the opposite kind which allows the euchelaion to be given to persons in perfect health as a complement of penance and a preparation for Holy Communion. Many Western theologians, following Goar (Euchologion, pp. 349 sq.), have denied that this rite was understood and intended to be sacramental, though the matter and form were employed precisely as in the case of the sick; but, whatever may have been the intention in the past, it is quite certain at the present time that at least in the Constantinopolitan and Hellenic branches of the Orthodox Church the intention is to give the sacrament itself and no mere sacramental to those in sound health who are anointed (Kern, op. cit., 281). On the other hand, in the Russian Church, except in the metropolitan churches of Moscow and Novgorod on Maundy Thursday each year, this practice is reprobated, and priests are expressly forbidden in their faculties to give the euchelaion to people who are not sick (Kern, pp. 279 sq.; Fortescue, The Orthodox Eastern Church, London, 1907, p. 425). We have already noticed (III) among Nestorians what appears to have been a similar abuse, but in the Orthodox Church till long after the schism there is no evidence of its existence, and the teaching of Eastern theologians down to modern times, to which the Russians still adhere, has been at one with the Western tradition in insisting that the subject of this sacrament must be labouring under a serious sickness.

(4) Nor will danger, or even certainty, of death from any other cause than sickness qualify a person for extreme unction. Hence criminals or martyrs about to suffer death and other similarly circumstanced may not be validly anointed unless they should happen to be seriously ill. But illness caused by violence, as by a dangerous or fatal wound, is sufficient; and old age itself without any specific disease is held by all Western theologians to qualify for extreme unction, i.e. when senile decay has advanced so far that death already seems probable. In cases of lingering diseases, like phthisis or cancer, once the danger has become really serious, extreme unction may be validly administered even though in all human probability the patient will live for a considerable time, say several months; and the lawfulness of administering it in such cases is to be decided by the rules of pastoral theology. If in the opinion of doctors the sickness will certainly be cured, and all probable danger of death removed by a surgical operation, theologians are not agreed whether the person who consents to undergo the operation ceases thereby to be a valid subject for the sacrament. Kern holds that he does (op. cit., p. 299), but his argument is by no means convincing.


The decree of Eugene IV for the Armenians describes the effects of extreme unction briefly as "the healing of the mind and, so far as it is expedient, of the body also" (Denzinger, no. 700--old no. 595). In Sess. XIV, can. ii, De Extr. Unct., the Council of Trent mentions the conferring of grace, the remission of sins, and the alleviation of the sick, and in the corresponding chapter explains as follows the effects of the unction: "This effect is the grace of the Holy Ghost, whose unction blots out sins, if any remain to be expiated, and the consequences [reliquias] of sin, and alleviates and strengthens the soul of the sick person, by exciting in him a great confidence in the Divine mercy, sustained by which [confidence] he bears more lightly the troubles and sufferings of disease, and more easily resists the temptations of the demon lying in wait for his heel, and sometimes, when it is expedient for his soul's salvation, recovers bodily health." The remission of sins, as we have seen, is explicitly mentioned by St. James, and the other spiritual effects specified by the Council of Trent are implicitly contained, side by side with bodily healing, in what the Apostle describes as the saving and raising up of the sick man (see above, II).

(1) It is therefore a doctrine of Catholic faith that sins are remitted by extreme unction, and, since neither St. James nor Catholic tradition nor the Council of Trent limits this effect to venial sins, it is quite certain that it applies to mortal sins also. But according to Catholic teaching there is per se a grave obligation imposed by Divine law of confessing all mortal sins committed after baptism and obtaining absolution from them; from which it follows that one guilty of mortal sin is bound per se to receive the Sacrament of Penance before receiving extreme unction. Whether he is further bound, in case penance cannot be received, to prepare himself for extreme unction by an act of perfect contrition is not so clear; but the affirmative opinion is more commonly held by the theologians, on the ground that extreme unction is primarily a sacrament of the living, i.e. intended for those in the state of grace, and that every effort should be made by the subject to possess this primary disposition. That the remission at least of mortal sins is not the primary end of extreme unction is evident from the conditional way in which St. James speaks of this effect; "and if he be in sins" etc.; but, on the other hand, this effect is attributed, if conditionally and secondarily, yet directly and per se to the unction--not indirectly and per accidens as we attribute it to other sacraments of the living--which means that extreme unction has been instituted secondarily as a sacrament of the dead, i.e. for the purpose not merely of increasing but of conferring sanctifying grace sacramentally. Hence, if for any reason the subject in mortal sin is excused from the obligation of confessing or of eliciting an act of perfect contrition, extreme unction will remit his sin and confer sanctifying grace, provided he has actual, or at least habitual, attrition, or provided (say on recovering the use of reason) he elicits an act of attrition so that the sacrament may take effect by way of reviviscence (see below, X). By habitual attrition in this connection is meant an act of sorrow or detestation for sins committed, elicited since their commission and not retracted in the interval before the sacrament is received. The ordinary example occurs when the act of attrition has been elicited before the sick person lapses into unconsciousness or loses the use of reason. That such attrition is necessary, follows from the teaching of Trent (Sess. XIV, cap. i, De Poenit.) regarding the absolute and universal necessity of repentance for the remission, even in baptism, of personal mortal sins. Schell has maintained (Kathol. Dogmatik, III, pp. 629 sq.) that such attrition is not required for the validity of extreme unction, but that the general purpose and intention, which a Christian sinner may retain even when he is sinning, of afterwards formally repenting and dying in the friendship of God, is sufficient; but this view seems irreconcilable with the teaching of Trent, and has the whole weight of theological tradition against it.

Extreme unction likewise remits venial sins provided the subject has at least habitual attrition for them; and, following the analogy of penance, which with attrition remits mortal sins, for the remission of which outside the sacrament perfect contrition would be required, theologians hold that with extreme unction a less perfect attrition suffices for the remission of venial sins than would suffice without the sacrament. But besides thus directly remitting venial sins, extreme unction also excites dispositions which procure their remission ex opere operantis.

The relics or effects of sin mentioned by the Council of Trent are variously understood by theologians to mean one, or more, or all of the following: spiritual debility and depression caused by the consciousness of having sinned; the influence of evil habits induced by sin; temporal penalties remaining after the guilt of sin has been forgiven; and venial, or even mortal, sins themselves. Of these only the remission of temporal punishment is distinct from the other effects of which the council speaks; and though some theologians have been loath to admit this effect at all, lest they might seem to do away with the raison d'être of purgatory and of prayers and indulgences for the dying and dead, there is really no solid ground for objecting to it, if passing controversial interests are subordinated to Catholic theory. It is not suggested that extreme unction, like baptism, sacramentally remits all temporal punishment due to sin, and the extent to which it actually does so in any particular case may, as with baptism, fall short of what was Divinely intended, owing to obstacles or defective dispositions in the recipient. Hence there is still room and need for Indulgences for the dying, and if the Church offers her prayers and applies Indulgences for adults who die immediately after baptism, she ought, a fortiori, to offer them for those who have died after extreme unction. And if temporal punishment be, as it certainly is, one of the reliquioe of sin, and if extreme unction be truly what the Council of Trent describes (Sess. XIV, De Extr. Unct., introduct.) as "the consummation not merely of [the Sacrament of] Penance, but of the whole Christian life, which ought to be a perpetual penance", it is impossible to deny that the remission of temporal punishment is one of the effects of this sacrament.

(2) The second effect of extreme unction mentioned by the Council of Trent is the alleviation and strengthening of the soul by inspiring the sick person with such confidence in the Divine mercy as will enable him patiently and even cheerfully to bear the pains and worries of sickness, and with resolute courage to repel the assaults of the tempter in what is likely to be the last and decisive conflict in the warfare of eternal salvation. The outlook on eternity is brought vividly before the Christian by the probability of death inseparable from serious sickness, and this sacrament has been instituted for the purpose of conferring the graces specially needed to fortify him in facing this tremendous issue. It is unnecessary to explain in detail the appropriateness of such an institution, which, were other reasons wanting, would justify itself to the Christian mind by the observed results of its use.

(3) Finally, as a conditional and occasional effect of extreme unction, comes the restoration of bodily health, an effect which is vouched for by the witness of experience in past ages and in our own day. Theologians, however, have failed to agree in stating the condition on which this effect depends or in explaining the manner in which it is produced. "When it is expedient for the soul's salvation", is how Trent expresses the condition, and not a few theologians have understood this to mean that health will not be restored by the sacrament unless it is foreseen by God that a longer life will lead to a greater degree of glory--recovery being thus a sign or proof of predestination. But other theologians rightly reject this opinion, and of several explanations that are offered (cf. Kern, op. cit., pp. 195 sq.) the simplest and most reasonable is that which understands the condition mentioned not of the future and perhaps remote event of actual salvation, but of present spiritual advantage which, independently of the ultimate result, recovery may bring to the sick person; and holds, subject to this condition, that this physical effect, which is in itself natural, is obtained mediately through and dependently upon the spiritual effects already mentioned. The fortifying of the soul by manifold graces, by which over-anxious fears are banished, and a general feeling of comfort and courage, and of humble confidence in God's mercy and peaceful resignation to His Will inspired, reacts as a natural consequence on the physical condition of the patient, and this reaction is sometimes the factor that decides the issue of certain diseases. This mediate and dependent way of effecting restoration of health is the way indicated by the Council of Trent in the passage quoted above, and the view proposed is in conformity with the best and most ancient theoretical teaching on the subject and avoids the seemingly unanswerable difficulties involved in opposing views. Nor does it reduce this effect of extreme unction to the level of those perfectly natural phenomena known to modern science as "faith cures". For it is not maintained, in the first place, that recovery will follow in any particular case unless this result is spiritually profitable to the patient--and of this God alone is the judge--and it is admitted, in the second place, that the spiritual effect, from which the physical connaturally results, is itself strictly supernatural (cf. Kern, loc. cit.).

(4) There remains the question, on which no little controversy has been expended, as to which of these several effects is the principal one. Bearing in mind the general theory that sacramental grace as such is sanctifying grace as imparted or increased by the sacrament, with the right or title to special actual graces corresponding to the special end of each sacrament, the meaning of the question is: Which of these effects is the sacramental grace imparted in extreme unction primarily and immediately intended to produce, so that the others are produced for the sake of, or by means of, it? Or, more ultimately, what, according to Christ's intention in instituting it, is the primary and distinctive purpose of this sacrament, its particular raison d'être as a sacrament? Now, clearly this cannot be either the remission of mortal sin or the restoration of physical health, since, as we have seen, extreme unction is primarily a sacrament of the living; and restoration of bodily health is not a normal effect, but only brought about, when at all, indirectly. There remain the remission of venial sins and of the temporal punishment due for sins already forgiven, and the invigoration of the soul in face of the probability of death. Reference has already been made to the Scotist view (VI) which singles out the final and complete remission of venial sin as the chief end or effect of extreme unction, and which logically leads to the practical conclusion, adopted by St. Bonaventure and Duns Scotus, that only the dying should receive the sacrament; and the same conclusion, which must in any case be rejected, would also follow from holding in a similarly exclusive sense that the principal effect is the remission of temporal punishment. Thus we are left in possession of the theory, held by many of the best theologians, that the supernatural invigoration of the soul in view of impending death is the chief end and effect of extreme unction. This effect, of course, is actually realized only when the subject is sui compos and capable of co-operating with grace; but the same is true of the principal effect of several other sacraments. It is no argument, therefore, against this view to point to the fact that sins are sometimes remitted by extreme unction while the recipient is unconscious and incapable of using the invigorating graces referred to. The infusion or increase of sanctifying grace is an effect common to all the sacraments; yet it is not by this of itself that they are distinguished from on another, but by reference to the special actual graces to which sanctifying grace as infused or increased gives a title; and if the realization of this title is sometimes suspended or frustrated, this is merely by way of an accidental exception to which, in general, sacramental efficacy is liable. It does not seem, however, that this theory should be urged in an exclusive sense, as implying, that is, that the remission of venial sin or of temporal punishment is not also a primary effect which may be obtained independently; rather should the theory be enlarged and modified, and the primary and essential end of the sacrament so described as to comprehend these effects.

This is the solution of the whole question proposed by Kern (op. cit., pp. 81 sq., 215 sq.), who, with no little learning and ability, defends the thesis that the end of extreme unction is the perfect healing of the soul with a view to its immediate entry into glory, unless it should happen that the restoration of bodily health is more expedient. This view is quite in conformity with, and may even be said to be suggested by, the teaching of the Council of Trent to the effect that extreme unction is "the consummation of the whole Christian life"; and Kern has collected an imposing weight of evidence in favor of his thesis from ancient and medieval and modern writers of authority. Dr. Pohle (op. cit., pp. 535, 536) reviews Kern's suggestion sympathetically. Besides being self-consistent and free from any serious difficulty, it is recommended by many positive arguments, and in connection with the controverted point we have been discussing it has the advantage of combining and co-ordinating as parts of the principal effect--i.e. perfect spiritual health--not only the remission of venial sins and the invigoration of the soul, for which respectively Scotists and their opponents have contended too exclusively, but also the remission of temporal punishment, which not a few theologians have neglected.


Theologians are agreed that extreme unction may in certain circumstances be the only, and therefore the necessary, means of salvation for a dying person. This happens when there is question of a person who is dying without the use of reason, and whose soul is burdened with the guilt of mortal sin for which he has only habitual attrition; and for this and similar cases in which other means of obtaining justification are certainly or even probably unavailing, there is no doubt as to the grave obligation of procuring extreme unction for the dying. But theologians are not agreed as to whether or not a sick person in the state of grace is per se under a grave obligation of seeking this sacrament before death. It is evident ex hypothesi that there is no obligation arising from the need of salvation (necessitate medii), and the great majority of theologians deny that a grave obligation per se has been imposed by Divine or ecclesiastical law. The injunction of St. James, it is said, may be understood as being merely a counsel or exhortation, not a command, and there is no convincing evidence form tradition that the Church has understood a Divine command to have been given, or has ever imposed one of her own. Yet it is recognized that, in the words of Trent, "contempt of so great a sacrament cannot take place without an enormous crime and an injury to the Holy Ghost Himself" (Sess. XIV, cap. iii); and it is held to depend on circumstances whether mere neglect or express refusal of the sacrament would amount to contempt of it. The soundness, however, of the reasons alleged for this common teaching is open to doubt, and the strength of the arguments advanced by so recent a theologian as Kern (pp. 364 sq.) to prove the existence of the obligation which so many have denied is calculated to weaken one's confidence in the received opinion.


The Council of Trent teaches that "if the sick recover after receiving this unction, they can again receive the aid of this sacrament, when they fall anew into a similar danger of death" (Sess. XIV, cap. iii, De Extr. Unct.). In the Middle Ages doubts were entertained by some ecclesiastics on this subject, as we learn from the correspondence between Abbot (later Cardinal) Godfried and St. Yves, Bishop of Chartres (d. 1117). Godfried considered the custom in vogue in the Benedictine monasteries, of repeating extreme unction, reprehensible on the ground that "no sacrament ought to be repeated" (P.L., CLVII, 87 sq.); but he wished to have St. Yves's opinion, and the latter quite agreed with his friend (ibid., 88). Not long afterwards Peter the Venerable, Abbot of Cluny, was asked by Abbot Theobald to explain "why it was that the unction of the sick was the only unction [out of many] repeated, and why this took place only at Cluny", and Peter in reply gave a convincing explanation of the Benedictine practice, his main contention being that the person anointed may on recovery have sinned again and be in need of the remission of sins promised by St. James, and that the Apostle himself not only does not suggest that the unction may be given only once, but clearly implies the contrary--"ut quoties quis infirmatus fuerit, toties inungatur" (P.L., CLXXXIX, 392 sq.). After this all opposition to the repetition of the sacrament disappears, and subsequent writers unanimously teach, what has been defined by the Council of Trent, that it may under certain conditions be validly and lawfully repeated. It should be noted, moreover, that the practice of repeating it at this period was not confined to the Benedictines or to Cluny. The Cistercians of Clairvaux, for example, were also in the habit of repeating it, but subject to the restriction that it was not to be given more than once within a year; and several Ordines of particular Churches dating from the ninth, tenth, eleventh, and twelfth centuries, have a rubric prescribing the repetition of the unction for seven successive days (cf. Kern, op. cit., pp. 334, 338 sq.).

Coming to the more accurate determination of the circumstances or conditions which justify the repetition of extreme unction, theologians, following the authority of Trent, are agreed that it may be validly and lawfully repeated as often as the sick person, after recovery, becomes seriously ill again, or, in cases of lingering illness where no complete recovery takes place, as often as the probable danger of death, after disappearing, returns. For verification of this latter condition some theologians would require the lapse of a certain interval, say a month, during which the danger would seem to have passed; but there is really no reason for insisting on this any more than on the year which medieval custom in some places was wont to require. St. Bonaventure's remark, that "it is absurd for a sacrament to be regulated by the motion of the stars" (in IV Semt., dist. xxiii, a. 2, q. iv, ad 2), applies to a month as well as to a year. Not a few theologians (among recent ones De Augustinis, "De Re Sacramentariâ, II, 408) understand, by the new danger of death, proximate or imminent danger, so that, once imminent danger has passed and returned, the sacrament may be repeated without waiting for any definite interval to elapse. The majority of theologians, however, deny the validity of extreme unction repeated while the danger of death remains the same, and they assume that this is the implicit teaching of the Council of Trent. But among contemporary authors, Kern, following the lead of several positive theologians eminent for their knowledge of sacramental history (Ménard, Launoi, Martène, Juénin, Drouven, Pouget, Pellicia, Binterim, Heinrich.--See references in Kern, op. cit., pp. 357, 538), maintains the probable validity of extreme unction repeated, no matter how often, during the same danger of death; and it will be found easier to ignore, than to meet and answer, the argument by which he supports his view. He furnishes, in the first place, abundant evidence of the widespread practice in the Western Church from the ninth to the twelfth, and even, in some places, to the thirteenth century, of repeating the unction for seven days, or indefinitely while the sickness lasted; and he is able to claim the authority of Oriental theologians for explaining the modern practice in the Eastern Church of a sevenfold anointing by seven priests as being due to a more ancient practice of repeating the unction for seven days--a practice to which the Coptic Liturgy bears witness. By admitting the validity of each repeated unction we are able to give a much more reasonable explanation of the medieval Western and modern Eastern practice than can possibly be given by those who deny its validity. The latter are bound to maintain either that the repeated rite is merely a sacramental--though clearly intended to be a sacrament--or that the repeated unctions coalesce to form one sacrament--an explanation which is open to several serious objections. In the next place, since extreme unction does not imprint a permanent "character", there is no reason why its proper sacramental effect may not be increased by repetition, as happens in Penance and Holy Communion--that is, with an increase of sanctifying grace, the right to spiritual invigoration may be increased, and more abundant actual graces become due. And this, on internal grounds, would suffice to justify repetition, although the effect of the previous administration remains. Finally, in reply to the principal dogmatic reason urged against his view--viz., the teaching of the Council of Trent--Kern fairly maintains that the intention of the council was merely positive, and not exclusive, i.e., it wished to define, in opposition to more restrictive views that had been held, the validity of extreme unction repeated in the circumstances it mentions, but without meaning to deny its validity if repeated in other circumstances not mentioned. The exhaustive examination of tradition which is supposed to precede a definition had not, so far as this particular point is concerned, been carried out at the time of Trent; and the point itself was not ripe for definition. Modern discipline in the Western Church can be explained on other than dogmatic grounds; and if it be urged as dogmatically decisive, this will imply a very sweeping condemnation of medieval Western and modern Eastern practice, which the prudent theologian will be slow to pronounce.


The question of reviviscence arises when any sacrament is validly administered, but is hindered at the time from producing its effect, owing to the want of due dispositions in the recipient. Thus, in regard to extreme unction, the subject may be unconscious and incapable of spiritual invigoration in so far as this requires co-operation with actual grace. Or he may, for want of the necessary attrition, be indisposed to receive remission of sins, or indisposed in case of mortal sin for the infusion of sanctifying grace. And the want of disposition--the obstacle to the efficacy of the sacrament--may be inculpable or gravely culpable; in the latter case the reception of the sacrament will be sacrilegious. Now the question is, does extreme unction revive, that is does it afterwards (during the same serious illness) produce such effects as are hindered at the time of reception, if the obstacle is afterwards removed or the requisite disposition excited? And theologians all teach that it certainly does revive in this way; that for its reviviscence, if no sacrilege has been committed in its reception nor any grave sin in the interval, all that is needed is that the impeding defect should be removed, that consciousness, for instance, should be recovered, or habitual attrition excited; but that, when a grave sin has been committed at or since the reception, this sin must be remitted, and sanctifying grace obtained by other means (e.g. penance or perfect contrition) before extreme unction can take effect. From this doctrine of reviviscence--which is not, however, defined as a dogma--there follows an important practical rule in regard to the administration of extreme unction, viz., that, notwithstanding doubts about the dispositions of a certainly valid subject, the sacrament should always be conferred absolutely, never conditionally, since a condition making its validity dependent on the actual dispositions of the recipient would exclude the possibility of reviviscence. The conditional form (si capax es) should be used only when it is doubtful whether the person is a valid subject for the sacrament, e.g., whether he is not already dead, whether he has been baptized, has attained the use of reason, or has the implicit habitual intention of dying in a Christian manner

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