Exsufflation is a strongly forced expiration of air. In medicine, airway secretions can be cleared with manual and mechanical exsufflation. Mechanical insufflation-exsufflation devices (also known as In-Exsufflator, Cofflator, and cough machine) alternate positive and negative airway pressure to stimulate cough. It is typically used in patients with neuromuscular disorders and sleep apnea.
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People with neuromuscular weakness and atelectasis benefit from mechanical insufflation-exsufflation. Mechanically-assisted coughing greatly improves secretion clearance in the setting of respiratory infection in the patient with neuromuscular disease and should be first-line therapy for this patient population. Mechanical insufflation-exsufflation physiotherapy is greatly aided by simultaneous manual augmentation of cough with either a thoracic squeeze or abdominal thrust during the expiratory phase (exhale). An American Thoracic Society consensus statement in 2004 supported the use of mechanical insufflation- exsufflation physiotherapy for patients with Duchenne muscular dystrophy.
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Celsus (according to Origen) reports the use of exsufflation by Egyptian magicians.Origen, Contra Celsum 1.68, ed. Marcel Borret, Origène: "Contre Celse," 1, Sources Chrétiennes 132 (Paris, 1967), 266 (PG 11:787/788A).
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29 (Louvain, 1961), 281. the basis of the later Roman pontifical. Ordo Romanus L also contains a triple exsufflation of the candidates for baptism, immediately preceding the baptism itself.Ordo L, xx.5; Andrieu, 5:131.
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Scannell, T. (1908). Catechumen in The Catholic Encyclopedia New York: Robert Appleton Company. Retrieved May 21, 2014 from New Advent. Augustine noted that rites of exorcism by exsufflation (breathing upon the candidate) were also performed for the baptism of infants.
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266, note m; Whitaker, Documents of the Baptismal Liturgy, p. 256; Kelly, The Devil at Baptism, p. 235. Döger, Der Exorzismus im altchristlichen Taufrituel, p. 130 similarly distinguishes between exsufflation and "halation"; and Suntrup, Die Bedeutung der liturgischen Gebärden, p.
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After the Protestant Reformation, Martin Luther abbreviated the Roman ritual used for exorcism. In 1526, the ritual was further abbreviated and the exsufflation was omitted. This form of the Lutheran Ritual for Exorcism was incorporated into the majority of the Lutheran service-books and implemented.
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Uta-Renate Blumenthal (Washington, DC, 1983), 169-238. One anonymous 9th-century catechism is unusual in distinguishing explicitly between the exsufflation of catechumens and the insufflation of baptismal water,André Wilmart, "Une catéchèse baptismale du IXe siècle," Revue Bénédictine 57 (1947): 199 (Keefe, "Expositions," text 50). but most of the tracts and florilegia, when they treat both, do so without referring one to the other; most confine themselves to exsufflation and are usually content to quote extracts from authorities, especially Isidore and Alcuin.E.g. in Keefe's texts 34/6 and 3: Jean-Paul Bouhot, "Alcuin et le 'De Catechizandis Rudibus,'" Recherches Augustiniennes 15 (1980): 224; and Wilmart, Analecta, 158.
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307 warns that the distinction is a hard one to maintain. The Episcopal Dictionary of the Church, s.v. insufflation (accessed 14 Jan 2007) similarly says that "the distinction between insufflation and exsufflation has not always been preserved." And the Oxford Dictionary of the Christian Church, 3rd ed.
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God's breath can be fiery, consuming all it touches: "I will blow upon you with the fire of my wrath" (Ezekiel 21:31, RSV).Vulg. "In igne furoris mei sufflabo in te." Cp. the fiery brimstone breath of God in Isaiah 30:33. Some of the interpretations of exsufflation may reflect this.
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There are also Biblical antecedents for exsufflation, properly speaking, that is, exorcistic blowing, especially the numerous Old Testament passages in which "the breath of God" is the vehicle or symbol not of life but of death and destruction — an expression of the wrath of God: "by the breath of God they perish / and by the blast of his anger they are consumed" (Job 4:9, RSV).Cp. Isaiah 11:4 ("with the breath of his lips he shall slay the wicked"). The same power is attributed metaphorically to Christ: "The lawless one will be revealed, and the Lord Jesus will slay him with the breath of his mouth" (2 Thessalonians 2:8, RSV). Even less obvious passages could be associated with liturgical exsufflation.
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Oxygen can be insufflated into the nose by nasal cannulae to assist in respiration. Mechanical insufflation-exsufflation simulates a cough and assists airway mucus clearance. It is used with patients with neuromuscular disease and muscle weakness due to central nervous system injury. Glossopharyngeal insufflation is a breathing technique that consists of gulping boluses of air into the lungs.
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This text may, however, originate on the Continent: see H. M. J. Bantin, Two Anglo-Saxon Pontificals, Henry Bradshaw Society 104 (London, 1989), xxiii-xxv. The contemporary, and genuinely English, Egbert Pontifical, from York, lacks mention of sufflation. In the 11th century, the Salisbury Pontifical (BL Cotton MS Tiberius C.1) and the Pontifical of Thomas of Canterbury require insufflation of the font; the Missal of Robert of Jumièges (Canterbury) has an erased rubric where it may have done likewise, as well as having an illegible rubric where it probably directed the exsufflation of catechumens, and retaining the old ordo ad caticuminum ex pagano faciendum, complete with its sufflation ceremony; and an English Ordo Romanus (BL Cotton MS Vitellius E.12) contains a triple exsufflation of baptizands.W. G. Henderson, ed., York Manual, 144, 136, 133, 142; H. A. Wilson, ed.
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Sometimes the exorcist used the rite of exsufflation, and sometimes, as St. Cyprian states, adjured the evil spirit to depart per Deum verum (by the true God). Lectors also had many liturgical functions to perform. The lector, for example, recited the lessons from the Old and New Testaments, and possibly even read (parts of) the Gospel from the pulpit to the people. In later ages his duties were divided, and some were given to the other ministers, some to regular chanters.
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An intrapulmonary percussive ventilator machine Mechanical devices used include positive expiratory pressure (PEP), intrapulmonary percussive ventilators, mechanical insufflation-exsufflation known as a mechanically assisted cough, and airway oscillatory devices. Several mechanical techniques are used to dislodge mucus and encourage its expectoration. Chest percussion can be administered as a manual technique but can also be performed using specific devices that use chest wall oscillation or intrapulmonary percussive ventilation. Intrapulmonary percussive ventilators (IPVs) are machines which deliver short bursts of air through a mouthpiece to help to clear mucus.
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In Celtic Rite, the unclean spirit is evoked and exorcized per deum patrem omnipotentem, "by God, All-powerful Father"; the same phrase is used in both Gallican (exorcidio te, spiritus immunde) and Milanese exorcism. The Milanese rite prescribes exsufflation: Exsufflat in faciem ejus in similitudinem crucis dum dicit ("Breathe out onto [the subject's] face in the likeness of the cross while speaking").Ordo Baptismi, Sacramentarium Gallicanum, edition of Jean Mabillon p. 324; also in an Ambrosian Ritual (Ordo xxi) quoted by Edmond Martène, De Antiquis Ecclesiae Ritibus (1788), vol.
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The other Gallican rites are largely devoid of sufflation, though the so-called Missale Gothicum contains a triple exsufflation of baptismal water,Neale, Gallican Liturgies, 97; or L. C. Mohlberg, ed., Missale Gothicum, Rerum Ecclesiasticarum Documenta, Series Maior, Fontes 5 (Rome, 1961), 67. and a prebaptismal insufflation of catechumens is found in the hybrid Bobbio MissalNeale, Gallican Liturgies, 266 and the 10th-century Fulda sacramentary, alongside the more common baptismal exsufflation.Fulda Sacramentary, 332 (§2631) and 343 (§2679-80). The 11th- century North-Italian baptismal ritual in the Ambrosian Library MS. T.27.Sup.
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But thereafter the practice vanished from Lutheranism, and indeed from Protestantism generally. Luther's revised edition of 1526 and its successors omit exsufflation altogether, as do the Luther-influenced early reformed rites of England (Thomas Cranmer's Prayer Book of 1549) and Sweden (the Manual of Olavus Petri), despite the former's conservative basis in the medieval Sarum ritual and the latter's strong interest in exorcism as an essential part of the baptismal ritual.For a handy comparison, see The Manual of Olavus Petri, 1529, ed. Eric E. Yelverton (London: SPCK, 1953), p. [110].
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On the other side of the Channel, in Anglo-Saxon England, sufflation is mentioned in Bishop Wulfstan's collection of Carolingian baptismal expositions, the Incipit de baptisma, and in the two vernacular (Old English) homilies based on it, the Quando volueris and the Sermo de baptismate. The Incipit de baptisma reads: "On his face let the sign of the cross be made by exsufflation, so that, the devil having been put to flight, entry for our Lord Christ might be prepared."In cuius … facie a sacerdote per exsufflationem signum crucis sit, ut effugeto diabolo, Cristo Domino nostro preparetur introitus. Wulfstan, Homilies, ed.
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From an early period, the act had two distinct but not always distinguishable meanings: it signified on the one hand the derisive repudiation or exorcism of the devil; and, on the other, purification and consecration by and inspiration with the Holy Spirit. The former is technically "exsufflation" ("blowing out") and the latter "insufflation" ("blowing in"), but ancient and medieval texts (followed by modern scholarship) make no consistent distinction in usage. For example, the texts use not only Latin insufflare ('blow in') and exsufflare ('blow out'), or their Greek or vernacular equivalents, but also the simplex sufflare ('blow'), halare ('breathe'), inspirare, exspirare, etc.P. Pashini, et al.
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There are hints in some of the Church Fathers that Christians had a habit of breathing (or hissing) at evil spirits as a recognized act of revulsion or repulsion, even apart from the ceremonies of the church. Tertullian is perhaps the best witness. He seems to be talking about an extra- liturgical casting out of demons by means of exsufflation and signing when he declares that gods rejected by Christians are driven from the bodies of men "by our touch and by our breath," and are thus "carried away by the thought and vision of the fire [of judgment]."Tertullian, Apologeticus, 23.15-16, ed.
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For the Maronite rite, derived from the ancient Syriac liturgy, see Mysteries of Initiation, Baptism, Confirmation, Communion according to the Maronite Antiochene Church, (Washington, DC, 1987); summarized by Bryan D. Spinks, Early and Medieval Rituals and Theologies of Baptism..., (Aldershot, Hants., 2006), 89-91. an exsufflation of the candidate for baptism, right up to the 1960s: > [THE INSUFFLATION] He breathes thrice upon the waters in the form of a > cross, saying: Do You with Your mouth bless these pure waters: that besides > their natural virtue of cleansing the body, they may also be effectual for > purifying the soul.Saint Andrew Daily Missal..., by Dom Gaspar Lefebvre > (Bruges [Belgium]: Biblica, 1962), 492 [liturgy for the Easter vigil].
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In the period of post-Apostolic Christianity, baptism and the Eucharist required the prior riddance of both unclean spirits and illness.William Brashear and Roy Kotansky, "A New Magical Prayer Formulary," in Magic and Ritual in the Ancient World, edited by Paul Mirecki and Marvin Meyer (Brill, 2002), p. 13 online. Because the possessing demon was conceptualized as a pneuma or spiritus, each of which derives from a root meaning "breath," one term for its expulsion was exsufflation, or a "blowing out."For medieval liturgical examples — the Rheinau Ritual (12th century), Constance Ritual (1482), and the Magdeburg Agenda (1492) — see Bryan D. Spinks, Early and Medieval Rituals and Theologies of Baptism: From the New Testament to the Council of Trent (Ashgate Publishing, 2006), p. 136 online and 138.
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In 1526, the ritual was further abbreviated and the exsufflation was omitted. This form of the Lutheran Ritual for Exorcism was incorporated into the majority of the Lutheran service-books and implemented. According to a Pastoral Handbook of the Lutheran Church, These pastoral manuals warn that often, symptoms such as ecstasy, epileptic seizures, lethargy, insanity, and a frantic state of mind, are the results of natural causes and should not be mistaken for demon possession. According to the Lutheran Church, primary symptoms that may indicate demon possession and the need of an exorcism include: #The knowledge of secret things, for example, being able to predict the future (Acts 16:16), find lost people or things, or know complex things that one has never learned (e.g.
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However, regarding magic, in Syria, where ceremonial breathing became formalized as part of the rite of visitation of the sick. Ephraem Syrus advises that "if medicine fails you when you are sick, the 'visitors' will help, will pray for health, and one of them will breathe in your mouth, the other will sign you [with the sign of the cross]."Quoted by Döger, Exorzismus, 125n. If it was either originally Christian (citation needed), Catholic or from the pagan practices, almost similar methods of healing have been reported, continuing until modern times: in Westphalia, the healing of a wound by triple signing and triple cruciform sufflation, or by exsufflation accompanied by a rhyming charm; and in Holland the alleviation of toothache by similar means.
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Most of these variations persist in one branch or another of the hybrid Romano- Germanic rite that can be traced from 5th-century Rome through the western Middle Ages to the Council of Trent, and beyond that into modern (Tridentine) Roman Catholicism. As the 'national' rites such as the Ambrosian tradition in northern Italy and the Spanish Mozarabic rite faded away or were absorbed into international practice, it was this hybrid Roman-Gallican standard that came to dominate western Christendom, including Anglo-Saxon and medieval England, from the time of Charlemagne, and partly through his doing, through the high and late Middle Ages and into the modern period. Roman practice around the year 500 is reflected in a letter by a somewhat mysterious John the Deacon to a correspondent named Senarius. The letter discusses the exsufflation of catechumens at length.
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In religious and magical practice, insufflation and exsufflationInsufflation (from Latin word elements meaning "a blowing on") and exsufflation ("a blowing out") often cannot be distinguished in usage, and so are considered together in this article. are ritual acts of blowing, breathing, hissing, or puffing that signify variously expulsion or renunciation of evil or of the devil (the Evil One), or infilling or blessing with good (especially, in religious use, with the Spirit or grace of God). In historical Christian practice, such blowing appears most prominently in the liturgy, and is connected almost exclusively with baptism and other ceremonies of Christian initiation, achieving its greatest popularity during periods in which such ceremonies were given a prophylactic or exorcistic significance, and were viewed as essential to the defeat of the devil or to the removal of the taint of original sin.See Franz Josef Dölger, Der Exorzismus im altchristlichen Taufrituel, Studien zur Geschichte und Kultur des Altertums 3 (Paderborn, 1909), chap.
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The practice entered the baptismal liturgy proper only as the catechumenate, rendered vestigial by the growth of routine infant baptism, was absorbed into the rite of baptism. Both exsufflation and insufflation are well established by the time of Augustine and in later centuries are found widely. By the Western high Middle Ages of the 12th century, sufflation was geographically widespread, and had been applied not only to sufflating catechumens and baptizands,Nearly universally. E.g. (1) in Egypt: Canons of Hippolytus, Canon 19 (or §110), trans. Riedel 211, Achelis 93, Whitaker 88; Horner's translations of the Ethiopic, Arabic, and Sahidic versions may be found on pp. 152, 252, and 316. (2) In western Syria: Cyril, Procatechesis, cap. 9, ed. F. L. Cross, St. Cyril of Jerusalem's Lectures on the Christian Sacraments: The "Procatechesis" and the "Five Mystical Dialogues" (London, 1951), 5-6, trans. 45 = Patrologia Graeca 33:347-50 (translated also by E. H. Gifford, Catechetical Lectures, Nicene and Post-Nicene Fathers, 2nd series (N.
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