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The rule of 9: Rule of Nines – StatPearls

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Rule of Nines – StatPearls

Ross A. Moore; Abdul Waheed; Bracken Burns.

Author Information and Affiliations

Last Update: May 30, 2022.

Introduction

The Rule of Nines, also known as the Wallace Rule of Nines, is a tool used by trauma and emergency medicine providers to assess the total body surface area (TBSA) involved in burn patients.  Measurement of the initial burn surface area is important in estimating fluid resuscitation requirements since patients with severe burns will have massive fluid losses due to the removal of the skin barrier. This tool is only utilized for second-degree and third-degree burns (also referred to as partial thickness and full thickness burns) and aids the provider in quick assessment to determine the severity and intravenous fluid needs. Alterations to the Rule of Nines may be made based on body mass index (BMI) and age. The Rule of Nines has been shown to be the most frequently recited algorithm by physicians and nurses for estimating burn surface area in numerous studies. [1][2][3]

The Rule of Nines estimation of body surface area burned is based on assigning percentages to different body areas. The entire head is estimated as 9% (4.5% for anterior and posterior). The entire trunk is estimated at 36% and can be further broken down into 18% for anterior compnents and 18% for the back. The anterior aspect of the trunk can further be divided into chest (9%) and abdomen (9%). The upper extremities total 18% and thus 9% for each upper extremity. Each upper extremity can further be divided into anterior (4.5%) and posterior (4.5%). The lower extremities are estimated at 36%, 18% for each lower extremity. Again this can be further divided into 9% for the anterior and 9% for the posterior aspect. The groin is estimated at 1%.[4][5]

Function

The Rule of Nines functions as a tool to assess second-degree and third-degree total body surface area (TBSA) in burn patients. Once the TBSA is determined and the patient is stabilized, fluid resuscitation may begin often with the use of a formula. Often the Parkland formula is used. It is calculated as 4 mL intravenous (IV) fluid per kilogram of ideal body weight per TBSA percent (expressed as a decimal) over 24 hours. Due to reports of over-resuscitation, other formulas have been proposed such as the Modified Brooke formula, that decrease the intravenous fluid to 2 mL instead of 4 mL. After the total volume of intravenous fluid resuscitation for the first 24 hours is established, the first half of the volume is given over the first 8 hours and the other half is given over the next 16 hours (this is converted to an hourly rate by dividing half the total volume by 8 and 16). The 24-hour volume time starts at the time of the burn. Should the patient present 2 hours after the burn and intravenous fluid resuscitation have not been started, the first half of the volume should be given in 6 hours with the remaining half of fluids running as per protocol. Fluid resuscitation is highly important in the initial management of second-degree and third-degree burns that encompass greater than 20% TBSA as complications of renal failure, myoglobinuria, hemoglobinuria, and multi-organ failure may arise if not aggressively treated early. Mortality has been shown to be higher in patients with greater than 20% TBSA burns that do not receive appropriate fluid resuscitation immediately following the injury.[6][7][8]

Issues of Concern

There is a concern among clinicians of the accuracy of the Rule of Nines pertaining to the obese and pediatric populations. The Rule of Nines can be best used in patients greater than 10 kilograms and less than 80 kilograms if defined by BMI as less than obese. For infants and obese patients special consideration should be take as outlined below:

Obese Patients

  • Patients that are defined as obese by BMI have disproportionately large trunks compared to their non-obese counterparts.

  • Obese patients have a closer approximation to 50% TBSA of the trunk, 15% TBSA for each leg, 7% TBSA for each arm, and 6% TBSA for the head.

  • Android-shaped patients, defined as a preferential trunk and upper body distribution of adipose tissue (abdomen, chest, shoulders, and the nape of the neck), have a torso that is closer to 53% TBSA.

  • Gynecoid-shaped patients, defined as a preferential lower body distribution of adipose tissue (lower abdomen, pelvis, and thighs), have a torso that is closer to 48% TBSA.

  • As the degree of obesity increases, the degree of underestimation of truncal and leg TBSA burn involvement increases when adhering to the Rule of Nines.

Infants

  • Infants have proportionately larger heads which alters the surface area contribution of other major body segments.

  • A “Rule of Eights” better approximates infants weighing less than 10 kg.” This rule dictates approximately 32% TBSA for the patient’s trunk, 20% TBSA for the head, 16% TBSA for each leg, and 8% TBSA for each arm.

Despite the efficiency of the Rule of Nines and its penetrance into the surgical and emergency medicine specialties, studies show that at 25% TBSA, 30% TBSA, and 35% TBSA, percentage TBSA is overestimated by 20% when compared to computer-based applications. Overestimation of TBSA burned can lead to excessive intravenous fluid resuscitation giving the potential for volume overload and pulmonary edema with more cardiac demand. Patients with pre-existing comorbidities are at risk for acute cardiac and respiratory decompensation and should be monitored in the intensive care unit (ICU) during the aggressive fluid resuscitation phase, preferably in a burn center.[9][10]

Clinical Significance

The Rule of Nines is a quick and easy tool used for the initial management of resuscitation in burn patients. Studies find that after examining the fully undressed patient, the percentage TBSA can be determined by the Rule of Nines within a few minutes.

Multiple studies found in a literature review stated that the patient’s palm excluding the digits represented approximately 0.5% TBSA and that verification was noted with computer-based applications. The inclusion of the digits to the palm was found to be approximately 0.8% TBSA. The use of the palm, which is the basis for how the Rule of Nines was established, is found to be more appropriate for smaller second-degree and third-degree burns.  It has been noted that the more training a specialist has, the less overestimation is present, especially on smaller burns.

Other Issues

Due to the inherent nature of the error in the human evaluation of burns even in the setting of rules, computer-based applications available for smartphones are being produced to minimize overestimating and underestimating TBSA percentages. The applications are utilizing standardized sizes of male and female models of small, average, and obese sizes. The applications are also moving towards measurements of infants. These computer applications are finding variability in the reporting of TBSA percentages by up to 60% overestimation of burn surface area down to 70% underestimation.

Intravenous fluid resuscitation guided by the Rule of Nines stands only for patients that have greater than 20% TBSA, and these patients should be transported to the nearest trauma center. Except for special areas, such as the face, genitals, and hands, that need to be seen by a specialist, transfer to major trauma centers are only necessary for greater than 20% TBSA burns. The American Burn Association (ABA) also has defined criteria of which patients should be transferred to a burn center.

Once fluid resuscitation has been initiated, it is important to identify if appropriate perfusion, hydration, and renal function are present. The resuscitation derived from the Rule of Nines and intravenous fluid formula (Parkland, Modified Brooke, among others) should be closely monitored and adjusted as these initial values are guidelines. The management of severe burns is a fluid process requiring constant monitoring and alterations. Lack of attention to details can result in higher morbidity and mortality as these patients are critically ill.

Enhancing Healthcare Team Outcomes

The Rule of Nines, also known as the Wallace Rule of Nines, is a tool used by health care professionals to assess the total body surface area (TBSA) involved in burn patients. Measurement of the initial burn surface area by the healthcare team is important in estimating fluid resuscitation requirements since patients with severe burns have massive fluid losses due to the removal of the skin barrier. The activity updates healthcare teams on the Rule of Nine use in burn victims which will produce better patient outcomes. [Level V]

Review Questions

  • Access free multiple choice questions on this topic.

  • Comment on this article.

Figure

Diagram of rule of 9s for adults. Contributed from Wiki commons user Jmarchn, CC By-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/

Figure

Diagram of rule of 9s modifications for pediatric patients. Contributed by Rian Kabir, MD

References

1.

Cheah AKW, Kangkorn T, Tan EH, Loo ML, Chong SJ. The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast? Burns Trauma. 2018;6:7. [PMC free article: PMC5828346] [PubMed: 29497619]

2.

Tocco-Tussardi I, Presman B, Huss F. Want Correct Percentage of TBSA Burned? Let a Layman Do the Assessment. J Burn Care Res. 2018 Feb 20;39(2):295-301. [PubMed: 28877135]

3.

Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg. 2017 Dec;51(6):375-380. [PubMed: 28417654]

4.

Ali SA, Hamiz-Ul-Fawwad S, Al-Ibran E, Ahmed G, Saleem A, Mustafa D, Hussain M. Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi. Ann Burns Fire Disasters. 2016 Mar 31;29(1):4-9. [PMC free article: PMC5108226] [PubMed: 27857643]

5.

Thom D. Appraising current methods for preclinical calculation of burn size – A pre-hospital perspective. Burns. 2017 Feb;43(1):127-136. [PubMed: 27575669]

6.

Parvizi D, Giretzlehner M, Dirnberger J, Owen R, Haller HL, Schintler MV, Wurzer P, Lumenta DB, Kamolz LP. The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment. Ann Burns Fire Disasters. 2014 Jun 30;27(2):94-100. [PMC free article: PMC4396802] [PubMed: 26170783]

7.

Williams RY, Wohlgemuth SD. Does the “rule of nines” apply to morbidly obese burn victims? J Burn Care Res. 2013 Jul-Aug;34(4):447-52. [PubMed: 23702858]

8.

Vaughn L, Beckel N, Walters P. Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 2: diagnosis, therapy, complications, and prognosis. J Vet Emerg Crit Care (San Antonio). 2012 Apr;22(2):187-200. [PubMed: 23016810]

9.

Prieto MF, Acha B, Gómez-Cía T, Fondón I, Serrano C. A system for 3D representation of burns and calculation of burnt skin area. Burns. 2011 Nov;37(7):1233-40. [PubMed: 21703768]

10.

Neaman KC, Andres LA, McClure AM, Burton ME, Kemmeter PR, Ford RD. A new method for estimation of involved BSAs for obese and normal-weight patients with burn injury. J Burn Care Res. 2011 May-Jun;32(3):421-8. [PubMed: 21562463]

Disclosure: Ross Moore declares no relevant financial relationships with ineligible companies.

Disclosure: Abdul Waheed declares no relevant financial relationships with ineligible companies.

Disclosure: Bracken Burns declares no relevant financial relationships with ineligible companies.

Rule of Nines – StatPearls

Ross A. Moore; Abdul Waheed; Bracken Burns.

Author Information and Affiliations

Last Update: May 30, 2022.

Introduction

The Rule of Nines, also known as the Wallace Rule of Nines, is a tool used by trauma and emergency medicine providers to assess the total body surface area (TBSA) involved in burn patients.  Measurement of the initial burn surface area is important in estimating fluid resuscitation requirements since patients with severe burns will have massive fluid losses due to the removal of the skin barrier. This tool is only utilized for second-degree and third-degree burns (also referred to as partial thickness and full thickness burns) and aids the provider in quick assessment to determine the severity and intravenous fluid needs. Alterations to the Rule of Nines may be made based on body mass index (BMI) and age. The Rule of Nines has been shown to be the most frequently recited algorithm by physicians and nurses for estimating burn surface area in numerous studies.[1][2][3]

The Rule of Nines estimation of body surface area burned is based on assigning percentages to different body areas. The entire head is estimated as 9% (4.5% for anterior and posterior). The entire trunk is estimated at 36% and can be further broken down into 18% for anterior compnents and 18% for the back. The anterior aspect of the trunk can further be divided into chest (9%) and abdomen (9%). The upper extremities total 18% and thus 9% for each upper extremity. Each upper extremity can further be divided into anterior (4.5%) and posterior (4.5%). The lower extremities are estimated at 36%, 18% for each lower extremity. Again this can be further divided into 9% for the anterior and 9% for the posterior aspect. The groin is estimated at 1%. [4][5]

Function

The Rule of Nines functions as a tool to assess second-degree and third-degree total body surface area (TBSA) in burn patients. Once the TBSA is determined and the patient is stabilized, fluid resuscitation may begin often with the use of a formula. Often the Parkland formula is used. It is calculated as 4 mL intravenous (IV) fluid per kilogram of ideal body weight per TBSA percent (expressed as a decimal) over 24 hours. Due to reports of over-resuscitation, other formulas have been proposed such as the Modified Brooke formula, that decrease the intravenous fluid to 2 mL instead of 4 mL. After the total volume of intravenous fluid resuscitation for the first 24 hours is established, the first half of the volume is given over the first 8 hours and the other half is given over the next 16 hours (this is converted to an hourly rate by dividing half the total volume by 8 and 16). The 24-hour volume time starts at the time of the burn. Should the patient present 2 hours after the burn and intravenous fluid resuscitation have not been started, the first half of the volume should be given in 6 hours with the remaining half of fluids running as per protocol. Fluid resuscitation is highly important in the initial management of second-degree and third-degree burns that encompass greater than 20% TBSA as complications of renal failure, myoglobinuria, hemoglobinuria, and multi-organ failure may arise if not aggressively treated early. Mortality has been shown to be higher in patients with greater than 20% TBSA burns that do not receive appropriate fluid resuscitation immediately following the injury.[6][7][8]

Issues of Concern

There is a concern among clinicians of the accuracy of the Rule of Nines pertaining to the obese and pediatric populations. The Rule of Nines can be best used in patients greater than 10 kilograms and less than 80 kilograms if defined by BMI as less than obese. For infants and obese patients special consideration should be take as outlined below:

Obese Patients

  • Patients that are defined as obese by BMI have disproportionately large trunks compared to their non-obese counterparts.

  • Obese patients have a closer approximation to 50% TBSA of the trunk, 15% TBSA for each leg, 7% TBSA for each arm, and 6% TBSA for the head.

  • Android-shaped patients, defined as a preferential trunk and upper body distribution of adipose tissue (abdomen, chest, shoulders, and the nape of the neck), have a torso that is closer to 53% TBSA.

  • Gynecoid-shaped patients, defined as a preferential lower body distribution of adipose tissue (lower abdomen, pelvis, and thighs), have a torso that is closer to 48% TBSA.

  • As the degree of obesity increases, the degree of underestimation of truncal and leg TBSA burn involvement increases when adhering to the Rule of Nines.

Infants

  • Infants have proportionately larger heads which alters the surface area contribution of other major body segments.

  • A “Rule of Eights” better approximates infants weighing less than 10 kg.” This rule dictates approximately 32% TBSA for the patient’s trunk, 20% TBSA for the head, 16% TBSA for each leg, and 8% TBSA for each arm.

Despite the efficiency of the Rule of Nines and its penetrance into the surgical and emergency medicine specialties, studies show that at 25% TBSA, 30% TBSA, and 35% TBSA, percentage TBSA is overestimated by 20% when compared to computer-based applications. Overestimation of TBSA burned can lead to excessive intravenous fluid resuscitation giving the potential for volume overload and pulmonary edema with more cardiac demand. Patients with pre-existing comorbidities are at risk for acute cardiac and respiratory decompensation and should be monitored in the intensive care unit (ICU) during the aggressive fluid resuscitation phase, preferably in a burn center.[9][10]

Clinical Significance

The Rule of Nines is a quick and easy tool used for the initial management of resuscitation in burn patients. Studies find that after examining the fully undressed patient, the percentage TBSA can be determined by the Rule of Nines within a few minutes.

Multiple studies found in a literature review stated that the patient’s palm excluding the digits represented approximately 0. 5% TBSA and that verification was noted with computer-based applications. The inclusion of the digits to the palm was found to be approximately 0.8% TBSA. The use of the palm, which is the basis for how the Rule of Nines was established, is found to be more appropriate for smaller second-degree and third-degree burns. It has been noted that the more training a specialist has, the less overestimation is present, especially on smaller burns.

Other Issues

Due to the inherent nature of the error in the human evaluation of burns even in the setting of rules, computer-based applications available for smartphones are being produced to minimize overestimating and underestimating TBSA percentages. The applications are utilizing standardized sizes of male and female models of small, average, and obese sizes. The applications are also moving towards measurements of infants. These computer applications are finding variability in the reporting of TBSA percentages by up to 60% overestimation of burn surface area down to 70% underestimation.

Intravenous fluid resuscitation guided by the Rule of Nines stands only for patients that have greater than 20% TBSA, and these patients should be transported to the nearest trauma center. Except for special areas, such as the face, genitals, and hands, that need to be seen by a specialist, transfer to major trauma centers are only necessary for greater than 20% TBSA burns. The American Burn Association (ABA) also has defined criteria of which patients should be transferred to a burn center.

Once fluid resuscitation has been initiated, it is important to identify if appropriate perfusion, hydration, and renal function are present. The resuscitation derived from the Rule of Nines and intravenous fluid formula (Parkland, Modified Brooke, among others) should be closely monitored and adjusted as these initial values are guidelines. The management of severe burns is a fluid process requiring constant monitoring and alterations. Lack of attention to details can result in higher morbidity and mortality as these patients are critically ill.

Enhancing Healthcare Team Outcomes

The Rule of Nines, also known as the Wallace Rule of Nines, is a tool used by health care professionals to assess the total body surface area (TBSA) involved in burn patients. Measurement of the initial burn surface area by the healthcare team is important in estimating fluid resuscitation requirements since patients with severe burns have massive fluid losses due to the removal of the skin barrier. The activity updates healthcare teams on the Rule of Nine use in burn victims which will produce better patient outcomes. [Level V]

Review Questions

  • Access free multiple choice questions on this topic.

  • Comment on this article.

Figure

Diagram of rule of 9s for adults. Contributed from Wiki commons user Jmarchn, CC By-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/

Figure

Diagram of rule of 9s modifications for pediatric patients. Contributed by Rian Kabir, MD

References

1.

Cheah AKW, Kangkorn T, Tan EH, Loo ML, Chong SJ. The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast? Burns Trauma. 2018;6:7. [PMC free article: PMC5828346] [PubMed: 29497619]

2.

Tocco-Tussardi I, Presman B, Huss F. Want Correct Percentage of TBSA Burned? Let a Layman Do the Assessment. J Burn Care Res. 2018 Feb 20;39(2):295-301. [PubMed: 28877135]

3.

Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg. 2017 Dec;51(6):375-380. [PubMed: 28417654]

4.

Ali SA, Hamiz-Ul-Fawwad S, Al-Ibran E, Ahmed G, Saleem A, Mustafa D, Hussain M. Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi. Ann Burns Fire Disasters. 2016 Mar 31;29(1):4-9. [PMC free article: PMC5108226] [PubMed: 27857643]

5.

Thom D. Appraising current methods for preclinical calculation of burn size – A pre-hospital perspective. Burns. 2017 Feb;43(1):127-136. [PubMed: 27575669]

6.

Parvizi D, Giretzlehner M, Dirnberger J, Owen R, Haller HL, Schintler MV, Wurzer P, Lumenta DB, Kamolz LP. The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment. Ann Burns Fire Disasters. 2014 Jun 30;27(2):94-100. [PMC free article: PMC4396802] [PubMed: 26170783]

7.

Williams RY, Wohlgemuth SD. Does the “rule of nines” apply to morbidly obese burn victims? J Burn Care Res. 2013 Jul-Aug;34(4):447-52. [PubMed: 23702858]

8.

Vaughn L, Beckel N, Walters P. Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 2: diagnosis, therapy, complications, and prognosis. J Vet Emerg Crit Care (San Antonio). 2012 Apr;22(2):187-200. [PubMed: 23016810]

9.

Prieto MF, Acha B, Gómez-Cía T, Fondón I, Serrano C. A system for 3D representation of burns and calculation of burnt skin area. Burns. 2011 Nov;37(7):1233-40. [PubMed: 21703768]

10.

Neaman KC, Andres LA, McClure AM, Burton ME, Kemmeter PR, Ford RD. A new method for estimation of involved BSAs for obese and normal-weight patients with burn injury. J Burn Care Res. 2011 May-Jun;32(3):421-8. [PubMed: 21562463]

Disclosure: Ross Moore declares no relevant financial relationships with ineligible companies.

Disclosure: Abdul Waheed declares no relevant financial relationships with ineligible companies.

Disclosure: Bracken Burns declares no relevant financial relationships with ineligible companies.

The 9-Thing Rule: A Way to Do Everything

How often have you taken on several tasks at the same time, but in the end did not have time to do anything worthwhile for the whole day? At such moments, we usually dream of finding at least a couple of extra hours in the day and finding a way to be more productive and not burn out. Together with an expert, we analyze a simple but effective technique that will help you distribute the load and achieve all your goals for the day!

Tags:

Life style

time management

You must have wondered: “Why do people around me somehow magically manage to do everything, and I almost nothing?” If you are familiar with this problem, then our material will come in handy. Especially for VOICE readers, the psychologist spoke about the tricky technique “9 things to do”, which will help in the correct planning of the day and will not let you drive yourself into stress. Try to follow these tips, and very soon you will notice that almost everything is subject to you!

Elena Milto

Candidate of Psychological Sciences, promoter of the psychology of effectiveness and author of the method of sheff_thinking

There is a lot of information around, the flow of the desired is outlined, but, alas, there is not enough competence for everything. Hence the broken biorhythms, stress, burnout and other “charms” of the modern world. This can lead to apathy, fear and increased levels of anxiety. To avoid this, it is enough to apply a prophylactic from the arsenal of sheff_thinking.

The right “pill” here is, first of all, the ability to plan correctly. The vertical of effective planning is built in turn: hour, day, week.

The simplest and most effective way of prevention is the “9 things” technique. I use it myself and also often recommend it to our sorority members who are facing time constraints. So the formula is simple: 9=1+3+5. And now we understand in detail!

Nine tasks is the maximum that we promise ourselves to accomplish in a day: there are both large and small tasks among them. To begin with, we choose one of the largest and most urgent things – it will be the main and mandatory one. Next, we highlight three tasks of “medium severity” and five more tasks that do not require a lot of effort, time and energy for implementation.

ADVERTISING – CONTINUED BELOW

Let’s analyze the formula using a simple example from my life:

  • +1: I will write one chapter of my book, which is resource-intensive for me;
  • +3: zoom with a colleague + set tasks for employees + draw up a birthday itinerary – these tasks are time-consuming, but not paramount;
  • +5: I’ll sign the child up for a doctor’s appointment + I’ll put the dishes in the dishwasher + I’ll publish a post on Instagram (The social network is recognized as extremist and banned on the territory of the Russian Federation) + I’ll order groceries at home + pay the bills. All these things do not require much effort and time.

The result is 9, where 4 tasks are quite voluminous and require a lot of resources, and 5 are easy, but which must be done every day and not accumulated.

It is also important to remember that in addition to determining the tasks for the day, each of us has our own biological clock and form peaks. It is believed that the most important and great things are best done at the beginning of the day, when we are still full of energy, cheerful and in tune. It is this time of day that is suitable for the majority, but you know your own biorhythms much better, so do not be guided by the majority, but listen to yourself!

In this way, we get a harmonious, stress-free schedule that allows us to correctly allocate resources and the ability to manage time, filling life with various tasks. By developing the habit of effective planning, we gain the most useful skill that turns time from our enemy into a good friend. You can live only by having time, and it is possible to be in time only by competent planning!

Photo: Shutterstock

Rule 9 of the Holy Apostles, Rules of the Holy Apostles and Ecumenical Councils with interpretations, St. Nicodemus (Milash)

Priest Nikodim (Milash)

Rules of the Holy Apostles and Ecumenical Councils with interpretations

Rule of 8 Holy Apostles Rule of 10 Holy Apostles

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All the faithful who enter the church and listen to the writings, but who do not remain in prayer and holy communion to the end, as if committing disorder in the church, should be excommunicated from church communion .

(Trul. 66, 80; Antioch. 2; Serdic. 11) .

The fellowship of Christians in the early days of the church was expressed mainly in the common participation of all the faithful in the Lord’s table (1 Cor. 10:16, 17) and in the unanimous presence of all in the temple (Acts 2:46; 20:7). This communion, expressed in this way, is placed, among other things, at the basis and in the composition of the rite of the liturgy, so that the catechumens, who could remain in the church with the faithful only until certain prayers, as soon as the rite of the Eucharist itself began, were invited by the deacon to leave the church, so that only the faithful remained in the temple, and were participants in the Lord’s table. This expressed the general idea of ​​the church about spiritual unity among the faithful, as well as the fact that, for the sake of this spiritual unity, each faithful can and has the right to participate in the church at all prayers and at the holy Eucharist and in corporate prayer, after St. communion, thank the Lord for His great gift. So it was at the beginning of the church of Christ, and all the faithful always came to church, and not only listened to the reading of the Holy Scriptures in the church, but remained there until the priest, having finished the divine liturgy, gave them a blessing to leave the church. Such zeal, however, began to cool off among some, and many, having listened only to the reading of Holy Scripture, left the church. For the sake of this, no doubt, it was introduced, as we read in the Apostolic Constitutions (VIII, 9), at the rite of the liturgy, after a reminder to the catechumens to leave the church, the deacon’s exclamation that none of those who have the right to remain until the end of the service should not leave it. In all likelihood, this did not help; even after the deacon’s exclamation, many still left the church before the end of the service, thereby offending the reverent feeling of the truly faithful and causing disorder in the church itself. As a result, a real strict rule was issued requiring the excommunication of everyone who comes to the church and does not remain in it until the end of the service 145 .

Some canonists understand this rule in such a way that the faithful not only had to remain in the church until the end of the Divine Liturgy, but were also obliged to all partake of St. secret 146 . It is possible that such an interpretation is correct, since the passages from the Holy Scriptures cited above in the explanation of this rule can serve as confirmation of this. However, it cannot be that all the faithful are forced to take communion every time they attend church, since it could easily be that not everyone was always prepared for communion, either by the prompting of the voice of their own conscience, or due to some other personal or social reasons. life. On the one hand, in order that even such people should be honored with at least some participation in the shrine, and in order to avoid the severity of the punishment imposed by this rule on the other, and also in order to oblige even those who cannot take communion, nevertheless, to remain until the end of the divine liturgy, the distribution of antidoron was instituted, which everyone had to accept from the hands of the priest for their own consecration 147 .

* * *

145

The holy fathers and teachers of the church of the following centuries did not stop talking and admonishing about how to come and stand in church during the time of St. liturgy. Basil. ad caesar. [Migne, s. g., t. 32, col. 245–268]. — Hieron. apol. adv. Jovin. [Migne, s. l., t. 23, col. 211-338]. – Ambros. de sacram. 4, 6, 5, 4. [Migne, s. l., t. 16, col. 445-446, 450-454]. – Chrysost. hom. 3. in cp ad. Ephes. [Migne, s. g., t. 62, col. 23–30]. – See and note. 1 to this is right. in Pidalion (12 pp.).

146

See the interpretations of Zonara and Aristinus (Aph. Sint., II, 13, 14). In glory. The helmsman (ed. 1787, I, 3) reads this rule: “let those who do not stay in the church until the last prayer, who do not take communion, be excommunicated.” Wed 17 ch. Reply to Balsamon Patr. Alexander. Mark in Af. Sint., IV, 461.

147

Antioch. Sob., Af. Sint., III, 128 and Synt. Vlastara, K, 25 (Af. Sint.