By W. M. Ramsay
The Thorn in the Flesh
From the Epistle we can gather something as to the nature of the disease. Lightfoot’s discussion of the subject is excellent, and we adopt every one of his conclusions, except his final opinion that the disease was epilepsy, and his suggestion that “the meanness of his personal appearance (2Co 10:10) was perhaps due to” the permanent effects of his painful malady.
First, the disease was active during Paul’s residence in Galatia, and yet it was quite compatible with long journeys. That is implied alike on the North and the South Galatian theories. The disease was active, because the Galatians saw it and did not despise the sufferer; it is implied that the Galatian Churches in general, and not some single one alone, witnessed the Apostle’s condition. Yet he was able to make long journeys; on the North Galatian theory he went about between Ancyra, Tavium and Pessinus, then proceeded towards Bithynia (or, as some say, Pontus), then went through Mysia to Troas; and all these journeys must have been made very quickly, for no chronological system leaves free a long period for this work. On the South Galatian theory Paul went from Perga to Syrian Antioch, and then to Iconium, etc. These journeys need not have been performed with the speed and exertion implied in the North Galatian theory, but still one of them is very long.
It follows that the disease did not take the form of one single attack of illness. It was intermittent. At one time Paul was prostrated by an attack, at another he was able for considerable exertion, both in travel and in preaching.
Second, the disease was such as to be naturally regarded by the people of Asia Minor with contempt or loathing; but, far from so regarding him, they received him as an angel of God. The verbal contrast is so pointed as to suggest that the disease was one which the people ordinarily regarded as due to the direct action and curse of God. We need not understand that it caused any loathsome external effect; but a sufferer was usually regarded as one under the Divine curse on account of some crime.
Now, the inscriptions show that one disease was regarded in Asia Minor as due to the immediate action of God. These show that, when a native of the country prayed to the god or goddess to avenge him on his enemy, he asked that his enemy should be “burnt up” with fever, “in which strength wastes away without any visible affection of a. part of the body. This kind of disease was understood to be caused by fire sent from the world of death by direct act of the god, which consumed the inner life and spirit of the sufferer.”1 A full description of an attack of fever, with its recurring paroxysms and characteristic symptoms, is given in a late curse: “May he suffer fevers, chill, torments, pallors, sweatings, heats by day and by night”.2
When Paul was among the Galatians, this disease was “the thing that tried them in his body”; it tested the reality of their love for him and their respect for him: it constituted a temptation to regard him as a person cursed by God, But they stood the test; they resisted the temptation; and they regarded him as a messenger come from God.
Every one who is familiar with the effect of the fevers that infest especially the south coasts of Asia Minor, but are found everywhere in the country, knows that they come in recurring attacks, which prostrate the sufferer for the time, and then, after exhausting themselves, pass off, leaving him very weak; that a common remedy familiar to all is change to the higher lands; and that, whenever any one who has once suffered has his strength taxed, physically or mentally, the old enemy prostrates him afresh, and makes him for a time incapable of any work. Apart from the weakness and ague, the most trying and painful accompaniment is severe headache.
Now, the tradition about Paul was, for some reason, far more closely concerned with his personal appearance and physical history than was the case with any other Apostle. This must undoubtedly be due to the immense personal influence that he exerted on Asia Minor, where the tradition had best chance of being preserved owing to the very early general adoption of the new religion in several parts of the country.3 His personal appearance, his age, at conversion and at death, are recorded in Asia Minor tradition, and, as I believe, with trustworthiness. The common opinion, current as early as the second century, was that the extreme physical pain, which he describes elsewhere as “the stake in the flesh,” the accompaniment of his disease, was severe headache. Lightfoot rightly recognises that, if we give any weight at all to ancient opinion, we must follow this statement, which was current in the second century and may confidently be taken as forming part of the unbroken Asia Minor tradition.
In St. Paul the Traveller (p. 97 f.) an argument is founded on the remarkable analogy between the expression used by Paul himself to describe one specially prominent accompaniment of his disease — “a stake in the flesh” — and the words which rise to the lips of several persons known to me, all innocent of Pauline prepossession in describing their own experience of the headache that accompanies each recurrence of chronic malaria fever — “a red-hot bar thrust through the forehead”. In corroboration of this, we may quote the description of “a bad attack of malarial neuralgia,” given by the South African author, A. Werner, on p. 236 of his collection of stories, entitled The Captain of the Locusts, 1899. He speaks of “the grinding, boring pain in one temple, like the dentist’s drill — the phantom wedge driven in between the jaws,” and describes the acuteness of the suffering, in which every minute the patient seems to have “reached the extreme point of human endurance”.
Is it possible to have more convincing analogies than this? A similar metaphor rises to the lips of quite independent persons to describe the sensation. There are perhaps some who may think it wrong procedure to imagine that Paul was really describing with what they might brand as morbid anatomical detail the exact species of pain that he suffered. I think Paul was not so different from the ordinary human being that he must describe his enemy in the flesh only by some general and vague expression. Every one who has to contend often with any special enemy of this kind, if he speaks of it at all, tends to use some phrase about it that reveals his own personal experience. Commonly he is silent about it; but if he is deeply moved, and alludes to it while he is showing his inmost soul under the stimulus of emotion, his expression lights up by a flash the physical fact.
That is the case in 2Co 12:7. There is no passage in all Paul’s writings in which he is more deeply moved. There is no other passage in which he shows so much of his inner mind, or speaks so freely of his private personal experiences. He alludes, among these experiences, to his secret communing with the Divine nature; and he describes the counter-balancing evil at once an extremely painful, almost unendurable, suffering, and a serious impediment to his work. These are the two features about this enemy in the flesh, on which the human being is sure to insist. It is “a stake in the flesh, — a messenger of Satan,” the enemy of the truth.
When we take this striking realistic detail in conjunction with the strong and very old tradition that Paul was in this expression describing the fever-headache, it seems to me that there is an exceedingly strong case, such as one could hardly have expected about such a matter. And this is clinched by the superstition current in Asia Minor that fever was the special weapon hurled by the gods of the underworld against criminals.
The theory that Paul’s disease was epilepsy deserves a word. Appearances are, at first sight, in its favour — the example of Julius Caesar, Napoleon, Cromwell, all epileptics — the fact that the nervous system, when working at its highest pressure, is nearest to breaking down. But if we take epilepsy as Paul’s trial, then we must accept the medical inferences from it. It follows inexorably that his visions were epileptic symptoms, no more real than the dreams of epileptic insanity. In fact, it is the visions which give probability to the theory of epilepsy: as a distinguished pathologist says to me, you will find hundreds of exact parallels to Paul’s visions, if you want them: any lunatic asylum in the country will furnish them in plenty. The nerve-centres of sight and vision are close together, and naturally affected together, when the system is on the point of collapse. The temporary blindness that followed the first vision is exactly what the pathologist expects as the sequel of an epileptic vision.
The theory is seductive. But are we prepared to accept the consequences? Paul’s visions have revolutionised the world. Has the modern world, with all that is best and truest in it, been built upon the dreams of epileptic insanity? Is reason the result of unreason, truth of falsity?
Moreover, we do not find that Caesar or Napoleon attributed their greatness to their epileptic seizures. But Paul did so: he regarded his visions as the crowning glory of his life, the sole source of his knowledge and his power: he distinguished absolutely his visions from the “messenger of Satan, the stake in the flesh”. Now the latter has much less analogy to epileptic seizure. Lightfoot shows conclusively that “the stake in the flesh” must be some “physical pain of a very acute kind”; but pain is not a feature of epileptic fits. The premonitory symptoms, the aura, sometimes include pain; but on the epileptic theory the visions were the aura, and the fit followed.
We cannot take Paul as an epileptic lunatic. The only alternative seems to be to take him as afflicted by those seizures which were regarded as the messengers of the gods of the underworld.
 See Expository Times, Dec, 1898, p. no; comp. WŁnsch in Corp. Inscr. Att., Appendix, p. XII.
 WŁnch, Sethianische Verjluchungstafeln, 1898, p. 7. These were found in Rome; but embody magic of indubitably Oriental type.
 The Phrygian saint of the second century, Avircius Marcellus, travelled “with Paul in his hands”; he mentions no other Apostle or teacher in his epitaph (Cities and Bishoprics of Phrygia, II, p. 722).