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OUP CORRECTED PROOF – FINAL, 22/6/2016, SPi
OXFORD THEOLOGY AND RELIGION MONOGRAPHS
Editorial Committee
J. BARTON M. N. A. BOCKMUEHL
M. J. EDWARDS P. S. FIDDES
G. D. FLOOD S. R. I. FOOT
D. N. J. MACCULLOCH G. WARD
OXFORD THEOLOGY AND RELIGION MONOGRAPHS
Patmos in the Reception History of the Apocalypse

Ian Boxall (2013)
The Theological Vision of Reinhold Niebuhr’s The Irony of American History
“In the Battle and Above It”
Scott R. Erwin (2013)
Heidegger’s Eschatology
Theological Horizons in Martin Heidegger’s Early Work
Judith Wolfe (2013)
Ethics and Biblical Narrative
A Literary and Discourse-Analytical Approach to the Story of Josiah
S. Min Chun (2014)
Hindu Theology in Early Modern South Asia
The Rise of Devotionalism and the Politics of Genealogy
Kiyokazu Okita (2014)
Ricoeur on Moral Religion
A Hermeneutics of Ethical Life
James Carter (2014)
Canon Law and Episcopal Authority
The Canons of Antioch and Serdica
Christopher W. B. Stephens (2015)
Time in the Book of Ecclesiastes
Mette Bundvad (2015)
Bede’s Temple
An Image and its Interpretation
Conor O’Brien (2015)
Defending the Trinity in the Reformed Palatinate
The Elohistae
Benjamin R. Merkle (2015)
The Vision of Didymus the Blind
A Fourth-Century Virtue-Origenism
Grant D. Bayliss (2015)
Angels in Early
Medieval England
RICHARD SOWERBY
1
3
Great Clarendon Street, Oxford, OX2 6DP,
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First Edition published in 2016
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Acknowledgements
The seeds of this book were planted a very long time ago, in an essay about
Bede and Adomnán written during my final year as an undergraduate at the
University of St Andrews. I suspect that Alex Woolf might not have been so
encouraging about that piece of work had he known how long I would be
carrying it around in my head, through the Universities of Oxford and
Cambridge. Much of this book’s evolution in those years was overseen by
Sarah Foot, for whose tireless enthusiasm, careful critique, and patient for-
bearance I remain profoundly grateful. Further support of another kind was
given by the Arts and Humanities Research Council; by a Senior Scholarship
at Christ Church, Oxford; and by a Fellowship at Sidney Sussex College,
Cambridge, endowed by the generosity of John Osborn.
A great number of people have given gladly of their time, expertise, and
unpublished research in answer to all manner of queries, great and small.
Particular thanks go to John Arnold, Graham Barrett, Lisa Colton, Marie
Conn, Katy Cubitt, Helen Foxhall Forbes, Yannis Galanakis, Mary Garrison,
Cristian Gaşpar, Karen Jolly, Anne Kreps, Diarmaid MacCulloch, George
Molyneaux, Ellen Muehlberger, Conor O’Brien, James Palmer, Henry Parkes,
Tom Pickles, Christine Rauer, Tamsin Rowe, Maria Elena Ruggerini, Laura
Sangha, Alan Thacker, Laura Varnam, Benjamin Withers, David Woodman,
and Charles Wright. I am no less indebted to the kindness and good humour
of friends: chief among them Lesley Abrams, Leif Dixon, Phil Dunshea, Renée
Hlozek, John Hudson, Patrick Lantschner, Sarah Mallet, Rosamond McKitterick,
Oliver Pengelley, Ben Pohl, and Andy Woods. But the greatest debt is owed
to my parents, Ann and Steve Sowerby, by whose generosity and love I am
continually humbled; and to Stacey Caldicott, without whom the last few years
would have been much more difficult, and much less fun.
Contents
List of Illustrations ix
Abbreviations and Short Titles xi
Introduction 1
Part I. Past Opinions

1. Filling the Silence of the Bible 17
2. The Meanings of Angels 45
Part II. Unseen Worlds

3. The Changing Fortunes of the Guardian Angel 79
4. The Rules of the Otherworld 110
Part III. Losing Beliefs

5. The Servants of the Saints 149
6. Prayer, Benediction, and the Edges of Beliefs 185
Postscript 220
Bibliography 223
Index 251
List of Illustrations
1. Oxford, Bodleian Library, Junius 11, p. ii 18

© Bodleian Library, University of Oxford.
2. London, British Library, Cotton Claudius B.iv, 2r 43
© The British Library Board.
3. Oxford, Bodleian Library, Junius 11, p. 3 43
© Bodleian Library, University of Oxford.
4. Eyam, Derbyshire: remains of standing cross 51
© Richard Sowerby.
5. Dewsbury, West Yorkshire: fragment of cross arm 53
© Archaeological Services WYAS, photographed by Paul Gwilliam.
6. Otley, West Yorkshire: fragment of cross-shaft 53
© Corpus of Anglo-Saxon Stone Sculpture, photographed by Ken Jukes
and Derek Craig.
7. Halton, Lancashire: fragment of cross-shaft 53
© Corpus of Anglo-Saxon Stone Sculpture, photographed by Ross
Trench-Jellicoe.
8. Halton, Lancashire: fragment of cross-shaft 56
© Corpus of Anglo-Saxon Stone Sculpture, photographed by Ross
Trench-Jellicoe.
9. Basilica of Sant’Apollinare Nuovo, Ravenna: detail of mosaic 56
© Nick Thompson, University of Auckland.
10. London, British Library, Harley 603, 17v and 18r 108
© The British Library Board.
11. Utrecht, Universiteitsbibliotheek, MS 32, 17r 108
© Universiteitsbibliotheek Utrecht.
12. Remains of St Cuthbert’s wooden coffin 198
© Richard Sowerby, after Donald McIntyre, The Coffin of Saint Cuthbert,
ed. Ernst Kitzinger (Oxford, 1960).
Abbreviations and Short Titles
Adomnán, VC Adomnán, Vita S. Columbae, ed. and trans. Alan Orr

Anderson and Marjorie Ogilvie Anderson, Adomnán’s
‘Life of Columba’ (2nd edn., Oxford, 1991)
Ælfric, CH, I Ælfric, Catholic Homilies (first series), ed. Peter
Clemoes, Ælfric’s Catholic Homilies: The First Series
(Oxford, 1997)
Ælfric, CH, II Ælfric, Catholic Homilies (second series), ed. Malcolm
Godden, Ælfric’s Catholic Homilies: The Second Series
(Oxford, 1979)
Ælfric, Supp. Ælfric, Supplementary Homilies, ed. J. C. Pope, Homilies
of Ælfric: A Supplementary Collection, 2 vols. (Oxford,
1967–8)
Ælfwine’s Prayerbook London, British Library, Cotton Titus D.xxvi + xxvii
(Ælfwine’s Prayerbook), ed. Beate Günzel, Ælfwine’s
Prayerbook (London, 1993)
Æthelwulf, DA Æthelwulf, De abbatibus, ed. and trans. Alistair
Campbell, Æthelwulf: De abbatibus (Oxford, 1967)
Alcuin, Ep. Alcuin, Epistolae, ed. Ernst Dümmler, MGH, Epp. IV.2
(Berlin, 1895), 18–48
Aldhelm, CdV Aldhelm, Carmen de uirginitate, ed. Rudolf Ehwald,
MGH, Auct. ant. XV (Berlin, 1913–19), 327–471
ASC Anglo-Saxon Chronicle
A The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 3: MS A, ed. Janet M. Bately (Cambridge, 1986)
B The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 4: MS B, ed. Simon Taylor (Cambridge, 1983)
C The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 5: MS C, ed. Katherine O’Brien O’Keeffe
(Cambridge, 2001)
D The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 6: MS D, ed. G.P. Cubbin (Cambridge, 1996)
E The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 7: MS E, ed. Susan Irvine (Cambridge, 2004)
F The Anglo-Saxon Chronicle: A Collaborative Edition.
Volume 8: MS F, ed. Peter S. Baker (Cambridge, 2000)
ASE Anglo-Saxon England
xii Abbreviations and Short Titles

ASPR The Anglo-Saxon Poetic Records, ed. George P. Krapp
and Elliott van Kirk Dobbie, 6 vols. (New York,
1931–53)
B., VD B., Vita S. Dunstani, ed. and trans. Michael
Winterbottom and Michael Lapidge, The Early Lives of
St Dunstan (Oxford, 2012), 1–109
Bazire–Cross Joyce Bazire and James E. Cross (eds.), Eleven Old
English Rogationtide Homilies (2nd edn., London, 1989)
Bede, HE Bede, Historia ecclesiastica gentis Anglorum, ed. and
trans. Bertram Colgrave and R. A. B. Mynors, Bede’s
Ecclesiastical History of the English People (Oxford,
1969)
Bede, Hom. Bede, Homeliarum euangelii, ed. David Hurst, CCSL
122 (Turnhout, 1960), 1–378
Bede, VCP Bede, Vita S. Cuthberti, ed. and trans. Bertram
Colgrave, Two Lives of Saint Cuthbert: A Life by an
Anonymous Monk of Lindisfarne and Bede’s Prose Life
(Cambridge, 1940)
Blickling Princeton, Scheide Library, MS 71 (The Blickling
Homilies), ed. and trans. Richard J. Kelly, The Blickling
Homilies (London, 2003)
Brodie Pontifical London, British Library, Add. 57337 (The Brodie
Pontifical), ed. Marie A. Conn, ‘The Dunstan and
Brodie (Anderson) Pontificals: an edition and study’,
unpublished Ph.D thesis, University of Notre Dame
(1993), 172–338
Byrhtferth, VO Byrhtferth, Vita S. Oswaldi, ed. and trans. Michael
Lapidge, Byrhtferth of Ramsey: The Lives of St Oswald
and St Ecgwine (Oxford, 2009), 1–203
CASSS Corpus of Anglo-Saxon Stone Sculpture (Oxford,
1984– )
CCCC Corpus Christi College, Cambridge
CCCM Corpus christianorum continuatio mediaeualis
CCSA Corpus christianorum series apocryphorum
CCSL Corpus christianorum series latina
Cerne Cambridge, University Library, Ll.1.10 (The Book of
Cerne), ed. A. B. Kuypers, The Prayer Book of Aedeluald
the Bishop, Commonly Called the Book of Cerne
(Cambridge, 1902)
CSEL Corpus scriptorum ecclesiasticorum latinorum
Die Briefe Die Briefe des heiligen Bonifatius und Lullus,
ed. Michael Tangl, MGH, Epp. sel. I (Berlin, 1955)
Abbreviations and Short Titles xiii

Dunstan Pontifical Paris, Bibliothèque nationale de France, lat. 943 (The
Dunstan Pontifical), ed. Marie A. Conn, ‘The Dunstan
and Brodie (Anderson) Pontificals: an edition and
study’, unpublished Ph.D thesis, University of Notre
Dame (1993), 24–172
Durham Collectar Durham, Cathedral Library, A.IV.19 (The Durham
Collectar): 1r–61r, ed. Alicia Corrêa, The Durham
Collectar (London, 1992); 61r–88v, ed. U. Lindelöf,
Rituale ecclesiae Dunelmensis. The Durham Collectar
(London, 1927)
Egbert Pontifical Paris, Bibliothèque nationale de France, lat. 10575
(The Egbert Pontifical), ed. H. M. J. Banting, Two
Anglo-Saxon Pontificals (London, 1989)
EETS Early English Text Society
EHR English Historical Review
Eighth-Century Gelasian Paris, Bibliothèque nationale de France, lat. 12048 (The
Gellone Sacramentary), ed. A. Dumas, CCSL 159–159A
(Turnhout, 1981)
EME Early Medieval Europe
Fadda A. M. Luiselli Fadda (ed.), Nuove omelie anglosassoni
della rinascenza benedettina (Florence, 1977)
Felix, VG Felix, Vita S. Guthlaci, ed. and trans. Bertram Colgrave,
Felix’s Life of St Guthlac (Cambridge, 1956)
H&S Arthur West Haddan and William Stubbs (eds.),
Councils and Ecclesiastical Documents relating to Great
Britain and Ireland, 3 vols. (Oxford, 1869–78)
Harleian Prayerbook British Library, Harley 7653 (The Harley Fragment),
ed. F. E. Warren, The Antiphonary of Bangor: Part II
(London, 1895), appendix
HBS Henry Bradshaw Society
JEGP Journal of English and Germanic Philology
JML Journal of Medieval Latin
JTS Journal of Theological Studies
Lantfred, Translatio Lantfred, Translatio et miracula S. Swithuni, ed. and
trans. Michael Lapidge, The Cult of St Swithun (Oxford,
2003), 252–333
Leofric Missal A, B, C Oxford, Bodleian Library, Bodley 579 (The Leofric
Missal), ed. Nicholas Orchard, The Leofric Missal,
2 vols. (London, 2002)
LSE Leeds Studies in English
xiv Abbreviations and Short Titles

MGH Monumenta Germaniae Historica
Auct. ant. Auctores antiquissimi
Capit. Capitularia regum Francorum
Capit. episc. Capitularia episcoporum
Epp. Epistolae
Epp. sel. Epistolae selectae
Poetae Poetae Latini medii aevi
SS Scriptores (in folio)
SS rer. Germ. Scriptores rerum Germanicarum in usum scholarum
separatim editi
SS rer. Merov. Scriptores rerum Merovingicarum
Napier Arthur Napier (ed.), Wulfstan. Sammlung der ihm
zugeschriebenen Homilien (Berlin, 1883)
Nunnaminster British Library, Harley 2965 (The Book of
Nunnaminster), ed. Walter de Gray Birch, An Ancient
Manuscript of the Eighth or Ninth Century (London, 1889)
Old Gelasian Vatican, Biblioteca apostolica, cod. reg. 316 + Paris,
Bibliothèque nationale de France, lat. 7193, 41/56 (The
Old Gelasian Sacramentary), ed. Leo Cunibert
Mohlberg, Liber sacramentorum Romanae aeclesiae
ordinis anni circuli (Rome, 1960)
OTP James H. Charlesworth (ed.), The Old Testament
Pseudepigrapha, 2 vols. (London, 1983–5)
P&P Past and Present
PG Patrologia Graeca, ed. J.-P. Migne, 161 vols. (Paris,
1857–66)
PL Patrologia Latina, ed. J.-P. Migne, 221 vols. (Paris,
1844–65)
RegConc Regularis concordia, ed. Lucia Kornexl, Die ‘Regularis
Concordia’ und ihre altenglische Interlinearversion
(Munich, 1993)
Robert Benedictional Rouen, Bibliothèque municipale, Y.7 (369) (The
Benedictional of Archbishop Robert), ed. H. A. Wilson,
The Benedictional of Archbishop Robert (London, 1903)
Robert Missal Rouen, Bibliothèque municipale, Y.6 (274) (The Missal
of Robert of Jumièges), ed. H. A. Wilson, The Missal of
Robert of Jumièges (London, 1896)
Royal Prayerbook British Library, Royal 2.A.xx (The Royal Prayerbook),
ed. A. B. Kuypers, The Prayer Book of Aedeluald the
Bishop, Commonly Called the Book of Cerne
(Cambridge, 1902), appendix
Abbreviations and Short Titles xv

S P. H. Sawyer, Anglo-Saxon Charters: An Annotated List
and Bibliography (London, 1968); unless otherwise
stated, charters are cited from the Electronic Sawyer,
<http://esawyer.org.uk>
Stephen, VW Stephen, Vita S. Wilfridi, ed. and trans. Bertram
Colgrave, The Life of Bishop Wilfrid by Eddius
Stephanus (Cambridge, 1927)
Supplement Supplementum Anianense, ed. Jean Deshusses,
La sacramentaire grégorien, 3 vols. (Freiburg, 1971–82),
i. 349–605
VCA Vita S. Cuthberti auctore anonymo, ed. and trans.
Bertram Colgrave, Two Lives of Saint Cuthbert: A Life
by an Anonymous Monk of Lindisfarne and Bede’s Prose
Life (Cambridge, 1940), 59–139
Vercelli Vercelli, Biblioteca Capitolare, CXVII (The Vercelli
Homilies), ed. D. G. Scragg, The Vercelli Homilies and
Related Texts (Oxford, 1992)
Winchcombe Sacramentary Orléans, Bibliothèque municipale 127 [105] (The
Winchcombe Sacramentary), ed. Anselme Davril, The
Winchcombe Sacramentary (London, 1995)
Wulfstan, Hom. Wulfstan, Homilies, ed. Dorothy Bethurum, The
Homilies of Wulfstan (Oxford, 1957)
Wulfstan of Winchester, Wulfstan of Winchester, Narratio metrica de
Narratio S. Swithuno, ed. and trans. Michael Lapidge, The Cult of
St Swithun (Oxford, 2003), 372–551
Wulfstan of Winchester, Wulfstan of Winchester, Vita S. Æthelwoldi, ed. and
VÆthel trans. Michael Lapidge and Michael Winterbottom,
Wulfstan of Winchester: The Life of St Æthelwold
(Oxford, 1991)
Introduction
Searching for an appropriate image to sum up the Anglo-Saxon past in

the first decades after the Norman Conquest, an unnamed author sought
to conjure a sense of a golden age irrevocably lost. He struggled at first
for words—‘What shall I say about England? What shall I tell future
generations?’—before finally offering his lament for the present age. It went as
follows:
Woe unto you, England, you who once shone forth with holy, angelic offspring,
but who now groans mightily with worry for your sins.1
Fleeting though this eulogy for pre-Conquest England was, the Anglo-Saxons
themselves would have thought its choice of imagery apt. When they had
considered their own history, they too had found it studded with angels. They
had believed that the occasional visitations of heavenly beings had played a
direct role in bringing the early Anglo-Saxon kingdoms to Christianity, and that
a steady stream of supernatural messengers had continued to take an interest in
the affairs of the English ever since. From the end of the sixth century until the
middle of the eleventh, Anglo-Saxon Christians dedicated churches to angels
and adorned others with their image, speculated about their nature and their
origins, prayed for their assistance, and anticipated a future world in which they
would live alongside them in deathless eternity. Early medieval England in fact
produced such a volume of material relating to these immaterial spirits that it
would be possible, if one were so inclined, to string it together as a narrative,
starting with the Northumbrian slave-boys whose faces were allegedly so angelic
that a pope determined to convert their countrymen, and ending with the
Norman fleet which landed in Sussex just as the churches of England were
preparing to offer their annual prayers to the archangel Michael.2
1
Vita Ædwardi regis, II.7, ed. Frank Barlow, The Life of King Edward who Rests at Westminster,
attributed to a Monk of Saint-Bertin (2nd edn., Oxford, 1992), 108.
2
The sources disagree about whether Duke William’s forces landed on Michaelmas or
Michaelmas Eve: see Marjorie Chibnall, The Ecclesiastical History of Orderic Vitalis, 6 vols.
(Oxford, 1968–80), ii. 170–1, n. 2. For Pope Gregory and the Northumbrian slave-boys, see later
in this Introduction.
2 Angels in Early Medieval England

A book which sought to produce that kind of narrative might succeed in
drawing attention to a few lesser-known aspects of early medieval storytelling,
but would only reinforce old impressions that these ideas occupied some
quaint and esoteric corner of a superstitious Middle Ages. It is instead the
aim of this book to find a way to use the Anglo-Saxons’ apparent fascination
with angels to reveal something about their social ideals, their religious culture,
and their mental picture of the world.
The notion of taking seemingly arcane ideas about the supernatural, the
otherworldly, and the imaginary, and using them as lenses with which to
examine the society in which they evolved, is no longer an unusual one. In
place of the regret once voiced by scholars, that so many ancient and medieval
authors were prevented from commenting fully on the serious matters of their
day by their taste for writing about the mysterious and the fantastical, there is
now a greater awareness of the potential for using such preoccupations to
uncover alternative—but complementary—insights into past societies. Anglo-
Saxon England, indeed, has always been a productive focus for this kind of
study, due in large part to the draw of the demon-stalked landscape at the
heart of the poem Beowulf, as well as the variety of legendary material related
to the saints and their miracles. It is now possible to turn to the Anglo-Saxons’
writings about elves in order to reconstruct their ideas about gender and
medicine, to find their ecclesiastical politics buried within accounts of marvels
worked at saints’ shrines, and to see stories about the wandering dead used in
conjunction with the archaeological remains of their society.3
Examining the mental picture of the universe which early medieval men
and women carried around in their heads has undoubtedly proved rewarding.
Where the evidence permits us to come close to seeing the world as they did, it
has frequently helped us to make sense of their actions, their outlook, and their
societies. All too often, however, their thoughts remained their own. Every
now and then, one or two particularly garrulous men and women might leave
us some unusually full account of their beliefs, but such individuals are always
few in number. Not only does this have the effect of reducing our source
material to a handful of potentially unrepresentative opinions, it also inhibits
our ability to see early medieval beliefs as dynamic and changeable, subject to
3
The literature here is vast, and the following works represent only some of the fullest self-
contained discussions. For Beowulf, see esp. Andy Orchard, Pride and Prodigies: Studies in the
Monsters of the Beowulf-Manuscript (Cambridge, 1993). For elves: Alaric Hall, Elves in Anglo-
Saxon England: Matters of Belief, Health, Gender and Identity (Woodbridge, 2007). For saints’
cults: David Rollason, Saints and Relics in Anglo-Saxon England (Oxford, 1989); and Alan
Thacker and Richard Sharpe (eds.), Local Saints and Local Churches in the Early Medieval
West (Oxford, 2002). For the wandering dead: John Blair, ‘The dangerous dead in early medieval
England’, in Stephen Baxter et al. (eds.), Early Medieval Studies in Memory of Patrick Wormald
(Farnham, 2009), 539–59. A holistic consideration of many of these separate strands is offered by
Helen Foxhall Forbes, Heaven and Earth in Anglo-Saxon England: Theology and Society in an
Age of Faith (Farnham, 2013).
Introduction 3
reinterpretation by successive generations. A single document preserves a
single iteration of an idea, suspended as if in amber, but seldom gives any
sense of how much it resembled or differed from earlier versions of that same
idea. Does a twelfth-century Anglo-Norman ghost story, for instance, express
a view of the world which would have been recognizable to, say, a seventh-
century Anglo-Saxon Christian? Presumably the answer is: in some ways, but
not in others. It can nevertheless be difficult to say more about how and why
such ideas might have changed over time if our body of source material is
discontinuous. And for the ideas and beliefs of Anglo-Saxon England at least,
discontinuous sources are indeed a major problem. They hamper not only our
sense of beliefs which lay outside the Christian mainstream, the evidence for
which is notoriously fragmentary, but also even our understanding of com-
paratively well-attested religious phenomena like the cult of saints, since the
great majority of our sources about the veneration of the holy dead is confined
either to first three decades of the eighth century or to the final quarter of
the tenth.
Angels, on the other hand, appear to have received more or less constant
attention from the thinkers, writers, and artists of Anglo-Saxon England after
c.700 CE. Celestial beings reappear time and again in the earliest hagiographies
of the eighth century, in the letters of insular writers sending word from the
Carolingian empire, in the prayerbooks of the ninth century and the sermons
of the tenth, as well as in manuscript decoration completed on the eve of the
Norman Conquest. Their recurring presence in almost all the surviving traces
of Anglo-Saxon culture means that this is above all a book about change. It
traces one particular collection of beliefs as they shifted and developed over
time, in ways perhaps barely registered by contemporaries, yet in ways which
remodelled their own sense of the world they inhabited. For this was a period
which experienced profound changes in other respects: changes of political
allegiance, as the early Anglo-Saxon kingdoms were brought under the control
of an overarching ‘English kingdom’; of social organization, in tandem with
the growth of towns and urban markets; and of ecclesiastical provision, as the
character and structure of religious institutions underwent gradual transform-
ation.4 It is easy to suspect that the mental world experienced similar trans-
formations over this same long period, but often difficult to say more about
how and why. This book aims to do just that, and to show how this single
strand of early medieval thought connects with and illuminates other aspects
of the religious imagination in Anglo-Saxon England.
4
The best points of entry into each of these issues are now: George Molyneaux, The
Formation of the English Kingdom in the Tenth Century (Oxford, 2015); D. M. Palliser (ed.),
The Cambridge Urban History of Britain. Vol. I: 600–1540 (Cambridge, 2008), 25–270; John
Blair, The Church in Anglo-Saxon Society (Oxford, 2005).

The prospect of using Anglo-Saxon beliefs about angels in this way, as a
prism through which to study broader changes in contemporary society, might
initially seem limited. Faced with images of winged beings carved upon stone
monuments from the Anglo-Saxon past, like the extraordinarily well-preserved
angel found in excavations at Lichfield in 2003, the modern viewer could be
forgiven for seeing little that was distinctive to the early Middle Ages and to
early medieval thought. Visitors to the Lichfield Angel’s glass case in the city’s
cathedral might be struck by its similarity to artistic models from Late
Antiquity, or note that the arrangement of curled hair derives from still
older, Hellenistic traditions; or they might observe that the angel was originally
only the left-hand side of a larger panel, and speculate that the lost right-hand
piece once contained an image of the Virgin Mary, thereby putting them in
mind of other representations of the Annunciation familiar from later medieval
and early modern art. Like many other artistic representations of angels, the
Lichfield Angel appears caught between two worlds—between the creativity of
Christianity’s early centuries, which first generated the familiar image of
winged angels clad in flowing robes, and the definitive expression of that
image during the Renaissance.5 Any distinctively early medieval contribution
to that long tradition seems difficult to discern, or confined to the level of
fleeting, ultimately inconsequential, details. A contemporary piece of theo-
logical writing might provoke the same response when an ostensibly detailed
discussion of angels in an Anglo-Saxon sermon or biblical commentary is
revealed, upon closer inspection, to be nothing more than an assemblage of
recycled phrases culled from the pages of Augustine of Hippo, Gregory the
Great, or Isidore of Seville. This ‘slavish adherence to earlier authorities’ which
has been observed in more than one theological tract from the early Middle
Ages might only dissuade us further from trying to find evidence of innovation
in such a well-worn part of medieval Christian teaching.6
Anglo-Saxon intellectuals would hardly have sought to detract from this
impression, either. Looking back through their scriptures, which gave abun-
dant though somewhat disconnected evidence about the nature of angels, and
through the writings of the Church Fathers, which attempted to impose order
on those biblical hints, medieval Christians saw little that still required original
interpretation. They were of the opinion that, although thinking about angels
had once involved the careful assembly of enigmatic scriptural statements, this
was no longer necessary. Instead, they surveyed the development of Christian
5
On the development of a distinctive iconography for angels in Late Antiquity, see Federica
Pirani, ‘Quando agli angeli spuntarono le ali?’, in Serena Ensoli and Eugenio La Rocca (eds.),
Aurea Roma. Dalla città pagana alla città cristiana (Rome, 2000), 389–94. On the Lichfield Angel
itself, see Warwick Rodwell et al., ‘The Lichfield Angel: a spectacular Anglo-Saxon painted
sculpture’, Antiquaries Journal 88 (2008), 48–108.
6
The opinion is that of M. L. W. Laistner, ‘A ninth-century commentator on the Gospel
according to Matthew’, Harvard Theological Review 20 (1927), 129–49, at 129.
Introduction 5
thought about angels with an air of confidence in a task which was now
complete, singling out key figures who had resolved scripture’s deepest mys-
teries. In the Northumbrian monastery of Whitby, one early eighth-century
hagiographer emphasized the contribution of Gregory the Great (d. 604), the
revered pope who is now remembered chiefly for having launched a mission to
convert the early Anglo-Saxons:
Gregory dealt with their orders—the orders of the [angelic] hosts, that is—with
an ingenuity that we have never found in any other saint before or since. Even
St Augustine, a man sound in faith and pure of life, from whose belly flow rivers
of living water, said about them: ‘I confess that I know nothing about these
things.’ But not only did Gregory divide them up in their hosts, basing everything
on holy scriptures, he also drew out the commonalities to our way of life, with
that clean heart by which only the blessed shall see God.7
This sense of living in an age in which even the invisible organization of
the heavens had been laid bare in the pages of patristic theology seems to reject
any notion that the Anglo-Saxons—or any other early medieval Christians—
could hold their own views, different from both what had come before and
what was to follow. The sight of medieval writers expressing their complete
indebtedness to past authorities gave cheer to some twentieth-century scholars
too, who sought to uphold the sound doctrine of pre-modern believers by
pointing to those occasions when they had found the shape of Christian
teaching about angels to be at its ‘most constant and solid’.8
But in truth, patristic footsteps only led so far. Even those who followed the
trail left by Pope Gregory the Great, whose contribution had been applauded
in eighth-century Northumbria, would soon find that the opinions of the
Church Fathers did not provide comprehensive guidance for every aspect of
this invisible world of spirits. Someone who was interested in other theological
questions could often rely upon enormous and influential works of sustained
exegesis: the nine homilies on Creation penned by Ambrose of Milan, the
twenty-two books written by Augustine about the City of God, or the massive
exegetical project undertaken in Gregory’s own thirty-two-volume Moralia in
Iob. On the subject of angels, however, the professional religious in the Latin
West relied first and foremost on a single sermon, first delivered by Gregory to
a congregation in Rome in the year 591.9 There, in the course of an exposition
7
Liber beatae Gregorii papae, ch. 25, ed. Bertram Colgrave, The Earliest Life of Gregory the
Great by an Anonymous Monk of Whitby (Cambridge, 1968), 118–20. The words attributed to
Augustine echo the sentiments of De ciuitate Dei (XV.1), Enchiridion (ch. 58), and De trinitate
(III.iii.5), but are not an exact quotation.
8
Jean Daniélou, Les Anges et leur mission d’après les Pères de l’Église (Paris, 1951), 93. Cf. also
Erik Peterson, Das Buch von den Engeln. Stellung und Bedeutung der heiligen Engel im Kultus
(Leipzig, 1935).
9
Gregory, Homeliae in euangelia, XXXIV, ed. Raymond Étaix, Gregorius Magnus: Homiliae
in evangelia, CCSL 141 (Turnhout, 1999), 299–319.

on two parables from the gospel of Luke, the pope sketched for his audience
the intricate workings of an unseen world. He described an ascending
sequence of angelic orders, spanning the divide between humankind and the
Creator. The names of these orders could be found scattered through the Old
and New Testaments, and there were nine in total: angels, archangels, virtues,
powers, principalities, dominations, thrones, cherubim, and seraphim. The
titles indicated that each rank fulfilled its own distinct function, and implied
that the nine hosts were arranged hierarchically, from the lower angels and
archangels who brought messages to humanity, to the higher cherubim and
seraphim who offered incomparable worship to God by virtue of their
eternal closeness to him. Although Gregory noted apologetically that, ‘in
unveiling the secrets of the heavenly citizens, I have digressed far from my
proper subject’, his digression swiftly became embedded in the intellectual
fabric of early medieval Christendom. The literate studied his words, or
made use of the encyclopedic summary of them in the widely read Etymo-
logiae (‘Etymologies’) written by Isidore, bishop of Seville (d. 636).10 What
they found they pressed into service in their own sermons and liturgies.11
Passing references to ‘nine orders of angels’ were soon to be found in
everything from private prayers to judicial formulae—so much so that
when one monk from Ramsey sat down to list the exegetical significance of
numbers at the turn of the eleventh century, the number nine suggested to
him only angelic meanings.12
Gregory’s explanation of the angelic hosts had clearly proved revelatory. His
Northumbrian devotee from early eighth-century Whitby (either a monk or a
nun of that institution, given that the monastery housed both male and female
inmates) in fact held up Gregory’s exposition as proof that the pope had
gained his knowledge by revelation, thereby showing him to be the equal of
St Peter and of the prophet Ezekiel before him.13 In reality, Gregory had drawn
10
Isidore, Etymologiae, VII.5, ed. W. M. Lindsay, Isidori Hispalensis episcopi etymologiarum
sive originum libri XX, 2 vols. (Oxford, 1911).
11
A litany in a Breton psalter of c.900 does contain an additional rank of ‘seats’ (sedes)
alongside the usual nine, but this in fact only confirms a general dependency on the Etymologiae.
It derives from a misreading of Isidore’s statement that ‘throni sunt agmina angelorum, qui
Latino eloquio sedes dicuntur’, by a compiler who was intent on listing as many heavenly
intercessors as possible: Salisbury, Cathedral Library 180, 170r, ed. Michael Lapidge, Anglo-
Saxon Litanies of the Saints (London, 1991), 288 [no. 44].
12
Byrhtferth, Enchiridion, IV.1, ed. Peter S. Baker and Michael Lapidge, Byrhtferth’s ‘Enchir-
idion’ (Oxford, 1995), 212–14. A rare invocation of ‘XX ordines angelorum’, found in an
adjuration against toothache in an Anglo-Saxon medical manuscript, is a simple scribal error,
for later versions of the same formula give the more usual nine: see Lacnunga, 183v–184r, ed.
Edward Pettit, Anglo-Saxon Remedies, Charms, and Prayers from British Library MS Harley 585:
The Lacnunga, 2 vols. (Lewiston, NY, 2001), i. 108 [no. 158].
13
Liber beatae Gregorii, ch. 27 (ed. Colgrave, p. 122). For the text’s creation and audience
within a double monastic context, see esp. Diane Watt, ‘The earliest women’s writing? Anglo-
Saxon literary cultures and communities’, Women’s Writing 20 (2013), 537–54, at 545–50.
Introduction 7
heavily upon the writings of a man whom he took to be Dionysius the
Areopagite (a convert of St Paul’s briefly mentioned in the book of Acts),
but who is now known to have been a Neoplatonic writer based, in all
likelihood, in Syria around 500 CE.14 One of the treatises written by this
pseudo-Dionysius was entitled The Celestial Hierarchy, an audacious piece
of mystical theology based around an explanation of the angelic society, and it
was from this that Gregory had derived much of his understanding of the nine
orders of angels.15 Quite how Gregory came to know the works of pseudo-
Dionysius is unclear, given that he had elsewhere professed his ignorance of
Greek.16 But since pseudo-Dionysius’ Celestial Hierarchy would remain un-
known in the West until the ninth century, when it was made more widely
available in Latin translations, Pope Gregory’s homily was for many centuries
the only sustained treatment of angels available in early medieval Europe.17
Early medieval Europe produced nothing to rival pseudo-Dionysius’ Celes-
tial Hierarchy, nor even anything to rival Gregory’s much-simplified rework-
ing of pseudo-Dionysus’s theology in his sermon on Luke. Only after the
thirteenth century would medieval theologians begin to write their own
sustained discourses about angels, and it has often seemed, as a result, that
there is nothing more to say about the place of angels in the religious
imagination of the early Middle Ages. But it would be a mistake to take that
as a sign of an inactive age, populated by intellectuals who were content simply
to repeat the judgements of previous thinkers. To do so is to ignore indications
from other quarters that early medieval imaginations were still actively grap-
pling with the subject of invisible beings.
Take, for instance, the basic issue of what an angel was and how one might
recognize it if it appeared before one’s eyes. A good grounding in patristic
theology would equip an early medieval intellectual with the knowledge that it
was technically incorrect to talk about ‘angels’ as if they were a particular kind
of being. The Latin word angelus (like the Greek angelos from which it derived)
meant simply ‘messenger’, and so denoted their function rather than their
14
On the author and his works, see variously: see Andrew Louth, Denys the Areopagite
(London, 1989); Paul Rorem, Pseudo-Dionysius: A Commentary on the Texts and an Introduc-
tion to their Influence (Oxford, 1993); Rosemary A. Arthur, Pseudo-Dionysius as Polemicist: The
Development and Purpose of the Angelic Hierarchy in Sixth Century Syria (Aldershot, 2008).
15
Pseudo-Dionysius, The Celestial Hierarchy, ed. Günter Heil and Adolf Martin Ritter,
Corpus Dionysiacum II (Berlin, 1991).
16
For Gregory’s knowledge of Greek, with particular reference to the Celestial Hierarchy, see
Joan M. Petersen, ‘Homo omnino Latinus? The theological and cultural background of Pope
Gregory the Great’, Speculum 62 (1987), 529–51, esp. at 530–42.
17
P. G. Théry, Études dionysiennes. Hilduin, traducteur de Denys, 2 vols. (Paris, 1932–7);
Iohannis Scoti Eriugenae Expositiones in ierarchiam coelestem, ed. J. Barbet, CCCM 31 (Turn-
hout, 1975). See further Paul Rorem, Eriugena’s Commentary on the Dionysian Celestial Hier-
archy (Toronto, 2005).

nature.18 They themselves were spirits, and therefore immaterial, adopting a
visible form only when they had to appear before humans, who were otherwise
unable to see them in their natural state. The learned were in broad agreement
on this point, and observations along similar lines would issue easily from the
pens of sermon-writers and biblical commentators for centuries to come.19
Alongside this consensus about the general theory, however, could be found
a quite considerable range of opinion about the details of precisely how the
spirits chose to manifest themselves. There were stories of angels attending
the dead and the dying in the guise of beautiful robed men in one place, or in
the form of brightly coloured songbirds in another.20 There were storytellers
convinced that, no matter what shape a spirit took, its heavenly origin and
nature would be clearly revealed by the unnatural light which encased its body;
while still others not only supposed that angels could hide such obvious signs
if they chose, but even held that they could adopt the faces and manners of
living human beings, so that one might never be quite sure if one were
speaking with the person themselves or only with a spirit who had briefly
taken their shape.21 While some of these ideas might strike us as more novel or
interesting than others, it is their contemporaneity which I wish to emphasize
here. My preceding examples have all been drawn from a single early medieval
polity—from the Anglo-Saxon kingdom of Northumbria—and from docu-
ments separated by no more than a few decades of each other. While one could
certainly widen the net to find still more disparate ideas from across medieval
Christendom, to do so would be to miss the significance of this variety of
opinion. The surprising fact is not that such variety existed, but that early
medieval Northumbrians appear not to have recognized it. They spoke of
things being ‘angelic’ in appearance and assumed that their meaning would be
transparent, as if the word called to mind a specific set of characteristics which
all Christians might share. There was, for instance, a story told in the north
18
The eventually commonplace observation seems to have begun with Augustine: Enarra-
tiones in psalmos, CIII.i.15, ed. Franco Gori, CSEL 95, 5 vols. (Vienna, 2001–11), i. 131–2;
Sermones de uetere testamento, VII.3, ed. Cyrille Lambot, CCSL 41 (Turnhout, 1961), 72. Cf. also
Gregory, Hom. in euang., XXXIV (ed. Adriaen, p. 306); Isidore, Etym., VII.5 (ed. Lindsay);
Isidore, Sententiae, I.10, ed. Pierre Cazier, CCSL 111 (Turnhout, 1998), 29–38.
19
See Glenn Peers, Subtle Bodies: Representing Angels in Byzantium (Berkeley, 2001),
esp. 1–4, 107–8.
20
Compare, for instance, Bede, HE, IV.11 and V.12 (ed. Colgrave and Mynors, pp. 366 and
488–96), with Æthelwulf, DA, chs. 8 and 18 (ed. Campbell, pp. 20–2 and 46). Although angelic
birds have sometimes been taken to reflect distinctively Irish influence, inspiration may also have
come from Jerome’s commentary on Ecclesiastes, which refers to ‘angels in the likeness of birds
which bear our words and our thoughts of heaven’: Commentarius in Ecclesiasten, X.20, ed.
Marcus Adriaen, CCSL 72 (Turnhout, 1959), 344.
21
For shining light: Alcuin, VdP, ll. 1607–48 (ed. Godman, pp. 130–2). For angels taking the
shape of specific individuals, see later in this Introduction; and cf. also Einhard, Translatio et
miracula sanctorum Marcellini et Petri, III.13, ed. Georg Waitz, MGH, SS XV.1 (Hanover, 1887),
252–3.
Introduction 9
about a group of young pagan Northumbrians who had ended up in the city of
Rome, where they were seen by the soon-to-be Pope Gregory the Great. The
tale explained that Gregory had become transfixed by these youths, struck by
the exceptional whiteness and beauty of their faces and hair, and that he had
found it highly significant that these men called themselves ‘Angles’, for they
were, he said, like the angels of God. These words were said to have prefigured
future events, for in 597 papal missionaries would land in Kent, bearing
instructions from Gregory to convert the English kingdoms to Christianity.
It was a convenient and flattering story, and attempts have occasionally been
made to find a kernel of historical truth within it.22 Yet there was one detail
which marred the tale, and which the Northumbrians who told it were hardly
in a position to notice. They saw nothing strange about the fact that Gregory
should associate young men with pale faces and paler hair with the angels of
God, and these were indeed attributes frequently given to angels by many
seventh- and eighth-century English and Irish Christians. Italian artists
from Gregory’s own day, however, supposed instead that God’s messengers
would naturally carry Mediterranean features if they took human form, and
consistently presented them with darker hair and complexions. This was a
trivial discrepancy, but a revealing one. The Anglo-Saxons who told the tale
remained utterly unaware that their own sense of the angelic might not be
shared by all.
It is curious that this should be so, given the real diversity of opinion about
angels and angelic bodies which could exist, as we just have seen, within the
borders of even a single early medieval kingdom. Yet when faced with ideas
that ran counter to their own, our early Anglo-Saxon writers gave every
impression that they sought to reject the beliefs of others rather than to
rethink their own. The anonymous hagiographer from Whitby whose Life in
praise of Pope Gregory we have already met, was one such individual whose
understanding of angels came to be rejected in this way. Appended to the
Whitby Life’s account of Gregory’s meeting with the Northumbrian youths are
a series of stories about the pope’s missionary Paulinus, and his role in the
conversion of the north. One was a strange tale about an encounter between
Edwin, the exiled pagan king of Northumbria, and a mysterious visitor who
forewarned the king about the approaching missionary and the powerful god
to whom Paulinus was devoted. This the visitor did by taking on Paulinus’
physical appearance, and instructing the king ‘to obey the man who first
appears to you in this form (cum hac specie)’.23 Among the first readers of
the Whitby Life of Gregory was the monastic scholar Bede (d. 735), who retold
the story in his own Historia ecclesiastica gentis Anglorum (‘The Ecclesiastical
22
For such efforts, see Michael Richter, ‘Bede’s Angli: Angles or English?’, Peritia 3 (1984), 99–114.
23
Liber beatae Gregorii, ch. 16 (ed. Colgrave, p. 100). It is the hagiographer who supplies the
information that ‘it is said to have been Bishop Paulinus who first appeared to him in that form’.

History of the English People’).24 Bede was happy to accept that the sudden
appearance of strange men offering instructions about the service of ‘the one
true living God who created all things’ surely identified them as God’s spiritual
messengers rather than earthly creatures of flesh and blood, and his retelling
did not hesitate to observe that ‘this was not a man but a spirit who had
appeared before the king’. But all references to the ability of spirits to clothe
themselves in the bodily forms of particular, living individuals were quietly put
aside. Something about that notion had evidently troubled Bede, although an
Ecclesiastical History was clearly no place to deal with these concerns at
length. Dismissing what he considered to be the story’s problematic features,
Bede reassembled the rest into a form that seemed to him ‘much more
probable’ (ut uerisimile uidetur), until there was little that remained to distin-
guish King Edwin’s mysterious visitor from any of the other divine messengers
who appeared now and then in the pages of his historical works.
Seeing Anglo-Saxon ecclesiastics disagreeing about the mechanics of heav-
enly apparitions puts the modern reader in mind of the old joke about
medieval intellectuals arguing over the number of angels which could dance
on the head of a pin.25 Nothing could seem further from the concerns of the
‘real world’ in which such people lived. And yet, in the way that these
seemingly inconsequential beliefs were presented, we can see something of
that real world. They give us a glimpse of a landscape made up of somewhat
unconnected communities of thought, each holding beliefs which they took to
be universal, and yet which were often quite distinct from those of their
neighbours. The degree to which our individual writers seem unaware of the
real variety of contemporary opinion, seen in the ease with which they could
dismiss divergent views as erroneous rather than endemic, is perhaps suggest-
ive of a period of time in which local communities still remained in indirect
and occasional contact with others. If so, it was not to last. Before long, Anglo-
Saxon writers began to speak with a more consistent voice and draw from a
shared religious imagination. By at least the middle of the tenth century,
stories about angels taking physical form to intervene in human affairs
spoke only about anonymous men of radiant whiteness, with little of the
variety which once characterized such tales.26 It was perhaps the mark of an
24
Bede, HE, II.12 (ed. Colgrave and Mynors, pp. 174–83). While it has not always been
accepted that Bede knew the Whitby Life directly, I follow Alan Thacker’s reasons for thinking it
likely that he did: ‘Memorializing Gregory the Great: the origin and transmission of a papal cult
in the seventh and early eighth centuries’, EME 8 (1998), 59–84, at 69–70.
25
For the joke, see Robert Bartlett, The Natural and the Supernatural in the Middle Ages
(Cambridge, 2008), 73–5.
26
Cf. Lantfred, Translatio, chs. 2 and 35 (ed. Lapidge, pp. 266–70); B., VD, chs. 29–30 (ed.
Winterbottom and Lapidge, pp. 86–90). Ælfric tended to remark that angels appeared ‘shining
with light’ even when it jarred with the story he was telling, as it often did when he was
paraphrasing biblical tales about angels being mistaken for ordinary mortal men: see e.g.
Supp., XIII (ed. Pope, p. 593).
Introduction 11
increasingly homogenized religious culture, a sign that certain sets of ideas were
managing to achieve a monopoly over others. Caught within this outwardly
esoteric matter of angels and their bodies, in short, are small indications of the
way that one particular society was undergoing change.
Observations of a similar kind could easily be made for other clusters of
beliefs held in any part of early medieval Christendom, and my brief sketch
of changing ideas in a changing world may stand for a more general process in
which the religious inheritance of Christian antiquity underwent gradual
evolution during the early Middle Ages. By drawing attention to a particular
bundle of ideas about angels in the way that I have just done, I do not wish to
imply that these alone proved ripe for reconceptualization in ways that other
parts of the Christian tradition were not; and nor is my focus on only a
single part of the early medieval West intended to suggest that the Anglo-
Saxons were unique in the way that they handled their beliefs about angels and
the supernatural. This book in fact joins a small collection of other historical
studies which have begun to use angels as a way to talk about topics as various
as religious diversity in the late Roman world, the emergence of Christian
asceticism, the issues of representation and veneration contested in Byzantium
during the iconoclast era, and the new confessional identities forged in
Europe during the Reformation.27 Each has found it productive to pursue
these quite distinct enquiries by paying close attention to the ways in which
particular societies thought about angels, because of the way that the subject
raised fundamental questions about issues like free will, goodness, divine
foreknowledge, and life and death. This was as true in the medieval West as
it was elsewhere, but here scholars have been rather less interested in exploring
how ideas about angels responded to the intellectual currents of particular
times and places. It is perhaps the discontinuous nature of the historical record
which has encouraged scholars to write more impressionistically about the
ways that angels were understood during the Middle Ages, and which has led
them to give particular emphasis to the works of major patristic and scholastic
theologians, who gave the subject the most systematic discussion.28 But to skip
27
Peers, Subtle Bodies; Conrad Leyser, ‘Angels, monks, and demons in the early medieval
West’, in Richard Gameson and Henrietta Leyser (eds.), Belief and Culture in the Middle Ages:
Studies Presented to Henry Mayr-Harting (Oxford, 2001), 9–22; Peter Marshall and Alexandra
Walsham (eds.), Angels in the Early Modern World (Cambridge, 2006); Feisal G. Mohamed, In the
Anteroom of Divinity: The Reformation of the Angels from Colet to Milton (Toronto, 2008); Joad
Raymond, Milton’s Angels: The Early Modern Imagination (Oxford, 2010); Alexandra Walsham,
‘Invisible helpers: angelic intervention in post-Reformation England’, P&P 208 (2010), 77–130;
Rangar Cline, Ancient Angels: Conceptualizing Angeloi in the Roman Empire (Leiden, 2011); Joad
Raymond (ed.), Conversations with Angels: Essays towards a History of Spiritual Communication,
1100–1700 (Basingstoke, 2011); Laura Sangha, Angels and Belief in England, 1480–1700 (London,
2012); Ellen Muehlberger, Angels in Late Ancient Christianity (Oxford, 2013).
28
David Keck, Angels and Angelology in the Middle Ages (Oxford, 1998); Richard F. Johnson,
Saint Michael the Archangel in Medieval English Legend (Woodbridge, 2005); Meredith J. Gill,

over the period between the seventh century and the eleventh is a mistake, for
it was during those very centuries that many of the seemingly commonplace
beliefs about angels in the Christian tradition underwent slow but fundamen-
tal transformation. Understanding how and why this was so is the real object
of this book; and while one could readily find evidence of change from every
quarter of early medieval Europe, it has seemed better to follow the process of
cultural development of one relatively discrete region than to use an eclectic
range of unconnected evidence drawn from a much wider area. The choice of
Anglo-Saxon England is, in that sense, more or less arbitrary, and might at
first appear too narrow a frame of reference to explore changes which were
occurring throughout medieval Christendom. But when one finds within that
single region eight-foot stone sculptures covered in winged figures, collections
of prayers seeking the aid of strange archangels for a good harvest, and
sermons drawing on apocryphal traditions from ancient Judaism and patristic
theology alike, then the potential of using Anglo-Saxon beliefs as an entry-
point into a much larger world of medieval imagination seems rather more
promising after all.
The argument of this book proceeds in three stages. The first begins in the
pages of patristic theology, and explores the way that the ideas of the Church
Fathers spiralled off in new and varied directions during the early Middle
Ages. Finding that the religious imagination of Anglo-Saxon England was by
no means as unchangingly traditional as we often imagine, the second part of
the book reconstructs the Anglo-Saxons’ own ideas about the world which they
thought they shared with invisible spirits. It points in particular to a gradual
process of diminution, by which Anglo-Saxon Christians grew increasingly
unwilling to ascribe to angels the powers which previous generations had
once believed them to possess. The final part of this book asks why this might
have been, and considers the dwindling importance of angels within the context
of other trends and developments which were transforming the religious culture
of Anglo-Saxon England.
To focus as I have upon change inevitably means that some themes which
were undoubtedly important for the Anglo-Saxons themselves, but which
show little or no evidence of significant historical development, are noticeably
absent from this investigation. The Anglo-Saxon artist from Lichfield who had
laboured over his sculpture of the archangel Gabriel, for instance, would
certainly have expected any book about angels to include a detailed consider-
ation of the story of the Annunciation with which the gospels began. Such
Angels and the Order of Heaven in Medieval and Renaissance Italy (Cambridge, 2014). More
compelling is the published text of an inaugural lecture given by Henry Mayr-Harting in 1997,
but the constraints of the occasion place understandable limits on the discussion: Perceptions of
Angels in History (Oxford, 1998); repr. in Henry Mayr-Harting, Religion and Society in the
Medieval West, 600–1200: Selected Papers (Farnham, 2010), no. VII.
Another random document with
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Neuralgic attacks are usually characterized, besides the pain, by a
highly-interesting series of symptoms, which are in part transitory
and functional, and in part due to structural changes in the tissues.4
4 See Notta, Arch. gén. de Méd., 1854; Anstie, Neuralgia and its Counterfeits.
The spasm and subsequent dilatation of blood-vessels in the

affected area have already been alluded to. A disturbance of
secreting organs in the neighborhood of the painful region, the
lachrymal gland, the skin, the mucous membranes, the salivary
glands, is of equally common occurrence, and is probably in great
measure due to direct irritation of the glandular nerves, since the
increased secretion is said to occur sometimes unattended by
congestion.
The hair may become dry and brittle and inclined to fall out, or may
lose its color rapidly, regaining it after the attack has passed.
The increased secretion of urine already alluded to attends not only

renal neuralgias, but those of the fifth pair, intercostal, and other
nerves. There may be unilateral furring of the tongue (Anstie).
The muscles supplied by the branches of the affected nerve or of

related nerves may be the seat of spasm, or, on the other hand, may
become paretic; and this is true even of the large muscles of the
extremities.
Vision may be temporarily obscured or lost in the eye of the affected

side in neuralgia of the fifth pair, and hearing, taste, and smell are
likewise deranged, though more rarely. I am not aware that distinct
hemianopsia is observed except in cases of true migraine, where it
forms an important prodromal symptom.
In connection with these disorders of the special senses the

occasional occurrence of typical anæsthesia of the skin of one-half
of the body should be noted, which several observers have found in
connection with sciatica. The writer has seen a cutaneous
hyperæsthesia of one entire half of the body in a case of cervico-
occipital neuralgia of long standing. These symptoms are probably
analogous to the hemianæsthesia which comes on after epileptic or
other acute nervous seizures, or after concussion accidents, as has
lately been observed both in this country and in Europe, and it is
perhaps distantly related to the hemianæsthesia of hysteria. Local
disorders of the sensibility in the neuralgic area are far more
common than this, and, in fact, are usually present in some degree.
The skin is at first hyperæsthetic, but becomes after a time
anæsthetic; and this anæsthesia offers several interesting
peculiarities. When this loss of sensibility is well marked, areas
within which the anæsthesia is found are apt to be sharply defined,
but they may be either of large size or so small as only to be
discovered by careful searching (Hubert-Valleroux). The sensibility
within these areas may be almost wanting, but in spite of this fact it
can often be restored by cutaneous faradization around their
margins, and the functional or neurosal origin of the anæsthesia is
thus made apparent. Where the anæsthesia is due, as sometimes
happens, to the neuritis with which the neuralgia is so often
complicated, it is more lasting, but usually less profound and less
sharply defined.
These changes may be transient, or, if a neuralgia is long continued

and severe, they may pass into a series of more lasting and deeper
affections of the nutrition.
The skin and subjacent tissues, including the periosteum, from being
simply swelled or œdematous may become thickened and
hypertrophied. The writer has known a case of supraorbital
neuralgia, at first typically intermittent, to lead to a thickening of the
periosteum or bone over the orbit, which even at the end of several
years had not wholly disappeared.
Neuralgias of the fifth pair, which are as remarkable in their outward

results as they are in their severity and their relation to other
neuroses, are said to give rise to clouding and ulceration of the
cornea, to iritis, and even to glaucoma.
Herpetic eruptions on the skin sometimes occur, of which herpes
zoster is the most familiar instance.
Muscular atrophy is very common, especially in sciatica, and in

some cases this occurs early and goes on rapidly, while in others it
may be only slight and proportioned to the disease and relaxation of
the muscles, even where the neuralgia has lasted for weeks or
months.
Neuritis of the affected nerve is a common result or attendant of

neuralgia, and may remain behind for an indefinite period after the
acute pain has gone, manifesting itself by subjective and objective
disorders of sensibility, by occasional eruptions on the skin, or by
muscular atrophy.
It is plain that in this list of symptoms a variety of conditions have

been described which would never all be met with in the same case,
and which, as will be shown in the section on Pathology, are
probably due to different pathological causes.
Neuralgia of the Viscera.
These neuralgias are less definitely localized by the sensations of

the patient than those of the superficial nerves, and it is not definitely
known what set of nerves are at fault.
They are deep-seated and are referred to the general neighborhood

of the larynx, œsophagus, heart, or one of the abdominal or genital
organs, as the case may be.
The pain is usually of an intense, boring character, and does not dart
like the pain of superficial neuralgia, but is either constant or comes
in waves, which swell steadily to a maximum and then die away,
often leaving the patient in a state of profound temporary prostration.
Deep pressure often brings relief. A patient of the writer, who is
subject to attacks of this kind in the right hypochondrium, will bear
with her whole weight on some hard object as each paroxysm comes
on, or insist that some one shall press with his fists into the painful
neighborhood with such force that the skin is often found bruised and
discolored.
The functions and secretions of the visceral organs are apt to be

greatly disordered during a neuralgic attack, and it is often difficult or
impossible to tell with certainty which of these conditions was the
parent of the other. Undoubtedly, either sequence may occur, but the
pain excited by disorder of function, or even organic disease of any
organ, is not necessarily felt in that immediate neighborhood. Thus I
have known the inflammation around an appendix cæci, of which the
patient shortly afterward died, to cause so intense a pain near the
edge of the ribs that the passage of gall-stones or renal calculus was
at first suspected.
There seems to be as much variation as to modes of onset and

duration among the visceralgias as among the superficial neuralgias,
but the tendency to short typical attacks of frequent recurrence
seems to be greater with the former.
The visceral neuralgias are quite closely enough related to certain of

the superficial neuralgias to show that they belong in the same
general category. The two affections are often seen in the same
person, and not infrequently at the same time or in immediate
succession. Thus in the case of the patient just alluded to above, the
attacks of deep-seated neuralgia in the neighborhood of the right
flank are at times immediately preceded by severe neuralgia of the
face or head. Similarly, intercostal neuralgia may occur in immediate
connection with neuralgias of the cardiac or gastric nerves.
The phenomenon of tender points is not entirely wanting in the

visceralgias, though less constant and definite than in the superficial
neuralgias.
The liver and the uterus especially become the seat of more or less
localized tenderness, and possibly the tenderness in the ovarian
region which is so common, and so often unattended by real
inflammation, is, in part, of this order.
The secondary results of the visceralgias are not easy to study.

Besides the disorders of secretion and function above alluded to,
swelling of the liver with jaundice and paresis of the muscular walls
of the hollow viscera may be mentioned as having been ascribed to
neuralgia.
It is not known to what degree neuritis occurs as a cause or

complication of these neuralgias, and this is a question which is
greatly in need of further study.
Migraine, or Sick Headache.
This is often classified as an affection of a different order from the

neuralgias, but there seem to be no real grounds for this distinction.
The superficial neuralgias themselves are probably not one, but a

group of affections, with the common bond of severe and
paroxysmal pain.
Neither is what is called migraine always one and the same disease.
Although in its most typical form it presents very striking

characteristics, such as a marked preliminary stage, with peculiar
visual and sensory auras, sometimes occupying one entire half of
the body, a short and regular course and periodical return, deep-
seated pain without tender points, and prominent unilateral vascular
disorders, yet these symptoms shade off by imperceptible degrees
into those of neuralgia of the fifth pair, or more often into one or
another form of unilateral neuralgic headache which stands midway
between the two.
The vascular phenomena of migraine are believed by various
observers, as is well known, to constitute the primary and essential
pathological feature of the disease, and to be the cause of the pain.
But this is a pure hypothesis, and as a matter of fact the cases are
abundant in which no greater vascular changes are present than in
other neuralgias of equal severity.
Migraine seems to occupy an intermediate position between the

grave neuroses, especially epilepsy, and the neuralgias of neurosal
origin.
The symptomatology will be described at greater length below.
GENERAL ETIOLOGY.—The causes of neuralgia may be divided into

predisposing and exciting causes.
The most important of the first group are—
1. Hereditary tendencies;
2. The influences associated with the different critical periods of

life;
3. The influences attached to sex;
4. The action of constitutional diseases, such as phthisis,

anæmia, gout, syphilis, diabetes, nephritis, malarial poisoning,
metallic poisoning.
The most important of the second group of causes are—
1. Atmospheric influences and the local action of heat and cold;
2. Injuries and irritation of nerves;
3. Irritation of related nerves (so-called reflex and sympathetic

neuralgias);
4. Acute febrile diseases.

In most cases more than one cause is to blame, and each should be
separately sought for.
PREDISPOSING CAUSES.—1. Hereditary Tendencies.—It is generally

admitted as beyond question that neuralgias are most common in
families in which other signs of the neuropathic taint are prominent.
Such affections as hysteria, neurasthenia, epilepsy, asthma, chorea,
dipsomania, and even gout and phthisis as it would seem, are akin
to the neuralgic tendency.
The neuropathic family is thought to contain, in fact, a much larger

number of members than this,5 but there is danger of exaggerating
the importance of an influence of which we know as yet so little.
5 Féré, Arch. de Névrologie, 1884, Nos. 19 and 20, “La famille névropathique.”
It should be remembered, moreover, that even where an inherited

taint is present its influence may be but slight as compared with that
of some special exciting cause.
Some neuralgias are more closely associated with the inherited

neuropathic diathesis than others. The connection is especially close
in the case of migraine;6 then follow other forms of periodical
headache and the visceral neuralgias. Even the superficial
neuralgias7 are more or less subject to this influence. This is thought
to be especially true of the facial neuralgias.
6 There is a witty French saying (quoted by Liveing), “La migraine est le mal des
beaux esprits;” which might be rendered, “The disease of nervous temperaments.”
7 For tables of illustrative cases see Anstie, Neuralgia and its Counterfeits, and J. G.
Kerr, Pacific Med. and Surg. Journ., May, 1885.
Reasons will be offered later for suspecting that many cases usually
classed as neuralgia, and characterized by gradual onset and
protracted course, are essentially cases of neuritis; and there is need
of further inquiry as to how far hereditary influences are concerned in
producing them, and whether such influences act by increasing the
liability of the peripheral nerves to become inflamed, or only by
increasing the excitability of the sensory nervous centres.
2. Age.—Neuralgia is oftenest seen in middle life and at the epochs

marked by the development and the decline of the sexual functions.
The affection, when once established, may run over into advanced
age, but cases beginning at this period are relatively rare and very
intractable (Anstie).
Childhood is commonly said to be almost exempt from neuralgia,

but, in fact, there seems no sufficient reason for withholding this term
from the so-called growing pains of young children8 so long as it is
accorded to the almost equally irregular neuralgias of anæmia in the
adult. The same remark applies to the attacks of abdominal pain in
children, which often seem to be entirely disconnected from digestive
disorders.
8 Probably due to anæmia or imperfect nutrition (see Jacobi, “Anæmia of Infancy and
Childhood,” Archives of Med., 1881, vol. v.).
Adolescents and children also suffer from periodical headaches,

both of the migrainoid and of the neuralgic type. These are obstinate
and important affections.9 Migraine especially, coming on in early life,
points to a neuropathic constitution, and will be likely to recur at
intervals through life, or possibly to give place to graver neuroses.
9 Blache, Revue mensuelle de l'enfance, Mar., 1883, and Keller, Arch. de Névroloqie.
1883.
3. Sex.—Women show a stronger predisposition than men to certain

forms of neuralgia, as to the other neuroses, but it is generally
conceded that whereas neuralgias of the fifth and occipital and of the
intercostal nerves are met with oftenest among them, the brachial,
crural, and sciatic neuralgias are commoner among men. This
probably indicates that the neurosal element is of greater weight in
the former group, the neuritic element in the latter.
4. Constitutional Diseases.—The blood-impoverishment of phthisis
and anæmia, the poison of malaria, syphilis, and gout, and the
obscurer forms of disordered metamorphosis of tissue, undoubtedly
predispose to neuralgia and the other neuroses, as well as to neuritis
and others of the direct causes of neuralgic attacks.
Anstie regards the influence of phthisis as so important as to place it

fairly among the neuroses. Gout is likewise reckoned by some
observers among the neuroses,10 but we tread here upon uncertain
ground. Anstie does not regard gout as a common cause of
neuralgia, but most writers rate it as more important, and gouty
persons are certainly liable to exhibit and to transmit an impaired
nervous constitution, of which neuralgia may be one of the
symptoms. The neuralgias of gout are shifting, irregular in their
course, and sometimes bilateral.
10 Dyce-Duckworth, Brain, vol. iii., 1880.
Syphilitic patients are liable to suffer, not only from osteocopic pains
and pains due to the pressure of new growths, but also from attacks
of truly neuralgic character. These may occur either in the early or
the later stages of the disease. They may take the form of typical
neuralgias, as sciatica or neuralgia of the supraorbital nerve
(Fournier11), or they may be shifting, and liable to recur in frequent
attacks of short duration, like the pains from which many persons
suffer under changes of weather, anæmia, or fatigue.
11 Cited by Erb in Ziemssen's Encyclopædia.
There are other obscure disorders of the nutrition, as yet vaguely

defined, in connection with which neuralgia of irregular types is often
found. Some of these are classed together under the name of
lithæmia, and are believed to be due to imperfect oxidation of
albuminoid products.12
12 See DaCosta, Am. Journ. of Med. Sciences, Oct., 1881, and W. H. Draper, New
York Med. Record, Feb. 24, 1883.
Diabetes seems also to be an occasional cause of neuralgia,
especially sciatica, and Berger,13 who has recently described them,
says that they are characterized by limitation of the pain to single
branches of the sacral nerves, by a tendency to occur at once on
both sides of the body, by the prominence of vaso-motor symptoms,
and, finally, by their long duration and obstinacy. There may not, at
the moment, be any of the characteristic symptoms of diabetes
present.
13 Neurologisches Centralblatt, 1882, cited in the Centralbl. für Nervenheilk., etc.,
1882, p. 455.
Chronic nephritis also causes neuralgia, either directly or indirectly;

and severe neuralgic attacks may accompany the condition, which is
as yet but imperfectly known, characterized pathologically by a
general arterio-fibrosis and by increased tension of the arterial
system.
True rheumatism does not appear to be a predisposing cause of

neuralgia.
Anæmia, both acute and chronic, is a frequent cause of neuralgia,

both through the imperfect nutrition of the nervous tissues, to which it
leads, and, it is thought, because the relatively greater carbonization
of the blood increases the irritability of the ganglionic centres.
Even a degree of anæmia which might otherwise be unimportant

becomes of significance in the case of a patient who is otherwise
predisposed to neuralgia; for such persons need to have their health
kept at its fullest flood by what would ordinarily seem a surplus of
nourishment and care.
Under the same general heading comes the debility from acute and
chronic diseases, and the enfeeblement of the nervous system from
moral causes, such as anxiety, disappointment, fright, overwork and
over-excitement, and especially sexual over-excitement, whether
gratified or suppressed (Anstie), or, on the other hand, too great
monotony of life; also from the abuse of tea, coffee, and tobacco.
Lead, arsenic, antimony, and mercury may seriously impair the
nutrition of all the nervous tissues, and in that way prepare the way
for neuralgia.
IMMEDIATE CAUSES.—1. Atmospheric and Thermic Influences.—

Neuralgia is very common in cold and damp seasons of the year, in
cold and damp localities, and in persons whose work entails frequent
and sudden changes of temperature. Exposures of this sort may at
once excite twinges of pain here and there over the body, and may
eventually provoke severe and prolonged attacks of neuralgia.
The action of damp cold upon the body is complicated, and it exerts
a depressing influence on the nervous centres in general which is
not readily to be explained. One important factor, however, is the
cooling of the superficial layers of the blood, which occurs the more
easily when the stimulus of the chilly air is not sufficiently sharp and
sudden to cause a firm contraction of the cutaneous vessels, while
the moisture rapidly absorbs the heat of the blood. From this result,
indirectly, various disorders of nutrition of the deeper-lying tissues or
distant organs; and, among these, congestion and neuritis of the
sensitive nerves.
Neuralgia often coincides with the presence or advent of storms. A

noteworthy and systematic study of this relationship was carried on
through many years under the direction of S. Weir Mitchell14 by a
patient of his, an officer who suffered intensely from neuralgia of the
stump after amputation of the leg. The attacks of pain were found to
accompany falling of the barometer, yet were not necessarily
proportionate to the rapidity or amount of the fall. Saturation of the
air with moisture seemed to have a certain effect, but the attacks
often occurred when the centre of the storm was so remote that
there was no local rainfall. It was impossible to study the electrical
disturbances of the air with accuracy, but a certain relationship was
observed between the outbreak of the attacks and the appearance of
aurora borealis.
14 Am. Journ. of Med. Sci., April, 1877, and Philada. Med. News, July 14, 1883.
This patient's neuralgic attacks were almost certainly of neuritic
origin, and it is possible that the exacerbations were due to changes
of blood-tension in and around the nerve-sheaths. It is also possible
that they were the result of circulatory changes and disordered
nutrition of the nervous centres, already in a damaged condition from
the irritation to which they had been exposed.
2. Injuries and Irritation of Nerves.—Wounds and injuries of nerves15

and the irritation from the pressure of scars, new growths, and
aneurisms are prolific causes of neuralgic pain, partly by direct
irritation, partly by way of the neuritis which they set up. Neuralgias
are likewise common during the period of the healing of wounds, as
Verneuil long since pointed out. The pain may be near the wound
itself or in some distant part of the body.
15 See S. Weir Mitchell, Injuries of Nerves.
Neuralgia due to the pressure and irritation of tumors, new growths,

or aneurisms requires a special word. The pain is apt to be intensely
severe, but what is of especial importance is that the symptoms may
not present anything which is really characteristic of their origin,
except their long continuance; and this should always excite grave
suspicion of organic disease.
These attacks of pain may be distinctly periodical; and this is true

whether they are felt in the distribution of the affected nerve or of
distant nerves.
Not only are direct injuries of nerves a cause of neuralgia, but

sudden concussion or jar may have a like effect—whether by setting
up neuritis or in some other way is not clear. Ollivier16 reports a case
where a blow beneath the breast caused a neuralgia which
eventually involved a large portion of the cervico-brachial plexus;
and the writer has seen a like result from a blow between the
shoulders.
16 Cited by Axenfeld and Huchard, p. 116.
Peripheral irritations, such as caries of the teeth (see below, under
Facial Neuralgia) and affections involving other important plexuses,
such as those of the uterine nerves, are a frequent cause of
neuralgia, and should always be sought for. They act in part by
setting up neuritis, and in part evidently in some more indirect
manner, since the neuralgia which they excite may be referred to
more or less distant regions, forming the so-called—
3. Reflex and Sympathetic Neuralgias.—The term reflex, as here

used, is ill chosen, and the term sympathetic only covers our
ignorance of the real processes involved, and which we should seek
for in detail. Thus, disease of the uterus or ovaries may cause facial,
mammary, intercostal, or gastric neuralgia.
Hallopeau17 suggests that some of these results may be brought

about by the pressure of enlarged lymphatic glands attached to the
affected organ.
17 Loc. cit., p. 766.
Another important centre of nervous irritation is the eye. Slight errors

of refraction, or weakness of the muscles of fixation, especially the
internal recti, are a source of frontal headaches and other nervous
symptoms, and even of typical migraine,18 to a degree which is not
usually appreciated. It is improbable that in the latter case the
irritation acts as more than an exciting cause, but it may
nevertheless be a conditio sine quâ non of the attack.
18 St. Barthol. Hosp. Repts., vol. xix.
Acute and chronic inflammations of the mucous membrane of the

frontal sinuses, perhaps even of the nasal membrane, are likewise
important; and although it is probable that the opinions sometimes
expressed as to the significance of these causes are exaggerated, it
is equally true that obstinate and, as it were, illogical persistence in
their removal will sometimes be richly rewarded.
It is especially worthy of note that there need be no local sign
whatever to call the attention of the patient to the presence of the
peripheral irritation.
Nothnagel19 has described neuralgias which come on in the first

week of typhoid, and are to be distinguished from the general
hyperæsthesia of later stages. He describes an occipital neuralgia of
this sort which finally disappeared under the use of a blister. Other
acute diseases may have a like effect. The writer has seen a severe
facial neuralgia in the first week of an insidious attack of pneumonia
in a person who was not of neuralgic habit, and before the fever or
inflammation had become at all severe.
19 Virch. Arch., vol. liv., 1872, p. 123.
PATHOLOGY AND DIAGNOSIS.—In surveying the clinical history of the

neuralgias and the circumstances under which they occur, we have
grouped together a large number of symptoms of very different
character from each other, and we have now to inquire to what
extent these symptoms are really united by a pathological bond.
Two opposite opinions have been held concerning the pathology of

neuralgic affections. According to one opinion, every neuralgic
attack, no matter how it is excited, is the manifestation of a neurosis
—that is, of a functional affection of the nervous centres—to which
the term neuralgia may properly be applied. This view is based on
the resemblance between the different forms of neuralgia, or the
apparent absence, in many cases, of any adequate irritation from
without, and the fact that the persons in whom neuralgias occur
usually show other signs of a neuropathic constitution.
According to the other opinion, the various forms of neuralgia are so

many different affections, agreeing only in their principal symptom,
and are due sometimes to congestion or anæmia of the nerves or
the nerve-centres; sometimes to neuritis, the pressure of tumors, or
the irritation of distant nerves; sometimes, finally, to a functional
disorder of the nervous centres. The arguments in favor of this
opinion are that the difference between the symptoms of the different
neuralgias as regards their mode of onset and decline, their duration,
the persistence of the pain, and the degree to which the attacks are
accompanied by organic changes of nutrition in the tissues and in
the nerve itself, are so great as to make it appear improbable that we
are dealing in every case simply with one or another modification of
a single affection.
This is a valid reasoning, and it is certainly proper to exhaust the

possibilities of explaining the symptoms that we find in a particular
case by referring them to morbid processes which we can see or of
which we can fairly infer the presence, before we invoke an influence
of the nature of which we understand so little as we do that of the
functional neuroses. At the same time, it must be distinctly borne in
mind that the symptoms of certain neuralgias, and the relation which
the neuralgias in general bear to other neuroses, can only be
accounted for on the neurosal theory, and that in a given case we
can never be sure that this neurosal tendency is not present and is
not acting as at least a predisposing cause. It is especially important
to bear this possible influence in mind in deciding upon prognosis
and treatment.
We may now review briefly the signs which should lead us to

diagnosticate or suspect the presence of the various special causes
of neuralgic symptoms.
Neuritis is indicated by the presence of organic disorders of nutrition

affecting the skin, hair, or nails, or of well-marked muscular wasting;
by pain, not only occurring in paroxysms, but felt also in the
intermissions between the paroxysms, or continuous sensations of
prickling and numbness, even without pain; by tenderness along the
course of the nerve; by anæsthesia, showing itself within the first few
days of the outbreak of a neuralgia; by persistent paralysis or paresis
of muscles.
Neuritis may be suspected, even if one or all of these signs are

absent, in the prolonged neuralgias which follow wounds or strains of
nerves or exposure to damp cold, or which occur in nerves which are
in the immediate neighborhood of diseased organs; also where the
pain is relieved by compression of the nerve above the painful part,
or, on the other hand, where pressure on the nerve excites a pain
which runs upward along the course of the nerve.
It may also be suspected in the large class of superficial neuralgias

which follow a regular and protracted course with gradual onset and
decline, and where the pain is felt not only in the region of
distribution of a nerve, but also along its course—that is, in the
nerve-fibres (either the recurrent nerves or the nervi nervorum)
which are distributed in the sheath of the main trunk or the adjoining
tissues.20
20 See Cartaz, Des Névralgics envisagés au point de vue de la sensibilité récurrente,
Paris, 1875.
It must be remembered that the study of neuritis, and especially of

chronic neuritis, is still in its infancy, and that we are by no means in
possession of its complete clinical history.21
21 See Pitres and Vaillard, Arch. de Névrologie, 1883.
The presence of congestion of the sensory nerves or nerve-centres

may be inferred with some degree of probability where neuralgic
attacks of relatively sudden onset and short duration occur in parts
which have been exposed to heat or cold, or in connection with
suppression of the menstruation, or, it is said, as a result of
intermittent fever. The exacerbations of pain which take place in
cases of chronic neuritis under changes of weather and after fatigue
are very likely due to this cause; and the same may be true of some
of the fleeting pains which occur in chlorotic and neuropathic
persons who are subject to fluctuations of the circulation of vaso-
motor origin.
The same vaso-motor influences which cause congestion may also

cause the correlative state of anæmia, which becomes thus a cause
of transient and shifting though often severe attacks, which may be
irregular in their distribution. General anæmia is also a predisposing
cause of severe typical seizures, as has been pointed out above.
The pressure of new growths or of aneurisms is to be suspected
when neuralgic attacks are unusually severe and prolonged, recur
always in the same place, and occur in persons who are not
predisposed to neuralgias. The pains from this cause are apt to be
relatively continuous, but they may, on the other hand, be distinctly
paroxysmal, and may occupy a part of the body far removed from
the irritating cause.
Bilateral pains should also excite suspicion of organic disease,

though they may be due to other causes, such as gout, diabetes,
and metallic poisoning.
Neuralgic attacks may be supposed to be of neurosal origin when

they are of sudden onset and short duration, or when they occur in
persons of neuropathic constitution, and, by exclusion, when no
other cause is found. These conditions are best fulfilled in the case
of migraine and the visceral neuralgias. It must, however, be borne in
mind that the neuropathic predisposition is sometimes well marked
even in the case of the superficial neuralgias, especially the
epileptiform neuralgia of the face.
GENERAL TREATMENT.—To treat neuralgia with satisfaction it is

necessary to look beyond the relief of the particular attack and
search out the causes by which it was provoked. As has already
been remarked, these are usually multiple, and among them will be
found, in the great majority of cases, some vice of nutrition or faulty
manner of life.
It is safe to say that any dyscrasia occurring simultaneously with

neuralgia, whether gout, phthisis, malaria, or diabetes, should
receive its appropriate treatment, whatever theory we may hold as to
the real connection between the two conditions.
In protracted neuralgias it is always proper to assume that neuritis

may be present—i.e. to treat the nerve itself by galvanism and local
applications. Local irritations, such as diseases of the eye, ear, teeth,
nose, or uterus, should be sought out and removed; and attention
may here be called again to the fact that a neuralgia may be due to
some local condition which does not of itself attract the patient's
attention.
Patients who are subject to pain at changes of weather or on

exposure should be suitably protected by clothing, and should have
their cutaneous regulatory apparatus strengthened by baths and
friction. The best protection, however, is incapable of entirely
warding off the effect of atmospheric changes upon the nervous
centres. Vaso-motor changes of neurotic origin can be, in a
measure, prevented by removing the patient from the influence of
irregularity of life and emotional excitement and through an improved
nutrition.
If the patient has been subjected to chronic fatigue or nervous strain,

not only must these be avoided, but their action should be
counteracted by the requisite rest and tonic treatment.
Long hours of sleep at night may often be supplemented to

advantage by rest during certain hours of the daytime. If the patient
cannot take active exercise, massage is indicated, and in some
cases of anæmia this may advantageously be combined with the wet
pack, in the manner described by Mary Putnam Jacobi.22
22 Massage and Wet Pack in the Treatment of Anæmia.
Where these measures cannot be carried out, the writer has found it
of much service in these, as in a large class of debilitated conditions,
to let the patient rub himself toward the end of the forenoon in a
warm room with a towel wet in cold or warm water, and then lie down
for an hour or so or until the next meal. If acceptable, the same
operation may be repeated in the afternoon.
Neuralgic patients are apt to be underfed, and even where this is not
distinctly the case, a systematic course of over-feeding,23 with
nourishing and digestible food, such as milk, gruel, and eggs, given
at short intervals, is often of great service if thoroughly carried out.
The full benefit of this treatment cannot always be secured unless
the patient is removed from home, and, if need be, put to bed and
cared for by a competent nurse.
23 See S. Weir Mitchell, Fat and Blood; and Nervous Diseases, especially of Women.
A change of climate, and especially the substitution of a dry and

warm for a moist and cold climate, will sometimes break up the
neuralgic habit, for the time at least. In making choice of climate or
locality, however, the physician should keep distinctly in view the end
that he desires to gain. Thus, the debility or anæmia which is the
essential condition of many neuralgias may often be relieved by
surroundings which would not be thought favorable to the neuralgic
tendency as such. Oftentimes the sedative influence of quiet country
life is all that is required.
Of the tonic drugs, cod-liver oil, iron, arsenic, and quinine are by far
the most important, and it is often well to give them simultaneously.
Iron may be used in large doses if well borne, for a short time at
least. Quinine may be given in small doses as a tonic, or in larger
doses to combat the neuralgic condition of the nervous system. This
remedy has long been found to be of great value in the periodical
neuralgias of the supraorbital branch of the fifth pair, but its
usefulness is not limited to these cases. It may be of service in
periodical neuralgias of every sort, and often even in non-periodical
neuralgia.
When the attacks recur at stated intervals care should be taken to

anticipate them with the quinine by about four hours, even if the
patient has to be waked in the early morning for the purpose. Single
doses of fifteen, twenty, or even thirty grains may check the attacks
where smaller doses have failed. Such doses cannot, however, be
long continued, and are not to be classed as tonic.
Of other remedies which directly influence the neuralgic condition,

the following are the most important: opium, aconite, gelsemium,
phosphorus, belladonna, chloride of ammonium, cannabis Indica,
croton-chloral, electricity, hydropathy, massage, counter-irritation,
subcutaneous injections of water, chloroform, osmic acid, etc.;
surgical operations.
Opium is usually employed only for the momentary relief of pain, but
it has also been claimed that in small and repeated doses it may
exert a really curative action. This should not, however, be too much
counted on. Opium should never be used continuously for the simple
relief of pain unless under exceptional circumstances, the danger of
inducing the opium habit is so much to be dreaded. Moreover, both
patient and physician are less likely to seek more permanent means
of cure if this temporary remedy can always be appealed to. It is best
given by subcutaneous injections of the various salts of morphine.
The dose should always be small at first (gr. 1/12 and upward), unless
the idiosyncrasy of the patient is already known; and there is
probably no advantage in making the injections at the seat of pain or
in the immediate neighborhood of the nerve supplying the affected
part, except such as might attend the injection of any fluid (see
below).
Belladonna (atropia), which is so often given with morphine to

diminish its unpleasant effects, seems at times, even when given
alone, to have an effect on neuralgia out of proportion to its
anæsthetizing action, which is very slight. It is considered to be
especially useful in the visceralgias.
Aconite, given, if necessary, in doses large enough and repeated

often enough to cause numbness and tingling of the lips and the
extremities for some days, will sometimes break up an attack,
especially of trigeminal neuralgia,24 better than any other means; but
its use is liable to depress the heart, and it is a dangerous remedy if
not carefully watched. Some patients complain that it causes a
marked sense of depression or faintness, and a feeling of coldness;
and indeed its full therapeutic effect is sometimes not obtained until
such symptoms as these are induced to some degree. The use of
the crystallized alkaloid, aconitia, has the advantage of ensuring
certainty of dose.
24 See Seguin, Arch. of Med., vol. i., 1879; vol. vi., 1881.

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Abbreviations and Short Titles

Adomnán, VC Adomnán, Vita S. Columbae, ed. and trans. Alan Orr

xii Abbreviations and Short Titles

Abbreviations and Short Titles xiii

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The spasm and subsequent dilatation of blood-vessels in the

The increased secretion of urine already alluded to attends not only

The muscles supplied by the branches of the affected nerve or of

Vision may be temporarily obscured or lost in the eye of the affected

In connection with these disorders of the special senses the

These changes may be transient, or, if a neuralgia is long continued

Neuralgias of the fifth pair, which are as remarkable in their outward

Muscular atrophy is very common, especially in sciatica, and in

Neuritis of the affected nerve is a common result or attendant of

It is plain that in this list of symptoms a variety of conditions have

Neuralgia of the Viscera.

These neuralgias are less definitely localized by the sensations of

They are deep-seated and are referred to the general neighborhood

The functions and secretions of the visceral organs are apt to be

There seems to be as much variation as to modes of onset and

The visceral neuralgias are quite closely enough related to certain of

The phenomenon of tender points is not entirely wanting in the

The secondary results of the visceralgias are not easy to study.

It is not known to what degree neuritis occurs as a cause or

Migraine, or Sick Headache.

This is often classified as an affection of a different order from the

The superficial neuralgias themselves are probably not one, but a

Although in its most typical form it presents very striking

Migraine seems to occupy an intermediate position between the

The symptomatology will be described at greater length below.

GENERAL ETIOLOGY.—The causes of neuralgia may be divided into

The most important of the first group are—

2. The influences associated with the different critical periods of

3. The influences attached to sex;

4. The action of constitutional diseases, such as phthisis,

The most important of the second group of causes are—

1. Atmospheric influences and the local action of heat and cold;

2. Injuries and irritation of nerves;

3. Irritation of related nerves (so-called reflex and sympathetic