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Small Fiber Neuropathy
and Related Syndromes:
Pain and
Neurodegeneration

Sung-Tsang Hsieh
Praveen Anand
Christopher H. Gibbons
Claudia Sommer
Editors

123
Small Fiber Neuropathy and Related
Syndromes: Pain and Neurodegeneration
Sung-Tsang Hsieh • Praveen Anand
Christopher H. Gibbons
Claudia Sommer
Editors

Small Fiber
Neuropathy and Related
Syndromes: Pain and
Neurodegeneration
Editors
Sung-Tsang Hsieh Praveen Anand
Department of Neurology Department of Neurology
National Taiwan University Hospital Imperial College London
Taipei Hammersmith Hospital
Taiwan London
UK
Christopher H. Gibbons
Department of Neurology Claudia Sommer
Harvard Medical School Neurologische Klinik
Beth Israel Deaconess Medical Center Universitätsklinikum Würzburg
Boston, MA Würzburg
USA Germany

ISBN 978-981-13-3545-7    ISBN 978-981-13-3546-4 (eBook)

https://doi.org/10.1007/978-981-13-3546-4

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189721, Singapore
Sung-Tsang Hsieh dedicates this book to
beloved family (Whei-Min, Paul-Chen, and Christine Yi-Chen) and
mentor (late Professor Jack Griffin)
Foreword

This is a very good book focusing on small fiber neuropathy (SFN), an

­important and interesting disease. When I was a young neurologist in the
1980s, there were few clinicians or researchers whose main theme was SFN;
since it was a very complicated disease entity, there were few practical tests
for its diagnosis; and it was very difficult or impossible to care for patients
with SFN. In fact, as written in Chap. 1 (Overview) by Prof. Hsieh, chief edi-
tor of this book, “SFN is a commonly encountered clinical entity that signifi-
cantly compromises patients’ overall quality of life. Patients having SFN are
heterogeneous in clinical presentation, underlying causes, and pathophysiol-
ogy. The presence of symptoms and/or signs of small fiber damage warrant a
thorough evaluation for SFN. Furthermore, a diagnosis of SFN should also be
considered in patients with chronic pain and autonomic dysfunctions with
unclear causes.”
However, due to the tireless efforts by some clinicians and researchers
including the authors of this book, causes of SFN have been gradually
­clarified, and treatments for some diseases have been established, as shown
clearly in this book. In addition, some clinical testing methods are now used
to make a diagnosis of SNF.
I strongly recommend this book to not only experts of SFN but also
junior clinicians to study SFN, since this book clearly covers both basic and
up-to-­date knowledge on the disease.

Ryusuke Kakigi
International Federation
of Clinical Neurophysiology (IFCN)
Vancouver, BC, Canada
Department of Integrative Physiology
National Institute for Physiological Sciences
Okazaki, Japan
The Graduate University for Advanced Studies
of Life Science (SOKENDAI)
Kanagawa, Japan

vii
Foreword

If your feet hurt, everything hurts. (widely attributed quote)

Springtime in nerveland (one of my patients with HIV neuropathy)

Two illuminating quotes from patients with neuropathic pain of small fiber
neuropathy illustrate the tremendous constant impact of this disease entity or
syndrome on quality of life. The incidence and prevalence of neuropathic
pain continues to rise, and a recent systematic review estimated the preva-
lence of painful diabetic peripheral neuropathy ranging from 15.3 to
72.3/100,000 PY. Diabetes mellitus is certainly the most common trigger for
painful neuropathy, and rates will likely to continue to rise with the epidemic
of obesity and overconsumption of refined carbohydrates. Considering the
wide range of systemic and primary neurological conditions associated with
neuropathic pain related to small fiber neuropathy, this is clearly an affliction
that is often misdiagnosed or inadequately treated. In recent years, consider-
able research has been dedicated to understanding its mechanisms, and new
techniques have been developed for diagnosis including the much wider use
of genetic testing, at substantially lower costs, and punch skin biopsy that has
now entered the field as a simple and reliable tool to assess intra-epidermal
nerve fiber densities and sweat gland innervation. Despite these advance-
ments, there have been few advances in definitive treatments, with the excep-
tion of ASO therapies silencing therapies (siRNA and antisense
oligonucleotide) for amyloid neuropathy, approved in 2018. In contradistinc-
tion, we now have a much better understanding of effective use of combina-
tion pain-modifying agents and increasingly of neuromodulatory strategies
using devices such as the Scrambler™ and Rebuilder™. There are several
new elements, however, that have changed the landscape for the management
of neuropathic pain in small fiber neuropathy. First, these symptomatic thera-
pies have developed in the setting of the opioid crisis that kills on average 116
people daily in the USA. Since the late 1990s, pharmaceutical companies
reassured the medical community that patients would not become addicted to
opioid pain relievers and healthcare providers began to prescribe them at
greater rates. This led to widespread misuse of both prescription and nonpre-
scription opioids before it became clear that these medications could indeed
be highly addictive. According to the 2015 National Survey on Drug Use and
Health (NSDUH), approximately 91.8 million adults aged 18 or older were
users of prescription pain relievers in 2015, representing more than one-third
(37.8%) of the adult US population. About 11.5 million adults misused pre-

ix
x Foreword

scription pain relievers at least once in the past year. The most common rea-
son for their last misuse of pain relievers was to relieve physical pain (63.4%).
In 2017, HHS declared a public health emergency and announced a 5-point
strategy to combat the crisis. A second element is the spreading legalization
of marijuana. Medical marijuana is now legal in 30 states in the USA, and
public support reached new levels in 2018 with 64% of Americans favoring
legalization. It is highly likely that legal forms of marijuana will increasingly
be used to treat small fiber neuropathy-related neuropathic pain. Finally, I
believe that the future of developing even more effective therapies for small
fiber neuropathy will predictably involve a “precision medicine” approach
incorporating genetic testing (e.g., COMT and the variant allele V158M),
metabolic parameters (diabetic control, hypertriglyceridemia, and inflamma-
tory markers), and comorbid conditions.
The contributors to this book are internationally renowned leaders in the
field of small fiber neuropathy. They discuss clinical approaches to diagnosis
and treatment of small fiber neuropathy neuropathic pain and its underlying
mechanisms. This book will serve as a useful guide for diagnostic approaches
and treatment of small fiber neuropathy for the student, resident, practicing
physician or advanced practice provider, researcher, and neuromuscular
specialist.

Justin C. McArthur
Department of Neurology
Johns Hopkins University Hospital
Baltimore, MD, USA
Preface by Sung-Tsang Hsieh

Small fiber neuropathy or syndrome of small fiber pathology has become a

recognized disease entity due to improvement in diagnostic tools during the
past decades. The development of skin biopsy is a key step to revolutionize
assessments of small fiber neuropathy by providing objective and quantita-
tive evidence of nociceptive nerve degeneration at the level of pathology.
During the past 20 years, additional examinations on psychophysics and
physiology such as quantitative sensory testing, pain-evoked potentials
including laser-­evoked potentials, and contact heat-evoked potentials offer
complementary evaluations for functional deficits of small fiber neuropa-
thy. Initially small fiber neuropathy was recognized as the major manifesta-
tions of neuropathies mainly affecting nociceptive and autonomic nerves,
for example, diabetic neuropathy and familial amyloid polyneuropathy.
With the applications of these advanced and integrated examinations includ-
ing pathology of skin innervation, psychophysics of quantitative sensory
testing, and physiology of pain evoked potentials, the spectrum of small
fiber pathology actually extended to neuropathies in which large fiber defi-
cits were considered as the main presentations, e.g., Guillain-Barré syn-
drome and vasculitic neuropathy. In addition to documenting nociceptive
nerve degeneration in small fiber neuropathy of sensory type, skin biopsy
also provides assessments for small fiber neuropathy of autonomic type
including sudomotor, pilomotor, and vasomotor innervation. Furthermore,
the applications of these tests expanded our understanding of neurodegen-
erative disorders and complex pain syndrome: Parkinson’s disease, fibro-
myalgia, etc. This is an intriguing topic which certainly provides foundations
for future studies to test whether small fiber pathology in the periphery
could serve as a window to neurodegenerative disorders in the central
­nervous system.
This contributed volume intends to provide updated and concise infor-
mation in the field of small fiber neuropathy and syndrome. Such a book
project would never become a reality without the tremendous expertise and
efforts of all coeditors, Professors Anand, Sommer, and Gibbons. I am
indebted to the excellent editorial assistance from Springer Nature, particu-
larly Xuewen, who enthusiastically initiated this project. Forewords by
Professors Kakigi and McArthur are greatly appreciated which point the
significance of this field. This work is in memorial for late Professor Jack
Griffin, a great mentor in my research career, and also dedicated to my wife,

xi
xii Preface by Sung-Tsang Hsieh

Whei-Min, who took care of checking the format of the writing with my
son, Paul-Chen, and daughter, Christine Yi-Chen, and offer endless support
with my works.
Neurology is in rapid progress, and the information needs update continu-
ously. We look forward to comments from colleagues and readers.

Taipei, Taiwan Sung-Tsang Hsieh

October 15, 2018
Acknowledgments

Dr. Hsieh’s laboratory of nerve degeneration and neuropathic pain has

received funding and support from the Ministry of Science and Technology,
National Taiwan University College of Medicine, National Taiwan University
Hospital, and National Health Research Institute, Taiwan.
Dr. Sommer received grant support for subjects related to the content of
the book from Deutsche Forschungsgemeinschaft (SO 328/10-1) and from
International Parkinson Fonds; she has received funding (2014–2017) to
study neuropathic pain from the European Commission FP7-Health-2013-­
Innovation, Grant No. 602133.
At the organization stage of this book, colleagues provided valuable
suggestions and are highly appreciated: Professor Michael Polydefkis,
­
Michael Shy, and Roy L. Freeman.

xiii
Contents

Part I Overview and Assessments of Small Fiber Neuropathy

1 Overview of Small Fiber Neuropathy��������������������������������������������   3

Ming-Tsung Tseng, Chun-Liang Pan, and Sung-Tsang Hsieh
2 Pathology of Small Fiber Neuropathy: Skin Biopsy
for the Analysis of Nociceptive Nerve Fibers�������������������������������� 11
Claudia Sommer
3 Neurophysiological Assessments in Small Fiber Neuropathy:
Evoked Potentials���������������������������������������������������������������������������� 25
Rosario Privitera and Praveen Anand
4 Psychophysics: Quantitative Sensory Testing in the Diagnostic
Work-Up of Small Fiber Neuropathy�������������������������������������������� 33
Claudia Sommer
5 Autonomic Testing and Nerve Fiber Pathology���������������������������� 43
Ahmad R. Abuzinadah and Christopher H. Gibbons

Part II Small Fiber Neuropathy in Peripheral Nerve Disorders

6 Diabetes-Related Neuropathies������������������������������������������������������ 59
Christopher H. Gibbons
7 Genetic Small Fiber Sensory Neuropathy and
Channelopathy �������������������������������������������������������������������������������� 73
Rosario Privitera and Praveen Anand
8 Amyloid Neuropathy������������������������������������������������������������������������ 83
Chi-Chao Chao, Hung-Wei Kan, Ti-Yen Yeh, Ya-Yin Cheng,
and Sung-Tsang Hsieh
9 Small Fiber Pathology and Functional Impairment
in Syndromes of Predominantly Large Fiber Neuropathy���������� 99
Chi-Chao Chao, Chun-Liang Pan, and Sung-Tsang Hsieh
10 Autoimmune and Infectious Neuropathies������������������������������������ 109
Ahmad R. Abuzinadah and Christopher H. Gibbons

xv
xvi Contents

Part III Roles of Small Fiber Pathology: Pain Syndromes and

Neurodegeneration

11 Small Fiber Pathology in Pain Syndromes������������������������������������ 121

Claudia Sommer and Nurcan Üçeyler
12 Visceral Pain and Hypersensitivity Disorders������������������������������ 131
Rosario Privitera and Praveen Anand
13 Small Fiber Pathology in Neurodegenerative Disorders�������������� 141
Kathrin Doppler and Claudia Sommer

Part IV Neuropathic Pain in Small Fiber Neuropathy: Mechanisms

and Therapy

14 Neuropathic Pain in Small Fiber Neuropathy������������������������������ 153

Ming-Chang Chiang, Paul-Chen Hsieh, and
Sung-Tsang Hsieh
15 Therapy for Small Fiber Neuropathy�������������������������������������������� 165
Ahmad R. Abuzinadah and Christopher H. Gibbons
Index���������������������������������������������������������������������������������������������������������� 179
Contributors

Ahmad R. Abuzinadah, MD Neurology Division, Internal Medicine

Department, King Abdulaziz University, Jeddah, Saudi Arabia
Praveen Anand, MD Peripheral Neuropathy Unit, Centre for Clinical
Translation, Division of Brain Sciences, Imperial College London,
Hammersmith Hospital, London, UK
Chi-Chao Chao, MD, PhD Department of Neurology, National Taiwan
University Hospital, Taipei, Taiwan
Ya-Yin Cheng, MS Department of Anatomy and Cell Biology, National
Taiwan University College of Medicine, Taipei, Taiwan
Ming-Chang Chiang, MD, PhD Department of Biomedical Engineering,
National Yang-Ming University, Taipei, Taiwan
Kathrin Doppler, MD Universitätsklinikum Würzburg, Würzburg, Germany
Christopher H. Gibbons, MD, MMSc Neurology Department, Harvard
Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
Paul-Chen Hsieh, MD Department of Dermatology, National Taiwan
University Hospital, Taipei, Taiwan
Sung-Tsang Hsieh, MD, PhD Department of Anatomy and Cell Biology,
National Taiwan University College of Medicine, Taipei, Taiwan
Center of Precision Medicine, National Taiwan University College of
Medicine, Taipei, Taiwan
Graduate Institute of Brain and Mind Sciences, National Taiwan University
College of Medicine, Taipei, Taiwan
Graduate Institute of Clinical Medicine, National Taiwan University College
of Medicine, Taipei, Taiwan
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
Hung-Wei Kan, PhD Department of Anatomy and Cell Biology, National
Taiwan University College of Medicine, Taipei, Taiwan
Chun-Liang Pan, MD, PhD Graduate Institute of Molecular Medicine,
National Taiwan University College of Medicine, Taipei, Taiwan
Center of Precision Medicine, National Taiwan University College of
Medicine, Taipei, Taiwan

xvii
xviii Contributors

Rosario Privitera, MD Peripheral Neuropathy Unit, Centre for Clinical

Translation, Division of Brain Sciences, Imperial College London,
Hammersmith Hospital, London, UK
Claudia Sommer, MD Universitätsklinikum Würzburg, Würzburg, Germany
Ming-Tsung Tseng, MD, PhD Graduate Institute of Brain and Mind
Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
Nurcan Üçeyler, MD Universitätsklinikum Würzburg, Würzburg, Germany
Ti-Yen Yeh, PhD Department of Anatomy and Cell Biology, National
Taiwan University College of Medicine, Taipei, Taiwan
Abbreviations

AAN American Academy of Neurology

ABCA1 Adenosine triphosphate-binding cassette transporter 1
ACC Anterior cingulate cortex
ACCORD Action to Control Cardiovascular Risk in Type 2 Diabetes
ALS Amyotrophic lateral sclerosis
anti-dsDNA Anti-double-stranded DNA
ApoA1 Apolipoprotein A1
ASIC Acid-sensing ion channel
BDNF Brain-derived neurotrophic factor
BMS Burning mouth syndrome
BOLD Blood-oxygen-level-dependent
BoNT/A Botulinum toxin
BPS/IC Bladder pain syndrome/interstitial cystitis
CADASIL Cerebral autosomal dominant arteriopathy with subcorti-
cal infarcts and leukoencephalopathy
CAN Cardiac autonomic neuropathy, cardiovascular auto-
nomic neuropathy
CASPR2 Contactin-associated protein-like 2
CB1 Cannabinoid receptor 1
CBD Corticobasal degeneration
CCI Chronic constriction injury
CCM Corneal confocal microscopy
CGRP Calcitonin gene-related protein
CHEP Contact heat-evoked potential
CIDP Chronic inflammatory demyelinating polyneuropathy
CIPN Chemotherapy-induced peripheral neuropathy
CMAP Compound muscle action potential
CMT Charcot-Marie-Tooth neuropathy (disease)
CMT2 Charcot-Marie-Tooth neuropathy type 2
CNS Central nervous system
CRPS Complex regional pain syndrome
CSF Cerebrospinal fluid
CTCAE Common Terminology Criteria for Adverse Events
DAB 3,3′-Diaminobenzidine
DBH Dopamine beta-hydroxylase
DCCT Diabetes Control and Complications trial
DLPFC Dorsolateral prefrontal cortex

xix
xx Abbreviations

DLRPN Diabetic lumbosacral radiculoplexus neuropathy

DRG Dorsal root ganglion/ganglia
DSPN Distal symmetric polyneuropathy
EFNS European Federation of Neurological Societies
EMG Electromyography
EPO Erythropoietin
EPSC Excitatory postsynaptic current
EPSP Excitatory postsynaptic potential
ESCS Electrical spinal cord stimulation
FAC Familial amyloid cardiomyopathy
FACT/GOG-Ntx FACT/GOG-Neurotoxicity subscale
FAP Familial amyloid polyneuropathy
FDA Federal Drug Administration
fMRI Functional magnetic resonance imaging
GABA γ-aminobutyric acid
GAP-43 Growth-associated protein 43
Gb3 Globotriaosylceramide
GBS Guillain-Barré syndrome
GDNF Glial cell-derived neurotrophic factor
GERD/GORD Gastroesophageal (esophageal) reflux disease
GL3 Globotriaosylceramide
HbA1C Hemoglobin A1C
HDL High-density lipoprotein
HIV Human immunodeficiency virus
HSN/HSAN Hereditary sensory (and autonomic) neuropathies
HSV Herpes simplex virus
IASP International Association for the Study of Pain
IB4 Isolectin B4
IBD Inflammatory bowel disease
IBS Irritable bowel syndrome
IDO Idiopathic detrusor overactivity
IENF(s) Intraepidermal nerve fiber(s)
IENFD Intraepidermal nerve fiber density
IgM Immunoglobulin M
IL-1β Interleukin-1β
IL-2 Interleukin-2
iRBD Idiopathic rapid eye movement (REM) sleep behavior
disorder
IVIg Intravenous immunoglobulin
LDIFLARE Laser Doppler imager-FLARE
LEP Laser-evoked potential
LGI-1 Leucine-rich glioma-inactivated 1
LTD Long-term depression
LTP Long-term potentiation
M-CSF Macrophage colony-stimulating factor
mGluR5 Metabotropic glutamate receptor subtype 5
MPEP 2-methyl-6-(phenylethynyl)-pyridine
MSA Multiple system atrophy
Abbreviations xxi

Nav Voltage-gated sodium channels

NCS Nerve conduction studies
NeuPSIG Neuropathic Pain Special Interest Group of International
Association for the study of Pain
NFκB Nuclear transcription factor κB
NGF Nerve growth factor
NK1 Neurokinin-1
NMDA N-methyl-d-aspartate or N-methyl-d-aspartic acid
NNH Number needed to cause harm
NNT Number needed to treat
NPY Neuropeptide Y
NSAID Nonsteroidal anti-inflammatory drug
NT-3 Neurotrophin-3
PAG Periaqueductal gray
PD Parkinson’s disease
PENS Percutaneous electrical nerve stimulation
PEPD Paroxysmal extreme pain disorder
PGP9.5 Protein gene product 9.5
PHN Postherpetic neuralgia
PKA Protein kinase A
PKC Protein kinase C
PMP22 Peripheral myelin protein 22
PNQ Participant Neurotoxicity Questionnaire
PNS Peripheral nervous system
POEMS Polyneuropathy associated with organomegaly, endocri-
nopathy, monoclonal gammopathy, and skin
hyperpigmentation
POTS Postural tachycardia syndrome
PPI Psychophysiological interaction
PSP Progressive supranuclear palsy
QSART Quantitative sudomotor axon reflex test
QST Quantitative sensory testing
RA Rheumatoid arthritis
RAGE Receptors for advanced glycation end products
RBD Rapid eye movement (REM) sleep behavior disorder,
REM sleep behavior disorder
RBP Retinol-binding protein
REM Rapid eye movement
RTX Resiniferatoxin
RVM Rostroventromedial medulla
SFN Small fiber neuropathy
SGNFD Sudomotor nerve fiber density/sweat gland nerve fiber
density
SLE Systemic lupus erythematosus
SNRI Serotonin noradrenalin reuptake inhibitor
SP Substance P
SSEP Somatosensory-evoked potential
SSR Sympathetic skin response
xxii Abbreviations

SSRI Serotonin specific reuptake inhibitor

T4 Thyroxine
TCA Tricyclic antidepressant
tDCS Transcranial direct current stimulation
TGF Transforming growth factor
TH Tyrosine hydroxylase
TIND Treatment-induced neuropathy of diabetes
TMS Transcranial magnetic stimulation
TNFα Tumor necrosis factor α
TNSc Total Neuropathy Score clinical version
TRPV1 Transient receptor potential subfamily vanilloid 1
TST Thermoregulatory sweat testing
tTMS Repetitive TMS
TTR Transthyretin
UC Ulcerative colitis
VAS Visual analog scale
VEGF Vascular endothelial growth factor
VGKC Voltage-gated potassium channels
VIP Vasoactive intestinal peptide
VZV Varicella zoster virus
WHO World Health Organization
WHOQoL WHO quality of life
α-Gal A α-galactosidase A
 Part I
Overview and Assessments
of Small Fiber Neuropathy
 Overview of Small Fiber
Neuropathy 1
Ming-Tsung Tseng, Chun-Liang Pan,
and Sung-Tsang Hsieh

Abstract is often described as burning, shooting,

Small fiber neuropathy (SFN) results from ­tingling, and even pruritic. Usually, symptoms
impairment of small-diameter myelinated Aδ- have a length-dependent distribution, but they
and unmyelinated C-fibers. This debilitating may also present in a non-length-dependent
condition usually leads to alterations in noci- manner. The natural course of SFN is highly
ceptive processing, thermal sensations, and variable, and, in some cases, large fiber neu-
autonomic functions. The most common clini- ropathy may develop. Despite being regarded
cal feature of SFN is neuropathic pain, which as a distinct nosologic entity, SFN is either
idiopathic or associated with a heterogeneous
group of diseases. The pathogenesis of the
development and maintenance of SFN is not
M.-T. Tseng (*) completely understood. Recently, gain-of-­
Graduate Institute of Brain and Mind Sciences, function mutations of the sodium channels
National Taiwan University College of Medicine,
have been found to enhance the excitability of
Taipei, Taiwan
e-mail: [email protected] dorsal root ganglion neurons, which may
explain the presence of neuropathic pain
C.-L. Pan
Graduate Institute of Molecular Medicine, symptoms in patients with SFN. However, the
National Taiwan University College of Medicine, underlying mechanisms leading to the axonal
Taipei, Taiwan degeneration of small-diameter sensory nerves
S.-T. Hsieh remain unclear. On neurological examination,
Graduate Institute of Brain and Mind Sciences, impaired small fiber sensations can be
National Taiwan University College of Medicine,
detected, including thermal or pinprick hypo-
Taipei, Taiwan
esthesia or hyperalgesia, and allodynia to
Department of Anatomy and Cell Biology,
mechanical stimulations. At present, the diag-
National Taiwan University College of Medicine,
Taipei, Taiwan nosis of SFN relies upon clinical signs of
small fiber damage, abnormality in small fiber
Graduate Institute of Clinical Medicine,
National Taiwan University College of Medicine, neurophysiological testing, and reduced
Taipei, Taiwan intraepidermal nerve fiber density. Non-­
Center of Precision Medicine, National Taiwan length-­dependent SFN is underdiagnosed due
University College of Medicine, Taipei, Taiwan to the absence of a typical topographic pattern.
Department of Neurology, National Taiwan In conclusion, patients having chronic pain
University Hospital, Taipei, Taiwan and autonomic dysfunctions with unclear

© Springer Nature Singapore Pte Ltd. 2019 3

S.-T. Hsieh et al. (eds.), Small Fiber Neuropathy and Related Syndromes: Pain and Neurodegeneration,
https://doi.org/10.1007/978-981-13-3546-4_1
4 M.-T. Tseng et al.

causes warrant a diagnostic consideration innervation requires taking consideration of age-

of SFN. After the diagnosis is confirmed, and gender-adjusted normative values for inter-
­underlying etiologies that are potentially treat- preting IENF density (IENFD). SFN has been
able should be investigated. reported to affect at least 52.95 cases per 100,000
populations per year [8].
Keywords
Painful neuropathy · Autonomic neuropathy
Neuropathic pain · Pruritus · Skin biopsy 1.2 Clinical Manifestation
Intraepidermal nerve fiber · Clinical presenta-
tions · Pain evoked potential (pain-related Typical symptoms of SFN stem from impairment
evoked potential) · Dysautonomia in nociceptive processing, thermal sensation, and
autonomic function (Table 1.1) [2, 9]. The most
prominent clinical feature of SFN is neuropathic
pain, which is noted in more than 80% of patients
1.1 Introduction [1, 2, 8]. Pain quality in SFN is commonly
described as burning, shooting, tingling, and even
Small fiber neuropathy (SFN) is characterized pruritic. Among different characters of pain,
by the impairment of small-diameter myelinated burning pain is a frequent symptom, affecting
Aδ- and unmyelinated C-fibers. The term SFN about two-thirds of patients, which is followed by
commonly involves “painful neuropathy” and sharp pain. In addition to spontaneous pain,
“autonomic neuropathy,” and frequently neuro- patients with SFN may also complain of allo-
pathic pain or autonomic symptoms dominate dynia (i.e., pain elicited by a stimulus that does
the clinical picture, respectively [1, 2]. From not normally provoke pain) evoked by static light
clinical and research’ points of view, SFN is touch, dynamic mechanical stimulation, or
defined according to a set of criteria at three lev- innocuous heat. Most patients complain of both
els of diagnostic certainty after exclusion of spontaneous and evoked pain, although some
large fiber involvement: (1) clinical symptoms/ may have either of them alone.
signs, (2) abnormal psychophysical and/or neu- Pruritus has been reported to occur frequently
rophysiological examinations, and (3) reduced in patients with SFN, involving up to 68.3% of
skin innervation as pathological evidence (see
Sect. 1.4 and Sect. 2.8 for details in Chap. 2) Table 1.1 Presentations of small fiber neuropathy
[1–4]. Although Paul Langerhans described the
Sensory Spontaneous pain (burning, sharp)
presence of small-­diameter sensory nerves in the system Evoked pain (allodynia,
epidermis in 1868 [5], evaluating the integrity of hyperalgesia)
small-diameter sensory nerves, especially the Pruritus (alloknesis, hyperknesis)
Paraesthesias
intraepidermal nerve fibers (IENFs) systemati-
Dysesthesias
cally and quantitatively at the light microscopic Hypoesthesia (thermal and pinprick)
level, was not feasible until the 1990s, when Restless legs syndrome
immunohistochemical procedures using pan- Autonomic Sudomotor (hypohidrosis,
neuronal markers (particularly protein gene system anhidrosis)
Cardiovascular (orthostatic
product 9.5) were established [6, 7]. hypotension)
SFN accounts for approximately 50% of sen- Gastrointestinal (diarrhea,
sory neuropathy [1]. The precise prevalence of constipation, dysphagia)
SFN remains unclear, because routine nerve con- Genitourinary (retention,
incontinence, sexual dysfunction)
duction and evoked potential studies fail to detect Visual (blurred vision, light
the integrity of small nerve fibers. Moreover, dif- hypersensitivity)
ferent diagnostic criteria have been used in differ- Mucocutaneous (dry eye, dry mouth,
ent studies, and the confirmation of reduced skin skin discoloration)
1 Overview of Small Fiber Neuropathy 5

patients [10]. It is usually accompanied by neuro- also develop in a non-­length-­dependent distribu-

pathic pain and rarely occurs alone, given that tion, involving face, trunk, or proximal limbs in
pruriceptors and nociceptors are usually coex- the early phase of disease. Patchy involvement of
pressed in the same peripheral nerve fibers [11]. small fibers has been proposed to be the underly-
It is more severe in the evening and often present ing etiology for some focal burning pain syn-
in a distal-to-proximal gradient. Like allodynia dromes, such as burning mouth syndrome [18]
and hyperalgesia in neuropathic pain, alloknesis and notalgia paresthetica [19]. Compared to
(itch sensation provoked by non-itching stimuli length-dependent SFN, patients with non-length-
such as light touch) and punctate hyperknesis dependent SFN appear to have younger age of
(itch sensation provoked by punctate mechanical onset, report more pruritic symptoms and allo-
stimuli) may occur in SFN patients with neuro- dynia, and have more immune-­mediated but less
pathic pruritus [12]. It remains unknown why dysglycemic etiologies [20, 21].
some SFN patients manifest pain but others had SFN is now considered as a distinct nosologic
pruritus. An interesting observation is that herpes entity after exclusion of large fiber dysfunctions.
zoster is associated with a high incidence of neu- Symptoms and signs of large fiber dysfunctions,
ropathic pruritus [13]. such as imbalance, abnormal joint position sense,
During the disease course, about half of the weakness, and muscle wasting, may develop
patients exhibit manifestations related to the together with above described clinical presentation
autonomic nervous system. The most common of SFN. Furthermore, small fiber pathology may
autonomic presentation is hypohidrosis or anhi- coexist with a disease status such as fibromyalgia
drosis, occurring in about 25% of patients [1]. [22, 23] or neurodegenerative disease of Parkinson’s
Other autonomic symptoms include dysfunctions disease [24]. A general nomenclature of small fiber
in the cardiovascular (orthostatic hypotension), pathology or syndrome [23] is designated for small
gastrointestinal (diarrhea, constipation, dyspha- fiber nerve degeneration and corresponding func-
gia, gastroparesis, increased gastric motility, and tional impairments on a background of larger fiber
early satiety), and genitourinary systems (reten- neuropathy (described in Chap. 9) or pain syn-
tion, incontinence, and sexual dysfunction) [9]. dromes (discussed in Chap. 11) and neurodegen-
Some patients may also complain of blurred erative disease (described in Chap. 13). In many
vision, light hypersensitivity, skin discoloration, systemic diseases, such as diabetes (please see
dry eyes, dry mouth, and dizziness. Although Chap. 6), amyloidosis (detailed in Chap. 8), para-
small-diameter sensory fibers mediate both neoplastic syndromes, etc., pure SFN may be rare
somatosensory and autonomic functions, no evi- or variable in frequency depending on study popu-
dence suggests a clear relationship between man- lations. Damage of small fibers is frequently
ifestations attributed to these two classes of small encountered in some forms of neuropathies at the
fiber nerve functions [14, 15], suggesting that the early stage, such as amyloid neuropathy and large
involvement of autonomic and somatic functions fiber involvement developed at the late stage. About
could be independent. 10% of patients with a first diagnosis of SFN will
Other SFN symptoms include dysesthesia, develop symptoms and signs indicating the involve-
numbness, and coldness sensations. Restless legs ment of large fibers in the following 2 years [1].
syndrome is present in about 40% of patients with The natural course of SFN is highly variable.
painful neuropathy [16]. Negative symptoms can Clinical symptoms may remain stationary, remit
include thermal and pinprick hypoesthesia and spontaneously, or deteriorate during the disease
insensitivity to pain. Symptoms usually present in course [1]. In patients with idiopathic SFN and
a length-dependent distribution, i.e., “stocking- SFN associated with diabetes or impaired glu-
glove” pattern, starting from the toes and slowly cose intolerance, recent evidence suggests that
progressing to the distal legs, at which point the the small fiber degeneration progresses in a
distal parts of the upper extremities may also non-­
­ length-­dependent manner at a 2–3-year
become affected [17]. However, symptoms may ­follow-­up [25].
6 M.-T. Tseng et al.

1.3 Etiology causes could only be confirmed in 25% of SFN

patients during a follow-up period of 2 years [1].
Although many conditions are associated with For SFNs secondary to other causes, diabetes
SFN (Table 1.2), the largest proportion of and impaired glucose tolerance are the most
patients is categorized as idiopathic [2]. In a common causes, accounting for about 36% of
large case series, up to 41.8% of SFN patients SFN patients in total [1].
have no identifiable cause, and the underlying The pathogenesis of the development and
maintenance of SFN is not completely under-
stood. For SFN associated with hyperglycemia,
Table 1.2 Etiology of small fiber neuropathy evidence indicates that dysregulated axonal
Metabolic Glucose metabolism-related transport and reduced vascular growth play
(DM, IGT) important roles in the impairment of axonal
Chronic kidney disease
Hypothyroidism regeneration [26, 27]. With regard to immune-­
Hyperlipidemia related SFN, evidence suggests that both autoan-
Vitamin B12 deficiency tibodies and proinflammatory cytokines are
Immune-mediated Autoimmune diseases (SLE, SS) elevated in patients with SFN [28, 29], and vas-
Inflammatory neuropathies
culitis contributes to the degeneration of small-­
(GBS, CIDP)
Monoclonal gammopathy (AL, diameter nerve fibers [30, 31]. In alcohol-related
MGUS) SFN, the direct neurotoxic effects of ethanol or
Inflammatory bowel disease its metabolites had been implicated [32].
Vasculitis
Recently, altered nerve excitability due to gain-­
Paraneoplastic syndrome
Sarcoidosis function mutations in Nav1.7, Nav1.8, and
of-­
Infectious Human immunodeficiency virus Nav1.9, three voltage-gated sodium channels, had
Hepatitis C virus been reported in painful neuropathy [33–35].
Leprosy Mutations of these sodium channels have been
Lyme disease
found in up to 30% of carefully selected cases
Drugs and toxic Ethanol
Bortezomib diagnosed as idiopathic SFN. Gain-of-function
Metronidazole mutations of Nav1.7, Nav1.8, and Nav1.9 enhance
Nitrofurantoin the excitability of dorsal root ganglion neurons,
Hereditary Hereditary sensory and which likely contributes to pain in
autonomic neuropathies
Channelopathy (SCM)
SFN. Nevertheless, whether and how these muta-
Familial amyloidosis tions lead to axonal degeneration of small-­
Fabry disease diameter sensory nerves remains unclear.
Tangier disease
Neurodegenerative Parkinson’s disease
Pure autonomic failure
Motor neuron disease 1.4 Diagnosis
Idiopathic Idiopathic
Fibromyalgia On neurological examination, the major findings
Complex regional pain syndrome are sensory deficits related to small fiber dys-
Focal burning syndrome (BMS,
NP)
function. About half of the patients demonstrate
thermal and/or pinprick hypoesthesia, 10–20%
AL light chain amyloidosis, BMS burning mouth syn-
drome, CIDP chronic inflammatory demyelinating poly- with hyperalgesia, and about half of them with
neuropathy, DM diabetes mellitus, GBS Guillain–Barré allodynia to mechanical stimulation [1, 8]. Large
syndrome, IGT impaired glucose tolerance, MGUS mono- fiber motor (muscle strength and deep tendon
clonal gammopathy of undetermined significance, NP
reflexes) and sensory functions (light touch,
notalgia paresthetica, SCM sodium channel mutations,
SLE systemic lupus erythematosus, SS Sjögren’s vibration, and proprioception) are relatively pre-
syndrome served. With regard to dysautonomia, common
1 Overview of Small Fiber Neuropathy 7

manifestations include sluggish or absent light These graded diagnostic criteria were
reflexes, orthostatic hypotension, skin color d­eveloped for length-dependent SFN and also
changes, and warmth or coldness of the skin. applicable for non-length-dependent SFN. Note
Patients with suspected dysautonomia should that, due to the absence of a typical topographic
receive a complete assessment of the autonomic pattern of symptoms in non-length-dependent
nervous system, including the cardiovascular SFN, it is conceivable that non-length-dependent
adrenergic (blood pressure response to postural SFN is an underdiagnosed condition. Serious
changes), gastrointestinal (constipation, gastro- comorbidities may complicate the diagnosis of
paresis), genitourinary (libido, erectile function), isolated SFN. Moreover, malfunctions of the
sudomotor (sweat output), and pupillary func- small fibers, especially overactivity, can occur
tions (light reflex) [36]. even without evidence of loss of function or
Irrespective of the underlying causes, a diag- reduction of IENFs on skin biopsies.
nosis of SFN can be made when at least two of
the following criteria are met [1–4]:
1.5 Treatment
1. Clinical symptoms and signs of small fiber
damage (pinprick and thermal sensory loss Treatment of SFN should be aimed at the under-
and/or allodynia and/or hyperalgesia), with a lying etiology if identifiable [40]. Nevertheless,
length-dependent or non-length-dependent whether and how disease-modifying therapy
distribution halts small fiber degeneration remains unclear.
2. Abnormal warm and/or cooling threshold in In diabetes-related SFN, persistent glycemic
control appears to reduce SFN symptoms [39],
the foot based on quantitative sensory testing,
or abnormalities in small fiber neurophysio- but rapid improvement in glycemic control
logical testing, such as nociceptive evoked paradoxically induces painful neuropathy [41].
potential (pain evoked potential or pain-­ In Fabry disease, although preliminary evi-
related evoked potential, which will be dis- dence suggests that enzyme replacement ther-
cussed in Chap. 3) by laser, electrical, or apy improves clinical manifestations of SFN
contact heat stimulators [37, 38] [42, 43], its effects on small-diameter sensory
3. Reduced IENFD in the distal leg nerves remain to be clarified. For idiopathic
SFN, treatment is mainly directed to the relief of
Clinically, these criteria are used to define symptoms, especially the control of neuropathic
three levels of diagnostic certainty: pain, which will be detailed in Chap. 15 of this
monograph. Antidepressants and antiepileptic
1. Possible SFN: the presence of length-­ drugs that have shown their efficacy for neu-
dependent symptoms and/or clinical signs of ropathic pain in general (pregabalin, gabapen-
small fiber damage tin, tricyclics, duloxetine, etc.) are considered
2. Probable SFN: the presence of length-­ as first-line treatment. Other options include
dependent symptoms, clinical signs of small opioids, lidocaine, and capsaicin patches [44,
fiber damage, and normal sural nerve conduc- 45]. Nav1.7 and Nav1.8 blockers are potential
tion study therapeutic options in the future. With regard
3. Definite SFN: the presence of length-­ to the autonomic neuropathy, most symptoms
dependent symptoms, clinical signs of small are mild to moderate and do not require medi-
fiber damage, normal sural nerve conduction cal treatment [1, 14]. There might be regional
study, and reduced IENFD at the ankle and variations in the degree of dysautonomia. For
abnormal quantitative sensory testing thermal severe postural hypotension affecting quality of
thresholds in the foot and/or abnormal small life, inotropic agents (midodrine and pyridostig-
fiber neurophysiological findings [17, 39] mine) and mineral corticosteroids (fludrocor-
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CORNELL UNIVERSITY LIBRARY
The Book of Wisdom
 The Oxford Church Bible Commentary THE BOOK OF
WISDOM WITH INTRODUCTION AND NOTES EDITED BY THE REV.
A. T. S. GOODRICK, M.A. RECTOR OF WINTERBOURNE, BRISTOL
FORMERLY FELLOW AND TUTOR OF ST, JOHN'S COLLEGFE,
OXFORD RIVINGTONS 34 KING STREET, COVENT GARDEN LON
DON 1913
 COPYRIGHT 125HI 6.28 PILE Pac ‘WHEN will the learned
man appear,’ asks Harnack, speaking of the Apocrypha, ‘who will at
length throw light upon these writings ?? The answer, so far as
concerns the Book of Wisdom, is ‘Never.’ No learned man will ever be
able to explain the mind of an author who did not know it himself.
Such attempts have been made in respect of modern writers, and
the result has been unsatisfactory. With regard to the ‘Wisdom of
Solomon,’ the time of theories is past. They must still be chronicled,
but they are never final. All that remains is to secure a rational
exegesis, for which much has yet to be done. « ' For such exegesis
Grimin's admirable Commentary must always be the foundation. For
the summary of the views of previous critics, for the collection of
parallel and illuminative passages, and for rational explanation of
difficulties, the work stands by itself. Yet it has its faults. Jar too little
attention is paid to the last chapters of the book, which are indeed
generally neglected as of little philosophical interest. Theologically,
as a matter of fact, and as representing a distinctly Egypto-Hebraic
point of view of God’s Providence, they are infinitely more interesting
than the first part, and that they were full of difficulty even for
ancient readers is shown by the
 iv THE BOOK OF WISDOM number of variations of
interpretation in the versions far more numerous than in the earlier
chapters. Yet these are almost entirely neglected by Grimm, who
does not even notice the strange aberrations (or paraphrasges) of
the Peshitto-Syriac. Moreover, the number of his false citations is
amazing. In many cases this is probably duc to the printer’s error,
but not always!; the present editor has collected upwards of seventy
such mistakes—a warning that the book must be treated with the
greatest caution in this respect. The present editor had purposed,
and did to a certain extent execute, a careful study of the older
commentators enumerated in Mr. Deane’s Bibliography of ‘Wisdom.’
He quickly found that, with the exception of the merely homiletic
writers, there were few indeed whose conclusions had not been
briefly and acutely summarised by Grimm. Exception must be made
in the case of Holkot, whose merits are hereafter discussed, and
whose works Grimm seems to have as a rule neglected. Nor is he
quite fair to the brilliantly original work of Bretschneider, among later
critics. But with the writings called forth by the famous German ‘
Apokryphenfrage’ (which often contained a good deal more than
mere polemic) he was thoroughly acquainted, and gives us the
results. Grimm's work, in the form of a judicious adaptation (at times
a translation), was presented to English readers by Dr. Farrar in the
Speaher's Commentary. He added to it much illustration from
modern and especially English sources, and, best of all, he
supplemented his author’s 1 #.g. on 147, after enumerating
passages, quite correctly, where ξύλον means the cross of Christ,
Grimm subjoins Acts 1644, where it means ‘the stocks.’ τῶν —— ΟΝ
arn i ees SRT mits, tle ge PREFACE v jejune notes on the last ten
chapters so effectively that he is cited by modern German critics
(under the name of ‘“Wace’!) as an independent authority. Unhappily
Dr. Farrar did not verify Grimm’s references," and he quoted books
which he had never seen. Yet at the time of its appearance (1888),
and for long after, his work was far the best available for English
students. In many respects it is so still. A few years before the
appearance of the Speaker's Commentary, in 1881, Mr. Deane had
published his elaborate edition of the Old Latin, the Greek Text, and
the Authorised Version. To this work, with its full citations from the
Fathers and its commonsense way of dealing with difficulties, the
editor must acknowledge his great indebtedness. Mr. Deane'’s
estimate of Philo’s philosophy, in his Introduction, is severe; but no
one who has had to read through the hazy and often contradictory
lucubrations of the old Alexandrian will deny that it is to some extent
deserved. On the other hand, he speaks too slightingly of Bissell’s
American edition of the Apocrypha, which certainly contains some
remarkable interpretations,’ but of which the greatest fault is
certainly not that it ‘seems to be chiefly a compilation from 1 A
single instance may suffice. Grimm on Wisdom 145 quoted the
famous ‘Illi robur et aes triplex’ as from the second ode of Horace,
Book I. (the equally famous ‘Jam satis terris’). Farrar copies the
error! As to the second charge: he cites Noack (Introd., 413 n.) as
saying that ‘Apollos wrote (Wisdom) with the help of St. Paul? Now
Noack’s point is to prove the antagonism between Apollos and St.
Paul. For other instances see the notes. Siegfried in Hast. 2). B., iv.
9314, cites the works of Farrar and Deane as ‘recent English
translations.” Both adopt the Authorised Version as their text. 2 Eg.
1538. a2
 vi THE BOOK OF WISDOM German sources.’ Dr. Bissell’s ‘
Introductions’ are often excellent. Quite recently there has appeared
a small edition of the Book of Wisdom, with Introduction and Notes
by Mr. J. A. F. Gregg. Nominally part of the Cambridge Series ‘for
Schools and Colleges,’ this little book really embodies, especially in
the Introduction, some of the most valuable results of modern
criticism. The notes are excellent in respect of exegesis, but from the
necessary limitations imposed on such a work do not deal with many
questions which are here discussed. The edition of ‘Wisdom’ by the
late Father Cornely (Paris, 1910), revised by Zorell, appeared just in
time to be utilised by the present editor. It contains undoubtedly the
best commentary which has yet been published. The writer is
distinguished both for his lucidity of thought and the candour of his
statements. He is by no means wedded, like so many of his
predecessors, to the Latin version (cf. his notes on 174, 181), and he
does not hesitate to adopt the opinions of ‘ Acatholici’ when they
appear the better, citing the English version at times with approval.
His knowledge of the early commentators is superior even to that of
Grimm. He has, however, his limitations. Apart from the onerous
task, imposed on all members of his church, of defending the
canonicity of the book, and to that end explaining away the blunders
of Pseudo-Solomon, he exhibits certain idiosyncrasies. He holds to
the idea that the picture of the persecuted Righteous Man in chap. 2
refers distinctly to the suffering Christ, and he refuses to
acknowledge that the ‘Wisdom’ of the first nine chapters is tacitly
forgotten in the last ten. He even tape er hay τοῦτ τα ye me ὡς
PREFACE vii insists, in spite of the strongest internal evidence, that
the, person addressed in chaps. 11-12 is not God but Wisdom,
though he acknowledges that such Wisdom is there and thereafter
treated merely as an attribute of God. On the other hand, he
brushes aside without hesitation the timehonoured efforts to extract
from the book authority for modern Roman doctrines. Sce his note
on ‘refrigerium’ in 47. Lastly, we may note that he has little or no
acquaintance with the Rabbinic legends and ideas by which so many
passages of ‘Wisdom’ can be elucidated. Within the last thirty years
the recognition of the arbitrary nature of the Jewish canon of
Scripture, and the awakened interest in the documents which form
the ‘bridge’ between Old and New Testament doctrine, have
produced a number of works of which the result at least should be
presented to the student of ‘Wisdom.’ Some writers, as Bois,
Bertholet, André, Grafe, Siegfried (in his all too brief Commentary
appended to his translation in Kautzsch’s Apokryphen), and Zenner,
deal directly with the text of the book ; while among collateral works
those of Edmund Pfleiderer, Schwally, Charles, Bousset, Margoliouth,
Weber, Lincke, Deissmann, Drummond, and others furnish invaluable
side-lights. To these should be added numerous articles in Hastings’
Dictionary, in the Encyclopedia Biblica, and in the new edition of
Herzog’s Real-Encyklopadie. The contribution of Mr. F. C. Porter to
our knowledge of ‘Wisdom’s’ psychology is dealt with here in a
separate Additional Note. Nor should it be forgotten that within the
period mentioned many monumental works of criticism, for the
knowledge of which English scholars were once condemned to wait
for a translation often inadequate and sometimes
 viii THE BOOK OF WISDOM misleading, have, owing to the
increasing knowledge of German in this country, been rendered
accessible to multitudes of Biblical students. Gfrérer, Gratz, Langen,
Bruch, Budde, Duhm, can now be read in their mothertongue, and
the advantage to English theological knowledge has been
incalculable, from the side both of constructive and destructive
criticism. From the Revised Version little or no assistance has been
derived. It is perhaps the least successful of the translations of the
Apocrypha undertaken by the revisers. It is diffuse without being
explanatory ; and it includes some of the worst faults which made
the New Testament revision fail, eg. the attempt to represent the
same Greek word by the same English word in whatever sense it
occurs. In the case of the author of Wisdom, who, with a vocabulary
at once limited and peculiar, had to make the same Greek word
serve as the equivalent for many ideas, this is especially unhappy.
The best renderings will generally be found, not in the text, but in
the margin of the Revised Version.! On two points the editor has
ventured to differ from his predecessors: on one, from most; on the
other, from practically all. He cannot accept the assumption that the
Book of Wisdom is a homogeneous whole, written by the same pen,
at the same time, and with the same purpose. Secondly, a careful
study of the text has convinced him that the author did not really
know Greek. For both these views he trusts that he has submitted
sufficient grounds. The establishment of the 1 For an instance of
something like absolute mistranslation see 15°, where the meaning
of ἔρχεται εἰς seems to be completely misunderstood. we ee
PREFACE ix second’ would at all events clear away a mass of
difficulties from the interpretation of ‘ Wisdom.’ ὦ The text adopted
for translation is Swete’s, but with occasional corrections from
Fritzsche, chiefly on the ground of the closer correspondence of the
latter with the ancient versions. These the editor has examined and
utilised to the best of his ability, and in particular he has used
throughout the Hexaplar version of the Syriac, which has been
greatly neglected, as reputed to be a mere slavish version of the
Septuagint text. ut which text? The whole importance of the version
depends upon that. Quotations, where it seemed that they really
tended to elucidation, have been given in full, even at the risk of
considerably increasing the volume of the book. It is unfair to expect
the ordinary student to spend time over the consultation of every
authority quoted ; it is still more disappointing for him to look out a
reference with pains and trouble, and to find that the merest verbal
1 Dr. J. H. Moulton, in his admirable ‘Prolegomena,’ writes as follows
of the New Testament authors: ‘There is not the slightest
presumption against the use of Greek in writings purporting to
emanate from the circle of the first believers. They would write as
men who had used the language from boyhood, not as foreigners
painfully expressing themselves in an imperfectly known idiom. . . It
does not appear that any of them used Greek as we may sometimes
᾿ find cultivated foreigners using English, obviously translating out of
their own language as they go along.’ This is no doubt ‘absolutely
true with regard to the New Testament authors: they wrote the
κοινή ; but Pseudo-Solomon does not write the cown. He writes
classical Greek exactly as Dr. Moulton’s cultivated foreigner would
write English—with a scanty vocabulary and a tendency to
oldfashioned forms of expression. It is much to be desired that some
critic of Dr. Moulton’s capacity and knowledye would turn his
attention to the Greek of ‘Wisdom.’
 x THE BOOK OF WISDOM correspondence is contained in
the passage cited. the volumes and pages of Mangey’s edition. A. T.
5. GOODRICK. _ WINTERBOURNE RECTORY, October 1912. LIST OF
ABBREVIATIONS Most of the abbreviations used in this work explain
themselves the following, which occur only occasionally, may be
noticed :— J. g ἢ =Jewish Quarterly Review. 4. 5.5 Journal of the
Royal Asiatic Society. me Rel. des Jud. = Religion des Judentumsim
Neutestamentlichen ZAcitalter, Berlin, 1903. Schiirer, //. J. ?. =
/fistory of the Jewish People, English translation, . vol. iit, Edinburgh,
1886. Bois, “στα τε ἔσται sur les ortgines de la Philosophie
Judcoalevandrine, Toulouse, 18go. The following are common to the
volumes of this serics :— 1 =the Hebrew text. G:,. G4, GS, etc. =the
various Greek MSS. of the Old and New Testaments. + Ὁ =the Old
Latin Version. SP =the Syriac Peshitto. Sh=the Syriac Hexaplar. SPA"
= (in this volume) the fragments of the Syriac Palestinian Version.
T= Fargum, ΖΝ, Targum of Jonathan, T!"*, the Jerusalem Targum.
The references to Philo, it may be remarked, are given, in
accordance with modern usage, to the sections of the various books
and not, as in the old cumbrous system, to At ter ! TD. ON THE
CONNECTION OF E. Gop AND MAN CONTENTS INTRODUCTION— 8
1. WIspoM AND THE HEBREW CANON, . 8 2. Dare ΟΕ
CoMPOSITION, § 3. OnJECT OF THR Book, . § 4. TITLE, 8 5.
AuTHORSIIP OF WISDOM, 8 6. ΤΙΒ CONCRPTION OF “WispoM' IN
THE Book 8. 7. Tur Escnavo.ocy or Wispom, § 8. LANGUAGE OF THE
BOOK, 8 9. Unity oF TIlE Book, 810. TUF MANUSCRIPTS AND
VERSIONS, 811. SYNOPSIS OF THE BOOK, TEXT AND NOTES,
ADDITIONAL NOTES— A. “ON THE PRE-EXISTENCR OF THE SOUL
IN THE BooK oF WIspoM,’ B. ON tHE INTERPRETATION OF WISDOM
3'7, C. Tur Connection oF St. PAUL’s EvistLes WITH THR Book oF
WISDOM, *Wispom’ PIILOSOPHY, In “Wispom,’ ¥F. A Naw
ἹΝΤΕΚΡΚΕΤΑΤΙΟΝ OF PsEUDO-SOLOMON’s IDRA oF WIspom, WITH
GREEK xi PAGE 398 404 411 416
 xii THE BOOK OF WISDOM PAGE APPENDICES— A.
EcyrTiAN DEATH-SONGS, . : Ἴ Γ + 420 Β. PASSAGES OF ENOCH
BRARING ON CHAP. 2, RTC., OF WIspoM, ᾿ i z Ἶ ᾿ . 421 C. THe
Syriac HEXAPLAR, . : 3 : - 423 INDICES— I. Inpgx oF Greek WorpDs,
: : ᾿ ες 415 II. INDEX OF MATTERS AND PERSONS, ‘ 7 . 432 III.
TRANSLATIONS OF THE OLD LATIN VERSION, . . 436
INTRODUCTION § 1. Wisdom and the Hebrew Canon. Tis study of
the non-canonical books of the Old Testament should be at the
present day of peculiar interest. The progress of Biblical criticism,
with the introduction of sounder methods of interpretation, has
inclined us to reconsider the subject of inspiration, and the question
may well be raised whether there are not books outside the Canon
which are more deserving of inclusion than some of those which
have gained admission.* Of such outside works the book of Wisdom
stands out foremost with its noble statement of the doctrine of the
Immortality of the Soul, its indignant denunciation of idolatry at a
time when such denunciation may have been dangerous, and its firm
stand against the Epicureanism which was sapping the very
foundations of Jewish morality and helicf. So exalted Indeed are the
sentiments of the writer that he has been, as we shall see, claimed
as one of the foremost teachers of the early Christian Church. On
what ground his book was never admitted to the Canon we do not
know. Possibly he was after all too late; possibly his unfortunate
parade of Greek learning disgusted the Jewish doctors. a Ryle,
Canon of Ὁ, T.,171. Cheyne, Job and Solomon, 280, states that
‘when after the destruction of Jerusalem Jewish learning reorganised
itself at Jamnia (44 leagues south of Jaffa), the view that the Song
and Koheleth ‘defile the hands,” t.¢e, are holy Scriptures, was
brought forward in a synod held about A.D. 90, and finally
sanctioned in a second synod held a.p. 118. The arguments urged
on both sides were such as belong to an uncritical age. No attempt
was made to penetrate into the spirit and object of Koheleth, but
test-passages were singled out. The herctically sounding words in
11% were at first held by some to be decisive against the claim of
canonicity ; but, we are told, when the ‘‘ wise men” took the close of
the verse into consideration (‘‘ but know that for all this God will
bring thee into the judgment”) they exclaimed, ‘Solomon has spoken
appropriately.”’ Dr. Cheyne adds (281) that ‘there was even as late
as a.D. 90 a chance for any struggling book (e.g. Sirach) to find ite A
 2 INTRODUCTION It is, moreover, high time that the value
of the so-called Apocryphal books (we shall use the term ‘
apocryphic’ as not implying the idea of falsification or forgery which
attaches to the other word) should be recognised, not merely on the
ground of their intrinsic merit, but also because they represent a
transition stage between the doctrines of the Old and New
Testaments. The more the nature of the gap between these has
been recognised, and the more clearly the distinct points of view
which the Old and the New Dispensations afford have been set forth,
the more men’s attention has been directed to the Apocrypha. Under
this name we include not only the books recognised as deutecro-
canonical by Jerome and the Fathers, but also the rich stores of
kindred literature which modern research has unearthed or recalled
to notice. Among the former ‘ Wisdom’ easily holds the first place.
Valued by the early Christians for the beauty of its diction and of its
ideas, it now occupies a higher place as Introducing us to the mind
of a man who stood at the very turning-point of belief ; a Jew so
advanced in his opinions that inconsiderate critics have even called
him Christian. Of this Intermediate literature we recognise three
distinct classes or currents, answering to the 1064] conditions of the
dispersed Jews. We have first the purely Palestinian school,
represented by Siracides, 1 Maccabees, Judith, and the book of
Jubilees. They keep to the old ways; their one concern is with the
observance of the Law and the respect due to the Temple. They
exhibit no ideas with regard toa future state, and they cling to the
old doctrine of retribution meted out by God to the righteous and to
the wicked in this life, In the way into the Canon.’ But Budde
(Althebr. Lit., p. 2) goes further. As late 88 125 a.D., he says, there
was ἃ dispute as to the admission of the Song and Ecclesiastes. It is
true that we find no mention of the rejected candidature of any book
; but the Rabbis seem to have proceeded on two principles—(1) that
books which claimed an authorship older than Moses (e.g. Enoch)
were not genuine ; (2) that Apocalyptic works must be excluded, For
this latter there was ἃ reason; Christian writers had already begun to
employ such books for their own ends. See also Bertholetin the
same volume, p. 338, on the use of the Jewish Apocalypses by
Christian writers, and F. C. Porter in Hast. D. B.,i. 1144. 80 Corn. A
Lapide says that the Jews rejected Wisdoin because the death of
Christ was there predicted. For the views of the Western Fathers on
the Canon, see the full and clear account in Salmon’s Introduction to
the Speaker's Apocrypha, vol. i. pp. xxv-xxviii,'and Bissell, Introd. 51
sqq., cf. Aug. de Doctr. Chr., ii. 8, who practically maintains the
absolute right of the Church to say what is canonical and what is not
; and he is speaking of O.T. as well as N.T. WISDOM AND THE
HEBREW CANON 3 book of Judith in particular we have the old idea
of Yahwe as the national God, protecting his own at the expense of
other nations, and even countenancing the base assassination of
Holofernes as he had countenanced that of Sisera. To the second
class belong those works which, though chiefly of Palestinian origin,
are deeply affected by views imbibed during the captivity from the
followers of Zoroaster. These are 2 Maccabees, Baruch, the additions
to Daniel, and, most ‘of all, on the score of local origin as well as of
content, Tobit. In these books we find the Resurrection of the Just
plainly set forth, coupled with elements which had but little influence
in the ancient Jewish theology. We have a doctrine of angels
approaching to that of mediacval times, accompanied by a similar
development of belief as to demonic Interference; we have hints of
miraculous interference in the most trifling affairs of domestic life;
and we have the efficacy of prayer for the dead plainly stated. We
have, in short, signs of intermediate opinion; a distinct variation
from Old Testament doctrine; ἃ distinct approximation to that of the
New. But most important of all is the Jewish-Alexandrian class,
which represents not merely the growth of Jewish opinion, unfertile
in itself and yet capable of development when assisted from without,
but also the assimilation of Ilellenic elements. To this class we may
assign without hesitation 1 Esdras, the Prayer of Manasses, and
Wisdom. On the merits and value of our book the most diverse
opinions have been held and expressed. Thestorm of controversy
which began with the decision of the Bible Society to exclude the
Apocrypha from their editions in 1827 involved ‘Wisdom’ in the
general denunciation of books as widely different from it as ‘Bel and
the Dragon.’* We can here only refer to the great dispute over the
retention of the Apocrypha which raged in Germany in the early
fifties of the last century. Conservative Lutherans like Stier and
Hengstenberg, as well as liberal theologians like Bleck, were rightly
in favour of the toleration of the books on precisely the grounds laid
down in our own Articles. But the great value of the discussion was
that it suggested a deeper study of the Apocrypha than had hitherto
been known. ‘The work of its opponents, like Keerl, is most
important. With regard to English scholars of the time, one can only
suppose that their knowledge of ‘Wisdom’ in particular was most
superficial. Brucker’s History of Philosophy was their text-book, and
when Brucker insisted on dis® For specimens of the unmeasured
language used with regard to the Apocrypha in general, cf.
Fairweather in Hast, 2). L., ν. 278. : ἢ
 4 INTRODUCTION covering Platonism, Stoicism, the anima
mundi, and what not, in every chapter of ‘ Wisdom,’ they blindly
followed him. Burton'a Bampton Lectures are a good example of
such criticism, and PayneSmith's words (Bamp. Lect., p. 368) are
worth quoting: ‘It is in the book of Wisdom that we find the open
expression of those philosophlical opinions which finally ruined the
Alexandrian school... . Nothing can be more unsound than its
philosophy, and It did introduce into the Church principles contrary
to the teaching of the New Testament.’ He cites three points: (1) the
eternity of matter, (2) the pré-existence of souls, (3) the inherent
badness of matter and of the body. But the extremest views
naturally were those of the Evangelical school in the Church. We
may cite one specimen from Gurney's Dictionary of the Bible (1828)
: ‘Sundry phrases of It seem taken out of the prophets and even the
New Testament. Some will have Philo the Jew to be the author of it,
but he seems rather to have been a fraudulent Christian. He talks as
if souls were lodged in bodies according to their former merits;
makes the murder of Abel the cause of the flood: represents the
Egyptians as plagued by their own idols, though it [8 certain they
never worshipped frogs or locusts; and calls the divine Logos or
second person of the Trinity a vapour and stream.’ On the other
hand, appreciation at the present day goes too far, as when André
(Les Apocryphes de U Ancien Test., Florence, 1903, p. 312) says that
‘Wisdom’ contains the first attempt at a systematic Jewish
philosophy. Theocratic Monotheism has no place for philosophy ; and
Pseudo-Solomon is nothing if not unsystematic. , Nevertheless, the
book has been repeatedly used In the Christian Church as of
evidential value. It was employed in the Trinitarian controversies, in
which the attributes of Wisdom were connected sometimes with the
person of the Son, sometimes with that of the Holy Ghost.
Methodius used Chap. 4 in pleading for the monastic and conventual
life. Chap. 2 was quoted against the Jews to support the view of a
suffering and nota triumphant Messiah. Chap. 3 is an
encouragement for martyrdom. St. Augustine used the words as to
the inherited guilt of the Canaanites in his argument against the
Pelagian heresy; and the ‘idolatry’ chapters were naturally quoted in
the Iconoclastic disputes (Church Quart. Rev., Apr. 1879). Lastly, the
pseudo-Dionysius in the treatise De divinia nominibus uses the
passage in 8? ἐραστὴς ἐγενόμην τοῦ κάλλους αὐτῆς as a justification
of the erotic or passionate form of devotion, of which enough Is said
in the notes on the text. The book was continually used by the
Christian DATE OF COMPOSITION 5 Fathers for centuries, during
which, according to Freudenthal,® it remained unrecognised by the
Jews. § 2 Date of Composition. The question of date is In the case
of the book of Wisdom of great importance, and that for two
reasons: the first concerning its position in the development of
Jewish Eschatology; the other affecting the question of the purpose
which the author had in view in composing It. We may here
summarise briefly what will be more fully treated of hereafter. (1) If
the date of the writing be pushed as far back as the earliest period
assigned to it by any reasonable critics—say 200 8.c.— then it
represents a most remarkable step forward in the doctrine of the
Resurrection and ofa future life. If, onthe other hand, we accept the
opinion, now more and more advocated, that the book was
composed in the reign of Caligula (37-41 a.v.)," then it contains little
more than the formulation of a belief already current among a large
section of the Jewish people ;° a belief in the Resurrection of the
Dead and the Life Everlasting. (2) Again, If we accept the earller
date, the persecutions indicated must almost certainly be those
alleged to have taken place under the Egyptian Ptolemies. No
authoritative writer considers that the oppression of the Jews by the
kings of Syria can be referred to. But if Egyptian persecution be in
question, then the purpose of the book is little more than an
exhortation to hold fast by God and his Providence, and to resist the
temptations of idolatry. If, however, we adopt the latter date, there
is much ground for accepting the theory that ‘Wisdom’ has, to begin
with, a distinct and definite aim: that [0 [8 directed against those
renegade Jews who, embracing heathenism, had risen high in
imperial favour and held great offices 8 J. Q. R., iii, (1891) 722 sqq.
> Bourset, Theolog. Rundschau, 1902, p. 185. © The whole
question of the differences of the opposing sects of Pharisees and
Sadduceer, and in particular of their antagonistic views on the
subject of the Resurrection, is involved in obscurity. Cf. Griitz,
@eschichle der Juden, iii. 647 sqq., who thinks that the Sadducees
admitted a life after death in some form, but not future rewards and
punishments. There can be little doubt that Josephus is a bad
authority on the subject; he is too much concerned with the
laudation of the Essenes. Yet not only Christian authority (Mk. 1212,
Acts 23 8) ascribes to the Sadducees denial of the Resurrection, but
at least one Talmudic tract (Sanhedrin, 164, quoted by Griitz)
testifies to the same effect. ,
 6 INTRODUCTION unde er the Roman government. They
are regarded as oppressors *® chap. 1 Sane Fi ee 2), and as
idolaters: and certainly, if epted, the purport of the bo violent
rhetoric more justified. fe Cn ewer Ww : aoe mua our attention,
therefore, in the first place, to this ἡ πεν οἰ oe sae ny at once accept
the common dccision eS written later than the ‘Sept ᾿ than those
New Testam : ee ent books in which iti βιὰ ORB : ; 8 quoted or
referred to. πάν cat tat ἐν wales with the Greek Old Testament is
plain cai: es οὐ γὰρ ὑποστελεῖται πρόσωπον ὁ πάντων δεσπότης is
from ἈΠ: 1", οὐ μὴ ὑπόστέϊλῃ πρόσωπον ἀνθρώπου. So also 114
ἐδύθ' ὅν aS ἐκ πέτρας ἀκροτύμου ὕδωρ from Deut. 86, τοῦ ΕἾ τῆν
τως ἠδ se oe ἀκροτύμον πηγὴν ὕδατος ; and though the allusion in
cali 1¢ hornets of Ex. 2378, ete., shows no verbal identity, πῦ a
γύμενον ἐν τῇ χαλάζῃ 167 ia Ex. 9% with the single finns of δι ἀπ με
προ φλογίζον. But the question is set at rest by two pasaii " n 1510
Wisdom has σποδὸς ἡ καρδία αὐτοῦ directly from Tan, 44 20 har ᾿
16 present Hebrew text reads ‘he feedeth on ashes’; and apes rk ee
πον δίκαιον ὅτι δύσχρηστος ἡμῖν ἐστι is irom Isa. 319 mae sh ae ὅτι
δύσχρηστος ἡμῖν ἐστι Which is the Greek transe Hebrew, ‘sa i i ; aaa
y ye to the righteous that it shall be well These are decisive proofs
that the writer knows the Septuagint ; a i ' ἃς: ΕΣ ὩΣ of Philo
generally quoted as condemnatory of the apostates ae ως ing., 8 2),
it is noteworthy that their fault is stated rather as inet oy ᾿ ee They
deride the law. οἱ μὲν δυσχεραίνοντες τὴ πατρίῳ τείᾳ (which seems
to fix the charge on renegade J . γορίαν del τῶν νόμων μελετῶντες,
τούτοις K baste dae viata 0 ‘ A al rots παραπλησίοις, ws ἂν ἐπιβά τῆς
ἀθεότητος αὑτῶν, ol δυσσεβεῖς ῶ Z Ἷ ee fi , ι , χρῶνταὶ, φάσκοντες;
ἔτι νῦν σεμνηγορεῖ: ΤᾺ re i sida ok τοὺς ἀληθείας κανόνας αὐτῆς
περιεχόντων rid μῶμον : at it was his own explaining away of the
historical facts wi i : al fa hich encouree ic De te ai § 16(the whole
section), he protests sednat : can be neglected on account of its
spiritual significati ΤῊ ἀρ τετνὴ τ ἘΝ ideas re spiritual observance of
the law) τε penis 34. est glory is ‘to honour God, not with gifts and
ἜΝ ᾿ purity of xoul and pious belief.’ W ; inlythe dé ee oan De a nce
e see here plainly the decay of belief in the Basic iae of the fidelity of
the apostates to their Egyptian lords, cf. the a corp ti 15), who saved
the life of Ptolemy Piopalor ὃ ist. 0 εἰσί 8}. Nation, 71) nakes out o
iliettus ( Hist ἶ good case f Ϊ Alexander in his suppression of the
tumults at Alexandria. Tieden at actually attempted to set fire t
Pienaar re to the amphitheatre and destroy the multitudes DATE OF
COMPOSITION 7 but they do not justify Farrar (420b) in saying that
he ‘could not have known Hebrew.’ St. Paul Is represented in the
Acts (13 343!) 88 quoting not only the Septuagint but its peculiar
translations. Yet no one argues that he did not know the original. Ἢ
We have, therefore, the “date of the Septuagint’ * as fixing the
earliest time at which our book could have been written. But this
date is almost no date at all. The idea of the simultaneous or even
contemporary translation of the books of the Old Testament has long
ago been given up, and it is recognised that the narrowest time-limit
which can be assigned to the compilation of the Greek Old
Testament [8 that of 283-205 5.0. (the reigns of Ptolemy
Philadelphus, Euergetes, and Philopator). No book of which the
author can be proved to have known the Septuagint can be dated
earlier than 210 B.c. On the other hand, 4 date, not much more
definite, is fixed as the latest at which the book can have been
composed, by the quotation of it by New Testament writers. The
question of such quotation becomes, therefore, of considerable
importance. Before entering upon it, we may dismiss ina few words
the matter of the relation or want of relation between ‘ Wisdom’ and
Philo. Philo’s lifetime may be roughly put between 20 n.c. and 45
A.D., and if there were the slightest reference in him to Wisdom or in
Wisdom to him, we should have some vague indication of date. But
no auch allusions can be traced, and we are left to the ἃ priori
conjectures of scholars. Schiirer (Jewish People, Eng. tr., 11. tii. 234)
argues that, as the PscudoSolomon’s standpoint is a preliminary step
to Philo’s, he must precede Philo. Farrar, on the contrary (4210),
thinks that he must be later ; for, ‘if he had preceded Philo, some
traces of the powerful style and individuality and phraseology of the
Pseudo-Solomon must surely have been observable in the
voluminous pages of the Jewish Theosophist.’. The argument is not
without force; but the conflicting views ὁ It is noteworthy, though it
militates against the theory of the late origin of ‘Wisdom,’ that the
books especially quoted by Paeudo-Solomon were precisely those
which are supposed to have been first translated. For a clear and
succinct account of the probable origin of the Septuagint, see
besides Swete, Introduction to the Old Testament in Greek, Salmon’s
Introduction to the Apocrypha (Speaker's Com.), § 22. For its date
cf. Schiirer, Jewish People in the Time of Christ (Eng. tr.), Div. 11 vol.
iii. 161, 201. The earliest writer who quotes it seems to be a certain
Demetrius, about 210 B.c., but even then it is possible that some
books remained untranslated. Gritz (Gesch. der Juden, iii, 623) puts
Demetrius much later, and indeed refers the whole Septuagint to
adate not earlier than 150 B.c. Cf. Swete, Introduction, pi 17.
 8 INTRODUCTION are almost reconciled if we suppose, that
the two writers are nearly contemporary. In that case Εἰ ὰ further
position, that we have here ‘anauthor who was famili μὐά! τῇ the
speculations of Philo, but who regarded them from οπαι αν
independent point of view,’ may be fully justified on In dealing with
quotation 88 we shall find reason to do, ompletely in any given case.
Nevertheles ἘΠ: here too striking to coe θεν το Sore mat - The
coincidence—to call it nothing more—of Epistle to the Hebrews with
that of Wisdom is tiaras gave Tse to somewhat extravagant theories,
hereafter to be sentenced A few instances willsuffice. In Heb. 12the
unusual phrase ἀπαύ : τῆς δόξης αὐτοῦ corresponds to Wisd. 726
ἀπαύγασμα φωτὸς didio aia it is applied to σοφία. Again, the words
τόπος μετανοίας in Wied 1200 are repeated in Heb. 1217, IIere,
indeed, the verbal xesoritlan cease, except for παιδεία in the sense
of disciplinary sufferin aa repeatedly in Heb. 12 511 and alao in
Wisd. 35 (παιδευθέντες); ‘xB τὰ the result and end of life ἴῃ Heb.
137 and Wisd. 217, and θε ray oad Ἢ Moses as the ‘servant’ of the
Lord in Heb, 3% and Wisd. Ἵ 21 the mee not occurring elsewhere in
the New Testament. But besides ΤῊΝ ther seem to be genuine
resemblances of thought in Heb. 412.13, Wisg 7" (cf. also 1 5),
where the word " of God in the first case and his wisdo in the latter
is spoken of as " quick to discern the thoughts pial intents of the
heart’; and again the description of ‘the true tabernac] which the
Lord pitched, not man’ in I[eb, 82 is compared with fies Wisd. Ὁ 8,
‘the holy tabernacle which thou hast prepared from the beginning.’
Other supposed correspondences quoted by Plumptr (Expositor,
Series 1. i. 333-9) are too vague to be of value. πον * Any attempt
to argue (as Drummond Philo i ineli to do) that the Septuagint held a
‘ Logos oy nec ee aa tion of may ὙΔῚ by λόγος is hopeless, They
constantly render the same phrase by ῥῆμα θεοῦ (cf. Exod. 10 70,1
Sam. 81, etc.), and as Freudenthal (J.Q.2., iii. 723 remarks, they
were wretched translators with no knowledge of Greek hil sophy.
Drummond is compelled to say (139) that the ‘word of the Lat τὸ
some extent stands in opposition to the Jater idea i of the 1, i of
fact, has it any connection with it at all? Saintes Sener ane DATE OF
COMPOSITION 9 We turn as of course to the sententious and
practical Epistle of St. James for references to the ‘sapiential’
literature current in his time, and we are not disappointed. But
naturally he makes most use of the wise maxims of the son of
Sirach, from whom heseems at times to quote directly : e.g. 1.13,
‘Let no man say when he is tempted, I am tempted of God,’
compared with Ecclus, 15", ‘Say not thou, It is through the Lord that
I fell away,’ etc. There are no such close correspondences with the
book of Wisdom; but Dr. Mayor, in his edition of the Epistic (pp.
1xxv-vi), has collected some ten instances which certainly seem to
show that the writer knew the work of the Pseudo-Solomon and was
imbued with his views. The oppression of the just man, the value of
suffering as a means of education, the strong condemnation of
slander and backbiting, are ideas common* to both; but the verbal
resemblances are few indeed, except perhaps καταλαλεῖν nnd
καταλαλία in Jos. 4"! and Wisd. 1", while in one instance (Jas. 4
compared with Wisd. 2‘) the New Testament writer seems to adopt
the very view which Pseudo-Solomon condemns: the likeness
between chap. 41} and Wisd. 24 is very close indeed. But St. James
uses the very phraseology of Wisdom's epicureans to rebuke the far-
reaching schemes of avaricious men. Ile refers to Wisdom, and that
in terms which might well have been used by the Pseudo: Solomon
(3"); and there is even a hint of a personification, but none of a
separate entity. But the most remarkable verbal correspondence with
Wisdom to be * found in the New Testament, apart from those
passages of St. Paul where the similarity is explained by derivation
from a common source, is undoubtedly to be found in 1 Pet. 157,
compared with Wiad. 35°, A parallel arrangement will make this
clear. 1 Peter, Wisdom. καὶ ὀλίγα παιδευθέντες μέγαλα ἐν ᾧ
ἀγαλλιᾶσθε ὀλίγον ἄρτι εἰ εὐεργετηθήσονται ὅτι ὁ θεὺς ἐπείρασεν
δέον λυπηθέντες ἐν ποικίλοις πειρασμοῖς, ἵνα τὸ δοκίμιον ὑμῶν τῆς
πίστεως πολυτιμότερον χρυσίον ὡς χρυσὸν ἐν χωνευτηρίῳ
ἐδοκίμασεν τοῦ ἀπολλυμένου διὰ πυρὸς δ ΟΑαὀὐτοὺς καὶ ὡς
ὁλοκάρπωμα θυσίας δοκιμαζομένον εὑρέθῃ eis ἔπαινον προσεδέξατο
αὐτούς. ΓΑΒ ΠῚ "» ὁ πὰ ποτε =, QUTOUS καιευρεν AUTOUS ἀξίως
εαυτον κτλ. ® Here, however, the resemblance in phraseology to
Wisdom is as nothing compared to the exact similarity between Jas.
3 and Ecclus. 28.. The two should be read side hy side to appreciate
the likeness.
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