133 Sweating Sickness
History and Geography
The sweating sickness, or sudor anglicus, is one of the great puzzles of historical epidemiology because no modem disease corresponds very well to its principal epidemiological and clinical features.
Thus it is a topic that has generated much speculation and debate in the understanding of what caused the five English epidemics attributed to the “Sweat.”The first description was written in 1486, which indicated that the earliest epidemic occurred (northern England) during June of 1485, where strictly contemporary accounts use the words “plague” and “pestilence” to describe the local mortality crisis (Wylie and Collier 1981). However, Charles Creighton (1891), whom most authors follow, claims that the initial outbreak began later, in London, on September 19, 1485, brought back with Henry VIFs mercenaries from France and Flanders.
Once in London the epidemic displayed some of its most characteristic and consistent features: higher mortality among men than women, peaking during middle adulthood among the economically advantaged, and a sudden, acute fever accompanied by profuse sweating. Its victims generally lapsed into coma and died within 24 to 48 hours. Similar outbreaks have been identified: in 1508, 1517, 1528, and 1551. Oddly, the disease favored Englishmen at home and abroad. In the British Isles, Scots, Welsh, and Irish were spared.
The “Sweat” had no important demographic repercussions, as the numbers affected were always small in comparison to the poxes and plagues of this period. Nonetheless, each recurrence of the disease produced widespread fear (Gottfried 1977; Slack 1979). In 1528-9, the Sweat uncharacteristically extended to Calais and to many German regions, but was clearly associated with severe famine, as well as an epidemic of typhus (petechial fever) and plague. As might be expected, a body Ofliterature on the disease had accumulated at the time as well as later, and it has fueled continued interest in the Sweat’s identity.
In 1508 Sir Thomas More informed Cardinal Wolsey of the Sweat’s progress among young scholars at Oxford and Cambridge, but little discussion was generated. In fact, the 1517 and 1551 epidemics are the only two epidemics for which we have substantial contemporary accounts. Edward Hall’s chronicle reports that in 1517, “this malady was so cruel that it killed some within three houres, some within two houres, some merry at dinner and dedde [dead] at supper. Many died in the Kynges court, the lord Clinton, the Iorde Gray of Wilton, and many Knightes, gentlemen and officers” (Wylie and Collier 1981).
Comt historian Polydore Vergil’s graphic description of the disease was based on his experience during the Sweat’s 1508 and 1517 appearances and written from memory. First published in 1534, it directly follows this text. In addition, there is some speculation that Vergil may have had access to chronicled reports contemporary with the 1485 outbreak. The earliest description provided by a physician was not written until 1552, when noted humanist John Caius published his Boke, or Counseill against the Disease Commonly called the Sweate or Sweatyng Sicknesse (text in Hecker 1844). His advice, however timely or expert, was to no avail, for the disease never recurred.
Etiology
The early nineteenth-century historical epidemiologist J. F. K. Hecker, who was fascinated by the Sweat’s abrupt appearances and disappearances, felt that English methods of therapy were partly responsible for the high case-fatality rates. Writing over a century later, Maurice Strauss (1973) concurred, arguing that efforts to encourage perspiration and to stimulate vigorous purging of the bowels would have exacerbated fluid and salt losses associated with a high fever and led to circulatory collapse. Hecker (1844), however, also blamed the English climate and the habits of the English nobility.
[T]he English sweating sickness was a spirit of the mist, which hovered amid the dark clouds.
Even in ordinary years the atmosphere of England is loaded with these clouds during considerable periods, and in damp seasons they would prove the more injurious, as the English of these times were not accustomed to cleanliness, moderation in their diet, or even comfortable refinements. Gluttony was common among the nobility as well as among the lower classes; all were immoderately addicted to drinking.Building on the suggestion that peculiarities of the sixteenth-century English diet might account for the disease, Adam Patrick (1965) argued that the Sweat resembled a shock reaction, with its hyperacute pyrexia (fever) and sweating, occasionally associated with evidence of circulatory collapse. Among the most likely toxins, he passed over bacterial endotoxins and exotoxins in favor of fungal toxins associated with food poisoning. Ultimately, he felt that the sweating sickness was a form of ergotism.
Writing in 1891, Creighton, by contrast, denied the possibility that local conditions could alone explain the appearances of the Sweat, and he was loath to identify it with any one known infection. He was, however, convinced that it was introduced by the Flemish mercenaries hired by Henry Tudor, “a swarm of disreputable free-booters from Normandy, natives of a soil which developed the sweat as an indigenous malady in the long course of generations.” An opponent of the germ theory of disease, Creighton believed that the soil of the lower basin of the Seine perennially harbored the disease, its epidemic appearances dictated by variations in weather conditions. He concluded firmly that “it must have come from the persons of the foreign soldiers”: He contrasted the ability of the French to host the disease and survive, and the partial immunity many Africans displayed when exposed to yellow fever, with the susceptibility of the English and drew a parallel with the effect, on unprotected flocks of cattle, Ofbringing an animal infected with Texas cattlefever into the fold.
Most recent authorities concur with Creighton that whatever caused the Sweat, it was a disease that found “virgin soil” in England or among the English.
In so doing, they follow Hans Zinsser’s assessment that the Sweat was caused by a viral illness to which the uniquely susceptible English population gradually acquired immunity (Zinsser 1935). Zinsser departed from earlier twentieth-century physicians in ascribing the cause of the Sweat to influenza (Hamer 1906; Crookshank 1919), and today there seems to be agreement that the Sweat was not an influenza virus, although it spread in a similar manner (Shaw 1933; Roberts 1965).Finally, John Wylie and Leslie Collier (1981) speculate that a novel arbovirus infection, transmitted by an insect vector, accords with most of the clinical and epidemiological information. By the mid-sixteenth century, the disease was becoming endemic in England, affecting children more than adults and in the process losing some of its terror.
Ann. G. Carmichael
Polydore Vergil’s (1534) description of the Sweating Sickness (from Shaw, 1933, 270-1)
The same year (1485), a new disease pervaded the whole kingdom, during Henry’s first descent into the island, a pestilence horrible indeed, and before which no age could endure, a well-known fact; suddenly a fatal sweat attacked the body wracking it with pains in the head and stomach, moreover there was a terrific sensation of heat. Therefore the patients cast off the bed coverings from the beginning, as some of them suffered less heat if they lay in bed; if they were dressed they stripped off their clothes, the thirsty ones drank cold water, others suffering from this fetid heat, provoked a sweat which had a foul odor, by adding bed clothes, all of them dying immediately or not long after the sweat had begun; so that not one in a hundred evaded it. Nor did any art of medicine or science avail to help it, meanwhile, for this strange disease escaped all their knowledge. In fact, after twenty four hours (the severity of the disease continued for that length of time) the sweat departed bringing this conclusion, i.e., that they were not cleansed by the sweat, as many of them perished.
But that fact pointed out a final measure in the treatment for this great torture; those who had sweat once, since they sickened again put into use those things which they had discovered to have been beneficial in the first attack. Even so, when the calamity befell the sickly race again (1508), from earlier observations they had forgotten how to care for themselves, in order that they might bear more easily the strenuous sweating. Thus from experience, after such a huge slaughter of human beings, it follows that the most prompt relief should have been found, which was this: if anyone was seized during the daytime he should go to bed forthwith, with his clothes on; if, while he was in bed at night, he should lie quietly and not move from that place, remaining so for twenty four hours exactly, covered with not enough bed clothes to provoke the sweat but just enough to allow him to sweat spontaneously, taking no food, if possible to bear the hunger, and drinking no more water than usual or of less warmth, which should satisfy in a way and quench the thirst; in the first stages of this treatment care should be taken that there should be no occasion either for warming up or cooling off the hands or feet as to do so means death. Such was the treatment found for this plague which covered so much OfEngland at this time and in times past has so often afflicted it, for the first year that Henry began to reign was remarkable for the plague, which was taken by many as a bad omen.Bibliography
Brossollet, J. 1974. Expansion europeenne de la suette anglaise. Proceedings of the XXIII International Congress of the History of Medicine, 1972, Vol. 1: 595—600. London.
Creighton, Charles. 1891. A history of epidemics in Britain, Vol. 1. Cambridge.
Crookshank, F. G. 1919. The history of epidemic encephalomyelitis in relation to influenza. Proceedings of the Royal Society of Medicine, Section of the History of Medicine 12: 1-21.
Gottfried, Robert S. 1977. Population, plague and the sweating sickness: Demographic movements in late fifteenth-century England, Journal of British Studies 17:12-37.
Hamer, (Sir) William H. 1906. Epidemic disease in England. Milroy Lecture. London.
Hecker, J. F. K. 1844. Epidemics of the Middle Ages, trans. B. G. Babbington. London.
Patrick, Adam. 1965. A consideration of the nature of the English sweating sickness. Medical History 9: 272-84.
Roberts, R. S. 1965. A consideration of the nature of the English sweating sickness. Medical History 9: 385-9.
Shaw, M. B. 1933. A short history of the sweating sickness. Annals of Medical History, new ser., 5: 246-74.
Slack, Paul. 1979. Mortality crises and epidemic disease in England, 1485—1610. In Health, medicine and mortality in the sixteenth century, ed. Charles Webster. New York.
Strauss, Maurice B. 1973. A hypothesis as to the mechanism of fulminant course and death in the sweating sickness. Journal of the History of Medicine and Allied Sciences 28: 48—51.
Wylie, John A. H., and Leslie H. Collier. 1981. The English sweating sickness (sudor anglicus): A reappraisal. Journal of the History of Medicine and Allied Sciences 36:425—45.
Zinsser, Hans. 1935. Rats, lice and history. Boston.