SWEATING-SICKNESS. A remarkable form of dis-ease, not known in England before, attracted attention at the very beginning of the reign of Henry VII. It was known indeed a few days after the landing of Henry at Milford Haven on August 7, 1485, as there is clear evidence of its being spoken of before the battle of Bos-worth on August 22. Soon after the arrival of Henry in London on August 28 it broke out in the capital, and caused great mortality. Two lord mayors successively and six aldermen, beside numerous other persons, died in one week. At the end of October, however, the epidemic in London suddenly ceased. In Oxford it had already begun at the end of August, and lasted with great mortality for six weeks. In the course of the autumn it attacked various places, and by the end of December had spread over all England. Then the epidemic disappeared as suddenly as it'came. This alarming malady soon became known as the sweating-sickness. It was regarded as being quite distinct from the plague, the pestilential fever, or other epidemics previously known, not only by the special symptom which gave it its name, but also by its extremely rapid and fatal course and by other characters to be noted presently.
From 1485 nothing more was heard of it till 1507, when the second outbreak occurred, which was much less fatal than the first (it is said because the treatment was better understood) and attracted less notice. In 1517 was a third and much more severe epidemic. It began in London in July, and lasted till the middle of December. Many distinguished persons died, including Lord Clinton, Lord Grey of Wilton, Andrea Ammonio, the king's secre-tary, and others, with an immense number of the common people. In Oxford and Cambridge it was also very fatal, as well as in other towns, where in some cases half the population are said to have perished. There is evidence of the disease having spread to Calais and Antwerp, but with these exceptions it was confined to England.
In 1528 the disease recurred for the fourth time, and with great severity. It first showed itself in London at the end of May, and speedily spread over the whole of Eng-land, though not into Scotland or Ireland. In London the mortality was very great; the court was broken up, and Henry VIII. left London, frequently changing his residence. When the epidemic ceased cannot be accurately stated, nor have we any precise estimate of the mortality. The most remarkable fact about this epidemic is that for the first and last time it spread over the Continent. On the 25th July 1528 (English style) or 1529 (Boman style), when it was beginning to decline in London, it suddenly appeared at Hamburg. The story went that the infection was brought by a ship returning from England, the sailors of which were suffering from the disease. However this may have been, the disease spread rapidly, so that in a few weeks more than a thousand persons died. In less than a week it had spread to Liibeck, and thus was the terrible sweating-sickness started on a destructive course, during which it caused fearful mortality throughout eastern Europe. France, Italy, and the southern countries were spared. It spread much in the same way as cholera, pass-ing, in one direction, from north to south, arriving at Switzerland in December, in another northwards to Denmark, Sweden, and Norway, also eastwards to Lithuania, Poland, and Bussia, and westwards to Flanders and Holland, unless indeed the epidemic, which declared itself simultaneously at Antwerp and Amsterdam on the morning of September 27, came from England direct. In each place which it affected it prevailed for a short time only, generally not more than a fortnight. By the end of the year it had entirely disappeared, except in eastern Switzer-land, where it lingered into the next year y and the terrible " English sweat" has never appeared again, at least in the same form, on the Continent.
England was, however, destined to suffer from one more outbreak of the disease, which occurred in 1551, and with regard to this we have the great advantage of an account by an eye-witness, John Kaye or Caius, the eminent physician. It first appeared at Shrewsbury on April 13, and, after spreading to other towns in Wales and in the midland counties, broke out in London, causing in one week the death of seven hundred and sixty-one persons. At the end of July it ceased in London, but it went through the east of England to the north, until the end of August, when it began to diminish. At the end of September it ceased altogether, without affecting Scotland or Ireland. Nor did it apparently widely affect the Con-tinent, though Caius mentions its occurrence at Calais, and Brasavolus (De Morbo Gallico) speaks of the English sweating-sickness as raging in Flanders in the year 1551, in which he wrote, causing the death of several thousand persons, and lasting at least till September.
Symptoms.The symptoms as described by Caius and others were as follows. The disease began very suddenly with a sense of apprehension, followed by cold shivers (sometimes very violent), giddiness, headache, and severe pains in the neck, shoulders, and limbs, with great prostration,in short, the usual symptoms of an acute febrile attack. In some cases the stomach was affected, and there was vomiting, but according to Caius this happened only in those who were full of food. The breathing was deep and frequent, the voice like a moan. After the cold stage, which might last from half an hour to three hours, followed the stage of heat and sweating. The characteristic sweat broke out suddenly, and, as it seemed to those unaccustomed to the disease, without any obvious cause. In some cases it was much more copious than in others, these differences depending, according to Caius, mainly on age, clothing, food, and other external circumstances, and also on the season, sweating being more profuse in hot weather. "With the sweat, or after that was poured out, came a sense of heat, and with this headache and delirium, rapid pulse, and intense thirst. Palpitation and pain in the heart were frequent symptoms. No eruption of any kind on tlie skin was generally observed; Caius makes no allusion to sucli a symptom. In the later stages there was either general prostration and collapse, or an irresistible tendency to sleep, which was thought to be fatal if the patient were permitted to give way to it. The malady was remarkably rapid in its course, being sometimes fatal even in two or three hours, and some patients died in less than that time. More commonly it was protracted to a period of twelve to twenty-four hours, beyond which it rarely lasted. Those who survived for twenty-four hours were considered safe.
The disease, unlike the plague, was not especially fatal to the poor, but rather, as Caius affirms, attacked the richer sort and those who were free livers according to the custom of England in those days. " They which had this sweat sore with peril or death were either men of wealth, ease, or welfare, or of the poorer sort, such as were idle persons, good ale drinkers, and taverne haunters."
Relapses were not uncommon; but the statements sometimes made about the disease attacking the same person several times seem to rest on a misunderstanding of the original authorities. What is meant is that they had several, even twelve, successive attacks of sweating. The disease was not thought to be transmitted by contagion from one person to another. Nevertheless, in its spread, it appears, like cholera, to have followed the main lines of human travel and traffic,passing with Richmond's army to Bosworth, thence to London, and so on. It would be difficult other-wise to explain why Calais should have been affected and not the adjacent parts of France. Even the very circumstantial story of the disease having been brought to Hamburg by a ship from England seems by no means incredible, though it is doubted by some.
Causes. Some attributed the disease to the English climate, its moisture and its fogs, a view which was thought to be supported by the occurrence of unusual rainfall and atmospheric moisture in the years of the sweating-sickness. But it is plain that the English climate was much the same before and after, and can hardly be regarded even as a predisposing cause, certainly not as an explana-tion. Nor is there much evidence that the epidemic years were distinguished for their humidity.
In 1485, 1507, and 1517 the seasons were in no way remarkable. The year 1528 (1529 in Continental reckoning) was, however, certainly notable for excessive moisture. In England eight weeks continuous rain began in April, and the harvest was spoiled. In Germany the copious rainfall, and the cold fogs which endured through the summer, gave the impression that the air of England had been carried over to the Continent. In 1551 the outbreak of the sickness in Shrewsbury is described as having been preceded by dense and stinking fogs, which arose from the valley of the Severn and spread over other parts of England. The summer was everywhere very hot, and in England moist as well. In Amsterdam a similar fog announced the outbreak of the sickness in 1528. But we cannot attribute much importance to these circumstances, since in other epidemics they were wanting, and similar conditions have often occurred without any pestilence resulting.
It was again attributed by some to the intemperate habits of the English people, and to the frightful want of cleanliness in their houses and surroundings which is noticed by Erasmus in a well-known passage, and about which Caius is equally explicit. But causes such as these cannot, any more than climate, account for the incidence in time of an epidemic, even if they do something towards explaining its geographical range. Nor is there much evidence that the English were worse in these respects than most European nations, though the native country of Erasmus may have set an early example of cleanliness.
Caius and some of the chroniclers make out that this special liability of Englishmen to the sweating-sickness followed them even into foreign parts, so that in Calais, Brabant, and Spain it affected the English only and not the natives. This is puzzling and improbable, except so far that the English abroad may have belonged to the same classes who mainly suffered at home. But a careful examination of those statements shows that they referred either to Englishmen who had left England while the disease was raging there and carried the infection with them, or to merchants and others who were in direct communication with home. This disease, like others introduced into a foreign country, did not always take root there. But it did so sometimes, as, according to contem-porary evidence, was the case in Flanders in 1551. The statement also made that foreigners in England were not affected likewise requires qualification, since we know several instances of foreigners in London who died of it. On the whole, no great importance can be attached to this supposed special liability of the English physical constitution.
From all this wo must conclude that climate, season, and manner of life were not adequate, either separately or collectively, to pro-duce the disease, though each may have acted sometimes as a pre-disposing cause. The sweating-sickness was in fact, to use modern language, a specific infective disease, in the same sense as plague, typhus, scarlatina, or ague. The origin of such diseases is not explained by causes such as those above enumerated. We can only suppose that they come into being by laws similar to those which have determined the- evolution of species of animals and plants. But when once their specific distinctness is established they " breed true " and always present the same characters.
Probable Identity with Miliary Fever:The important question, however, arisesDid this specific disease exist before or has it existed after the sixty-six years of its recognized history? or is it identical with any other known disease called by another name? It is very unlikely that any epidemic of so striking a disease should have existed before without having been noticed, and there is certainly no record since of any outbreak precisely similar. The only disease of modern times which bears any resemblance to the sweating-sickness is that known as miliary fever ("Schweiss-friesel," "suette miliaire," or "the Picardy sweat"), a malady which has been repeatedly observed in France, Italy, and Southern Germany, but not in the United Kingdom. It is characterized by intense sweating, and occurs in limited epidemics, not lasting in each place more than a week or two (at least in an intense form). On the other hand, the attack lasts longer than the sweating-sickness did, is always accompanied by an eruption of vesicles, and is not usually fatal. It is therefore evidently not the same as the English disease, though allied to it. The first clearly described epidemic was in 1718 (though probably it existed before), and the last in 1861. Between these dates some one hundred and seventy-five epidemics have been counted in France alone. A single epidemic of a disease which had a striking resemblance to the sweating-sickness was observed in 1802 at Köttingen, a village in the district of Wiirzburg, Germany. Its access was sudden; it affected chiefly robust persons; it was accompanied by profuse perspiration, rheumatic pains, &c, without any constant eruption. If death resulted it was usually in twenty-four hours. The epidemic lasted some ten days, and then entirely vanished. It may be considered as an extremely severe form of miliary fever. Finally, Hirsch has drawn attention to certain cases of a choleraic affection, observed first by Dr Murray in India (1839-40), which has been described as a sweating-sickness. It has, however, more resemblance to miliary fever than to the English sweat. A similar form of disease has been described by some French physicians as "cholera eutane ou sudoral." On a review of the whole evidence, it would appear that the only disease which the sweating-sickness much resembled was the miliary fever, of which it may conceivably have been, like the Rottingen epidemic, a highly malignant form.
Where did it Originate?Whether it really originated in England is a question difficult to answer. Its appearance certainly coincided with the arrival of a foreign army, consisting, as we know, largely of foreign mercenaries, men of foul habits and irregular lives (whom the French king was thought to have done his country a service by getting rid of), and crowded into small vessels. Among such men any infective disease which arose would, by want of cleanliness and overcrowding, be likely to be fostered into great intensity. It is in accordance with the history of many epidemics to suppose that an ordinary and not very fatal disease might under such circumstances assume a malignant form. Now, supposing that the French soldiers brought with them their native "Picardy sweat," a malady local and not severe in its French home, might not this have become developed into the formidable English sweat-ing-sickness? If so, its great destructiveness in England would also be in great measure explained by its affecting a new popula-tion. For we find that any exported epidemic disease is generally more fatal in a country which receives it for the first time, among a population which offers a virgin soil to the disease, than it was in the country where it was endemic, and where men were inured to the infection. The notable exemption of northern France from the true sweating-sickness would then have depended upon the population there being already inured to a milder form of the same disease. As to southern France and other countries of the south, they were evidently not adapted by climate to receive the infection. If this be true, we need hardly expect to see the sweating-sickness again. The sweat of Picardy may continue from time to time to produce its comparatively slight epidemics; but the conditions which launched the English sweat on its rapid career of destruc-tion are unlikely to occur a second time. The example of the Rottingen epidemic, which on a small scale was scarcely less re-markable, may show, however, that such an event is not quite impossible.
Authorities.For history see Bacon's Life of Henry VII., and the chronicles of Grafton, Holinshed, Baker, Fabyan, &c. The only English medical account is that of John Caius, who wrote in English A Boke or Counseill Against the Disease commonly called the Siceate, or Sweating Sicknesse (London, 1552), and in Latin De Ephemera Britannica (Louvain, 1556; reprinted London, 1721). The English tract is reprinted in Babington's translation of Hecker's Epidemics of the Middle Ages, Syd. Soc, 1844. This also contains Hecker's valuable treatise on the English sweat, published in German, 1834, and also printed in his Volkskrankheiten des Mittelalters, edited by Hirsch, Berlin, 1865. Grüner's Scriptores de Sudore Anglico, Jena, 1847, contains nearly all the original documents, including the two treatises of Caius. See also Hirsch, Handbook of Geographical and Historical Pathology, transl. by Creighton, New Syd. Soc, 1885. (J. F. P.)
The above article was written by: J. F. Payne, M.D.