The Sweating Sickness

A remarkable form of disease; 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 the 7 Aug 1485, as there is clear evidence of its being spoken of before the battle of Bosworth on the 22 Aug. Soon after the arrival of Henry in London on the 28 Aug it broke out in. the capital, and caused great mortality. 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.

The cause is the most mysterious aspect of the disease. Commentators then and now put much blame on the general dirt and sewage of the time which may have been sources of infection. The first outbreak at the end of the Wars of the Roses means that it may have been brought over from France by the French mercenaries which Henry VII used to gain the English throne, particularly as they seem to have been immune. The fact that the disease seems to have been more virulent among the rich then the poor suggests why it was noted compared to other illnesses of the time. Today the most likely candidate for the cause is relapsing fever which is spread by ticks and lice and the outbreaks were usually in the summer months when they flourish.

Thomas Forestier recorded his observations of the 1485 epidemic in two treatises. His shorter account 'Treatise on the venyms fever of pestilens', in English, summarized contemporary observations on the rapidity and violence of the new disease. His other account 'Tractatus contra pestilentiam thenasmonen et dissinteriam', written in Latin for fellow physicians, includes the following description:

'... The exterior is calm in this fever, the interior excited... the heat in the pestilent fever many times does not appear excessive to the doctor, nor the heat of the sweat itself particularly high... But it is on account of the ill-natured, fetid, corrupt, putrid, and loathsome vapors close to the region of the heart and of the lungs whereby the panting of the breath magnifies and increases and restricts of itself...'

From 5485 nothing more was heard of it till 1507, when the second outbreak occurred, which was much less fatal than the first. In 1517 was a third and much more severe epidemic. In Oxford and Cambridge it was 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. Contemporary observers distinguished the condition from plague, malaria, and typhus.

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 England, though not into Scotland or Ireland. Many people in Henry VIII's court fell sick with the sweating sickness and Henry developed a morbid fear of contracting the disease himself. He would change residences every other day in an effort to avoid coming within contact with those of his court who became infected. He also busied himself with a study of the disease and its purported cures such as herbs laced with molasses and bleeding from certain points on the body (the arm, between the thumb and forefinger, or between the shoulders). The French Ambassador to the English court, Du Bellai, wrote in 1528, "...One of the filles de chambre of Mlle Boleyn was attacked on Tuesday by the sweating sickness. The King left in great haste, and went a dozen miles off...This disease is the easiest in the world to die of. You have a slight pain in the head and at the heart; all at once you begin to sweat. There is no need for a physician: for if you uncover yourself the least in the world, or cover yourself a little too much, you are taken off without languishing. It is true that if you merely put your hand out of bed during the first 24 become stiff as a poker".

 The most remarkable fact about this epidemic is that it spread over the Continent, suddenly appearing at Hamburg, and spreading so rapidly that in a few weeks more than a thousand persons died. 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, passing, in one direction, from north to south, arriving at Switzerland in Dec, in another northwards to Denmark, Sweden and Norway, also eastwards to Lithuania, Poland and Russia, and westwards to Flanders and Holland, unless indeed the epidemic, which declared itself simultaneously at Antwerp and Amsterdam on. the morning of 27 Sep, came from England direct. In each place which it affected it prevailed for a short time onlygenerally not more than a fortnight. By the end of the year it had entirely disappeared, except in. eastern Switzerland, where it lingered into the next year; 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 eyewitness, John Kaye or Caius of Gonville Hall, Cambridge, the eminent president of the Royal College of Physicians.

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. 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 accustomed to the disease, without any obvious cause. 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 the skin was generally observed; Caius makes no allusion to such 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. One attack did not offer immunity and some people suffered several bouts before succumbing.

All accounts agree as to the summer preponderance of the sweating sickness. All five epidemics disappeared with the onset of winter. Narrative accounts recorded in Holinshed's Chronicles of England, Scotland and Ireland and in correspondence reported a distinct age and sex predisposition: "It is to be noted, that this mortalitie fell chieflie or rather upon men, and those of the best age as between thirtie and fortie years. Few women, nor children, nor old men died thereof". These narrative accounts emphasized the susceptibility of upper-class men. Such epidemiologic characteristics, however, rely heavily on observer interpretation. The preponderance of wealthy male victims in narrative accounts probably reflects the high profile of these men within society rather than an actual susceptibility to the sweating sickness.

The malady was never seen again in England after 1578 although a similar illness known as the Picardy sweat occurred in France between 1718 and 1861 but this was less likely to be fatal and was accompanied by a rash which was not an important feature of the earlier outbreaks.

Any Chicago medical malpractice attorney would agree that medieval physicians should not be blamed for all the deaths from the sweating sickness. Recent studies of the epidemic suggest that the symptoms could have been caused by either a version of the hantavirus or anthrax spores in wool, both of which are still difficult to treat today.


Ridley, Jasper: The Tudor Age

Thwaites, G., Taviner, M., Gant, V. (1997). The English Sweating Sickness, 1485 to 1551. N Engl J Med 336: 580-582

Wagner, John A: Bosworth Field to Bloody Mary: An Encyclopedia of the early Tudors

Wilson, Derek: In the Lion's Court: Power, Ambition and Sudden Death in the Reign of Henry VIII

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