The Sweating sickness or English Sweat has been described as one of the black holes in historical epidemiology. It first appeared at the very beginning of the reign of Henry VII and made its last, very brief, appearance in 1578. On two occasions it ravaged the whole of England but always stopped at the Scottish border. It appeared in both Dublin and Calais but only seemed to affect Englishmen. Similarly, there are no records of any foreigners in England being affected by it. Its sudden onset and incredibly rapid course terrorised the citizens of 16th century England.
On August 22 1485, the Battle of Bosworth Field brought an end to the Wars of the Roses and put Henry VII on the throne of England. Within weeks, a strange new malady broke out amongst the survivors of the battle who had returned to London with the new king. Francis Bacon described it thus:
About this time in autumn, towards the end of September, there began and reigned in the city, and other parts of the kingdom, a disease then new: which by the accidents and manner thereof they called the sweating sickness. This disease had a swift course, both in the sick body, and in the time and period of the lasting thereof; for they that were taken with it, upon four and twenty hours escaping, were thought almost assured. And as to the time of the malice and reign of the disease ere it ceased, it began about the one-and-twentieth of September, and cleared up before the end of October, insomuch as it was no hindrance to the king's coronation, which was the last of October; nor, which was more, to the holding of the parliament, which began but seven days after. It was a pestilent fever, but, as it seemeth, not seated in the veins or humours, for that there followed no carbuncle, no purple or livid spots, or the like, the mass of the body being not tainted; only a malign vapour flew to the heart, and seized the vital spirits; which stirred nature to strive to send it forth by an extreme sweat. And it appeared by experience, that this disease was rather a surprise of nature than obstinate to remedies, if it were in time looked unto. For if the patient were kept in an equal temper both for clothes, fire, and drink, moderately warm, with temperate cordials, whereby nature's work were neither irritated by heat, nor turned back by cold, he commonly recovered. But infinite persons died suddenly of it, before the manner of the cure and attendance was known. It was conceived not to be an epidemic disease, but to proceed from a malignity in the constitution of the air, gathered by the predispositions of seasons; and the speedy cessation declared as much. This disease made five further appearances in 1506, 1517, 1528, 1551, and 1578. It was confined to England, except in 1528-29, when it is said to have spread to the European continent, appearing in Hamburg and passing northward to Scandinavia and eastward to Lithuania, Poland, and Russia; the Netherlands also were involved, but the disease did not spread to France or Italy. It never spread across the Scottish border and there is only one certain record of it in the Irish Annals:
A. D. 1528. A pestilential sickness, called the English sweat, which first appeared in Ireland in 1491, now again raged with great violence, and at Dublin swept away archbishop Inge, lord chancellor, William Talbot, Richard Elyot, Richard Fitzwilliams, Walter Fian, and two canons Luett, with Stanihurst, and great numbers of other citizens. The reference to 1491 is not supported by other data and the fact that this does not correspond with an appearance in England suggests that it may have been something else. It generally became known as the Sweating sickness but was also dubbed sudor anglicus or the English Sweat because it appeared to affect only English people. It remains one of the unsolved mysteries of historical epidemiology. Scholars have agonised over and debated the possible and origin of the disease origin for centuries but have made very little headway.
Its first appearance in London caused near panic. It began without warning and usually at night or in the early morning. The patient initially experienced chills and tremors and these were followed by a high fever and a great weakness. The body was covered with perspiration and, in most cases, a rash. It was extremely 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 generally safe and the perspiration was replaced by an abundant flow of urine. Recovery was complete within a week or two at the utmost. In those who did not recover the perspiration was quickly followed by a great thirst, intense headache, convulsions and coma with death arriving in an incredibly short space of time.
In contrast to most mediaeval epidemics the English Sweat showed a preference for the better-off sections of society and especially the middle-aged males of those sections. This was so obvious, even at the time, that the poorer classes dubbed the malady the "Stop Gallant". In the first year of its outbreak it carried off two Lord Mayors of London and six Aldermen. Those of the poorer classes who did suffer appear to have been the "free livers" of the Age. In his treatise on the disease, Johannes Caius noted:
"They which had this sweat sore with peril of 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."Surviving the disease conferred no immunity - Cardinal Wolsey is reported to have survive no fewer than three successive attacks. Another famous sufferer was Ann Boleyn who wrote the following letter to Wolsey during here recuperation:
"My lord,In contrast to other epidemics such as the plague and the smallpox, which moved steadily through a population, the Sweat darted here and there and struck completely at random. This only added to the terror already heightened by its incredibly swift course. Although it was devastating in local populations, it had no major impact on the overall demographics of the country. The panic in 1485 resulted in the abandonment of the University at Oxford which was shut down for six weeks. It also frustrated Henry VII, whose claim to the throne was very tenuous, as his coronation had to be postponed. However the pestilence went as rapidly as it had arrived and had completely disappeared five weeks later. The coronation duly took place in Westminster Abbey on October 31st 1485. To the naturally superstitious mind of the period, this sudden appearance of a new and terrifying disease at the beginning of a reign was seen as a very bad omen which h only served to underline Henry's weak claim. His position was bolstered by a hastily passed Act of Parliament which declared that the inheritance of the Crown had come as of right to him and the heirs of his body. He also had the support of Pope Innocent III who threatened to excommunicate anyone who challenged Henry's legitimate kingship.
In my most humble wise that my poor heart can think, I do thank your grace for your kind letter, and for your rich and goodly present, the which I shall never be able to deserve without your help, of which I have hitherto had so great plenty, that all the days of my life I am most bound of all creatures, next the king's grace, to love and serve your grace, of the which I beseech you never to doubt that ever I shall vary from this thought, as long as any breath is in my body. And as touching your grace's trouble with the sweat, I thank our Lord that them I desired and prayed for are escaped; and that is the king's grace and you, not doubting that God has preserved you both for great causes known alonely of His high wisdom. And as for the coming of the legate, I desire that much. And if it be God's pleasure, I pray him to send this matter shortly to a good end; and then I trust, my lord, to recompense part of your great pains. In the which I must require you, in the mean time, to accept my goodwill in the stead of the power; the which must proceed partly from you, as our Lord knoweth, whom I beseech to send you long life, with continuance in honor. Written by the hand of her that is most bound to be your humble and obedient servant,
The second outbreak occurred in 1508, when coincidentally, Henry was approaching the end of his reign. It again began in London and quickly spread to both Oxford and Cambridge carrying off many distinguished scholars. However, its duration was even shorter than the first outbreak and there are few records of it. The third outbreak, in 1517, was far more serious. Henry VIII and his court abandoned London for Windsor but this provided no protection and many courtiers were carried off. Within six months it had appeared, again at random, over much of England and killed between one third and one half of the populations of the hardest hit towns. Once again, many of the students and professors at both Oxford and Cambridge were amongst the victims. And, again characteristically, it stopped at the Scottish border. During this outbreak, death is reported to have followed after only two or three hours and that a person "merry at dinner" could be dead by supper. It was also reported that people dancing at the court at nine o'clock were dead by eleven. During this outbreak it was said to have passed across the English Channel to the continent and appeared at Calais where, however, it only affected Englishmen.
The first outbreak which is reputed to have affected people other than the English was the 1528 epidemic which was also the most ferocious. Once again, it began in London, spread rapidly across all of England but stopped at the Scottish and Welsh Borders. It did appear in Dublin where the victims all appear to have been of English stock. However it was also reported to have appeared in the Baltic and North Sea ports and quickly spread to Germany, the Netherlands, Denmark, Sweden, Livonia, Lithuania, Russia, Poland and Switzerland. At this time, these countries, and Germany in particular, were already over-run by typhus and the plague. Consequently medical historians now question whether the Sweating Sickness really was amongst the causes of the huge mortality that devastated eastern Europe in 1528-9. Back in England, however, there was no question. The entire country was terrorised to the point that social organisation broke down, all agricultural activity stopped and famine set in.
The last major outbreak was in 1551 and, uncharacteristically, it did not this time start in London but in Shrewsbury. In that town, 900 people died in the first few days. It quickly appeared across the whole of England but, yet again, stopped at the Scottish and Welsh Borders. There were reports that it was once again afflicting only Englishmen on the continent and that foreigners in England were unaffected. This outbreak is responsible for one of the more unusual records in English history. The sons of Charles Brandon, Duke of Suffolk, and Lady Mary, sister of Henry VIII, were school fellows of Prince Edward. Their father died in 1545 and in July 1551 Henry Brandon, then the fifteen-year-old Duke of Suffolk, was at St John's College Cambridge with his thirteen-year-old brother Charles when the outbreak of the disease caused them to flee home to the village of Buckden, near Huntingdon. However, they had left it too late and both were taken ill the evening they arrived in the village. The Duke died that night and his brother about half an hour later. The death of Henry meant that Charles succeeded him to the title and was himself the Duke of Suffolk for the few minutes before he died - the shortest tenure of any peerage that has been recorded. The tomb of these unfortunate brothers can still be seen in the village churchyard.
There has been much speculation about the origin of this disease. Some have attributed it to the English climate, its moisture and its fogs, or to the intemperate habits of the English people. It has also been attributed 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 it must be concluded that climate, season, and manner of life were not adequate, either separately or collectively, to produce the disease, though each may have acted sometimes as a predisposing cause. The sweating-sickness was, in fact, a specific infective disease, in the same sense as plague, typhus, scarlatina or malaria.
It was once thought that this was a form of typhus but that has been discounted because of the speed with which the symptoms appeared and the extremely short course of the disease. Influenza is another candidate which can be discounted because of the absence of any respiratory symptoms or secondary cases of pneumonia. It has also been suggested that the medical treatments common in the 15th and 16th centuries may have been a contributing factor in the high mortality rate - which would explain the disproportionate number of the better-off amongst the victims. And then, of course, the French were blamed.
In 1891, Charles Creighton suggested that the disease was harboured in the soils of the lower basin of the Seine and that it was brought to England by the Flemish mercenaries employed by Henry VII. Because, he argued, it had been prevalent in France and other European countries for centuries, the peoples of those areas had built up a relative immunity to it which the English lacked. This is an attractive hypothesis but it fails on two major counts. Firstly, there is no evidence that exposure granted immunity, indeed, quite the opposite is true. Secondly, there is the absolute fact that it never crossed the Scottish Border. There is no record of even a single suspected case of this disease in Scotland. The Irish outbreaks can be questioned and there is a very slight reference to it in Wales but in Scotland - nothing!
This difficulty led researchers to another possible explanation in the form of an arbovirus which was transmitted by an insect such as a mosquito. The evidence in support of this hypothesis is the fact that the appearance of the disease was invariably preceded by a period of prolonged rainfall and, in some areas, extensive flooding. These conditions would have greatly encouraged mosquito proliferation. The barriers of the Scottish and Welsh mountains together with the colder northern climate could account for the fact that it respected these borders. However, arboviruses are generally found only in the tropics and England does not have a tropical climate, so that this hypothesis can also be questioned.
The only disease of modern times which bears any resemblance to the sweating-sickness is that known as military fever (Schweiss-friesel, suette militaire 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 characterised 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 eruption of vesicles, and is not usually fatal. The first clearly described epidemic was in 1718 (though probably it existed before then), and the last in 1861. Between these dates some one hundred and seventy-five epidemics have been counted in France alone.
In 1997, it was suggested that the English Sweat was a mediaeval ancestor of the hantavirus which had recently appeared in North America.
"Both diseases are carried by a rodent and occur in rural environments in summertime. Unlike many other viruses that hit elderly populations hardest, these two diseases kill healthy adults. Most striking, however, is the rapid deterioration of the patient. Victims suffer from flu-like symptoms that progress to severe respiratory and cardiac difficulty. Hantavirus causes the lungs to fill with fluid and leaves people gasping for air in the same way that sweating sickness left its victims breathless.However, there are problems with this identification also. If the Sweating Sickness had been a hantavirus isolated cases would still occur in England and there has never been a report of this virus in Britain. The nature and origin of the sudor anglicus is a medical mystery and has every appearance of remaining so.