Sudor Anglicus

SUDOR ANGLICUS, English sweating sickness. In August 1486 in England, among the troops of Henry VII, an unknown until then severe contagious disease developed, quickly spreading throughout the country and claiming many victims. This disease, according to its characteristic signs, was named sweating sickness (sweating-sickness), later 'English sweat', 'English sweating fever'. The epidemic ended at the end of the year. The next two epidemics were observed in England in 1507 and 1518. The fourth epidemic, also starting in England in 1529, then spread far beyond its borders and over the next 5 months spread to Germany, Switzerland, Holland, Denmark, Sweden, Poland and Russia. France and southern European countries were spared by it. The next epidemic, which lasted from April to September 1551, was limited to England. Since then, the epidemic of 'English sweat' has not appeared again. The epidemic lasted in individual cases from several days to several weeks, on average 1-2 weeks, affecting a huge number of people. Mortality varied: in Hamburg about 1,000 people died, in Copenhagen - 400, in Augsburg out of 18,000 sick 1,400 died, in Antwerp in 4 days about 400 people died, while in Stuttgart out of 4,000 sick only 6 people died. In England the mortality rate reached 80-90%. Clinically, the disease manifested as an acute infectious disease and was accompanied by chills, high fever, gastrointestinal phenomena ('stomach cramp attacks') and extremely profuse sweating. In severe cases, cerebral phenomena (headache, delirium, convulsions, stuporous state) and severe shortness of breath were observed. Death often occurred several hours after the onset of the disease. In favorable cases, acute phenomena disappeared 24-48 hours after the onset of the disease, sweating gradually decreased, and recovery occurred in 1-2 weeks. A number of authors mention spotted, papular, vesicular, and millet-like rash on the skin. Some compare this rash with measles. The nature of 'English sweat', which caused five severe epidemics in 65 years - from 1486 to 1551 - and then completely disappeared, remained unclear. Some later authors suggest that these were typhus-like epidemics (Gottstein). A number of authors see a repetition of 'English sweat' in the later appearing epidemics of sweating fever (febris miliaris, French 'suette miliaire', German 'Schweissfriesel'). The first reliable information about this disease dates back to 1718 in France in Picardy ('Picardy sweat' - 'suette des Picardes'). Hirsch counts from 1718 to 1874 in France no less than 194 outbreaks of this disease; some of them had the character of pandemics. In France, suette miliaire is subject to mandatory registration; cases of it are still observed now (in 1926 - 260 cases). Several outbreaks of it were observed in Italy between 1755 and 1875; it first appeared in Germany in 1802 and was last observed in 1897-98; in Austria from 1835 to 1849, in Belgium - in 1838 and 1849, etc. Epidemics of sweating fever usually lasted from 2 to 4 weeks, they began suddenly, sometimes preceded by individual cases, after which mass diseases occurred. After the end of the epidemic, individual diseases were also often observed. Epidemics quickly affected the masses of the population and in this respect they can only be compared with influenza epidemics. Mortality was 1-5% in relation to the sick, but in a number of outbreaks it reached 15-30 and even 50%. Most epidemics were observed in the spring-summer months. By its clinical picture, suette miliaire in many ways resembles 'English sweat': rapid onset, feverish state, palpitations, shortness of breath, most profuse sweat, often convulsions, in severe cases - death within the first 24 hours. In less severe cases - weakening of nervous phenomena, appearance of exanthema ('blisters, spots and millet-like rash'), disappearance of sweat usually on the 6th day and slow recovery. The similarity of clinical and epidemic pictures allows many authors to speak of a connection between 'English sweat' and suette miliaire.