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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 1; 335(7630): 1159.
PMCID: PMC2099520
Medical Classics

A Boke or Counseill against the Disease Commonly Called the Sweate or the Sweating Sickness

John Black, retired consultant paediatrician

Sweating sickness was a disease of unknown cause and very high mortality that first appeared in England in 1485. John Caius's book is our main source of knowledge about the disease, outbreaks of which recurred until 1578.

John Caius was born in Norwich in 1510. He entered Gonville Hall in Cambridge in 1529 and then moved to Padua to study under Vesalius. He refounded his former college as Gonville and Caius College and became its master. In the first part of his book Caius describes the disease as “not a sweat onely (as it is thought or called) but a fever.” It lasted 24 hours, with pain in the arms, legs, back, and shoulders, followed by a “marvellous heavinesse, and a desire to sleape.”

Dengue fever (“break bone fever”) seems the most likely candidate, although it usually lasts more than 24 hours and is often accompanied by a rash, which the book doesn't mention. At a time when conditions in England were favourable to the ague (malaria), it is plausible that dengue fever, another mosquito-borne disease, would also be prevalent.

Caius then deals with the causes of the condition: “infection” and “impure spirites in bodies corrupt by repletion [overeating].” Infection is due to “evil mistes and exhalations drawn out of the grounde.” He makes an interesting comparison with fire damp in coal mines: “Of like dampes, I heard in the north country in cole pits, whereby the laboring men be streight killed, except before the houre of coming thereof (which thei know by ye flame of their candle) thei avoid the ground.” Repletion, from eating too much meat, bad meat, or rotten fruit, causes an “excess of humores” to develop.

He then discusses “preservacion” (prevention). He recommends a long list of meat, fish, and fruit to eat. In his view people have become effete: “But we are nowe a daies so unwisely fine, and womanly delicate, that we may in no wise touch a fisshe. The olde manly hardnes, stoute courage, & peinfulnes of Englande is utterly driven awaye, in the stede whereof, men now a daies receive womanlines & become nice, not able to withstande a blaste of wynde, or resiste a poore fishe. And children be so brought up, that if they be not all daie by the fire with a toste and butire, and in their furres, they be streight sicke.” He recommends fresh air and clean, sweet smelling clothes. Exercise such as hunting, hawking, or tennis is helpful (bowls for women). People should live quietly “as men were wont to do in the old world when this countrie was called merye England.”

He then goes on to describe “the cure or remedy.” The most important thing is to let out the poison by sweating, he says. He recommends numerous herbs, such as “wilde tansy, mogwort [common wormwood] or feverfew.” Sweating should be provoked by gentle rubbing and warm drinks. The patient's nose and ears should be pulled to prevent sleep. After 24 hours have passed the patient may get up and put on warm clothes but not go out for two days.

Finally, Caius says, “If other causes ther be supernatural, theim I leve to the divines to serche, and the diseases thereof to cure, as a matter with out the compasse of my facultie.”

Although Vesalius was beginning to discard Galenical medicine, it is clear that Caius still clung to Galen's teaching. Despite sweating being an important symptom of the disease, it is curious that Caius lays great emphasis on the induction of sweating as part of the cure.


By John Caius

First published 1552

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