Skip to main content

Advertisement

SpringerLink
Log in

Sudor Anglicus: an epidemic targeting the autonomic nervous system

  • Review Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Renaissance England witnessed a series of brief epidemics of a rapid and often fatal illness, the predominant feature of which was a disturbance of the autonomic nervous system. Profuse sweating was both an emblematic and ominous sign of this Sudor Anglicus. Its story is medically fascinating as well as historically noteworthy. Possible sites of pathological involvement include the hypothalamus, serotonergic neurons in the brainstem or spinal cord, autonomic ganglia, peripheral sympathetic nerves, neuroeffector junctions, or eccrine glands. Of candidate etiologic agents, a virus is most likely, given the seasonal variation, geographic clustering, and pattern of spread of the epidemics. Hantaviruses, enteroviruses, influenza, and others provide clinical comparisons, but a definitive match with known viruses has remained elusive.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Amano T, Igarashi A, Fujii N, Hiramatsu D, Inoue Y, Kondo N (2018) Beta-adrenergic receptor blockade does not modify non-thermal sweating during static exercise and following muscle ischemia in habitually trained individuals. Eur J Appl Physiol 118:2669–2677

    CAS  PubMed  Google Scholar 

  2. Baker LB (2019) Physiology of sweat gland function: the roles of sweating and sweat composition in human health. Temperature (Austin) 6:211–259

    Google Scholar 

  3. Batko B, Kustra S (1980) Hyperhidrosis as the only symptom of post-influenza diencephalitis. Wiad Lek 33:149–152

    CAS  PubMed  Google Scholar 

  4. Binks SNM, Klein CJ, Waters P, Pittock SJ, Irani SR (2018) LGI1, CASPR2 and related antibodies: a molecular evolution of the phenotypes. J Neurol Neurosurg Psychiatry 89:526–534

    PubMed  Google Scholar 

  5. Blunt SB, Lane RJ, Turjanski N, Perkin GD (1997) Clinical features and management of two cases of encephalitis lethargica. Mov Disord 12:354–359

    CAS  PubMed  Google Scholar 

  6. Bridson E (2001) The English 'sweate' (Sudor Anglicus) and Hantavirus pulmonary syndrome. Br J Biomed Sci 58:1–6

    CAS  PubMed  Google Scholar 

  7. Brown R, Burton AR, Macefield VG (2018) Autonomic dysreflexia: somatosympathetic and viscerosympathetic vasoconstrictor responses to innocuous and noxious sensory stimulation below lesion in human spinal cord injury. Auton Neurosci 209:71–78

    PubMed  Google Scholar 

  8. Butler JC, Peters CJ (1994) Hantaviruses and Hantavirus pulmonary syndrome. Clin Infect Dis 19:387–394 (quiz 395)

    CAS  PubMed  Google Scholar 

  9. Caius J (1552) A boke, or counseill against the disease commonly called the sweate, or sweatyng sickness. Reprinted in: Hecker JFC (1846) The epidemics of the middle ages. The Sydenham Society, London, pp 353–380

  10. Caplan RH, Glasser JE, Rodman CA (1982) Partial hypothalamic insufficiency resulting from herpes simplex encephalitis: report of a probable case. Minn Med 65(341–344):340

    Google Scholar 

  11. Carmel PW (1985) Vegetative dysfunctions of the hypothalamus. Acta Neurochir (Wien) 75:113–121

    CAS  Google Scholar 

  12. Carod-Artal FJ (2018) Infectious diseases causing autonomic dysfunction. Clin Auton Res 28:67–81

    PubMed  Google Scholar 

  13. Cheshire WP, Fealey RD (2008) Drug-induced hyperhidrosis and hypohidrosis: incidence, prevention and management. Drug Saf 31:109–126

    CAS  PubMed  Google Scholar 

  14. Cheshire WP Jr (2016) Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 196:91–104

    PubMed  Google Scholar 

  15. Coon EA, Cheshire WP Jr (2020) Sweating disorders. Continuum (Minneap Minn) 26:116–137

    Google Scholar 

  16. Creighton C (1891) The sweating sickness, 1485–1551. A history of epidemics in Britain. Cambridge University Press, London, UK, pp 237–279

    Google Scholar 

  17. Devereaux MW (1968) The English sweating sickness. South Med J 61:1191–1195

    CAS  PubMed  Google Scholar 

  18. Dickman MS (2001) von Economo encephalitis. Arch Neurol 58:1696–1698

    CAS  PubMed  Google Scholar 

  19. Eadie MJ (2003) Convulsive ergotism: epidemics of the serotonin syndrome? Lancet Neurol 2:429–434

    CAS  PubMed  Google Scholar 

  20. Folly AJ, Dorey-Robinson D, Hernandez-Triana LM, Phipps LP, Johnson N (2020) Emerging threats to animals in the United Kingdom by arthropod-borne diseases. Front Vet Sci 7:20

    PubMed  PubMed Central  Google Scholar 

  21. Forestier T (1490) Tractatus contra pestilentiam thenasmouen et dissinteriam. Guillaume le Talleur, Rouen

  22. Gould EA, Higgs S, Buckley A, Gritsun TS (2006) Potential arbovirus emergence and implications for the United Kingdom. Emerg Infect Dis 12:549–555

    PubMed  PubMed Central  Google Scholar 

  23. Heyman P, Cochez C, Hukic M (2018) The English sweating sickness: out of sight, out of mind? Acta Med Acad 47:102–116

    PubMed  Google Scholar 

  24. Heyman P, Simons L, Cochez C (2014) Were the English sweating sickness and the picardy sweat caused by Hantaviruses? Viruses 6:151–171

    PubMed  PubMed Central  Google Scholar 

  25. Hu Y, Converse C, Lyons MC, Hsu WH (2018) Neural control of sweat secretion: a review. Br J Dermatol 178:1246–1256

    CAS  PubMed  Google Scholar 

  26. Hunter PR (1991) The English sweating sickness, with particular reference to the 1551 outbreak in Chester. Rev Infect Dis 13:303–306

    CAS  PubMed  Google Scholar 

  27. Iqbal MM, Basil MJ, Kaplan J, Iqbal MT (2012) Overview of serotonin syndrome. Ann Clin Psychiatry 24:310–318

    PubMed  Google Scholar 

  28. Irani SR, Pettingill P, Kleopa KA, Schiza N, Waters P, Mazia C, Zuliani L, Watanabe O, Lang B, Buckley C, Vincent A (2012) Morvan syndrome: clinical and serological observations in 29 cases. Ann Neurol 72:241–255

    PubMed  Google Scholar 

  29. Ishikawa S, Aoki H, Akahane C, Shimada H, Takei Y, Ichinose Y, Ikeda S (2001) Hypothalamic encephalitis with bradycardia. Intern Med 40:805–807

    CAS  PubMed  Google Scholar 

  30. Leblebicioglu H, Ozaras R, Irmak H, Sencan I (2016) Crimean-Congo hemorrhagic fever in Turkey: current status and future challenges. Antiviral Res 126:21–34

    CAS  PubMed  Google Scholar 

  31. Lichtenstein MJ, Tilley WS, Sandler MP (1982) The syndrome of hypothalamic hypopituitarism complicating viral meningoencephalitis. J Endocrinol Invest 5:111–115

    CAS  PubMed  Google Scholar 

  32. Lu B (2015) The destructive effect of botulinum neurotoxins on the SNARE protein: SNAP-25 and synaptic membrane fusion. PeerJ 3:e1065

    PubMed  PubMed Central  Google Scholar 

  33. Macneil A, Nichol ST, Spiropoulou CF (2011) Hantavirus pulmonary syndrome. Virus Res 162:138–147

    CAS  PubMed  Google Scholar 

  34. Mamilla D, Gonzales MK, Esler MD, Pacak K (2019) Pseudopheochromocytoma. Endocrinol Metab Clin North Am 48:751–764

    PubMed  Google Scholar 

  35. Masri MFB, Mantri CK, Rathore APS, John ALS (2019) Peripheral serotonin causes dengue virus-induced thrombocytopenia through 5HT2 receptors. Blood 133:2325–2337

    CAS  PubMed  Google Scholar 

  36. McSweegan E (2004) Anthrax and the etiology of the English sweating sickness. Med Hypotheses 62:155–157

    PubMed  Google Scholar 

  37. Meyfroidt G, Baguley IJ, Menon DK (2017) Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol 16:721–729

    PubMed  Google Scholar 

  38. O'Keefe E, Cuatecasas P (1978) Cholera toxin and membrane gangliosides: binding and adenylate cyclase activation in normal and transformed cells. J Membr Biol 42:61–79

    CAS  PubMed  Google Scholar 

  39. Owe-Larsson B, Berglund M, Kristensson K, Garoff H, Larhammar D, Brodin L, Low P (1999) Perturbation of the synaptic release machinery in hippocampal neurons by overexpression of SNAP-25 with the semliki forest virus vector. Eur J Neurosci 11:1981–1987

    CAS  PubMed  Google Scholar 

  40. Patrick A (1965) A consideration of the nature of the English sweating sickness. Med Hist 9:272–279

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Reisch N, Peczkowska M, Januszewicz A, Neumann HP (2006) Pheochromocytoma: presentation, diagnosis and treatment. J Hypertens 24:2331–2339

    CAS  PubMed  Google Scholar 

  42. Roberts RS (1965) A consideration of the nature of the English sweating sickness. Med Hist 9:385–389

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Shaw MB (1933) A short history of the sweating sickness. Ann Med Hist 5:246–274

    Google Scholar 

  44. Shibasaki M, Crandall CG (2010) Mechanisms and controllers of eccrine sweating in humans. Front Biosci (Schol Ed) 2:685–696

    Google Scholar 

  45. Shibasaki M, Secher NH, Selmer C, Kondo N, Crandall CG (2003) Central command is capable of modulating sweating from non-glabrous human skin. J Physiol 553:999–1004

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Slack P (1990) The impact of plague in Tudor and Stuart England. Clarendon Press, Oxford University Press, Oxford, UK

    Google Scholar 

  47. Sloan AW (1971) The sweating sickness in England. S Afr Med J 45:473–475

    CAS  PubMed  Google Scholar 

  48. Strauss MB (1973) A hypothesis as to the mechanism of fulminant course and death in the sweating sickness. J Hist Med Allied Sci 28:48–51

    CAS  PubMed  Google Scholar 

  49. Taviner M, Thwaites G, Gant V (1998) The English sweating sickness, 1485–1551: a viral pulmonary disease? Med Hist 42:96–98

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Thwaites G, Taviner M, Gant V (1997) The English sweating sickness, 1485 to 1551. N Engl J Med 336:580–582

    CAS  PubMed  Google Scholar 

  51. Valent P, Akin C, Bonadonna P, Hartmann K, Brockow K, Niedoszytko M, Nedoszytko B, Siebenhaar F, Sperr WR, Oude Elberink JNG, Butterfield JH, Alvarez-Twose I, Sotlar K, Reiter A, Kluin-Nelemans HC, Hermine O, Gotlib J, Broesby-Olsen S, Orfao A, Horny HP, Triggiani M, Arock M, Schwartz LB, Metcalfe DD (2019) Proposed diagnostic algorithm for patients with suspected mast cell activation syndrome. J Allergy Clin Immunol Pract 7(1125–1133):e1121

    Google Scholar 

  52. Vergilio P (1950) Anglica Historia. Royal Historical Society, London

    Google Scholar 

  53. Vilensky JA (2011) Encephalitis Lethargica. Oxford University Press, New York

    Google Scholar 

  54. Vissing SF, Hjortso EM (1996) Central motor command activates sympathetic outflow to the cutaneous circulation in humans. J Physiol 492(Pt 3):931–939

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Wylie JA, Collier LH (1981) The English sweating sickness (sudor Anglicus): a reappraisal. J Hist Med Allied Sci 36:425–445

    CAS  PubMed  Google Scholar 

  56. Wylie JA, Linn IJ (1980) Observations upon the distribution and spread of the English sweating sickness (sudar anglicus) in Devon in 1551. Devon Assoc Adv Sci 112:97–111

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 4500 Mellish Rd., Jacksonville, FL, 32224, USA

    William P. Cheshire & Jay A. van Gerpen

  2. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

    James J. Sejvar

Authors
  1. William P. Cheshire
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jay A. van Gerpen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James J. Sejvar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William P. Cheshire.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheshire, W.P., van Gerpen, J.A. & Sejvar, J.J. Sudor Anglicus: an epidemic targeting the autonomic nervous system. Clin Auton Res 30, 317–323 (2020). https://doi.org/10.1007/s10286-020-00698-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-020-00698-x

Keywords

Search

Navigation