Sweating sickness, also known as the sweats, English sweating sickness or English sweat or Latin: sudor anglicus, was a mysterious and contagious disease that struck England and later continental Europe in a series of epidemics beginning in 1485. The last outbreak occurred in 1551, after which the disease apparently vanished. The onset of symptoms was sudden, with death often occurring within hours. Sweating sickness epidemics were unique compared to other disease outbreaks of the time. Where other epidemics were typically urban and long-lasting, cases of sweating sickness spiked and receded very quickly and heavily affected rural populations. Its cause remains unknown, although it has been suggested that an unknown species of hantavirus was responsible.

Signs and symptoms

John Caius was a practising physician in Shrewsbury in 1551, when an outbreak occurred, and he described the symptoms and signs of the disease in A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse (1552), which is the main historical source of knowledge of the disease. It 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 exhaustion. The cold stage might last from half an hour to three hours, after which the hot and sweating stage began. The characteristic sweat broke out suddenly without any obvious cause. A sense of heat, headache, delirium, rapid pulse, and intense thirst accompanied the sweat. Palpitation and pain in the heart were frequent symptoms, as well. No skin eruptions were noted by observers, including Caius. In the final stages, there was either general exhaustion and collapse, or an irresistible urge to sleep, which Caius thought was fatal if the patient were permitted to give way to it. One attack did not produce immunity, and some people suffered several bouts before dying. The disease typically lasted through one full day before recovery or death took place. The disease tended to occur in summer and early autumn.

Thomas Forestier, a physician during the first outbreak, provided a written account of his own experiences with the sweating sickness in 1485. Forestier put great emphasis on the sudden breathlessness that is commonly associated with the final hours of those who had contracted this disease. Forestier claimed in an account written for other physicians that "loathsome vapors" had congregated around the heart and lungs. His observations point towards a pulmonary component of this disease that was previously unknown.

Transmission

Transmission of the sweating sickness mostly remains a mystery, with only a few pieces of evidence in written works. The names that the peasantry called the disease, such as "Stup-Gallant", lead to the possibility that it affected the rich much more often.

The greater number of people in London to witness the coronation of Henry VIII may have greatly increased the spread of this disease.

Cause

The cause is the most mysterious aspect of the disease. Commentators then and now put much blame on the sewage, generally poor sanitation, and contaminated water supplies of the time, which might have harboured the source of infection. The first confirmed outbreak was in August 1485 at the end of the Wars of the Roses, which has led to speculation that it may have been brought over from France by the French mercenaries whom Henry Tudor used to gain the English throne. However, an earlier outbreak may have affected the city of York in June 1485, before Tudor's army landed, although the record of that disease's symptoms is not adequate enough to be certain. Regardless, the Croyland Chronicle mentions that Thomas Stanley, 1st Earl of Derby used the sweating sickness as an excuse not to join with Richard III's army prior to Tudor's victory over Richard at the Battle of Bosworth.

Relapsing fever, a disease spread by ticks and lice, has been proposed as a possible cause. It occurs most often during the summer months, as did the original sweating sickness. However, relapsing fever is marked by a prominent black scab at the site of the tick bite and a subsequent skin rash.

A previously proposed theory suggested ergot poisoning but was quickly ruled out due to England having much less rye (the main cause of ergotism) than the rest of Europe.

Several researchers have noted that symptoms overlap with hantavirus pulmonary syndrome and have proposed an unknown hantavirus as the cause.

Specific similarities between the English sweating sickness and diseases caused by various species of hantavirus indicate that a hantavirus may have been the cause of the sweating sickness. Hantavirus species are zoonotic diseases which are carried by bats, rodents, and several insectivores. There are indications that the English sweating sickness may have been rodent borne. Evidence of this includes the seasonal occurrences, fluctuations multiple times a year, and the occasional cases which occurred between major outbreaks. Other diseases carried by rodents demonstrate similar trends.

The epidemiology of hantavirus also correlates with the trends found in the English sweating sickness. Hantavirus infections generally did not strike infants, children, or the elderly, and most violently affected middle-aged adults. The infection of the English sweating sickness was also predominantly in people of middle age. This is opposite of the trends observed in most epidemics of the medieval ages, and this rare trend may indicate that the sweating sickness was caused by a hantavirus species.

A critique of this hypothesis argued that sweating sickness was thought to be transmitted from human to human, whereas hantaviruses are rarely spread that way. However, infection via human contact has been suggested in hantavirus outbreaks in Argentina. Modern day hantaviruses, unlike the sweating sickness, do not randomly disappear and can be seen affecting people on an isolated basis.

In 2004, microbiologist Edward McSweegan suggested that the disease may have been an outbreak of anthrax poisoning. He hypothesized that the victims could have been infected with anthrax spores present in raw wool or infected animal carcasses, and he suggested exhuming the victims for testing.

The disease has been the subject of numerous attempts to define its origin by the modern molecular biology methods, but so far all efforts have failed due to lack of material, DNA or RNA.

Epidemiology

Arthur, Prince of Wales, who may have died of the sweating sickness in 1502

Henry Brandon, 2nd Duke of Suffolk, who in 1551 died of the sweating sickness hours before his brother Charles

Charles Brandon, 3rd Duke of Suffolk, died of the sweating sickness

Fifteenth century

Sweating sickness first came to the attention of physicians at the beginning of the reign of Henry VII, in 1485. It was frequently fatal; half the population perished in some areas. There is no definitive statement that the sickness was present in troops landing at Milford Haven. Henry arrived in London on 28 August soon after the Battle of Bosworth Field, and the disease broke out on 19 September 1485; it had killed several thousand people by its conclusion in late October that year. Among those killed were two lord mayors, six aldermen, and three sheriffs.

Mass superstition and paranoia quickly followed the new plague. The Battle of Bosworth Field had served as the end of the Wars of the Roses between the houses of Lancaster and York. Richard III, the final York King, was killed at this battle and Henry VII of England was crowned as Henry VII. As chaos, grief, and anger spread, people searched for a culprit to blame for the newest plague. Since the first cases recognized were shortly following the Battle of Bosworth Field, the English people started to believe that the English sweating sickness was sent by God to punish those who supported the new reign of Henry VII.

This alarming malady soon became known as the sweating sickness. It was regarded as being quite distinct from the Black Death, the pestilential fever, or other epidemics previously known because of the sweating which gave it its name and its extremely rapid and fatal course. It reached Ireland in 1492, when the Annals of Ulster record the death of James Fleming, 7th Baron Slane from the pláigh allais, newly come to Ireland. The Annals of Connacht also record this obituary, and the Annals of the Four Masters record "an unusual plague in Meath" of 24 hours' duration; people recovered if they survived it beyond that 24-hour period. It did not attack infants or little children. Richard Grafton, an English chronicler, made mention of the sweating sickness of 1485 in his work Grafton's Chronicle: or History of England. He noted that the common treatment of the disease was to go immediately to bed at the first sign of symptoms; there, the affected person was to remain absolutely still for the entire 24-hour period of the illness, abstaining from any solid food and limiting water intake. However, Freeman denies that this "plague" was the sweating sickness, despite the similarity of the names. He thought it to be "Relapsing or Famine Fever"—possibly typhus.

Sixteenth century

Title of a publication in Marburg, 1529, about the English Sweating sickness

Nothing was recorded of the ailment from 1492 to 1502. It may have been the condition which afflicted Arthur, Prince of Wales (the elder brother of Henry VIII of England) and his wife Catherine of Aragon in March 1502; their illness was described as "a malign vapour which proceeded from the air". Other suggestions include tuberculosis ("consumption"), the Black Death, and influenza.

Researchers opened Arthur's tomb in 2002 but could not determine the exact cause of death. One possible cause was a genetic ailment which also affected Arthur's nephew Edward VI. Catherine recovered, but Arthur died on 2 April 1502 in his home at Ludlow Castle, six months short of his sixteenth birthday.

A second, less widespread outbreak occurred in 1507, followed by a third and much more severe epidemic in 1517, a few cases of which may have also spread to Calais. In the 1517 epidemic, the disease showed a particular affinity for Englishmen; the ambassador from Venice at the time commented on the peculiarly low number of cases in foreign visitors. A similar effect was noted in the subsequent epidemic in 1528 when Calais (an English territory bordering France) experienced an outbreak of sweating sickness which did not spread into France. It was frequently fatal; half the population perished in some areas. It reached epidemic proportions in 1528 during its fourth outbreak. It broke out in London at the end of May and speedily spread over the whole of England, save the far north. It did not spread to Scotland, though it did reach Ireland where Lord Chancellor Hugh Inge was the most prominent victim. The mortality rate was very high in London; Henry VIII broke up the court and left London, frequently changing his residence. In 1529 Thomas Cromwell lost his wife and two daughters to the disease.

Along with Thomas Cromwell's family, it is believed that several of the closest people to King Henry VIII contracted the English sweating sickness. In his love letters to his mistress, Anne Boleyn, it is revealed that physicians believed that Anne had contracted the illness. Henry VIII sent his most renowned physician to her aid and she fortunately survived. Additionally, one of King Henry VIII's closest friends and advisors, Cardinal Wolsey, also contracted the illness and survived.

It appeared that the illness mostly targeted young men and also favored the wealthy or powerful. This earned the disease the nicknames such as "Stoop Gallant" or "Stoop Knave" (indicating that the proud were forced to 'stoop' and relinquish their proud status).

The disease suddenly appeared in Hamburg, spreading so rapidly that more than a thousand people died in a few weeks. It swept through eastern Europe as an epidemic causing high mortality rates. It arrived in Switzerland in December, then was carried northwards to Denmark, Sweden, and Norway, and eastwards to Lithuania, Poland, and Russia. Cases of the disease were not known to occur in Italy or France, except in the Pale of Calais which was controlled by England at the time. It also emerged in Flanders and the Netherlands, possibly transmitted directly from England by travellers; it appeared simultaneously in the cities of Antwerp and Amsterdam on the morning of 27 September. In each place, it prevailed for a short time, generally not more than two weeks. By the end of the year, it had entirely disappeared except in eastern Switzerland, where it lingered into the next year. After this, the disease did not recur on mainland Europe.

Final outbreak

The last major outbreak of the disease occurred in England in 1551. Though burial patterns in smaller towns in Europe suggest that the disease may have been present elsewhere first, the outbreak is recorded to have begun in Shrewsbury in April. It killed roughly 1,000 there, spreading quickly throughout the rest of England. It had all but ceased by October. It was more prevalent among younger men than in other groups, though this may have been due to greater social exposure of younger men. In response to the disease, John Caius wrote A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse as an eyewitness account. Henry Machin also recorded it in his diary:

the vii day of July begane a nuw swet in London…the x day of July [1551] the Kynges grace removyd from Westmynster unto Hamtun courte, for ther [died] serten besyd the court, and caused the Kynges grase to be gone so sune, for ther ded in London mony marchants and grett ryche men and women, and yonge men and old, of the new swett…the xvi day of July ded of the swet the ii yonge dukes of Suffoke of the swet, both in one bed in Chambrydge-shyre…and ther ded from the vii day of July unto the xix ded of the swett in London of all dyssesus… [872] and no more in alle

— The Diary of Henry Machyn 1550–1563

Reference is made in the Annals of Halifax Parish in 1551 to an outbreak there, resulting in 44 deaths. A disease outbreak of something called 'sweating sickness' occurred in Tiverton, Devon in 1644, recorded in Martin Dunsford's History, which led to the deaths of 443 people, 105 of them buried in the month of October. However, there were no medical particulars recorded, and the 1644 date falls well after the generally accepted disappearance of the 'sweating sickness' in 1551.

Picardy sweat

A similar illness occurred in France between 1718 and 1918 known as the Picardy sweat. The Picardy sweat was significantly less lethal than the English Sweat. However, the frequency of outbreaks were strikingly high, with over 196 outbreaks in France during the early 18th and end of the 19th century.

Llywelyn Roberts noted "a great similarity between the two diseases." It was accompanied by a rash, which was not described as a feature of the English disease. Similar to the English sweating sickness, there was also intense sweating and fever noticed with the Picardy sweat. However, Henry Tidy argued that John Caius' report applies to fulminant cases fatal within a few hours, in which type no eruption may develop. A 1906 outbreak of Picardy sweat struck 6,000 people; bacteriologist André Chantemesse led a commission which studied it, and they attributed infection to the fleas of field mice. Henry Tidy found "no substantial reason to doubt the identity of sudor anglicus and Picardy sweat." Furthermore, it was speculated that the English sweating sickness and the Picardy Sweat may both be caused by a species of hantavirus.

There were notable differences between the Picardy sweat and the English sweating sickness. Along with the rash observed in the Picardy sweat, the Picardy sweat appears to have had a different epidemiology than the English sweat. The English sweating sickness appeared to most heavily affect urban and highly populated areas, while the Picardy sweat was most prevalent in rural areas. It was noticed that individuals who slept close to the ground and/or lived on farms and fields more quickly contracted the disease. This supports the possibility that the disease could be rodent borne, common in hantaviruses.

Popular culture

The Tudors episode "Message to the Emperor" (2007), depicts the 1528 outbreak. William Compton is killed by the disease, and both Anne Boleyn and Cardinal Wolsey are stricken. Wolsey actually did survive several attacks of sweating sickness. Henry VIII's illegitimate son Henry FitzRoy, 1st Duke of Richmond and Somerset dies of the sweat as a young child several episodes prior. A physician treats a mortally afflicted Compton by puncturing his back and bleeding him, on the rumor that it has worked for some by releasing "the toxin". The real Henry FitzRoy died about one month after his 17th birthday, probably of tuberculosis, and the real William Compton died of sweating sickness at age 46.

In Hilary Mantel's historical novel Wolf Hall (2009), a small outbreak in 1527 kills Liz, the wife of Thomas Cromwell, Cardinal Wolsey's advisor. In 1529, the disease also claims the lives of Cromwell's daughters Grace and Anne. In the eponymous 2015 television adaptation of Mantel's novel, all three die on the same day, in episode 1.

The American science fiction television series Warehouse 13 features sweating sickness midway through season 4. It is revealed to be an artifact in the form of a Chinese orchid that would release the deadly disease if removed from its container. The events of the story arc suggest that the disease originally vanished from Europe when the orchid was reconstituted into its original form and stored in a previous warehouse.

The British fantasy-adventure drama television series Merlin features sweating sickness, although the illness historically did not appear until many centuries after any of the supposed dates for the historical Arthur, and none of the legends surrounding him discuss plague outbreaks.

Season One episode 2 of The Spanish Princess, a 2020 series from US cable premium service Starz, depicts a sweating sickness outbreak beginning first with the Princess Catherine's Lady Lina and spreads through the castle to also infect Prince Arthur. Prince Arthur dies of the sweating sickness.

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