Sweating sickness

• 1. Introduction

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  Within eight to ten hours of the first symptoms, a person struck by the sweating sickness was often either dead or already recovering. People called it the sweats, the English sweat, and in Latin, sudor anglicus. It arrived in waves, burned through a region in a matter of weeks, and then withdrew. Unlike the great plagues of its age, it left no lasting foothold in the cities. Physicians who watched it left vivid descriptions of what the body went through. Yet nobody has been able to say what the illness actually was. Why did it favour the English? Who did it kill, and who did it spare? And how did a disease that terrified kings simply stop appearing?

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• 2. The Course of an Attack

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  In Shrewsbury in 1551, the physician John Caius watched the sweating sickness arrive and wrote down what he saw. He published his findings in 1552 under the title A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse. It remains the main historical source for the disease.

  Caius described an onset that came without warning, starting with a sense of apprehension. Cold shivers followed, sometimes very violent, along with dizziness, headache, and severe pains in the neck, shoulders, and limbs. Great exhaustion set in alongside them.

  The cold stage lasted between half an hour and three hours. Then the sweat broke out suddenly and without any obvious cause. A feeling of heat came with it, along with headache, delirium, a rapid pulse, and intense thirst. Palpitations and pain in the heart were frequent. Observers noted no skin eruptions at all.

  In the final stages, Caius saw patients either collapse in general exhaustion or feel an irresistible urge to sleep. He believed that giving in to sleep was fatal. The illness typically ran for one full day. A single attack gave no protection against the next, and some people suffered several bouts before dying. Outbreaks tended to come in summer and early autumn.

  Thomas Forestier, a physician who lived through the first outbreak, wrote an account of his own illness in 1485. He stressed the sudden breathlessness that marked the last hours of sufferers. He told fellow physicians that "loathsome vapours" had gathered around the heart and lungs. His observations suggest the lungs were involved. That first outbreak arrived just as one royal house replaced another.

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• 3. Bosworth and the First Outbreak

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  The first confirmed outbreak came in August 1485, as the Wars of the Roses ended at the Battle of Bosworth Field. Richard III, the last York king, was killed there, and Henry VII was crowned. Some people suspected French mercenaries had carried the disease over from France. An earlier outbreak may have hit the city of York in June 1485, before Henry Tudor's army landed. The records of its symptoms are too thin to be sure.

  The Croyland Chronicle adds a telling detail about the battle. It says Thomas Stanley, 1st Earl of Derby, cited the sweating sickness as his reason for not joining Richard III's army. Others believed the disease came through trade with Scandinavia and Russia, entering by the towns of the Yorkshire-Lincolnshire coast.

  The Ricardian scholar John Ashdown-Hill conjectures that Richard III himself fell ill the night before the battle. On that view, the illness would explain the king's sleepless night and his excessive thirst early in the fighting. No source states that Henry Tudor's troops, landing at Milford Haven, carried the sickness.

  Henry VII reached London on the 28th of August 1485, and the disease broke out there on the 19th of September 1485. By late October it had killed several thousand people. Among the dead were two lord mayors, six aldermen, and three sheriffs. The crowds gathered to witness Henry's coronation may have helped it spread, as they would have for many other airborne pathogens. In some areas, half the population perished.

  Among the English, a belief took hold that God had sent the plague to punish the supporters of Henry VII. Superstition and paranoia spread with it. The idea of divine wrath was not new, and it returned with every later outbreak.

  Because it moved so fast and brought such heavy sweating, people treated it as something apart from the Black Death and the pestilential fever. The chronicler Richard Grafton, in Grafton's Chronicle: or History of England, recorded the usual treatment. At the first sign of symptoms the patient went straight to bed and lay still for the whole 24 hours, taking no solid food and little water.

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• 4. Who It Struck

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  Among recorded victims, mortality was highest in men aged 30-40. The sweating sickness did not spare the wealthy, and young, seemingly fit men from privileged classes were no less likely to fall ill. It also weighed heavily on rural and working people. Infants and young children were not affected. Because it reached every level of society, from rich to poor, people gave it nicknames such as "Stoop Gallant" and "Stoop Knave". The names pointed to the way the proud were forced to stoop and face their own humanity.

  Most epidemics of the period were urban and long-lasting. Cases of the sweating sickness instead spiked and receded very quickly, and they reached deep into the countryside.

  The disease also seemed to follow the English abroad. In the severe epidemic of 1517, the Venetian ambassador remarked on the peculiarly low number of cases among foreign visitors. A few cases may have spread to Calais that year. In 1528, Calais, then an English territory, suffered an outbreak that did not cross into France.

  That 1528 outbreak was the fourth, and it reached epidemic proportions. It also reached the people closest to the king.

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• 5. Royal Households

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  In March 1502, Arthur, Prince of Wales, and his wife Catherine of Aragon both fell ill. The disease had not been recorded since 1492, but theirs may have been the same condition. Their illness was described as "a malign vapour which proceeded from the air". Catherine recovered. Arthur died at Ludlow Castle on the 2nd of April 1502, six months short of his sixteenth birthday. Researchers who opened his tomb in 2002 could not determine the exact cause of death.

  The earliest written reference to the 1528 outbreak is a letter dated the 5th of June 1528. Brian Tuke wrote it to Cuthbert Tunstall, Bishop of London. Tuke said he had fled to Stepney to escape a servant at his house who was ill with "the sweat." That suggests the disease broke out in London at the end of May. It spread over all of England except the far north. It did not reach Scotland, but it did reach Ireland, where Lord Chancellor Hugh Inge died on the 3rd of August 1528. He was the most prominent victim there.

  Mortality in London was very high. Henry VIII broke up his court and left the city, frequently changing his residence. In 1529, Thomas Cromwell lost his wife and two daughters to the disease. Several of the people closest to the king are believed to have caught it. His love letters to Anne Boleyn reveal that physicians believed she had the illness. Henry sent his second-most trusted physician to her aid, because his first was unavailable, and she survived. Cardinal Wolsey also caught the sickness and survived.

  By July 1529 the disease had left England altogether, carried across the sea on a ship.

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• 6. Across the Water

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  The sickness had first reached Ireland in 1492. The Annals of Ulster record the death of James Fleming, 7th Baron Slane, from the pláigh allais, which means "perspiring plague", newly come to Ireland. The Annals of Connacht carry the same obituary. The Annals of the Four Masters record "an unusual plague in Meath" that lasted 24 hours. Anyone who survived beyond that day recovered.

  In July 1529, a ship from England brought the disease to Hamburg. It spread along the Baltic coast, north to Denmark, Sweden, and Norway, and south to Strasbourg, Frankfurt, Cologne, Marburg, and Göttingen by September. Italy and France saw no cases, apart from the English-controlled Pale of Calais.

  It emerged in Flanders and the Netherlands, possibly carried straight from England by travellers. It appeared in Antwerp and Amsterdam at the same time, on the morning of the 27th of September. In each place it prevailed for a short time, generally no more than two weeks. By the end of 1529 it had disappeared entirely, except in the eastern part of the Swiss Confederacy, where it lingered into the next year. It never returned to mainland Europe.

  England would see one more outbreak, which began in Shrewsbury in April 1551.

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• 7. The Last Outbreak

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  In April 1551, the sweating sickness was recorded in Shrewsbury, where it killed around 1,000 people. It spread quickly through the rest of England and all but disappeared by October. Burial patterns in smaller European towns hint that the disease may have been present elsewhere first. This time it was more prevalent among younger men than other groups, possibly because they had greater social exposure.

  John Caius gave his eyewitness account of this outbreak. He ascribed the cause to dirt and filth, though some modern investigators have considered the disease a form of influenza. Henry Machyn also recorded the outbreak in his diary.

  Later records are harder to interpret. The Annals of Halifax Parish for 1551 record 44 deaths in an outbreak there. In Tiverton, Devon, an outbreak called sweating sickness struck in 1644, according to Martin Dunsford's History. It killed 443 people, 105 of them buried in October. No medical details were recorded, and the date falls well after the generally accepted disappearance of the disease in 1551.

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• 8. Suspects and Echoes

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  Sewage, poor sanitation, and contaminated water have all been blamed by commentators then and now. Other suspects have fared no better. Relapsing fever, spread by ticks and lice, occurs mostly in summer, as the sweating sickness did. But it leaves a prominent black scab at the bite and a later rash, and neither is described in the English disease. Ergotism was ruled out because England grew much less rye than the rest of Europe, and ergot grows typically on rye.

  Researchers have noted that the symptoms overlap with hantavirus hemorrhagic fever with renal syndrome. They have proposed an unknown hantavirus as the cause. Hantaviruses are carried by bats, rodents, and several insectivores. The seasonal pattern, the fluctuations several times a year, and the occasional cases between major outbreaks all suggest a rodent-borne disease. There are problems with the idea. Modern hantaviruses mostly affect middle-aged adults. They do not randomly disappear, and they strike isolated people. They are also rarely passed between humans, although human transmission has been suggested in an outbreak in Argentina and one aboard a cruise ship.

  Between 1718 and 1918, France saw an illness called the Picardy sweat, with about 200 recorded outbreaks. It was much less lethal than the English sweat. Llywelyn Roberts noted a great similarity between the two diseases, and Henry Tidy found no substantial reason to doubt they were the same. Both brought suffocation and pain in the abdomen and chest with no physical abnormality. The Picardy sweat came with a rash, which the English disease lacked. Tidy argued that Caius described cases so fulminant, and fatal within hours, that no eruption had time to develop. People who slept close to the ground or lived on farms seemed more susceptible, which fits a rodent-borne disease. A commission led by the bacteriologist André Chantemesse blamed the fleas of field mice for a 1906 outbreak that struck 6,000 people.

  In 2004, the microbiologist Edward McSweegan suggested anthrax poisoning, from spores in raw wool or infected animal carcasses. He proposed exhuming victims for testing. Attempts to settle the question by molecular biology have so far failed because no DNA or RNA is available.

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