Sweating sickness

Henry Brandon, 2nd Duke of Suffolk who in 1551 died of the sweating sickness hours before his brother Charles Brandon, 3rd Duke of Suffolk

Charles Brandon, 3rd Duke of Suffolk

Sweating sickness, also known as "English sweating sickness" or "English sweate" (Latin: sudor anglicus), was a mysterious and highly virulent 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 dramatic and sudden, with death often occurring within hours. Though its cause remains unknown, it has been suggested that an as yet unknown species of hantavirus pulmonary syndrome was responsible for the outbreak.

Epidemiology

15th century

Sweating sickness first came to the attention of physicians at the beginning of the reign of Henry VII. It was known a few days after the landing of Henry at Milford Haven on 7 August 1485, as it was noted before the Battle of Bosworth Field on 22 August. Soon after the arrival of Henry in London on 28 August, it broke out in the capital. There, it killed several thousand people by its conclusion in late October that year.^[1] Among those killed were two lord mayors, six aldermen, and three sheriffs.^[2] This alarming malady soon became known as the sweating sickness. It was regarded as being quite distinct from the plague, the pestilential fever or other epidemics previously known, not only by the special symptom that gave it its name, but also by its extremely rapid and fatal course. The sweating sickness reached Ireland in 1492 when the Annals of Ulster (vol.iii, ed. B. MacCarthy, Dublin, 1895, pp 358f.) record the death of James Fleming, Baron of Slane from the pláigh allais, newly come to Ireland. The Annals of Connacht (ed. A. M. Freeman, Dublin, 1944, pp 594f.) also record this obituary, and the Annals of the Four Masters (vol.iii, ed. J. O'Donovan, Dublin, 1856, pp 1194f.) record 'an unusual plague in Meath … of 24 hours' duration; and any one who survived it beyond that period recovered. It did not attack infants or little children. However, Freeman in his footnote to the Annals of Connacht denies that this 'plague' was the sweating sickness, in spite of the similarity of the names. He thought it to be 'Relapsing or Famine Fever' – possibly typhus.

16th century

From 1492 to 1502, nothing was recorded of the ailment. In 1502, it was believed to have caused the death of young Arthur, Prince of Wales, elder brother of Henry VIII of England. He died in his home at Ludlow Castle in 1502, leaving his young wife, Catherine of Aragon, a widow.

In 1507 a second, less widespread outbreak occurred, followed in 1517 by a third and much more severe epidemic. In Oxford and Cambridge it was frequently fatal, as well as in other towns, where in some cases half the population are said to have perished. There is evidence of this outbreak spreading to Calais and Antwerp, but nowhere else outside England.

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

In 1528 the disease reached epidemic proportions for the fourth time and with great severity. It first broke out in London at the end of May and speedily spread over the whole of England, save for the far north, not spreading to Scotland, though it did reach Ireland, where the Lord Chancellor, Hugh Inge, was the most prominent victim.^[3] In London the mortality was very great; the court was broken up, and Henry VIII left London, frequently changing his residence. The most remarkable fact about this epidemic is that it spread to Europe, suddenly appearing at Hamburg and spreading so rapidly that in a few weeks, more than a thousand people died. The sweating sickness swept through eastern Europe as an epidemic causing high mortality rates. It appeared to be infectious similar to cholera, perhaps spread as a result of poor sanitation and contaminated water supplies. 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 France or Italy. It also emerged in Flanders and the Netherlands, probably transmitted directly from England by travellers, as it appeared simultaneously in the cities of Antwerp and Amsterdam on the morning of 27 September. In each place it infected, it prevailed for a short time, generally not more than a fortnight. 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. An eminent physician, John Caius, wrote an eyewitness account of the disease at this time called A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse.

Characteristics

The symptoms and signs as described by Caius and others were as follows: The disease 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. After the cold stage, which might last from half an hour to three hours, the hot and sweating stage followed. The characteristic sweat broke out suddenly without any obvious cause. Accompanying the sweat, or after that was poured out, was a sense of heat, headache, delirium, rapid pulse, and intense thirst. Palpitation and pain in the heart were frequent symptoms. 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 to be fatal if the patient was permitted to give way to it. One attack did not offer immunity, and some people suffered several bouts before succumbing.

The malady was never seen again in England after 1578. A similar illness, known as the Picardy sweat, occurred in France between 1718 and 1861, but was less likely to be fatal. It was accompanied by a rash, which was not a feature of the earlier outbreaks.

Cause

The cause is the most mysterious aspect of the disease. Commentators then and now put much blame on the generally poor sanitation, sewage and contaminated water supplies of the time, which may have harboured the source of infection. The first outbreak at the end of the Wars of the Roses means that it may have been brought over from France by the French mercenaries whom Henry VII used to gain the English throne. However, 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 the Battle of Bosworth Field.

Relapsing fever has been proposed as a possible cause. This disease, which is spread by ticks and lice, 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.

Noting symptom overlap with hantavirus pulmonary syndrome, several scientists proposed an unknown hantavirus as the cause.^[4][5] A critique of this hypothesis included the argument that, whereas sweating sickness was thought to be transmitted from human to human, hantaviruses are not known to spread in this way.^[6] However, infection via human to human contact has been proven in hantavirus outbreaks in Argentina.^[7]

In fiction

The 1528 outbreak is depicted in the 2007 episode of The Tudors titled "Message to the Emperor". William Compton is killed by the disease and both Anne Boleyn and Cardinal Wolsey are stricken. In Season 1, Episode 5, Henry FitzRoy, 1st Duke of Richmond and Somerset, the king's officially recognized, illegitimate son dies of "The Sweat" at about 3–5 years old. The real Henry FitzRoy died about one month after his seventeenth birthday, probably of tuberculosis.

A small outbreak in 1527 kills Liz, the wife of Thomas Cromwell, Cardinal Wolsey's advisor, in Hilary Mantel's Wolf Hall. In 1529, the disease also claims the lives of Cromwell's daughters Grace and Anne.

The 2012 mid-season finale of Warehouse 13 titled "We All Fall Down" uses sweating sickness as a plot device. Agents of the eponymous warehouse are seeking a quasi-mystical artifact, a Chinese orchid, which within the fiction of the series was the cause of the 1485 outbreak. The episode ends with the artifact releasing the sickness, potentially infecting the entire world.

Sweating sickness is also featured in the British television series Merlin, which gives a heavily fictionalized account of the lives of Merlin and King Arthur. The illness historically did not appear until many centuries after any of the supposed dates for King Arthur's reign, and none of the legends surrounding him discuss plague outbreaks.

Notes

References

•  This article incorporates text from a publication now in the public domain: Chisholm, Hugh, ed. (1911). Encyclopædia Britannica (11th ed.). Cambridge University Press 
• Bridgett, Thomas Edward (1904). Life and Writings of Blessed Thomas More, Lord Chancellor of England and Martyr Under Henry VIII.. Original from the University of Wisconsin – Madison. p. 74. 

External links

• E. Bridson – "The English 'sweate' (Sudor Anglicus) and Hantavirus pulmonary syndrome" in Br J Biomed Sci. 2001;58(1):1–6.
• Sweating Fever Dr Jim Leavesley commemorates the 500th anniversary of the first outbreak – transcript of talk on Ockham's Razor ABC Radio National
• The Curious Case of the English Sweating Sickness, contains a map of the disease dispersion created and mapped by Kirstyn Pittman from California State University, Chico (requires Adobe Flash)