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Sweating sickness, also known as the "English sweate" ( ), was a mysterious and highly virulent disease that struck Englandmarker, 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. Its cause remains unknown. One suspect is a hantavirus.

Repeated epidemics

1485

Sweating sickness first came to the attention of physicians at the very beginning of the reign of Henry VII. It was known, indeed, a few days after the landing of Henry at Milford Havenmarker on 7 August 1485, as there is clear evidence of it being spoken of before the Battle of Bosworth Fieldmarker on 22 August. Soon after the arrival of Henry in Londonmarker on 28 August, it broke out in the capital. There, it killed several thousand people by its conclusion in late October that year. Among those killed were two lord mayor, six aldermen, and three sheriffs. 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 Irelandmarker in 1492 when the Annals of Ulster (vol.iii, ed. B. MacCarthy, Dublin, 185, 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. Note, however, that 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, but 'Relapsing or Famine Fever', possibly Typhus.

1502, 1507, 1517

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

In 1507, another second, less widespread outbreak occurred, followed in 1517 by a third and much more severe epidemic. In Oxfordmarker and Cambridgemarker 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 Calaismarker and Antwerpmarker, but nowhere else outside of England.

1528

In 1528 the disease recurred for the fourth time and with great severity. It first showed itself in London at the end of May and speedily spread over the whole of England, save for the far north, sparing Scotlandmarker and Irelandmarker. 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 over Europe, suddenly appearing at Hamburgmarker and spreading so rapidly that in a few weeks more than a thousand people died. Thus was the terrible sweating sickness started on a destructive course, during which it caused fearful mortality throughout Eastern Europe. It spread much in the same way as cholera. It arrived at Switzerlandmarker in December, then northwards to Denmarkmarker, Swedenmarker and Norwaymarker, and then eastwards to Lithuaniamarker, Polandmarker and Russia. It never appeared in Francemarker or Italymarker. It also emerged in Belgiummarker and the Netherlandsmarker, probably transmitted direct from England as it appeared simultaneously in the cities of Antwerpmarker and Amsterdammarker 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, it did not re-appear on mainland Europe.

The 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 was 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 although a similar illness, known as the Picardy sweat, occurred in France between 1718 and 1861, but was less likely to be fatal and 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 general dirt and sewage 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, particularly as they seem to have been immune. However, 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, which suggests that the illness was already established in England before Henry Tudor's landing. The fact that the disease seems to have been more virulent among the rich than the poor suggests why it was judged noteworthy in comparison to the other illnesses of the time.

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, whereas contemporaries did not note these relatively obvious signs, so the identification is far from certain.

More recently, a hantavirus has also been proposed, and appears to be an interesting candidate for consideration in the etiology of this illness. However, certain clinical features of hantavirus outbreaks do not seem to match the progression of the sweating sickness; specifically, while hantavirus has only rarely been observed to be transmitted from one human to another, this is believed to be a significant mode of transmission of the sweating sickness. Although hantavirus pulmonary syndrome outbreaks share a very similar clinical picture with descriptions of the sweating sickness, a number of questions yet to be answered leave the door open to other theories of etiology.

Notes

  1. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1043971
  2. http://www.findarticles.com/p/articles/mi_qa3874/is_200101/ai_n8939673


References

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