Sweating sickness
Sweating sickness, also known as the sweats, English sweating sickness, English sweat or sudor anglicus in Latin, was a mysterious and contagious disease that struck England and later continental Europe in a series of epidemics beginning in 1485. Other major outbreaks of the English sweating sickness occurred in 1508, 1517, and 1528, with the last outbreak in 1551, after which the disease apparently vanished.[1] The onset of symptoms was sudden, with death often occurring within hours. Sweating sickness epidemics were unique compared with other disease outbreaks of the time: whereas other epidemics were typically urban and long-lasting, cases of sweating sickness spiked and receded very quickly, and heavily affected rural populations.[2] Its cause remains unknown, although it has been suggested that an unknown species of hantavirus was responsible.
For the benign condition characterized by abnormally increased perspiration, see Hyperhidrosis. For the tick-borne disease of cattle in Africa, see Sweating sickness (cattle).Sweating sickness
English sweating sickness, English sweat, (Latin) sudor anglicus
Unknown
Signs and symptoms[edit]
John Caius was a 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), dizziness, 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. No skin eruptions were noted by observers. 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.[1] The disease typically lasted through one full day before recovery or death took place.[3] 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.[4] Forestier put great emphasis on the sudden breathlessness commonly associated with the final hours of sufferers.[4] Forestier claimed in an account written for other physicians that "loathsome vapors" had congregated around the heart and lungs.[4] His observations point towards a pulmonary component of the disease.[4]
Transmission[edit]
Transmission mostly remains a mystery, with only a few pieces of evidence in writing.[3] Despite greatly affecting the rural and working classes of the time, the sweating sickness did not discriminate, as it was no less likely to affect young, seemingly fit men, including those of the elite or privileged classes. Based upon recorded accounts, the mortality rate among victims was highest in males aged 30-40 years.[4] The fact that it infected all levels of society, from rich to poor, earned the sweating sickness various nicknames, such as "Stoop Gallant" or "Stoop Knave"—referencing how the 'proud' castes were forced to 'stoop' and face their own humanity, thus relinquishing their higher status.[5][3]
The large number of people present in London to witness the coronation of Henry VII may have accelerated the spread of the disease, and indeed many other airborne pathogens.[3]
Cause[edit]
The cause is unknown. Commentators then and now have blamed the sewage, poor sanitation, and contaminated water supplies. The first confirmed outbreak was in August 1485 at the end of the Wars of the Roses, leading to speculation that it may have been brought from France by French mercenaries.[6] However, an earlier outbreak may have affected the city of York in June 1485, before Henry Tudor's army landed, although records of that disease's symptoms are not adequate enough to be certain.[7] Regardless, the Croyland Chronicle mentions that Thomas Stanley, 1st Earl of Derby cited the sweating sickness as reason not to join Richard III's army prior to the Battle of Bosworth.[1]
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.
The suggestion of ergot poisoning was ruled out due to England having much less rye (the main cause of ergotism) than the rest of Europe.[3]
Researchers have noted symptoms overlap with hantavirus pulmonary syndrome and have proposed an unknown hantavirus as the cause.[1][4][8] Hantavirus species are zoonotic diseases carried by bats, rodents, and several insectivores.[9] Sharing of similar trends (including seasonal occurrences, fluctuations multiple times a year, and occasional occurrences between major outbreaks) suggest the English sweating sickness may have been rodent borne.[9] The epidemiology of hantavirus correlates with the trends of the English sweating sickness. Hantavirus infections generally do not strike infants, children, or the elderly, and mostly affect middle-aged adults. In contrast to most epidemics of the medieval ages, the English sweating sickness also predominantly affected the middle aged. A criticism of this hypothesis is that modern day hantaviruses, unlike the sweating sickness, do not randomly disappear and can be seen affecting isolated people.[3] Another is that sweating sickness was thought to have been transmitted from human to human, whereas hantaviruses are rarely spread that way.[10] However, infection via human contact has been suggested in hantavirus outbreaks in Argentina.[11]
In 2004, microbiologist Edward McSweegan suggested 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 suggested exhuming victims for testing.[12]
Numerous attempts have been made to define the disease origin by molecular biology methods, but have so far failed due to a lack of DNA or RNA.[13]
Picardy sweat[edit]
Between 1718 and 1918 an illness with some similarities occurred in France, known as the Picardy sweat.[37] It was significantly less lethal than the English Sweat but with a strikingly high frequency of outbreaks; some 200 were recorded during the period.[3] Llywelyn Roberts noted "a great similarity between the two diseases."[15] There was intense sweating and fever, and Henry Tidy found "no substantial reason to doubt the identity of sudor anglicus and Picardy sweat."[1][38] There were also notable differences between the Picardy sweat and the English sweating sickness. It was accompanied by a rash, which was not described as a feature of the English disease. Henry Tidy argued that John Caius's report applies to fulminant cases fatal within a few hours, in which case no eruption may develop. The Picardy sweat appears to have had a different epidemiology than the English sweat in that individuals who slept close to the ground and/or lived on farms appeared more susceptible, supporting the theory that the disease could be rodent borne, common in hantaviruses.[3] In a 1906 outbreak of Picardy sweat which struck 6,000 people, a commission led by bacteriologist André Chantemesse attributed infection to the fleas of field mice.