​It began with a sense of apprehension. The patient would find themselves shaking from an  sense of cold, complaining of a headache, and maybe even experience severe pains in their upper limbs and neck. This stageled. Several people were recorded to experience the Sweating Sickness on multiple occasions before dying, and that testament is confirmed by it's five recurrent outbreaks in 1485, 1508, 1517, 1528, and 1551. In fact, it was not uncommon for patients to have several attacks, and it occurred most often during the summer months.

This disease, oddly, was nearly entirely confined to England, except in 1528-29, where it spread to the European continent in Hamburg, Scandinavia, and eastward to Lithuania, Poland, and Russia. Interestingly, the disease did not spread to France or Italy.

With regard to incubation time (the amount of time needed for the ingested viral particles to reproduce enough in order to elicit symptoms), the most reliable source surrounds the movement of the military and reports of the sickness afterwards. For example, one writer mentions that there were reports of the sweating sickness in England on the 19th of September; following this, there were other records of the disease in the troops of Henry VII during or after the arrival of the Army in Wales on the 7th of August, and the Battle of Bosworth on the 22nd of August. This suggests that the incubation time could be anywhere from 1 to 29 days after exposure.

In contrast to many medieval epidemics, the sweating sickness did not primarily affect the young and old (weak and underdeveloped immune systems), but the middle-aged, professionally active section of the population--especially the wealthy, upper-class males. Due to some reports of the illness occurring between outbreaks, it is suggested that rats could be the vector of disease--and if the sweat was in fact rodent-borne, the black rat is likely the prime candidate.

The sweating sickness appeared and disappeared geographically at random. Both the duration and the mortality of the outbreaks varied; for example, the third outbreak (1517) was more deadly than the second (1508). For many reasons, including the inconsistency of the outbreaks, human-to-human transmission is considered to be less likely due to the restriction of the disease to England, despite trade by ships.

Since the disease was very isolated in both outbreak and occurrence, historical medical sources are rare on the subject. The disease was fully described first by the physician John Caius in 1551. Practicing in Shrewsbury, he recorded an outbreak in his account, A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse (1552). This single account is the main historical source of knowledge on this disease. Thomas More (councilor of Henry VII, who fell out of grace and was beheaded) once described the disease as "more harmful than the sword."

​Theories Surrounding the Cause

While speculation surrounds sewage, generally poor sanitation of the time, and possibly contaminated water supplies (such as in the Bubonic Plague), no one truly knows what this illness was spawned from or what the modern identification of this illness could be.

Modern researchers of historical diseases have offered a handful of possible suspects as the real cause of the illness, including:

  • Relapsing fever, which is spread by ticks and lice. It occurs most often during the summer months (like the sweating sickness). However, relapsing fever has two other distinguishing symptoms which weren't mentioned in John Caius' account: a prominent black scab at the site of the tick bite, and a subsequent skin rash.
  • Ergot Poisoning, which is a mold that grows on rye and is the main cause of ergotism. This is most commonly known as being the prime suspect in the Salem Witch Trials in North America. However, this theory was ruled out due to England having a significantly less amount of rye than the rest of Europe, which would indicate a different pattern of transmission across the continent.
  • Anthrax Poisoning, as offered in 2004 by a microbiologist named Edward ScSweegan. He theorized that the victims could have been infected with anthrax spores present in raw wool or infected animal carcasses. Anthrax poisoning varies depending on the method of ingestion;
    • if it's cutaneous (skin) anthrax poisoning, then the patient should present with blisters, swelling, and a painless skin sore (ulcer) with a black center that appears after the blisters or bumps.
      • This is the least dangerous form, and without treatment, up to 20% of people with cutaneous anthrax die.
    • If it's inhalation anthrax poisoning (e.g. you breathe in the spores), the symptoms should be fever, chills, chest discomfort, nausea/vomiting/stomach pains, drenching sweats, and cough. This is a big risk with people who work in wool mills, slaughterhouses, and tanneries. It starts primarily in the lymph nodes in the chest before spreading throughout the rest of the body, usually ending in severe breathing problems and shock.
      • This is considered to be the most deadly form of anthrax, but infection usually develops within a week after exposure--but can also take up to two months to develop symptoms. Without treatment, it's almost always fatal; with aggressive treatment, about 55% of patients survive.
    • If it's gastrointestinal anthrax (e.g. a person eats raw or undercooked meat from an animal infected with anthrax), then the ingested anthrax spores are released and can affect the upper gastrointestinal tract (throat and esophagus), stomach, and intestines, causing a wide variety of symptoms. Symptoms could include fever/chills, swelling of neck/neck glands, sore throat, painful swallowing, hoarseness, blood vomit, diarrhea/bloody diarrhea, headache, red face/eyes, stomach pain, fainting, and swelling of the stomach.
      • Without treatment, more than half of the patients with GI anthrax will die; with proper treatment, 60% live.

​

The Picardy Sweat

Nearly 200 years after the mysterious English sweating sickness last reared its head, a similar virus reappeared in the northern region of France in 1718. In the province of Picardy, there were reports of a sweat that bore a resemblance to the English sweating sickness.

While the sweat began in northern France, outbreaks occurred in Germany, Belgium, Switzerland, Austria, and Italy. Between 1718 and 1874, 194 epidemics of the Picardy sweat were recorded. The last extensive outbreak was in 1906, and the last case known and diagnosed as the Picardy sweat was in 1918 during WWI.

Unlike the English sweating sickness, there were two main types of Picardy sweat: one that was benign similar to Hantavirus hemorrhagic fever with renal syndrome (HFRS), and one more severe form that resembled the English sweat. The rate of transmission was anywhere from 25-30% of the population, but the mortality rate was between 0-20%. Similar to the English sweat, the more severe version of the Picardy sweat showed patients with intense sweating, high fever, a rash, and bleeding from the nose--but the symptoms were also less fatal. Many of these victims, were they to die, died within two days.

​Why Do We Care?

One major candidate for this sweating sickness that I have yet to name are the hantaviruses. In 1997, it was suggested that the English Sweat was caused by a medieval ancestor of the hantaviruses. As some of you may know, hantaviruses have appeared in North America. As of January 2017, 728 cases of hantavirus disease have been reported since surveillance in the United States began in 1993.

Hantaviruses have primarily affected men (67%) more than women (37%), mostly occurring in white people (78%), patients having a mean age of 38 years (range: 5 years to 84 years), and a 36% mortality rate. It was most commonly found in states west of the Mississippi, with the most cases in New Mexico, Colorado, Arizona, and California, respectively.

Hantaviruses are found in the urine, saliva, or droppings of infected deer mice and other wild rodents. It's mostly known for causing a rare but very serious lung disease called Hantavirus pulmonary syndrome (HPS). It can be contracted through inhalation of droplets or dust, or when contaminated material gets into broken skin or ingested. The symptoms appear within 1 to 5 weeks after exposure, with the average being 2-4 weeks. It begins as a flu-like illness, with fever, chills, headaches, nausea, vomiting, rapid heartbeat. From there, the disease progresses rapidly and infected people will experience an abnormal fall in blood pressure as their lungs fill with fluid, leading to severe respiratory failure. It can occur within a few days of the early stage symptoms. There are no known cures or treatments for hantavirus in the modern day.

The English Sweating Sickness, the Picardy Sweat (and it's version similar to HFRS), and HPS all seem to have many overlapping symptoms (see a table comparison here). The incubation time is similar to that of hantaviruses, and many other overlaps exist between the onset of symptoms. While it can't be confirmed without uncertainty that it was a hantavirus, the gaps between outbreaks are uncanny--there was a gap of 150 years between the English sweat and the Picardy sweat, and a gap of more than 100 years between the Picardy sweat and the hantavirus epidemics of today.

​Especially in the era of SARS (COVID-19), we can appreciate what learning about these ancient viruses can do for modern healthcare. Hantaviruses and hantavirus infections have been detected and described on all continents except Australia, and are an increasing health problem in many countries. Learning more about these viruses allows researchers to learn more about what methods may be effective in combating illness caused by these viruses. Learning if these illnesses could be culprit for ancient illnesses can help describe the progression of the virus genetically, which can allow for the progression of a treatment today

​sources

  1. https://en.wikipedia.org/wiki/Sweating_sickness
  2. https://en.wikipedia.org/wiki/Picardy_sweat
  3. https://www.britannica.com/science/sweating-sickness
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917436/#:~:text=The%20English%20sweating%20sickness%20caused,%2C%20in%201718%2C%20in%20France.
  5. https://pharmaceutical-journal.com/article/opinion/just-what-was-english-sweating-sickness
  6. https://www.cdc.gov/anthrax/symptoms/index.html
  7. https://www.cdc.gov/anthrax/basics/types/index.html
  8. https://academic.oup.com/jhmas/article-abstract/XXXVI/4/425/706250?redirectedFrom=PDF
  9. https://www.cdc.gov/hantavirus/surveillance/reporting-state.html
  10. https://pubmed.ncbi.nlm.nih.gov/19254169/
  11. https://www.ccohs.ca/oshanswers/diseases/hantavir.html#:~:text=Hantavirus%20is%20a%20virus%20that,Hantavirus%20pulmonary%20syndrome%20(HPS)).