April 24, 2024

The Mystery of the Sweating Sickness

In the 16th century a mysterious ‘Sweating Sickness’ ravaged England and changed the course of history. Its cause is still unknown.

Thomas Cromwell
Thomas Cromwell

The late writer Hilary Mantel is best known for her ‘Wolf Hall’ trilogy, Booker prize winning novels that tell the story of Thomas Cromwell. Cromwell, a real-life figure, was a merchant who rose from poor circumstances to become chief political fixer for Henry VIII.

A pivotal moment arrives in Cromwell’s life, before he enters the King’s service. It is 1527, and Cromwell is living happily in London with his wife Elizabeth, and three young children.

Then, disaster strikes.

Cromwell wakes one morning to find Elizabeth unwell; she is feverish, and sweaty. But she brushes off his concerns, and sends him off to work, tells him it is nothing.

He returns in the evening to a silent house. One of his servants tells him that his wife has died, during the day.

‘At ten this morning, Elizabeth sat down. She said, “I’m dizzy”. At midday, she lay down. She was shivering, though her skin burned.

 

At one o’clock she called for a priest. He gave her absolution, and then could not wait to get out of the house, so afraid he might take the contagion.

 

At three in the afternoon, she declined. At four, she put off the burden of this world.’

 

‘Wolf Hall’, Hilary Mantel

Cromwell can barely comprehend this rapid turn of events: his wife had seemed only mildly unwell just a few hours beforehand. His tragedy is deepened a few years later, when the same illness carries off two of his children, in equally rapid fashion.

While Mantel used artistic license to fill in the details of her books, the events that she describes are all real. This includes this fatal illness, which came to be known as ‘Sweating Sickness’, a perplexing medical mystery that remains unsolved.

Physician John Caius
Physician John Caius

There were five major outbreaks of Sweating Sickness between 1485 and 1551. The illness always arrived in summer and was particularly deadly: an estimated 50% of people who caught the disease, died from it.

The symptoms, and rapid onset, were much as described by Mantel.

London physician John Caius, who treated patients suffering from the illness, recorded that it started with a headache, or pain in the upper back, which then spread through the body. The patient would begin to sweat profusely, although they would be cold to the touch.

They felt overwhelming fatigue, and a desire to sleep; Caius recommended pulling their hair, ears and nose to keep them awake. Once unconscious, many patients would simply expire.

There were no other treatments, other than to wait. The symptoms came and went usually within 24 hours, anyone who survived that period would likely make a full recovery.

Catching the disease did not prevent people from catching it again, although subsequent doses were likely to be less severe. In an eerie precursor of modern pandemics, a house that contained a Sweating Sickness patient was required to quarantine for 40 days.

These precautions seemingly had little effect: hundreds of thousands of people would die from the illness.

16th century depiction of Sweating Sickness
16th century depiction of Sweating Sickness claiming a victim

There were other mysterious elements to the disease as well.

In a surprising reversal of the usual pattern, Sweating Sickness was more likely to afflict people from affluent households; it was also more common among males. A judgment, some said, by God, on the decadent lives of wealthy young men.

It was also largely geo-located to England.

By the 16th century, trade and travel between European countries was common, the flow of people and goods would usually carry diseases between countries as well. The bubonic plague and smallpox, both deadly viruses in this era, were two well-known examples.

But only a small number of cases of Sweating Sickness were found on mainland Europe, and there were no major outbreaks outside of England (although there were minor ones).

This unusual aspect of the disease gave it another name; in its time it was referred to as Sudor Anglicus, the ‘English Sweat’. And beyond the death toll, it would leave its mark on the country’s history.

Richard III
Richard III

Sweating Sickness was first recorded in England in 1485.

This was a tumultuous year in British history. On the throne was Richard III, an unpopular leader seen by many as an illegitimate usurper; Richard’s younger nephews, ahead of him in the succession, had both disappeared under suspicious circumstances.

Henry Tudor, then based in France, launched a military campaign to seize the throne. Henry was the half grandson of Henry V, and now claimed to be the rightful heir.

Tudor landed his army in Wales and headed for London. Opposing him were the much larger royal forces, and the affiliated private armies of other English noblemen. Battle was joined near the town of Bosworth, in Leicestershire.

This was to be the climax of the ‘War of the Roses‘, the 30 year struggle to claim the British throne between the houses of York (Richard) and Lancaster (Henry).

Knights in conflict: The Battle of Bosworth Field
Knights in conflict: The Battle of Bosworth Field

But while Richard held a numerical advantage, his unpopularity would cost him: at key moments in the battle, his allies turned against him.

Lord Stanley, commanding his own army of 6 000, crucially switched sides and joined forces with Henry. And the Earl of Northumberland, commander of Richard’s rear guard, did not reinforce the King when he was under attack.

Debate has since swirled around Northumberland’s actions.

Richard had recently passed him over for a royal position, some historians see his reluctance as retribution. Afterwards Northumberland claimed he was hampered by unfavourable terrain, and an outbreak of sickness in his ranks.

Richard himself was also said to be sick, which hindered his command.

Aided by these events, Henry would win the Battle of Bosworth Field and claim the English throne. Richard was killed during the fighting: the last British monarch to die in battle.

Shortly afterwards, Henry marched into London in triumph.

Depiction of death celebrating the Sweating Sickness toll
Depiction of death celebrating the Sweating Sickness toll

The first cases of Sweating Sickness were reported in the city three weeks later.

‘A newe Kynde of sickness came through the whole region, which was so sore, so peynfull, and sharp, that the lyke was never harde of to any mannes rememberance before that tyme.’

 

– Eyewitness account, quoted in the ‘New England Journal of Medicine’

Thousands of people died in this initial outbreak.

The timing of these first cases has led many to suspect that Henry’s army may have been the source. Most of his troops were mercenaries from France and northern Europe, they could have brought the disease with them from the continent.

It is possible that the illness that afflicted Northumberland’s troops, and even King Richard, at Bosworth were unidentified cases of Sweating Sickness. If so, the virus had intervened dramatically in the country’s history.

But other investigators reject this. If the ‘Sweat’ came from mainland Europe, why was it unknown there? The disease seems to have simply appeared out of nowhere.

After the outbreak the virus raged through the summer, before disappearing again.

Arthur, Prince of Wales
Arthur, Prince of Wales

Installed as King Henry VII, Britain’s new ruler now looked to his legacy.

In January 1486 he married Elizabeth of York, Richard’s niece, seeking to head off other claims to the throne. In September Elizabeth produced an heir: Arthur.

The couple would have 6 more children, including another boy who became Henry’s namesake; born in June 1491, the younger Henry was next in line to the throne, behind Arthur.

The king doted on his eldest son, neglecting his other children, and preparations for his future rule began while he was still a child. At 5, Arthur was made Prince of Wales, at 11 he was engaged to Catherine of Aragon, daughter of the Catholic Monarchs of Spain.

The young couple were wed in 1501, aligning the Tudors with a powerful ally. Arthur’s future, and that of the country, seemed set.

The tomb of Prince Arthur, Worcester Cathedral
The tomb of Prince Arthur, Worcester Cathedral

After the wedding, Arthur and Catherine moved to Ludlow Castle, near the border of Wales.

In March 1502, the couple suddenly became ill. The symptoms, and rapid onset, of their affliction matched those of Sweating Sickness.

Catherine was sick for several days, before recovering. Arthur, who had pre-existing health problems, survived the first onset of the illness, but never fully recovered. He died on April 2, 1502.

While historians have since speculated that Arthur may have had tuberculosis, flu, or even the plague, at the time he was considered another victim of the English Sweat. And descriptions of his illness make that seem likely.

With Arthur deceased, his younger brother Henry now became heir apparent. He would also marry his brother’s wife, taking Catherine of Aragon as his bride after her marriage to Arthur was annulled.

He would later rule as Henry VIII, and become a figure of fascination and controversy. Henry’s complex legacy includes six wives and a dramatic break from the Papacy that would lead to the formation of the Church of England, turning the country Protestant.

The Sweating Sickness had again intervened in Britain’s destiny.

Henry VIII
Henry VIII

There were pandemic levels of Sweating Sickness in the English summers of 1507, 1517, 1527/8 and 1551. During these years, many thousands were killed, and low-level panic was felt throughout society.

People who were able fled the cities to less populated regions; those who could not tried to stay indoors and avoid crowded areas. After what happened to his brother, Henry VIII was terrified of the disease and kept his court moving around the countryside during the summer.

There was much speculation as to the cause and transmission of the illness, but medical science was not advanced enough to provide any answers.

And then, almost as suddenly as it arrived, the illness disappeared again.

After the last major outbreak in 1551, only a small number of cases were recorded. The last known death occurred in 1578.

What was this history altering virus, and where did it go?

A well provisioned 16th century kitchen: haven for rodents
A well provisioned 16th century kitchen: haven for rodents

In the modern era, medical researchers have continued to speculate.

400 years having passed there is no physical evidence available, meaning the net of possible suspects is wide. People have claimed the Sweating Sickness was a type of flu, or scarlet fever, or an enterovirus, similar to SARS and polio.

Some think it was caused by anthrax, some think it was a type of hantavirus, a deadly group of viruses spread by rodents, that remain lethal today.

If it was a hantavirus, this may provide a clue to its mysterious propensity among the wealthy. More affluent households had larger kitchens and larders, which attract rats and mice; some scientists think Sweating Sickness may have been spread via the faeces of these animals.

It did not appear to be spread by direct transmission, person-to-person.

A frozen Thames during 'The Little Ice Age'
A frozen Thames during ‘The Little Ice Age’

Sweating Sickness’ sudden disappearance is also puzzling.

Reports noted it was more common in the summer, meaning it may have required certain climatic conditions to activate. In the 16th century, Europe was going through an extended period of cooling known as ‘The Little Ice Age’, where average temperatures declined over an extended period.

It is possible that temperatures may have dropped to the point where the virus was eradicated.

Another possibility is that it may have mutated into a form that was either less contagious, or less deadly, receding into the background of everyday afflictions that people learn to live with. It could also have mutated the other way, becoming more deadly to its host animals who would then die before passing it on to humans.

We will likely never know for sure.

The 'Four Corners' region
The ‘Four Corners’ region

In 1993, there was an outbreak of an unexplained illness in the southwestern United States, in an area shared by Arizona, New Mexico, Colorado and Utah known as ‘The Four Corners’.

The virus affected the native Navajo population of the region, causing pulmonary distress that was often fatal. This illness shared many similarities with Sweating Sickness, including rapid onset, uncontrollable sweating, and fatigue.

Doctors were unable to develop a cure, patients simply had to rest and wait it out.

The new illness was named Hantavirus Pulmonary Syndrome (HPS). Investigators would eventually trace the source to the ‘Sin Nombre’ virus, which was carried by the area’s mice, and spread to humans via their dried out faeces.

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