Sunday, August 17, 2008

Question from April - "The Sweat"

When Arthur died they said it was the sweat. I was wondering what the modern day equivalent of the sweat would be. Everyone I have asked says they think it's pneumonia or small pox or even the flu. What is it?

[ed note - this is a repeat, but I wouldn't mind some additional input on it. Here's the previous post on the subject, which I responded to with some of the information I had at the time: ]


Kelly said...

I read that Arthur died from consumption.

Elizabeth M. said...

The sweat was a very contagious disease which first popped up in England in 1485 and had periodic outbreaks until the last recorded one in 1551. The symptoms included chills, dizziness, headaches, and joint pain. There would be a period of intense sweating, hence the name. The onset was usually dramatically sudden, and a sufferer could fall ill and die within hours.
It first appeared in England after henry VII assumed the throne, which led to the belief that it was a divine punishment on the English for supporting Henry Tudor's battle for the crown against Richard III. However, the sweating sickness had been popping up in Europe for a while before first reaching England, and outbreaks occurred throughout Europe throughout the 16th century, though supposedly it never broke out in France or Italy. Henry VII began his battle for the crown in France, where he had been living in exile, and brought French fighters with him to England. It could be that the French were carriers of the disease, though why the people of one or two countries would seem to be immune is a mystery.
It is also a mystery as to why the disease seemed to be so devastating to the wealthy population and much less so to the poor. Hygiene and sanitation were primitive in the extreme, but even so, the wealthy had a few more luxuries for sanitation than did the poor, so that is a mystery why the poor did not suffer as much from this disease. Perhaps, if the French and Italians were carriers, it was more likely that the wealthy would come into contact with these foreigners at court, or come into contact with a person who had been at court. A poor farmer was hardly likely to come into contact with someone who had seen, say, a member of the French ambassador's retinue. But that is just a supposition on my part.
There was a bad outbreak of the sweat in England in 1528. Among those who died were William Carey, the first husband of Mary Boleyn. Mary Boleyn's father, Thomas, and more importantly, her sister Anne, were taken ill. Anne's case was said to be especially severe, because of "the turning in of the sweat before its time." What an interesting turn history would have taken if she had succumbed that summer of 1528.

PhD Historian said...

I do love the questions that come in to this site, as they prompt me to learn more and more every day! I just did some thorough reading-up in medical journals on "the sweating sickness" and was fascinated by what I found.

But first, in regard to Arthur, early modern physicians, though crudely limited in their understanding of the origins and treatments of diseases, were nonetheless often remarkably sophisticated in differentiating one illness from another. And they easily recognized the marked differences between simple pneumonia, small pox, and influenza. Arthur died suddenly, by all accounts, but other details necessary for suggesting a diagnosis are lacking. Small pox is unlikely, for that disease was so notoriously well known that chroniclers would certainly have mentioned Arthur's having suffered from it. Influenza and sweating sickness can both be sufficiently sudden that either could be the cause of his death, as could several other diseases. Syphilis, for example, was rapidly fatal when it was first introduced into England ... at precisely the time when Arthur died. But in the absence of a thorough description of Arthur's symptoms, we simply cannot know today exactly what disease killed him at such a young age.

Of course, one cannot study the Tudor period without having heard of the sweating sickness, especially since so many well-known figures from the period either caught it (Anne Boleyn) or died from it (Charles Brandon's two sons by Katherine Willoughby), and Henry VIII lived in constant fear of it. And it was a disease for which no definitive cause has yet been found. It was very frightening disease for the people who encountered it, primarily because it killed even more rapidly than did the plague. It was not, however, as widespread or as deadly as the plague and many other diseases of the period. Examination of parish death registers has shown a mortality rate attributable to sweating sickness during the epidemic of 1551 of only about 0.5% of the total population, compared to 1% for plague during the epidemic of 1563 or 2% for influenza during each of the three epidemics of that disease in 1557, 1558, and 1559.

As for the sweating sickness, modern historians of medicine and disease seem to concur that it was perhaps related to the modern disease known as Hantavirus Pulmonary Syndrome. Researchers have done some remarkable study of everything from weather patterns before and during the outbreaks of sweating sickness to geographic patterns that the outbreaks followed and estimations of variations in the size of the rodent population based on weather and crop yields. Many have suggested that the disease was actually brought into England by Henry VII's army when he invaded from France in 1485, as this marks the first epidemics of the disease in England and outbreaks in that year seemed to coincide geographically with the army's movements.

The current consensus of researchers is that the disease was viral, probably carried by rodents. It may have originated in the northeastern corner of Asia (Siberia and Korea), like Hantavirus, which is itself named after the river valley in Korea where it was first discovered in the 1950s. From there sweating sickness was transported westward into Europe by timber and fur traders, arriving in western Europe in the 1400s. It seems to have first appeared in England in the 1480s.

The disease was almost certainly harbored in rodents and transmitted from rodent to human by biting insects, much as bubonic plague was. It seems not to have been transmitted directly from human to human in the way that pulmonary plague, influenza, or small pox were. Symptoms started with those typical of a viral infection or "the flu": headache, muscle aches, and abdominal pain. From there it progressed within hours to chest pain and a marked inability to breath. High fever seems to have been absent. Death from respiratory failure usually occurred within 24 hours of the first symptom. Outbreaks and epidemics of the disease appeared suddenly, progressed rapidly, and disappeared equally quickly, sometimes within a few days or weeks, unlike plague and influenza, which could persist for several months. Most mysteriously, sweating sickness did not target the very young, very old, or poor and already unhealthy in the way that plague or influenza did. Sweating sickness seems to have disproportionately (though not exclusively) affected otherwise healthy men of status between the ages of 15 and 49.

Modern Hantavirus Pulmonary Syndrome follows a similar course of infection and disease. The virus kills its victim when it invades the tissue of the lung and causes swelling and fluid accumulation within the lung. Death often occurs within one day if the patient is not placed on a respirator. Outbreaks are usually localized geographically and disappear quickly. It does not, however, seem to favor the same group (healthy young men) that sweating sickness did.

The modern problem with identifying the disease is the suddenness with which it seemingly ceased virtually to exist. The outbreak of 1551 is the last time the disease is mentioned in the records. No other disease has appeared so quickly on the historical scene and disappeared so suddenly and so shortly thereafter. The total history of sweating sickness covers barely more than 65 years, whereas plague, small pox, and influenza each caused epidemics for several centuries. It is possible, since the disease was viral, that it simply mutated into a non-lethal form. Or it may have become overshadowed as other diseases became more threatening, especially repeated outbreaks of the plague. It has even been speculated that the rodent population that carried it may have itself become extinct.

Undisturbed tombs of victims of sweating sickness have been identified known in England, so it is possible that researchers may one day soon open one or more of these tombs and, using samples from any surviving lung tissue, perform DNA mapping to identify the agent causing sweating sickness. This may reveal a modern equivalent, or it may prove that sweating sickness was a unique and short-lived disease unrelated to any today.

Monica said...

I don't think it's clear what Arthur died of. For those whoare interested in this area, McNalty's book on the medical problems of Henry VIII is very good.

LadyShalott said...

I've been reading John Guy's new book Children of Henry VIII and he stipulates it could have been the bubonic plague or testicular cancer based on the little information available but it's impossible to know for sure what is that killed him. John Guy himself says there is very little information to say for sure what the cause was.

I have seen some of the articles posted on facebook, new on this blog though, great page.

Anonymous said...

Most people have heard of the Black Death, which obliterated 60% of Europe’s population during the mid-14th century. Yet there was another medieval epidemic that took many thousands of lives, known as the English sweating sickness. Although this disease claimed many fewer lives than the plague, it gained infamy because its victims were killed within 24 hours by sweating to death.

Science has identified the pathogen that caused the plague and current cases are treatable with antibiotics, but no one knows what caused the sweating sickness. Now modern researchers have proposed two possible pathogens that could have caused it, both of which still kill people today.

Holinshed's Chronicles, published in 1557, described English sweating sickness as "so sharp and deadly that the lyke was never hearde of to any manne’s remembrance before that tyme." This was written by men whose grandfathers saw the Black Death. The disease began abruptly with fever, extreme aches in the neck, shoulders, and extremities, and abdominal pain with vomiting. Intense chills were followed by a hot phase involving sweating so profuse that the disease soon became known as, simply, “the Sweat." Death came swiftly after profound weakness and agonizing shortness of breath culminated with chest pain, rapid pulse, and cardiac palpitations.

The outbreaks were mostly contained within England, where they occurred during the summers of 1485, 1508, 1517, 1528, and 1551. Then this enigmatic disease vanished. During those summers, physicians struggled madly to understand the disease, notably Thomas Forrestier in 1485 and John Caius in 1552.

Medical researchers at the Queen Astrid Military Hospital in Brussels have been poring over the medieval reports and comparing them to current epidemiology. Last January, they published their review article in the journal Viruses.