English 'sweate' (Sudor Anglicus) and Hantavirus pulmonary syndrome, The

British Journal of Biomedical Science, 2001 by Bridson, Eric

Abstract: A rapidly fatal viral infectious disease appeared in England in 1485, persisted for the summer months and disappeared as winter approached. This pattern of infection re-appeared in 1508, 1517, 1528, and finally 1551. The epidemic never returned. It had no respect for wealth or rank, and predominantly attacked males between the ages of 15 and 45 years. The incubation period was frighteningly short and the outcome normally fatal. The symptoms of acute respiratory disease and copious sweating were characteristic, providing the name `the English sweating disease'. It was never in the big league of killer epidemics, such as plague and influenza, but its pockets of instant lethality in communities gave it a special ranking of horror. The infective cause of this disease remained a total mystery until it was compared with Hantavirus pulmonary syndrome (HPS) in 1994. The strength of this theory is examined in this paper, and it is concluded that, although there is a close resemblance, HPS does not match the English sweating disease completely and positive identification of a possible rodent carrier for the latter was not established.

Key words: Hantavirus infections. Hantavirus pulmonary syndrome. Sweating sickness.

Introduction

A newe kind of sickness came through the whole region, which was so sore, so peynfull and sharp, that the like was never harde of to any mannes remembrance before that time.

(R Grafton. A chronicle at large and meere history of the affayres of England. London: H. Denham, 1569)

In the summer of 1485, a rapidly fatal infectious disease struck England, which Richard Grafton described so graphically (above) in 1569. Sudor Anglicus, the English sweating sickness, arrived apparently out of the blue sky, creating panic and misery before departing as winter approached. It re-appeared 23 years later, in 1508, and then came again in 1517 and 1528, before the final epidemic of 1551, which left again as winter approached, never to re-appear.

It was a unique disease in that it did not respect princes, high nobles, rich merchants or poor men; differing from most infectious epidemics that slaughtered the poor whilst leaving the rich relatively spared. It seemed to show a male preference, between the ages of 15 to 49 years. Those that succumbed to the disease died rapidly. A man could be healthy one day, short of breath the next and dead the day after. `Merrie at dinner, dedde at supper' may have been an exaggeration but it revealed the devastating impact of this disease.

Clinical features of the disease

Most of the clinical evidence is derived from the publications of two physicians: Thomas Forrestier1 published his account in 1490, and John Caius2 published his in 1552. Both physicians agreed about the major symptoms, which today would be described as a typical viral prodrome: myalgia and headache, leading to abdominal pain, vomiting and delirium. This was followed by cardiac palpitation, chest pains, prostration, agonal breathlessness with `foul, loathsome, putrid vapours' - a clear indication of pulmonary infection.

Surprisingly, the physicians did not report excessive fever; and whilst sweating was a significant symptom, it was most likely caused by acute pain and high anxiety. This fatal clinical progression could be completed in one day. One observer described a group of seven London householders who `did sup together and before cockcrow the following morning, five of them were dead'.

Outbreaks of the disease in any one locality appeared to be violent but short, and they would rapidly disappear.

Epidemiology of the disease

Until the institution of parish registers in 1538, there was no means of quantifying the lethality of the disease. Sixty years later, it was discovered that the paper records were not surviving storage, and all clerics were ordered to transfer their records of births, marriages and deaths onto parchment. The instructions stressed that such records must start from 1558 at least, when Queen Elizabeth I was made queen. Unfortunately, the result of this edict meant that many parish registers restarted in 1558, thus losing all traces of the 1551 epidemic in those parishes.

Nevertheless, Dyer3 searched 680 of the surviving 1000 parish registers that covered 1551, to gather information about deaths from the 'sweate' and date the mini-epidemics in each location. He commented on the difficulty of the task; for example, parishes at that period were often very small with no more than 100-150 residents. The crude death rate in 1550 was approximately 26 per thousand; therefore, average burials would be two to four per year. Cause of death was not always noted, but the 'sweate' had a characteristic death-rate pattern, whereby, over a very short period of time, high numbers (relatively speaking) of burials occurred. Thaxted in Essex had 11 burials ex sudore over four days in July 1551. In another parish, five burials took place in one day.

Geographically plotting the parish records and recording the dates of each cluster of burials, Dyer determined the distribution and progression of the 1551 epidemic, and agreed with Caius' account in 1552. The epidemic started in Shrewsbury, moved up along the Welsh border to Chester, and continued north and north-east. A southern route of infection swung towards London and then up into East Anglia. An isolated epidemic in Devon and Cornwall, which started in Plymouth, suggested that the infection was sea-borne from London (Figures 1 and 2).