In the first episode of the BBC's adaptation of Wolf Hall, Thomas Cromwell returned home to find his wife and two daughters had all died during the night, victims of a pestilence – the "sweating sickness" – that was scything through the Tudor world.
The speed of onset of this disease and its relentlessly high mortality rate gave the sweating sickness the same aura of terror that we attach to Ebola today. Contemporary accounts describe an illness that began with a general feeling that something was not right, a strange premonition of oncoming horror, followed by the onset of violent headaches, flu-like shivers and aching limbs.
This was succeeded by a raging fever complicated by pulse irregularities and cardiac palpitations. Death often simply seemed to occur due to dehydration and exhaustion. As one commentator said: "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."
The sweating sickness first appeared around the time that Cromwell was born, at the end of the Wars of the Roses. Some believe it arrived with the invading army of the first Tudor king, Henry VII, in 1485. By the time it disappeared in 1551, it had caused five devastating outbreaks. To observers on the other side of the Channel, whose countries had apparently remained miraculously untouched, it was Sudor Anglicus, or the "English Sweat".
One man’s name became synonymous with the sickness. Norwich-born and Cambridge-educated John Kays had spent his early medical career travelling extensively on the continent, returning around the end of the reign of Henry VIII with a fashionably Latinised moniker, Dr Johannus Caius. The sweating sickness panic during the outbreak of 1551 gave him the ideal opportunity to make his name.
The fact that the wealthy seemed to be more frequently affected also gave him the opportunity to make money. Despite most of Caius’s patients still ending up dead, he was eventually rich enough to make a splendid endowment to his old Cambridge college, which changed its name to Caius College in his honour. To the rest of us, Caius left his classic description of the disease: Account of the Sweating Sickness in England, first published in 1556.
Suggestions have been made over the years that it was influenza, scarlet fever, anthrax, typhus or some Sars-like pulmonary enterovirus. Then in 1993, an outbreak of a remarkably similar syndrome occurred among the Navajo people in New Mexico. This episode, known as the Four Corners outbreak after the region of south-western USA in which it was located, turned the attention of sweating sickness investigators towards its cause, the Sin Nombre virus, a member of a group of viruses mostly known for causing kidney failure syndrome, and a cousin of several tropical fever viruses transmitted by biting insects. The new disease was given the name hantavirus pulmonary syndrome (HPS).
And, as in Tudor times, rich people were more likely to be victims.
Large households in Tudor London and the regional cities of England needed a large staff, and large numbers of people need large kitchens full of large deposits of grain and other foodstuffs. Shortly after the people moved in, the rats and mice followed.
The Four Corners outbreak was due to the presence of the Sin Nombre virus within the droppings of deer mice living in the vicinity of the Navajo dwellings. Disturbed when brooms passed over them to sweep them away, they created an environmental airborne infection.
Similarly, Tudor housekeepers, fastidiously brushing rodent droppings away, may have released a cloud of hantavirus-loaded dust that triggered the sweating sickness across England.
Sweating sickness had disappeared by late Elizabethan times. Its reign of terror barely lasted a century. If, indeed, it was an ancient variant of HPS, we can perhaps speculate about what led to its demise. The virus may have mutated to a less virulent form, perhaps in the process acquiring the capacity to be passed between humans as a more benign feverish illness, rather than being just a sporadic environmental hazard. Or perhaps its evolutionary trajectory took it in the other direction, becoming more fatal to its rodent hosts, thereby reducing the quantity of infected droppings around human habitations.
There is a third possibility. We know that the climate of Europe was becoming progressively colder from the late Middle Ages onwards, so perhaps some subtle change in rodent ecology made life harder for the virus. (For instance the Four Corners outbreak was linked to El Niño.) We’ll never know for sure. Much of the mystery of sweating sickness remains. However, we do know that hantaviruses are still with us, and their day could come again.
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