This Podcast Will Kill You - Ep 65 Sweating Sickness: Ready, Sweat, Go!

Episode Date: January 26, 2021

Here’s a pop quiz for all of you: what disease makes you sweat profusely, run a slight fever, develop body aches and a pounding head and then makes you drop dead within hours of symptom onset? If you answered “I have no idea”, you passed! Because we haven’t a clue either. In this episode, we attempt to tease apart the mysterious sweating sickness, which struck only five times in the 1400s and 1500s in England, leaving in its wake terror, confusion, and a trail of bodies. Although the sweating sickness has not been seen since (or has it?), scientists and scholars continue to investigate this mysterious illness and propose various pathogens as the likely causative agent. Tune in to hear us go through the most popular explanations to see if we can form our own consensus on ‘the sweat’. See omnystudio.com/listener for privacy information.

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through the whole region, even after the first entering of the king into this aisle, which was so sore, so painful and sharp that the like was never heard of to any man's remembrance before that time. For suddenly, a deadly and burning sweat invaded their bodies and vexed their blood, and with a most ardent heat infested the stomach and the head grievously. By the tormenting infixation of which sickness, men were so sore-handled and so painfully panged that if they were laid in their bed, being not able to suffer the importunate heat, they cast away the sheets and all the clothes lying on the bed. If they were in their apparel and vestures, they would put off all their garments, even to their shirts. Others were so dry that they drank the cold water to quench their

importunate heat and insatiable thirst. Others that could, or at the least would, abide the heat and stink, for indeed the sweat had a great and strong savor, caused clothes to be laid upon them as much as they could bear, to drive out the sweat, if it might be. All in manner, as soon as the sweat took them, or within a short space after, yielded up their ghost, so that of all of them that sickened, there was not one amongst a hundred that escaped, insomuch that, besides, the great number which deceased within the city of London, two mayors successively died of the same disease within eight days and six aldermen. And when any person had fully and completely sweat 24 hours, for so long did the strength of this plague hold them, he should be then clearly

delivered of his disease, yet not so clean rid of it, but that he might shortly relapse and fall again into the same evil pit. Yay, again and twice again, as many a one indeed did, which after the third time died of the same. I was trying to like listen for clues. And this is going to be a fun episode, Aaron. It is going to be a very fun episode. I am so excited. So that was a contemporary account of the sweating sickness.

I'm not sure actually which epidemic, but I found it in a paper by Flood from 2003. Hi, I'm Aaron Welsh. And I'm Aaron Olman Updike. And this is, this podcast will kill you. And today we're talking about sweating sickness. Sweeting sickness. It is, I'm like so excited because a lot of people have suggested this over the years as we've been doing this podcast.

And I was like, okay, yeah, that sounds really interesting. And I was like, yeah, I know about sweating sickness. Like, you know, people sweat and they died. And that was it. And then like I started to read more about it. And I was like, what? I'm excited because I know literally nothing about it. Like when people have suggested it, I've been like, okay, yeah, sure. I have no idea what it is. I am very excited. So the way that we did this episode, and I think it's like the way that we did the dancing plague episode. Yeah. Is where I like research the historical epidemics. And by the way,

sweating sickness is a mystery. So this is like a mysterious epidemic episode. Right. It's going to be like our encephalitis lethargica and our dancing plague episode. So a little different than Tritish. Yeah. And so yeah, I did all the research for like the history of it as usual. But instead of Aaron taking on, oh, this is the biological cause and the epidemiology of it, I was like, hey, research these five things that people think it was. Right. And so then we'll go through. them and look at the biology of these, you know, possible explanations and try and figure out what we think. Yeah. Yeah. I mean, I think this will kind of be like an episode of unsolved mysteries where you're like, oh, this is so exciting. Like, what's going to happen? What's

going to happen? And then ultimately, like, you're not really going to get a very fully satisfying answer. Do you mean, you think that like, because this has been how many hundreds of years that we have yet to figure out exactly what caused it. You don't think we're going to solve it on this podcast today? We're not. I mean, I feel like with some exhumations of some royal bodies or something and then testing some DNA, that is possible. But also, yeah, that has like not, that has been tried and no permission has ever been granted. So. Well, yeah. All right. We'll do our best. We'll do our best. So, Aaron, yeah. It's a very special time. It is. I checked. It is quarantini time. It is quarantini time. This week, we are drinking, sweat it out.

Sweat it out. And in Sweat it out is it's going to be like a little bit of a spicy and smoky situation. Of course, to like really give you that sheen. Exactly. We want you to, we want to see those beads of perspiration on your dewy forehead. We have mescal, lime juice, habanero simple syrup, mango juice, and orange liqueur. Yum. And we will post the full recipe for that quarantini as well as our non-alcoholic placebo-rita on all of our social media channels and this podcast will kill you.com. We will. Do we have any other business to talk about? We do have one small piece of business. We have a correction. We have a correction. actually. Yes, we do. So in our last episode, which was on Rubella, one of the terms that we used was differently abled. And a bunch of people have reached out to let us know that that is actually

not the preferred term. And we apologize for doing that and we will do better in the future. Yeah. And thank you, honestly, thank you for pointing that out. And people pointed it out in a way that makes it easy for us to learn. And so now we can teach everyone else too. So the preferred term is disabled, not differently abled. Yes. And we appreciate it. Do we have any other business to take care of?

We have merch, which is amazing, created by incredible artists available on this podcast, we kill you.com under merch. We have a bookshop link as well as a goodreads list. if you're interested in finding or purchasing books that we recommend on this podcast. Ooh, and we're getting transcripts. Yay! So you can read more. Yes.

We're very excited. These have been very long awaited and will be available on this podcast. We'll Kill You.com. Just click on transcripts. We're super excited. Heck yeah. I think that's enough business. Well, should we dive into this episode?

Erin, I can't wait. I really, like I'm not kidding when I'm. say I know nothing about sweating sickness, and I want to learn all about it. Excellent. Well, I will dive right in right after this break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on prep.

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Oh, yeah. Sweat. Oh, go. Oh, Erin. I feel like planned and rehearsed jokes are probably the best, right? Definitely. Yeah. Absolutely.

I mean, I didn't see it coming. Spontaneity is overrated. Quick wit? Absolutely not. Who needs it? Okay. But for real. The English sweating sickness was basically a series of five epidemics occurring in 1485, 1508, 1517, 1528, and 1551, primarily in England and only England.

Huh. It's entire history takes place within that not quite 70-year time frame. It caused nowhere near the same level of population devastation that plague epidemics did. And I'm not talking just about the Black Death, but I mean the outbreaks of plague that continued across England and the rest of Europe for centuries after. And if it wasn't a plague year, people were still no stranger to deadly illnesses that would burn through a city or a village and wipe out one side of a family tree within a matter of days. Life was precarious. Death was always hovering at the edge, hence like all the rad metal art from that time, all the skeletons. So with these epidemics of plague, typhoid, malaria, influenza, smallpox, etc. constantly on rotation, what made sweating sickness so remarkable to people in that time? What was it about sweating sickness that led to such terror and panic that Henry the 8th, for example, fled with his members of court to avoid the sickness, somewhat in vain, I might add? And what is it about this mysterious yet very isolated and short-lived illness

that still leads people in the 21st century, 500 years later, to talk about it, publish articles about it, highlighted in novels and TV shows? Let's find out. Yeah. England in 1485 was at a bit of a turning point. The War of the Roses was finally drawing to a close with Richard III losing his life and his army defeated at the decisive Battle of Bosworth Field, which led to Henry, Earl of Richmond, taking the throne as Henry the 7th and kicking off a 115-ish-year rule by the House

of Tudor in England. Okay. And like all of that stuff about the history of the English royal families and succession and blah, blah, blah, I think is really interesting. But like that's not what we do in this podcast. I'm not equipped to do it. And so that's all I'm going to say about that. But the reason that I mention it is because the year 1485 was not just this end of the War of the Roses. We care about it because that's when we first see. sweating sickness. And the exact date within that year of the earliest cases is a little bit

controversial because some early chroniclers claimed that it was brought over at the time of the battle by Henry's French mercenaries, but that's actually unlikely for a number of reasons. Among them the fact that there aren't any descriptions of this disease in France during that time and that there were sporadic cases reported elsewhere in England prior to this battle, which took place in late August. August, okay. But where there may have been scattered cases throughout England earlier in the summer of 1485, later it had erupted into a full-on outbreak.

In early September, the mysterious sweating sickness had spread to Oxford. By late September, it had reached London, and by October, it was in most of the western and southern counties. One contemporary chronicler reported that it had killed 15,000 people in London, which is surely an exaggeration, because that would have been about a third of London's population at the time. But that does just further illustrate the impression that it left on the people who were witnessing this illness sweep through. And this impression was just of total helplessness and devastation. But what were they seeing?

Yeah. Okay. So I guess maybe before I go through the next few epidemics, I should probably describe sweating sickness and a little more detail. a little more detail? I am like on edge right now. I know, I can tell. I love it. I'm writing notes literally as you're talking so that I can try and figure out what's going on. Okay, okay. This is great because I get to pretend to be you in this, in this episode. It starts with a fever. With a fever. Yes, I never get to say that. And it actually does. It actually starts with a fever.

Okay, cool. And it comes on quickly. One may minute you're doing whatever it is people were doing in England in the 1400s and 1500s. Like maybe you were rolling out some rye dough or you were tending to your crops or you were writing a sermon denouncing Martin Luther and his 95 Theses or whatever. Just casual. Just cash stuff. And the next minute, you feel the slight fever coming on. And along with that fever, an intense sweat.

Okay. This isn't any old, heavy after a workout type sweat. This is unprecedented. Not only because of the volume of moisture leaking from your armpits and beating up all of your skin, but also from the vile stench accompanying it. What? Fetid, corrupt, putrid, loathsome. These are just some of the words that contemporary physicians or scholars use to describe this sweat.

Okay, but can I already take a time out and ask a question? Of course. This is a rolls reverse, Erin. Now I know how you feel. Okay. Are people stinking, like, is it the sweat that is stinky? Or is it just that like it's 1485? People don't have great hygiene. And so when you sweat, you smell yourself. And so when everyone's sweating and so now they stink. Like, is it more stinky than other illness sweat? I'm confused. Well, so I can't answer that except for the fact that the horrible smell was noted in like all of the descriptions. Okay. Which like would lead me to believe.

believe that there is something special about this sweat because how do you avoid smelling yourself? Like, you know, I don't know. I'm just going through what you asked me to research, Aaron, and already I'm like, well, no idea. I mean, maybe it is possible. So there are some modern scholars that say, well, perhaps the excessive sweat was due to anxiety because the fever wasn't all that high. It wasn't all that burning. It didn't seem to be. It seemed like a slight fever. And so the successive sweat seemed strange, but it also was incredibly notable. Like it was, it's in the name. It's in the name.

They called it sweating sickness. Yeah. So I can't answer you about the smell part, but I would have to believe that like at a certain point, you would have gotten a custom to how much you and everyone around you stank. Right. And so then this is above and beyond 1485 stink. It seems to be. Okay. That's the sense I got from this.

All right. Okay. Okay. So this sweating, which never seems to cease, brings on an unquenchable thirst. Okay. Your heart starts racing. Your back and arms and legs ache. You feel stabbing pains in your stomach and bowels. And oh, my God, does your head hurt so badly that you're having a hard time keeping a grasp on reality. If you're lucky enough to have been close to home when the symptoms began, you find, find yourself unable to crawl out of bed. And if you weren't so lucky, you lay on the ground where you stood when you first felt the illness coming on. Okay.

As you lay there, sweating, rancid sweat, guts roiling, body aching, head absolutely pounding, delirious, your breathing starts to become more and more shallow, and a great heaviness seems to settle on your chest. Maybe you pile on more and more blankets or clothes to try to keep the sweat in, which might have been prescribed by your quote-unquote doctor. Or you drink as much lukewarm liquid as you can get down. But what you really want to do, what your body really wants you to do, is sleep. And so you close your eyes and give in. But just like your insatiable thirst, there never seems to be an amount of sleep that's enough to make you feel rested. If you can endure the first 24 hours of this sweating, aching, burning, breathlessness, you're probably in the clear. The relapses leading to death were common.

But, according to writings from the time, few escaped the illness and most succumbed to death within a few hours, a few hours of symptom onset. If you are well at lunch, you could be dead by dinner. Quote, but all alike died, either as soon as the fever began or not long after, so that of all the persons infected, barely one in a hundred escaped death. Whoa. The precise cause of death was unclear, still is unclear, but there are some isolated reports of people recovering after being given an enema,

which suggests, along with the list of symptoms, that severe dehydration may have played a major role. Okay, okay, okay. Yeah, okay. So now, after hearing this description of sweating sickness, which I based off of a few contemporary accounts by Thomas Forrester and John Keyes, who lived through the 1485 and 1551 epidemics, respectively, I think we can mostly answer my earlier question as to why sweating sickness left such an impression on people at that time, even though epidemics of sweating. sickness were nearly as widespread or devastating as something like the plague. This was a terrifying rap and rapid disease that would kill you within a few hours. Everyone's dying from it. I need to know more. Yeah. Okay. Well, here we go. Okay. So what I'm going to do is I'm going to talk

first a little bit about the characteristics of sweating sickness and then sort of go through each of the epidemics. And then I think, and then I want to hear from you about the different diseases that you have and we'll try to like symptom match. And then at the same time, like I have sort of at the end of my notes like an epidemiological breakdown of things, like who had affected where it happened, when it happened, et cetera. Yeah. Okay. And the rapid thing, I mean, like how quickly people died, it doesn't seem to be just, you know, the exaggeration. or drama of the 14 and 1500s.

Like one of the authors or one of these scholars wrote that, quote, we saw two priests standing together and speaking together and saw both of them die suddenly. Also, in the last day, we see the wife of a tailor who suddenly died. Another young man walking by the street fell down suddenly. What? Immediately some were killed opening their windows, some in playing with children in their street,

some in one hour, many and two it destroyed. As it found them, so it took them. Some in sleep, some in wake, some in mirth, some in care, some fasting and some full, some busy, and some idle. What, Aaron? I know, I know. And what you're telling me, too, is, like, the number one symptom is the fever and sweat. I mean, stench, but... Fever, sweat, rapid death. There's also seems to be difficulty breathing, so... Okay. But how much of that is just because you've been sweating so much, and your heart rate is so high that now you're just like to kipnik because your body is like on overdrive, which is what it sounds like more than like that you're literally having any pulmonary issues.

Right. There's no cough. There's no sputum. There's no, oh my gosh, Erin. I mean, yeah, there doesn't seem to be a cough. There's no rash. Like I— There's no rash.

Yeah. What? I know. I know. Okay. Okay. The people living in England during the time, of the sweat were no stranger to a quick and unexpected death, but this was shocking, like,

even to them. Yeah. And another reason that it may have stood out was not just how rapidly it seemed to descend on a village or town, but also how quickly it left. So within, let's say, like, five days, you might see the same number of burials you would normally see in several months. And it's just this big blip on the radar. Whereas outbreaks of plague and influenza and smallpox and other infectious diseases would show up in more of like this rolling wave fashion, a slow build, sustained intensity, and then a gradual decline. And sweating sickness was like a rogue wave, just like boom, right in the middle. Right. What? And this characteristic of sweating sickness is also super useful for a present day analysis or investigation into the disease because it allows

researchers to identify likely outbreaks of sweating sickness using parish registers, which recorded baptisms, marriages, and burials, among other things. Okay. And so even if a parish register didn't note that it was specifically the sweat that was responsible for a burst of death, you can use information from nearby registers to note likely outbreaks and to estimate the impact that an epidemic of sweating sickness had on a particular village or a town and to also study geographical variation in outbreaks. So not only was the sweating sickness deadly and lightning fast, it also appeared to be brand new and unknown outside of England, at least at the time of the 1485 epidemic. And so like we heard in the first hand account, a new kind of sickness came

through the whole region, which was so sore, so painful and sharp that the like was never heard of to any man's remembrance before that time. I'm really having a hard time with this. I know. I love it. And this newness also played into the explanations put forth by scholars who live during that time. So remember, germ theory is hundreds of years away at this point. And so superstition or meteorological or celestial explanations really took kind of front and center. Honestly, I'm not surprised.

Like, I'm leading that way right now. I know. I know. Maybe it was punishment for supporting Henry the 7th, or maybe it was the way that the planets were aligned, or maybe it was just bad air. Bad air. What did seem clear was that there seemed to be no way to predict or control when it emerged and when it disappeared, which only did a handful of times, never to be seen again. Or was it? I don't know, Erin. You tell me.

Okay. So now I'm going to go through these sweating sickness epidemics briefly. Just finish up the timeline. And then I want to hear from you. Okay. All right. So the 1485 epidemic of sweating sickness arrived in mid to late summer and disappeared within a few months. Okay. And it wasn't until 1508 that the sweat showed up again. And there isn't a whole lot of information about this particular outbreak maybe because, it seemed to be less extensive than the previous one. But one important thing to note is that it

began, like the previous one, in summer, so June, 1508, and burned out by October that same year. Okay. And again, this epidemic seemed to be restricted to England, and I mean just England, like not even Wales or Scotland. What? Okay. Yeah. And next, we have 1517, again, beginning near the end of June and stopping by the end of October, at which point it was overshadowed by an outperisholed by an outbreak of the plague that was apparently much more devastating, so which is why we probably don't know a whole lot about that one. And like the previous two epidemics, this one was again constrained to England and primarily in London, although nearby areas were affected.

So like Oxford and Cambridge were said to have become ghost towns during this outbreak, and 400 students at Oxford reportedly died within a week. What? This is a lot. That's a lot. 400 students. So we're talking young people. Yeah, yeah. Okay. That's an important piece of information. It is. And the fourth epidemic, which occurred in 1528, broke with the established pattern of epidemics in that this one also seemed to cross the English channel to continental Europe the following year.

And this outbreak also seemed to be particularly devastating, with some reports of up to 40,000 people in London becoming infected, although only 2,000. dying. And this 1928 epidemic is the one that Henry the 8th fled from with many members of his court, although several of them died, some only after like an hour or two of symptoms appearing. What? And just like, just to further illustrate how quickly this came on and how rapidly devastating it could be, at the Archbishop of Canterbury's house, 18 members of the household died of the sweat in just four hours. What? I'm losing it, Erin.

I know. I know. It's very strange. 18 people died within four. Okay. I mean, this doesn't even sound like an infectious disease. Well, okay. Interesting that you should say that.

Put a pin in that. Okay. Yeah. Also, Anne Boleyn became infected but recovered. Okay. I feel like, okay, because I remember you saying that this was in the Tudors. And I was like, oh, should I watch that season? But then I didn't because I didn't want to learn about it.

But also it was in the first season, wasn't it? It was in the, it was, yeah, I watched like, I didn't manage to watch the entire episode, but it's season one, episode seven. Okay. I definitely have seen it, but it was long enough ago that I don't remember anything, except like a vague running down the halls being sweaty or something. Yeah, I don't know. I'm not sure how representative it was.

I also started reading Wolf Hall, which also apparently portrays like sweating, sickness epidemics because it takes place during the same time, covers the same people, et cetera, et cetera. But also that book is a lot bigger than I thought it was. So didn't quite make it all the way through. Anyway. And so again with this 1528 epidemic, the disease emerged in June and disappeared in September. But the following year, 1529, is when we see a similar disease appear in continental Europe, beginning in July in Germany. And, and the following year, 1529, and Austria and then spreading to the Netherlands, Poland, Prussia, Denmark, Sweden, Norway, Finland, Lithuania, Russia, and elsewhere. So like all over. And by September, it was gone. And there's

been some discussion as to whether or not this disease on continental Europe was the same as the English sweating sickness, but it seems like they were. Because the description of symptoms are similar and maybe the biggest clue is that it was referred to as the English sweat or Suter Angelicus or the English bath or other names that clearly place its origin in England. Did they talk about how bad they stunk? Yeah. So perfect. Thank you for asking that.

I have a quote. In 1529, a terrible disease spread in the lowlands at Cologne, Antwerp, Frankfurt, reaching as far as Strasbourg. So that in these places, a great many people died and they called this disease the English sweat because it came from England. And whoever was affected by this disease went from life to death in 24 hours. For when one was afflicted with the disease, it came with a great poisonous sweating and one sweated to death forthwith so that countless people died of the disease everywhere. Some people sat down to table in good health and were carried away dead.

What? Aaron! I know. Are you going to devote the rest of your life to study the English sweating sick? Yeah, that's it. That's my career. Okay. Forget family medicine. It's inevitable. It's sweating sickness all the time. And so after this 1528 and 1529 epidemic, which seems to be the only one that spread to continental Europe, the sweating sickness made only one more appearance in 1551 again in England.

And that's a long time later. Yeah. Yeah. We'll talk about the intervals. So Keyes describes this last epidemic as beginning in April in 1551 and spreading over the country over the next few months before dying out in September. London's death toll peaked at over 700 people in a week in the middle of July, and some towns reportedly lost half of their population. After 1551, sweating sickness seems to have just dropped off the face of the earth entirely. isolated cases of a similar disease may have shown up in parts of Germany, France, northern Spain, northern Italy, and Holland over the next couple hundred years, but no large epidemics. And these isolated cases aren't often mentioned in histories of sweating sickness. What is commonly mentioned, however, is Picardy sweat? I'm hoping I'm saying that right.

Another infectious disease of unknown cause that first emerged in 1780. in northern France and later spread to Germany, Austria, Belgium, Switzerland, and Italy. And the last extensive outbreak of this disease occurred in 1906 in France. And there were, so there seems to be two forms of the Picardy sweat, one very mild, resembling nephropathia epidemica. Is that one of the hantaviruss? Uh-huh. Okay, yeah.

And another more severe version that more closely resched. resemble the sweating sickness, but was still much more mild. There were also some like fairly substantial differences between the two diseases in terms of their symptoms. So for instance, the Picardy sweat was often accompanied by a rash and subsequent peeling of the skin as well as nosebleeds, neither of which seemed to be symptoms of sweating sickness. But is it just because everyone died so quickly that they didn't show any other symptoms? That's something I'm wondering. Yeah, That's possible. I don't know how quickly the rash came on, but definitely the more severe version of the Picardy sweat does seem to be like extremely rapid onset. Okay.

But the mortality rate of the Picardy sweat ranged from like zero to 20 percent while the sweating sickness was much, much more fatal. Like estimates put it at 30 to 50 percent. Okay. So the two diseases probably weren't the same. but I think that they were probably, or a lot of people think that they were probably linked. Like may have been caused by the same vector or reservoir or may have similar ecological origins, I should say. Or like a similar type of pathogen or something like that maybe? Yeah, yeah.

So. I have a lot of ideas, Erin. Yeah. I mean, I don't know. So now at this point, it's like, is it time? to go through what might have caused? I'd love to. I really would love to.

So what are the things I even told you to research? Because I don't remember. There's several. It's actually fun because some of these things we've already covered. And some of them were going to cover. So you told me to research Urgot, relapsing fever, hauntavirus, or a type of hauntavirus, and anthrax. And then also peripherally influenza.

But I feel like we can say it's not influenza. Yeah. And the reason, so I will say that like I told you these before I really started doing extensive research. And this was I pulled those. Right. That's what Wikipedia says. Being like these are what scholars have put forth as possible explanations. Yeah.

So let's go through them. And I have a favorite already. Ooh, what's your favorite? Well, we'll go over it last. Okay. Let's just take a quick break. I feel like we need to breathe. Yeah, yeah, yeah, for sure.

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Listen to the sixth bureau on the IHeart radio app, Apple Podcasts, or wherever you get your podcasts. Okay. Yeah, I have a favorite already, Aaron. But the thing is, it's not perfect. I guess that's the point of a medical mystery is like nothing really fits perfectly. Yeah. But based on the ones that you told me to look up because Wikipedia said, we can very quickly eliminate several of them and we can talk about why and then we can go through the one that I think seems like the best

option. Okay, perfect. Okay. So influenza, if you haven't listened to our very first episode of this entire podcast, you can learn all about influenza on that episode. But basically, this does not sound anything like influenza. It does not. And so that was one of like the, that was one of the earliest explanations put forth. And I think that it was very popular and retained popularity for a while because the 1918 influenza had a similar, like, pattern in that it attacked, who seemed to be like the youngest and healthiest with a male predominance. Yeah. Right. And certainly it's not out of the question that you would have a brand new strain of influenza and it could be much more deadly like the 1918 pandemic. But otherwise, symptoms wise, like this.

sudden onset of fever and fever being the one and only like major symptom that just doesn't really fit with what we see with influenza, even if it's a different strain. Like, influenza is usually a slightly more gradual onset. You're definitely going to have some kind of respiratory symptoms a lot of times because it is a respiratory pathogen. And usually when we see the more severe forms, it's because it's causing like a viral pneumonia rather than just, you know, sweating and then dying. Right.

So I think we can pretty confidently say it's very unlikely that this was an influenza, especially an influenza strain that remained localized to only England and then didn't spread to anywhere else. Right. What does that tell us about transmission? Yeah, it probably wasn't respiratory. Okay, another one I think we can pretty quickly eliminate is actually going to be Urgot. Yes, for sure. So Ergot we talked a lot about in the dancing plague. episode. This whole episode is actually just like, see previous episodes. I know, I know, I know. But we will go through it. So ergot of fungus produces a number of different alkaloids, including

ergotamine, which if you ingest ergid or any of these other alkaloids, that's when you get these type of symptoms. What I like about this as an explanation is that ergot is not an infectious disease, right? It's like you're ingesting this alkaloid produced by this fungus. And so the onset can be really rapid. And from what you're saying, the onset of this is so rapid that it's hard to believe this is an infectious disease because it's so very rapid like that. Well, yes. And it also affected like members of a household in clusters. Right. So I could see that as well. Right. But there are a lot of things against Urget too. Yeah. Like for example, the symptoms are nothing like. Correct. So that would be the number one thing. Yeah. So the signs and symptoms of ergot generally have to do with like it causes vaso-constriction. So depending on where that vaso-constriction is, you're either going to have like tissue death and limbs falling off or you have like a convulsive form where it's affecting your central nervous system. So you have like nausea, vomiting, diarrhea, convulsions, all kinds of weird sensations, but nothing like this super high fever.

sweating, like, that's just not something that you really see. Certainly hallucinations and delirium, like you were talking about, but because of the ergotomy, not because of the fever and sweat. Yeah. I think maybe not ergot, but a food-borne type of thing was also, like, I know botulism was briefly proposed at some point, but I don't, that again doesn't fit. It doesn't fit. Yeah. Symptoms-wise, it doesn't fit. I agree that, like, close. I agree that, like, close. luster-wise in a household and onset-wise, some kind of preformed toxin or a food-borne something, I could see that fitting with some of the epidemiological characteristics. But there aren't a ton of those.

I mean, there are some that cause fever, but really, actually, no, they're not a ton that really caused this kind of fever that you would see because fever is indicative of inflammation, which is something that we see more with, you know, infection rather than. I don't know. Right. Well, and I think there's also the matter. And I kind of, I mean, I definitely have withheld some key points. Oh, great. Thanks a lot, Erin. I just think that it would be, I think that we can back and forth this. So like, yeah. So like when we're talking about how sweating sickness seemed to be spread, it doesn't really fit food board pathogen. It does seem to have traveled along roads. So like if it took 15.000. days to travel between one village and another, that is often the interval, like that was seen, the interval between outbreaks and particular villages or towns. And that bit of information, I think, is really interesting because it points towards human to human transmission.

But the pattern geographically of epidemics is that rural areas seem to be hit hard. And cities, maybe not as hard as you might expect if it were something. something like a crowd disease or transmitted person to person. So what it seems to be is that there was another source of infection, but that human to human was also possible. Okay. Okay. So another one that you had me research that I don't think that it is, even though I do think there are a number of things that I understand why this is a common proposition is hauntavirus. Ooh, see, your face tells me that you think Haunted virus is the best fit. I do. Yeah. I mean, you're withholding a lot of information,

so maybe that information is going to tell me that I agree. But I actually, this is a spoiler, but I think relapsing fever fits really well. Okay. Interesting. And there's a few reasons why I think that could be the case, even though there are some symptoms that don't really fit relapsing fever. But, okay, so let's go through hauntavirus then. Or do you want to go through anthrax? Because I don't think it's anthrax. I don't think it's anthrax either. Okay. So do we want to talk about why or should we just wait until we do anthrax as an episode? I think we should talk about why, just briefly. Okay. So anthrax is a disease caused by a bacterium, kind of, called bacillus anthracis. This is a gram-positive, aerobic, spore-forming bacterium. So that is important because what it means is that

when this bacteria senses a change in their environment such that it becomes unfavorable, like a low-nutrient environment, they form this spore, which is very environmentally hardy, much like claustridium species do, like we talked about in botulism. And so it can survive in the soil for years. So anthrax is kind of global in distribution. Like this bacteria lives and this spore can persist in the soil for like decades, potentially. But what happens is if you get exposed to the spores in a couple of different ways, either through your skin, like a break in your skin, or through your gastrointestinal tract, or the worst form is if you inhale the spores. What happens is those spores get engulfed by our macrophages, which are white blood cells. And then within our white blood cells,

as they travel like to our lymph nodes, they can reactivate into the live bacteria. And these bacteria produce a number of different exotoxins that cause a lot of problems. So, I mean, really none of the symptoms of cutaneous, like, which is skin or gastrointestinal or inhalational anthrax, none of those symptom-wise really fit with the description of the illness that you gave for sweating sickness. Certainly, one thing that does fit is that this is something that, like, these spores could be transmitted on an animal, for example. It's very common for people who work with animals or livestock to become infected either with inhalational or gastrointestinal anthrax.

So kind of the travel and like that kind of distribution, maybe if you had anthrax in one area and then it moved, you know, with, I don't know, livestock or something to another area. Maybe you could see that. And also inhalational anthrax is very deadly and very rapid. You start with like a pretty non-specific fever, feeling cruddy, having muscle aches. You especially because we're talking about inhalational here, you usually have a cough, right? This is something that's causing inflammation in your lungs. So you might have abdominal pain, but also chest pain. And then over a couple of days, you get a further fever, but also more shortness of breath,

a lot of trouble breathing. This occurs over a couple of days. And then, like at that point, especially if this crosses your blood brain barrier and causes meningitis, then very rapidly you progress to shock hypothermia and death within like a number of hours, like 24 hours or something. But that's after a few days of feeling cruddy and having a fever and that kind of thing. So that doesn't really fit. And then the cutaneous and gastrointestinal-wise absolutely doesn't fit.

Well, and also the fact that, like, anthrax was known and is still, like, was around. It didn't disappear, whereas this really does seem to be this incredibly unique disease that then disappeared. That's interesting. But that's why, okay, I'm going to make an argument still for relapsing fever. Oh, no, that's totally fine. I'm curious because this is the thing is that, like, maybe I feel like I'm like I'm, like, I feel like I'm, leaning more towards Hanta virus, A, because of the papers I read, but B, because I already know more about Hanta virus, I don't know really anything about relapsing fever except its transmission route.

Right. Well, and I mean, I, like, I dove into all of these, but I don't think I dove as deeply as I would have if we were doing a full-length episode on it. So I also feel like I don't know everything there is to know about relapsing fever, and I definitely feel like I know more about hontovirus. But, yeah, I mean, okay, let's talk about Hanta virus. Yeah. So if you want even more deep dive on hantavirus, it's all the way back in season two. We did a whole episode on it. But there's a whole bunch of different hontoviruses. They all are RNA viruses.

They're commonly found in rodents and moles and shrews. That was Aaron Hontovirus was the episode when I learned that moles and shrews are not rodents. I think I just relearn that when you said that. The most deadly of hanteviruses is the synombre virus, which causes hantavirus pulmonary syndrome, which has the highest case fatality rate of like 40 to 50%. But there are a number of other hantiruses that we know of, including soul virus, hantan virus, puma virus, and dobrava virus, which tend to cause a disease that we call hemorrhagic fever with renal syndrome. So if we're talking about like Hauntavirus pulmonary syndrome, you definitely get fever,

you definitely get muscle aches, headache is certainly one of those symptoms, abdominal pain, diarrhea, maybe. And importantly, you don't have those upper respiratory symptoms, which is interesting because even though this is a pulmonary illness, at the first part of this disease, you don't really have any kind of pulmonary, like lung symptoms. symptoms. But this is a long, like, it's a longer disease. Like, the first phase usually lasts

three to five days, but even up to two weeks. And then after that first phase where you're just kind of feeling cruddy, then you start to have these heart and lung symptoms. And within 24 to 48 hours of that is when you could die. But even still, you have a longer period of feeling not good and having a fever and having all these other symptoms before you die. I don't know, Erin. Okay. I feel like we have pretty successfully ruled out a few of them. Yes. Okay. And we are now left with like what we think and what has been commonly reported as like the two leading proposed explanations. What if you briefly laid out just the very basic characteristics of, the hauntavirus pulmonary syndrome and relapsing fever.

Okay. Just like how they're transmitted, you know, table form type stuff. And then I'll go through the epidemiological characteristics of sweating sickness and we'll kind of talk about each point for each of them. Okay. That sounds fun. Okay. Okay. So focusing on hontovirus pulmonary syndrome. So hontovirus pulmonary syndrome has a case fatality rate about. 30 to 50 percent.

Sounds familiar. It does sound familiar. Relapsing fever, first of all, importantly, there are two different forms of relapsing fever. There's louseborne relapsing fever and there's tick-borne relapsing fever. And they're very different in terms of their epidemiological characteristics. And I think this sounds much more like louss-borne relapsing fever, which is more common in groups. It's more common in epidemics and has a case fatality rate of between 10 to. to 40%. Okay. Okay. Okay. So hauntavirus transmission. Hontovirus is transmitted by aerosolized mouse poop,

essentially. It's transmitted by aerosols, but not person to person. However, there is an asterisk next to that not transmitted person to person because there have been instances reported in Argentina that suggest person to person transmission. Yes. There is some possibility of at least one specific strain, but most hauntaviruses have not ever been shown to be able to be transmitted person to person. Now, what about relapsing fever? This is fun. First of all, relapsing fever is caused by Borrelia species. So these are spirokate bacteria, not too distantly related to Lyme disease, but different species. And there's a number of different species of Borrelia that can cause relapsing fever, which I think is important. And while tick-borne

relapsing fever is transmitted from the bite of a tick, much like many other tick-borne diseases, louse-borne relapsing fever is transmitted from the hemalymph, which is the blood of a louse. That means that if a louse is living on you and, you know, biting you and so you're itchy, and then you scratch, you like schmush that louse, and then you scrape it open and you scrape their blood into your skin. That's how you become infected. And I'm pretty sure that there have been some suggestion that there might be for louse-borne relapsing fever that there could be person-to-person transmission based on epidemiological characteristics. Okay, cool. Interesting. I got so excited that I couldn't finish that word.

Some other characteristics. So incubation period, I think is probably important because, like you said, if this was moving kind of like village to village or area to area in about the time it takes for someone to travel, then you're probably not looking at something that has a super long incubation period. So for hauntavirus, it's actually quite a long incubation period. It's usually like two to three weeks incubation period after exposure to. symptoms. Relapsing fever, there's a pretty big range in general. It's about seven days, but it can be as low as four or as high as like 18. Okay. And then duration of illness, and this is the part where

honestly none of these fit really well. Because with hauntavirus, especially hauntavirus pulmonary syndrome, you have a first phase of kind of fever, malaise, not feeling great, headache. And that usually lasts three to five days, but even up to like 12 days where you're just feeling bad. And then when you get to the second phase where you have shock and pulmonary edema, so like fluid in your lungs, that usually happens really quickly within like 24 to 48 hours. And then you might die. But in general, you're feeling cruddy for at least three to five days before that. Yeah.

Okay. Now with relapsing fever, I mean, you said that sometimes people relapse, Aaron. So relapsing fever does start very abruptly with a very abrupt onset of a really, really high fever, along with shaking, chills, headache, and delirium. Interesting. And you often also have very severe joint pain, muscle aches, nausea, and vomiting, and extreme weakness. Like you can't even get up and walk because you're so weak and you feel extremely lethargic. Okay. Like you said, all you want to do is sleep.

Yeah. And then you can also get like a very profound anorexia feeling so bad like you just don't want to eat. You might have weight loss. But and this is this is where it just falls apart, Aaron. The first fever, this really high onset fever, your skin is usually hot. Hot and dry. It's like a very classic description. It's a hot and dry, which the reason that this is like outlined in all of these clinical descriptions is because a lot of other diseases that cause a fever, especially a relapsing fever like malaria, you usually are sweating quite a lot in association with the fever.

Right. But with this one, your skin is described as hot and dry. Yeah. That does not sound like sweating sickness. But it also doesn't, I mean, Hanta doesn't sound like that either. So I have a question about relapsing fevers. Okay. How diverse is this group or like, you know, how many different bacterial species cause relapsing fever and how much variety in symptoms is there among those species?

Very good question. So there's, I saw, and I didn't write down every single species, but But lousborne relapsing fever is mostly one species, and that's Borrelia recurrences. Okay. But there are at least like three or four other species of Borrelia that caused tick-borne relapsing fever. Yeah. And there's a number of different tick species that also can transmit. So hard ticks and soft ticks, which is fun. It is fun.

Yeah. I know. We never talk about soft ticks. But they do. So tick-borne and lousbored relapsing fever look a little bit different. So like the length of illness is different. The mortality rate is different. Tick-borne relapsing fever is not as deadly as Laosborne relapsing fever. Laosborne usually lasts a little bit longer, like five and a half days of symptoms rather than three days. And then the interval between relapses is also longer for Laosborne relapsing fever. And you generally have fewer relapses. You have like maybe one, maybe two relapses. But with tick-borne relapsing fever, you often have like three or more relapses of symptoms.

Okay. Okay. Now, you do often have a rash. It's not uncommon. But, and this is why I mentioned that in the French epidemic where people did have a rash, the rash can look a lot of different ways. Like there's a lot of different kind of presentations of a rash. but it usually happens after the first set of symptoms while you're otherwise asymptomatic. So if people survived long enough to get to that point, maybe they would have had a rash.

Okay. Okay. But this is getting off of the epi characteristics a little bit. But I want to get into the path of physiology of how relapsing fever works because this is part of what makes me think that maybe it was like a certain subtype of Borrelia that caused. caused these particular epidemics. Because what I think is really interesting is like what causes this relapsing disease, right? The reason that you have a relapsing fever and symptoms in tick-borne or louseborne relapsing fever is that the bacteria that caused this vary their surface antigens. So they change out those proteins that are on their surface that our body is responding to

in order to kill them. and they do so during cycles of disease, they change them so well that so you get infected, right? The bacteria enter your bloodstream, either by you scratching them in or by a tick spitting them into your bloodstream. They replicate. Our body reacts, which is why you have all these symptoms, fever, feeling crappy. And then our immune system like tries to kill them off, but the bacteria go, okay, well, you figured out this antigen. So we'll just change our outer proteins, and then our body's like, oh, we did it. These bacteria are gone. And they don't recognize these anymore. So then they can start to replicate all over again. You have a huge

amount of bacteria in your blood again, and it's like a whole new infection. That is unbelievably cool. I am very, that is fascinating. It is so fascinating. Wow. And so I wonder, could it be that there was, you know, a particular antigenic subtype? that was present in England at this time that happened to cause a slightly different presentation of this disease. I don't know. I just don't know, Eric. I know. I know. I know. Okay. So I have a few more questions about like the epi characteristics of relapsing fever and hantavirus or hantavirus pulmonary syndrome. So first of all, is there any general pattern in in who like, whether it's age group or. whatever that is most susceptible or seems to have the most outcomes with either of these?

I don't think so, at least nothing that like stands out in the research that I did. It's not like young people only die from this or old people only die from this. Okay. And then what about like any seasonal or temporal aspect? So with tick-borne relapsing fever, it certainly is something that's going to be more common when people are outside and when ticks are outside, which is going to be in the summer months. Louseborne, it tends to be a more epidemic disease. It doesn't tend to be sporadic the way that tick-borne relapsing fever does. But these are human body lice, and so there doesn't tend to be like a specific seasonal variation necessarily because human body lice live on us all of the time. With hauntavirus, I think I remember it being something where it's just

depends on when you're in contact with mice. Well, for hauntavirus pulmonary syndrome, it was summer. Summer. That makes sense, because that's when you're in contact with mice. Right. Okay. One final question. Okay. Immunity. Do you gain immunity after infection? Oh. And are there asymptomatic infections? Really good question, Aaron. I'm going to guess with relapsing fever, no, you don't gain immunity because already they're changing up their antigens so much that that's why you're having relapses to begin with. For hauntavirus, there is a vaccine that's available at least in some parts of the world. So I would think that there's immunity for at least some portion of time, not sure how long that

immunity would last. Okay. Okay. So I feel like now that we know a bit more about the two leading, you know, potentially, causes. Let's go over the epi characteristics of sweating sickness. Okay. Okay. Let's take a quick break first. All right. So I've grouped the epi characteristics into five basic sections. Okay. So, you know, what was sweating sickness? So like symptoms, case fatality rate, et cetera. Number two, how it seemed to spread. Number three, where it occurred. Number four, who it affected? And number

five when it happened. Okay. Okay. So starting with what it was, it was rapid onset, fatal disease characterized by excessive foul-smelling sweating, fever, body aches and pain, stomach pains, headache and delirium, heart palpitations, and breathing that was shallow and labored. Death often occurred within the first few hours of the first symptoms showing up, and case fatality rates vary among epidemics in and affected regions. So like sometimes it seemed to be very low. Sometimes it was really high. But overall, it does seem that it was a very high mortality rate. And most estimates put it at like 30 to 50 percent. Okay. The only epidemic where mortality could actually be somewhat reliably calculated was the 1551 one. And because that's because like by that point,

but not for the previous epidemics, parish registers actually began to be in use. And so we get an estimate from some guy's amazing analysis of parish registers that around 15,000 deaths were due to sweating sickness in the 1551 epidemic in England. Okay. But let's compare that to 30,000 deaths from the plague in 1563 in a plague epidemic year. and 180,000 deaths from influenza epidemics in 1557, 1558, and 1559. So although it was deadly, it wasn't nearly, didn't cause nearly the same loss of life as some of these other diseases. Yeah. Okay.

All right. Number two, how it spread. And we talked a little bit about this, but this is very challenging to nail down. So basically it does seem that human-to-human transmission was possible, but that that may not be the only route through which a pathogen was transmitted. See, this is why I lean Laosborne, because, like, lice move from person to person and thereby move the disease. Right. So it's not directly person to person, but it's not directly person to person, but it's, is person to person in that sense, right? It's not, it's not, it doesn't need an animal reservoir.

It's, it's a human disease. It doesn't, right. But I think what makes me lean away from Laos are a number of things. Like one is the seasonality, which was very pronounced. Like it was summer months. It's true. And then it emerged suddenly, disappeared suddenly. So that to me implies some sort of like ecological characteristic of this disease. And the second thing is, and I didn't really go that into it yet, and I will right now, I'll skip ahead to number four, is who it affected. So who sweating sickness mostly affected. Okay. And so, you know, like I said, it seemed to primarily impact England only, even respecting political boundaries. And I don't really know what to make of that. Like maybe contemporary writers were just being a bit dramatic and wanting to play up the role of England as a victim. Or maybe it was just, you know, real, in which case I wonder if there was some sort of like cultural or behavioral difference

that prevented its spread. So like maybe one type of grain was more commonly grown and stored in England, thus providing more food for rodents, or maybe it was stored in a particular way or a certain place that would have changed how rodents and humans or arthropod vectors and humans interacted with one another. And while some of the names for the disease highlight how sweating sickness seemed to be an English thing. So like Sudo-angelicus, the English sweat, others seem to draw attention to the type or class of person that was commonly affected. So stoop gallant, Stoop nave and know thy master, which is like basically it seemed to affect wealthy, well-to-do, healthy young men primarily. So between the ages of like 15 and 40. And that would lean kind of away from a

lousborne just because lice usually it's in more crowded conditions, more lower socioeconomic status when you don't have access to like be able to clean yourself and get rid of lice. Right. And I talked a bit about the urban to rural difference as well where it did seem to be predominantly like would hit hard rural areas. But it also was in urban areas as well. I don't know. But not not to the same degree as it was maybe in rural areas. Okay. And so then the final thing. is when it happened. And by this, I mean two things. So one is a very sporadic nature of the epidemics. So these, like the years separating them are 23, 9, 11, and again, 23. So that's weird.

It's very strange. You could say, so some people suggest that it's an 11 year, a 10 year gap, and that there are just two missing epidemics, whether they're missing to our knowledge or missing to, like, whether they actually happened or not is not known. But there's also this very strong seasonal pattern to infection. And if we're going along with the hauntavirus thing, some current or modern scholars suggest that there were wet years that preceded these epidemics or very wet summers, which is what happened in the 1993 Four Corners Sinombray outbreak that led to like a much higher mouse population. Right, exactly. But I think that like, I don't know, I mean, if we're talking about louseborne relapsing fever and we're talking about hauntavirus pulmonary

syndrome, those are two very different roots of transmission. Yes. And so I think that's one, and also exposure patterns. So like in putting together these pieces, you have the strong seasonality, which puts it more in the column of hantavirus pulmonary syndrome. which is when, like, you would have a very distinct times of year during which you would be in contact with rodents. And certain years where you're certainly going to have a higher risk of transmission because of ecological factors, definitely. Right. Exactly. And you also have this urban to rural variation and infection that does not seem to be mediated by, like, other roots of transmission, I guess. Yeah.

The symptoms are a whole other thing. Yeah. And that's where for me it falls apart. Like for me, the symptoms really do not sound like... Like HPS? Like the, I mean... Well, but here's something that... I mean, obviously I have a little like, you know, pet theory.

Yeah. It's not my theory at all. I found it in papers. but before the 1993 four-corner's outbreak of synombris virus, we didn't have, like, we didn't know about haunted virus pulmonary syndrome. We didn't know that that's how it could manifest in your body. And then, you know, they do in the descriptions of sweating sickness, they talk about how, oh, you were well at lunch and or you, you sat down to dinner and then you were carried off. Right. And I do wonder, like, because you also had to take.

take into account that this was like the late 14 and early 1500s, their definition of someone who's well might not be the same as our definition of someone who's well. So they might actually be kind of miserable, but like that's normal for them. Right, right. So then, yeah, so then maybe it does seem as though you were fine and now you're dead when really like they've been feeling cruddy for a couple of days, but they, you know, they just thought that they didn't get enough sleep or they're always kind of feeling cruddy, whatever it is. So in that case, you do have very rapid death once you hit that particular phase of hauntavirus pulmonary syndrome. And even with, you know, the other hantoviruses that are a lot less deadly that now circulate in Europe and

other parts of the world, when you do die from those, you die pretty rapidly, right? It's either, like you recover over a very long period of time or you die pretty dang quick. So, so yeah, I guess that does, there are things that fit. It's just, I don't know. I mean, I think, like I said at the beginning of this, this is like an episode of Unsolved Mysteries. I hope you didn't go into it. It is. And it's just, it's also so bizarre that, that it would be only in England, even if it was a hauntavirus, because whatever mice populations or whatever that would be high in England, like, why wouldn't they also be high in Scotland and Wales? I don't think that the ecology is, I don't know the ecology all that well, but I would assume that there are a lot of

similar rodent species in those areas. Yeah, definitely. And I think there were, people have looked in the, in like, writings of the time and found no evidence or nothing, to suggest that there were massive either population booms or massive die-offs of rodents, like anything unusual about rodent populations. But that's where I was wondering

whether grain was stored in a different way or in a different location in the house in England. I mean, there's also like there could be a wet summer in certain parts of England and it could have missed Wales or Scotland entirely. And also how much of that is

just a little bit of like, oh, the English are being punished for our support of Henry the 7th or something. Yeah. So going over, like, what do we know? What can we say about this? Yeah. Do we think it was an infectious, contagious, transmissible pathogen? Maybe.

I think yes, based on how it seemed to travel along roads or along like common roots. So it seems more like an infectious. And like there's some component of person to person. There's some component of person to person, but it's not driven by that. And there's a strong ecological component as well. Yeah. So that points towards either arthropod or rodent, the two most likely. I mean, in all likelihood, this is something that we don't have anymore.

Like why did it disappear? No idea. Which is even more fascinating. Like if this was a virus, whether a hauntivirus or some other virus or a bacteria that caused these specific outbreaks across an entire country and then disappeared? Yeah. Where did it go? Well, unless it didn't, unless it really was the Picardy sweat. Which, but what's that?

They don't know. Right. So then where did it go? It caused one outbreak? No, it caused outbreaks starting from 17, 18, all the way through 1906 was the last outbreak. The last diagnosed case was in 1918. That's even weirder, Aryan. What is the case, though, is that most people seem to believe that Picardy sweat and sweating sickness were different diseases. It didn't, like, sweating sickness didn't turn into Picardy's sweat, but that they were probably. be caused by the same thing, whether that was like a rodent, a rodent reservoir, some sort of arthropod transmitted virus, or like relapsing fever where there is no rodent reservoir. Fascinating. Yeah. And there's still like, there's still no consensus. Is that correct? There's still no consensus. If you look at the evolution of thought as to what caused sweating sickness,

It started out influenza and relapsing fever. And then it kind of morphed into some sort of arbovirus. So virus transmitted by an arthropod. But that was kind of discarded even by the authors themselves because they were like, we don't see any bites or rashes. Like that would have been noted, they feel like it would have been noted. And then following the 1993, Four Corners, Sonombray outbreak, that is when Hanta virus pulmonary syndrome became the leading cause.

Interesting. Yeah. Even though there's still no pulmonary symptoms. I mean, I guess what they view as pulmonary symptoms are the like shallow breathing, difficulty shallow breathing and the heaviness on the chest. Interesting. Yeah. But, you know, I think that it's interesting to think about why do we care about this still.

Like, why are we still talking about it? Well, I feel like do we have to explain the answer to that question when we're living through a pandemic of a brand new virus? Yeah, exactly, exactly. But I think, like, it is, this is such a bizarre and terrifying and fascinating illness, sweating sickness. Yeah. In these diseases that we think could be related to it that exists today, like, they're still around. Does that mean that there's the potential for something like this to happen again? Who knows?

Absolutely. I mean, yeah, I think it all boils down to the fact that, like, understanding the nature and the cause of epidemics, whether they're present or especially those in the past, can help us just prevent future ones from happening. Right. And trying to understand, too, like, I think we went through, like, the ecological characteristics of this disease as well as the, you know, temporal characteristics and the epidemiological, like, understanding all. understanding all these different facets can really help you to narrow in on what you think might be the cause. Right. You can't just compare symptoms. Right. You have to consider the context. Yeah. So yeah. I mean, I don't know. Sweating sickness. It was a deadly, mysterious, probably infectious, contagious disease with an ecological component. Fascinating, Aaron. I learned so much. I mean, I also.

learned nothing, but I learned so much. I know. I know. It's interesting. If anyone has any other thoughts on what it could have been or wants to vote for their favorite. Yeah. I mean, I really, really felt like I wanted for it to be relapsing fever. But I agree, ecologically, it just doesn't quite fit.

And even symptoms-wise, it doesn't quite fit. You know, none of these symptoms-wise really quite fit. perfectly. Because obviously, if they did, then we'd have an answer. But some kind of hauntavirus, I mean, I could see it. I understand that argument. Yeah. We may never know. We may never know, but I think I could live with that. Yeah. Yeah. Okay. Well, there you have it, everyone. There you go. We could both be okay with it being hauntavirus. Some kind. Well, all right, then. I bet you have a ton of sources. I do have a lot of sources. Okay, so I'll call out a few of them, one by Eric Britson from 2001, and that was the first one to propose hantavirus pulmonary syndrome as the cause of the English sweat. Then there was another incredible paper from 1997 by Alan Dyer called the English Sweating Sickness of, 1551 and epidemic anatomized. And then there were some other pretty good ones. So I read one

by Flood from 2003, safer on the battlefield than in the city. And by Tavener et al from 1998, the English sweating sickness, a viral pulmonary disease. Awesome. If you'd like to do a deeper dive on any of the illnesses that we talked about on this podcast, I will have sources from previous episodes as well as a few more for diseases that we haven't touched on yet. And you can find the sources from every single one of our episodes on this podcast will kill you.com under the episodes tab. That's right. Well, thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you to the exactly right network of which we are proud to be a part. Yes, thank you. And thank you to you, listeners, for listening. We hope that

you don't hate this unsatisfying episode. I hope that you had fun. I had fun. Yeah, I had a lot of fun. And if you have any ideas as to what it could be. Yeah, let us know. Or if you have other medical mysteries you'd like for us to not be able to solve. Ooh, yes. Okay, well, until next time, wash your hands. You filthy animals. I'm Amanda Knox, and in the new podcast, Doubt the Case of Lucy Letby, we unpack the story of an unimaginable tragedy

that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit. The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe? Oh my God, I think she might be innocent.

Listen to Doubt, the case of Lucy Lettby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. This is Special Agent Regal, special agent Bradley Hall. In 2018, The FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world.

The Sixth Bureau podcast is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Clayton Eckerd. In 2022, I was the lead of ABC's The Bachelor. But here's the thing. Bachelor fans hated him. If I could press a button and rewind it all I would. That's when his life took a disturbing turn. A one-night stand would end in a courtroom.

The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you. This is unlike anything I've ever seen before. I'm Stephanie Young. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Thank you.