Editing Sweating sickness (section)

== Cause ==
The cause is unknown. Commentators then and now have blamed the sewage, poor sanitation, and contaminated water supplies. The first confirmed outbreak was in August 1485 at the end of the [[Wars of the Roses]], leading to speculation that it may have been brought from France by French mercenaries.<ref>{{cite book |last1=Theilmann |first1=John M. |editor1-last=Byrnes |editor1-first=Joseph P. |title=Encyclopedia of pestilence, pandemics, and plagues |date=2008 |publisher=Greenwood Press |isbn=978-0313341014 |page=686, "Sweating Sickness" }}</ref> However, an earlier outbreak may have affected the city of [[York]] in June 1485, before [[Henry VII of England|Henry Tudor]]'s army landed, although records of that disease's symptoms are not adequate enough to be certain.<ref>{{cite book |last1=Petre |first1=James |title=Richard III crown and people |date=1985 |publisher=Sutton Publishing Ltd |isbn=978-0904893113 |page=383 |quote=A 'plage of pestilence' was known in York as early as June 1485, but no symptoms were described, and we cannot tell what gave [Sir Thomas] Stanley the idea to cite the sweating sickness.}}</ref> Regardless, the ''[[Croyland Chronicle]]'' mentions that [[Thomas Stanley, 1st Earl of Derby]] cited the sweating sickness as reason not to join [[Richard III of England|Richard III]]'s army prior to the [[Battle of Bosworth]].<ref name=Heyman2014/>

[[Relapsing fever]], a disease spread by ticks and lice, has been proposed as a possible cause. It occurs most often during the summer months, as did the original sweating sickness. However, relapsing fever is marked by a prominent black scab at the site of the tick bite and a subsequent rash, neither of which are described as the symptoms of sweating sickness.

The suggestion of [[ergotism]] was ruled out due to England growing much less [[rye]] (which [[ergot]]s typically grow on) than the rest of Europe.<ref name="Heyman 2014b"/>

Researchers have noted symptoms overlap with [[hantavirus pulmonary syndrome]] and have proposed an unknown [[hantavirus]] as the cause.<ref name=Heyman2014/><ref name="Thwaites 1997">{{Cite journal|pmid=9023099|year=1997|last1=Thwaites|first1=G|author1-link=Guy Thwaites|last2=Taviner|first2=M|last3=Gant|first3=V|title=The English sweating sickness, 1485 to 1551|volume=336|issue=8|pages=580–582|doi=10.1056/NEJM199702203360812|journal=The New England Journal of Medicine}}</ref><ref>{{cite journal|pmc=1043971|year=1998|last1=Taviner|first1=M|last2=Thwaites|first2=G|last3=Gant|first3=V|title=The English sweating sickness, 1485–1551: A viral pulmonary disease?|volume=42|issue=1|pages=96–98|journal=Medical History|doi=10.1017/S0025727300063365|pmid=9536626}}</ref> Hantavirus species are zoonotic diseases carried by [[bat]]s, [[rodent]]s, and several [[insectivore]]s.<ref name="Heyman 2014a">{{Cite journal|last1=Heyman|first1=Paul|last2=Simons|first2=Leopold|last3=Cochez|first3=Christel|date=2014-01-07|title=Were the English Sweating Sickness and the Picardy Sweat Caused by Hantaviruses?|journal=Viruses|language=en|volume=6|issue=1|pages=151–171|doi=10.3390/v6010151|issn=1999-4915|pmc=3917436|pmid=24402305|doi-access=free}}</ref> Sharing of similar trends (including seasonal occurrences, fluctuations multiple times a year, and occasional occurrences between major outbreaks) suggest the English sweating sickness may have been rodent-borne.<ref name="Heyman 2014a" /> The epidemiology of hantavirus correlates with the trends of the English sweating sickness. Hantavirus infections generally do not strike infants, children, or the elderly, and mostly affect middle-aged adults. In contrast to most epidemics of the medieval ages, the English sweating sickness also predominantly affected the middle-aged. A criticism of this hypothesis is that modern-day hantaviruses, unlike the sweating sickness, do not randomly disappear and can be seen affecting isolated people.<ref name="Heyman 2014b"/> Another is that sweating sickness was thought to have been [[Human-to-human transmission|transmitted from human to human]], whereas hantaviruses are rarely spread that way.<ref>{{cite journal|pmid=11284216  |title=The English 'sweate' (Sudor Anglicus) and Hantavirus pulmonary syndrome|journal=British Journal of Biomedical Science |year=2001 |last=Bridson |first= Eric|volume=58|issue=1|pages=1–6}}</ref> However, infection via human contact has been suggested in hantavirus outbreaks in Argentina.<ref name="Padula">{{cite journal|last1=Padula|first1=P|last2=Edelstein|first2=A|last3=Miguel|first3=SD|last4=López|first4=NM|last5=Rossi|first5=CM|last6=Rabinovich |first6=RD|date=15 February 1998|title=Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus|journal=Virology|publisher=Elsevier|location=London|volume=241|issue=2|pages=323–330|doi=10.1006/viro.1997.8976|pmid=9499807|doi-access=free}}</ref>

In 2004, microbiologist [[Edward McSweegan]] suggested the disease may have been an outbreak of [[anthrax]] poisoning. He hypothesised that the victims could have been infected with anthrax spores present in raw wool or infected animal carcasses, and suggested exhuming victims for testing.<ref>{{cite journal |url=https://www.newscientist.com/article/mg18124302.400-riddle-solved.html |title=Riddle solved? |date=17 January 2004 |journal=New Scientist |author=McSweegan, Edward |access-date=27 June 2018 |archive-date=23 May 2015 |archive-url=https://web.archive.org/web/20150523105717/http://www.newscientist.com/article/mg18124302.400-riddle-solved.html |url-status=live }}</ref>

Numerous attempts have been made to define the disease origin by molecular biology methods, but have so far failed due to a lack of available [[DNA]] or [[RNA]].<ref>{{cite journal|year=2018|url=https://www.researchgate.net/publication/326092598|title=The English Sweating Sickness: Out of Sight, Out of Mind?|volume=47|issue=1|pages=102–116|doi=10.5644/ama2006-124.22|journal=Acta Medica Academica|author=Paul Heyman, Christel Cochez, Mirsada Hukić|pmid=29957978|doi-access=free|access-date=20 August 2020|archive-date=1 February 2021|archive-url=https://web.archive.org/web/20210201052157/https://www.researchgate.net/publication/326092598_The_English_Sweating_Sickness_Out_of_Sight_Out_of_Mind|url-status=live}}</ref>

=== Transmission ===
[[Pathogen transmission|Transmission]] mostly remains a mystery, with only a few pieces of evidence in writing.'''<ref name="Heyman 2014b"/>''' Despite greatly affecting the rural and working classes of the time, the sweating sickness did not discriminate, as it was no less likely to affect young, seemingly fit men, including those of the elite or privileged classes. Based upon recorded accounts, the mortality rate among victims was highest in males aged 30–40 years.<ref name="Thwaites 1997" /> The fact that it infected all levels of society, from rich to poor, earned the sweating sickness various nicknames, such as "Stoop Gallant" or "Stoop Knave" — referencing how the 'proud' castes were forced to 'stoop' and face their own humanity.<ref name="Wylie 1981" /><ref name="Heyman 2014b"/>

The large number of people present in [[London]] to witness the coronation of [[Henry VII of England|Henry VII]] may have accelerated the spread of the disease, and indeed many other airborne [[pathogen]]s.<ref name="Heyman 2014b"/>