Primary pneumonic plague had a 2 to 3 day incubation period that was followed by an abrupt onset of high fever, chills and often a severe headache. Coughing developed within 24 hours, initially mucoid but rapidly developing blood spotting and then acquiring a uniform, bright red, often foamy appearance. Most patients died within 48 hours after onset. This form of the Plague was spread by bacteria coughed out in the sputum of the victim, or by the inhalation of infected droplets from a sneeze. Because of its dependence on respiratory transmission and not on fleas, this extremely virulent form of the Plague tended to be associated with European winters. Considering the much reported incidence of bloody sputum, a continued high mortality in the winter months, and the very rapid spread between communities in the Fourteenth and Fifteenth Centuries, it is highly probable that this form of the plague was active with bubonic plague during this period.³

It may be natural to assume that survivors of the Plague had suffered the bubonic form. However, Pestis minor, a benign form of bubonic plague, has been identified as occurring alongside bubonic plague in (modern) epidemic areas.⁴ The signs and symptoms of Pestis minor are similar to that of bubonic plague but subside within a week. This may explain why some plague epidemic areas had a higher than average survival rate.

Apart from the bubonic and pneumonic plague, a further disease swept through Europe. It had many names and was known as The Sweat, The Swat, New Acquaintance, Stoupe, or Knave know thy master. It was claimed that it only killed the rich, middle aged - not the young or the old, and that it caused a quick death : "They were dancing in court at nine and dead at eleven", wrote a Poole minister, while Dr Caius, physician to Henry VIII, compared it to "the Plague at Athens, a pestilent contagious fever of one natural day". Dr Caius recorded the signs and symptoms as "... burning heat, sickness, headache, delirium, intense thirst, laboured breathing, erratic pulse, followed by faintness, drowsiness, profuse sweating, sickness of stomach and heart but seldom vomiting". He added "... the symptoms reached their height by the seventh hour after onset, by the ninth delirium set in, and that death often quickly followed... However, if the victim survived the fifteenth hour the symptoms abated, and if they passed the twenty-fourth hour, they usually survived." The Sweat is believed to have arrived in England in 1485, transported from Rouen by mercenaries recruited to help establish Henry Tudor. The first recorded outbreak was at Milford Haven, the port at which Tudor landed his invading force. Other outbreaks were recorded throughout the country in 1508, 1517, and 1551.⁵

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