mortality rates. It arrived in Switzerland in December, then was carried northwards to Denmark, Sweden, and Norway, and eastwards to Lithuania, Poland, and Russia. Cases were unknown in Italy or France, except in the English-controlled Pale of Calais. It emerged in Flanders and the Netherlands, possibly transmitted directly from England by travellers; it appeared simultaneously in the cities of Antwerp and Amsterdam on the morning of 27 September. In each place, it prevailed for a short time, generally not more than two weeks. By the end of the year, it had entirely disappeared except in eastern Switzerland, where it lingered into the next year. The disease did not recur on mainland Europe. Final outbreak The last major outbreak of the disease occurred in England in 1551. Although burial patterns in smaller towns in Europe suggest that the disease may have been present elsewhere first, the outbreak is recorded to have begun in Shrewsbury in April. It killed around 1,000 there, spreading quickly throughout the rest of England and all but disappearing by October. It was more prevalent among younger men than other groups, possibly due to their greater social exposure. John Caius wrote his eyewitness account A Boke or Counseill Against the Disease Commonly Called the Sweate, or Sweatyng Sicknesse. Henry Machin also recorded it in his diary: The Annals of Halifax Parish of 1551 records 44 deaths in an outbreak there. An outbreak called 'sweating sickness' occurred in Tiverton, Devon in 1644, recorded in Martin Dunsford's History, killing 443 people, 105 of them buried in October. However, no medical particulars were recorded, and the date falls well after the generally accepted disappearance of the 'sweating sickness' in 1551. Picardy sweat Between 1718 and 1918 an illness with some similarities occurred in France, known as the Picardy sweat. It was significantly less lethal than the English Sweat but with a strikingly high frequency of outbreaks; some 200 were recorded during the period. Llywelyn Roberts noted "a great similarity between the two diseases." There was intense sweating and fever, and Henry Tidy found "no substantial reason to doubt the identity of sudor anglicus and Picardy sweat." There were also notable differences between the Picardy sweat and the English sweating sickness. It was accompanied by a rash, which was not described as a feature of the English disease. Henry Tidy argued that John Caius's report applies to fulminant cases fatal within a