The dreadful mortification

A case published in The Medical Museum of 1781 is a reminder of a world we have gratefully left behind; one in which infection could rapidly maim or kill entire families, while doctors looked on helplessly.  Life could be, in Thomas Hobbes’s phrase, ‘solitary, poor, nasty, brutish and short’.  Hobbes was writing about war, but disease was as formidable an enemy as the eighteenth century could muster.  A Dr Woollaston witnessed this story unfold at a village in Suffolk:

John Downing, a poor labouring man, living at Wattisham, in January 1762, had a wife and six children; the eldest a girl of fifteen years of age, the youngest about four months. They were all at that time very healthy, and had not any of them been ill for some time before. On Sunday the tenth of January, the eldest girl complained in the morning of a pain in her left leg; particularly in the calf of the leg. Towards evening the pain grew exceedingly violent. The same evening another girl complained of the same violent pain in the same leg. On the Monday the mother and another child, and on the Tuesday all the rest of the family, were affected in the same manner; some in one leg, some in both legs.

Even the baby was affected.  The entire family was in severe pain.

In about four, five, or fix days, the diseased leg began to turn black gradually; appearing at first covered with blue spots, as if it had been bruised. The other leg of those who were affected at first only in one leg, about that time also began to be affected with the same excruciating pain, and in a few days that leg also began to mortify. The mortified parts separated gradually from the sound parts, and the surgeon had in most of the cases no other trouble than to cut through the bone, which was black, and almost dry.

The summary that follows is simply written, but brutal in its impact.

The state of their limbs at present is this:

Mary, the mother, aged forty, has lost the right foot at the ankle; the left foot also is off, and the two bones of the leg remain almost dry, with only some little putrid flesh adhering in some places. The flesh is sound to about two inches below the knee. The bones would have been sawn through at that place if she would have consented to it.

Mary, aged fifteen, both legs off below the knees.

Elizabeth, aged thirteen, both legs off below the knees.

Sarah, aged ten, one foot off at the ankle. The other foot was affected, but not in so great a degree; and is now sound again.

Robert, aged eight, both legs off below the knees.

Edward, aged four, both feet off.
An infant four months old, died.

Only the father escaped relatively unscathed: he lost a couple of fingers, but his lower extremities were not affected.

It is remarkable, that during all the time of this misfortune, the whole family is said to have appeared in other respects well, eat heartily, and slept well when the violence of the pain began to abate. The mother is now emaciated, and has very little use of her hands. The eldest girl has a superficial ulcer in one thigh, and seems also ill. The rest of the family are pretty well. The stumps of some of them are perfectly healed.

Dr Woolaston, after giving the matter some thought, decided that the family’s diet was to blame.

John Downing was a poor labouring man: He had a fruitful wife, and a large family; and being the month of January, the season inclement, provisions dear, wages low, gains small, probably their distresses might be great; therefore it is not unlikely, considering all these circumstances, that this miserable family might be drove to the deplorable dilemma of suffering by famine, or of feeding upon damaged or unwholsome bread-corn.

Several authorities wrote about this case; others doubted that the illness was caused by malnourishment, and indeed it seems unlikely that gangrene would appear so rapidly unless it had been caused by an infection of some kind.  The case was also documented in a book about plagues, The City Remembrancer, published in 1769.  It contains this dreadful update, from a doctor who visited the family some time later:

The mother lies in bed, with her legbones bare, which she will not suffer to be taken off.