Henry's health problems are usually linked to the accident during the jousting bout on 24th January 1536 at Greenwich, it is possible that this even only exacerbated an already existing problem, as in late 1527 king was unable to move due to 'sore leg' that was promptly healed. It is possible that this could have been a varicose ulcer, that can suggested predisposition to circulation problems in lower appendages, such as e.g. advanced deep vein thrombosis. This might have been corroborated by the 1541 examination by Andrew Boorde who noticed 'fleshy body with large arteries, pale skin and great pulse". Syphilis theory is largely considered not that probable, as syphilitic ulcers are generally not painful, rarely appear near the knee and, most importantly, none of his four kids that survived childhood have shown any signs of syphilis. In addition, royal accounts do not show any substantial purchases of mercury, a main active ingredient in 'grey ointment', a go-to treatment for syphilitic lesions at the time.

It is possible that Henry VIII suffered from Cushing's Syndrome characterized by large fat deposits on face, neck, abdomen and back, diabetes, severe hypertension and diminished healing capacity, with mood swings, insomnia, irascibility and even paranoidal tendencies being frequent neuropsychological symptoms. Common symptoms are also purple striae covering the skin. We can't be sure, but the generalized clinical image of Cushing's Syndrome fits the behaviour and health issues of Henry VIII very well. Although Henry was healthy and fit in his youth, this particular condition can be caused by the pituitary tumour causing the excessive production of ACTH (adrenocorticotropic hormone) or the tumours of adrenal glands that can occur at any age. The main problem is that Cushing's Syndrome usually leads to characteristic body figure, with large body and thin appendages, while all descriptions and depiction show adult Henry as obese and stout man. On the other hand, the fat distribution is a highly individual trait.

As the condition of the king was not deteriorating in a manner suggesting gangrene or severe infection, physicians generally resorted to treatment of the visible wounds with the active cooperation of the monarch himself, who was known to be interested in medicine and experimented with various treatments himself. Henry VIII was known to use various plant-based ointments and similar medicines, usually consisting various types of herb and fruit extracts, including wine of pomegranates, strawberry infusion, rose water, Armenian clay, lapis lazuli, henbane (Hyoscyamus niger) or nightshade (Atropa belladonna). These ingredients suggest a hit-and-miss approach and although some of the could have helped in the treatment of superficial ulcers, they would have been unable to heal ones deep under the skin, leading to recurrent sepsis. In addition, it is possible that some of the king's mood swings and relapses of weakness and debilitation could have been at least partially caused by the poisoning with the psychoactive alkaloids present in nightshade or henbane that, being acetylcholine antagonists, have a paralytic, comatose and vasodilatory effect, what quite well corresponds to the following account:

'and for ten to twelve days the humours which had no outlet were like to have stifled him, so that he was some time without speaking, black in the face and in great danger’
(from the letter of Louis de Perreau to Anne de Montmorency).

Although the description of the wounds are quite vague and make it difficult to pinpoint the location, it is quite possible that the ulceration was reaching the thigh. Amputation of the lower appendage above the knee joint is still dangerous in modern times and in mid-16th century, even with application of the state-of-the-art techniques and flawless execution, it could have still led to a life-threatening haemorrhage as it would have been necessary to sever the femoral artery and vein, belonging to the largest blood vessels in a human body, not to mention numerous major vessels running along in the thigh. Chances of hypovolemic shock in an already weakened patient were high. In addition, the ulceration of the wound or wounds very strongly suggests chronic infection or similar condition indicating compromised immunity system and recovery mechanisms. This, in turn, could have easily cause the complications in the large post-operational wound, further exacerbating condition of the patient (what at this point could have likely been lethal). Although 16th-century doctors and surgeons lacked most of our knowledge, they still understood that the poor condition of the patient decreases chances of a recovery after the surgery and the risks associated with the operation.

It should be noted that although the surgical ligatures were known since Galen, the most common method of staunching blood flow was cauterization, usually by the heated metal cauterizers and sometimes with an additional application of boiling oil (with elder oil being preferable). The main drawback of these methods was that cauterization, although quite efficient in cases of small wounds, was easy to botch in case of larger vessels, leading to prolonged haemorrhage that in the case of largest ones could have led to hypovolemic shock and death in less than a minute. In addition, the shock caused by the cauterization, especially on the large surface, could have contributed to the general shock, increasing chance of death. Suturing of blood vessels with the use of 'crow beaks', early prototypes of haemostats (almost identical to modern ones, although they lacked a ratchet lock) followed by application of plant-based disinfectant, commonly consisting of rosin distillates were introduced in 16th century by French royal surgeon Ambroise Paré, but only several decades after death of Henry VIII (his main book about surgery has been published in 1567 and translated to English in 1634) and it took almost half a century before such methods gained any popularity around Europe. Thus, the amputation was usually limited only to the cases of gangrene or severe damage making usage of the limb impossible and the risk of infection very high. In other words, amputation and high chances of patient's death was almost always an alternative of certain death due to inaction.

So, to sum it up, the amputation, especially as severe as one performed over the knee carried a very high risk of death and thus was used only in most dire circumstances. Henry VIII, although certainly suffered, did not show signs of quick deterioration (he lived for the next 11 years after his Greenwich accident) and thus doctors and surgeons were not eager to propose amputation. Also please note that the pain in lower extremities that sometimes prevented movement was not something exceedingly rare due to the prevalence of gout, so the king's condition could have been considered serious but manageable.

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Chalmers, C.R., Chaloner, E.J., 500 years later: Henry VIII, leg ulcers and the course of history, in: Journal of the Royal Society of Medicine, 102(12), 2009, pp. 514-517.

Hey there,

Just to let you know, your question is fine, and we're letting it stand. However, you should be aware that questions framed as 'Why didn't X do Y' relatively often don't get an answer that meets our standards (in our experience as moderators). There are a few reasons for this. Firstly, it often can be difficult to prove the counterfactual: historians know much more about what happened than what might have happened. Secondly, 'why didn't X do Y' questions are sometimes phrased in an ahistorical way. It's worth remembering that people in the past couldn't see into the future, and they generally didn't have all the information we now have about their situations; things that look obvious now didn't necessarily look that way at the time.

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