In 1862, J.H. Bill’s Notes on Arrow Wounds appeared in The American Journal of the Medical Sciences:
The arrow is a weapon of the greatest antiquity. It is one with which, in this country, at least, we are all familiar; nevertheless, there is nowhere now extant an account of the wounds produced by it sufficiently accurate or definite to guide a surgeon in their treatment, or to give to the medical antiquary a record of their history and appearance. Before long these wounds will become of unfrequent occurrence, for our Indian tribes are fast being exterminated. We propose, in the first place, as a matter of historical interest, to state in this article what we know of arrow wounds. The subject still presents much of practical interest to the surgeon, and must continue so to do, in a greater or less degree, for the future. It will be some time before all our Indian tribes are “civilized off the face of all creation,” and many a soldier and settler has yet to pay the death penalty for his courage or hardihood. Moreover, the bow and arrow is in use among the Tscherkesses of the Russian army, for the purpose of picking off sentinels without creating an alarm. It is probable that a corps of carefully selected bowmen would be found of great use in our own army for like purposes. Franklin has suggested the employment of arrows in battles, to be shot from bows or fired from guns. Arrow wounds are, therefore, and for some time likely to be, of practical interest.
Tscherkesses, by the way, appear to be Circassians.
Dr. Bill finds arrow wounds especially lethal, because of the arrows’ two-part construction, with the shaft loosely attached to the head:
Such being the mechanism of the arrow, we can readily understand the danger peculiar to arrow wounds in general, a danger often seen in pistol-ball wounds of the chest. Let us suppose a case to illustrate and explain our meaning. An arrow is shot at a man at a distance of fifty yards. It penetrates his abdomen, and without wounding an intestine or a great vessel, lodges in the body of one of the vertebrae. The arrow is grasped by the shaft by some officious friend, and after a little tugging is pulled out. We said the arrow is pulled out. This was a mistake; it is the shaft only of the arrow that is pulled out. The angular and jagged head has been left buried in the bone to kill — for so it surely will-the victim. The explanation of such mishaps is this: the ribbon of tendon which compressed together the split sides of the end of the arrow, and so clamped the head and the shaft together, had become wetted with the fluids effused in the course of the wound. When wetted, it was, of course, lengthened, and, if lengthened, loosened. It ceased longer to bind together the split sides of the shaft; this and the head were, consequently, very feebly united and readily detached. Experience has abundantly shown, and none know the fact better than the Indians themselves, that any arrow wound of chest or abdomen, in which the arrow-head is detached from the shaft and lodged, is mortal. From this we conclude that the danger peculiar to all arrow wounds is, that the shaft becoming detached from the head of an implanted arrow, leaves this so deeply imbedded in a bone that it cannot be withdrawn, and that, remaining, it kills. It is not possible with forceps to extract an arrow-head so lodged (if lodged deeply), throwing aside the difficulty of discovering and the danger of searching for it. The blades of forceps long enough for this purpose (supposing the foreign body deeply lodged in the chest) would bend too readily with the force required for the removal of the missile. The greatest force is sometimes required for the extraction of an arrow-head so lodged. We have seen an arrow shot at a distance of one hundred yards, so deeply imbedded in an oak plank, that it required great force, applied by strong tooth-forceps, to remove it. In the case of a man shot in the shaft of the humerus by an arrow, it was only after using both knees, applied to the ends of the bone as a counter-extending force, and a stout pair of tooth-forceps, that we succeeded in removing the foreign body. Another similar case will be mentioned hereafter. Asst. Surgeon McKee had a case, also, in which considerable force was required to extract an arrow-head lodged in the trochanter, and other instances illustrating the difficulty sometimes encountered in the removal of arrow-heads lodged in bone could readily be adduced.
We have dwelt thus at length upon the mechanism of the arrow because we consider that upon a rightful understanding of the same must depend an intelligent and a skilful treatment of the wound which it occasions. The arrow-head removed by proper treatment, and we have an ordinary punctured wound, such as a poniard or stiletto would make. The wounds inflicted by these last named weapons are dangerous and troublesome for this reason. When such a weapon pierces any deep tissue, it must do so through some other tissue possessed of a contractile or muscular power. As soon as the weapon is withdrawn, this last named tissue contracts, and thus draws the wound in itself upwards or downwards, interrupting the continuity of the wound as a whole; whence it happens that all such wounds, the pus or efi‘used liquids finding no outlet, are apt to be attended with burrowing of matter and deep-seated abscess. This remark applies to arrow wounds, although they partake of the nature of incised wounds, and, therefore, oftener heal by first intention than do the punctured wounds of the stiletto or bayonet, attended as these are with much bruising and tearing of tissues. Arrow wounds are often complicated by profuse hemorrhage, and for the same reason that in bayonet wounds abscesses form, through inability of matter, to find a ready outlet, in arrow wounds haematomata result. In fact, when arrow wounds suppurate, they generally do so through disorganization of these collections of blood.
What parts of the body are oftenest wounded by the arrow, and what is the relative fatality?, he asks — and then produces this table:
The above table includes all the reliable cases of arrow wounds falling under our notice.
On referring to it, it will be seen that the upper extremity is oftenest wounded, next comes the abdomen, next the chest, next the lower extremity, next the head, and, lastly, the neck. The reason that the upper extremity is so often wounded, is that a person can see an arrow darting towards him, and very naturally putting out his arm to ward it 011′, receives a wound oftener in this member than in any other. Wounds of the abdomen are oftenest fatal (more than three-fifths of the total deaths occurred from wounds of abdomen), next come wounds of chest, wounds of head and heart next, and wounds of spinal marrow, and upper and lower extremity are last.
An expert bowman can easily discharge six arrows per minute, and a man wounded with one is almost sure to receive several arrows. In the above table, when a man was wounded in more places than one, the most serious wound, or that which immediately caused his death, is recorded. We have not seen more than one or two men wounded by a single arrow only. In three of our soldiers shot by Nabajoes, we counted forty-two arrow wounds; this is an extreme case, as the manufacture of the arrow costs the Indian too much labour and time to expend one unnecessarily. The cause of death in the twenty-nine fatal cases may be thus summed up :—
A flesh wound really is just a flesh wound, by the way:
First, then, for the simplest case; an arrow wound involving no parts essential to life. Let us suppose a case.
A man is shot by an arrow which passes through integuments and muscles, and grazing the bone, makes its exit on the other side of a limb. What appearance is presented after the accident? We will find at the spot where the arrow entered, a very small and narrow slit, surrounded by a circular patch of bruised integument of a dusky-red colour. It is almost impossible to say whether the slit was made by a pistol-ball or an arrow, so closely does the entrance wound made by an arrow resemble that made by a small ball. On the other side of the limb another slit, somewhat larger than that above described, is seen, but not surrounded by the red areola. This is the exit wound. What is the treatment? Apply cold or evaporating lotions, place the limb at perfect rest, let the patient diet himself, and the chances are favourable of such a wound healing by first intention. At all events this is the indication. Ordinarily, such a wound will be quite well in a week.
There’s just something about the writing of that era:
- “We have seen but one case of a large artery of a limb divided by an arrow, and that case terminated fatally before we saw the man. He was a Mexican, and was shot in the groin while on horseback. The arrow pierced the femoral artery just below Poupart’s ligament. The man lived twelve hours, but was brought into the post dead.”
- “Private Martin, of the 3d Infantry, was shot in his right leg by an arrow — the arrow passing out. I saw him shortly after the receipt of the injury. The only thing remarkable was the agonizing pain, referable to the small toes and outside of foot.”
- “Private Bishop was shot in the head of the humerus with an arrow, and the shaft having been plucked out, the iron head was left deeply imbedded in the bone. The man was in great pain, synovia was flowing out of the wound, and all motion was lost. I enlarged the wound, introduced my finger, and so ascertained the position and depth of the arrow-head. It was very deeply implanted.”
- “I have already alluded to another case, in which I removed an arrow from the shaft of the humerus by bracing the end of the humerus against my knees, and then applying all my strength to the foreign body by means of forceps.”
- “The first case was that of a Mexican shot by an Apache, the arrow-head striking the ulna in its upper third. The man withdrew the shaft immediately, and then came to me. I enlarged the wound, and prudently made an examination with my finger.”
- “The second case was that of Corporal Scott, shot at Fort Defiance, by a Nabajoe. I enlarged the wound, and followed the arrow shaft with my finger until I reached the iron head. The arrow had entered on the posterior and outer aspect of the leg, penetrated the muscles of the calf, scraped the fibula about two inches from its head, and then wrapped itself firmly around this bone.”
- “Dr. Kennon informs us that he had a case of this kind, in which he re~ moved from the thigh of a Mexican an arrow-head which had been lodged six months previously in the femur. The surgeon attending the man at the time of the accident, had failed to remove the foreign body, contenting himself merely with a withdrawal of the arrow shaft.”
- “A fourth case, illustrating this peculiar accident, occurred in the practice of Asst. Surgeon Clements, U. S. A., during the last campaign against the Nabajoes. A surgeon was shot through the upper part of the posterior fold of the axilla with an arrow, which penetrated deeply. The shaft was pulled out, leaving the head imbedded. The man then went to the doctor. The case was treated by Dr. Clements for six weeks or two months, but without benefit, and finally it was decided that the arrow-head must be re moved. The doctor accordingly made a T-shaped incision over the seapula, cutting through integument and muscle, and exposing the bone. The foreign body was, after some search, found, but so twisted and bent, that notwithstanding the large incisions made, it was only after the application of some force by strong tooth-forceps, that the head was removed. Secondary hemorrhage took place twelve hours after, but was checked by (we believe) the actual cautery. The man slowly recovered.”
- “Miguel “ Nigro,” the post-guide at Fort Union, was shot with an arrow by a Utah Indian. I found the arrow-head sticking in the left parietal bone, the shaft having been detached. I made traction on it, and drew it out of the wound. The symptoms of compression present at once vanished, the man turned over and sneezed, and rose up on his feet. I had made arrangements to trephine the skull if necessary, but I had probably restored to its proper level that portion of the inner table which was depressed, so that measure was unnecessary. The cause of the compression was gone, and I had nothing to trephine for. The next day the man complained of headache. His face was flushed, eyes sufl’used, pulse hard, and irregular. I ordered croton oil, shaved his head, and applied cold. Presently, when delirium came on, I bled him until he fainted. This bleeding was repeated the night of the same day. The next day he was greatly better; the croton oil had operated well. The man was left to recover, which he did in three weeks.”
It gets “better”:
An arrow wound of lung is from first to last more dangerous than a gunshot wound of the same parts. There are three reasons for this. First, the hemorrhage occurring at the time of the injury, or a few hours after, is much more profuse than in an ordinary gunshot wound. A ball going through the chest does not often give trouble from hemorrhage, unless it should wound a large vessel. The reason is, that a ball tears and bruises, while an arrow makes clean slits and punctures. Secondly, an arrow wounding the lung, is almost sure to lodge, whilst a ball generally passes. Now, hear what Guthrie says about balls that lodge in the chest:
“General McDonald, of the Royal Artillery, was present at Buenos Ayres when a bombardier of that corps received a wound from a two pound shot, which went completely through the right side, so that when led up to the general, who was lying on the ground, he saw the light quite through him, and supposed, of course, that he was lost. This, however, did not follow, and some months afterwards the man walked into General (then Captain) McDonald’s quarters so far recovered from the injury as to be able to undertake several parts of his duty before he was invalided, thus proving the advantage of a shot, however large, going through rather than remaining in the chest.”