THE DOCTOR'S BAG

The blog about medical and surgical practice in the Old West

by Keith Souter 

aka CLAY MORE

MORE NOTES ON ARROW WOUNDS

Welcome back to the days of digging out arrows, bullets, mending busted bones and removing tonsils on a well-scrubbed kitchen table. After I complied two years or so of blogs into the book The Doctor's Bag, published by the good folk at Sundown Press, I thought that I had probably said as much as I needed to on the subject. Yet on looking back at some of those articles and the sources I used, I think there is quite a lot more information that writers of westerns and historical novels might find useful.

This month I am revisiting one of the earliest articles that I wrote for The Doctor's Bag. It was entitled Dig It Out, Doc! Part one - Arrow wounds.  It covers the history of arrow wounds from antiquity until the work of Doctor Joseph H. Bill. Of necessity, it merely covered the basics about the treatment of arrow wounds. There is certainly all that the writer needs in the chapter in the book if  he or she needs to deal with such a scene in their novel or story.  In this article I thought I'd look at one or two cases that Joseph Bill used to illustrate his work and also give some of his views about prognosis. 

A contemporary drawing of Bradmore's arrow extractor, from the book, Fair Book of Surgery, c 1450

Doctor Bill was an Assistant Surgeon in the US Army and had great practical experience in the treatment of arrow wounds. He wrote a short treatise entitled Notes on Arrow Wounds published in the American Journal of Medical Sciences, October, 1862.

The writing of such texts has changed considerably over the years. Doctor Bill would give his opinions  about the dangers posed by the different tribes, when discussing the different types of arrows. He writes:

"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 that 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."

Don't just pull it out!

He gives an account of the way that arrows are made, which he indicates is crucial to understanding the aims of treatment.  He gives this scenario:

"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 friends, and after a little tagging is pulled out. We said the arrow is pulled out. That was a mistake, it is the shaft only of an 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 isthmus: the ribbon of tendon which compressed together the slit ends 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 embedded a bone that it cannot be withdrawn, and that, remaining, it kills."

So there you have the stark fact. All those novels and movies where the arrow was plucked out and cast aside, had actually consigned the person to death, rather than a short convalescence after whiskey was poured over the wound and it was covered with a pad and bandage.

Laudable pus 

Pus is the white or yellow inflammatory fluid that forms when infection is present. Its colour depends upon its constituents, or which bacteria are present. Surgeons from the days of antiquity talked about 'laudable pus.' They thought that pus was a natural part of the healing process and that it was a necessary nuisance. It was not until the Germ theory  that they realized it was as sign of infection.

One of the oldest surgical maxims is 'Ubi pus, ubi evacuation,' which is Latin for 'where there is pus, let it out.'

Doctor Bill was working in the days before the Germ Theory, but he was aware of the special problems that arrow wounds caused, even after the whole arrow was removed.  He noted that the muscular tissue would contract after removal, distorting the tract of the arrow. Thus, when pus formed, it would lose its natural channel and collect in a pocket within the wound. Effectively it would become an abscess. The next stage was often sepsis, or spread of the infection to the bloodstream, often producing death in days or weeks. 

Poison arrows

Despite the problem of infection, Bill said that some tribes deliberately poisoned their arrows. 

"It is occasionally the practice of some of our Indian tribes to poison their arrows. The plan pursued is this (on the testimony of a Moquis Indian). The liver of some animal is exposed, and a rattlesnake compelled to insert his fang into it. The animal is at once killed, the liver removed, and wrapped up in the skin and buried. After seven or eight days the bundle is dug up, and the arrow-heads dipped in the pulpy and putrescent mass inclosed in the skin. After they are dry they are dipped in blood, again dried, and preserved for us."

Sometimes people did survive chest wounds

This is recorded as CASE V:

A Mexican, name unknown, whilst travelling the road near Fort Defiance, was shot by Navajoes with five arrows, all the arrows injuring the lung, and one of them passing through the upper border of the liver. I saw the man twenty minutes after the accident. The bleeding was most profuse, and the man fainted. Both lungs were wounded, I made the worst possible prognosis, but proceeded to extract the arrows, all of which I  safely removed. After the haemorrhage had ceased, I applied muslin soaked in collodion to each of the wounds, eight in number (some had penetrated right through the chest) and had the patient put to bed, and given  gram of morphia.

The next morning the patient was more comfortable than I had expected. He had been vomiting, and I gave him some acetum spit and acetate of lead, to quiet this and restrain secretion. In the afternoon the man complained of pain the right side, and difficulty in breathing. I removed the dressing from the wound, involving the liver and lung, and broke up some clots whereupon a considerably quantity of mixed fluids were discharged from the wound. These contained bile as I discovered by Pettenkofer's test (a standard test for bile)  . This procedure greatly relieved him, and he expressed himself much better. I ordered the prescriptions of the morning to be repeated.

The next day the patient vomited a considerable quantity of black, decomposed blood, and complained if the frequency of his urination. Urine very dark coloured, sp gravity 1036; urine contained chalice acid and sugar. All medicines ordered to be discontinued. 

After this the patient gradually recovered, all the wounds healing by first intention, except that implicating the liver, and that ceased discharging on the sixth day. In two weeks the man left the hospital, his urine still containing sugar, but no bile. In a few days the lat traces of sugar disappeared from his urine. He recovered completely.

Protection advocated

Doctor Bill felt that more should be done to protect soldiers from arrow wounds. 

"We wish in conclusion to recommend to those in authority the plan for protecting soldiers and others exposed arrow wounds with a slight curios. The Indians have a method of dressing bulls' hide for shields for themselves which renders it arrow proof. A cuirass made of such material, protecting the whole trunk from  before and behind, need not weigh more than eight or ten pounds, and by means of it a soldier could enter an Indian fight with fair chance of escaping death."

___________________