heal the old fashioned way

Greece (~1000 BC) 

“a healer is worth many men in his ability to cut out arrows and smear soothing medicaments on wounds.”  —Illiad XI. 514-515

Greek soldiers would “intially recieve a sip of stimulating wine. Arrowheads were either extracter or excised, and the dressing consisted of pain-relieving herbs and a woolen bandage.” 

India (~600s BC)

Our best look at ancient Indian surgery comes from Sushruta Samhita. Disclaimer: there doesn’t seem to be a definite date on when this was written, but a lot of sources say around the 6th century BCE, so that’s what we’re going with. The full text I used is here.

Symptoms: All, including those detailed below, or in any vital body parts. In cases of superficial penetration, they are only faintly exhibited.  (General) — ulcer: marked by pain, swelling, and presentation of a raised or bloated aspect like a water bubble, assumes a dark brown hue and appears soft to the touch. The seat of the ulcer is seen to be studded over with pustular eruptions and a constant bleding sets in from its inside.  (Specific)—mark an arrow lodged in the skin; hardness and extended character of the local swelling and the darkness/discoloring of the skin.  In cases where the arrow is lodged in the flesh, the swelling increases, and the resulting ulcer does not heal and cannot bear any pressure. The wound begins to fester (suppuration; form pus), and is characterized by a sort of sucking pain. Some authorities say the patient is tormented with an unquenchable thirst.  

Arrow penetrated into muscle: Patient exhibits all of the above symptoms, with the exception of the swelling and sucking pain/thirst Arrow penetrated into a vein: Additional swelling and aching of a vein mark. 

Arrow penetrated into ligament: Upheaval and swelling of fibres together with intense pain. 

Arrow penetrated into artery: A flow with red and frothy blood with a gurgling sound, accompanied by thirst, nausea, and aching of the limbs.

Arrow penetrated into bone: Pain and swelling “of diverse kinds,” the appearance of goose-flesh on the skin, a stuffed sensation inside the cavity of the affected bone, and a violent piercing bone-ache. 

Arrow lodged in abdomen: The bowels become constipated, the abdomen becomes distended with a rumbling in the intestines and the suppresion of flatus and urin; ingested food matter, as well as urine and feces are found to ooze out of the fissure or mouth of the ulcer. 

Treatment: 

1. Finding the shaft 

In order to find the shaft, first lubricate the affected limb/part with oil, and then apply heat (warmed lotions) to the surface. Then apply a plaster (plaster made of clay, masha-pulse, yava, godhuma, and cow-dung over the injured limb/part. The shaft should be considered lodged in the part marked by pain, redness, or swelling, after this application. 

An alternative would be plastering the part with clarified butter, common clay, and sandal paste. The embedded shaft would then be located in the spot where, owing the the heat of the affected part, where the ingredients have melted or dried up. 

If the arrow resides in a vein, artery, or ligament, the patient should be made to ride in a carriage with a broken or lopped of wheel. The pain and swelling incidental to the jolting would occur at the part of their body where the shaft is embedded. 

General Rule: 

A painful swelling, occuring at any part of the body and incidental to such physical or natural endeavours of the patient would clearly indicate the exact location of the embedded shaft. 

2. Determine Type

Sushruta posited there being two types of “splinters:” loose and firm. There are fifteen methods of extracting loose splinters, which you can read about here if you’re interested, but since it doesn’t really pertain to arrow infected wounds, I’m skipping it for now. Arrows, as a foreign matter which penetrate into the deeper tissues of the flesh, classify as a firm splinter, and must therefore be extracted through outside means, as letting it putrify would loosen the fixture of the arrow, and the weight of the pus and blood would cause it to burron deeper into the frlesh. 

 3. Extraction (Easy)

Loose, unbarbed arrow: An unbarbed arrow lodged in a wound with a broad mouth and lying in a natural direction should be withdrawn by applying a magnet to the end. And, importantly, “a shaft of grief, driven into the heart by any of the multifarious emotional causes, should be removed by exhilaration and merry-making.” Thanks, Sushruta 

If that was not the case, or if the shaft remained in place, there were two methods of withdrawing it. 

Anuloma (expulsionem): Anuloma, or expulsionem, is drawing out the arrow through a way other than that of its penetration, or pushing it through the body. This should be used when a shaft pierced deep into any part of the body as to reach the other side of the wounded spot (but not cutting out clean through it owing to the diminution of its original momentum) and remained protruded in the heaved up flesh. Pushing it through was achieved by stirring/twisting it, or striking it with hand or hammer. 

The “heaved up flesh” (the flesh on the other side of penetration, heaved up likely referring to the bulging of the arrowhead on the other side) should be opened with an incision, and the embedded arrowhead drawn out by stirring or striking it with the hand as before. 

Pratiloma (extractionem): Pratiloma, or extractionem, is withdrawing the arrow from the same way it entered, or pulling it backwards out of the wound. It should be used when the arrow is close to the spot of its penetration. Other cases where it was used was if the arrowhead was lodged in any soft part of the abdomen, chest, armpits, inguinal regions, or ribs. 

A slightly different method should be used if the arrowhead is lodged in a vein or a ligament. In that case, it should be extracted with the help of a probe; the shaft, lodged in the body and lying burined under the incidental swelling, should be extracted by firmly tying blades of Kusha grass around its body. A shaft lodged in a spot situated anywhere close to the heart should be withdrawn by that way by which it has entered; and the patient should be enlivened with sprays of cold water, etc. during the operation. 

3.5 Extraction (Hard) 

Sushruta ends this section with a kind of disclaimer that I’m going to start with. That is, an arrow, “not removed from the body and left in its place of lodgement, brings on swelling suppuration, mortification of the affected part, and a sort of excruciating pain, and may ultimately lead to death. Hence a physician should spare no pain to extract a[n arrow] from its seat of lodgement.” With that dire note, moving on. 

These methods of extraction are for arrows lodged in parts of the body not mentioned above, especially when the arrow has pierced through the bone. 

Method 1: In case of a shaft piercing into the cavity of a bone, the surgeon should firmly press the affected bone with his legs, and pull out the embedded shaft with all his might by gripping it with a surgical instrument. If that fails, he might ask a strong man to firmly hold the patient, and the process repeated. 

Method 2: Alternatively, the bottom of the shaft should be tied to the string of a bow, strung and fully bent down; and the arrow should be ejected with the means of a full twang. 

Method 3: A horse should be harnessed in the fashion known as the Panchangi-vandhanam (lit. bound in the five parts of the body), and the end of the arrow should be bent down and tied to the bridle. Then the horse should be so whipped as to raise its head first, thus pulling out the embedded shaft from its seat by the jerk of the horses head. 

Method 4: A high and tough bough of a tree should be lowered down and tie to the bent end of the shaft as in the preceding case. The bough should then be let loose, thus pulling out the shaft with its rebounding force. 

4. Aftercare

A patient, having fainted during the course of the operation, should be woken by throwing cold water over his face, then “solaced with many a hopeful and cheering word, and a nourishing diet such as milk, etc. should be given, and vital parts should be protected”. 

Having extracted the arrowhead and wiped off the blood, the wound should be bathed with warm water, lotions, or clarified butter until it is devoid of pain, and can be left without further bleeding. Cauterisation would be a last resort. 

After that, the wound should be plastered with honey and clarified butter, and bandaged with a piece of clean linen. 

Rome (1st century) 

Cornelius Celsus could be said to have literally written the book on early arrow treatment; his De Medicina (On Medicine) is our best look into the Roman world’s medical knowledge. The section Of arrows— is as follows, with my explanations in parentheses. Paragraph breaks are also my own. 

“Of arrows.—The foregoing directions are general: besides which, there are some particular rules for the several kinds of weapons, which I shall immediately subjoin (the extra weapons described are broad weapons, leaden bullets/stones, and poisoned weapons). Nothing is so easily lodged in the body as an arrow, and it goes to the greatest depth. The reasons are, both that it moves with great force, and because it is small.  Therefore it must be extracted more frequently on the opposite part (referring to expulsionem, where the arrow is pushed through the body instead of pulled out), than on that by which it is entered, and especially because it is generally surrounded with beards (beards refering to the auricle/ear/shoulder of an arrow, or the two wider bits by the fluting), which lacerate more, if they be drawn backward than forward.  But an orfice being made on the opposite part, the flesh ought to be opened by an instrument made in the form of the Greek letter “ ; “ and when the point appears, if the shaft adheres to it, it must be pushed forward, till it can be taken hold of at the opposite part, and extracted. If that is already broken off, and only the iron head is within, the point must be taken hold of by the fingers, or a forceps, and thus pulled out. And there is no method of extracting it, when it is thought advisable to pull it out by the orifice it entered at (referring to extractionem, or pulling the arrow out the same way it entered, without making a new inciscion on the other side); for after the wound is enlarged, either the shaft, if that be lodged within, must be pulled out; or if that be not there, the iron itself. But if the beards are visible, and they are short and small, they out to be broken off with a forceps, and the weapon, when freed of them, to be brought out; if they are larger and stronger, they must be covered with writing reeds split, to prevent their lacerating any part, and thus pulled out. This is the method observed in extracting arrows.” 

A somewhat simpler summary of this process is found here: “Cornelius Celsus was the first to systematically differentiate removal of arrows. An arrow can be extracted from the side where it entered the body (per extractionem) or it can be pushed or pulled through after incision of the soft tissues at the opposite side (per expulsionem). If the arrowhead was still attached to the shaft Celsus commonly preferred removal per expulsionem – he also found that wounds from arrows removed in this way tended to do better than wounds with only a single opening. If for example there was bone or essential organs located in front of the arrow, the arrow had to be removed per extractionem; this meant that the entry wound had to be enlarged and barbed hooks had to be broken off with a forceps or covered with split tubes. Instead of split tubes Celsus recommended the spoon of Diocles (a surgical instrument specially designed for extraction of arrows). The instrument was used to follow the shaft and detect the arrowhead, after an enlargement of the wound. The cups of the spoon enclosed the arrowhead and at the same time covered barbed hooks, if present. With the spoon of Diocles, extraction of arrows was possible without causing additional trauma to the patient.”

Pliny the Elder’s Natural History (77-79 AD) mentions dittany as an arrow extractor, saying “the power of the herb dittany, in extracting arrows, was first disclosed to us by stags that had been struck by that weapon; the weapon being discharged on their feeding upon this plant.” The powers of this plant are backed up by Aristotle in his History of Animals (~300 BC) with “Wild goals in Crete are said, when wounded by arrows, to go in search of dittany, which is supposed to have the property of ejecting arrows in the body;” Cicero’s De Natura Deorum (45 BC) with the very similar “Wild goats in Crete, when pierced with poison arrows, seek a herb callded dittany, and on their swallowing this the arrows, it is said, drop out of their busy.”  Virgil in the Aeneid (~29-19 BC): (long quote all relevent, I swear): 

The fam'd physician tucks his robes around  With ready hands, and hastens to the wound.  With gentle touches he performs his part,  This way and that, soliciting the dart,  And exercises all his heav'nly art.  All soft'ning simples, known of sov'reign use,  He presses out, and pours their noble juice.  These first infus'd, to lenify the pain,  He tugs with pincers, but he tugs in vain.  Then to the patron of his art he pray'd:  The patron of his art refus'd his aid.  Meantime the war approaches to the tents;  Th' alarm grows hotter, and the noise augments:  The driving dust proclaims the danger near;  And first their friends, and then their foes appear:  Their friends retreat; their foes pursue the rear.  The camp is fill'd with terror and affright:  The hissing shafts within the trench alight;  An undistinguish'd noise ascends the sky,  The shouts those who kill, and groans of those who die.  But now the goddess mother, mov'd with grief,  And pierc'd with pity, hastens her relief.  A branch of healing dittany she brought,  Which in the Cretan fields with care she sought:  Rough is the stern, which woolly leafs surround;  The leafs with flow'rs, the flow'rs with purple crown'd,  Well known to wounded goats; a sure relief  To draw the pointed steel, and ease the grief.  This Venus brings, in clouds involv'd, and brews  Th' extracted liquor with ambrosian dews,  And odorous panacee. Unseen she stands,  Temp'ring the mixture with her heav'nly hands,  And pours it in a bowl, already crown'd  With juice of med'c'nal herbs prepar'd to bathe the wound.  The leech, unknowing of superior art  Which aids the cure, with this foments the part;  And in a moment ceas'd the raging smart.  Stanch'd is the blood, and in the bottom stands:  The steel, but scarcely touch'd with tender hands,  Moves up, and follows of its own accord,  And health and vigor are at once restor'd. 

Byzantine Empire (7th century) 

I’m having a bit of trouble pinning a location down. The pioneer of this method, Paulus of Aegina, was a Byzantine Greek, but he traveled a great deal, including Alexandria, and boasted a great reputation in the Arabic world. His method was generally the same as Celsus’, though he had additionally reasoning behind pulling the arrow out or pushing in. [FULL TEXT] 

Paulus recommended extracting the arrow if the arrowhead did not penetrate deeply, or if additional damage to vessels, nerves, or organs could be expected from pushing the arrow out (based on his knowledge of anatomy). Removal by pushing the arrow through the wound was recommended in cases where the arrowhead was close to the skin at the opposite side from entry, or where no essential structures were located in front of arrowhead. 

Additionally, he emphasized that if the arrowhead was embedded in bone, extraction was absolutely necessary, even if it “meant cutting a wide access through soft tissue and removal of adjacent bone with a chisel.” 

If the arrow could not be easily found, he suggested that the wounded person should place themselves in the same or nearest possible position as they were when they recieved the wound. 

Europe (13th/14th century)

And wel ye knowe that of a sursanure In surgerye is perlious the cure,  But men myghte touch the arwe or come therby. 

[And you well know that a superficially healed wound / is hardly cured in surgery / unless men can touch or get to the arrow.] 

—The Cantebury Tales; Chaucer

Main source is Medicine in the Crusades: Ware, Wounds, and the Medieval Surgeon, by Piers D. Mitchell. Everything with a link is from another source, and may be conflicting. 

The tips of some arrows had barbs, which made their removal difficult, while others were without barbs, which made penetration of armor easier. 

Arrows caused a deep, penetrating injury while only leaving a small wound in the skin. As a result, it would have been difficult for a surgeon to explore the wound to assess the degree of internal damage without enlarging the wound and perhaps worsening it. If the arrow could not easily be pulled out the way it went in, medical texts recommended pushing it right through so it came out the other side, taking care to cause as little damamge as possible to the uninjured tissues.

Modern films often show alcohol being used as a kind of primitive anesthetic, but a good surgeon—even a medival one—would have known that alcohol thins the blood, making it slower to coagulate. While they certainly might have washed wounds with wine, using it as an antiseptic isn’t a wise choice. 

 If barbs prevented its immediate removal, an alternative approach was to wait a few days for the tissues around the arrow to putrefy and soften, enabling the arrow to be pulled out. Another potential problem was that it could be very difficult to remove the injured person’s armor, as the weapon had effectively nailed it to their body.

I have also read that this method derives from the concept of humors, applied by leaving the arrow in the wound for several days until the accumulation of pus ensured the arrow could be extracted relatively easily, with help from bent irons, an extractor (a probe with a threaded end for screwing into the sawed-off arrow shaft), forceps, and gouges were used to extract the arrow. Then they would burn the wound, effectively cauterizing it, with boiling oil/a branding iron. 

Sometimes, ingenous contraptions were used to remove projectiles, including sliding tubes or even a crossbow itself in a supposed case from 13th century Spain. I couldn’t find any details on the sliding tubes, but as for the crossbow, it was described once by Henri de Mondeville: “The arrow was tied to the drawstring of a fixed cross-bow, which was then fired.” 

One 14th century Spanish physician, Arnaldus de Villa Nova, recommends treating wounds with “a powder of lesser poligony daily as follows, taking a spoonful of it with wine, fasting—or, if they are poor, with water; and when the wound has been cleansed let the powder be sprinkled on externally too. If someone is poisoned, by an arrow or something else, he should take, fasting, one spoonful of the following powdre with aromatic wine or the above mentioned tisane: Rx one part citron seed, three parts of hart’s tongue ferm, and make a powder. Such patients can also be given cabbages with oil as food.” 

The most famous survived arrow-injury in that time period (1403) was inflected upon Prince Henry’s head. At the battle of Shrewsbury, Henry was “struck by an arrow next to his nose on the left side. The arrow entered at an angle, and after the arrow shaft was extracted, the head of the aforesaid arrow remained in the furthermost part of the bone of the skull for the depth of six inches.” It should be noted that the physician who wrote this, John Bradmore, did not pull out the shaft himself (a bad move, and the mark of a bad doctor), but it was done before he arrived. 

In order to treat it, Bradmore “made small probes from the pith of an elder, well dried and stitched in purified linen made to the length of the wound. These probes were infused with rose honey. After that [he] made larger and longer probes, and so continued to enlarge these probes until [he] had the width and depth of the wound as [he] wished it. And after the wound was as enlarged and deep enough so that, by my reckoning, the probes had reached the bottom of the wound, [he] prepared anew some little tongs, small and hollow, and with the width of an arrow. A screw ran through the middle of the tongs, whose ends were well-rounded both on the inside and outside, and even the end of the screw, which entered into the middle, was well rounded overall in the way of a screw, so that it should grip better and more strongly.” 

The screw latched onto the arrowhead and Bradmore slowly pulled on it until it was extracted. To heal the wound, Bradeford “squirted white wine and put into the wound a probe made of barley, flour, honey, and flax fibres. For the next twenty days he repeated the process, cleaning the wound and making the probes smaller and smallers. This allowed the wound to heal naturally and eventually close.” (Another source for this) (Plus a quick Wikipedia summary) (As well as a Discovery Channel documentary on the injury and treatment)

Europe, esp. Germany (15th century)

In all honesty, there wasn’t a ton of medical advancements in the European middle ages (though I should mention this does not apply to other parts of the world during this time), especially in Germany, but I want to give a special mention to German physician and Teutonic Knight, Heinrich von Pfolspeundt, the earliest known Germany surgical writer. 

In order to treat an arrow wound, Pfolspeundt would saw off the shaft of the rrow a few centimenters above the wound and leave the arrow in for 8-14 days, “until the wound becomes full of pus” and the arrow could be extracted more easily. Enlargement of the wound was steadfastedly avoided, and extraction would be performed using “bent irons, a probe with a threaded end for screwing into the sawed-off shaft, forceps, and gouges.” 

Though, regarding Pfolspeundt, despite this unsanitary treatment, he was one of the few who said surgeons should “bind with clean white cloths, for if they are not clean, harm results. He should also wash his hands before he treats anyone,” in a time where bandages were often “a strip of the victim’s riding coat, possible contaminated with horse excrement.” 

Europe (late 16th century/early 17th) 

Sources from this generally come from Ambroise Paré’s (1510-1590) The method of curing vvounds made by gun-shot Also by arrowes and darts, with their accidents. Written by Ambrose Parie of Laual, counsellor and chiefe chirugean to the French King. Faithfully done into English out of the French copie, by Walter Hamod chirurgean (1643), which I would say is honestly twenty-three chapters of awesome, if I wanted to sound like a 2010-era middle schooler. 

I’ll go into more detail in this in a minute, bit first, a TLDR:  Paré’s major achievements were in his deviations from the old style, which had involved treating arrow wounds with scalding oil and branding irons. However, he found that leaving wounds “untreated” with oil gave them a better chance of healing, and also abandoned the idea of the branding iron achieving hemostasis. Other than that, the method of arrow extraction was essentially the same as Paulus’.  

Like many physicians before him, Paré warns that to leave an arrow in the body would cause inevitable death, and the surgeon would be deemed inhumane; it would be better to attempt a doubtful remedy then to let the patient die, without “any succor at all.” He also warns against against incising, dilacerating (tearing apart), or breaking any veins, arteries, nerves, or tendons (for it would offend nature more than the arrow). 

Treatment: 

1. Clean out strange bodies: First, the surgeon should amplify the wound if possible, in order to draw forth “straunge bodyes” which may have entered into the body from the shot, such as any part of the patient’s close, paper, pieces of harness, mail, splinters of bone, cut flesh, etc. It’s important to do this at the beginning, so “pain and sensibility are not so great.” 

2. Situate the patient:  First, the patient should be sitting in the same position as at the they were when they were injuried. Otherwise, muscles and other parts of the body may hinder the way. 

3. Types of wounds

General

Paré has two methods of removing arrows: extraction, and “thrusting it through,” the wound. 

The doctor will find where the arrowhead is by feeling a roughness or inequality, and the flesh will appear bruised and black, and the patient will feel a heinous and continual pain. Paré mentions two instruments for removing arrows: tenacles with a vice [I admit to being unsure what tenacles are: the merrian webster dictionary defines a tenacle as the stalk of a plant, while the dictionary of practical surgery mentions Pare’s tenaculum as being a hook], and a Crowes bill. 

If the arrowhead is barbed, with some part of the wooden shaft broken, in that case the surgeon should cut away the wood as close as they can, with incising or cutting tenacles. Afterwards, the surgeon can draw forth the arrowhead with the tenacles that are toothed. 

Arrow is broken

If the head is broken, in such a way that it cannot be “apprehended by the aforesaide tenacles,” Pare recommends that if be extracated with the Cranes bill or the Crowes bill [images in links]. 

If the arrow shaft is broken so near the head that the doctor can not take hold of neither the head nor the shaft with the Cranes bill, then it should be removed with a Tirefond [in modern french, this just translates to ‘screw’], which is turned by a screw within a pipe or hollow instrument, and was usually used to remove bullets. The reasoning behind that that if it can penetrate into led, it would easily enter into wood. 

Arrow is barbed

If the arrow is barbed (”as most commonly your English mens Arrowes are”), then the arrow should not be pulled out, but pushed out. Although this method is more dangerous than pulling the arrowhead out, you avoid greater danger, as the barbs may cut through nerves, veins, arteries, etc. So it is beter to make a cut on the other side of the entry wound and thrust it clean through.

Arrow in the bone

If the arrow is fixed in the bone (which happens a lot in the muscles of the thigh, arm, and leg), and the doctor can not thrust it through the affected body part, then the doctor should discreetly move it back and forth, especially taking care that they not break the arrow and leave some part of it sticking in the bone. Then it should be extracted with a Crowes bill.

If the arrow is barbed and hits a bone, then the doctor should enlarge the wound, avoiding nerves and larger blood vessels (”as the good and expert Anatomical Chirurgean ought to do), and then gently keep the wound open, apply a dilatory hollow into the wound so it apprehends the two barbed ends of the arrow, and then draw the arrow forth with a Cranes bill. 

Aftercare: 

After the arrow is extracted, let the wound bleed “sufficiently” (indicated by the strength of the patient), so that the wound is discharged, and less likely to have inflammation, putrification, or other infection. If the wound was simple, then “thou shalt handle it as a simple wound” (no special treatment). If it was complicated (infected), then it might be treated with oleum catellorum (lit. “oil of whelps,” apparently a mixture of bruised worms, the grease of puppies boiled down alive, and other ingredients [x]). 

America (18th-19th century) 

There are two sides to this story, but unfortunately, one is much longer than the other. Arrow wounds in America came primarily (if not exclusively) from the so-called Indian Wars. I found very little on the Native American side. 

“The removal is effected by taking a willow stick and carefully splitting it and rubbing it as smooth as possible; then the pith (a kind of soft tissue in the stems of plants) is carefully cleaned out, and the ends rounded to present as little obstacle as possible in following the wound-track. One stick is introduced very carefully to reach and cover the uppermost fang of the head, and the other to cover the lower fang, and when both are properly adjusted the outer ends are bound to the shaft of the arrow, and all are carefully and slowly withdrawn.”

And, as usual, no definite names of doctors or specific tribes. If anyone has anymore resouces, I’d appreciate it. 

The definitive treatise on arrow wounds in early America comes from Dr. Joseph Howland Bill’s Notes on Arrow Wounds, which I highly suggest you read if you can get your hands on it. And its probable that a lot of what you’re going to find online will ultimately come from Bill’s Notes. But here’s a fairly comprehensive summary. 

TL;DR: 1. An arrowhead must be removed as soon as found 2. In the search for the arrow, extensive incisions are justifiable. 3. An arrow may be pushed out as well as plucked out.  4. The finger should be used for exploration in preference to a probe. 5. Great care must be taken to avoid detachment of the shaft. 6. Healing by first intention should be encouraged 7. The surgeon should strive to comofrt the patient. Although arrow wounds are not attended with much shock, they are usually the cause of great depression of spirits. 

Arrow materials: Arrowheads could be made from stone (used by Apache indians, could shatter bone), metal (used by Plain indians, embedded in deep tissue), antlers, shells, hardwood, or bone. The heavier the arrowhead, the larger the feathers needed to be. The shaft was usually made from dogwood; a dogwood branch would be soaked, all the bark would be removed, and then was straightened using a “twisting method.” The straightening process would take about three days. 

The arrowhead was attatched to the shaft using tendons and sinews. The kept the arrowhead secured until the tendon got wet. We’ll go into why that was important in a moment. 

Where: First, it was unlikely for a wounded soldier to have only one arrow wound. Bill estimated that an “expert bowman can easily discharge six arrows per minute,” and once described a case where three soldiers suffered a total of 42 arrow wounds between them. 

Chest injuries were most common. Punctured lungs (4/6 of the men Bill treated died, and about 1/2 of chest injuries occured with lung injury) and abdomenial injuries (motality rate of about 90%; due to lack of protection from ribs/other bones, the risk of blood vessel and intestinal damage, and the increased chances of infection) boasted the most fatalities, along with damage to the spine. But if you managed to avoid those, you had a pretty good chance of surivival. (Interestingly, Mexican soliders, unlike Americans, were aware of the risk of abdomenial injuries and reportedly wrapped blankets around their abdomen before going into battle). 

Wounds to the extremities (arms and legs) gave the wounded their best chance of survival, with less then a 5% mortality rate, and a number of injuries to the arm were reported (its been postulated that’s because soldiers would attempt to shield themselves). Arrows were more likely to pass straight through the limb, without hiting bone, artery, or nerve. The enterence of the wound would appear as a “very small and narrow slit, surrounded by a reddish bruise.” The exit wound would be “larger, but without the bruise.” 

Head injuries were treatable, on the condition that they not penetrate the skull or cause any brain damage, and this didn’t happen unless (1) It was fired straight at the head from a short distance or, (2) It went through the eyesocket. 

Check-in: (This is a general overview. However, more comprehensive individual case summaries can be found in Arrow Wounds by Thomas Wilson and A Report of Surgical Cases Treated in the Army of the United States from 1865 to 1871)

1. Straight through

For limb injuries where the arrow passed straight through the limb, leaving no arrowhead to extract, treatment was simply cleaning and wrapping the wound, and they healed fairly quickly: in some cases as fast as two days. 

2. Find the arrow head

For absolutely every arrow injury, the most important thing was to locate and extract the arrowhead. Due to the sharp, rough edges of the head, the body could not heal around it, while there have been cases of bullets becoming “encysted in tissue, or encased in bone.” Left in, the arrowhead would aggravate the injury until it inevitably lead to infection and/or amputation. 

Because of this, the absolute worst thing someone could do would be to pull out the shaft. Remember how the arrowhead was attached to the shaft with sinews & tendons, which loosened when wet? The injured person’s blood and other bodily fluids could certainly be described as a loosening agent. If someone attempted to remove an arrow by pulling on a shaft, the arrowhead would be left behind, forcing the doctor to search for it by making a larger incision and probing through the tissue, so it was best to remove the shaft and arrowhead at once.

Things were even trickier if the arrowhead wasn’t iron—especially stone—because they were liable to break “either when the arrow entered the body, or shortly thereafter when the shafat was yanked and twisted when removing it.” 

If the shaft had not been pulled out, the doctor would make a small incision to enlarge the entry wound, then slide a finger down the shaft to feel the depth of the wound and determine if the arrowhead was lodged in bone. 

3. Lodged in bone

According to one study, about 30% of 162 arrows in the Indian Wars struck bones. 

One way to find if the arrowhead was lodged in bone (that is, person was shot, arrowhead was prevented from exiting the body because of skeletal structure) was described above. The other method was “twirling the shaft,” or trying to twist it between the palms of your hands. If it moved, the arrowhead was declared not be be lodged in bone, and could be removed normally by enlarging the wound and carefully pulling it out, and the injury would heal naturally. 

If lodged in bone, it took a great deal of force to remove the arrowhead. Bill wrote, “bracing my knees against the patient’s thorax, I applied all the traction I could muster. Suddenly the arrow-head flew out of its seat, and I would have fallen on the floor, had not the steward caught me.” Two methods were frequently used to remove bone-lodged arrowheads. (1), a wire loop was used to grasp the arrowhead or (2) the doctor would use dental tooth-forceps, guide them down with their finger and onto the arrowhead; once the forceps had grasped the head, the finger would be removed and traction could be applied. 

Complications

1. Muscle Contractions 

If the arrowhead “scrapes the bone near the edge,” it could cause a muscle contraction strong enough that the metal arrowhead tip bent to resemble a “fish-hook,” confirmed through examining with the fingers (as described above). If the arrowhead was pulled out while still bent, it would exaberate the injury. In this case, the doctor would push down on the arrowhead to dislodge the hook, and then the doctor’s finger should remain on the curved point of the arrowhead during remove in order to prevent it further tearing any tissue. 

picture source

here’s a more modern sources for treating arrow-injuries in the wild, if you want to adjust for your character having a greater chance of survival 

Extra

At the moment, I’m unable to find more comprehensive or reliable sources for these (generally they’re not European and I can’t find English translations online), but just in case. 

Hua Tuo of China (c. 140-208) who, in the 14th century Chinese novel Romance of the Three Kingdoms,  operated on general Kuan Kung, who had been wounded in the arm by a poisoned arrow. The general declined to be anesthesized and continued a game of chess while Hua Tuo removed the arrow, cleansed the wound, and sutured the incision. The anaesthetia would have been mafeisan (lit. cannabis boil powder), though the exact recipe seems to have been lost. 

Philo of Byzantium (c. 280-220) recommended the application of honey and cerate-wax mixed with oil, lard, and sometimes other medicinal ingredients to treat arrow wounds in his Mechanical Syntax v. 96.15-19. [Full text in Latin]

Abu Bakr al-Razi of Persia (c. 865-925)  mentioned extractive drugs possessing the power to draw out arrowheads, made of a honey basse and compounded with ammoniac salt, narcissus bulb, and reed root

Al-Zahrawi / Abulcasis of Al-Andalus, by Spain (936-1013), who I’m honestly heartbroken I can’t find a good source for, because he had an absolutely enormous impact on medicine in general. Here’s Kitab al Tasrif in the original Arabic, a small section of translations that details some cases and like a paragraph on method, and essentially the same section on pg. 87 of this. 

Ali al-Majusi / Masoudi / Haly Abbas of Persia, (c. ~980), who has a section on arrows in his Complete Book of the Medical Art (Kitab kamil al-sina’at al-tibbiya), which seems to be patly based on Paulus’. He adds though, to Paulus’ work, that after extracting an arrow, if swelling occurs, one should bleed the patient and press on the wound cooling dittany, wild chicory juice, coriander juice, houseleek juice, and what is similar to these, and place on the bandages a drying dittany. He also mentions that if an arrow has lodged in an artery, “you must tie of these veins and arteries on both sides with silken threads, which are spliced together well, by introducing the needle below the vein. Make sure that it is well tied, and then extract the arrow.” [link for the quote is a good source on arabic doctors takes on arrow wounds in general). 

Ibin Sina / Avicenna of Persia (c. 980-1037)  also listed extractive drugs, such as reed root crushed on the wound, narcissus bulb added to a plaster of gillyroot and birthroot, or skinned frogs applyed to arrow wounds. 

Broken nose (Ancient Egyptian Surgery 34)

Fatal Fracture:

Before any ruling or treatment, the doctor would put their hand on the patient’s nose, in the place of the fracture. 

If the skin trembled under the doctor’s fingers, and the patient is bleeding from the nostril and ear closest to the fracture, and hardly open their mouth, and is apathetic (apathetic meaning here that the patient does not say anything/cannot speak, and is in low spirits, “like the one who is stunned by something that has come from the outside”) 

In these cases, the injury would be ruled fatal. 

Current medical note: This case shows a smashed unilateral injury to the facial region/closed comminuted nasal area fracture, produced by a downward blow to the nasal area; difficult to treat even today. Nasal bleeding could be caused either from the trauma that caused the fracture, or from the anterior (front) skull base. Bleeding from ear indicates a unilateral basilar skull fracture in the middle fossa. Bleeding from the mouth could be from disrupted nasal structures, temporal petrous bone fractures, and/or the roof of the mouth.  The description is decepitively minor: shifting of a fractured nose under the examiner’s hand, and hemorrhaging from the nose, ears, and mouth, as well as evidence of brain damage (apathetic). 

Pillar of the nose (the ridge and side part of the nose, and the center of the nose between the nostrils): 

Symptoms: Nose is flat, face even, and bleeding from both nostrils.

Treatment: The doctor would clean the patients nose with two linen rolls, and then insert two linen rolls soaked in oil into the nasal cavities. Then they’d place the patient on a bed until the swelling goes down. The doctor would attach two solid linen cylinders to prevent the nose from moving, hen would apply oil and honey every day until the patient is better. 

Nasal cavity (the center of the nose, all the way up to between the eyebrows): 

Symptoms: Nose is askew and very swollen, causing the face to look deformed

Treatment: The doctor would put the nose back into the right position, then clean the nasal cavities with two linen bands until all the blood clots dried inside the nasal cavities are removed (blood clots are described as worms living in water). Then the doctor would push two linen rolls soaked in oil into his nasal cavities, then attach two solid linen cylinders and bandage that. The doctor would apply honey and oil every day until the patient had recovered. 

Lower jaw (Ancient Egpytian Surgery 38) 

Fatal Fracture

When examining someone with a broken lower jaw, the doctor would place their hand on the wound. If the fracture is trembling under their fingers, the injury would be ruled fatal. 

Dislocated Jaw

Symptoms: The patient’s mouth is open and they cannot close it 

Treatment: The doctor would insert their thumbs under the end of the patient’s ramus (the end of the patient’s lower jaw, which is inserted into the temple “like the claw of the plover bird when holding something) and their index finders under the patient’s chin. They would then push the rami into their place. Until the patient is recovered, the doctor would wrap the wound every day with alum (a raw mineral with astringent properties, meaning it tends to bind body tissues), and honey (which has now been proven to contain antibacterial agents). 

Modern medical note: When replacing a dislocated jaw, the placement of the doctor’s thumbs is suprisingly crucial. Put your thumbs on the lower back molars, and you risk a serious bite as the jaw snaps into place. In this case, the Egyptians indicate the doctor must place their thumbs past the molars, avoiding the hazard. 

Collarbone (Ancient Egyptian Surgery 42) 

Dislocation 

Symptoms: Patient’s shoulders are dropped, and the head of their collarbone is closer to the patient’s face. Dislocated collarbone means that the ends of the patient’s collarbones are twisted, so that the heads rest in the upper bone of the patient’s chest and protrude all the way to the patient’s throat, with the flesh around the collarbone being in place.

Treatment: The doctor would push the collarbone so that it sinks back into place, then wrap it with firm linen cylinders and treat it every day with oil and honey. 

Fracture

Symptoms: Collarbone is shortened and diverted from its other part. 

Treatment: The doctor placed the patient on something rolled between their shoulder blades, then would spread their shoulders to stretch their collarbone and make the fracture sink back into place. The doctor would then prepare two linen cushions, and place one of them on the inner side of the upper part of their arm, and the other on the underside of their arm. Then the doctor would wrap it with an alum-laced bandage, and treat it every day with honey.

Rib (Edwin Smith Papyrus: Updated 267) 

Fatal Fracture

When examining a patient for a fracture in the ribs, a wound “having been smashed over it,” and you find the rib sections attatched to the breastbones of their chest and they are trembling under the doctor’s fingers, the injury is ruled fatal. 

Modern Medical Note: This case is a rib linear fracture, most often produced today by car accidents. In Egypt, they were most likely due to low velocity impact occuring in falls, labor-related accidents (like constructure), blows from fists, maces, clubs, or horses. 

Primary symtom of a rib fracture is chest pain. Others are an obvious chest wall deformity and crepitus (grating sound/sensation produced by friction between fractured parts of the bone) to manual exploration of fractured site. Severe cases my cause flail chest. Today, without infection, these cases generally heal on their own, and doctor’s primary goal is to reduce pain (through medication). 

There’s some disagreement on if the “wound” refers to an injury caused by the dislocation of the rib (from the inside out), or if it was produced over the rib cage, causing the fracture (outside in). If the dislocation of the rib caused a rupture of the overlying skin, there would be wound edges, an open chest wall, or a skin rupture from inside. 

Arm (Ancient Egyptian Surgery 42) 

Fracture

Symptoms: The patient’s arm hangs freely and deviates from its other part. 

Treatment: The doctor would place the patient on something rolled between their shoulder blade, then spread their arms to stretch them and make the fracture slip back into place. The doctor would then prepare two small linen cushions for him, and place on of them on the inner side of their arm and the other on the underside of their arm. Then the doctor would wrap it with an alum-bandage and treat it every day with honey. 

Current medical note: This is a closed linear fracture produced by blunt trauma to the arm, or by falling on an outstretched, abducted (motion of limbs away from the trunk of the body) arm. Meltzer and Sanchez note that these injuries would have generally occured during close combat (with clubs or maces), or construction accidents. Exevactions have revealed multiple examples of healed humeral shaft fractures, generally with complete healing and good bone realignment. 

 Sucessful treatment today is achieved by placing the patient in an upright standing or sitting position, essentially allowing gravity to assist in fracture reduction. It seems the Egyptians had about the same method, if a recumbent patient with a folded roll between their shoulder blades, so the shoulders would be elevated off the bed, allowing for the harm to hang alongside, allowing gravity to facilitate reduction and realignment of the fracture. 

Fracture with a wound

Symptoms: Broken arm (see above), and a wound inflicted on it. The fracture trembles under the doctor’s fingers. 

Treatment: The doctor prepares two small linen cushions, and wraps the injury with an alum-bandage and treat it with oil and honey until “a reversal has occured”