Most of the causes of death by arrows were secondary to infection, with peritonitis following an arrow that pierces the abdominal cavity being the most common cause of death. Second to peritonitis, the individual may die due to massive hemorrhage. Other causes of death included pneumonia, encephalitis, compression of the brainstem, empyema, tetanus, and shock.
For arrows that passed completely through, an assessment of the injured body part for any loss of function or damage to major organs. If no such trauma was observed, the wound required minimal intervention.
For intact arrows that were lodged, the most important thing to determine was if the arrow had impacted bone. The 19th-century physician may have determined this by gently twisting the arrow at its tip. The slightest mobility indicated an arrow that was free of impaction.
Once it was determined that the arrowhead was free of bone, the next step in management was to decide whether the arrow should be pulled out or pushed through. This was dependent on the depth of the arrow, as well as the tissues it may encounter. When it was decided that the arrow could successfully be removed by emergence, the shaft was to be lubricated and firmly pushed through at its base. As the tip of the arrowhead became visible underneath the skin, a scalpel would be used to release the arrow from the integument, ensuring no part breaks or was left behind. Once it was confirmed that the entire arrowhead had been removed, the rest of the arrow could be pushed through. If any portion of the arrow was suspected to remain in the wound, a drainage tube would be used to prevent suppuration.
If it was not feasible to push an arrow through, then it was extracted, which was done by grasping the arrowhead. However, the shaft of the arrow tended to be tightly surrounded by the skin, which proved to be problematic. Thus, for arrows that were more superficial, it was recommended to make an incision allowing the doctor to probe to visualize or feel for the arrowhead and eventually dressing forceps to retrieve it. The arrowhead and shaft were removed at the same time, grasping each together, so as to not let the arrowhead break from the shaft. If the arrow was deeply lodged, the 19th-century physician had to be more creative. Many tools have been developed for this very purpose, and in his report, Bill accounted for the more popular surgical instruments used for extraction of arrows at the time including the long nose “crocodile” forceps which could be inserted into the wound if the arrowhead broke into fragments.
When the arrow was embedded in flesh but not sticking in a bone a probe wire loop could be used to snare the arrowhead and remove the entire arrow. Above all, the arrowhead must be removed if the patient was to have a chance at recovery.
Arrow wounds to the thorax were deadly. If the arrow penetrated the lung there was a good chance the patient would die.
Arrow wounds of the abdomen and pelvis like bullet wounds were usually fatal. While peritonitis and fecal eruption often led to fatal infections. The abdomen has no rib cage to protect it. Of the 21 cases he treated all but one died.
Dr. Bill wrote that wounds to the lungs by an arrow was more deadly than a gunshot wound because an arrow makes “clean cuts and punctures” causing more bleeding while a bullet “tears and bruises.”
All in all, Dr. Bill “observed” eighty arrow wounds, the majority to the trunk, thirty-six in all. Of these 36 men injured 22 died. The extremities are next with a total of 35 wounds. Dr. Joseph N. Bill’s years of observing and treating soldiers and civilians suffering from arrow wounds, the research, postmortem and writing based on years of experience as a military physician provides the only documentation for the nature and treatment of arrow wounds, providing a huge service to medical service and especially to historians.