Treating a crossbow wound: to remove, or not to remove?

Kitkitdizzi · Oct 4, 2015

Ok, so looking for some advice on what is the more plausible method to treat a crossbow wound in my WIP. This is a fantasy world, medical knowledge is limited but I would put it on par with medieval Islamic medicine. There is some magical healing as well.

Here's the scenario: My character is shot in the front right shoulder with a crossbow quarrel. He is wearing chain mail. The characters are four to five days away by horse from any place that will have a doctor/healer. One other character has some knowledge of field medicine. Their supplies are limited to clean cloth, water, and wine.

The question is: should the medic leave the quarrel in, trying to stabilize it, or should she try to pull it out? And if she does pull it out, is it likely that the tip will be left in place like with an arrow shot from a bow? I've found resources regarding what to do with arrow wounds, but not crossbow wounds and not when you have to travel a far distance on horseback.

Note that whatever option happens, the wound is going to become infected. The character will have fever, become delirious, and develop septicemia by the time he his rescued. I am also planning on him having to have to loose the arm due to osteomyelitis.

Thank you so much.

Esmae Tyler · Oct 4, 2015

Modern emergency medical standards say that you never, ever, ever, ever remove an impaled object outside of a hospital setting unless it's obstructing the airway, interfering with CPR, or significantly interfering with transport. You break off most of the protrusion (leaving enough outside that it can be manipulated later) and pad/immobilize it as much as possible.

The deeper an object is embedded, the more stable it is. Trying to pull it out would cause more trauma and blood loss: while it's in, it can function as a somewhat leaky plug, but when you pull it out suddenly there's a big hole.

WeaselFire · Oct 4, 2015

Normal medieval era treatment was to break the arrow or quarrel off, transport to a doctor/physician and let them deal with it. The key would be what you need for your story line. If the victim is to die a painful death, have them break it off, get to a physician and the physician cannot remove the entire projectile or head. Infection, sepsis and death.

If you need the victim to survive, same scenario but have the physician heal them. If you need to not get to a physician, pull the quarrel, clean the wound and bandage. Toss a few herbs into a poultice and have him survive with minimal scarring.

Pretty much your call.

Jeff

Kitkitdizzi · Oct 5, 2015

Thank you so much! So it sounds like the quarrel should be left since the characters are trying to get to a doctor.

If I may ask some follow-up questions, will the arrowhead do any additional tissue damage while said injured character is riding a horse? I also have read that the glues used to fix the arrowhead to the shaft will be dissolved by blood so is it likely that the shaft will come out on its own anyways?

jclarkdawe · Oct 5, 2015

This is from the American West. Standard approach was cut the arrow off on the fletching end side. Hammer on shaft until head goes through, then grab and pull. Give patient as much whiskey as they can hold before starting. If patient is still conscious after the arrow goes through, more whiskey. Take heated knife blade and cauterize wound. (Mistaken belief that this would reduce infection -- they were wrong.)

I'm assuming a fair number of patients did not survive the treatment.

Traveling horseback with an arrow stuck in your shoulder would cause increased damage, no matter how tightly you try to bind it. This can change somewhat depending on the horse's gaits and the rider's ability. If the horse is not used to one handed riding, control could be a problem. Any gait faster than a walk is likely to cause your patient to scream.

Remember that if arrows had been used before, there would be a standard treatment. Unless you were a high rank, it would be the same standard treatment.

Travel by travois might be the best alternative, especially if they need to use speed.

Best of luck,

Jim Clark-Dawe

RKarina · Oct 6, 2015

I'd be inclined to say the risk of increased injury while riding - at what I would expect to be a fairly fast pace due to the urgency - would make a person with some medical training decide to risk removing the bolt.

On a long, dirty ride, with minimal access to anything but the most primitive of medical care, infection is still highly likely. Honestly, you could go either way, since your character is going to lose that arm anyway.

Removal option...

Modern medicine says leave it (unless it's obstructing an airway). But modern medicine has access to rapid, and relatively smooth, modes of transport.

Removing any penetrating object (arrow, fish hook, etc) usually involves first cutting off the big parts - such as an arrow, or fletching (or a hook, since I mentioned hooks). Once you're down to a smooth shaft, grasp firmly and remove.

Since your folks are enroute to a doc/healer, they'd probably wash the wound with wine (possibly boiled first) and/or boiled water, then dressing the wound with clean cloths. Possibly "packing" the wound with cloths soaked in the boiled liquid.

Leave it in option...
This is riskier if the tip is still embedded within the body. The jouncing around on horseback would conceivably cause far more damage than opting to remove the bolt.

If the thing had penetrated all the way through, and/or for some reason your field medico isn't comfortable doing the removal process above, then the bolt has to be stabilized.

The wound would be washed with boiled water and/or wine. Strips of cloth would be used to wind around the bolt where it enters/exits the skin, then more strips would be used to wrap the patient's body to keep the bolt from wiggling and jiggling too much. If it's a through-and-through in the shoulder, one way might be to wrap strips in a figure 8 type pattern around the bolt end, then around the body (either over the shoulder, or around the upper arm, or under the arm around the ribs, depending on where the injury is), then around the opposite end of the bolt. The affected arm should be immobilized against the patient's body to prevent movement.

Taejang · Oct 7, 2015

To add to the already fine advice given, if the quarrel is embedded in bone, that will significantly change treatment options. I once missed a target and embedded an arrow into a wooden fence post; it didn't go all that deep, and it was just a practice tip, but it was impossible to remove. I unscrewed the shaft from the tip and left the tip there. I would imagine that any quarrel embedded in a shoulder bone would be impossible to remove via the standard method of pushing it through to the other side, thus necessitating being cut out and/or pulled out backwards.

Another thought is the armor. Butted or riveted chain would be easily pierced by a bodkin bolt or arrow, but both types and especially riveted chain would be resistant to broadheads. Bodkin arrows are also much easier to remove from a wound than broadheads. Leather jerkins or cloth armor were worm under chain armor and were more resistant to arrows/bolts, which would alter penetration depth.

CWatts · Oct 7, 2015

jclarkdawe said:
Remember that if arrows had been used before, there would be a standard treatment. Unless you were a high rank, it would be the same standard treatment.

Taejang said:
To add to the already fine advice given, if the quarrel is embedded in bone, that will significantly change treatment options. I once missed a target and embedded an arrow into a wooden fence post; it didn't go all that deep, and it was just a practice tip, but it was impossible to remove. I unscrewed the shaft from the tip and left the tip there. I would imagine that any quarrel embedded in a shoulder bone would be impossible to remove via the standard method of pushing it through to the other side, thus necessitating being cut out and/or pulled out backwards.

There's some good info online from the BBC, etc. on the treatment Henry, Prince of Wales (future Henry V) received after he took an arrow to the face at the Battle of Shrewsbury. The arrowhead was embedded in his skull and the world-class surgeon invented an instrument to eventually remove it (sort of a screw on the end of a probe) but it took several weeks to get to that point. Of course he didn't need to travel and he had access to the very best care available in 1403 England.

GeorgeK · Oct 7, 2015

There are too many variables to have a definitive answer. Is the bolt barbed? Is it occluding an artery? What do you mean by the shoulder? Five days with a deep foreign object protruding is pretty much a guarantee of deep infection and the foreign object will prevent reasonable clotting anyway. This isn't a modern paramedic situation. Without specific answers to the above questions my gut says pull it, irrigate with wine and use a compression dressing.

Kitkitdizzi · Oct 7, 2015

RKarina said:
I'd be inclined to say the risk of increased injury while riding - at what I would expect to be a fairly fast pace due to the urgency - would make a person with some medical training decide to risk removing the bolt.

On a long, dirty ride, with minimal access to anything but the most primitive of medical care, infection is still highly likely. Honestly, you could go either way, since your character is going to lose that arm anyway.

Removal option...

Modern medicine says leave it (unless it's obstructing an airway). But modern medicine has access to rapid, and relatively smooth, modes of transport.

Removing any penetrating object (arrow, fish hook, etc) usually involves first cutting off the big parts - such as an arrow, or fletching (or a hook, since I mentioned hooks). Once you're down to a smooth shaft, grasp firmly and remove.

Since your folks are enroute to a doc/healer, they'd probably wash the wound with wine (possibly boiled first) and/or boiled water, then dressing the wound with clean cloths. Possibly "packing" the wound with cloths soaked in the boiled liquid.

Leave it in option...
This is riskier if the tip is still embedded within the body. The jouncing around on horseback would conceivably cause far more damage than opting to remove the bolt.

If the thing had penetrated all the way through, and/or for some reason your field medico isn't comfortable doing the removal process above, then the bolt has to be stabilized.

The wound would be washed with boiled water and/or wine. Strips of cloth would be used to wind around the bolt where it enters/exits the skin, then more strips would be used to wrap the patient's body to keep the bolt from wiggling and jiggling too much. If it's a through-and-through in the shoulder, one way might be to wrap strips in a figure 8 type pattern around the bolt end, then around the body (either over the shoulder, or around the upper arm, or under the arm around the ribs, depending on where the injury is), then around the opposite end of the bolt. The affected arm should be immobilized against the patient's body to prevent movement.

Thank you for the wonderful and thorough advice on what the best treatment would be for different scenarios.

Taejang said:
Another thought is the armor. Butted or riveted chain would be easily pierced by a bodkin bolt or arrow, but both types and especially riveted chain would be resistant to broadheads. Bodkin arrows are also much easier to remove from a wound than broadheads. Leather jerkins or cloth armor were worm under chain armor and were more resistant to arrows/bolts, which would alter penetration depth.

Thank you, I hadn't thought to consider the type of chain and was just starting to look at the different types of heads. Great info!

CWatts said:
There's some good info online from the BBC, etc. on the treatment Henry, Prince of Wales (future Henry V) received after he took an arrow to the face at the Battle of Shrewsbury. The arrowhead was embedded in his skull and the world-class surgeon invented an instrument to eventually remove it (sort of a screw on the end of a probe) but it took several weeks to get to that point. Of course he didn't need to travel and he had access to the very best care available in 1403 England.

I came across that historical tidbit in my research and Dr. Joseph Bill's work on treating arrow wounds in the Civil War. Fascinating, but again had the assumption on getting to the doctor ASAP, which is not an option in this case.

GeorgeK said:
There are too many variables to have a definitive answer. Is the bolt barbed? Is it occluding an artery? What do you mean by the shoulder? Five days with a deep foreign object protruding is pretty much a guarantee of deep infection and the foreign object will prevent reasonable clotting anyway. This isn't a modern paramedic situation. Without specific answers to the above questions my gut says pull it, irrigate with wine and use a compression dressing.

I think I'm going to agree with you. Now that I see what the various treatment options are for the different scenarios I think I can nail down exactly what is going to happen to my poor character and how it will be treated.

Thank you all for your comments. You folks are invaluable!

Thelassa · Oct 7, 2015

Another option to consider, which would add an extra layer of urgency to the medic's decision, is what may be coating the head of the bolt. Most people only think of "poisonous" projectiles as having heads covered in some kind of venom. In actuality, it wasn't uncommon for archers to dip their arrowheads in whatever disgusting muck they happened to find. They knew their weapons took time to kill, and this practice almost guaranteed a slow, agonizing death from infection even if they struck a non-vital area like a leg or a shoulder.

snafu1056 · Oct 7, 2015

The massive infections caused by physicians groping around in open wounds with unwashed hands would probably work as well as any poison too

Treating a crossbow wound: to remove, or not to remove?

Kitkitdizzi

Don't feed the critters

Esmae Tyler

This & That

WeaselFire

Benefactor Member

Kitkitdizzi

Don't feed the critters

jclarkdawe

Feeling lucky, Query?

RKarina

Taejang

Why not?

CWatts

down the rabbit hole of research...

GeorgeK

ever seeking

Kitkitdizzi

Don't feed the critters

Thelassa

From the ashes

snafu1056