Post by Elf of cave on Apr 27, 2011 12:42:20 GMT -6
A few years ago I wrote a summary of the article “Arrow Wounds: Major Stimulus in the History of Surgery” by Karger, Bernd et. al. for a forum on Fanfiction.net, which can no longer be found, and I thought that some of the authors over here might find it useful. I think that the diversity in treatment throughout our own history can serve as a reflection of the diversity of treatments that might exist in the different cultures of Arda.
The full article can be read here (includes images of the surgical instruments used): www.springerlink.com/content/xyx16pgwex3tcmme/fulltext.pdf
The treatment of arrow wounds is an old core element of surgery, and throughout history there has been changing patterns of wound care.
Antiquity:
People in ancient times developed a variety of methods for extraction of arrows – many which acquired considerable surgical skill and knowledge.
In ancient India they had many extraction methods, including excision of arrowheads, the use of magnets, bending of barbed hooks, and extraction from the opposite side after counter-incision of soft tissues. Arrowheads firmly embedded in thick bone represented a serious problem, and was in some cases solved by several people holding the patient down while one end of a string was attached to the arrowhead and the other was tied to a horse or a strongly bent branch. In the case of the horse the creature was made to shy so that the string tore the arrow out of the bone. In the case of the branch it was released and upon shooting up pulled the arrow with it.
Hippocrates of Kos and Galen, who were representatives of the humoral doctrine, both shunned surgical intervention and considered purulence a drainage of spoiled or surplus humors (bodily fluids: yellow bile, black bile, phlegm and blood).
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.
The Greek physician Paulus of Aegina made a systematic classification of arrows and arrowheads, and how the different types could be extracted. Overall Paulus was in agreement with Celsus on when to extract arrowheads per extractionem or per expulsionem. According to Paulus almost any forceps-like object can be used to extract an arrowhead, but, as the first person in history, he described a special instrument (a so-called propulsorium) for the removal of detached arrowheads per expulsionem, and also demanded ligature on both sides of a vessel before extracting the arrow.
Medieval Times:
In medieval Europe, the Catholic Church was the main cause for a decline in the standard of surgery. The humoral concept became dominant in the removal of arrows, which was usually done by leaving the arrow in the wound for several days until the accumulation of pus ensured that the arrow could be extracted more easily, and then burn the wound with boiling oil or/and a branding iron. They did not enlarge the wound, and bent irons, an extractor (a probe with a threaded end for screwing into the sawed-off shaft), forceps, and gouges were used for the extraction.
Later Times:
A renewal of surgery was achieved by Ambroise Paré in the 16th century, who went back to methods of arrow extraction known since Paulus, using the instruments in his own time.
The incidence of arrow wounds increased once more in the New World, especially during the westward expansion. The Indian method of removing arrowheads was to split a branch, often willow, then use the two pieces to cover the arrowhead and barbed hooks during removal, which was done by binding the pieces to the arrow shaft and withdrawing them all together.
U.S. Army Surgeon Joseph H. Bill made a catalogue of American Indian arrows which could be used to estimate the penetration depth of an arrow from the length of the exposed shaft. Bill realized the danger of the arrowhead disengaging from the shaft during extraction efforts, because it would often be left behind and subsequently cause infection and abscess formation. Also, an intact shaft provided a guide to the arrowhead and indicated the involvement of bone when twirled gently. Bill therefore recommended leaving the arrow undisturbed until the victim could receive medical treatment and “never apply traction to the shaft.”
Bill designed an instrument which worked by this principle: the arrow shaft was used as a guide by which to find the arrowhead. The arrowhead would be snared or seized in some way with a wire or loop (or similar device) by which the traction could be applied to the arrowpoint, then it (with the arrow shaft still attached) was withdrawn. He also constructed a strong forceps for the extraction of arrowheads lodging in bone.
Bill recapitulated his experience as follows:
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 comfort the patient. Although arrow wounds are not attended with much shock, they are usually the cause of great depression of spirits.
Essentially, these rules are still valid, and the principles established by Celsus, Paulus, Paré, and Bill serve as a well-established basis for modern approaches to arrow wound surgery.
The full article can be read here (includes images of the surgical instruments used): www.springerlink.com/content/xyx16pgwex3tcmme/fulltext.pdf
The treatment of arrow wounds is an old core element of surgery, and throughout history there has been changing patterns of wound care.
Antiquity:
People in ancient times developed a variety of methods for extraction of arrows – many which acquired considerable surgical skill and knowledge.
In ancient India they had many extraction methods, including excision of arrowheads, the use of magnets, bending of barbed hooks, and extraction from the opposite side after counter-incision of soft tissues. Arrowheads firmly embedded in thick bone represented a serious problem, and was in some cases solved by several people holding the patient down while one end of a string was attached to the arrowhead and the other was tied to a horse or a strongly bent branch. In the case of the horse the creature was made to shy so that the string tore the arrow out of the bone. In the case of the branch it was released and upon shooting up pulled the arrow with it.
Hippocrates of Kos and Galen, who were representatives of the humoral doctrine, both shunned surgical intervention and considered purulence a drainage of spoiled or surplus humors (bodily fluids: yellow bile, black bile, phlegm and blood).
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.
The Greek physician Paulus of Aegina made a systematic classification of arrows and arrowheads, and how the different types could be extracted. Overall Paulus was in agreement with Celsus on when to extract arrowheads per extractionem or per expulsionem. According to Paulus almost any forceps-like object can be used to extract an arrowhead, but, as the first person in history, he described a special instrument (a so-called propulsorium) for the removal of detached arrowheads per expulsionem, and also demanded ligature on both sides of a vessel before extracting the arrow.
Medieval Times:
In medieval Europe, the Catholic Church was the main cause for a decline in the standard of surgery. The humoral concept became dominant in the removal of arrows, which was usually done by leaving the arrow in the wound for several days until the accumulation of pus ensured that the arrow could be extracted more easily, and then burn the wound with boiling oil or/and a branding iron. They did not enlarge the wound, and bent irons, an extractor (a probe with a threaded end for screwing into the sawed-off shaft), forceps, and gouges were used for the extraction.
Later Times:
A renewal of surgery was achieved by Ambroise Paré in the 16th century, who went back to methods of arrow extraction known since Paulus, using the instruments in his own time.
The incidence of arrow wounds increased once more in the New World, especially during the westward expansion. The Indian method of removing arrowheads was to split a branch, often willow, then use the two pieces to cover the arrowhead and barbed hooks during removal, which was done by binding the pieces to the arrow shaft and withdrawing them all together.
U.S. Army Surgeon Joseph H. Bill made a catalogue of American Indian arrows which could be used to estimate the penetration depth of an arrow from the length of the exposed shaft. Bill realized the danger of the arrowhead disengaging from the shaft during extraction efforts, because it would often be left behind and subsequently cause infection and abscess formation. Also, an intact shaft provided a guide to the arrowhead and indicated the involvement of bone when twirled gently. Bill therefore recommended leaving the arrow undisturbed until the victim could receive medical treatment and “never apply traction to the shaft.”
Bill designed an instrument which worked by this principle: the arrow shaft was used as a guide by which to find the arrowhead. The arrowhead would be snared or seized in some way with a wire or loop (or similar device) by which the traction could be applied to the arrowpoint, then it (with the arrow shaft still attached) was withdrawn. He also constructed a strong forceps for the extraction of arrowheads lodging in bone.
Bill recapitulated his experience as follows:
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 comfort the patient. Although arrow wounds are not attended with much shock, they are usually the cause of great depression of spirits.
Essentially, these rules are still valid, and the principles established by Celsus, Paulus, Paré, and Bill serve as a well-established basis for modern approaches to arrow wound surgery.
