• Tammy Euliano

Medieval Trauma Medicine


from Cole H and Lang T. (2003) “The Treating of Prince Henry’s Arrow Wound, 1403” in Journal of the Society of Archer Antiquaries, 46, 95-101.

I need medical information for a historical novel set in medieval times. The male

main character is shot with a barbed arrow somewhere on the left side of his torso.


After a harsh fight for survival and harrowing convalescence, he survives with lingering discomfort/mild disability. Would he be able to function somehow, right after the injury? He is very tough and would be hell-bent upon completing his mission.


After a period of time (how long could he last without help?), help would include a very experienced military surgeon, with skills on the level of the Roman army surgeons/ combat medics of antiquity.


What kind of wound (placement, depth, looks…) would fit this scenario? What is a likely timeline with regard to the wounded MC´s deterioration, crisis, and recovery? If he develops a high fever and/ or an unconscious state, will he hallucinate? Dream? Remember anything? Talk understandably? Just mutter or ramble? Etc.


Anatomy

A left torso wound with a barbed arrow could hit spleen (probably not survivable due to blood loss), or rib (fracture, very painful; +/- puncture lung), or if it happened to go between the ribs, it could hit lung (or heart if he’s really unlucky).

from Medical News Today

The lung is inside an o/w empty sack called the pleura. If the pleura is breached and air gets into it (inside the chest but outside the lung; called a pneumothorax (air in chest)) then the lung can have difficulty expanding. It’s painful, esp with breathing in, and would get worse over time (hours maybe?).


If it’s bad enough, and the air can get in but not back out (like a flap valve), then it can put pressure on the heart and kill your hero (tension pneumothorax), so you don’t want that. There are specific signs (enlarged neck vein on that side, the chest sounds hollow when tapped) and the treatment is to put in a tube (or reed) to drain the air. I found a reference to evacuating pus from the chest cavity from that time.


A barbed arrow is less likely to embed in bone apparently (wikipedia), so if it’s barbed and goes through the chest wall it could maybe just stay in the pleural cavity (outside the lung), then it’s removal and a stitch to prevent air from being sucked into the hole would be it (except the risk of infection of course). If it stays for a while, I would guess the lung would rub against it and become damaged, which again causes air in the space, chest pain and difficulty breathing. The treatment is the same, but the lung tissue might take a while to heal. As far as the wound reopening, I think the risk would be small as the hole would be small and generally not terribly bloody if it doesn’t hit a major blood vessel. Unless of course it gets infected and there is pus in the lung space.


Injury

So as a guess, he’s out in the field, gets struck by the arrow, needs to complete his mission. Wouldn’t lose consciousness. Maybe he has a  knife and cuts off most of the shaft so he’s less likely to move it…I suppose he could try unsuccessfully to remove it, but likely better to leave it in place. He should do something so his clothes don’t catch on the remaining shaft and move the arrow as he travels. He’d certainly be able to move. He’d be in pain, esp with breathing in so he’d probably “splint” – take shallow, faster breaths. It shouldn’t make him wheeze unless he also has asthma. Coughing would be REALLY painful. He might keep his left arm down (bent at the elbow maybe) to protect his rib cage on that side.


If you want it to be more hit or miss, but allow him to finish his task first, probably an infection is the best option. The drainage and irrigation described in the reference would certainly be painful, and likely result in some permanent lung damage. Really though, a healthy person can live just fine with only one lung… if you want him to have decreased function, you might have to give him another wound.  OR, he could get so sick from the infection (septic shock) that his heart takes a hit and never fully recovers. During the sepsis/major infection he would have a high fever, sweats, high heart rate, fast breathing, probably hallucinations and maybe combativeness, until he falls unconscious. He would sleep a lot. Give him cool baths.


Treatment

Regarding ointments, I found this:

  • Black ointment “is good for festering wounds, it cools and refreshes, soothes and heals and it stimulates the formation of pus (Leersum 1912: 21).

  • Populos ointment was used “in cases of extreme heat caused by high fever (Daems 1967: 191).”  [I couldn’t find any more about this and be careful googling it :-)]

You can get some smells from Medieval Medicine to treat Wounds. “Wounds were cleaned and vinegar was widely used as a cleansing agent as it was believed that it would kill disease. Mint was also used in treating venom and wounds. Myrrh was used as an antiseptic on wounds. Yarrow, or Achillea was used to treat headaches and wounds, especially battle wounds.”

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