Joseph Howland Bill, M.D., Arrow Wounds and Treatments on the Western Frontier
…a fatality greater then that produced by any other weapon.
Lisa A. Ennis
(Georgia College and State University)
Hugh T. Harrington
In the early 1860's American medical doctors would face one of their greatest challenges. The Civil War would introduce "improved" implements of death and destruction. The minie ball, heavy artillery, and the shear numbers of wounded soldiers would test every ounce of medical knowledge and skill doctors could muster. But on the frontier Army doctors were facing an ancient and effective weapon that tested their mettle as well. The use of bows and arrows was still common among Native American groups in the late 1800s. Further, the weapon posed distinct advantages over guns and rifles and produced injuries that sometimes required unusual and creative methods of treatment. Oddly, very little medical or historical accounts of the use of arrows, the wounds they made, and the treatments used to mend injuries exists. The most complete and detailed account of arrow wounds and treatments is Dr. Joseph Howland Bill’s “Notes on Arrow Wounds,” which is considered the “definitive work on American arrow wounds.”
Unfortunately, very little is known about Dr. Bill’s life. Historian Scott Earle pieced together Bill's career in his work on surgery in America. According to Earle, Bill was originally from Philadelphia and attended Jefferson Medical College. After graduation Bill joined the Army, was commissioned 1st Lieutenant, and in 1860 was assigned to Fort Defiance, New Mexico; where he wrote his 22-page essay, "Notes on Arrow Wounds,” published in the American Journal of Medical Sciences, 1862. In less than a year Bill was transferred east where he served with distinction in the Civil War. He continued to serve in the Army until his death in 1885.
Bill recognized the use of arrows would eventually decline and even issued an apology for his essay because “Indian tribes are fast being exterminated.”  However, he is quick to point out the advantages of bow weapons and their continued use on the American frontier as reasons for his documentation of medical treatments. He also believed the Native groups on the frontier would be much harder to “civilize” than the groups located east of the Mississippi. Bill believed a record of the medical treatment of arrow wounds would benefit the soldiers and settlers who would continue to face arrow wounds for some time to come. Bill states arrows inflict wounds “with a fatality greater than that produced by any other weapons --- particularly when surgical assistance cannot be obtained.” Further, in some situations the bow was actually the preferred weapon. Bill understood that his article would not be of use or interest to everyone, but he also understood the importance of recording his observations for the Army and future settlers as well as documenting his experiences and findings, from both living and dead arrow wound victims, for history and medicine.
The advantages of bows over guns were even apparent to Benjamin Franklin. In a 1775 letter to General Charles Lee, George Washington’s second in command, Franklin lists five reasons why he believed the Continental soldiers and militia units should use bows and arrows against the British. According to Franklin men shoot as accurately with bows as with muskets, four arrows can be shot for every one bullet, bows are smokeless so the soldier’s view is never obscured, arrows flying through the air "terrifies" the opponent, and once a person was struck by an arrow they were incapacitated until the arrow was removed. Almost a hundred years later Bill's observation and experience on the western frontier were remarkable similar.
In the 1800's guns and ammunition were a valuable and expensive commodity. Any Indian in want of a firearm would have to purchase or steal the weapon and ammunition from white settlers or soldiers. Bows and arrows, however, were considered renewable resources; anyone could learn to make their own bows and arrows freeing themselves from dependence on white traders. Bows were also preferred over guns during ambushes and night raids for reasons of stealth and quickness. This quiet weapon was also superior to the firearms for "the purpose of picking off sentinels without creating an alarm."
Further, Indians did not have the tools or know how to repair a broken firearm. As, Colonel Richard Irving Dodge, aide-de-camp to General Sherman, states; “ammunition may be scarce, or the gun itself get out of order, and as no Indians have the proper tools, and very few the mechanical knowledge for its repair” Indians must carry their bow as well. Colonel Dodge goes on to say that only the “older warriors of the tribe” carried guns while the “young and poor use the bow exclusively” and the bow was an “indispensable possession of every male Indian.” Thus, the bow and arrow continued to be considered the most dependable and important weapon to Indian groups on the Western Frontier.
Crafting arrows involved time, skill, and patience. Arrowheads could be made from stone, antlers, shells, hardwood, bone, or metal. The arrowheads Dr. Bill most encountered were filed metal while the shaft was usually made from a dogwood branch. Bill does not give an indication of the amount of time required to make an arrowhead but it is estimated a skilled Apache arrow maker could produce a flinthead in about six minutes. For the shaft the dogwood branch was soaked, all the bark removed, and then the limb was straightened using a twisting method. This whole straightening process took about three days. Feathers were also an important part of the arrow. The size and type of feather used determined the speed and rotation of the arrow. The heavier the arrowhead the larger the feathers needed to be to spin the arrow.
Once the shaft was ready the arrowhead was attached using tendons and sinews. This kept the head secure, until the tendon got wet. Once wet, the arrowhead would become loose and easily separate from the shaft. So, when the arrow penetrated the body the arrowhead would loosen from its contact with blood and others bodily fluids. Dr. Bill explains the worst thing a friend could do was to try to remove the arrow by pulling on the shaft, which would cause the arrowhead to be left behind forcing the doctor to search for the projectile.
Some Indian warriors also poisoned the arrowheads. One method used animal liver and rattlesnake venom. The snake would be enticed to bite the liver saturating it with venom. The liver was then buried for several days. After a sufficient amount of time had passed the liver is recovered and the arrowheads dipped into the poisoned spoiled liver. Once dry the arrow heads are again dipped in blood and allowed to dry. The only poison arrow injury Bill encountered was in a horse which "swelled up enormously, evidently suffered much pain, and died in the course of a night, certainly from the effects of a poison, as the wound inflicted by the arrow was not mortal…" Whatever manner of poison used it must have been incredibly potent to kill a horse in less than twenty-four hours.
Bows and arrows were designed to inflict “maximum injury” thus, the nature of arrow wounds was just as deadly as any gunshot wound and, in some situations the arrow proved more destructive to the victim and more difficult to treat for the doctor. The problems came from the nature of arrow warfare and the shape and texture of the projectile. Dr. Bill estimates an "expert bowman can easily discharge six arrows per minute." Colonel Dodge’s description is equally compelling; “He will grasp five to ten arrows in his left hand, and discharge them so rapidly that the last will be on its flight before the first has touched the ground…” Thus, it was rare for Dr. Bill to treat a patient with just a single wound. In one of Dr. Bill's cases three soldiers suffered a total of 42 arrow wounds between them. Although this number of wounds was extreme, Bill states he rarely saw someone with a single arrow wound.
Further complicating the multiple wounds was that each arrowhead had to be removed. Unlike a gunshot wound, the projectile of an arrow wound must be located and extracted. Arrowheads were rough and sharp, no tissue around the arrowhead could heal and in the body’s attempt to rid itself of the foreign object infection would rage forming an abscess. Every time the victim moved the arrowhead’s rough edges would inflame and aggravate the injury and eventually lead to a fatal infection or amputation. In contrast a 19th century bullet did not have the sharp edges and could become encysted in tissue or encased in bone and safely remain in the body. The importance of removal is clear in Dr. Bill’s instructions; “We might as well cut the patient’s limb up until we do find the arrow-head.”
Now the gravity of a friend’s attempt to pull the arrow from a wounded comrade becomes apparent. If the shaft was left in place Dr. Bill’s treatment was to make an incision to enlarge the entry wound and slide a finger down the shaft to feel the depth of the wound and determine if the arrowhead is lodged in bone. Without the shaft in place the doctor was forced to search for the arrow by making a larger incision, probing through tissue, causing more trauma, and taking more time. It was much easier for the doctor and patient if the shaft was left in tact until a doctor could remove the head and shaft as one piece. Further, there was always the danger that the arrowhead could not be found leaving the “angular and jagged head has been left buried in bone to kill – for so it surely will.” If, however, the arrowhead is removed properly the wound was likely to heal naturally.
If lodged in bone the doctor could expect to use great force to remove the head. Special instruments were usually employed for this procedure. For instance, a wire loop was often used to grasp the arrowhead, but Dr. Bill frequently reported using strong dental tooth-forceps. The doctor would guide the forceps down his finger and onto the arrowhead. Once the forceps grasped the arrowhead the finger was withdrawn and traction could be applied. Sometimes, however, the arrowhead would be lodged so deeply in bone the forceps would bend from the force of the traction used.
One method to determine if the arrowhead was lodged in bone was by “twirling the shaft,” if the shaft moved the arrowhead was declared not to be lodged in bone. The force needed to remove an arrowhead embedded in bone was surprising. In one particular case Private Bishop was hit in the upper arm near the shoulder. Dr. Bill describes his effort; “…and 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.” In 1876 Dr. Bill presented his own design of forceps specifically for removing arrowheads.
Much of the victims’ chance of survival depended where they were injured and how deep the wound. A number of injuries to the arms were reported, probably because soldiers would attempt to shield themselves with their arms and hands. If the arrow went through a limb it would usually heal normally. The entrance wound appeared as a “very small and narrow slit“ surrounded by a reddish bruise while the exit wound would be larger but without the bruise. For the treatment of this kind of wound Bill would apply “cold or evaporating lotions” and order the patient to allow the injured arm or leg to rest. Meanwhile Bill would watch for any sign of infection which he would treat with “bandages, compresses, and an early evacuation” of any drainage if necessary. Barring any infections, however, the injury would generally heal in a week.
Complications could occur, however. For instance, even though doctors knew how to treat a severed artery medical help often could not be obtained in time to stop the victim from bleeding to death. Other complications included fractures, broken bones, and severed nerves, but if the arrowhead was removed these injuries were not usually fatal. One particular example of a complication and Bill’s skill is that of Private Martin of the 3rd Infantry. Martin suffered an arrow wound to his right leg, while the arrow did pass through Martin was left with “agonizing pain” in his toes and foot. The arrow had injured a major nerve, which Dr. Bill divided to stop the pain.
One particular complication of limb wounds involved muscle contractions. If the arrowhead “scrapes the bone near the edge” it could cause a muscle contraction so forceful the metal arrowhead tip was bent to resemble a “fish-hook.” Apparently this complication was common enough for Bill to write “that the digital examination of arrow wounds should always be practised” because if the arrow head is bent upward pulling on it would only injure the victim more. Two precautions should be taken. First, the doctor should 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 the removal “in order to prevent the entangling” of the hook in any tissue. Bill treated two men who suffered this complication. In the first injury the arrowhead had wrapped around the ulna, in the forearm, and the second around the fibula, in the lower leg.
Some of Bill’s most interesting cases involved the head. Bill reports on a total of five head wounds, in three of the cases the brain was wounded and two men died and in the two cases where the brain was not injured both men lived. Unless the arrow was fired straight at the head from a short distance it usually did not penetrate the skull. According to Bill the danger of a headshot came mainly from compression of the outer table of the skull since few arrows reached the brain itself. The result of cerebral compression can include unconsciousness, slowed respirations, high blood pressure, fever, and rapid pulse. Thus, the doctor would have to not only remove the arrowhead but also trephine the skull to release the pressure. However, usually fatal were hits to the “orbit” or eye socket but Bill never treated this particular wound himself.
A post guide named Miguel was hit on the left side of his skull by a Utah’s arrow. By the time Miguel reached Bill someone had removed the shaft and Miguel was suffering from the symptoms of compression sickness. Bill prepared to trephine the skull after he removed the arrowhead. However, once the arrowhead was dislodged “symptoms of compression at once vanished, the man turned over and sneezed, and rose up on his feet.” Later Miguel had to be treated for a headache but otherwise recovered fully.
A great deal of Dr. Bill’s essay deals with wounds of the trunk. The chest and abdomen represents the largest part of the human body and houses the majority of the major organs; the bowmen knew that a hit to the trunk was likely to be fatal so, that is where they aimed. Thus, the trunk received more injures than other area of the body. Moreover, particular care had to be allotted for all trunk injuries until the location and depth of the wound could be ascertained because any arrowhead could be potentially lodged in the spine, which was usually fatal. Bill would use his knowledge of anatomy and arrow wounds to ascertain if an arrowhead was more likely to be lodged in a rib or vertebrae from the length of the exposed shaft.
An arrow wound to the lung, explains Bill, is much more dangerous than a gunshot wound for three reasons; amount of blood loss, infection, and emphysema. For example, arrow wounds cause more bleeding than gunshot wounds because an arrow “makes clean slits and punctures” while a “ball tears and bruises.” Bill also explains arrows tend to lodge themselves in the lung “whilst a ball generally passes” causing empysema, an infection in the body cavity. Bill states the "third danger peculiar to arrow wounds of lung is the supervention of emphysema" about twelve hours after the injury occurred. Emphysema is a condition where the air spaces in the lungs are distended causing difficulty in breathing. However, Bill goes on to say that the onset of emphysema is more of a nuisance than danger.
Of the fifteen men Bill saw with chest wounds six had injured lungs, four of them died. Of the nine men without injuries to the lungs all survived. The wide range of chest injuries Bill encountered demonstrates the nature of complications possible. From the five detailed cases included chest wounds were usually accompanied by infections, such as the case of Salvador Martinez. An arrow entered Martinez ‘s chest “between the fifth and sixth ribs on the right side, and passed out between the seventh and eighth on the left.” When Martinez saw Dr. Bill he was having difficulty breathing and in great pain. Bill treated Martinez aggressively for sixteen days but was unable to save him. Upon a postmortem examination Bill found the right lung “solidified and engorged with pus” and the left lung also full of infectious matter.
Abdominal wounds also proved to be exceedingly dangerous because unlike the lungs the abdomen is not protected by the rib cage. These wounds were so dangerous that Mexicans soldiers were known to wrap blankets around their middle to keep the arrows from penetrating the abdominal cavity. Of Bill's twenty-one abdominal cases all but one was fatal.  As Bill states “Arrow wounds of the abdomen are generally fatal. An arrow can scarcely pass through the abdomen and fail to open a vessel or wound an intestine.” If the abdominal wall is breached the main threat is from a hemorrhage or an infection resulting from a punctured intestine. Bill recommends enlarging the wound in order to examine the abdominal cavity. If the intestines are lacerated gold wire was used to suture the injury. Again the arrowhead must be removed if the patient was to have a chance at recovery.
Overall Bill reports he “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. Bill suggests that since the trunk injuries are more likely to be fatal that soldiers wear protective clothing. For example, many Indians wore bull’s hide to help protect their chests and abdomens. Bill even suggests that “the recently invented ‘bullet proof vests’ might be better adapted to the service.” His certainty that protective vests would greatly lessen the number of fatal arrow wounds, especially on the plains, went unheeded.
Long after the end of the Civil War fighting with various Indian groups continued in the American West. Settlers and soldiers continued to come into conflict with Indians as the white hunger for land raged across the continent. Bill was correct when he stated the topic of arrow wound treatment was “for some time likely to be, of practical importance.” His observations from treating the wounded as well as his empirical postmortem research provided the medical community then and the history community today with the only documentation for the nature and treatment of arrow wounds.
 A. Scott Earle, ed., Surgery in America (New York: Praeger, 1983), 228.
 Ibid., 228, 230.
 Joseph Howland Bill, "Notes on Arrow Wounds," American Journal of Medical Sciences 154 (1862): 365.
 Bill, 366.
 Ibid., 387, 365.
 Edward Langworthy, Memoirs of the Life of the Late Charles Lee, Esq. (New York: T. Allen Booksellers and Stationer, 1793), 155.
 H. Henriette Stockel, "The Arrows that Wounded the West, " Wild West 10 no3 (October 21, 1997), 51 and Bill, 366.
 Stockel, "The Arrows that Wounded the West, " 51.
 Bill, 365.
 Colonel Richard Irving Dodge, Our Wild Indians: Thirty-three Years’ Personal Experience Among the Red Men of the Great West (New York: Archer House, 1959): 416-417.
 Stockel, "The Arrows that Wounded the West, " 51.
 Bill, 366.
 H. Henriette Stockel, The Lightning Stick: Arrows, Wounds, and Indian Legends (Reno: University of Nevada Press, 1995), 47-48.
 Ibid., 366-367.
 Bill, 368.
 Stockel, The Lightning Stick, xii.
 Bill, 369.
 Dodge, 420.
 Ibid., 374.
 Ibid., 370.
 Ibid., 367.
 Ibid., 368.
 Stockel, "The Arrows that Wounded the West, " 53, ibid, 367.
 Ibid., 370.
 Ibid., 367.
 Ibid., 381.
 Ibid., 371.
 Earle, 238.
 Bill, 369.
 Ibid., 370.
 Ibid., 371.
 Ibid., 372-373.
 Ibid., 373.
 Ibid., 379.
 Ibid., 368.
 Ibid., 375.
 Clayon Thomas, M.D., Taber's Cyclopedic Medical Dictionary 18th Edition (F. A. Davis Company, Philadelphia, 1997): 426
 Taber’s, 1992.
 Bill, 374.
 Ibid., 375.
 Ibid., 376.
 Ibid., 380.
 Ibid., 382.
 Ibid., 376-377. Taber's, 630.
 Bill, 377.
 Taber’s, 629.
 Bill, 377.
 Ibid., 368.
 Ibid., 378.
 Ibid., 376.
 Ibid., 385.
 Ibid., 385-386.
 Ibid., 386.
 Ibid., 365.