Doctor's Review: Medicine on the Move

October 2, 2014
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Needle trade

Believe it or not, the simple syringe was centuries in the making

Until relatively recently, the effectiveness of therapeutic tinctures and tonics was greatly limited by the clumsiness with which they were administered. While swallowing pills and potions had their place, and the creative application of clysters and creams provided some comfort, nothing compares with having direct access to a patient’s bloodstream. Today, the brilliant perfection of a hollow needle attached to a simple syringe provides billions with improved health and longer lives, from preventing viruses via inoculations and treating the daily ups and downs of diabetics, to alleviating pain with anesthetics and fighting cancer with chemotherapy.

The eye of the needle

By most accounts, the true inventor of the hypodermic needle was an 11th-century Iraqi physician with an interest in ophthalmology. Though Ammar ibn `Ali al-Mawsili’s major work, Choice of eye diseases, may sound more like a menu than a medical manuscript, in it he chronicles his creation of a thin metal tube and accompanying glass syringe, which he used to suck cataracts off the surface of a patient’s eye. While the treatment itself wasn’t popular in its time, the medieval medicine man’s main contribution would always be his nifty needle.

The next breakthrough in subcutaneous injection was a long time coming. A device able to suck cataracts off the surface is one thing, but a needle thin enough to pierce through skin was another entirely. Until then, physicians wanting to deliver drugs directly into a vein would have to slice through skin in order to do so.

Literature records attempts to solve the problem throughout the 17th century, most notably in 1656, when famed English architect Christopher Wren (1632-1723) dabbled in doctoring with his effort to directly “conveigh liquors immediately into the mass of blood.” He attached a quill to an animal bladder, which he filled with various liquids and injected into his patients’ tied-off veins. His patients were dogs, none of which likely fared too well. Wren’s veterinary venesections were most notable, perhaps, for the fact that one of the liquids he tried out on the hapless hounds was an opiate solution. And so, while heroin addiction may have been born that fateful day, the hypodermic needle had yet to be perfected.

Injection perfection

The innovation is commonly believed to have arrived at last in 1853, when two doctors — a French physician and Scottish surgeon — simultaneously solved the problem. However, the ivory-handled, hollow, metal needle invented by Irishman Francis Rynd (1801-1861) in 1844, which he used to inject pain medication into patients, was the early precursor of the device. For some reason, Rynd didn’t publish his results until 1861, though recent research has shown that a patent was filed on the device. And so, Rynd is indeed the rightful and respected father of the hypodermic needle. The monopoly of oral medication was over.

In order to treat an aneurysm with a direct injection of ferric chloride, French orthopedic surgeon Charles Gabriel Pravaz (1791-1853) of Lyon created a hollow needle in 1853. It was so fine that his syringe is widely credited with being the first to promise widespread painless and practical applications. The actual dose of medication was meted out through Pravaz’s syringe by tightening a screw.

That same year, Alexander Wood (1817-1884) of Edinburgh also devised a metal hypodermic syringe able to inject medication directly into his patients’ bloodstreams. While Pravaz used his syringes to treat aneurysms, Wood was more interested in using his to combat people’s pain. Wood’s paper, “A new method of treating neuralgia by the direct application of opiates to the painful points” in The Edinburgh medical and surgical review, reports the first case in which a hypodermic needle and syringe were used successfully with therapeutic results. Sadly, Wood’s preoccupation with morphine had devastating personal results; not only did his experiments on his wife lead to her addiction to the concoction, but she ultimately succumbed to a fatal accidental opiate overdose — the very first one on record.

Piercing progress

It soon became apparent that sometimes, pulling stuff out was as effective, if not more effective, than putting stuff in and specialists across the scientific spectrum revelled in the new opportunities afforded by the hypodermic needle and syringe. Drawing blood, draining abscesses, removing bodily fluids of all kinds opened previously unknown diagnostic and therapeutic doors. Where once a scalpel would have been needed to accomplish the same task — along with the attendant surgical risks of infection and bleeding — all was less problematic now that the new needles were here.

After Pravaz and Wood, most of the advances in the hypodermic needle and syringe revolved around improving the already decent device. Adding a plunger to the setup was an obvious step, based in part on the work of another French doctor, Dominique Anel (1679-1730), who invented the plunger syringe to simplify suctioning during surgery. As time marched on, the sizes of syringes also became standardized, allowing the parts of various devices to become interchangeable and increasing the ease with which large collections of syringes could be put back together following sterilization.

In 1949, the American physician Arthur E. Smith created the first disposable glass syringe, though it would be a few more years until the medical technology company Becton, Dickinson & Co. began mass-producing them in 1954. Interestingly enough, there was a specific impetus behind the mass production of syringes that year: more than one million kids were waiting to receive Jonas Salk’s brand-new polio vaccine, nationally available at last.

Leery of lawsuits

Just a year later, a company known as Roehr Products got in on the game by offering the first disposable plastic syringes, whose benefits over glass were obvious in both their hardiness and lower production cost — only five cents a shot! The true reason behind the company’s desire to create disposable syringes, however, was not so much altruistic or even capitalistic as it was defensive. Even in the 1950s, a burgeoning age of American litigiousness was on the horizon, and corporate bigwigs feared the lawsuits that might arise from diseases spread by reusing glass syringes.

Still, most physicians felt sterilizing glass syringes was good enough. It would take a tragedy to change their minds. Which is exactly what happened in 1960 following a deadly and widely publicized hepatitis outbreak in which 15 people died. After New Jersey psychiatrist Albert Weiner’s reuse of contaminated syringes to inject sedatives into his patients was found to be the cause of the outbreak, disposable plastic syringes quickly became the norm.

Despite the advent of many modern medical “improvements” to the original syringe setup, such as microneedles and jet injectors, there isn’t much out there that can compare with a hypodermic needle. Whether you’re a plastic surgeon injecting botulinum toxin into a creased forehead, a diabetic self-injecting insulin multiple times a day, or a lab worker drawing blood, the practice of medicine, the prevention of disease and the management of patients’ health simply wouldn’t be the same without the direct access to the blood and body provided by the good old-fashioned hypodermic needle.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

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