Shooting Up: Development of the Hypodermic Syringe

Richard Li is a second-year chemistry major at Grinnell College. He is a member of the Chemistry Student Educational Policy Committee and works at ITS. Outside of schoolwork he enjoys music, tv shows, hiking and adventures.

When you try to make an appointment with a doctor today, you can choose to visit either your primary care physician, or a specialist in the area you are having problems with. Each of these employs the unique instruments that allow them to do their specific job. However, there is one instrument that is almost universal in its use by health care professionals throughout the world, and that is the hypodermic syringe and hollow needle (hereafter referred to as a syringe). Among the plethora of complex instruments, computers, and technologies that we use on an everyday basis to help patients, it is easy to forget where we started, and how we have sought to continuously improve the way we provide healthcare to the public. The most common use for the syringe up until vaccinations became the norm was pain relief. Prior to the mid-1800s, however, there was no effective way to directly deliver medicines to affected areas of the body.

For the most part, major developments of medical tools occurs synonymously with need. For example, a new surgical stapler was created to allow Colon & Rectal surgeons easier access to the pelvic region when performing lower-anterior colon resections on biological females. Surgeons were having a harder time using the current surgical stapler because the uterus was getting in the way of the optimal depth and angle for the cut, so a new stapler was developed to aid in this procedure. The syringe was not exempt from this supply and demand dynamic, and the device evolved through many different forms to get to where it is today. To what extent did major developments in history play a role in the transformation of the syringe? Especially considering the syringe has not undergone any major change within the last 50 years, is the current version of the syringe the ideal? Is there any way to continue to improve the device’s functionality, utility, or effectiveness?

Dr. Alexander Wood (1817-1884) is largely accredited with the first usage of a hypodermic syringe with a hollow needle. He published his successful results from using a syringe with a tip fine enough to pierce skin, and once he refined the design with a thinner needle, people started to adopt the use of the device universally.[1] His motivation for the use was the observed ineffectiveness of traditional methods of pain medication and medicine delivery. Seeking to find a quicker and more accurate way to deliver the medication, he fashioned a syringe originally used for nevus (birthmark) removal.[2] When the opiate morphine was injected into his first patient suffering from neuralgia, after a long sleep, the patient’s neuralgia never returned. Wood continued to experiment further with an additional nine case studies before convincing another doctor to try the procedure with success. Wood eventually wrote an account of these studies and their effects to recommend a venture to put this procedure to trial. Based upon the previous studies, he ultimately stipulated that the syringe “affords a safe, easy, and almost painless method of exhibition [of medicine].”2 In addition to patients, Wood also treated his wife for neuralgia.

The very early stages of the syringe started out as a hard rubber tube with a needle attached. Glass barrels soon replaced the rubber, but they required the use of a piston made of leather. The piston’s role would be to expel the fluid inside out. However, a seal would be needed to ensure the liquid would not leak out by itself. Thus, oiled leather was employed to create that seal. This version could be considered effective, if the glass and leather mechanism was not fraught with problems. Namely, the leather had to be consistently used or oiled to prevent shrinking or cracks, which would render the syringe worthless. Even when properly oiled and stored, the leather was prone to loosening or changing shape, thereby loosening the necessary seal.[3] This early version was developed because physicians wanted a faster and more accurate way to deliver pain medication to patients. Prior to the syringe, patients were given oral tablets of morphine, but the problems with tablets was the time it took for the morphine to take effect and the effect the gastrointestinal tract had on the medication itself.

Clearly, a newer iteration of the syringe was needed. The next form of the syringe would be made completely out of metal. Grinding the two cylindrical metal barrels together would create a perfectly shaped and warp-resistant syringe. In fact, the design was so effective that many physicians adopted this version of the syringe for use in their own practice. Unfortunately, although this design solved the leakage issue, it created another problem. Since the syringe barrel was made of metal, doctors were not able to visually see how much medication they were giving to patients, and had to rely on a scale marked on the piston itself. Even though doctors were unable to see exactly how much medicine they were giving to their patients, the reliability of the syringe was solved. Of course, this metal syringe was still far from ideal.

Ultimately, a third type of syringe became adopted, which included a metal piston ground to the size of a glass barrel. Some variants of those syringes also had the glass barrel encased in metal. This allowed the doctors to see how much fluid they were injecting into their patients, yet also prevented breaks in the seal. This development was critical as the complexity of manufactured drugs increased.

One of the different versions of the syringe that was invented due to need includes the syrette. The syrette is a single-use, single-dose of morphine that was given to medics in World War II.[4] It was developed to allow an easier way to administer an appropriate amount of morphine to casualties in the quickest manner possible. By eliminating the need to measure out a dose and disinfect the syringe afterwards, the syrette would allow the medics to ease the pain of more soldiers.

While the hypodermic syringe was emerging, a surge of new medicines, technologies, and sciences was also emerging throughout the nation. In particular, these medicines and technologies gave rise to the problem of addiction. The ability for factories to manufacture and distribute cheap and effective hypodermic syringes meant that although doctors could now order more syringes at a lower cost for patients, so too could the public order syringes to fuel their drug addiction. In fact, Julie Schablitsky, an archaeologist, found an early-mass-production glass syringe under the remains of a 19th-century home in Nevada, which she tested for DNA and found that four different people had used the syringe.[5] Becton Dickinson, a medical supply and technology company founded in 1897, states that in “1920, only 100,000 syringes were manufactured worldwide…[but] by 1930, global production had reached 2 million units per year, increasing to 7.5 million by 1952.”[6] Unfortunately, addiction to drugs was not something that many doctors had experience with, and certainly not with morphine. With this increase in mass production and use of syringes, the ease in which the general public was able to overdose on medications dramatically increased. It was in this time period that the idea of modernity started to emerge, and it eventually played a critical role in characterizing the addict, showing both a loss of agency due to dependence on the drug as well as a gain of agency in transcending old traditional values and ideas.[7]

In addition to problems with drug addiction, the increase in syringe availability and usage also created sterilization issues. In 1927, the American Journal of Public Health published an article outlining the necessity of cleanliness of the procedure of hypodermic injection.  They cite case studies from other physicians who administered drugs via hypodermic injection that resulted in death. In the cases where a patient did not die, many developed bacterial infections. The journal urges that a surgical precaution be applied to the use of the syringe, as the injections are in fact surgical procedures. The efficaciousness of the syringe is also called into question by the journal, stating that “the very expert methods of salesmanship employed by manufacturing houses have induced many physicians to adopt methods of medication which have no sound basis.”[8] A survey by Dr. Kane who was collecting statistics on the hypodermic injection of morphine found that many doctors throughout both the United States and Europe are administering morphine via hypodermic injection.[9] However, he also found that many doctors had been using it too often and without thought of a more efficacious method with fewer side effects such as addiction. With these injections, he also found that many people developed different infections or diseases as a direct result of using the method of hypodermic injection.

It cannot be contested that the hypodermic syringe has played an important role in history, especially in the ways we can help people with deadly diseases, infections, and easing pain. Since it was invented in the mid-1800s, the syringe has gone through many different forms, based on the available technology and needs of the time. However, the path of the physician using the syringe has not been easy, with a large number of patients developing addiction and infections. In the last 50 years, the syringe has not undergone any significant changes. Is the final form of the syringe, a disposable plastic tube with a rubber piston the ideal? Can we still increase the efficacy of the syringe without needing a societal push for the development? The answer to that question remains to be seen.

Further Reading

Fred J. Spielman, “The Syringe: Getting to the Point,” Bulletin of Anesthesia History 20:3

(2002): 12-13.

Harry H. Kane, The hypodermic injection of morphia. Its history, advantages and dangers.

(Based on the experience of 360 physicians). New York: Chas. L. Bermingham & Co..

Timothy A. Hickman, “’Mania Americana’: Narcotic Addiction and Modernity in the United

States,” The Journal of American History 90 (2004): 1269-1294.

 

[1] Fred J. Spielman, “The Syringe: Getting to the Point,” Bulletin of Anesthesia History 20:3 (2002): 12-13.

[2] Alexander Wood, “New method of treating neuralgia by the direct application of opiates to the painful points,” Edinburgh Medical and Surgical Journal 82 (1855): 265-281.

[3] George L. Servoss, The Hypodermic Syringe (New Jersey: Physicians Drug News Co., 1914), 1-28.

[4] “The History of WWII Medicine,” last modified April 05, 2002, http://www.mtaofnj.org/content/WWII%20Combat%20Medic%20-%20Dave%Steinert/wwii.htm#The%20Discovery%20of%20Penicillin.

[5] Julie Schablitsky, “Genetic Archaeology: The Recovery and Interpretation of Nuclear DNA from a Nineteenth-Century Hypodermic Syringe,” Historical Archaeology 40 (2006): 8-19.

[6] Glanz Veronika, History of Aids (Lulu, 2015), 162.

[7] Timothy A. Hickman, “’Mania Americana’: Narcotic Addiction and Modernity in the United States,” The Journal of American History 90 (2004): 1269-1294.

[8] American Journal of Public Health, Hypodermic Medication (New York: American Public Health Association, 1927), 60-61.

[9] Harry H. Kane, The hypodermic injection of morphia. Its history, advantages and dangers. (Based on the experience of 360 physicians). New York: Chas. L. Bermingham & Co.