- pushing back the frontiers of Medicine
Back in 2013 when I wrote this post for The Doctor's Bag blog I did not expect to be wielding a syringe as much as I am today in 2021. But no-one could have predicted the Covid-19 pandemic. The development of the various vaccines has been a phenomenal scientific achievement and the vaccination programmes that are going on in countries around the world gives us hope to escape the shackles of this dreadful pandemic.
Nowadays we take our pills, tablets and injections for granted. But they were all major developments in the history of medicine. The hypodermic syringe was a relatively recent invention, which as a vaccinator I am really grateful for. It is so simple, but its importance has never been so evident as it is today.
Let's start with Gunsmoke!
If you are a Gunsmoke fan you will doubtless have been amazed at how many medicines Doc Galen Adams crammed into that old black bag of his. He was prepared for any eventuality and would always have something that he could give to relieve the sick or injured.
Back in Wolf Creek Doc Logan Munro tries his best to stay up to date with modern medicine and surgery. He makes up all of his own medicines, often using herbs or traditional remedies that he has picked up along the way or been alerted to by Charlie Blackfeather.
But the way that the medicines were given is interesting, because in medicine you want to present a drug to the body in the most effective way that you can.
The invention of the pill
We must go back into the mists of time to look at a great boon to mankind, the development of the pill as a means of delivering medicine.
The ancient Egyptians seem to have been the first to come up with the idea. There are ten medical and surgical papyri, which detail treatments used in the days of the pharaohs. The Ebers papyrus, written about 1550 BC contains recipes for all manner of enemas, lozenges and pills. These early pills were hard compressed balls of clay or bread. In addition, they sometimes used the faeces of various creatures.
Now I guess you may have turned your nose up in disgust at that last sentence. But consider the times they lived in, with a pantheon of over 400 gods and goddesses. The world was a mystical place organised by the deities, and the priesthoods had rituals that covered just about every activity that could be undertaken.
The scarab, the dung beetle rolled a ball of dung in order to lay its eggs inside it. This the Egyptians believed was symbolic of the god Khepri, the scarab-headed god, who rolled the sun across the heavens each day.
The dung beetle rolling the ball was thought to be symbolic of the god Khepri
Rhazes (865-925 AD)
A century later another Persian polymath, known as Avicenna (980-1037 AD) further improved it by coating his pills in silver or gold leaf. In an age of alchemy, precious metals were thought to enhance the effectiveness of medicines. An interesting boost to the placebo effect.
Avicenna (980-1037 AD)
The first London Pharmacopoeia
A Pharmacopoeia is a book of drugs with all of their ingredients, actions and side effects. The first London Pharmacopoeia of 1618 contained recipes for 38 pills. Of these, 23 were derived from medical works written in Arabic. Two were from Avicenna and one from Rhazes.
This photograph shows a sample page detailing a purgative pill devised by Avicenna - Pilule Pestilentiales Ruffi.
The problem of bioavailability
Bioavailability means the readiness with which a drug can be absorbed and allowed to reach its target organs. The pills that had been in use for centuries often had poor bioavailability because the material they were encased in didn't break down in the intestines. In many cases it would be like swallowing and trying to absorb buckshot.
In 1834 the French pharmacist Mothes devised the gelatin capsule, which could be used to contain liquids or powders.These are still used today.
A real breakthrough came in 1884 when Dr William Upjohn (1853-1932) patented a 'friable pill,' which was made by compressing powder into a pill shape. This would then dissolve in the stomach and be absorbed quickly. It had good bioavailability.
Dr Upjohn lived, qualified and practiced in Michigan. He knew that his invention was a winner, the problem being to persuade other doctors to use his friable pills rather than their own hard pellets. He did it by sending thousands of pine boards along with traditionally made pills and his own friable pills to doctors all over the country, inviting them to try to hammer the traditional pills into the board. They often did so without breaking, showing how hard it was for the body to absorb. In comparison, one of his friable pills could be turned into powder, ready to be absorbed, merely with the pressure of the thumb. It was a brilliant and persuasive image which became the logo of The Upjohn Pill and Granule Company that he and his brother formed in Kalamazoo in 1886. It was to become one of the pharmaceutical giants of the 20th Century.
It changed the face of medicine.
The hypodermic syringe
We now come to a relatively recent invention, the hypodermic syringe. Being the sort of man that he is, Dr Logan Munro of Wolf Creek would certainly grasp its potential and soon be giving the citizens of Wolf Creek the benefits of the latest science.
Hypodermic comes from the Greek hypo, meaning 'under' and derma, meaning 'skin'. It therefore means syringing under the skin into the body.
This is one of the most important inventions in medicine, for it gave doctors a means of delivering drugs into the patient's system, by-passing the gastro-intestinal tract. That is often a good thing to do, especially if the person has an inflamed stomach or if they are vomiting and unable to keep anything down. But it wasn't invented until the mid-nineteenth century.
Syringes had been used in medicine for centuries, but for introducing fluid into bodily orifices, or to suck out fluids or pus. Some attempts to give drugs by injecting them into the body were made in the early seventeenth century, but they were not successful and fatalities did occur. In those days it would be highly likely that infections would have been directly introduced to the tissues.
The first necessity was to produce a hollow needle. This was done by Dr Francis Rynd (1801-1861) an Irish surgeon in 1843. He successfully develop a technique with a hollow needle for injecting opiates to treat neuralgia.
Dr Thomas Wood (1817-1884) a Scottish physician invented the first hypodermic syringe in 1853. Apparently he tried to copy the action of a bee sting, so he used a hollow needle that could be attached to a metal syringe. He used it to inject morphine and other opiates in the treatment of neuralgia, which was at that time an umbrella label for all manner of painful conditions.
Dr Thomas Wood (1817-1884)
During the Civil War most surgeons simply dusted morphine into wounds or gave opium pills. Dr John Billings (1838-1913), a Lieutenant Colonel in the Union Army was the first doctor to use a hypodermic syringe in the field. Despite his advocacy of it, however, probably less than a dozen were used during the war.
Dr John Billings (1838-1913)
Dr Billings would go on to become one of the most prominent physicians and librarians in American medicine.
A mid-19th century hypodermic syringe
Syringes are used to inject subcutaneously (just under the skin), intra-muscularly (into the muscle) and intra-venously (directly into the blood stream through a vein). It is important to expel any air when giving an intra-venous injection, sine an air bubble can travel throughout the circulation as an air embolism. It can have the same effect as a blood clot and could produce a heart attack, stroke or chest pain. They can be rapidly fatal. It is for this reason that you see doctors invert a syringe, as in the position in the photograph, tap it to get any air to the top of the syringe, below the aperture of the needle, then squirt some fluid out. This is to get rid of air bubbles to prevent an embolism.
If you are a Gunsmoke fan you will doubtless have been amazed at how many medicines Doc Galen Adams crammed into that old black bag of his. He was prepared for any eventuality and would always have something that he could give to relieve the sick or injured.
Back in Wolf Creek Doc Logan Munro tries his best to stay up to date with modern medicine and surgery. He makes up all of his own medicines, often using herbs or traditional remedies that he has picked up along the way or been alerted to by Charlie Blackfeather.
But the way that the medicines were given is interesting, because in medicine you want to present a drug to the body in the most effective way that you can.
The invention of the pill
We must go back into the mists of time to look at a great boon to mankind, the development of the pill as a means of delivering medicine.
The ancient Egyptians seem to have been the first to come up with the idea. There are ten medical and surgical papyri, which detail treatments used in the days of the pharaohs. The Ebers papyrus, written about 1550 BC contains recipes for all manner of enemas, lozenges and pills. These early pills were hard compressed balls of clay or bread. In addition, they sometimes used the faeces of various creatures.
Now I guess you may have turned your nose up in disgust at that last sentence. But consider the times they lived in, with a pantheon of over 400 gods and goddesses. The world was a mystical place organised by the deities, and the priesthoods had rituals that covered just about every activity that could be undertaken.
The scarab, the dung beetle rolled a ball of dung in order to lay its eggs inside it. This the Egyptians believed was symbolic of the god Khepri, the scarab-headed god, who rolled the sun across the heavens each day.
The scarab was the ancient Egyptian symbol of birth, regeneration and renewal as well as being used as a powerful talisman for health. It has been suggested that priest physicians invoked Khepri when they made their remedies, which they did as these crude pills, like the dung beetle.
Coating the pill
The basic design for the pill lasted almost 2,500 years until the Persian physician Rhazes (865-925 AD) improved upon it by giving it a coating. By using a psyllium-seed mucilage the solved the problem of the nauseating or bitter tasting pill.
Rhazes (865-925 AD)
A century later another Persian polymath, known as Avicenna (980-1037 AD) further improved it by coating his pills in silver or gold leaf. In an age of alchemy, precious metals were thought to enhance the effectiveness of medicines. An interesting boost to the placebo effect.
Avicenna (980-1037 AD)
The first London Pharmacopoeia
A Pharmacopoeia is a book of drugs with all of their ingredients, actions and side effects. The first London Pharmacopoeia of 1618 contained recipes for 38 pills. Of these, 23 were derived from medical works written in Arabic. Two were from Avicenna and one from Rhazes.
This photograph shows a sample page detailing a purgative pill devised by Avicenna - Pilule Pestilentiales Ruffi.
The problem of bioavailability
Bioavailability means the readiness with which a drug can be absorbed and allowed to reach its target organs. The pills that had been in use for centuries often had poor bioavailability because the material they were encased in didn't break down in the intestines. In many cases it would be like swallowing and trying to absorb buckshot.
In 1834 the French pharmacist Mothes devised the gelatin capsule, which could be used to contain liquids or powders.These are still used today.
A real breakthrough came in 1884 when Dr William Upjohn (1853-1932) patented a 'friable pill,' which was made by compressing powder into a pill shape. This would then dissolve in the stomach and be absorbed quickly. It had good bioavailability.
Dr Upjohn lived, qualified and practiced in Michigan. He knew that his invention was a winner, the problem being to persuade other doctors to use his friable pills rather than their own hard pellets. He did it by sending thousands of pine boards along with traditionally made pills and his own friable pills to doctors all over the country, inviting them to try to hammer the traditional pills into the board. They often did so without breaking, showing how hard it was for the body to absorb. In comparison, one of his friable pills could be turned into powder, ready to be absorbed, merely with the pressure of the thumb. It was a brilliant and persuasive image which became the logo of The Upjohn Pill and Granule Company that he and his brother formed in Kalamazoo in 1886. It was to become one of the pharmaceutical giants of the 20th Century.
It changed the face of medicine.
The hypodermic syringe
We now come to a relatively recent invention, the hypodermic syringe. Being the sort of man that he is, Dr Logan Munro of Wolf Creek would certainly grasp its potential and soon be giving the citizens of Wolf Creek the benefits of the latest science.
Hypodermic comes from the Greek hypo, meaning 'under' and derma, meaning 'skin'. It therefore means syringing under the skin into the body.
This is one of the most important inventions in medicine, for it gave doctors a means of delivering drugs into the patient's system, by-passing the gastro-intestinal tract. That is often a good thing to do, especially if the person has an inflamed stomach or if they are vomiting and unable to keep anything down. But it wasn't invented until the mid-nineteenth century.
Syringes had been used in medicine for centuries, but for introducing fluid into bodily orifices, or to suck out fluids or pus. Some attempts to give drugs by injecting them into the body were made in the early seventeenth century, but they were not successful and fatalities did occur. In those days it would be highly likely that infections would have been directly introduced to the tissues.
The first necessity was to produce a hollow needle. This was done by Dr Francis Rynd (1801-1861) an Irish surgeon in 1843. He successfully develop a technique with a hollow needle for injecting opiates to treat neuralgia.
Dr Thomas Wood (1817-1884) a Scottish physician invented the first hypodermic syringe in 1853. Apparently he tried to copy the action of a bee sting, so he used a hollow needle that could be attached to a metal syringe. He used it to inject morphine and other opiates in the treatment of neuralgia, which was at that time an umbrella label for all manner of painful conditions.
Dr Thomas Wood (1817-1884)
During the Civil War most surgeons simply dusted morphine into wounds or gave opium pills. Dr John Billings (1838-1913), a Lieutenant Colonel in the Union Army was the first doctor to use a hypodermic syringe in the field. Despite his advocacy of it, however, probably less than a dozen were used during the war.
Dr Billings would go on to become one of the most prominent physicians and librarians in American medicine.
A mid-19th century hypodermic syringe
Syringes are used to inject subcutaneously (just under the skin), intra-muscularly (into the muscle) and intra-venously (directly into the blood stream through a vein). It is important to expel any air when giving an intra-venous injection, sine an air bubble can travel throughout the circulation as an air embolism. It can have the same effect as a blood clot and could produce a heart attack, stroke or chest pain. They can be rapidly fatal. It is for this reason that you see doctors invert a syringe, as in the position in the photograph, tap it to get any air to the top of the syringe, below the aperture of the needle, then squirt some fluid out. This is to get rid of air bubbles to prevent an embolism.
VACCINE NOTE: With the Covid vaccines we do not tap the syringe to remove air bubble. In some of the vaccine syringes we are using there is vaccine in the needle and every last drop is vital. But fear not, we remove air into the vial and since this is an intramuscular injection there s no risk of embolism.
*****
I really enjoyed your post, sir. The origins of and administering of new medical procedures I find very interesting. Thank you.
ReplyDeleteThanks, Jerry. We can take some of these things so much for granted. The needle gauge is another important thing. The really small gauges have allowed dental injections to be so small that they are almost painless.
DeleteKeith, as always, a wonderful, informative post. I always love to read what you've written. I learn so much from your blogs!
ReplyDeleteThank you, Cheryl. That is kind of you to say.
DeleteLoved this. A fascinating insight into the beginnings of delivery of drugs in the 19th century and beyond.
ReplyDeleteMany thanks. The syringe was a great advance, but it was the introduction of aseptic techniques that made its use safe.
DeleteFascinating, as all of your posts are! We pharmacist-vaccinators have been told that thumping the COVID vaccine to rid the syringe of bubbles can actually harm the vaccine's integrity, so we don't tap or thump either ... just draw in a bit of air and trap the bubbles in the air pocket.
ReplyDeleteThanks, Jes. It is different to the way we were taught, but each drop of the vaccine is so important.
DeleteInteresting as always! Thank you.
ReplyDeleteThank you, Vicky. So many things in life can be taken for granted, but when you delve a little deeper you find so much thought and inventiveness went into them over decades, with prototypes and then different versions until you end up with the streamlined product in use today.
DeleteThank you! So necessary for anyone writing Western fiction.
ReplyDeleteThanks, Carolyn. That is certainly my aim, to date instruments and procedures so that they can be slipped into stories if they are appropriate time-wise.
DeleteVery interesting and informative post, Keith, as always. I never knew that Civil War doctors dusted morphine into the wounds. I always assumed the medicine was ingested. Thanks for a great post.
ReplyDeleteThank you, Michael. It must have been incredibly difficult practising during the Civil War. So many amputated limbs and the complications that would ensue. The agony of the wounded, many of whom would not be able to take oral medication. Surgeons would be creative and do their best.
DeleteAmazing, Dr. Keith! Always learn something new with your posts. Thanks!!
ReplyDeleteThanks, Meg. The syringe has been an amazing invention, but we still have to coax many people who are needle phobic.
DeleteBrilliant as usual. I found it very informative and so glad you posted it. Thank you. Doris
ReplyDeleteThanks, Doris. It seemed an apt one for today as we try to vaccinate the world.
Delete