Dr J J CHISOLM'S TALISMAN - THE SYRINGE

THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Keith Souter aka Clay More

Six months ago I wrote a post about the history of the hypodermic syringe. I said it then and I say it again now, it is one of the most important developments in medicine. It eventually also greatly facilitated the process of vaccination. Since I have been vaccinating over those six months I have used and discarded  at least several hundred syringes, because of course nowadays each syringe is used only once. 

In the early days a single hypodermic syringe was a prized possession that would be used multiple times.

A Short recap

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, who i am proud to say was born in my hometown of Cupar in Scotland 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)

The Civil War -  missed opportunity to help so many

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 in the Union Army. Many thousands of men could have benefitted from its use.

 Dr John Billings (1838-1913)

Dr Billings would go on to become one of the most prominent physicians and librarians in American medicine. Indeed, after the war he developed Index Medicus a bibliographic index of medical articles from journals all over the world. It ran from 1879 until 2004. As a young medical student and then as a hospital doctor I used it extensively to research papers in medical libraries. Medical historians have called it 'America's greatest contribution to medical knowledge.' I think few doctors of my and earlier generation s would disagree with that. 

  A mid-19th century hypodermic syringe

Dr Julian John Chisolm (1830-1903)

I have written several posts about Dr Billing's counterpart during the Civil War.  Julian John Chisolm, often referred to as John Julian Chisolm, or as J.J. Chisolm was born in Charleston, South Carolina in 1830. He obtained his MD medical degree from the Medical College of South Carolina in 1850, then travelled to Europe to study medicine and surgery in Paris and London.

Dr Julian John Chisolm (1830-1903)

He returned to Charleston in 1860 and took up the post of Professor of Surgery at the Medical College, from whence he had graduated a decade previously. He kept the position throughout the War and in 1861 published the first edition of his textbook A Manual of Military Surgery for the use of Surgeons in the Confederate States Army.

Dr Chisolm's 'talisman'

This book is a rich source of information about medical and surgical treatment during the Civil War. In it, Dr Chisolm also advocates the use of the syringe and the injection of morphine. 

Hes says:   " by the use of this simple process, a new and extensive field for doing good is open to the humane military surgeon, and he who is the fortunate possessor of this talisman (a Wood's endermic syringe - see above) will receive daily the thanks and blessings of his suffering patients.'

And he gives several cases as examples, of which this is one.

Captain M was accidentally shot in the neck with a Colt's pocket revolver. His head being turned, the ball entered the skin over the larynx, coursed downward and backward through the posterior triangle of the neck, and was found under the skin of the shoulder over the spine of the scapula, and was removed. 

Posterior triangle of the neck

Considerable swelling and extravasation followed, which, diffusing itself, discoloured that side of the neck. Some branches of the brachial plexus of nerves (the nerve supply to the upper limb) must have been injured by the ball, as the patient was seized with violent  pains shooting down the arm towards the fingers, and which, although never altogether absent, would increase to torture as evening advanced. Toward morning they would remit and allow sleep, after a restless and painful night. Gum opium and morphine in large doses, gave him no relief. the arm was so sensitive that he would not permit its being handled. One fourth of a grain of morphine, in three or four drops of water, was injected under the skin of the shoulder; in five minutes all pain had left him, and his arm could be examined rudely without the slightest suffering. 

Although other cases of gunshot woulds could be detailed in which the endermic use of morphine gave immediate and entire relief from pain, the above recital will suffice as proof of its decided usefulness. 

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