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. 

*****

THE HISTORY OF THE PILL AND THE SYRINGE

- 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

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 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.

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. 

*****

THE DOCTOR'S BAG

THE PILL AND THE SYRINGE 

- pushing back the frontiers of Medicine

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

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 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 cation of a bee sting, so he used a hollow needle that could be attached to a metal syringe.  He used t 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.

Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. 

Logan has been in Books 1, 4 and 6, and 8 and appears in the second Christmas anthology O DEADLY NIGHT in the story THE SPIRIT OF HOGMANAY 

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in RATTLER'S NEST in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

DOUBLE-DEALING AT DIRTVILLE was originally published by Hale as a Black Horse Western, but is now available as an ebook from Western Fictioneers Library.