The Hypodermic Needle

Sit back. This might sting. In this episode of Invention, Robert and Joe explore the history of hypodermic needles: what came before in human and evolutionary history and where we’re going with drug injections and blood withdrawls. 

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Episode Transcript

Speaker 1 (00:03):
Welcome to Invention, a production of I Heart Radio. Hey,
welcome to Invention. My name is Robert Lamb and I'm
Joe McCormick. And today I thought maybe we could inject
ourselves into the topic for this episode by the administration
route of some poetry and Greek myth. Robert, are you

(00:23):
willing to go that route with me? Let's do it? Okay.
So this is going to be from Ovid's Metamorphoses. This
is the section on the transformation of cy rinks into reads.
And this is the translation of Ovid by John Dryden.
I'll take it first and then you can pick up.
You'll know where Robert. All right, So it begins. Then
Hermie said, thus a nymph of late there was, whose

(00:44):
heavenly form her fellows did surpass the pride and joy
of fair Arcadius planes, beloved by deities, adored by Swain's
cy rinks, her name by Sylvan's oft pursued as off
she did the lustful God's delude, the rural and woodland
powers disdained, with Cynthia hunted and her rights maintained like

(01:06):
Phoebe clad even Phoebe's self. She seems so tall, so straight,
such well proportioned limbs. The nicest eye did no distinction. No,
but that the goddess bore a golden bow distinguished thus
the sight she cheated to. Descending from Lychaeus, Pan admires
the matchless nymph and burns with new desires. A crown

(01:30):
of pine upon his head he wore, and thus began
her pity to implore. But ever he thus began, she
took her flight so swift she was already out of sight.
Nor stayed to hear the courtship of the god, but
bent her course to Leyden's gentle flood. There By the
river stopped and tired before relief from water, nymphs her

(01:51):
prayers implore. Now, while the lustful god, with speedy pace,
just thought to strain her in a strict embrace, he
feel old his arms with reads new rising on the place,
And while he sized his ill success to find the
tender canes were shaken by the wind and breathed a
mournful air unheard before that much surprising Pan yet pleased

(02:16):
him more, admiring this new music, Thou, he said, who
canst not be the partner of my bed? At least
shall be the comfort of my mind? And often often
to my lips be joined. He formed the reads proportioned
as they are unequal in their length, and waxed with care.
They still retain the name of his ungrateful fair. And

(02:40):
of course that name is the name of the nymph
in the story, the name Syrinx, which gives us the
English word syene. There is, and that's going to be
our topic for today. The hypodermic needle and the hypodermic syringe,
I guess too, slightly different things, but very much entwined
in medical history. Not so much the god's chasing nymphs

(03:01):
through the reads, right, uh yeah, So this is a
strange connection. But the next time you are getting ready
to have blood drawn or to get an injection, get
a flu vaccine or something, and you're beholding the humble
medical syringe, know that this word comes from the Greek Syrinx,
this nymph who is known for her chastity. But then

(03:23):
the great god Pan, his his eye falls to her,
and he pursues her, and she defensively praised to be
transformed into hollow reads, which become the tubes of Pan's flute.
So a couple of thoughts that this is a weird
and fascinating myth. Number one, it's the most elaborate myth
that I could possibly imagine, exploring the concept of tubes.

(03:45):
And then second, uh so, characters get transformed into a
lot of different things in these myths. Obviously it's the metamorphoses, right,
But this is a double metamorphosis, right, because she prays
to be transformed into hollow reads, and then she is,
and then those reads get transformed by Pan into a
musical instrument. I kind of feel like the Smith has

(04:06):
an unhappy ending, which, of course, of course it does not,
not out of keeping with tales of God's turning individuals
into beasts and half beasts, so you know, and they're like,
uh no, no, the bad guy wins, like I guess
she she evades Pan, but then he cuts her into
reads and makes her into a flute. Uh yeah. By

(04:27):
the way, there's also a great poem by Elizabeth Barrett
Browning about the Smith called a Musical Instrument. If you've
never read it, it's worth reading. We're not going to
read that whole poem, but um, but it's got the
great lines. What was he doing? The Great God Pan
down in the reads by the river spreading ruin and
scattering bands, splashing and paddling with hoofs of a goat,
and breaking the golden lilies afloat with the dragonfly on

(04:48):
the river. If you haven't read it, you can look
it up online and find the full text. It's great.
But anyway, so we're gonna be talking today about the
hypodermic syringe and invention that I think we really rarely
do stop to appreciate, possibly because when most of us
are encountering it, we're trying to think about it as
little as possible. Maybe we're hoping our experience with it
is over very quickly. Uh, And it makes us underappreciate

(05:11):
how important and and and life saving this invention is.
It's actually extremely useful. It's deeply underappreciated. For one thing,
it causes us to ask a question about drugs that
we rarely ask. Right, yeah, what is the best way
to get a substance into the body? Not always straightforward, right,
I mean one of our favorite ways and probably our

(05:32):
preferred ways, of course, to eat something right now, which
is simply essentially what we're doing when we have a
we take a pill, right, um, you know, chewable swallow
or whatever it happens to be um and then we
just allow our digestive system to do its job. This
is oral absorption, just one of the internal routes for
drug absorption. The other two areas are sublingual and per rectum,

(05:56):
which is by use of a suppository, So we're talking
about suppository or something that goes under the tongue um.
And then there's also inhalation and topical. We'll come back
to two topical and a little bit too inhalation going on.
But essentially, any of these methods of bringing a substance
into your body, bringing a drug into your body, they're

(06:16):
gonna be pros and cons to each of the methods,
and some are gonna work better with certain substances than
others or not at all. It just depends on what
the substances and and uh, you know, and what its
properties are and how it is going to be best
absorbed by the body. Yeah, and well, and a few
other things about like the circumstances of the administration, like

(06:38):
how quickly do you want it to take effect, how
direct like how strong do you want the dose to
be when it gets absorbed, things like that exactly. But
there is another way into the human body, and that
is the parental route, And there are several different varieties
depending on where you want to stick it, but the
basic idea is that you inject the substance into the

(06:59):
body via uh what eventually would become a hypodermic needle
or via a catheter. Yeah, so I guess to see
the quick version of why it might be important to
inject a drug when you could just take a pill.
For one thing, you can't always just take a pill,
Like the pharmacology of administration routes is way more complicated
than that. For one thing, there are obvious practical reasons

(07:22):
why a pill won't always work. Think about a local
and aesthetic. Imagine you're you're trying to numb just a
certain patch of skin or tissue somewhere on the body
to do a local operation without putting the patient completely
under right, I mean, yeah, when you go to the dentist,
and the dentist uses gives you a shot to the
area of your gums that is about to be worked upon, Like,

(07:44):
you want a very localized effect because that's where it's
happening right there, not in your stomach, right there in
your mouth exactly. But There are also tons of molecular
and metabolic reasons why a pill isn't always the best
administration route for a drug. One example is the drug insulin,
which is used to treat diabetes. Insulin generally needs to

(08:05):
be injected because it doesn't survive the digestive system. Well,
if you take an insulin pill, it doesn't survive the
acids in our stomach. So if you you are to
take insulin orally, its effectiveness would be compromised. It needs
to enter the bloodstream directly. Another example would be you
know mentioned topical. The most popular one or more top

(08:27):
popular topical um UH systems we have is of course
the like that patch, like a nicotine patch. But for
that to work, first of all, you have to be
very okay with a slow process because you're not going
to get an instant you know action there. But then
also the drug molecules have to be small enough to
pass through skin pores, and that's not always not going
to be the case. Yeah. Oh, and the size of

(08:48):
the molecules and the absorption that also comes to be
a factor within the digestive tract. Right, Like, large molecules
have a harder time getting absorbed through the walls of
the intestine or some right. So I want to come
back to the catheter for a second. So the catheter
obviously is not a hypodermic needle. It doesn't create an
opening in the skin. Rather, it makes use of one

(09:11):
of our smaller orifices, the urethra. So evidence of catheter
usage actually goes back a long time, Like we're talking
three thousand b C. With scattered mentions in grease, Syria, India, China.
The ancient Chinese apparently used onion stalks, The Romans, Indians,
and Greeks used tubes of wood, sometimes tubes of precious metals.

(09:34):
The Syrians used wooden reeds, and we wouldn't actually see
malleable catheters until the eleventh century CE. The most common
usage and all this was to drain, you know, overfilled bladders.
And I found this interesting. This is skipping ahead a lot.
But our old friend Benjamin Franklin comes up. Oh yeah,
because Benjamin Franklin invented a silver catheter for his brother

(09:56):
who suffered from kinney's kidney stones and required a daily catheterization.
He was the original catheter cowboy. Yeah, he's out there,
he's out there. Electrocuting turkeys, doing catheters, creating catheters for
his brother, and then Franklin apparently suffered from kidney stones
later in life, so he likely used his own invention.
Rubber catheters didn't come along to the eighteenth century latex

(10:17):
didn't come around to the ninety five uh and the
you know a technology eventually. Essentially we're dealing with some
of the same technology that would eventually enter the veins.
Uh So, in a sense, the catheter is kind of
the precursor to the hypodermic needle. And of course the
catheterization also doesn't necessarily involve involved just the urethrow because

(10:39):
the French physiologist Claude Bernard performed the first cardiac catheorization
in eighteen forty four on a horse, and this application
remains in use for neurosurgens and cardiologists. But a catheter
is somewhat different than than a hypodermic surrent correct, So
what is a hypodermic syringe, Well, it has two main components.

(11:00):
This would be the hYP the hypodermic needle and the syringe.
So the syringe is if you imagine the common sort
of disposable medical needle you've seen these days. The syringe
is the plastic part, you know, it's the hollow tube
with a retractable plunger or piston inside which can be
used to inject or withdraw liquid. And the hypodermic needle.

(11:22):
Of course, the word hypodermic means under the skin, so
a hypodermic needle is a hollow needle made for piercing
the skin or other outer tissues to inject into or
withdrawal from what's underneath by way of pressure difference created
with the plunger inside the syringe. Yeah, Like I remember
when I was a kid, you know, obviously, you know,
I think everybody can relate to this. You're you're you're

(11:44):
getting stuck with hypodermic needles pretty early on, so you
have a pretty early understanding of what they are. But
I remember finding a hypodermic needle plunger, a clean one
because I and my dad was a dentist who worked
in a hospital, and so he would bring these home
and you know they're great, Oh boy, one other great
fun to play with, like in the bathtub, you know,
because it's actually a little plunger squirter, right, But then
I was then I found a knitting needle, and I

(12:05):
was like, oh, I can just put this on the end,
and I have and I have a hypodermic needle, thankfully,
you know, I didn't stick it in anything but that.
Obviously that would not have worked because that is a
solid needle. It does not have the aperture that is
necessary for the process to take place, right, the most
important part of the metal needle being that it is
the small bore needle that's hollow, right, the liquid can

(12:27):
pass in and out, so I wouldn't would not have
been able to inject warm bathwater into my veins even
if I had wanted to. Well, So, as I was
saying earlier, I I really do think this has got
to be one of the most underappreciated inventions, just because
I mean mostly people don't like them. Like even if you,
I mean, I'm somebody who I'm very pro vaccine, you know,

(12:49):
I think, like I don't try not to demonize medical science,
I still don't enjoy needles. I mean, when I've got
to get a shot. I get my flu shot every year,
but I don't like the getting stuck art right, Like
I I like to give blood when whenever there's a
blood drive and I, you know, I think to do it.
I know it more if they've called me and reminded
me to do it, you know, I'll go and give blood.

(13:09):
I I don't get faint or freak out or pass
out at the needle going in. But at the same time,
I really don't like to look at it, right, I
really have to look over here, and I don't. I
don't like the sensation of the needle remaining stuck in
my arm for you know, the duration of the withdrawal. Right,
So it's no mystery I think why this is a
grossly underappreciated medical invention, Like, despite all of the grade

(13:33):
it does in medical science. It you know, all of
the lives that saves every year, it's just it's just
kind of a key to think about. So like people
don't appreciate it in the same way they might appreciate
aspirin or something that's not as uh, you know, maybe
even a lot less life saving, but is less icky
to think about. Right now, this being said, we realized

(13:55):
that a lot of people out there, you may have
more familiarity with needles. Perhaps you you have a self
administer a shot. Maybe even every day. Uh, you know,
maybe you've you've gone through treatments sead of required a
great deal of familarity with hypodermic needles, and you know
this is the case. We would obviously love to hear
from you, you know, hear what your thoughts on it like.
To what extent do you get used to it? Um?

(14:16):
You know, does it ever feel anything like comforting? I
don't know. I guess it varies. Well, I mean, I hope,
I hope. I don't know if we can achieve this,
But by the end of this episode, maybe we'll give
you a new appreciation for the great value of the
hypodermic needle. I mean, such that it even viscerally affects
your reaction to when you have to get a shot

(14:37):
or get blood drawn, and maybe you feel a little
bit better about it. That would be a that'd be
a good goal to achieve if we can do it.
Sounds good. Now, before we get to life saving hypodermic
needles that we should all be thankful for, maybe we
should think about the hypodermic needles in nature that kill
well not necessary, Well, okay, I guess most of them
kill or most of them can kill. Under the rise circumstances,

(14:58):
because before we lay the mantle of syringe inventor on
a mere human, we really need to consider some of
the marvels of hypodermic mastery in the natural world. Let's
do it alright, So, for instance, just consider a spider
from uh, you know, a spider's thing is a perfect
injection tool. It evolved, after all, to pierce the prey

(15:19):
organisms outer layer and inject venom. We also find biological
injection needles and other organisms such as bees wasps. Both
of these are of course examples where they're using an
ovipositor that you know, as an egg laying organ that
has evolved to a pierce prey or to pierce an aggressor.

(15:39):
We've talked about bees and wasp on the show before,
but then also we have mosquitoes as well, and we're
talking about several different structures here that have evolved into injectors.
The ovipositors, mouthparts, teeth, the fang of a venomous serpent,
for example, is a highly evolved injection tool, and it's

(16:00):
just a wonderful example. Um In fact, scientists continue to
look at such bio injectors for possible ideas about how
to improve upon our injection designs. UH. This includes looking
at curved spider fangs, such as those of the wandering spider,
and this was studied by researchers at the Max Planck Institute. Now.
As amazing as spider fangs are in terms of biological

(16:22):
hypodermic injection, one thing I do want to make clear,
because this is one of my favorite distinctions about spiders,
is that we must remember that the hypodermic needle properties
of spider fangs only go one way. I remember when
I was a kid, I always just assumed, I, maybe
because of exposure to hypodermic needles used to draw blood,

(16:43):
that spiders would suck the juices out of their prey
with the needles of their fangs, right like it would
be like drawing blood or like a or like a mosquito,
which we can talk about in a minute. But um,
spiders don't do that. They don't suck the delicious prey
juices out through the fangs the way you might draw
blood from a vein with a needle. Spiders do something

(17:04):
much grosser that it involves often like I mean, different
spiders have slightly different methods, but it usually involves some
kind of external digestion, like like spitting or injecting fluid
that sort of dissolves the prey animal and then like
slurping parts of it up and chewing it with these
gross mouth parts. It it's it's much more amazing. Actually, yes,

(17:25):
And you know, I think next week we're gonna have
an episode of the show that deals with another creepy
crawley creature that utilizes a similar feeding strategy. So so
if you like creatures being hollowed out by digestive juices
and then uh and then it's slurped like like a
bubble t, then stay tuned for more stuff to blow
your mind. Dissolve and slurp. It's what we do now.

(17:47):
To come back to the mosquito though, Yeah, this is
this is certainly certainly an interesting species to look at
because the mosquito is rather skilled at withdrawing blood and
it does so through its proboscis. Uh so it's not
you know, it's not an ovipositor. It's it's you know,
it's it's it's not like an auxiliary mouth part. And

(18:08):
this is another area where scientists are looking for possible
bio mimetic solutions, so biommetic that's where we're looking to
the natural world saying, hey, how here's we have an
engineering problem. How did evolution solve this engineering problem? And
then how can we uh, you know, copy off of
Nature's notes. Actually, bio mimesis goes way back in the
history of hypodermic metals as well, discuss later in the episode.

(18:29):
So in this case, researchers at Osaka's Kansai University, we're
looking into ways to develop a pain free injection device
based on the the blood drinking functionality of mosquitoes. And
it's actually rather interesting to think about because sure, bacteria
in the anticoagulant of ax and that mosquito causes an

(18:50):
infection that results in itching. But the poke itself, how
does that feel? I mean, every now and then I'll
get a mosquito bite where I'll feel it, and I'll
look down and I'll catch the bugger in action and
and hopefully smite them. But most of the time you
do not feel it at all. And the reason, according
to the Osaka researchers, is that while a hypodermic needle

(19:12):
is smooth around the edges, the mosquito proboscis is jagged.
That seems counterintuitive, it does, but but apparently the way
it works is that the mosquito has two serrated max
silly that cut into the skin and then they allow
the labor um to slide in, which I find that
detail makes being bitten by a mosquito just a little

(19:34):
creepier to think of, like the mechanics of the first
skin being parted and then it's other organ entering into
me um. But at any rate, the reason that we
we don't see it has everything to do with the serration,
because the serrated parts result in a minimum amount of
surface area impacting nerves in the skin, while the human

(19:55):
needle impacts the maximum amount of surface area. So um.
They they've apparently been working with this for some time
and they've they've actually experimented with some prototypes, some prototype
needles based on the mosquitoes proboscis, and they found that
in the prototypes they were studying that individuals poked with

(20:16):
this needle, this mosquito needle, if you will, Uh, they
didn't really feel the prick of the needle as much,
but they thought it felt more painful the longer it
was in there. So Um, I don't know, be interesting
to see where this goes. I mean, obviously there are
other factors as well, like the mosquito proboscis is is
quite small, and uh the needle is going to be

(20:36):
a by necessity a little larger. Uh, So that could
be a part of it as well. But it would
be interesting to see, how you know, to see to
what extent we can take the the the the the
the mouth parts of the mosquito. Uh. You know this
this tremendous enemy of humanity and turn it around to
improve our healing capabilities. Yeah. Now, we always go out

(20:58):
of our way not to demonize animals on our shows,
but if there is any animal that really deserves a
spot as humanity's enemy, it's like the insects that are
disease vectors, like mosquitoes and ticks. Right. Though, to be
fair to the mosquitoes, as always have to point out
that they are pollinators, uh, and that also mosquito larvae
are a tremendous food source for a great number of creatures,

(21:20):
and of course bats eat flying adult mosquitoes. Of course.
I mean this is not to say they don't play
a role in nature, but still they are a danger
to humans, and they actively hunt us and on on
a on a scale of destruction to humankind that is
not comparable at all to the types of animals that
people actually like demonize and go out culling and stuff,
you know, and uh like large mega fauna predators that

(21:44):
almost so rarely actually attack humans. Right when you compare
historic u you know, tiger deaths versus malaria deaths. Yeah,
clearly the enemies the mosquito. All right, should we take
a quick break and then come back and talk about humans?
Sounds good? Alright, we're back. We've talked about how nature

(22:05):
solved the problem of how to uh squirt stuff into
or draw things out of a living creature. But now
it's time for the humans to tics interer stage. Yeah.
And the question of who should get credit for inventing
the hypodermic needle or the hypodermic syringe, I would say,
does not seem fully totally settled, though. I think there's

(22:26):
there's generally agreement that this medical technology came online around
the middle of the eighteen hundreds and then was steadily
adopted more and more throughout the later eighteen hundreds and
then especially in the twentieth century when the number of
injectable medications boomed. But which earliest attempt should really get credit,
I think is kind of disputed, and should also be

(22:48):
noted that there were various reports of inventions and experiments
kind of like a hypodermic syringe noted in history before
the nineteenth century. But to whatever extent they existed, into
whatever extent they served the purposes of a hypodermic syringe,
they didn't survive and remain in use or in practice
across time. But we will do a quick survey of

(23:09):
a few of these earlier records now. One is that
forms of syringes existed in medicine before they were equipped
with fine bore needles for piercing the skin or other tissues.
Like the first century Roman scholar Aulus Cornelius Kelsus wrote
in his book Daymondissina about a process for using a

(23:30):
syringe to wash out a wound or fistula by injecting
wine or vinegar or a solution of honey. Quote, it
is not inappropriate when changing the dressings and again before
inserting fresh medicaments to wash out the fistula using an
ear syringe with wine. If there is much puss with vinegar,
if there is hard callous, if it is already clean

(23:52):
with honey, wine, or a decoction of vetch, to which
also a little honey should be added. Uh. And I've
read several himes of Galen also using the mentioning the
use of a syringe. Now, again, this wouldn't be a
hypodermic needle, but this we think would be some kind
of plunger or piston based object that would basically squirt

(24:14):
liquid into an opening. Right, just a way of squirting
in the wine, the vinegar or the honey, whatever, the
delicious food stuff is going into all the good stuff
they squired into you. Yeah, that's so Uh. These kinds
of syringes predated the modern hypodermic needle, and you can
see them being used for things in history like squirting
liquid into an ear or even to administer enemas. You

(24:36):
know that that's another thing that predates the needle. There's
also a record in medieval Egypt by an Arab opthmologist
and oculus named Amar al Massili, who wrote extensively about
treatments for eye diseases and the site. Uh. And in
in one of his works he wrote this I think
this was around the year nine hundred or so. Quote.

(24:57):
Then I constructed a hollow needle, but I did not
operate with it on anybody at all. Before I came
to Tiberius, there came a man for an operation who
told me, do as you like with me, only I
cannot lie on my back. Then I operated on him
with the hollow needle and extracted the cataract, and he
saw immediately and did not need to lie, but slept

(25:19):
as he liked. Only I bandaged his eye for seven
days with this needle. Nobody preceded me. I have done
many operations with it in Egypt. So it sounds like
he's describing some kind of needle attached to a suction device.
We don't know if it would have been a piston,
but attached to some kind of suction device or tube
that can suck cataracts out of the eye. And part

(25:40):
of what he's saying here is that I think that
a treatment known to the medicine at the time in
the area would have been to have patients lie on
their backs. But this patient was like, no, I can't
do that, so you've got to do something else. And
apparently that involved a needle going in uh to suck
the cataracts out, which uh do not do not try

(26:01):
at home? Right? Uh? But yeah, it does sound like
he's describing some kind of early version of a kind
of hypodermic needle for suction or extraction. There much later, apparently,
Blaze Pascal experimented with designs for syringes to study pressure
and fluid dynamics, but it was apparent that these could
possibly be used for some kind of medical applications. And

(26:22):
then the seventeenth and eighteenth century English architect and polymaths
Or Christopher Wren experimented with intravenous injections. He created a
syringe out of an animal bladder attached to a needle
made from a goose quill, and he used it to
inject substances like poppy sap and wine into the veins
of animals and up building on that kind of thing.

(26:44):
In the sixteen sixties, the German physicians J. D. Major
and J. S. L. Schultz experimented with intravenous infusions of
blood and other liquid substances in humans, but their injection
methods were dangerous and unsuccessful due to multiple things like
or lack of knowledge about germs, lack of proper sterilization techniques,

(27:04):
also lack of knowledge about proper ivy dosage of medicines,
so their experiments were dangerous. They lead to human deaths,
and this is often written that it's sort of like
put a damper on on hypodermic needle technology because it
went so wrong like that, when we may have developed
modern hypodermic needle technologies earlier if they hadn't screwed their's up. Yeah,

(27:26):
you see. You see examples of this in in medical
history from this time period where you know, clearly they
were on the right track. But if you're you're getting
something wrong and it's resulting in like just death after
death like that, there's only at times it seems like
it's a dead end. I mean, you saw some of
this with the history of blood transfusions. Oh yeah, well

(27:46):
that's sort of what's going on here. Yeah, they were
doing blood transfusions and transfusions of other things. I mean,
I didn't read a list of all the stuff, but
I would not be surprised at all if they were
just transfusing wine into people's veins. All the kinds of
stuff people tried back then. What was it about wine
in medicine throughout history, just always the wine. Well, I mean,
and it's it's an alcohol. You know, we still use

(28:07):
alcohol for for medical purposes. And uh, and we've we've
discussed the you know, the properties of honey on the
show before or well we discussed it on Stuff to
Build your Mind, right, um, you know, which has long
been was was long used in medical practices. The short
version is that honey, despite having sugar, and it also
has antimicrobial properties, and vinegar is just delicious. I'm sure

(28:30):
it was balsamic vinegar. But yeah, So, so there are
all these precursors to things that would eventually become the
hypodermic needle. Um. But but it was really around the
mid eighteen hundreds that the true modern hypodermic syringe was
really invented. And even once we get to the mid
eighteen hundreds, it seems like there are a lot of

(28:50):
people simultaneously doing research and innovation innovation in this area.
So I think, my necessity, we're not going to be
able to mention them all. We'll mention several of the
name aimes that most commonly come up as inventors or
or sort of inventors of the hypodermic syringe. Now the
first one in many sources given credit for the invention

(29:11):
of the hypodermic needle is a nineteenth century Irish surgeon
named Francis Wrind r y in d I think that
would be Wrinnd, not Rind. But he lived eighteen o
one to eighteen sixty one. So Francis Wrind treated the
public at Meath Hospital, which at the time saw or
largely saw patients from the southern part of Dublin's inner

(29:34):
city who tended to be poor at the time, and
during his education Rind was apprenticed to the Irish surgeon
Sir Philip Crampton. I was trying to find out things
about Crampton. The main things I could find about him
where that he was considered important. He was considered imminent
uh in early nineteenth century Irish surgery. He helped found

(29:55):
a hospital for the treatment of poor children in Dublin,
and that for many years there was there. It was
like this bizarre looking memorial statue honoring Crampton at a
street crossing in Dublin. And it looked like first of all,
it had a fountain and a bust of him, but
over that it had a huge metal stalk of plant
matter with leaves peeling off of it, like a giant

(30:16):
elongated metal artichoke. I don't know what that was supposed
to represent. I don't think it's there anymore. But Wrind
was not a hugely significant figure in history apart from
the hypodermic needle, So it's um. It's hard to come
across a lot of detailed biographical information about him. According
to a nineteen seventy article in jama recognizing his achievements,

(30:38):
Francis Rind was described by his contemporaries as a perfect gentleman,
passionately fond of hunting, a fashionable dresser, and a favorite
with the ladies. That that tells us virtually nothing about
maybe he had syphilis. I don't know what makes me
wonder so he's a fashionable dresser, a gentleman favorite with

(30:58):
the ladies. We know our impressions of pain are highly
variable based on psychological factors. Right, do you think injections
subjectively freak people out less if the guy doing the
injection is like a sexy, well dressed gentleman. No, I don't.
I don't think so. I think based on my experience,

(31:18):
I think, um, uh, you know, professional equipment and a
calm demeanor. Demeanor go a long way towards reassuring me
during an injection or withdrawal. I guess it doesn't say
whether he was calm or not. Yeah, that's what I want.
I mean, he can the doc can can be uh
handsome as I'll get out, but I want him to
to be you know, to to be calm and efficient. Yeah, alright,

(31:40):
so let's get to that injection. So in May of
eighteen forty four, one of Dr Wrenn's patients was a
fifty nine year old woman named Margaret Cox who was
experiencing debilitating pain in the face and she couldn't sleep
as a result of it. And I think it's probably
pretty agreed now that this this was probably due to
a condition that we know today is trigeminal neuralgia now.

(32:04):
Trigeminal neuralgia or t N, is a condition that affects
the trigeminal nerve, also known as the fifth cranial nerve.
It's a large nerve that connects the face to the brain,
and it's the main pathway by which we do facial
motor functions. Like biting and chewing and by which we
feel sensations in the face, and people with chronic trigeminal

(32:25):
neuralgia can repeatedly have bouts of searing pain that just
shoot across the face or flare up when the face
is touched or otherwise stimulated, even just by doing something
like talking or chewing, and this condition can be extremely
painful and demoralizing. I was reading that there's even evidence
it might lead to depression, anxiety, and sleep disorders. And

(32:45):
one of the common causes is when a blood vessel
is in direct contact with the nerve inside your head,
and the pressure of the blood vessel on the nerve
causes false feedback that can be felt in the brain
as pain. So this patient came to Francis Rand seeking
help because she had acute pain over the entire left

(33:06):
side of her face, especially right over her left eye
and shooting down into the eye and the cheeks and
the gums, and every time she tried to close her
mouth or press her teeth together, the pain got worse.
Apparently she had had this pain for years and doctors
had tried to treat it by having her drink a
solution of morphine this did not work, so instead Rind

(33:27):
created a new surgical tool by combining a couple of
existing tools called a trocar and a canula, and he
used it to try treating his patient's pain locally with
local administration of the morphine or the morphia. And so
Rinda described his solution in a report to the Dublin

(33:48):
Medical Press in eighteen forty five that I'm going to
read from here, so Rind writes, on the third of June,
a solution of fifteen grains of acetate of morphia dissolved
in one drachm creosote was introduced to the super orbital
nerve and along the course of the temporal, melar and
bucle nerves by four punctures of an instrument made for

(34:09):
the purpose. In the space of a minute, all pain
except that caused by the operation, which was very slight,
had ceased, and she slept better that night than she
had for months. After the interval of a week, she
had slight return of pain and the gums of both
upper and under jaw. The fluid was again introduced by
two punctures made in the gum of each jaw, and
the pain disappeared. After this, the pain did not recur,

(34:32):
and she was detained in hospital for some weeks, during
which time her health improved, her sleep was restored, and
she became quite a happy looking person. She left the
hospital in the first of August and high spirits, and
promised to return if she ever felt the slightest pain. Again,
we conclude she continues well, for we have not heard
from her since now. One very important distinction is that

(34:52):
Francis Rin's hypodermic needle was not a hypodermic syringe like
we have today, which would have a tiny hollow need
or and a plunger or or piston for injecting and
withdrawing fluid. The hypodermic needle Francis Wrend created was a
relatively It would create a relatively large puncture wound, and
it worked by gravity. So the two tools he combined

(35:16):
to create it were, as I said, a trocar, which
is a device with kind of a cutting point that
this is the part that punctures the skin. And then
a canuloh, which is a hollow tube which the medicinal
fluid can drain down through. So essentially imagine kind of
a thin, sharp tipped metal funnel. It punches a hole
in the skin and you hold it up and let

(35:36):
the acetate of morphia run down through it, and you
sort of hope for the best, all right. So yeah,
basically it makes a hole and then pour stuff into
the hole. Right. Uh. And after Wrend reported this new
technique in the medical press, it spread to other doctors
and innovators and hospitals. Several sources report that the English
nurse and social reformer Florence Nightingale was treated with this technique,

(35:58):
and she wrote, quote, nothing did me any good but
a curious little new fangled operation of putting opium under
the skin, which relieved one for twenty four hours. This
is a rather delightful story of medical innovation in the
nineteenth century, you know. I mean it's it's like there
was a problem, a solution was introduced and it worked.
No horrors, horrors. I like that. Um. I mean, so

(36:21):
the history of hypodermic needles is not without any horrors,
but we've already explored some in the earlier centuries, right, Um,
But yeah, this does seem like a really good encounter here,
and so uh so great for Rind. Now. Wrin died
in eighteen sixty one, and I think maybe we should
go on to look at a couple of the other
people who were commonly cited as early innovators or or

(36:43):
inventors of the hypodermic needle. Many other sources credit a
different doctor or pair of doctors with the invention of
the modern hypodermic syringe, and these doctors are the Scottish
surgeon Alexander Wood and the French surgeon Charles Gabrielle Pravaz.
Now Alexander Would lived from eighteen seventeen to eighteen eighty
four and he was a physician at a few different

(37:05):
Scottish institutions in medical schools. Think he lived in Edinburgh
and in the year eighteen fifty three, Would made a
very important change, and it was pairing a small, hollow
bore needle with a syringe with a plunger, so the
drug could be injected rather than drained by the force
of gravity. So part of this might be just what

(37:26):
you consider a hypodermic needle. Yeah, this is this is
more of a true hypodermic needle. We're discussing here, right,
It's got the it's got a small needle, it's got
the so a small needle instead of the trocar cutting tip,
and it's got the piston for injecting. And so I
want to read a section from the biography of Alexander
Wood written by the very Reverend Thomas Brown, where where

(37:47):
he talks about this discovery and some some bio mimesis
going on here. So Brown rights, it was in the
year eighteen fifty three that the question became pressing to him.
He had encountered in his practice certain cases which, while
there was great suffering, the use of opiates in the
usual manner was impossible owing to some of the conditions
we have alluded to, a not at all uncommon state

(38:09):
of affairs. In one instance, indeed, things were critical, and
the obtaining of sleep was an absolute necessity were life
to be prolonged. A certain line of reasoning had led
doctor Wood to the belief that benefit was to be
expected from the injection of morphia under the skin. Taking
as his model the sting of the bee, he had
constructed a small glass syringe, to which was attached a

(38:34):
fine perforated needle. Point this needle he passed under the skin,
and through it he injected a small dose of morphia,
which he could not give by the mouth. In this manner,
all derangement of stomach and liver was avoided, an immediate
absorption of the morphia into the bloodstream took place. The
strikingly beneficial result which followed this bold experiment made doctor

(38:55):
Would aware that he now held in his hand a
new method of treatment which promised far reaching results. Certainly,
in his most sanguine thoughts, he could little have imagined
as he stood at that bedside, how in a few
years every physician would be armed with that syringe, and
countless patients would have seen cause to bless his skill.
Interesting and yeah, I like the bit about looking to

(39:17):
the world of the bee and uh and then trying
to sort of copy what the bee is doing. Yeah,
and so another thing we see here that's very true
about the early days of injections is that this new
injection method was used almost exclusively for the injection of
morphia and opium preparations, right, so, primarily in the treatment

(39:37):
of pain. But Alexander would predicted that other remedies best
shot directly into the bloodstream and tissues, that they would
make themselves apparent, and of course he was proven correct.
It would mainly come later in the twentieth century that
a lot of these medications would break through. Of course,
we already mentioned insulin, but you know there would be
tons of them. But what about this other guy, Charles

(39:59):
gave Real Provase. Well. Provaz was the French surgeon who's
also given credit for inventing the hypodermic syringe, and he
lived to eighteen fifty three. And it appears that without
any contact, both Provase and would invented versions of the
hypodermic syringe, something that used a small, fine bore needle

(40:20):
that could be attached to a syringe with a piston
or a plunger. Uh And and in truth, the the
addition of the piston and the plunger to the needle
had all kinds of benefits. It meant that injections could
be introduced much more quickly and easily. It also allowed
intravenous injections, meaning drugs could be inserted directly into the
blood inside of vein. It also made it easier to

(40:41):
draw blood, which has all kinds of other uses in medicine. Um.
But we should stress again that the very beginning of
this invention, the germ theory of disease was not quite
yet fully understood or widely accepted, so there was still
a risk of infection from unsterilized injections. And there's another
dark twist of the story which does sort of usage
later associations with hypodermic needles, which is that after experimenting

(41:05):
with treatments for pain, apparently both Alexander Wood and his
wife became addicted to injectable morphine. Yeah, and we'll we'll
definitely return to that theme later on, because I mean,
part of part of the appeal of of of the
hypodermic needle is that you can you can get a
very fast, fast reward on your drug absorption, and uh,

(41:25):
then you know that becomes a part of the story
of not only opium, but of course heroin. Yeah. But
then of course is also, like we say, of of
great even life saving use in a medical context. If
you need the medication to take take action now, or
you needed to take action in a very specific part
of the human anatomy, then a needle is the best
way in. I think we should take another quick break

(41:48):
and when we come back, we can talk more about
the legacy of the hypodermic syringe. Alright, we're back. So
I was reading an article that quoted a doctor, Declan
O'Keefe of the Faculty of Pain Medicine at the Irish
College of Anesthetists. And this was in the l and

(42:09):
according to to O'Keefe, there were an estimated twelve to
thirteen billion subcutaneous injections administered globally every year. That is
hard to imagine twelve to thirteen billion injections. Now we
don't know what all of those are, but I mean
that's billions of doses of medicine, probably a lot of

(42:30):
that life saving medicine. So in some ways, it's it's
hard to overstate how important the hypodermic syringe has been
as a life saving and and quality of life improving
medical innovation. Yeah, because because again I think back to
the various ways of getting drugs and vaccines specifically into

(42:50):
the body. Certain substances just won't work as well if
they're taken orally, and if you want a fast onset,
then you want injection. And we mentioned you know, some
of these substances early. But another great example example is
if you have an EpiPen, you know, if you're having
allergic reaction and you need a fast acting uh, you know,
use of your medication UH. The EpiPen is UH is

(43:13):
a way to inject it um. And the exact side
of injection is also key, not only for reasons of
you know, like dental surgery, you know, when you want
to target the mouth, but UH, for instance, most vaccines
have to be injected into the muscle tissue, and the
aim here is to optimize the immunogenacity of the vaccine
and to minimize adverse reactions. So and these are just

(43:34):
two quick examples, you know, that should give you a
huge idea of how crucial the hypodermic needle is to
modern medicine. Vaccines alone prevent millions of hospitalizations and hundreds
of thousands of deaths, and our ability to swiftly administer
a variety of drugs and to target specific areas of
the body are of tremendous importance. Where already talking about morphine,
Another example that came up in research was the morphine

(43:58):
syrette that was I in during World War two. And
it was essentially a kind of like if you imagine
a tiny superglue to like that, you know, the disposable
little tubes of superglue. It was essentially that, but it
contained a shot of morphine. And like a bubble and
then had a little needle on the end. And it
was a predecessor to auto injectors like the EpiPen. You

(44:19):
could you know, just have this in the kit and
then individual needed morphine help treating an injury. That's what
what you do. You just stick it in, squeeze it,
and and the morphine is in the body. So it
sounds to me like part of the benefit there is
that it could be administered in a situation that was
not necessarily like maybe if you're not good at giving injections,
or you don't know what you're doing, or you there's

(44:41):
like you know, the chaotic environment. It's just a kind
of stab and go yeah, like like a field medic
situation exactly. UM and and some of the early advancements
in UM autoinject or technology were for use in like
like military scenarios or bioweapons scenarios, et cetera. Now we've

(45:01):
discussed some of the dark corners of of injection so far,
but you know, certainly there's there's another huge area that
we should probably touch on. As with other technological achievements,
with the ability to greatly improve the human condition, we
also inevitably turn them into instruments of execution and murder. Uh. So,
lethal injection remains in use across the United States and

(45:23):
various other countries as well, and as a primary means
of state sanctioned murder. It was first proposed by New
York surgeon Julius mount Blyer in eighty eight as a
more humane um option uh than hanging. And there's a
you know, a lot we can discuss on this topic.
We touched on some of this in our episode and
the guillotine. You know, much of it comes down to

(45:44):
the the ethics of capital punishment, but there's also quite
a bit of strong disagreement on just how humane lethal
injection really is, not so much because of the needles,
but because of the drugs used, the differences among recipients, biochemistry,
and the general lacking of medical medical expertise in the
administration of these injections. Because, of course, to kill someone

(46:06):
with an injection for the state is you know, it's
a violation of the Hipocratic oath, and the American Medical Association,
for instance, argues that doctors should not participate in lethal injections.
So you often have people other than medical personnel that
are injecting these lethal substances. Yeah, and also I would
think about like the sort of oxymoron implied in the

(46:26):
idea of researching safe ways to administer lethal injections. And
then another potential dark side all of this, of course,
is the use of hypodermic needles in illicit drug use.
We already touched on morphine and UM and mentioned heroin. UM.
Heroin is a great example here. Heroin can be taken
by the mouth, it can be smoked, it can be
snorted or taken via rectal suppository, but it's most popular

(46:49):
as an injection for the same reasons that injections are
handy for medical purposes. And while vein damage is certainly
an issue, another huge issue is the spread of disease
via needle sharing, and for this reason, you know, in
many countries you'll find programs to supply users with clean
needles and sometimes sterile spoons and filters as well, in
order to prevent the spread of HIV and other illnesses. Yeah. Um,

(47:11):
and you could look at that actually, and the idea
of disposable needles as uh. You know, it might be
hard for some people to see it this way, but
that is another life saving technology. If it's preventing the
spread of disease that would be spread through the unclean
use of needles. I mean. One of the things that
it's kind of hard to believe also is that when
hypodermic needles first came online, when they were first being

(47:32):
used in the nineteenth century, they were reused. You know,
they didn't have disposable needles back then, like like we
have now disposable needles. I think we're they came around
the mid twentie century. Now there was a long period
between you know where we were reusing needles, but we
knew something about germ theory and what was generally happening there.
Happening there is that they would get autoclaved, you know,

(47:54):
they get sterilized in between uses. Um. But yeah, that
clearly the disposable needle is been a really important uh
development for for sterilization and the preventive spreading of diseases.
And I would say that needle exchange programs and stuff
probably fit into the same category, right. Yeah. And then
part of the argument there too is like if you're
going to if you're gonna tackle something like like an

(48:16):
epidemic of heroin abuse, um, like you should be able
to tackle the thing itself and not all the you know,
the residual complications of of infectious disease, etcetera. Now I wonder, though,
you know, how much of that too, you're dealing with
just the overall stigma stigmatization of needles in general, you know,
because we've already touched out. We don't want to think

(48:37):
about needles when we're getting them stuck in our body
for for you know, completely legal and reasonable purposes. Uh.
And so maybe we're even less inclined to to look
favorably upon somebody who's dealing with heroin addiction, uh, you know,
using needles. Well, I have a I have a suspicion
that I do not have evidence to back up. So,

(49:00):
you know, it could be completely wrong about this, But
I sometimes wonder if a some not insignificant part of
vaccine opposition has to do with just psychological aversion to needles.
I know that sounds way oversimplified, but I it kind
of fits together in my head. I think about the way, um,

(49:21):
you know I have to go to the vet and
even just see like a pet get a shot. It
can be painful, you know, it feels like, oh, that's
that's not good. And of course I know that this
this is so important for pets to get their shots,
and of course even more important for humans to get
their shots. And it's rough taking a human child to
get get vaccine shots. Yeah, you know, it's it's it's

(49:42):
part of it. And so I sometimes wonder if there
there's like a there's a bleed over and the kind
of like the visceral emotional psychological reaction you have to
to seeing a child, uh, feeling unhappiness at getting stuck
with the needle, even though it's for a life saving vaccine,
and that could possibly lead you to want to develop

(50:02):
rational justifications for for saying, well, maybe we shouldn't be
doing this right, and of course you know we we have.
It's interesting too when you look to our our fiction
or horror fiction and you see like all these exaggerations
of needle anxiety as well. Like I never I don't
think I ever even watched any of these Nightmine Own

(50:23):
Street movies, but there's the one where he has hypodermic
needles for fingers and well, yeah, I mean, so he's
got knives for fingers normal normally, but and it's funny
that they like they're like, let's make it even worse
than nice, Let's make it needles yea. And of course
there are various other films that play with with needle
anxiety as well, but uh, you know, you can look

(50:45):
at those as horror amping us up and making us
more afraid of the things that we shouldn't be afraid of,
or just simply being as a sort of a cultural
expression of how we feel about things, how we feel
about technologies, and uh, well, the way we feel technologies
has really has really serious impacts, especially if they're medical
technologies or their prophylactics of some sort or you know,

(51:08):
we talked in the episode we did about condoms about
how you might think, like a project to develop condoms
that people like using more, you know that they like
the feel of more something sounds frivolous. But no, if,
like if it actually affects adoption rates of a technology
that stops the spread of disease and saves lives, that

(51:29):
is a really useful thing to research. And I would
say the same thing could be true of needles. I mean,
on one hand, I just want to say, like, you know,
just get your flu shots, get your vaccines, you know,
get over it. It's not like super exciting to get
stuck with the needle. But uh, but like it's just
something we should deal with. But no, I can totally
see how if you could develop new ways of you know,

(51:51):
new alternatives for hypodermic needles, or new ways of changing
the way in injections happen so that people have less
of an innate psychological version to it, that might increase
the rates at which people, you know, get the vaccines
they should be getting, at which people get the flu
vaccine every year, and stop the spread of flu which
does actually kill people. Uh, get you know, get the

(52:13):
other shots they need. Yeah. So, as we've mentioned already,
scientists are always looking at ways to improve upon the design,
and there are also efforts to replace the hypodermic needle,
at least in some context. It seems like there there
are certain cases where they just there's no getting around
the effectiveness of a hypodermic needle. But other cases there
might you know, there's room for some of these other technologies. Um. Also,

(52:35):
such technology would cut down you know, it would cut
down a needle anxiety. Anxiety like we're talking about. It
would cut down on potentially on a needle biomedical waste.
But also it could cut down on accidental pricks of
the you know, on the needle. UH. The Centers for
Disease Control and Prevention have estimated that hospital based healthcare
workers accidentally pricked themselves with needles three and eighty five

(52:57):
thousand times per year. Wow, which is a lot um
So one alternative. We've touched about the on this already.
But like, you could have a patch, but a patch
is only going to work if the drug molecules are
small enough to pass through the skin pores and it
works very slowly. UH. Jet injectors are another possibility, and
the several versions are already on the market today. The
basic idea has been around for a long time, with

(53:18):
the first demonstration taking place in eighteen sixty six. I
don't think I know what that is. This is just
where you like, jet propelled the substance, like directly through
the skin. Another take on this, studied by M. I.
T is the Lorentz Force actuator, which is a small,
powerful magnet surrounded by a coil of wire that's attached

(53:39):
to a piston inside a drug ampuel and it essentially
does the same thing as a jet injector, but with
magnets just forcing this, uh, this blasting the doose of
drugs directly through the skin. Still, you know, these are
these are all fine for injections, but not so much withdraws.
When it comes to drawing blood out of the body.
They're various other innovations such as I was reading a

(54:02):
little bit about micro sampler technology that's aimed at drawing
less blood but making more use of it. But I
think this still essentially makes use of a hypodermic syringe
in the same way that an EpiPen, you know, still
has a hypodermic needle inside of it. Now, there certainly
are technologies that explore blood withdrawal without needles how at all.
Though researchers that start up TASSO are working on a

(54:26):
quote delicate vacuum to suction blood from your microscopic vessels
called capillaries into an attached container. Uh. This according to
Jordan Vilinsky, writing for Popular Mechanics. So again, I don't
think you know these these technologies replace hypodermic needles in
all situations. But you could see a situation where we're

(54:48):
looking at medicine, you know, decades from now and the
hypodermic needle will still be incredibly important, but maybe there
will be other areas of blood withdrawal or more injection
that can be left to these less prickly technologies. Yeah. Well,
I'm all for these technologies, especially if you can show
that they would probably increase the rates at which people

(55:11):
get the care they need to get the medications they need.
If if they might be averse to it otherwise just
because they don't like needles, but I would say I
hope a takeaway from today's episode is be thankful for needles,
even if you don't aesthetically like them, even if it's
not pleasant. Every time you get a shot, you should
like stop to think like this is amazing, This is
actually great, this, this is a wonder Yeah. I almost

(55:33):
wonder if there's a kind of like campaign we could
start this, like I don't know what you call it,
like like needle pride. You know, it's just like whenever
you get a shot that you need, when or whenever
you get blood drawn for some important medical reason, you
can like I don't know, we're we're like a like
your your pilot wings badge or something. Right, well, you know,
I think part of it is that we tend to

(55:55):
fear things we don't completely understand. And you know, I'm
not saying we don't understand the basics of hypodermic needle,
because I mean, it's a pretty it's pretty self explanatory.
But in not wanting to think about it, you know,
and not wanting to dwell on it, we perhaps give
it too much, almost like supernatural power, you know. We
we we we feed into the fear too much by

(56:17):
not confronting it. So you know, maybe part of it
is like we should try and look at the needle
more like I should look at the needle more when
I'm being given a shot or they're hooking me up
for a withdrawal for you know, for a blood donation,
that that ultimately this will help me face my fear,
you know, and feel better about it. This is a
crucial part of modern medical science. Be thankful for the needle,

(56:39):
respect to the needle, get used to it. You're gonna
get more of You're not done, but we are done
with this episode of invention. Now. Obviously everyone out there
has probably had shots, You've you've taken medicine in various forms,
So we'd love to hear your feedback on this episode
on the technology itself and how we feel about it.
If you want to check out more episodes of Invention,
you can find us at inventin pot dot com. And

(57:00):
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or any other it's agest topic for the future, just
to say hey, how you doing, you can email us

(57:22):
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