The Hypodermic Needle

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 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

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 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

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 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 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 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 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. 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 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 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 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 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 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, 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 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 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 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 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, 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 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 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 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

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. 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 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 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 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.

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.

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 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 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 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, 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. 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 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 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? 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 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, 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 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. 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 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 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, 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 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, 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.

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 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.

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 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 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 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 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 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 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 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,

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 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 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 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 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

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 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 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 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 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. 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

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 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 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 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.

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, 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, 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 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 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 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 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 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 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 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 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, 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 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, 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,

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. 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 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 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 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 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 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

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, 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 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 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 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, 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 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 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 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

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 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 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 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 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 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 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 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 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 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 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, 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 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 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

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 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

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 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 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 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 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 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 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 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 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

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 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, 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 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, 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 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 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, 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, 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

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 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 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 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, 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 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, 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

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, 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 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 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 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 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 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 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 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 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 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 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, 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 if you want to support the show, the best thing you can do is to just rate and review us wherever you have the power to do so, leave a nice comment, leave some nice stars, and make sure that you have subscribed. Huge thanks as always to our excellent

audio producer Seth Nicholas Johnson. If you would like to get in touch with us with feedback on this episode or any other it's agest topic for the future, just to say hey, how you doing, you can email us at contact at invention pod dot com. Invention is production of I Heart Radio. For more podcasts for my heart Radio because the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows.