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The history of the syringe

The practice of introducing substances into the body can be traced back to prehistory, where blowpipes and poison-tipped darts were utilized across various cultures around the globe.

In its simplest form, a syringe functions as a basic pump. Early forms of syringes, such as the 'clyster,' were used for giving enemas. The precise timeline of its development is obscure due to various parallel evolutions of devices used to inject medicines.

Many individuals are credited with inventing the syringe. Among them:
The first recorded injections


One notable instance involved injecting a dog with alcohol to observe intoxication effects. Yale's Christopher Wren experimented with basic syringes, attaching a quill to a small bladder and making incisions to access veins. Humans were also subjects for these tests, but results were often ineffective.

• The delinquent servant experiment by Wren failed when the subject swooned, emphasizing the high risks of using crude injecting devices. This issue persists today in settings like prisons where access to modern sterile equipment is limited.
  

In 1662, Johann D. Major injected an unrefined compound into a human vein, marking the first documented intravenous injection in a human. Poor outcomes halted further attempts for many years. More than 100 years passed before a syringe with an attached needle was developed.

In 1807, the Edinburgh Medical and Surgical Dictionary described a syringe as:

• “A well-known instrument designed to inject fluids into cavities or canals.”
  

The dictionary noted that syringes were primarily used for injecting substances into corpses for anatomical studies.

In the 17th century, De Graaf developed a metal-barreled device similar to a modern syringe, mainly for exploring blood vessels in cadavers.

Subcutaneous injection began in earnest only in the mid-19th century, becoming an extension of inoculation practices.

The Fergusson syringe, created in 1853, is a close precursor to the modern syringe. Alexander Wood used it for subcutaneous opiate injections for pain relief.


Early experiments
Intravenous injecting continued to evolve in the 17th century with various drugs used to treat conditions like epilepsy and syphilis. Substances such as opium were among the first drugs to be injected, though access issues and the use of inappropriate substances like cinnamon limited its effectiveness.

Absorption of drugs through the skin
The 19th century saw an increased focus on drug administration via the skin, initially through methods like blistering and applying drug-infused poultices. In 1836, Lafargue enhanced this by using a morphine-dipped vaccination lancet.

By mid-century, Lafargue's method evolved to embedding solid morphine pellets under the skin. Crombie later improved this method by drawing morphia-coated silk threads under the skin.

Subcutaneous injecting
From the 19th century into the early 20th, subcutaneous injection was favored over intravenous methods due to earlier interests in skin absorption and a lack of understanding about intravenous potency.

In 1880, H.H. Kane regarded intravenous injection as a side effect of subcutaneous methods, with methods to avoid it. Even in 1916, experts like Macht viewed hypodermic injections as having broader applications.

The discovery of systemic action

Early physicians believed injections had localized effects. The full-body, systemic effects of injections were largely unrecognized.

Opioids' pain-relieving effects were initially thought to stay localized at the injection site. However, all injected drugs eventually circulate throughout the body.

Alexander Wood posited that subcutaneous opiate action was mainly localized. The precision of syringes allowed better placement near nerves for pain relief.

This belief in localized action shaped medical practices. Dr. Francis Anstie, editor of The Practitioner, echoed this by claiming no danger from hypodermic remedies, suggesting their risk was lower than oral medication.

Charles Hunter realized that injections had systemic effects when abscesses forced him to change injection sites without losing pain relief benefits. This led to debates between Hunter and Wood.

As subcutaneous injections were popularized by Wood, misunderstandings about dependency contributed to a rise in morphine 'morphinists.' The injected drug's perceived local effect masked the potential for dependence.

Common problems with early injections

19th-century injections were prone to issues. For today’s users of street drugs, echoes of past problems persist.

Solutions for subcutaneous use had to be neutral, clear, and unnecessary. Fulfillment of such conditions was challenging with the available alkaloids.

• The active agent...must be in perfect solution...neutral, clear, foreign matter-free, and not too concentrated...difficulty fulfilling these conditions hindered use. (Sharpe & Dhome 1898)
  

Frequent injectors faced severe skin damage from repeated injection sites, resembling modern chronic injectors.

• An extraordinary spectacle... Scarred with discolored blotches from frequent injections.

The growth of the medical use of opiates

Opiates’ pain relief effectiveness boosted their injection popularity, especially affecting those with chronic pain.

Physicians, limited in effective treatments, likely turned to morphine as a fast, effective tool.

The administration of opium and morphine by physicians... (Courtwright 1982)

The spread of injecting practices, combined with available opiates and patent medicines, led to a rise in opiate injectors.

Injecting in the 20th century - the growth of intravenous injecting
Throughout the late 19th and early 20th centuries, subcutaneous injection dominated, both medically and non-medically.

Early intravenous accounts painted it in a negative light, likely due to high doses. Illicit users in the 1920s gravitated towards intravenous injection for its rapid effects and efficient use.

Richard Pates, in reviewing illicit intravenous injecting literature, noted its development through user adaptation.

• ...early 20th-century addicts... (Pates, et al. 2005)

Medicine started favoring intravenous routes for specific drugs like Salvarsan for syphilis.

Patricia Rosales highlighted intravenous injection's precision and standardization influences.

The first non-medical intravenous heroin injection was noted in 1925.

From subcutaneous to intravenous... (Wyatt 1920)

The switch to disposable needles and syringes

Early disposable syringe patents appeared by 1903 but saw little production.

James T. Greeley's collapsible tin tubes in 1912 were the first practical disposables, used extensively in wartime.

Asepsis is uncertain... (Greeley 1912)

Throughout the 20th century, glass syringes grew more precise.

Disposable plastic syringes emerged by the mid-20th century. The Monoject, developed by Roehr products in 1955, spurred similar products from Becton Dickinson.

Concern over hepatitis B transmission propelled the market towards plastic disposables.

In 1970, Becton Dickinson introduced one-piece insulin syringes.

Difficult to re-use syringes

Anti-reuse syringes were designed primarily for healthcare settings to prevent cross-contamination.

Their potential introduction to illicit users is debated, with concerns over increased hepatitis C and HIV transmissions due to older syringes’ reuse.

Both the United Kingdom Harm Reduction Alliance and National Needle Exchange Forum have highlighted these risks.

Accidental sharing and the development of the Nevershare syringe

Glasgow studies spotlighted ‘accidental sharing,’ attributed to same-looking syringes.

Recommendations included distinct, easily identifiable syringes to mitigate sharing risks. The Nevershare syringe debuted in May 2007 with distinct plunger colors and other injector-friendly features.

By September 2011, a 2ml detachable needle Nevershare syringe was introduced to cater to different injector needs.

References

Macht D I (1916) The history of intravenous and subcutaneous injecting of drugs. The Journal of the American Medical association. LXVI

Morris R and Kendrick J (1807) The Edinburgh Medical and Surgical Dictionary.

Kane H H (1880) The Hypodermic Injection of Morphia. Its History Advantages and Dangers. Chas L Bermingham and Co, New York.

Anstie F E (1871) On the effects of prolonged use of morphia by subcutaneous injection. Practitioner 6: 148-57

Berridge V and Edwards G(1987) Opium and the people. Opiate Use in Nineteenth Century England, pp. 139-40. Yale University press, USA.

Sharp & Dhome (1898), A brief summary of hypodermic medication, 6th edition pp.8-9. Sharp & Dhome, Baltimore.

Quoted in Rosales P, A history of the hypodermic syringe 1850’s – 1920’s. Harvard University Thesis, December 1997

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