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The hypodermic syringe, also known as the hypodermic needle, is a device used by medical professionals to transfer liquids into or out of the body. It is made up of a hollow needle, which is attached to a tube and a plunger. When the plunger handle is pulled back, fluids are drawn into the tube. The fluid is forced out through the needle when the handle is pushed down. The syringe was introduced in the mid s and has steadily improved with the development of new materials and designs. Today, it has become such an important medical tool that it is nearly a symbol synonymous with the practicing physician.
Since the advent of pharmaceutical drugs, methods for administering those drugs have been sought. Various important developments needed to occur before injections through a hypodermic syringe could be conceived. Early nineteenth century physicians were not aware that drugs could be introduced into the body through the skin. One early experiment that demonstrated this idea, however, was performed by Francois Magendie in . In his published work, he outlined a method for introducing strychnine into a dog by using a coated wooden barb. In , A. J. Lesieur described another method for administering drugs through the skin, applying them directly to blisters on the skin. Expanding on results from these experiments, G. V. Lafargue developed a procedure for introducing morphine under the skin using a lancet. A drip needle was invented by F. Rynd in for the same purpose. However, he did not publish his method until , eight years after the first hypodermic syringe was described.
The first true hypodermic syringe was created by Alexander Wood in . He modified a regular syringe, which at that time was used for treating birthmarks, by adding a needle. He then used this new device for introducing morphine into the skin of patients who suffered from sleeping disorders. A few years later, he added a graduated scale on the barrel and a finer needle. These modifications were enough to attract the attention of the rest of the medical community, resulting in its more widespread use.
Over the years hypodermic syringes have undergone significant changes that have made them more efficient, more useful, and safer. One such improvement was the incorporation of a glass piston within the cylinder. This innovation prevented leaks and reduced the chances of infections, making the device more reliable. The technology for the mass production of hypodermic syringes was developed in the late nineteenth century. As plastics developed, they were incorporated into the design, reducing cost and further improving safety.
The way in which a hypodermic needle works is simple. Fluid, such as a drug or blood, is drawn up through a hollow needle into the main tube when the plunger handle is pulled back. As long as the needle tip remains in the fluid while the plunger handle is pulled, air will not enter. The user can determine exactly how much material is in the tube by reading the measuring marks on the side of the tube. The liquid is dispensed out through the needle when the plunger handle is pushed back down.
The term hypodermic syringe comes from the Greek words hypo, meaning under, and derma, meaning skin. These terms are appropriate because they describe exactly how the device functions. The needle is used to pierce the top layer of the skin, and the material in the tube is injected in the layer below. In this subcutaneous layer, most injected materials will be readily accepted into the bloodstream and then circulated throughout the body.
A syringe is one of three primary methods for introducing a drug into the body. The others are transepidermal (through the skin) and oral. Using a hypodermic needle as the method of drug administration has some significant advantages over oral ingestion. First, the drugs are protected from the digestive system. This prevents them from being chemically altered or broken down before they can be effective. Second, since the active compounds are quickly absorbed into the bloodstream, they begin working faster. Finally, it is more difficult for the body to reject drugs that are administered by syringe. Transepidermal drug administration is a relatively new technology, and its effects are generally not as immediate as direct injection.
There are many hypodermic syringe designs available. However, all of them have the same general features, including a barrel, plunger, needle, and cap. The barrel is the part of the hypodermic needle that contains the material that is injected or withdrawn. A movable plunger is contained within this tube. The width of the barrel is variable. Some manufacturers make short, wide tubes, and others make long, thin ones. The exact design will depend to some extent on how the device will be used. The end of the barrel to which the needle is attached is tapered. This ensures that only the desired amount of material will be dispensed through the needle. At the base of the barrel away from the needle attachment, two arms flare out. These pieces allow the needle user to press on the plunger with the thumb while holding the tube in place with two fingers. The other end of the barrel is tapered.
The plunger, which is responsible for creating the vacuum to draw up materials and then discharge them, is made of a long, straight piece with a handle at one end and a rubber plunger head on the other. The rubber head fits snugly against the walls of the barrel, making an airtight seal. In addition to ensuring an accurate amount of material is drawn in, the squeegee action of the plunger head keeps materials off the inner walls of the tube.
The needle is the part of the device that actually pierces the layers of the skin. Depending on how deep the injection or fluid extraction will be, the needle orifice can be thinner or wider, and its length varies. It can also be permanently affixed to the body of the syringe or interchangeable. For the latter type of system, a variety of needles would be available to use for different applications. To prevent accidental needle stick injuries, a protective cap is placed over the top of the needle when it is not in use.
Since hypodermic syringes come in direct contact with the interior of the body, government regulations require that they be made from biocompatible materials which are pharmacologically inert. Additionally, they must be sterilizable and nontoxic. Many different types of materials are used to construct the wide variety of hypodermic needles available. The needles are generally made of a heat-treatable stainless steel or carbon steel. To prevent corrosion, many are nickel plated. Depending on the style of device used, the main body of the tube can be made of plastic, glass, or both. Plastics are also used to make the plunger handle and flexible synthetic rubber for the plunger head.
There are many manufacturers of hypodermic needles, and while each one uses a slightly different process for production, the basic steps remain the same, including needle formation, plastic component molding, piece assembly, packaging, labeling, and shipping.
The quality of the components of these devices are checked during each phase of manufacture. Since thousands of parts are made daily, complete inspection is impossible. Consequently, line inspectors randomly check components at fixed time intervals to ensure they meet size, shape, and consistency specifications. These random samples give a good indication of the quality of the hypodermic syringe produced. Visual inspection is the primary test method. However, more rigorous measurements are also performed. Measuring equipment is used to check the length, width, and thickness of the component pieces. Typically, devices such as a vernier caliper, a micrometer, or a microscope are used. Each of these differ in accuracy and application. In addition to specific tests, line inspectors are stationed at various points of the production process and visually inspect the components as they are made. They check for things such as deformed needles or tubes, pieces that fit together incorrectly, or inappropriate packaging.
Hypodermic syringe production is strictly controlled by the United States government, specifically the Food and Drug Administration (FDA). They have compiled a list of specifications to which every manufacturer must comply. They perform inspections of each of these companies to ensure that they are following good manufacturing practices, handling complaints appropriately, and keeping adequate records related to design and production. Additionally, individual manufacturers have their own product requirements.
Since Alexander Wood introduced the first device, hypodermic syringe technology has greatly improved. Future research will focus on designing better devices that will be safer, more durable, more reliable, and less expensive to produce. Also, improvements in device manufacture will also continue. One example of this is the trend toward utilizing materials such as metals and plastics that have undergone a minimum of processing from their normal state. This should minimize waste, increase production speed, and reduce costs.
Chicka, C. and Anthony Chimpa. Diabetic's Jet Ejectors. Diabetic Gun for Personal Insulin Injection. H.W. Parker, .
Trissel, Lawrence. Pocket Guide to Injectable Drugs: Companion to Handbook of Injectable Drugs. American Society of Health-System Pharmacists, .
&#; Perry Romanowski
Syringes were invented long before hypodermic needles. Their origins are found in Greek and Roman literature where there are descriptions of hollow reeds for the ritual of anointing the body with oil, and as musical instruments using a plunger to alter the pitch. Simple piston syringes for delivering ointments and creams for medical use were described by Galen (129-200 CE) and an Egyptian, Ammar bin Ali al-Mawsili, reported using glass tubes to apply suction for cataract extraction from about 900 CE. In , Pascal&#;s experimental work in hydraulics stimulated him to invent the first modern syringe which allowed the infusion of medicines. Christopher Wren (better known as an architect than for his medical training), used a &#;cut-down&#; technique to intravenously inject dogs with poppy sap through goose quill canulae. By Drs Major and Esholttz used this method on humans with similar fatal results due to ignorance of suitable dosage and the need for sterilising utensils and the infusion. The disastrous consequences of these experiments delayed the use of injections for 200 years.
The first hypodermic needle was probably made by Francis Rynd in Dublin in , using the technology of annealing the edges of a folded flat strip of steel to make a tube. This was then drawn through increasingly narrower dies whilst maintaining the patency of the needle. The bevelled point is cut and ground, and then the hub is added with its variety of fittings and locks. A syringe has three elements, the barrel (glass, plastic or metal), the plunger and the piston which may be of rubber, mineral, metal or synthetic material but in early examples waxed linen tape or asbestos was wound on a reel to obtain a watertight seal. Charles Pravaz, in France, administered coagulant to sheep in , but it seems that Alexander Wood in Edinburgh combined a functional syringe with a hypodermic needle in the same year, to inject morphine into humans and probably should be credited with inventing the technique. The basic design has remained unchanged though interchangeable parts and the use of plastic resulted in the almost universal use of disposable syringes and needles since the mid-s.
Looking to the future of the parenteral administration of medicines and vaccines, it&#;s likely that there will be increasing use of direct percutaneous absorption, especially for children. Micro-silicon-based needles, so small that they don&#;t trigger pain nerves are being developed, however, these systems cannot deliver intravenous or bolus injections so hypodermic needles, with or without syringes, are likely to be with us for a long time. They are also required for catheter-introduced surgical procedures in deep anatomical locations.
Some needles from the collection:
Figure 1 shows three generations of needles. The top left ones are single-use needles from the s with various lengths and gauges. At the top right is small sample of needles of a currently used type, supplied in a patent wrapper in their individual protective sheathes, with colour coded plastic hubs. Below these are the s screw-on double ended needles patented by Boots & Co Ltd to fit their cartridge loading syringes. The internal point pierced the rubber bung on pre-dosed cartridges which could be inserted in the patent syringe.
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The range of needles is extensive. Each manufacturer produced a different shaped hub. Also, the taper of the nozzle was non-standard though most used were the &#;Luer&#; and then the more tapered &#;Record&#; but in addition to this were different locking devices to fit different syringe nozzles. The gauge and length of needles varies greatly according to their purpose. Figure 2 illustrates infusion needles in which the bulbous hub fits directly on to rubber tubing. Pneumothorax needles are for withdrawing air from the pleural cavity. The side arm allows for the attachment of a suction bottle using a two-way tap. The Hamilton Bailey type infusion canulae needles are eight from the early 20thcentury, made of gold for sterility, with slots through which to thread a support tape. Figure 4. Shows aspiration needles. They have a bevel-pointed introducer to facilitate insertion of the needle.
Figure 1. Figure 2. Figure 3.
Figure 4 below, shows two unused, &#;Gord&#; type, infusion needles. Both are fitted with detachable rubber diaphragms to make repeated intravenous injection easier. With several minor variations they were used for many years until the s when single use &#;Butterfly Needles&#; were introduced.
Figure 5: This is a s portable lumbar puncture set used to measure the pressure of and test the cerebrospinal fluid which flows when the spinal meninges have been punctured.
Figure 6: Haemorrhoid needles are characterised by a shoulder on the haft a few millimetres short of the needle tip to prevent deep penetration when injecting the haemorrhoids. A secure needle-lock ensured that the increased pressure required to inject the viscous oil did not detach the needle.
Figure 4. Figure 5. Figure 6.
The needles pictured below represent the range of needles and packaging which were commonplace between and . They often became blunt with multiple use, were impossible to clean and sterilise adequately and caused infections leading to cellulitis and abscesses. Sharpening needles was sometimes solved by including a suitably shaped carborundum stone in the injection set. Needle sharpening devices were needed for rapid and consistent sharpening of many needles by large institutions (Figures 7. & 8.).
Figure 7. Figure 8.
Syringes and Injection Sets:
The Mussel Shell (Figure 9.), a pocket-sized syringe set, was patented by Burroughs Welcome, about , particularly for use with tabloids, containing a standardised dose of soluble preparations to be injected after dissolving in distilled water. It was not until later that pharmaceutical manufacturers prepared sterile injections in sealed glass ampoules. Probably the oldest syringe in the collection (c) has a small metal barrel with a plain glass tube to contain a medication. It is crude and has a waxed linen piston with thumb-hold on the plunger. The needle has a screw fitting like another of the older syringes in the collection with its ferrous metal ends and non-sterilisable, ivory thumb piece on a plunger with a rubber piston. (Figure 11.)
Figure 9. Figure 10. Figure 11.
There were a variety in syringes made from all glass to all metal, but the Rekordspritze introduced by the Berlin instrument makers Dewitt and Hertz in gained prominence through its dependability, lack of leakage and jamming, and ease of dismantling to enable sterilisation. This pattern persisted until plastic superseded it. It was manufactured by many companies with minor modification all over the world. All glass syringes retained some popularity but were more susceptible to jamming and leaking (Figure 13.). Cartridge syringes were popular with dentists, and for emergency kits (Figure 14.).
Figure 12. Figure 13. Figure 14.
The collection contains several special purpose syringes and syringe sets. The anaesthetic syringe set was in common use by GPs and specialists. (Figure 10.). One that took us a while to identify is shown in Figure 15. The copper cased cannulas and the thick metal syringe with a robust screw lock retain heat to enable the injection of melted paraffin wax into hollow organs and vessels for demonstration specimens for morbid anatomy classes. Another unusual syringe is the AGLA Micrometre Syringe Outfit shown in Figure 16. This was designed for analysis of diluted concentrations of biological fluid components where accurate measurement of precise quantities is required. The enclosed booklet suggests that it was particularly used in immunology research and assessment where serial dilutions are critical, but toxicology would suggest itself as another application.
Figure 15. Figure 16.
Needles and syringes were routinely sterilised in sets, usually by simple boiling but in clinics and hospitals autoclaves were used to obtain higher temperatures. Syringe sets enabled the non-interchangeable components to be kept together. Single use items now dominate the products though occasionally glass may be used in preference to plastic because of the characteristics of the substance to be injected. However, most syringes, intravenous giving sets and intravenous catheter placement sets are made from plastic with stainless steel needles, wrapped in cellophane and sterilised using gamma irradiation (Figure 17.). Expensive modern biological pharmaceuticals are often distributed in a single dose syringe with, plastic and rubber plunger with a sealed needle incorporated into the glass barrel for self- administration. This means the syringe is the container for the medicine and reduces the chance of wastage (Figure 18).
Figure 17. Figure 18.
The Marks-Hirschfeld Museum of Medical History aims to celebrate Queensland&#;s medical history by telling the stories of its people, events, objects, scandals and triumphs. We welcome all stories with a medical history aspect. Get in touch with us at .
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