Hundreds of millions of adults around the world can expect to be vaccinated against Covid over the next few months. It will be delivered by hypodermic syringe - but who invented it?

Most people with access to healthcare take vaccinations for granted.

The syringe that is now being used to provide protection against Covid may look simple enough - but appearances can be deceptive. 

It took millennia to create the hypodermic syringe in a form that was to allow mass vaccinations to take place today.

An Irish surgeon, Francis Rynd, and French physician, Charles Pravaz, made a huge contribution to the field in the mid-19th Century.

But it was a Scottish doctor, Alexander Wood, who is now widely credited with inventing the modern-day hypodermic syringe.

Wood may have had little idea of the importance of his invention in the 1850s.

But his creation of an all-glass syringe with plunger and fine-bore needle was to become as recognisable a medical device as the stethoscope.

Syringes in some form or another have been around at least since the time of the Greek physician Hippocrates in the 5th Century BC. 

Early versions were crude. Constructed of animal bladders and pipes or quills, they were largely used for irrigation - the practice of washing out or flushing a wound or body - or enemas. 

In the 11th Century, an Egyptian ophthalmologist used the first known hypodermic-like tool to remove cataracts.

But it wasn't until the mid-17th Century that the earliest confirmed experiments in intravenous injection were undertaken.

In experiments with dogs in 1656, Britain's Sir Christopher Wren - better known as an architect - administered drugs using an animal bladder attached to a hollow goose quill.

"He injected opium, alcohol and crocus metallodrug (a 17th Century emetic) into different dogs," explains anaesthetist Christine Ball, honorary curator of the Geoffrey Kaye Museum of Anaesthetic History in Melbourne.

"As we would expect, the first went to sleep, the second became very drunk and the third became very dead."

By the time Edward Jenner, who created the world's first vaccine, appeared on the scene nearly 150 years later, there was still no sign of a sophisticated method of administering drugs into the human body.

In 1796, he successfully vaccinated an eight-year-old boy against smallpox.

However, the vaccine was administered through a cut, and so was not technically an injection.

By the mid-19th Century, medical minds had begun to focus on a more efficient system of drug delivery.

In 1844, Irish surgeon Francis Rynd invented what was arguably the world's first hollow needle.

But it was a device which used gravity to make the liquid flow and involved breaching the skin with a tool known as a trocar.

Within 10 years, however, the modern version of the hypodermic needle was born. 

In 1853, Fife-born physician Alexander Wood added a plunger and developed the first all-glass syringe that allowed doctors to estimate dosage based on the amount of liquid observed through the glass.

His first patient was an 80-year-old woman who suffered from a form of neuralgia. 

Concerned only with relieving localised pain, he injected her with 20 drops of vinous solution of morphia (morphine dissolved in sherry wine) at a point in her shoulder where the pain was most severe.

She subsequently went into a deep sleep but later recovered.

Wood's invention coincided in the same year, by all accounts completely by chance, with the creation of a similar instrument by French surgeon Charles Pravaz.

But while Wood's device was made of glass and featured a plunger, Prava's invention was composed largely of silver and used a screw that had to be turned to push medicine into the body.

Wood's treatment by subcutaneous injection rapidly became popular in Great Britain.  His instruments were advertised as "Dr Alexander Wood's narcotic injection syringes".

Several years passed before a London surgeon, Charles Hunter, coined the term "hypodermic", based on the Greek words "hypo" (under), and "derma" (skin).

The Royal College of Physicians of Edinburgh (RCPE) says there are two reasons Wood - a past president of the organisation - should be given credit over Pravaz.

Daisy Cunynghame, library and heritage manager for the RCPE, explains: "Firstly, Wood trialled his new syringe by using it to inject a patient with medicine (morphine) while Pravaz tested his on a sheep. So the efficacy of Wood's method was more clear. 

"Secondly, Pravaz died before he published his findings - while Wood published about his discovery."

Dr Cunynghame says the modern day hypodermic needle has changed remarkably little from Wood's design.  "The main difference has been in the material the syringe is made from - more disposable plastics, less glass and metal, but other than that the design remains largely unchanged. The sort of precise doses needed for many medicines, including vaccinations, have only been made possible by Wood's invention."

A four-letter word is on a lot of people’s minds these days. That word is “shot,” as in, “I want my covid-19 shot! How do I get my covid-19 shot?”

Jon Simon was curious about that word. He is a 67-year-old word researcher who lives in Silver Spring, Md., and has done work for the Oxford English Dictionary.

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As Jon knows, words have to come from somewhere. For example, “vaccine” is derived from the Latin word for “cow,” a reminder that Edward Jenner used pus from a cowpox infection — a disease that affected cows and the milkmaids who worked with them — to prevent smallpox.

But why do we call an injection a “shot”?

“It’s not necessarily obvious,” said Jon. So, using online newspaper and book databases, he set out to trace the word back to its origins.

What Jon found is that this common word — employed today in a mostly positive context — first gained widespread use to describe the depths of drug addiction. That drug: morphine.

Opium had been smoked for centuries. Morphine had been swallowed in tablet form or drunk in solution. Then in an 1855 paper, Scottish physician Alexander Wood described a method of introducing morphine directly to the part of the body in pain. Wood used a syringe and fine-bore needle, what we know as a hypodermic needle. (Hypo: under. Derma: skin.)

This made treatment easier, but it also invited misuse.

One of the earliest “shot” mentions Jon found was in the San Francisco Chronicle of March 2, 1889. A story headlined “The Hypo-Gun. How Morphine Victims Are Fed” describes the scene inside a drug house. The quotation marks and explanations suggest the writer thought much of this would be new to the reader:

“The morphine victim is cared for there — as long as he has money. In all the houses frequented by the ‘fiends’ is a man or a woman who sells the drug and injects it for a small sum. This useful person is called the ‘gunner,’ the syringe is termed the ‘gun,’ and administers to the fiend an injection, that is ‘a shot,’ for which he is paid 5 cents.”

It looks like “shot” comes from “gun,” the euphemism for the apparatus that delivered the morphine.

“Shot” had a negative connotation in the waning years of the 19th century, used often in conjunction with morphine addiction:

• “Defendant claimed and testified . . . that he was at home, about a half-block from Rathja’s saloon, administering what he calls a ‘shot’ of morphine to one Boyden.” (From “Reports of Cases Determined in the Supreme Court of the State of California,” 1892.)

• “There is a place in San Francisco where victims of the insidious morphine habit go for ‘treatment’ daily . . . Men saunter in for a ‘shot’ as other men drop in at a saloon on the way to business for a morning bracer.” (From “Quarterly Journal of Inebriety,” 1894.)

I asked Jon what was going through his mind as he found reference after reference to drug dens.

“Some of it is very sad — and horrifying, even — but mostly it is the thrill of the hunt,” he said. “I’ll admit to that.”

Eventually, the negative connotations of “shot” were forgotten — or subsumed by the more beneficial ways a hypodermic needle can be used.

Jon was also curious about the phrase “a shot in the arm.” It came later. One of the earliest references he found was in the March 2, 1918, issue of Investment Weekly: “However unsound economically Mr. McAdoo’s War Finance Corporation may be, it is bound to have certain effects which the investor cannot afford to overlook. The first of these will be a great stimulus of business — the same sort of stimulation perhaps which results from a ‘shot in the arm’ — but very real stimulation nevertheless.”

While “shot” started out with negative connotations, here was “a shot in the arm” used positively.

“Exactly,” said Jon. “It’s very weird how that worked out.”

Inspired by Jon, I went down the rabbit hole of early morphine coverage. What’s clear is that people discovered pretty quickly that morphine was uniquely addictive — and that overprescribing it could lead to problems.

In 1887, a reporter for the San Francisco Chronicle wrote:

“If morphine is resorted to so constantly by the medical profession for the relief and cure of disease, it necessarily follows that the laity must become more or less familiar with its use. A prescription is given containing morphine; it gives infinite relief; the patient does not think it necessary to consult the physician a second time, but on his own responsibility renews the prescription again and again, unaware of the dangerous pit into which he is falling. Sooner or later he awakens to the realization that his disease is cured, but that he is a slave to morphine, without the power to escape.”

If executives at today’s drug companies had looked at old newspapers, a lot of heartache might have been prevented.

The United States Public Health Service is experimenting with monkeys in the City's Research Laboratory, at the foot of East Sixteenth Street, for the purpose of establishing definitely the value of vaccine in the prevention of pneumonia and of serum in its cure.

The research work, in which 200 monkeys already have been used, began in Washington in March of last year in order to follow up remarkable results obtained in some of the army camps in the use of vaccine against pneumonia, which in the last two years has caused more deaths than any infectious disease.

The experiments were started in the Army Medical School in Washington by Major Russell L. Cecil and Dr. Francis C. Blake, now of the Rockefeller, Institute of Medical Research. Both reported encouraging results to the New York County Medical Society and gave figures on the use of the vaccine at Camps Upton and Wheeler, indicating great value in the vaccine. Dr. Cecil is continuing the experiments with G. I. Steffen, a bacteriologist, for the United States Public Health Service. The work will continue for a year or more before the research is considered complete.

Monkey Scarcity Retards Work.

The experiments are progressing slowly at present because of the scarcity of Philippine monkeys. There are so few in this country at present for medical work that they command a price of $20 apiece. Louis Ruhe, an animal dealer, who recently brought in a shipload of 700 monkeys from India, said it was difficult to import the animals because freight shipping from the Orient was so brisk that ship owners would not allow space to animal importers, and because it was necessary to send men to India or the Philippines to look after the health of each cargo of monkeys.

Dr. Cecil, who stated in a report to the New York County Medical Society last week that the pneumonia rate at Camp Wheeler among the unvaccinated soldiers was twenty times the rate for the vaccinated, has finished the experimentation on monkeys with Type 1 of pneumonia. These experiments are held to indicate that the vaccine gives protection against this type of pneumonia, and that the serum, given in time, cures it. The vaccine is an extract made from dead pneumonococcus germs. The serum is taken from the blood of a horse inoculated with the germs. The theory is that the vaccine stimulates protective action in the blood of the human being to prevent the disease, while the serum contains an agency developed in the blood of the horse for combatting the disease, which agency aids in the battle which the human system makes against the disease after it had obtained a start.

A long series of preliminary experiments were made at the Army Medical School in Washington, which proves that pneumonia ran a course in the Phillipine monkey of almost exactly the same nature as in man. After that monkeys were used in sets of two. The pneumonia germs of Type 1 were shot into the throats of one vaccinated and one unvaccinated monkey, the unvaccinated one being used as a “control.” The unvaccinated monkey, it was reported, invariably got pneumonia and died from it. The vaccinated monkeys contracted the disease, but in a mild form, and soon recovered. Large doses of vaccine have been used in the experiments in this city with more favorable results. Six sets of monkeys have been inoculated with the germs here. The unvaccinated monkey has died each time, while the monkey vaccinated with the larger dose has not contracted the disease at all.

Experiments are now beginning in the use of Type II of pneumonia, which is in four types. The year or more of experimenting is to include the use of vaccines against each type and combinations of the vaccine against all the types. The advocates of the vaccine believe its value has been established in the army camps against the first three types, but less is known about the so-called fourth type, which is thought to comprehend several groups of pneumococcus and other infections.

Inoculated Monkeys Saved.

Other experiments were made in the cure of monkeys inoculated with Type I. They were given hypodermic injections of serum twice a day until their temperature had become normal. Uniform success was reported in saving the inoculated monkeys by this method.

The results from the use of vaccine at Camp Wheeler were similar to those obtained in the Y. M. C. A. in this city during the epidemic a year ago, which reported that of 287 persons treated with the vaccine developed by Dr. Ellis Honime in this city, only three developed influenza or pneumonia, while of 217 Y. M. C. A. Workers who were not vaccinated, 45 contracted influenza or pneumonia. Dr. Cecil in a report on the results at Camp Upton said:

“The final figures showed only 17 cases of pneumonia of all types occurring among 12,519 men who received vaccine; whereas, among unvaccinated troops during the same period there was a total of 173 cases of pneumonia of all types. For the ten weeks which the men were under observation, the pneumonia death rate for vaccinated troops was only .83 per thousand; for the unvaccinated it was 12.8.

Altogether 13,460 men, or about 80 per cent. of the entire strength of Camp Wheeler, were vaccinated against pneumonia with pneumococcus lipovaccine. Both the local and general reactions produced by the vaccine were mild. Only .7 per cent of those who received the vaccine were sufficiently affected to receive hospital care. None of these were seriously ill and a majority of them returned to duty in two or three days after admission.”

The limitations of the vaccine and some of the difficulties in bringing it into general use were stated as follows:

"One of the chief difficulties which we encounter in fighting against pneumonia is the variety of types of pneumonia which are encountered. Even if streptococcus, influenza and other rare forms are eliminated for the reason that they are not often seen in civil life, the pneumococcus itself occurs in such variety of types that it is difficult to prepare a vaccine capable of protecting against all of them. If Type IV pneumococcus were a fixed type similar to Types I, II and III, this difficulty could be obviated. But Type IV pneumococcus is simply a name given to a large group of pneumococci which appear to be entirely independent of each other and which give no mutual protection.

"Pneumonia rarely occurs as an epidemic scourge like smallpox, so there would be difficulty in having vaccination against pneumonia made compulsory. People do not fear the disease and are, therefore, unwilling to submit to the inconvenience of being vaccinated. Unless vaccination against pneumonia is practically compulsory; it will be very difficult to get a large number of candidates in civilian communities.”