Brot úr sögu stungulyfja : með sérstöku tilliti til íslenskra aðstæðna [seinni hluti : stungulyf á Íslandi]

Abstract

The first reliable syringes and hollow needles for the injections of drugs subcutaneously, intramuscularily and intravenously or for other injections came into use shortly after 1850. As far is known, morphine was the first drug to be injected subcutaneously, using a syringe and a hollow needle. Use of injection medicines, especially containing morphine or other alkaloids, became widespread among European doctors in the latter half of the 19th century. The use of injection medicines began before the existence of infectious microbes or microorganisms in general had become common knowledge, or the equilibria of electrolytes in and around living cells had been understood. Thus, injection medicines, their production and procedures of use had to pass through lengthy development lasting nearly one hundred years, in order to reach the levels of quality standards now universally accepted. It was also a definite advancement when disposable syringes and needles came into general use around 1960. Accessibility to injection medicines and their use was seemingly on a low scale in Iceland until 1930 or thereabout. The production of injection medicines in Iceland began in substance in the fourth decade of the last century. The production was generic, following official formulas, and was based in several pharmacies and a few drug companies. Only two producers offered a sizeable assortment of drugs. The production gradually became concentrated in a few firms and was finally handled by only one international, locally based, generic drugs firm, where the domestic production of injection medicines ended shortly after 2000.

Fyrsta heimild á prenti um að morfínstungulyf hafi verið notað við skurðaðgerðir hér á landi virðist vera frá tímabilinu 1890-1895. Guðmundur Guðmundsson (1853-1946), læknir, skar upp sjúkling með kviðslit og klemmdan þarm og gaf morfín í formi stungulyfs og „snafs” á undan aðgerðinni.41 Þessi unga heimild og það að Sjúkrahús Reykjavíkur virðist ekki hafa átt lyfjadælur árið 1878 bendir eindregið til þess að lyfjadælur hafi að minnsta kosti ekki verið almenn eign lækna fyrr en kom fram undir lok 19. aldar. Um aldamótin 1900 virðist samt „sprauta og morfín“ vera orðið meðal þarfaþinga í læknatöskum.13 Ef til vill skýrist þessi „fátækt“ af ummælum Vilmundar Jónssonar: „Allt fram á níunda tug aldarinnar, er ígerðarvarnir tóku loks að nema hér land, voru skurðaðgerðir íslenskra lækna með stökustu og strjálustu undantekningum einungis aðgerðir, sem nú myndu flokkast undir chirurgia minor í allra fábreyttasta formi.“41 Það þarfnast hins vegar fyllri skýringar, að svo virðist sem enginn á Íslandi hafi á þessum árum þjáðst af „neuralgia“, líkt og í nálægum löndum og áður ræðir, og þurft morfín í formi stungulyfs við verkjum. Eða voru Íslendingar bara látnir þola verki lyfjalaust?