Title: A Treatise on Regional Iodine Therapy for The Veterinary Clinician
Author: Steffen, Mart R.
Language: English
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THERAPY FOR THE VETERINARY CLINICIAN ***



  A Treatise
  on
  Regional Iodine
  Therapy

  for
  The Veterinary Clinician

  by
  MART R. STEFFEN, M.D.C., V.S.

  Author of Special Veterinary Therapy,
  Special Cattle Therapy, Clinical
  Diagnosis of Cattle Diseases,
  Special Equine Therapy,
  Veterinary Clinical
  Notes, etc.


  1919


  Published by
  PHARMACAL ADVANCE PUBLISHING CO.
  168 Duane Street, New York



  Copyright 1919 by
  Pharmacal Advance Publishing Co.



  CONTENTS.


  I.  Introduction.

  II.  General Considerations of Local Iodine Therapy.

  III.  Special Considerations of Local Iodine Therapy.

  IV.  The Selection of Iodine Preparations for Practical Use.

  V.  Method of using Regional Iodine Therapy in the Correction of
  Various Pathological Conditions.



I.

Introduction.


In presenting to the veterinary profession this treatise on Regional
Iodine Therapy, I do so with the object of bringing into the light
certain clinical facts that have to do with the topical application of
iodine in veterinary patients, and to discuss, from the standpoint of
the clinician, those particular pathological conditions to which these
facts apply.

It will be further my purpose to point out to the reader the special
indications for topical iodine medication which have, in the past, been
overlooked by the practitioner of veterinary medicine.

Throughout the treatise I shall confine myself to the exposition of
only such matter as I have found to be compatible with the practical
phases of veterinary science in the conduct of my own practice.

  M. R. S.

  Milwaukee, Wis.
  March, 1919.



II.

General Considerations of Local Iodine Therapy.


While it is a fact that iodine is one of the most popular of the
many medicinal agents used by the practitioner of veterinary
medicine and surgery, it also is a fact that iodine--more so than
any other agent--is frequently used in pathological conditions and
under circumstances that lack every scientific indication for its
application. To a certain extent this is true of almost any medicinal
agent in common use, even those whose field of applicability is less
broad than that of iodine; but it is especially noteworthy in the use
of iodine.

Iodine does not differ from any other therapeutic agent with regard to
individual indications for its application; it has these as prominently
marked as have the alkaloids, physiologically. But it does differ from
almost all other therapeutical agents in the fact that, it has such a
vast field of applicability in which the indications for its use are
supported solely by clinical evidence and in which its action defies
all attempts at an explanation of results attained, on a physiological
basis.

Although the practitioner may not be able to satisfy his ethical desire
to explain the action of preparations of iodine in the latter class
of pathological conditions, he soon makes the discovery that these
actions and results are, to a very considerable degree, dependent upon
more or less well-marked clinical and physical phenomena. In order
to be able to give to his use of iodine, in its various forms, even
a semblance of ethical practice, and, also, in order to be able to
roughly classify and select the conditions in which he may use iodine
with some expectation of uniform results, it becomes imperative that
the practitioner acquaint himself with these facts and phenomena. Not
only this, but he must acquaint himself, as well, with the peculiar and
individual effects and actions, in a clinical sense, of the different
forms in which iodine is used as a topical or regional application.

What may be an indication for the use of iodine in one form, may lack
the requisite pathological status for its application in a successful
manner in one of its other forms. Thus, in a given pathological
condition, an ointment of iodine may fall far short of the therapeutic
power that the practitioner expects it to exert, despite the fact that
the case is clearly one for iodine therapy. When, on the other hand, in
the same case, use is made of the tincture of iodine, or of an aqueous
solution of iodine, the desired results may be obtained with almost
amazing promptness. Again, in another class of cases, the reverse may
be true.

Although, in a goodly proportion of the cases to be discussed in the
following chapters in this treatise, the practitioner must come into
direct and frequent clinical contact with the pathological conditions
themselves in order to become thoroughly acquainted with the clinical
and physical facts referred to, he will derive much benefit from a
careful reading of these chapters, to the extent that he will note not
only new lines of thought with regard to iodine medication, but he
may also lay, in their reading, the foundation for an ethical system
of iodine therapy in so far as this is possible in the light of our
present acquaintance with the subject.



III.

Special Considerations of Local Iodine Therapy.


When we undertake the consideration of those features of iodine therapy
which have to do with its adaptability to definite remedial ends, we
enter upon a field of thought that may take several forms.

We are concerned, in this treatise, only with matter relating to
regional, topical, or local applications of the agent under discussion,
and we can well begin the consideration with the identification of the
agent itself and the different forms under which it is most commonly
used. For all practical purposes, we can confine the discussion of the
agent itself to that of the four forms, or preparations, of iodine
in almost universal use by practitioners of veterinary medicine and
surgery. When, in veterinary medicine, allusion is made to iodine, it
is almost, without exception, to one of the following preparations:

  1. Tincture of Iodine.
  2. Ointment of Iodine.
  3. Aqueous solutions of Iodine.
  4. Oily solutions or mixtures of Iodine.

Only in rare cases, and then under specific reference, is iodine used
in other forms, or in its elemental state, in veterinary medicine.
Iodine is a very active agent, chemically as well as therapeutically,
and is not readily compatible with other agents. It is for this reason,
that combinations of iodine with other drugs and chemicals are not
common, and therein lies a distinction for iodine that not many other
therapeutic agents can claim; namely, that beneficial effects resulting
from iodine medication are almost, without question, due to it alone;
it is hardly ever applied in combination with synergists which might
obscure the activity of individual ingredients.

This remarkable therapeutic activity of iodine is such that, when
properly applied in some of its forms, its presence can be demonstrated
in the underlying tissues. After prolonged courses of topical
application, its action is occasionally appreciated, both subjectively
and objectively, in the evidence of more or less clearly defined
constitutional or systemic indications of its presence within the
animal organism.

From this, it is apparent that, in iodine preparations of a particular
class, we have an agent whose topical remedial effects are, in some
slight measure, due to systemic action; in part at least, this action
being the effect of great physiological activity exerted in the limited
area of its topical application. In some degree this activity of
certain preparations of iodine can be explained by reference to the
chemical properties inherent in iodine as elemental matter, and in its
well-known affinity for certain elemental constituents of the tissues
of the animal organism.

The foregoing throws some light on the therapeutic accomplishments
of iodine preparations, when topically applied, and, to a certain
extent, explains its _modus operandi_ in a physiological sense--an
understanding somewhat essential from an ethical standpoint. The old
theory, which would ascribe to an increase in function of the regional
lymphatic glands all the agreeable therapeutic effects of local iodine
applications, does not cover enough ground; it is only when we amplify
this theory, with the assumption of the considerations aired in the
foregoing paragraphs, that we find it possible to attain a clear
understanding of the physiological action of iodine preparations
applied regionally.

_The Clinical Aims_ for topical therapy are to be classified as follows:

  1. PROPHYLACTIC.
  2. AMELIORATIVE.
  3. CURATIVE.

Under these three heads, we further sub-classify the actual clinical
conditions, which are indicated, into the following:

 Under 1. Surgical preparatory technique.

 Under 2. Acute pathological conditions, in the corrections of which
 topical applications of iodine preparations are used as an adjunct to
 internal medication with other agents.

 Under 3. Chronic pathological conditions, in which one or more of
 various iodine preparations, locally applied, constitutes the entire
 treatment.

This classification and sub-classification is important and essential
when we endeavor to make our use of iodine conform to ethical
standards; it is also very essential to the attainment of certain
therapeutic ends in actual practice.


 1. THE LOCAL APPLICATION OF PREPARATIONS OF IODINE IN THE SENSE OF
 PROPHYLACTIC AIM IN SURGERY.

The exhaustive pre-operative washing and scrubbing of the integument,
that veterinary practitioners applied to their surgical patients in
years past, has given way almost entirely to iodine painting. Even
those surgeons who still adhere to the scrubbing and washing of the
parts about to be incised, complete the process with an application of
iodine thereafter.

An application of iodine to the skin covering the region that is
about to be invaded by the knife of the surgeon, has been found much
more efficacious and much more reliable than has the washing and the
scrubbing with antiseptic solutions, soaps and other agents. Not only
this, but it has also greatly simplified and shortened an otherwise
tedious, prolonged and sloppy technique. Whereas, the surgeon formerly
spent from fifteen minutes to half an hour scrubbing and washing the
field of operation, he now applies a few coats of iodine tincture--a
few strokes of the swab or brush--and it is done.

This simplified technique has the added advantage of the total
elimination of basins, brushes, and sponges for use in the preliminary
stages of an operation, as well as the agreeable absence of the
wet, sloppy field that inevitably resulted from the use of the older
method in veterinary practice. Besides, it spares the patient in more
ways than one, especially in the cold months of the year when, in a
veterinary practice, operations frequently have to be performed in cold
stables, or even in the open.

While the application of tincture of iodine gives ample protection from
skin infection in surgical operations, there are a few things to be
observed that have to do with making the application correctly. First,
in veterinary patients, the hair must be clipped off and the area
shaved clean. The area clipped and shaved should be slightly greater
in extent than the field actually to be invaded by the knife. When
the clipping and shaving have been done, the area should be lightly
brushed with a stiff, dry brush, in order to remove dandruff and scurf.

The second--and the most important--point is that the surface that is
to be painted with the tincture of iodine be perfectly dry. In the
event that the area to be painted should contain a deposit of filth,
oily or greasy in nature, this should first be removed by swabbing and
wiping with gauze or cotton saturated with gasoline, benzine or ether;
these remove oily, greasy or fatty filth and evaporate quickly, leaving
the area perfectly dry and clean. Washing with watery solutions,
previous to the iodine application, is not recommended under any
conditions.

When the area has been clipped, shaved, freed from grease or other
filth, and then allowed to become perfectly dry, the tincture of iodine
is applied liberally with a soft brush, or with a cotton swab. This is
allowed to dry for a minute or two; another application is then made
directly on top of the first one, allowed to evaporate to dryness, and
the field is ready for the incision.

As iodine readily attacks metals, and spoils the plating on
instruments, no instrument should be allowed to come in contact with
the painted area while it is still moist; neither should the iodine
be used for disinfecting purposes on any utensils or apparatus made
of metal. The fact that the iodine may injure instruments can not be
considered in the light of a disadvantage, if the above precautions are
taken.

Another practice that has come to be recognized quite generally among
surgeons is that of painting the edges of the surgical wound with pure
tincture of iodine just before the wound is to be closed with sutures.
Whether this is good practice, on general principles, is a matter that
is open to debate. If the painting is done carefully, so that a pool of
iodine tincture is not formed by the surplus gathering by gravitation
into the deeper recesses of the wound, this may be considered good
practice. On the whole, however, it would appear that the iodine could
act, in many instances, as an undesirable irritant when it comes in
contact with delicate, freshly incised tissues.

As the object, in modern surgery, is to eliminate all things, even the
slightest, that may hinder prompt repair and smooth healing of the
invaded tissues, the presence of such an active agent as pure tincture
of iodine in a surgical wound may be looked upon as interfering with
the carrying out of that object.

On the other hand, in surgical wounds of an already infected character
in which primary union would be out of the question, the application
of pure tincture of iodine, in liberal amounts, can not be too highly
endorsed.

The latter statement applies, with even greater force, to all wounds of
an accidental character in the fleshy portions of the anatomy.

It is also the practice of many veterinary surgeons to apply pure
tincture of iodine to the wound after the sutures have been put into
place. This is a very satisfactory practice, if the painting is done
gently and not too freely. An excess of the tincture of iodine--if
the wound edges have not been coapted perfectly--may result in cause
for stitch abscess when a considerable amount of the iodine becomes
pocketed in some part of the wound under the line of suture.

In certain animals, whose skins are very tender, the local application
of pure tincture of iodine, previous to surgical incision, is followed,
in a few days, by slight peeling of the integument. This is so rare an
occurrence, however, and of so little consequence, that it need not be
considered, and can not be looked upon as a drawback to this otherwise
salutary practice.

Aside from its use in the preparation of the surgical field, tincture
of iodine is also used, in a prophylactic sense, to prepare the
skin--in a similar manner--for the entrance of the hypodermic needle
whenever a subcutaneous injection is to be made. It is not practical,
nor necessary, in this instance, to shave away the hair; the site that
has been selected for the needle puncture is merely painted liberally
with the iodine. As in the case of a surgical incision area, so also
here, the parts to which the application is made must be perfectly dry.


 2. THE USE OF IODINE AS AN ADJUNCT TO INTERNAL MEDICATION IN THE
 CORRECTION OF ACUTE PATHOLOGICAL CONDITIONS.

Iodine preparations of various forms are very commonly used topically
as an adjunctive treatment to internal medication in the treatment of
a number of acute pathological conditions in veterinary patients. The
object in adding local iodine applications to the handling of such
conditions is varied. In some cases, the object of the practitioner is
to hasten the correction of certain well-marked local manifestations of
the disease with which the patient is afflicted. In other instances,
the aim of the practitioner is toward the prevention of these local
manifestations. Occasionally, in a certain type of pathological
conditions, the practitioner intends, by the use of topical iodine
applications, to enhance the internal treatment being aimed at symptoms
whose entire nature is local in character and confined to a very
limited portion of the anatomy.

In every case coming under this sub-classification, the effect that
the iodine applications have--the only effect that they are able to
accomplish--is one of amelioration; they can have no direct curative
effect here. While the various conditions that are included under this
head will be fully discussed in following chapters, I will point to the
use of topical iodine medication in the handling of a case of parotitis
as an illustration. While regional applications of iodine are the rule,
in the handling of cases of this affection in veterinary patients,
no one at all versed in the condition as it occurs in practice would
give the credit of ultimate cure to the iodine applications. But all
will admit readily that, while the internal treatment indicated by
the pathology of the condition is correcting the lesion _per se_, the
regional applications of iodine do contribute materially to a smooth
termination of the case in that they do, without question, lessen
the possibility of abscess formation, relieve the pain, and hasten
resolution.

The conditions included under this heading form, in great part, that
class of cases to which reference was made in the beginning of this
treatise, namely, those in which iodine treatment is largely used under
circumstances and in conditions that lack almost every scientific
indication for its application. Yet, it is in these very conditions,
and under these very circumstances, that topical applications of
iodine are frequently most salutary in effect. And this effect is
enhanced to the degree, as will be pointed out later, to which the
practitioner becomes adept in the selection of the proper form or
preparation of iodine for the particular case in hand.


 3. REGIONAL IODINE APPLICATIONS FOR THE CURE OF CHRONIC PATHOLOGICAL
 CONDITIONS.

It is in the correction of chronic pathological conditions, that iodine
therapy finds its greatest field in the practice of veterinary medicine
and surgery. It is in chronic pathological conditions, that iodine,
in various forms, and with various modes of application, so forcibly
demonstrates its therapeutic work, for it is here that iodine is often
the only agent used in the handling of the case, thus constituting the
entire treatment. Under these circumstances, it is never a difficult
matter to decide as to the value of the treatment or the activity of
the agent used.

Were there no other means of demonstrating the fact that iodine, in
some of its forms, arouses the animal organism to the end, and in the
direction, of marked efforts at regional cure of various pathological
states, we would have evidence of ample weight to convince us of this
in the results that we daily get with its application in a general
practice.

There is hardly any therapeutic result from which the practising
veterinarian derives more professional satisfaction than he does
from the sure, gradual effect of properly selected and correctly
applied iodine preparations in chronic pathological conditions of
the articulations, from the speedy and specific effect of others in
certain skin diseases, and from the almost miraculous cure of certain
localized infections when the proper iodine medication is applied in
these.

So sure are the effects of iodine, in a curative way, in certain
diseased conditions among domestic animals, that it has value in this
regard from a diagnostic standpoint. Given a case apparently of this
type for handling, the practitioner can be assured that he has erred in
his diagnosis if iodine, in proper preparation and correct application,
does not effect a cure. To illustrate this, I need only refer to that
diseased condition of the skin commonly termed “ring worm.”

It is nothing unusual, in a veterinary practice, to see the curative
effects of iodine applications demonstrated in certain chronic
conditions, of the articulations for instance, after various other
means of handling, even including surgical interference, had failed
to effect the desired result. In not a few of such conditions, iodine
applications, in some form, are prescribed as a sort of “last resort”
treatment, even against the hopes of either client or practitioner, for
the accomplishment of anything in the way of benefit.

Almost any practitioner of veterinary medicine, with whom you may
care to discuss the matter, can point to case after case, in his own
practice, in which a spavin, or a ring-bone, that had been cauterized
or otherwise operated upon with failure, had yielded to a course
of topical iodine applications. In some instances, a cure of this
sort causes a practitioner to lose faith in operative measures for
the correction of the conditions in question. Usually, however, it
impresses upon him, with added force, the thought that he has not
fully acquired the knack--either along practical or scientific
lines--to select his cases properly. Could he be sure that a given
case would yield to applications of iodine preparations, he would much
prefer to treat it that way; but he is not often sure. He has learned
that there are certain cases, although to all appearances, as far as
he is able to tell, not differing from other cases of the same nature,
will yield to actual cautery; he has learned, also, that certain cases
will yield to local applications of certain iodine preparations. But
he finds it difficult to select these cases for the respective forms
of treatment in the general run of his practice. That he may be better
able to serve his clients, and that he may even more highly appreciate
the therapeutic worth of iodine in some of its forms of preparation, I
have made some clinical observations, in my own practice, which I shall
record in the following chapters, and which, I believe, will help to
solve this problem for him. While it is not possible to pick out every
case in which iodine applications will give the desired result, it is
not an exceptionally difficult matter to select the great majority. It
is the opinion of most veterinary practitioners, who have the ethics
of their profession at heart, that the treatment of certain well-known
pathological conditions of the articulations, by means of the actual
cautery, is one of the most disagreeable features of a veterinary
practice. It is one of the things that most veterinary practitioners
are trying to get away from; it smacks more of quackery and dark-aged
farriery than anything else that the veterinarian is obliged to do.
When, on top of this, we view this form of treatment from the angle
of the humanitarian, we fail to understand why otherwise able and
enlightened practitioners will resort to it under any conditions.
True, there are apparently a few forms--a very few--of equine lameness
that will yield to no other form of treatment. Note, I have said
_apparently_ there are some. I believe, in fact, that any case of
lameness located in an articulation is curable, _if it is curable at
all_, by means other than burning the area with a red-hot iron. While
most of us, in practice, do fire cases of articulation lameness, I
believe that we do so for the reason that frequently it is _for us_ the
easiest way to terminate the conditions connected with the case. And I
further believe that every time we resort to the actual cautery, for
the correction of a lameness in an articulation, we admit, in the fact
that we do so resort, that we do not fully understand the condition we
are attempting to cure. This belief is the result of actual contact
with ample clinical material and the observations made in actual
practice covering a period of time extending over more than fifteen
years.

Other chronic pathological conditions, in which iodine applications
are frequently serviceable, are various new-growths in the integument,
underlying tissues, and in the glandular tissue near the body surface.
It is often possible to accomplish, with topical iodine applications,
results in these conditions which could only be equalled by surgical
interference of much more costly and dangerous character. Iodine
applications are at times resorted to in such conditions as these,
to obviate the scar formation that might result from a surgical
operation. At other times, resort is had to iodine on account of such
objections to surgical interference as cost, danger to the patient’s
life, protracted period of convalescence, or other equally reasonable
objections.

In the effects that are obtained from the local applications of iodine
preparations, in chronic pathological conditions, these preparations
act not only in a palliative or ameliorative sense, but literally in
a curative manner. They accomplish, in these conditions, solely and
wholly through their own activity, the removal of the condition and
the correction of the respective abnormalities. While, in some of the
conditions under discussion, the desired result is attained only after
very prolonged treatment with iodine, the condition is usually of such
a character that neither the owner of the animal nor the attending
veterinarian is averse to lending the time consumed. In other of these
conditions, the desired result comes very promptly, at times with a
rapidity that causes astonishment. In all cases yielding to topical
iodine therapy, sufficient evidence of the beneficial effect derived is
discernible with sufficient promptness to encourage the continuance of
the treatment.



IV.

The Selection of Iodine Preparations for Practical Use.


Next in importance to the proper selection of cases amenable to topical
iodine application, is the selection of the particular preparation of
iodine to be applied. As I have already pointed out, in the chapter
on the general consideration of local iodine therapy, what may be an
indication for the use of iodine in one form may lack the requisite
pathological status for its successful application in another.

While the effect that the various preparations produce probably does
not vary to a great extent, the ability to exert this effect does vary
in the different preparations. Because of certain physical properties
with which the vehicle carrying the iodine is endowed, certain
preparations of iodine are more active in a given condition than
others. Others, again, hold the iodine in such a manner that it is more
readily available for the needs of the case under treatment, while yet
another preparation may hold, within its pharmaceutical dress, greater
quantities of available iodine than one very closely allied to it in
every other regard.

Then, too, it is not always the particular form or preparation that
influences the effect; frequently this influence is, for the most part,
in the pathological condition itself. Without going into the details of
what must be especially considered in the selection of the preparation
to be used in a given pathological condition, I have here set down
the observations that I have made, in my own practice, and which my
experience with this branch of veterinary practice has indicated to me
as being as nearly correct as could be expected in a practical way.


TINCTURE OF IODINE.

 Skin disinfection in Surgery.

 Skin disinfection previous to hypodermic injections.

 Adjunctive to systemic medication in the treatment of generalized
 infections with local manifestations, such as septicemia,
 actinomycosis, acute glandular swellings as a complication to fevers,
 parotitis, and distemper.

 First aid application for sprains of ligaments, tendons, and bursae.

 First aid application in puncture wounds, and wounds in the region of
 the hoof, articulations, and bone bruises and contusions.

 Injection into abscess cavities after the liberation of their contents
 by surgical means.

 Moist parasitic skin diseases.

 As an adjunctive in all conditions of an acute character in which it
 is desired to enhance the action of systemic medication aimed at the
 correction of local manifestations.

 For the rapid absorption of acute swellings, such as sternal cysts,
 cysts in the fleshy parts from kicks or bruises.

 As an injection into the synovial sack of enlarged bursae, after the
 contents have been drawn off.


OINTMENT OF IODINE.

 Chronic enlargements of the articulations.

 Chronic enlargements of osseous structures.

 Chronic tumefactions resulting from specific infection.

 Chronic thickening of tendons.

 Chronic thickening of ligaments.

 Chronic thickening of localized areas in the skin.

 Inoperable superficial tumors, when non-septic.

 Tumefactions accompanying chronic degenerative processes, such as
 fistulae, deep sinuses, and ulcers.

 For the absorption of old scar tissue.

 As a hoof dressing.

 Parasitic skin diseases.

 Herpes tonsurans.

 As a packing for abscess cavities, fistulae and sinuses.

 Mammitis.

 Orchitis.

 Chronic arthritis, spavin, ringbone.

 Side-bone lameness.

 Removal of splints, curb, buck shin.

 Goiter.

Ointments of iodine are especially serviceable in all conditions in
which it is desired to obtain the remote effects of topical iodine
medication, and in which the effect desired is a gradual, intensive
saturation of the parts treated with the iodine. In choosing an iodine
ointment for this use, the veterinarian should select a preparation in
which the iodine exists free and uncombined with other agents, in a
vehicle that is blandly penetrating and non-irritating. I can highly
recommend Iodex, as fulfilling exactly these requirements. It can be
applied freely and indefinitely, and, even when the course of treatment
is exceptionally prolonged, the parts to which it is being applied
show no sign of being irritated. With other preparations, it is often
necessary to discontinue the applications for a time because of the
local irritating effect. This delays not only the ultimate recovery
of the patient, but may even result in the cure being only partly
satisfactory. In addition to its non-irritating properties, Iodex is
much more active than any other ointment preparation of iodine with
which I am acquainted, and it has the remarkably noteworthy property
of leaving no stains. Although the ointment is a rich blue-black in
appearance, it may be applied to the treated area with the bare hand,
and will not stain the fingers. This is a quality not possessed by any
other _active_ iodine ointment to my knowledge. Iodex can be obtained
from all large wholesale drug houses and distributors of veterinary
supplies. It is a Menley & James product. Should the veterinarian have
difficulty in obtaining Iodex from his regular supply house, I would
advise him, rather than accept a substitute, to obtain it from them
direct, by writing to their New York Office at No. 168 Duane Street.
I have used many iodine preparations in my practice during the past
fifteen years, and have found in Iodex the ideal veterinary iodine
ointment because, as I have already pointed out, the iodine in it
appears to be in a free state, uncombined with detracting agents, it
is blandly penetrating and, therefore, will positively not irritate the
most tender animal skin, and it does not stain the hands with which it
is applied.

Comparing its properties and its marked activity with that of other
iodine ointments, it is by far the most economical for the veterinarian
to use.

Iodex is one of those preparations, so rare, that the veterinarian soon
learns to appreciate highly and without which he finds it difficult to
conduct his practice, once he has made its acquaintance. He finds that
there are so many conditions in which it is the only pharmaceutical
article that exactly fills all the therapeutic requirements, and he is
able to obtain with it results that he did not think possible before
he made its acquaintance. Iodex exceeds in activity the other iodine
preparations to the same extent that an autogenous bacterin exceeds
in specificity that of a stock bacterin, and I would advise that
every practitioner of veterinary medicine who has not yet made its
acquaintance write at once to Menley & James, No. 168 Duane Street,
New York City, for a trial package. I make this recommendation with a
full realization of the fact that Iodex is a proprietary agent, and the
veterinarian will, in the light of my numerous contributions to ethical
veterinary literature, correctly infer that Iodex must indeed be an
agent of more than ordinary merit.


OILY SOLUTIONS OR MIXTURES OF IODINE

 Sub-acute and chronic skin lesions.

 Acute, dry skin diseases.

 For injection into synovial bursae when the tincture of iodine is
 contra-indicated.

 To anoint arms and hands in the handling of obstetrical cases.

 For direct application to mucous membranes.

 Ringworm.

 As a moist dressing for wounds of long standing.

 Garget.

 Dry, scaly affections of hoofs and of the legs of poultry.

 Open joint.

 Injection for puncture wounds.

 All chronic surface conditions in which the use of iodine ointments
 would not be practicable.


AQUEOUS PREPARATIONS OF IODINE.

Although, from a chemical standpoint, the mixture of tincture of iodine
with water would be considered wrong, I have found that the addition of
one dram of tincture of iodine to a quart of sterile water makes a most
satisfactory combination for use in veterinary practice for a number of
diseased conditions.

In mal-odorous catarrhal diseases, a mixture such as this makes a fine
wash.

 In the treatment of foul-smelling ulcers and fistulous tracts, it
 should be used with an irrigator after the parts have been cleaned up
 and just before the usual dressing is applied.

 To stimulate the process of healing in wounds and lacerations such as
 barbed-wire cuts and tears.

 As a moist dressing applied on gauze in old wounds.

 As a soaking solution for foul-smelling hoof troubles.

 As a wash for the veterinarian’s hands and arms, to prevent infection
 and remove odors, after the handling of after-births, dead fetuses,
 and other conditions of a similar nature.

When this preparation is used at all, it should be applied liberally;
it is cheap and the cost need never be considered. It is additionally
valuable, in a veterinary practice, because it can be made up
extemporaneously anywhere that water can be obtained, as all
veterinarians carry, in their medicine case, a supply of tincture of
iodine.

The strength may be increased if desired; however, I have found the
proportions, as given above, the most satisfactory.

In my experience, I have found that I can do everything that it is
possible to do with iodine preparations by using the medicaments
already indicated.

However, I would draw the practitioner’s attention to that preparation
of iodine known as Lugol’s solution, because there is one condition
that the veterinary practitioner comes into contact with quite
frequently in which this iodine preparation has been found to give some
very good results.

Lugol’s solution of iodine has been found to act, in a very favorable
manner, in certain cases of periodic ophthalmia in horses. It is
injected hypodermically in the region of the fatty pad just over the
affected eye. While this is not truly a topical application, the effect
that is exerted is the same as that resulting from repeated inunctions
of other active iodine preparations. The use of Lugol’s solution,
in this manner, is only to be preferred because it accomplishes the
desired end more rapidly, and with less expense of time, than would
be required by topical applications, frequently repeated. I do not
doubt that just as good and lasting results could be obtained, in this
condition, from daily inunction of the indicated area with an oily
iodine preparation.

It remains to be said that, in this condition, internal medication is
usually indicated and the iodine, in any form, applied regionally,
merely acts adjunctively in any case. I have made mention of this
use of iodine preparations because some practitioners treat periodic
ophthalmia in this manner and have claimed good results repeatedly.

Before I proceed to the discussion of the special application of
iodine, in a number of pathological conditions in animals, I would urge
the veterinarian to give more thought to the forms and preparations of
iodine of which he makes use. It is a rather common occurrence that a
practitioner will allow agents of well-known therapeutic efficiency to
be displaced, by others of doubtful activity, on account of a small
difference in the cost of the same. This is especially true in the
case of preparations in which the active ingredient, and, therefore,
the ingredient to be depended upon for results, is iodine. Iodine, to
begin with, as an elemental article, is costly. The veterinarian may,
therefore, be sure that, whenever an iodine preparation, of a certain
stated strength, is offered for sale at a price considerably lower than
that of recognized preparations of a similar character, the lower price
is possible only because of the fact that the iodine content is not as
represented.

In choosing preparations of iodine, for use in his practice, the
veterinarian can easily deprive himself of much of the success
that goes with correct iodine therapy, if he allows his choice of
preparations to be influenced, to any great extent, by the cost of the
article.

This is the chief reason, and there is probably no other, why some
veterinarians fail to get satisfactory results from topical iodine
applications. They permit their better judgment, in the selection
of the preparations, to be influenced too markedly by price; the
preparation that they select fails to give the expected results because
it is an inferior preparation, either in the strength or the quality
of the iodine it is said to carry. Commonly, both strength and quality
are inferior.

Well made and honestly prepared iodine preparations are cheaper than
almost anything that the veterinarian uses, in a pharmaceutical
way; a little of a good iodine preparation “goes a long way”; and
it accomplishes what it does solely through the exertion of its own
energy. Almost never, it might be said, are other agents expected to
assist it in its action. For this reason, it is very essential that
the preparation be of correct and ample strength, that it contain the
iodine in a form readily available by the tissues, and that the vehicle
carrying the iodine have no detrimental action of its own.

There is still another point that I wish to bring out, and that is in
regard to the fee that the practitioner charges for the handling of
a case with more or less costly iodine preparations. Usually, his fee
is too low. The practitioner should consider the fact that, in not
a few of the cases in which he uses topical iodine treatment, he is
actually depriving himself of a surgical fee, and the charge that he
makes for the treatment, in place of the operation that would otherwise
be required, should, in some degree at least, offset the loss thus
apparent. In some cases, it is even possible to get a larger fee under
these conditions, for, frequently, the owner of an animal would much
prefer that a given condition be cured without a surgical operation,
and would offer no serious objection to a higher fee for the correction
of the condition by a prolonged course of topical iodine medication. In
the case of a valuable animal, where scar formation might depreciate
the value, the smooth results, that are not uncommonly attained
with iodine preparations, actually deserve to be rated as much more
agreeable, and, therefore, worth a larger fee, than a surgical
operation.

Whenever resort is had, by the veterinarian, to applications of iodine,
in considerable amounts, he should not hesitate to inform the client
that the agent used is costly, and that a special charge will be made
therefor.

Many veterinary practitioners have come into the habit of writing
prescriptions for all iodine preparations that they find it necessary
to use, while all other medicines they dispense out of their own
pharmacy. I do not consider this good practice, for several reasons.
The main fault that I find in this is the one making it possible for
the client to have the prescription refilled without consulting the
veterinarian. It is nothing unusual for a prescription to be given to
neighbors or relatives, thus depriving the veterinarian of his fee.
Another reason that I have for finding fault with this practice, is
that many druggists will not fill a veterinary prescription honestly;
seeing that it is “only for a horse” or a cow, they do not hesitate
to use drugs, in compounding the prescription, that they would not
think of putting into a prescription for a human being--old drugs,
drugs of inferior quality, and the like. For these, as well as other
equally important reasons, the veterinarian should dispense all iodine
preparations, just as he does all others. He should not be deterred,
from using these preparations, on account of the slightly higher price
which he must pay for them, if he makes it a point to impress the worth
of the article on his client, and charges the fee that he should.



V.

Method of Using Regional Iodine Therapy in the Correction of Various
Pathological Conditions.


If the reader has made an effort to follow me in what I have said in
the foregoing chapters of this treatise, he will have no difficulty in
applying, to cases occurring in his practice, many of the suggestions
offered.

In this, the closing chapter of the treatise on regional iodine
therapy, I intend to refer to a small number of conditions, in the
handling of which I have found great satisfaction in the use of the
preparations heretofore mentioned, and, at the same time, I shall
endeavor to explain my own particular methods of using the preparations.

I have already disposed of the manner in which the applications of
tincture of iodine are made, previous to incision of the integument,
in surgical operations. Aside from this quite common use of this
preparation, I have found tincture of iodine of great worth as an
application to calk wounds in the coronary region of the equine foot.
When the injured horn has been pared away under the wound in the
coronary band, and the loose particles of flesh and hair cleaned away,
the wound is freely painted with pure tincture of iodine. This painting
is to be repeated several times daily, until recovery takes place.
Severe infections rarely occur if the applications are begun within a
few hours after the accident occurs.

Whenever tincture of iodine is used, for the correction of an
abnormality in the horse and cow, it must be applied very liberally if
the effect is desired with any degree of promptness. This, together
with the fact that the tincture is quite irritating to the skin of
animals--a fact that precludes an extensive course of treatment with
this preparation--makes iodine, in this form, an agent that is chiefly
of use in acute conditions, and it is, therefore, the agent of choice
to act as an adjunctive treatment to the internal handling of such
conditions as septicemia, strangles, distemper, parotitis, lymphangitis
of a localized character, and acute inflammations in tendons,
ligaments, and synovial bursae. In any of these conditions, it is best
applied with a small, rather stiff brush, painting it liberally, over
the parts involved, several times daily. If the parts become very much
irritated from these applications, the treatment must be stopped and
the area treated with a coating of vaseline or lard.

The oily preparations of iodine are especially useful in various skin
diseases, ring-worm, and the parasitic form of scratches in horses.
The secret, in the successful handling of these conditions with
oily preparations of iodine, lies in the abstinence from water; the
parts should be given one thorough washing, when treatment is first
begun, after which no more water should be applied. If the parts need
cleansing, while the course of treatment is under way, it should be
done in a dry manner, with clean cloths or cotton wads.

Oily preparations of iodine may also be used to anoint the arms of the
surgeon during the handling of infected cases of obstetrics. Pouring a
quantity of the preparation into the palm of the hand, and then rubbing
it gently over the skin of both hands and arms, proves a reliable
barrier to infection from a decomposed fetus or after-birth.

In applying the oily preparations of iodine, to lesions on the
integument, it is always necessary to massage them into the tissues
quite vigorously; when this is done a single application each day
suffices.

Other indications for the oily preparations, as well as for aqueous
preparations, of iodine, have been pointed out in the chapter devoted
to the selection of iodine preparations for practical use.

Ointments of iodine--which, for me, mean Iodex--have, by far, the
most extensive field of application, and the uses to which an iodine
ointment may be put have already been quite clearly indicated. I
will, however, remark some of the points to be considered in using
Iodex in such cases as spavin lameness and similar affections of the
articulations.

In choosing, for treatment with Iodex, a case of spavin lameness, the
practitioner should select only those cases in which the horse warms
out of the lameness; these cases can positively be cured by Iodex
applications. Do not attempt to cure the lameness caused by spavin in
which the horse will not warm out of the lameness; these cases are not
only impossible of cure by this means but by other means, excepting
neurectomy, as well.

When the case has been selected, the Iodex should be applied, not
only in the immediate vicinity of the exostosis, but entirely around
the hock involved. An application should be made every morning and
every evening, in the following manner: Apply a thin coating of Iodex
and massage it into the hock for at least five minutes; then apply
another very thin coating, allowing this to remain on the surface.
The applications must extend over a period of from five to seven
weeks--about such a length of time as is required to effect a cure
with actual cautery--and, during the first few weeks of this period,
the animal should be at rest. After the second week, it may indulge in
light exercise in a lot or paddock, but may not be worked.

Cases of spavin, treated in this manner--cases selected for treatment
as above outlined--are not only cured of lameness, but, in many cases,
the enlargement also disappears.

The same results are obtained in cases of lameness from ringbone,
sidebone, splint and curb.

Buck shins can be entirely absorbed with applications of Iodex as
directed above.

Other conditions, in which the effects of Iodex frequently are most
remarkably satisfactory, are goitre, fibrous tumors on the body
surface, hygroma, and tendonous and ligamentous enlargements.

The applications, in these conditions, are made in a manner similar to
that in spavin, massaging the Iodex thoroughly into the parts involved.

In bringing this treatise to an end, I would again urge the
practitioner to add Iodex to his therapeutic armament, and use it not
only in the conditions of which I have here made mention, but in many
other indications for iodine therapy which come up almost daily in
every veterinary practice.



Transcriber’s Notes

Page 24: “as an an adjunctive” changed to “as an adjunctive”

Page 44: “exceeds in specifivity” changed to “exceeds in specificity”

Page 46: “Aqueous Preparatons” changed to “Aqueous Preparations”



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