REGIONAL IODINE THERAPY SF855 155 S74 1919 ®t|p i. M. Ml iCibrarg Nnrtlj (Earaltna g>talF •=« This book was presented by MILTON M. LEONARD, D.V.M. TO THE VETERINARY MEDICAL LIBRARY Nok'H AROlINA STATE UNIVERSITY LIBRARIES il nil lillllllllllll nil S00716977 . THIS BOOK IS DUE ON THE DATE INDICATED BELOW AND IS SUB- JECT TO AN OVERDUE FINE AS POSTED AT THE CIRCULATION E)«C£PTION earlier if thi Date due viH be item is RECALLED 150M/01-92— 920179 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. i68 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 Prepara- tions for Practical Use. V. Method of using Regional Iodine Therapy in the Correction of Various Pathological Conditions. Introduction. In presenting to the veterinary pro- fession this treatise on Regional Iodine Therapy, I do so with the object of bringing into the Hght certain cHnical facts that have to do with the topical application of iodine in veterinary pa- tients, and to discuss, from the stand- point 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 indi- cations for topical iodine medication which have, in the past, been over- looked by the practitioner of veterinary medicine. 5 Throughout the treatise I shall con- fine myself to the exposition of only such matter as I have found to be com- patible with the practical phases of veterinary science in the conduct of my own practice. M. R. S. Milwaukee, Wis. March, 19 19. 11. General Considerations of Local Iodine Therapy. While it is a fact that iodine is one of the most popular of the many medic- inal agents used by the practitioner of veterinary medicine and surgery, it al- so is a fact that iodine — more so than any other agent — is frequently used in pathological conditions and under cir- cumstances 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 es- pecially noteworthy in the use of iodine. Iodine does not differ from any other therapeutic agent with regard to indi- vidual indications for its application; it has these as prominently marked as have the alkaloids, physiologically. 7 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 at- tempts at an explanation of results at- tained, 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 uni- 8 form 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 appli- cation. What may be an indication for the use of iodine in one form, may lack the requisite pathological status for its ap- plication 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 thera- peutic power that the practitioner ex- pects it to exert, despite the fact that the case is clearly one for iodine ther- apy. 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 ob- 9 tained with almost amazing prompt- ness. Again, in another class of cases, the reverse may be true. Although, in a goodly proportion of the cases to be discussed in the follow- ing chapters in this treatise, the prac- titioner must come into direct and fre- quent clinical contact with the patho- logical 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 thoueht 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 sub- ject. 10 III. Special Considerations of Local Iodine Therapy. When we undertake the considera- tion of those features of iodine therapy which have to do with its adaptabiHty 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. 11 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 Io- dine. 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 iodme that not many other thera- peutic agents can claim; namely, that beneficial effects resulting from iodine medication are almost, without ques- 12 tion, due to it alone; it is hardly ever applied in combination with synergists which might obscure the activity of in- dividual ingredients. This remarkable therapeutic activity of iodine is such that, when properly applied in some of its forms, its pres- ence can be demonstrated in the under- lying tissues. After prolonged courses of topical application, its action is oc- casionally 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 io- dine preparations of a particular class, we have an agent whose topical reme- dial effects are, in some slight measure, due to systemic action ; in part at least, this action being the effect of great physiological activity exdrted in the limited area of its topical application. 13 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 cer- tain elemental constituents of the tis- sues of the animal organism. The foregoing throws some light on the therapeutic accomplishments of io- dine preparations, when topically ap- plied, and, to a certain extent, explains its modus operandi in a physiological sense — an understanding somewhat es- sential 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 ap- plications, 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 14 attain a clear understanding of the physiological action of iodine prepara- tions 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 condi- tions, which are indicated, into the fol- lowing : Under i. Surgical preparatory tech- nique. Under 2. Acute pathological condi- tions, in the corrections of which topical applications of iodine preparations are used as an adjunct to in- ternal medication with other agents. 15 Under 3. Chronic pathological con- ditions, in which one or more of various iodine preparations, locally ap- plied, constitutes the en- tire treatment. This classification and sub-classifica- tion is important and essential when we endeavor to make our use of iodine con- form to ethical standards; it is also very essential to the attainment of cer- tain therapeutic ends in actual practice. I. The Local Application of Prep- arations OF Iodine in the Sense OF Prophylactic Aim in Surgery. The exhaustive pre-operative wash- ing and scrubbing of the integument, that veterinary practitioners applied to their surgical patients in years past, has given way almost entirely ~v iodine painting. Even those surge r,ns who still adhere to the scrubbing and wash- ing of the parts about to be incised, 16 complete the process with an appUca- tion 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 wash- ing and the scrubbing with antiseptic solutions, soaps and other agents. Not only this, but it has also greatly sim- plified and shortened an otherwise te- dious, 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 elimina- tion of basins, brushes, and sponges for use in the preliminary stages of an 17 operation, as well as the agreeable ab- sence of the wet, sloppy field that in- evitably 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 veteri- nary 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 clip- ping and shaving have been done, the 18 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 de- posit of filth, oily or greasy in nature, this should first be removed by swab- bing and wiping with gauze or cotton saturated with gasoline, benzine or ether; these remove oily, greasy or fatty filth and evaporate quickly, leav- ing the area perfectly dry and clean. Washing with watery solutions, previ- ous to the iodine application, is not re- commended under any conditions. When the area has been clipped, shaved, freed from grease or other filth, and then allowed to become per- fectly dry, the tincture of iodine is applied liberally with a soft brush, or 19 with a cotton swab. This is allowed to dry for a minute or two; another ap- plication 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 io- dine be used for disinfecting- purposes on any utensils or apparatus made of metal. The fact that the iodine may injure instruments can not be consid- ered 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 tinc- ture of iodine just before the wound is to be closed with sutures. Whether 20 this is good practice, on general prin- ciples, 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, how- ever, it would appear that the iodine could act, in many instances, as an un- desirable irritant when it comes in con- tact with delicate, freshly incised tis- sues. As the object, in modern surgery, is to eliminate all things, even the slight- est, 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 inter- fering with the carrying out of that object. On the other hand, in surgical wounds of an already infected charac- ter 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 en- dorsed. The latter statement applies, with even greater force, to all wounds of an accidental character in the fleshy por- tions of the anatomy. It is also the practice of many veteri- nary surgeons to apply pure tincture ot iodine to the wound after the sutures have been put into place. This is a very satisfactory practice, if the paint- ing is done gently and not too freely. An excess of the tincture of iodine — if the wound edges have not been co- apted perfectly — may result in cause for stitch abscess when a considerable amount of the iodine becomes pocketed 22 in some part of the wound under the Hne of suture. In certain animals, whose skins are very tender, the local application of pure tincture of iodine, previous to sur- gical incision, is followed, in a few days, by slight peeling of the integu- ment. 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 injec- tion 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. 23 As in the case of a surgical incision area, so also here, the parts to which the application is made must be per- fectly dry. 2. The Use of Iodine as an Ad- junct TO Internal Medication IN THE Correction of Acute Pathological Conditions. Iodine preparations of various forms are very commonly used topically as an an adjunctive treatment to internal medication in the treatment of a num- ber 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 prac- titioner is to hasten the correction of certain well-marked local manifesta- tions of the disease with which the pati- ent is afflicted. In other instances, the aim of the practitioner is toward the 24 prevention of these local manifesta- tions. Occasionally, in a certain type of pathological conditions, the prac- titioner intends, by the use of topical iodine applications, to enhance the in- ternal treatment being aimed at symp- toms 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 follow- ing chapters, I will point to the use of topical iodine medication in the hand- ling of a case of parotitis as an illus- tration. While regional applications of iodine are the rule, in the handling of cases of this affection in veterinary 25 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 treat- ment indicated by the pathology of the condition is correcting the lesion per sc, 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, name- ly, 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 26 topical applications of iodine are fre- quently 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 selec- tion of the proper form or preparation of iodine for the particular case in hand. 3. Regional Iodine Applications FOR THE Cure of Chronic Patho- logical 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 appli- cation, so forcibly demonstrates its therapeutic work, for it is here that io- dine is often the only agent used in the 27 handling of the case, thus constituting the entire treatment. Under these cir- cumstances, it is never a difficult matter to decide as to the value of the treat- ment or the activity of the agent used. Were there no other means of demon- strating the fact that iodine, in some of its forms, arouses the animal organ- ism to the end, and in the direction, of marked efforts at regional cure of vari- ous 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 re- sult from which the practising veter- inarian derives more professional sat- isfaction 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 28 specific effect of others in certain skin diseases, and from the almost miracu- lous cure of certain locaHzed infections when the proper iodine medication is appHed in these. So sure are the effects of iodine, in a curative way, in certain diseased con- ditions among domestic animals, that it has value in this regard from a diag- nostic standpoint. Given a case ap- parently of this type for handling, the practitioner can be assured that he has erred in his diagnosis if iodine, in proper preparation and correct applica- tion, does not effect a cure. To illus- trate this, I need only refer to that dis- eased 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 cer- tain chronic conditions, of the articula- tions for instance, after various other 29 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 practi- tioner, for the accomplishment of any- thing 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 con- ditions in question. Usually, however, it impresses upon him, with added force, the thought that he has not fully 30 acquired the knack — either along prac- tical 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 cau- tery; 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 ap- preciate 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 31 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 mat- ter to select the great majority. It is the opinion of most veterinary prac- titioners, who have the ethics of their profession at heart, that the treatment of certain well-known pathological con- ditions 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 32 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 lame- ness located in an articulation is cur- able, 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 con- ditions connected with the case. And I further believe that every time we resort to the actual cautery, for the cor- rection 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. 33 This belief is the result of actual con- tact with ample clinical material and the observations made in actual prac- tice covering-, a period of time extending over more than fifteen years. Other chronic pathological condi- tions, 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 ap- plications, results in these conditions which could only be equalled by surgi- cal interference of much more costly and dangerous character. Iodine ap- plications 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 34 as cost, danger to the patient's life, pro- tracted period of convalescence, or oth- er equally reasonable objections. In the effects that are obtained from the local applications of iodine prep- arations, in chronic pathological con- ditions, 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 abnormali- ties. 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 at- tending veterinarian is averse to lend- ixig the time consumed. In other of these conditions, the desired result comes very promptly, at times with a 35 rapidity that causes astonishment. In all cases yielding to topical iodine therapy, sufficient evidence of the bene- ficial effect derived is discernible with sufficient promptness to encourage the continuance of the treatment. 36 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 con- sideration of local iodine therapy, what may be an indication for the use of iodine in one form may lack the re- quisite pathological status for its suc- cessful 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 en- Z7 dowed, 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 phar- maceutical dress, greater quantities of available iodine than one very closely allied to it in every other regard. Then, too, it is not always the par- ticular form or preparation that in- fluences the effect; frequently this in- fluence 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 vet- 38 erinary practice has indicated to me as being as nearly correct as could be ex- pected in a practical way. Tincture of Iodine. Skin disinfection in Surgery. Skin disinfection previous to hypo- dermic injections. Adjunctive to systemic medication in the treatment of generalized in- fections 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. 39 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 articu- lations. Chronic enlargements of osseous structures. Chronic tumefactions resulting from specific infection. Chronic thickening of tendons. Chronic thickening of ligaments. 40 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 ef- 41 fects 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 ex- ists free and uncombined with other agents, in a vehicle that is blandly penetrating and non-irritating. I can highly recommend lodex, as ful- filling exactly these requirements. It can be applied freely and indefinitely, and, even when the course of treat- ment 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 applica- tions for a time because of the local irritating effect. This delays not only the ultimate recovery of the pa- tient, but may even result in the cure being only partly satisfactory. In addition to its non-irritating proper- ties, lodex is much more active than any other ointment preparation of 42 iodine with which I am acquainted, and it has the remarkably note- worthy property of leaving no stains. Although the ointment is a rich blue- black in appearance, it may be ap- plied to the treated area with the bare hand, and will not stain the fingers. This is a quality not pos- sessed by any other active iodine ointment to my knowledge. lodex can be obtained from all large whole- sale drug houses and distributors of veterinary supplies. It is a Menley & James product. Should the veteri- narian have difficulty in obtaining lodex from his regular supply house, I would advise him, rather than ac- cept a substitute, to obtain it from them direct, by writing to their New York Office at No. i68 Duane Street. I have used many iodine prepara- tions in my practice during the past fifteen years, and have found in lodex 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 detract- 43 ing agents, it is blandly penetrating and, therefore, will positively not ir- ritate 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. lodex is one of those preparations, so rare, that the veterinarian soon learns to appreciate highly and with- out which he finds it difficult to con- duct 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 thera- peutic requirements, and he is able to obtain with it results that he did not think possible before he made its acquaintance. lodex exceeds in ac- tivity the other iodine preparations to the same extent that an autog- enous bacterin exceeds in specifivity that of a stock bacterin, and I would 44 advise that every practitioner of veterinary medicine who has not yet made its acquaintance write at once to Menley & James, No. i68 Duane Street, New York City, for a trial package. I make this recommenda- tion with a full realization of the fact that lodex is a proprietary agent, and the veterinarian will, in the light of my numerous contributions to ethical veterinary literature, correct- ly infer that lodex 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. 45 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 Preparatons of Iodine. Although, from a chemical stand- point, the mixture of tincture of io- dine with water would be considered wrong, I have found that the addi- tion of one dram of tincture of io- dine to a quart of sterile water makes a most satisfactory combination for use in veterinary practice for a num- ber of diseased conditions. In mal-odorous catarrhal diseases, a mixture such as this makes a fine wash. 46 In the treatment of foul-smelling ul- cers 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-smell- ing hoof troubles. As a wash for the veterinarian's hands and arms, to prevent infec- tion and remove odors, after the handling of after-births, dead fe- tuses, 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 valu- able, in a veterinary practice, because it can be made up extemporaneously 47 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 prac- titioner's attention to that preparation of iodine known as Lugol's solution, because there is one condition that the veterinary practitioner comes into con- tact 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 man- ner, in certain cases of periodic ophthal- 48 mia in horses. It is injected hypo- dermically 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 ap- plications, frequently repeated. I do not doubt that just as good and lasting results could be obtained, in this con- dition, from daily inunction of the in- dicated area with an oily iodine pre- paration. It remains to be said that, in this condition, internal medication is usually indicated and the iodine, in any form, applied regionally, merely acts adjunc- tively in any case. I have made men- 49 tion of this use of iodine preparations because some practitioners treat per- iodic 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 prep- arations in which the active ingredient, and, therefore, the ingredient to be de- pended upon for results, is iodine. Iodine, to begin with, as an elemental article, is costly. The veterinarian may, therefore, be sure that, whenever an 50 iodine preparation, of a certain stated strength, is offered for sale at a price considerably lower than that of recog- nized preparations of a similar char- acter, the lower price is possible only because of the fact that the iodine con- tent 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 veteri- narians fail to get satisfactory results from topical iodine applications. They permit their better judgment, in the selection of the preparations, to be in- fluenced too markedly by price; the preparation that they select fails to give the expected results because it is an 51 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 52 for the handling of a case with more or less costly iodine preparations. Usually, his fee is too low. The prac- titioner 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, 53 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 wTiting prescrip- tions 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 noth- ing unusual for a prescription to be 54 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 compound- ing the prescription, that they would not think of putting into a prescrip- tion for a human being — old drugs, drugs of inferior quality, and the like. For these, as well as other equally im- portant 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 im- press the worth of the article on his client, and charges the fee that he should. 55 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 men- tioned, and, at the same time, I shall endeavor to explain my own particular methods of using the preparations. I have already disposed of the man- ner in which the applications of tincture of iodine are made, previous to incision 56 of the integument, in surgical opera- tions. Aside from this quite common use of this preparation, I have found tincture of iodine of great worth as an appHcation to calk wounds in the coro^ nary 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 abnormal- ity 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 57 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 inflam- mations in tendons, ligaments, and synovial bursae. In any of these con- ditions, 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 dis- eases, ring-worm, and the parasitic 58 form of scratches in horses. The secret, in the successful handUng of these con- ditions 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 sur- geon 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 59 into the tissues quite vigorously; when this is done a single application each day suffices. Other indications for the oily prep- arations, as well as for aqueous prep- arations, of iodine, have been pointed out in the chapter devoted to the selec- tion of iodine preparations for practical use. Ointments of iodine — which, for me, mean lodex — 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 lodex in such cases as spavin lameness and similar affections of the articulations. In choosing, for treatment with lodex, a case of spavin lameness, the practi- tioner should select only those cases in 60 which the horse warms out of the lame- ness; these cases can positively be cured by lodex applications. Do not at- tempt 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 neurec- tomy, as well. When the case has been selected, the lodex should be applied, not only in the immediate vicinity of the exostosis, ibut entirely around the hock involved. An application should be made every morning and every evening, in the fol- lowing manner : Apply a thin coating of lodex and massage it into the hock for at least five minutes ; then apply an- other very thin coating, allowing this to remain on the surface. The appli- cations must extend over a period of from five to seven weeks — about such a length of time as is required to effect 61 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 man- ner — cases selected for treatment as above outlined — are not only cured of lameness, but, in many cases, the en- largement also disappears. The same results are obtained in cases of lameness from ringbone, side- bone, splint and curb. Buck shins can be entirely absorbed with applications of lodex as directed above. Other conditions, in which the effects of lodex frequently are most remark- ably satisfactory, are goitre, fibrous tumors on the body surface, hygroma, 62 and tendonous and ligamentous en- largements. The applications, in these conditions, are made in a manner similar to that in spavin, massaging the lodex thorough- ly into the parts involved. In bringing this treatise to an end, I would again urge the practitioner to add lodex 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. 63