REGIONAL IODINE
THERAPY

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1919

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This book was presented by

MILTON M. LEONARD, D.V.M.

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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