Aqueous Preparations of Iodine.
Although, from a chemical standpoint, the mixture of tincture of iodine with water would be considered wrong, I have found that the addition of one dram of tincture of iodine to a quart of sterile water makes a most satisfactory combination for use in veterinary practice for a number of diseased conditions.
In mal-odorous catarrhal diseases, a mixture such as this makes a fine wash.
In the treatment of foul-smelling ulcers and fistulous tracts, it should be used with an irrigator after the parts have been cleaned up and just before the usual dressing is applied.
To stimulate the process of healing in wounds and lacerations such as barbed-wire cuts and tears.
As a moist dressing applied on gauze in old wounds.
As a soaking solution for foul-smelling hoof troubles.
As a wash for the veterinarian’s hands and arms, to prevent infection and remove odors, after the handling of after-births, dead fetuses, and other conditions of a similar nature.
When this preparation is used at all, it should be applied liberally; it is cheap and the cost need never be considered. It is additionally valuable, in a veterinary practice, because it can be made up extemporaneously anywhere that water can be obtained, as all veterinarians carry, in their medicine case, a supply of tincture of iodine.
The strength may be increased if desired; however, I have found the proportions, as given above, the most satisfactory.
In my experience, I have found that I can do everything that it is possible to do with iodine preparations by using the medicaments already indicated.
However, I would draw the practitioner’s attention to that preparation of iodine known as Lugol’s solution, because there is one condition that the veterinary practitioner comes into contact with quite frequently in which this iodine preparation has been found to give some very good results.
Lugol’s solution of iodine has been found to act, in a very favorable manner, in certain cases of periodic ophthalmia in horses. It is injected hypodermically in the region of the fatty pad just over the affected eye. While this is not truly a topical application, the effect that is exerted is the same as that resulting from repeated inunctions of other active iodine preparations. The use of Lugol’s solution, in this manner, is only to be preferred because it accomplishes the desired end more rapidly, and with less expense of time, than would be required by topical applications, frequently repeated. I do not doubt that just as good and lasting results could be obtained, in this condition, from daily inunction of the indicated area with an oily iodine preparation.
It remains to be said that, in this condition, internal medication is usually indicated and the iodine, in any form, applied regionally, merely acts adjunctively in any case. I have made mention of this use of iodine preparations because some practitioners treat periodic ophthalmia in this manner and have claimed good results repeatedly.
Before I proceed to the discussion of the special application of iodine, in a number of pathological conditions in animals, I would urge the veterinarian to give more thought to the forms and preparations of iodine of which he makes use. It is a rather common occurrence that a practitioner will allow agents of well-known therapeutic efficiency to be displaced, by others of doubtful activity, on account of a small difference in the cost of the same. This is especially true in the case of preparations in which the active ingredient, and, therefore, the ingredient to be depended upon for results, is iodine. Iodine, to begin with, as an elemental article, is costly. The veterinarian may, therefore, be sure that, whenever an iodine preparation, of a certain stated strength, is offered for sale at a price considerably lower than that of recognized preparations of a similar character, the lower price is possible only because of the fact that the iodine content is not as represented.
In choosing preparations of iodine, for use in his practice, the veterinarian can easily deprive himself of much of the success that goes with correct iodine therapy, if he allows his choice of preparations to be influenced, to any great extent, by the cost of the article.
This is the chief reason, and there is probably no other, why some veterinarians fail to get satisfactory results from topical iodine applications. They permit their better judgment, in the selection of the preparations, to be influenced too markedly by price; the preparation that they select fails to give the expected results because it is an inferior preparation, either in the strength or the quality of the iodine it is said to carry. Commonly, both strength and quality are inferior.
Well made and honestly prepared iodine preparations are cheaper than almost anything that the veterinarian uses, in a pharmaceutical way; a little of a good iodine preparation “goes a long way”; and it accomplishes what it does solely through the exertion of its own energy. Almost never, it might be said, are other agents expected to assist it in its action. For this reason, it is very essential that the preparation be of correct and ample strength, that it contain the iodine in a form readily available by the tissues, and that the vehicle carrying the iodine have no detrimental action of its own.
There is still another point that I wish to bring out, and that is in regard to the fee that the practitioner charges for the handling of a case with more or less costly iodine preparations. Usually, his fee is too low. The practitioner should consider the fact that, in not a few of the cases in which he uses topical iodine treatment, he is actually depriving himself of a surgical fee, and the charge that he makes for the treatment, in place of the operation that would otherwise be required, should, in some degree at least, offset the loss thus apparent. In some cases, it is even possible to get a larger fee under these conditions, for, frequently, the owner of an animal would much prefer that a given condition be cured without a surgical operation, and would offer no serious objection to a higher fee for the correction of the condition by a prolonged course of topical iodine medication. In the case of a valuable animal, where scar formation might depreciate the value, the smooth results, that are not uncommonly attained with iodine preparations, actually deserve to be rated as much more agreeable, and, therefore, worth a larger fee, than a surgical operation.
Whenever resort is had, by the veterinarian, to applications of iodine, in considerable amounts, he should not hesitate to inform the client that the agent used is costly, and that a special charge will be made therefor.
Many veterinary practitioners have come into the habit of writing prescriptions for all iodine preparations that they find it necessary to use, while all other medicines they dispense out of their own pharmacy. I do not consider this good practice, for several reasons. The main fault that I find in this is the one making it possible for the client to have the prescription refilled without consulting the veterinarian. It is nothing unusual for a prescription to be given to neighbors or relatives, thus depriving the veterinarian of his fee. Another reason that I have for finding fault with this practice, is that many druggists will not fill a veterinary prescription honestly; seeing that it is “only for a horse” or a cow, they do not hesitate to use drugs, in compounding the prescription, that they would not think of putting into a prescription for a human being—old drugs, drugs of inferior quality, and the like. For these, as well as other equally important reasons, the veterinarian should dispense all iodine preparations, just as he does all others. He should not be deterred, from using these preparations, on account of the slightly higher price which he must pay for them, if he makes it a point to impress the worth of the article on his client, and charges the fee that he should.
V.
Method of Using Regional Iodine Therapy in the Correction of Various Pathological Conditions.
If the reader has made an effort to follow me in what I have said in the foregoing chapters of this treatise, he will have no difficulty in applying, to cases occurring in his practice, many of the suggestions offered.
In this, the closing chapter of the treatise on regional iodine therapy, I intend to refer to a small number of conditions, in the handling of which I have found great satisfaction in the use of the preparations heretofore mentioned, and, at the same time, I shall endeavor to explain my own particular methods of using the preparations.
I have already disposed of the manner in which the applications of tincture of iodine are made, previous to incision of the integument, in surgical operations. Aside from this quite common use of this preparation, I have found tincture of iodine of great worth as an application to calk wounds in the coronary region of the equine foot. When the injured horn has been pared away under the wound in the coronary band, and the loose particles of flesh and hair cleaned away, the wound is freely painted with pure tincture of iodine. This painting is to be repeated several times daily, until recovery takes place. Severe infections rarely occur if the applications are begun within a few hours after the accident occurs.
Whenever tincture of iodine is used, for the correction of an abnormality in the horse and cow, it must be applied very liberally if the effect is desired with any degree of promptness. This, together with the fact that the tincture is quite irritating to the skin of animals—a fact that precludes an extensive course of treatment with this preparation—makes iodine, in this form, an agent that is chiefly of use in acute conditions, and it is, therefore, the agent of choice to act as an adjunctive treatment to the internal handling of such conditions as septicemia, strangles, distemper, parotitis, lymphangitis of a localized character, and acute inflammations in tendons, ligaments, and synovial bursae. In any of these conditions, it is best applied with a small, rather stiff brush, painting it liberally, over the parts involved, several times daily. If the parts become very much irritated from these applications, the treatment must be stopped and the area treated with a coating of vaseline or lard.
The oily preparations of iodine are especially useful in various skin diseases, ring-worm, and the parasitic form of scratches in horses. The secret, in the successful handling of these conditions with oily preparations of iodine, lies in the abstinence from water; the parts should be given one thorough washing, when treatment is first begun, after which no more water should be applied. If the parts need cleansing, while the course of treatment is under way, it should be done in a dry manner, with clean cloths or cotton wads.
Oily preparations of iodine may also be used to anoint the arms of the surgeon during the handling of infected cases of obstetrics. Pouring a quantity of the preparation into the palm of the hand, and then rubbing it gently over the skin of both hands and arms, proves a reliable barrier to infection from a decomposed fetus or after-birth.
In applying the oily preparations of iodine, to lesions on the integument, it is always necessary to massage them into the tissues quite vigorously; when this is done a single application each day suffices.
Other indications for the oily preparations, as well as for aqueous preparations, of iodine, have been pointed out in the chapter devoted to the selection of iodine preparations for practical use.
Ointments of iodine—which, for me, mean Iodex—have, by far, the most extensive field of application, and the uses to which an iodine ointment may be put have already been quite clearly indicated. I will, however, remark some of the points to be considered in using Iodex in such cases as spavin lameness and similar affections of the articulations.
In choosing, for treatment with Iodex, a case of spavin lameness, the practitioner should select only those cases in which the horse warms out of the lameness; these cases can positively be cured by Iodex applications. Do not attempt to cure the lameness caused by spavin in which the horse will not warm out of the lameness; these cases are not only impossible of cure by this means but by other means, excepting neurectomy, as well.
When the case has been selected, the Iodex should be applied, not only in the immediate vicinity of the exostosis, but entirely around the hock involved. An application should be made every morning and every evening, in the following manner: Apply a thin coating of Iodex and massage it into the hock for at least five minutes; then apply another very thin coating, allowing this to remain on the surface. The applications must extend over a period of from five to seven weeks—about such a length of time as is required to effect a cure with actual cautery—and, during the first few weeks of this period, the animal should be at rest. After the second week, it may indulge in light exercise in a lot or paddock, but may not be worked.
Cases of spavin, treated in this manner—cases selected for treatment as above outlined—are not only cured of lameness, but, in many cases, the enlargement also disappears.
The same results are obtained in cases of lameness from ringbone, sidebone, splint and curb.
Buck shins can be entirely absorbed with applications of Iodex as directed above.
Other conditions, in which the effects of Iodex frequently are most remarkably satisfactory, are goitre, fibrous tumors on the body surface, hygroma, and tendonous and ligamentous enlargements.
The applications, in these conditions, are made in a manner similar to that in spavin, massaging the Iodex thoroughly into the parts involved.
In bringing this treatise to an end, I would again urge the practitioner to add Iodex to his therapeutic armament, and use it not only in the conditions of which I have here made mention, but in many other indications for iodine therapy which come up almost daily in every veterinary practice.