Next in importance to the proper selection of cases amenable to topical iodine application, is the selection of the particular preparation of iodine to be applied. As I have already pointed out, in the chapter on the general consideration of local iodine therapy, what may be an indication for the use of iodine in one form may lack the requisite pathological status for its successful application in another.
While the effect that the various preparations produce probably does not vary to a great extent, the ability to exert this effect does vary in the different preparations. Because of certain physical properties with which the vehicle carrying the iodine is endowed, certain preparations of iodine are more active in a given condition than others. Others, again, hold the iodine in such a manner that it is more readily available for the needs of the case under treatment, while yet another preparation may hold, within its pharmaceutical dress, greater quantities of available iodine than one very closely allied to it in every other regard.
Then, too, it is not always the particular form or preparation that influences the effect; frequently this influence is, for the most part, in the pathological condition itself. Without going into the details of what must be especially considered in the selection of the preparation to be used in a given pathological condition, I have here set down the observations that I have made, in my own practice, and which my experience with this branch of veterinary practice has indicated to me as being as nearly correct as could be expected in a practical way.
Skin disinfection in Surgery.
Skin disinfection previous to hypodermic injections.
Adjunctive to systemic medication in the treatment of generalized infections with local manifestations, such as septicemia, actinomycosis, acute glandular swellings as a complication to fevers, parotitis, and distemper.
First aid application for sprains of ligaments, tendons, and bursae.
First aid application in puncture wounds, and wounds in the region of the hoof, articulations, and bone bruises and contusions.
Injection into abscess cavities after the liberation of their contents by surgical means.
Moist parasitic skin diseases.
As an adjunctive in all conditions of an acute character in which it is desired to enhance the action of systemic medication aimed at the correction of local manifestations.
For the rapid absorption of acute swellings, such as sternal cysts, cysts in the fleshy parts from kicks or bruises.
As an injection into the synovial sack of enlarged bursae, after the contents have been drawn off.
Chronic enlargements of the articulations.
Chronic enlargements of osseous structures.
Chronic tumefactions resulting from specific infection.
Chronic thickening of tendons.
Chronic thickening of ligaments.
Chronic thickening of localized areas in the skin.
Inoperable superficial tumors, when non-septic.
Tumefactions accompanying chronic degenerative processes, such as fistulae, deep sinuses, and ulcers.
For the absorption of old scar tissue.
As a hoof dressing.
Parasitic skin diseases.
Herpes tonsurans.
As a packing for abscess cavities, fistulae and sinuses.
Mammitis.
Orchitis.
Chronic arthritis, spavin, ringbone.
Side-bone lameness.
Removal of splints, curb, buck shin.
Goiter.
Ointments of iodine are especially serviceable in all conditions in which it is desired to obtain the remote effects of topical iodine medication, and in which the effect desired is a gradual, intensive saturation of the parts treated with the iodine. In choosing an iodine ointment for this use, the veterinarian should select a preparation in which the iodine exists free and uncombined with other agents, in a vehicle that is blandly penetrating and non-irritating. I can highly recommend Iodex, as fulfilling exactly these requirements. It can be applied freely and indefinitely, and, even when the course of treatment is exceptionally prolonged, the parts to which it is being applied show no sign of being irritated. With other preparations, it is often necessary to discontinue the applications for a time because of the local irritating effect. This delays not only the ultimate recovery of the patient, but may even result in the cure being only partly satisfactory. In addition to its non-irritating properties, Iodex is much more active than any other ointment preparation of iodine with which I am acquainted, and it has the remarkably noteworthy property of leaving no stains. Although the ointment is a rich blue-black in appearance, it may be applied to the treated area with the bare hand, and will not stain the fingers. This is a quality not possessed by any other active iodine ointment to my knowledge. Iodex can be obtained from all large wholesale drug houses and distributors of veterinary supplies. It is a Menley & James product. Should the veterinarian have difficulty in obtaining Iodex from his regular supply house, I would advise him, rather than accept a substitute, to obtain it from them direct, by writing to their New York Office at No. 168 Duane Street. I have used many iodine preparations in my practice during the past fifteen years, and have found in Iodex the ideal veterinary iodine ointment because, as I have already pointed out, the iodine in it appears to be in a free state, uncombined with detracting agents, it is blandly penetrating and, therefore, will positively not irritate the most tender animal skin, and it does not stain the hands with which it is applied.
Comparing its properties and its marked activity with that of other iodine ointments, it is by far the most economical for the veterinarian to use.
Iodex is one of those preparations, so rare, that the veterinarian soon learns to appreciate highly and without which he finds it difficult to conduct his practice, once he has made its acquaintance. He finds that there are so many conditions in which it is the only pharmaceutical article that exactly fills all the therapeutic requirements, and he is able to obtain with it results that he did not think possible before he made its acquaintance. Iodex exceeds in activity the other iodine preparations to the same extent that an autogenous bacterin exceeds in specificity that of a stock bacterin, and I would advise that every practitioner of veterinary medicine who has not yet made its acquaintance write at once to Menley & James, No. 168 Duane Street, New York City, for a trial package. I make this recommendation with a full realization of the fact that Iodex is a proprietary agent, and the veterinarian will, in the light of my numerous contributions to ethical veterinary literature, correctly infer that Iodex must indeed be an agent of more than ordinary merit.
Sub-acute and chronic skin lesions.
Acute, dry skin diseases.
For injection into synovial bursae when the tincture of iodine is contra-indicated.
To anoint arms and hands in the handling of obstetrical cases.
For direct application to mucous membranes.
Ringworm.
As a moist dressing for wounds of long standing.
Garget.
Dry, scaly affections of hoofs and of the legs of poultry.
Open joint.
Injection for puncture wounds.
All chronic surface conditions in which the use of iodine ointments would not be practicable.
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.