Iodine, the 53rd Element... 1938

detail, dow iodine ad, 1938

Another fine Dow Chemical Co ad for iodine... I find it interesting that we have Dow chemical to thank for many of the brominated compounds we are deluged with... in fact, that's how Herbert Henry Dow began his career, by formulating a new process for extracting bromide from brine wells in Michigan(part of the "goiter belt"). But I digress...

Without further ado, an ad from Fortune Magazine, 1938. It seems that even as late as 1938 many of the other medical uses for iodine were known. What, exactly, happened to this knowledge?

I also find it interesting that the visuals in this ad focus on iodine's antiseptic/ topical usage, the tincture of iodine, with the word "poison" clearly visible, even though the use of iodine in lead poisoning , asthma, etc is much more profound than applying it to scrapes, in my opinion...

another Dow chemical iodine ad, 1950. Note that iodine's role  as a medicine is underplayed...:
                                                                 http://iodinehistory.blogspot.com/2013/01/iodine-good-soldier.html

detail, dow iodine ad, 1938

detail, dow iodine ad, 1938

Dow iodine ad, 1938, Fortune Magazine

And, just for the heck of it, a photograph of a first-day cover of a stamp honoring the American Chemical Society. Dow Chemical has brought much devastation to our planet. I suppose that I'm glad that they extracted some iodine as well, along the way, although in true scientific fashion I am sure that they were not happy leaving my favorite element alone...

First day cover, american chemical society stamp, Dow cachet

Iodine as counter-irritant, World War I

world war I veterans in hospital at Youngstown, Ohio

another snippet on counter-irritation with iodine for pain relief~

Another interesting class was the convalescent gassed patients, many of whom had the effort syndrome but the majority of whom were, especially the mustard gas cases, subject to a peculiar type of pain. They would report at sick call with a history of being unable to sleep because of a pain variously described as dull, short, lancillating, migratory, etc., somewhere in the neighborhood of the heart. It would be localized in various places from the left mid-axillary line to the right nipple line and from the clavicle to the level of the umbilicus but always radiating from the heart. No cause for this pain was ever found on physical examination, but the men were too positive in their statements for one to doubt that it was a real thing to them. Numerous remedies were tried but the only real results achieved were from generous counter-irritation with iodine applied over the whole pro-cardiac area, accompanied by the assurance that this pain was only a temporary affair which would soon disappear. We could never find that this pain in any way interfered with the man's work, but it was certainly a constant cause of complaint and quite trying to the sick call officer until the above treatment was instituted.

source:

published 1919

Iodine as counter-irritant, part 2

More on the use of iodine as a counter-irritant. Follow the link for more information including a lot of case histories, I have copied the intro and a few plates, with instructions. The take-home point is that the counter-irritant must be applied AWAY from the area of local inflammation, over the next "vascular territory".

The Treatment of Surgical Inflammations by a New Method ~ 1870

Other means of counter-irritation are discussed in the book, I focus on IODINE.

An introduction to the concept can be found here:

 http://iodinehistory.blogspot.com/2012/09/iodin-as-counter-irritant-artificial.html


KEY POINT~ What are the principal conditions which are needed for the prosperous beginning and progress of an inflammation? An inflamed part must have increased space —more room for swelling, it must have more blood, it is all the better for perpetual unrest. There must be no other inflammation near to interfere with it—two inflammations do not flourish together.

In the following pages I assume (and the results recorded hereafter justify the assumption) that the- inflammatory process is one and the same process wherever it- may occur, and that the best remedies for any inflammation are the best in all. That drugs have, for certain purposes, great utility I do not deny. Putting aside, however, specific inflammations I know no drug, or combination of drugs, that can cure an inflammation. Counter-irritation can unquestionably cure inflammations. Let me cite one fact among many. An inflamed patellar bursa, before chronic thickening sets in, can be most certainly cured by a ring of blister placed around it, when every other remedy fails. Seeing that counter-irritation could do what no other remedy could, I put a ring of counter-irritation around abscesses, carbuncles, cellulitis, and other inflammations, and discovered striking and rapid results. I next sought to find out the most favourable localities for counter-irritation in every inflammation.

It appeared to me that it should always be established over the next, or another, vessel or vascular territory.

I knew that even and gentle pressure could rapidly arrest some, especially chronic, inflammations. For removing the products of inflammation I knew no remedy to be compared with it. I used it, therefore, in all accessible inflammations.

The best mode of using the best remedies (counter-irritation, pressure, rest, and a few others) in every inflammation is not a routine treatment. Take counter-irritation alone; there is endless scope for individual and independent judgment in the determination of its best localities, best degrees of intensity, best extent and configuration of area, and best modes of production. It is the same with the other remedies advocated in these pages.

One of the greatest advantages of counterirritation is this—it immediately and efficiently relieves inflammatory pain. Most patients are eager to exchange a continuous, dull, wearing, inflammatory pain for a temporary smarting.

The cases are very briefly reported, as they are intended simply to illustrate the effects of treatment.


The following diagrams are mostly drawn from actual cases. The dotted lines show the extent of counterirritation, of a moderate character, as effected by iodine pigment. Unless otherwise indicated, the whole circumference of the limb is irritated.

PLATE I.
Fig. 1.—Extent of counter-irritation in a large abscess of the fore-arm. If the first application of iodine is efficient, the relief of pain is striking and immediate. See Mr. Hodges's case of Mammary Abscess, and Mr. Turton's cases of Carbuncle.

Fig. 2.—Shows singular appearance, after twenty-four hours of counter-irritation, in removing inflammation, and circumscribing pus. I have several times seen this tumourlike collection of pus removed in a few days by continued counter-irritation.

Fig. 3.—Extent of counter-irritation (iodine) in abscess of popliteal space. An iodine paint is applied to the whole circumference of the limb within the dotted lines.

PLATE V.

Fig. 1.—Counter-irritation in carbuncle. A mild form should be more extensive, as in next fig. also.

Fig. 2.—Counter-irritation in a single boil, and in a cluster of boils.

Figs. 1 & 2.—Show extent of moderately vigorous (iodine pigment) counter-irritation in synovitis and early articular ostitis of knee and ankle.

Fig. 3.—Is intended to show use of actual cautery in severe articular ostitis of shoulder. One stripe is at the front, one at the back of the joint, and one midway between the two.

PLATE XIV.

Fig. 1.—Shows mode of using counter-irritation (acetum lyttao in severest, iodine liniment in less severe cases) in purulent inflammations, especially gonorrheal, of conjunctiva. Where counter-irritation must be repeated or kept up, two horseshoe shapes, one within the other, are useful.

Fig. 2.—Shows sharp counter-irritation in the more acute laryngeal inflammations.

Fig. 3.—A milder counter-irritation in the less acute inflammations.

iodin as counter-irritant~ "artificial hyperemia", part 1

An introduction to the concept of "artificial hyperemia" and the usefulness of iodine as a counter-irritant.

text source: Dental materia medica and therapeutics  1920

"the blood must continue to circulate—there must never be a stasis of the blood." 

blood circulation~ wiki images

...Within recent years a new remedial measure has been introduced into therapeutics for the purpose of combating infectious diseases which is so surprisingly simple, and yet so very definite in its final result, that one can only wonder why it was not discovered a long time ago. The object of the treatment consists in the increased utilization of the natural resources which the body possesses in the fight against local infection, and is known at present as the hyperemic treatment of Bier. Bier founded his conception of this treatment on observations which he had made in the clinic of Rokitansky in Vienna. He had repeatedly pointed out that a lung with a chronic obstructive hyperemia resulting from some valvular insufficiency of the heart would not, in the great majority of cases, be attacked by tuberculosis. On logical reasoning Bier applied the same principle with surprisingly good results in the treatment of chronic infections of the joints. In due time the technic of this treatment, depending largely upon the construction of suitable apparatus, had to undergo many modifications; but, even with the remarkable increase of the scope of its utilization it is still employed by comparatively few practitioners...

...the aim of Bier's hyperemic treatment is to bring about "the increase of the beneficial inflammatory hyperemia resulting from the fight of the living body against invasion," and the most important principle underlying this treatment is that "the blood must continue to circulate—there must never be a stasis of the blood." ...

...At present it is generally conceded that inflammation is not a disease, but that it is the local defense of the tissues against an injury, manifesting itself by more or less pronounced symptoms— as redness, heat, swelling, pain, and impaired function. The most important changes occur in the blood vessels, which are distended by an increased influx of blood that is very quickly displaced by a retarded afflux. The white corpuscles conglomerate in bunches near the vessel wall, especially in the veins and capillaries, while the red blood corpuscles keep more to the center of the blood stream. The leucocytes and the lymphocytes now pass between the endothelial cells through the vessel walls of the veins and of the capillaries, but not of the arteries. This wandering of the white corpuscles—diapedesis—is accompanied by the transudation of blood serum, which fills the surrounding tissues, causing an edematous swelling. Later on the red blood corpuscles follow, but they migrate in very much smaller quantities... 

Whenever living tissue is injured—whether by mechanical, thermal, or chemic means—the system at once tries to protect itself against the invading foe by an increased rush of blood into the injured area, resulting either in a victorious fight—complete resolution, or in a surrender to the enemy—necrosis.



According to the conception of the older practitioners, irritants were employed for the purpose of depleting the "malignant humors" from the diseased part into the immediate neighborhood. Such irritants were known as derivants, while revulsives were used to disseminate these humors into the farther situated parts. In many instances irritants are applied to the healthy tissue somewhat distant from the primary seat of disturbance, with the intention of diverting the deep-seated congestion into a new direction, or, as our forefathers expressed it, "to leave a way for the escape of the humors." Proof for this supposition has never been furnished. Medicaments applied for these purposes are known as counterirritants. If strong irritants are applied to a circumscribed area of tissue, an exudation of small globules of serum occurs; the latter soon coalesce and raise the epidermis of the true skin, thereby forming a blister...

...At present it is generally recognized that the milder irritants produce the preliminary stages of inflammation—hyperemia. An increased influx and a retarded afflux of blood in the irritated tissue is the sequence of the irritation, and not, as it has been generally supposed, a diversion of the blood stream. Depending on the nature of the irritant, the congestion may be superficial, or it may reach to quite a depth. Hyperemia, in the sense of Bier (see Artificial Hyperemia), is one of the most important functions which nature possesses in overcoming morbid processes. Tissues which are richly supplied with blood possess a very pronounced restorative power, and there is no doubt that artificial hyperemia exercises a distinct beneficial influence on the reparative processes. This is partially the reason why wounds in the oral cavity heal so much quicker than in other parts of the body. Pain in deepseated structures is often mitigated by applying an irritant. By counterirritation of a sensory surface located somewhat distant from the primary seat of irritation, we may be able to divert the pain to this newly excited focus. Such applications are usually employed in the many forms of ill-defined pericemental disturbances. Some of the substances employed as irritants act by reflex action—that is, after their primary action they produce socalled reflexes, which have a beneficial influence on pathologic disturbances.

It should be remembered that the same irritant produces different effects on tissues of different resistance. The more delicate mucous membrane of the mouth requires naturally less severe irritation to produce definite results than the thick and horny layers of the skin.

Counterirritation is sometimes referred to as depletion. Depletives (to empty) are means which were very frequently used in former years for the purpose of locally abstracting blood or serum from the tissues in general or from the point of disease. Dry and wet cupping, scarification, and leeching were the usual methods employed for such purposes. Local depiction by physical means is rarely practiced at present. General depletion of the system by artificially increased perspiration or by abstracting fluids from the body through the bowel by salines or hydragogues are referred to under Cathartics and Diaphoretics.

Iodin in aqueous or in alcoholic solution occupies an important place among the irritants. It possesses a powerful and penetrating action. 

iodine molecule- wiki images

Iodin; Iodum, U. S. P., B. P.; I; Iode, F.; Jod, G.

Source And Character.—Iodin (from the Greek ioeides, violet-colored) was discovered by Courtois in 1811, and named iodin by Gay-Lussac on account of its violet-colored vapors. Iodin is prepared from crude iodin, which is obtained from kelp, but principally from the mother liquors of Chile saltpeter of South America. It forms heavy, bluish-black, friable crystals, having a characteristic odor and a sharp and acrid taste. It is soluble in 5,000 parts of water, 10 parts of alcohol, freely soluble in ether, chloroform, and in the solution of the iodids of the alkalies. Its alcoholic solution has a reddish-brown color, while, when dissolved in chloroform or carbon disulphid, it exhibits a violet tint. It volatilizes at ordinary temperature and fuses at about 239° F. (115° C). It is incompatible with starch, tannin, vegetable colors, etc.

Average Dose.—1/10 grain (0.005 Gm.).

Medical Properties.—Antiseptic, caustic, and alterative.

Therapeutics.—Iodin, in concentrated solution, acts as a caustic; in diluted solution, applied locally, it produces only irritant effects. Iodin has a peculiar action on the vessel walls, as it increases their penetrability. It produces typical fibrinous inflammation of the serous membranes. After the destruction of their epithelial coat, these serous membranes show a pronounced tendency to stick together and to heal by first intention. For this reason iodin is successfully employed in the treatment of fistulous tracts, etc. Painted on the skin, iodin quickly penetrates into the structures, and produces sensible irritation, thereby relieving pain which may be present in the deep-seated tissues. Incidentally it enlarges the walls of the various vessels, promotes absorption, and by reflex action produces venous hyperemia, which involves all the tissues within the affected area. The favorable influence of this artificially produced hyperemia on the diseased tissues is more fully discussed under Physical Therapeutics. (See Artificial Hyperemia.) Iodin is very freely employed in an alcoholic solution (tincture of iodin), and as the milder acting Lugol's solution. In using the tincture of iodin the alcoholic component of the latter must be accredited with a certain share of its action.

To promote the more ready absorption of iodin, various solutions have been recently introduced. Iodipin, an iodized sesame oil, containing respectively 10 and 25 per cent of iodin, and iothion, a glycerinated solution, containing 77 per cent of iodin, are the more important representatives of this group. Both preparations are almost colorless and odorless, and are used as substitutes for the tincture for external and internal purposes.


Preparations.—

Tincture of Iodin; Tinctura Iodi, II. S. P., B. P. It contains 7 per cent (2.5 per cent, B. P.) of iodin dissolved in alcohol. The U. S. P. tincture contains in addition 5 per cent of potassium iodin, which increases its therapeutic effect and stability.
Compound Solution of Iodin; Liquor Iodi Compositus, U. S. P.; Lugol's Solution. It contains 5 per cent of iodin dissolved in a 10 per cent aqueous solution of potassium iodid.

Iodin Liniment; Liquor Iodi Fords, B. P. It contains about 14 per cent of iodin.

Therapeutics.—Tincture of iodin is universally employed as a counterirritant in pericemental disturbances. Its beneficial influence is based on three principal functions of iodin—to act as a derivant by sensory irritation, to produce artificial hyperemia, and to promote absorption. Its antiseptic properties are of less importance in this connection. If a definite iodin action is desired in the mouth, the ordinary tincture is not well suited for this purpose. Its alcoholic component causes superficial coagulation of the delicate mucous membrane, and in reality very little iodin is absorbed from this weak solution. If the tincture is repeatedly applied at short intervals, the caustic effect of the alcohol destroys the mucous lining, and a painful excoriated surface is the result. The irritating effect of the alcohol is probably as much responsible for the apparent results attributed to the tincture as its iodin component. Liquid iodin preparation for dental purposes should be concentrated solutions in water, preferably in the form of Talbot's iodo-glycerol. (See page 206.) A colorless tincture of iodin is occasionally demanded; ammonia water added to the tincture will quickly destroy its color. If higher concentrated iodin solutions are wanted, Carson's or Churchill's iodin paint is serviceable, but these compounds should not be used indiscriminately on the mucous surfaces of the mouth...

merck manual, 1899

A search on "iodine" in the 1899 Merck Manual returns 96 hits. "Iodide", 100 hits. Were I to repeat the search using the term "iodopin" or "iodophorm", even more results would be returned...

Below is a sampling of conditions for which iodine in one or another form was prescribed in 1899. Iodine was certainly NOT the only suggested medicine, I am listing these conditions only to show you the wide range of conditions for which iodine was once prescribed. It was prescribed in many forms, from tincture to potassium iodide to iodized oil, and administered in a variety of ways, from internal dosing to painting to injection to inhalation. Some of the indications are to be expected, such as the use of iodine for goiter or uterine fibroid. Others were unexpected, such as the use of an iodine enema in hepatitis. This manual was published well after the initial iodine enthusiasm in the early part of the century, so I imagine that these treatments were well-established in 1899.


asthma

iodine: painting the line of the pneumogastric nerve with liniment or tincture in pure spasmodic asthma

Hordeolum(stye).- see also, eyelids

Iodine tincture

Meningitis, tubercular

Iodine

Ovarian diseases

Carbolate of Iodine

Smallpox

Iodine

Emphysema

Potassium iodide

Empyela

Iodine

endometriosis

iodine, iodi-tannin, solution of iodine and tannic acid, on cotton wool

Enuresis

Iodine

epydidimitis

iodine

erysypalis

iodine, solution not too strong painted over.

exotosis

iodine, potassium iodide

fever

carbolate of iodine, in the later stages of typhoid, and in chronic malarial poisoning

fractures

iodine, antiseptic dressing

freckles

iodine

glanders and farcy: more info here: Glanders in a Military Research Microbiologist

iodine

glandular enlargements

iodine, internally and painted around, not over the gland.
iodoform, as a dressing to breaking-down glands.
iodoformogen: equitable and persistent in action on open glands.
iodole: internally
lead iodide: ointment

goiter

iodine: internally, and locally as ointment or tincture, and as injection
iodoform
iodoformogen
iodothyrine
potassium iodide

gout

iodide of potassium
iodine
iodoform
iron iodide

gums, diseases of

iodine tincture, locally

hepatitis

iodine, as enema

hepatic diseases

iodine or iodides

hernia

iodine

hydrocele

iodine

hydrocephalus

iodine, potassium iodide

hydrothorax

iodine, injections after tapping.

inflammation

iodine, locally

joint affections- see also arthritis, bursitis, etc

iodine
iodoform
iodoformogen, more diffusible and persistent than iodoform
iodole
iron iodide

keratitis- see also, corneal opacities

potassium iodide

laryngitis, acute

iodine, as inhalation and counter-irritant over neck.

laryngitis, chronic

iodine, as counter-irritant

lupus

iodine, in glycerin

measles

iodine

meningitis, tubercular

iodine

menorhaggia and metrorrhagia- see also, amenorhea, hemmorhage, uterine tumors

iodine

mercurial cachexia - a condition arising from over-use of mercury- containing medications. for more: mercurial cachexia

iodine and iodides
iodopin
iodohemol

nausea

iodine

nevus- see also, tumors, warts

iodine, paint

obesity

iodides
iodoform
iodole

odontalgia

iodine: painted on to remove tartar on teeth; and in exposure of fang due to atrophy of gum.

opthalmia- see also, blepharitis, conjunctivitis, keratitis

iodine, iodoform, iodoformogen, iodole

ozena- see also, catarrh, chronic, nasal

carbolate of iodine
glycerine and iodine
iodine: as inhalation. Much benefit is derived from washing out the nose with a solution of common salt, to which a few drops of the tincture of iodine have been added.
iodopin
iodoform
iodoformogen
iodole

pericarditis- see also, endocarditis

iodides
iodine

peritonitis

iodine

pharyngitis- see also, throat, sore, tonsillitis

iodine, iodoform
iodoformogen

phthisis- see also, cough, hemoptysis, hectic fever, perspiration, night sweats, laryngitis, tubercular, meningitis, peritonitis, etc

iodine: liniment as a counter-irritant to remove the consolidation in early stages, and to remove pain and cough later, as inhalation to lessen cough and expectoration.
iodine tincture
iodopin
iodoform: inhalation
iodole

uterine tumors

iodine

a sampling of iodine preparations found in the 1899 Merck Manual:

topical iodine and tumors

image from book...

an early report on the use of topical iodine and "scirrhus"tumors(definition below). It was recognized then that if such growths were not attended to they could indeed develop into cancer. So much for FBD being a "benign" condition...   

(6.) Preparations of Iodine.—" That the external use of iodine, in the form of ointment, sometimes completely removes tumors possessing the characters of scirrhus*, (where it has been had recourse to at an early stage of their development,) is a fact of which we have witnessed some examples. The truly cancerous nature of such growths may of course be questioned ; yet a trial of iodine externally, provided the part be indolent, and its use excite no irritative action, is certainly advisable : the length of the trial should be regulated by the apparent influence produced on the tumor." Since I wrote these words in 1840, my confidence in the powers of iodine-friction, especially when combined with the use of the iodide of arsenic internally, has increased. Nor does my present experience allow me to conceive a single doubt that tumors, actually and truly scirrhous in structure,—tumors which would have run the common course of cancer,—may be arrested in their progress by early and judicious use of these agents. Nor is similar testimony wanting from others. Mr. Gr. N. Hill's cases afford very decisive evidence to the same effect, and Dr. Ashwell's statements on the subject (see Cancer of the Uterus) are strongly encouraging. The convictions of Mr. Travers on the point are stated with peculiar emphasis. " By an indolent scirrhus," says this writer, " I mean an incompressible permanent tumor, possessing for many years no distinguishing character of that disease ; but in a deranged state of health assuming its genuine character, and at a particular period of life breaking up into an actual cancer. I do not entertain a doubt that such a tumor may be, and often is, absorbed in its first stage, and need not therefore of necessity follow this course. I feel assured that most of the hard breasts of young and middle-aged women admit of being reduced by the iodine or the mercurial ointment, if early resorted to, and steadily persevered in, having often succeeded in procuring their absorption by such means, when, from the characters they presented, I should otherwise have felt compelled to urge their removal by operation Nothing is more certain than the susceptibility of absorption in many such tumors at an early stage of their existence.


The preparation of iodine used is not a matter of indifference. That ordinarily employed, a combination of iodide of potassium, iodine and lard, almost invariably produces a degree of cutaneous irritation, which makes it necessary to intermit its use frequently, and sometimes give it up altogether. The iodide of lead ointment (composed of a drachm of the salt and an ounce of lard) is not only completely free from this inconvenience, but has appeared to me more actively promotive of absorption. The ointment should be smeared in very gently, twice daily, for several minutes at a time.


***************************


source: The Nature and Treatment of Cancer", by Walter Hayle Walshe, M.D., 1846




*scirrhus~ Scirrhus is a hard, unequal tumor, which occasionally appears in different viscera, such as the liver and womb, but more fre-quently in the grandular parts, for instance, the breasts, arm-pits, and about the neck. chestofbooks.com

Hydrocele, encysted hydrocele and iodine

It seems that topical preparations of iodine were being used VERY early on in iodine history as a treatment for hydrocele. There is a lot of info on an improvement on this method, which involves injecting a tincture of iodine into the emptied cyst OR running a thread that has been saturated in an iodine through the cyst in order to get the iodine to the interior. As far as topical iodine usage, this is the only reference I could find:


"Having learned that the preparations of iodine had been employed as topical remedies in hydrocele"...


source: The London Medical Gazette, 1837


And here are a couple of references on iodine and hydrocele. Please note that the second link specifies "encysted hydroceles" aka testicular cysts, I presume.



"Hydrocele, a swelling of the scrotum, caused by the effusion of fluid into the coverings of the testicle or of the spermatic cord. While it may result from inflammatory conditions or from an injury such as a blow, the cause cannot always be ascertained. It forms a tense, elastic, smooth swelling, and it is distinguished from other conditions in the same situation by its translucency, which is agparent when the tumour is held between the observer’s eye and a lighted candle or a strong lamp. It may be mistaken for a rupture; but a hydrocele swelling gives no impulse under the hand when the sufferer coughs. Again, it is not, like strangulated hernia, associated with vomiting or pain. Congenital hydrocele, however, may give an impulse with coughing.


Palliative treatment consists in frequent tapping with a trocar and cannula: in the hydrocele of young children, cure may be effected by constant wearing of a truss, or by the external application of iodine. Radical cure in adults is effected by tapping and subsequently injecting iodine ; or by incising the sac, turning the covering not the outside skin) inside out, and stitching it in that position. The injection of a ten per cent. solution of chloride of zinc has lately been recommended as eflicacious, and as causing no pain or inflammation."


source: Nelson's Encyclopedia, Volume 6, 1907



A MORE EFFECTUAL MODE OF APPLYING IODINE TO THE INTERIOR OF CERTAIN CYSTS.


"Mr. Furneux Jordan, in some notes in the Lancet, remarks that he has found in practice two classes of scrotal-hydroceles, in which the ordinary methods of treatment are either difficult to use or uncertain in their result. In boys and men there are occasionally encysted-hydroceles of the testis, or the cord, which continue to increase in size, or in which treatment is urgently requested. In such cases, except in early infancy, acupuncture, or the use of a fine trocar, often fails to cure. The walls of the cysts are usually thin, and collapse so much, when their contents are withdrawn, that the injection of a fluid is uncertain. The end of the canula may be outside the cyst, and the iodine solution be consequently injected into the connective tissue at its exterior. In such cases the following is a reliable method of treatment:


"The cyst being well isolated, made tense, and brought near the surface, I pass through its centre a stout needle, armed with silk, and leave the threads hanging. The fluid quickly oozes away, especially if a little traction be made on the threads. I then, at one opening, wet the threads with iodine-liniment (liniment, because the quantity required is so limited), and draw the threads so as to leave moistened portions within the cyst. A little gentle friction will help to spread the iodine thoroughly over the lining membrane of the cavity. An hour later, freshlymoistened portions may again be drawn through, if the cyst be large, or if other methods of treatment have failed. On the other hand, in a very small cyst, a single thread, moistened and kept in one hour, will suffice."


source:  Medical Brief: A Monthly Journal of Scientific Medicine and Surgery, Volume 4, 1876