SOAP AS A THERAPEUTIC AGENT


On the seventh day the culture was negative for Vincents. The membrane and slough had entirely cleared from the throat and the tonsillar swelling had subsided considerably. All other subsequent smears were negative for spirofusiform bacilli. The case was discharged cured after being in hospital nine days, the last five of which she was under soap therapy.


From the Medical World, October 4th, 1935.

SIXTY years ago, when I was a boy, my father prescribed very frequently soapy water as a simple remedy for his patients for outward use, gargling, as an antiseptic, etc. I do not know whether it was his invention or whether it was used frequently by doctors in the past. The Medical World, a very excellent journal, published in its issue of October 4th an article on “Soap as a Therapeutic Agent,” and I would like to give some extracts from it which should be of interest to readers. Those who wish to read the article in its entirety should get the issue from the Medical World at 56 Russell Square, W.C.I.

My attention was originally called to the therapeutic use of soap in mouth and pharyngeal infections by a proven case of Vincents angina in 1928. It was a case of a young married woman who for many months ran a course with typhoidal symptoms. The spirofusiform bacillus was found on the gums, teeth and throat. When all therapeutic agents had failed, a soap solution was prepared from a commercial hard soap for the primary purpose of keeping the mouth clean.

In twenty-four hours there was a marked improvement and in forty eight hours the mouth had cleared, the temperature had reached normal and she felt like eating. While I thought it possible to be a mere coincidence, I determined immediately to test the therapeutic value of soap clinically on other patients with Vincents angina. The results were a revelation. It was then decided to use soap solution on all types of throat conditions and infections.

Because text and reference books make no mention of the germicidal action of soap I found it necessary to make a general review of the literature in order to see what had been done in the field. In 1911 Lamar showed that sodium oleate was strongly bactericidal against the pneumococcus and streptococcus.

In 1916, Ratynski, in his record of 1,500 dressings of war wounds with castile soap (25 gms to 1 L.), reported that this method was at least equal to any other method of treatment at the time and that the absence of pain was a special advantage. Also during the World War Nichols found that washing mess kits with ordinary soap solutions (about 0.5 per cent. sol.) destroyed the pneumococcus, streptococcus and influenza bacillus.

The following five cases picked at random demonstrate the various types in which one may expect to obtain therapeutic results:-.

CASE 1.

Miss C.H., age 23 years, employed as a clerk, has been suffering from a sore throat and discomfort on swallowing for three months. She has been under the care of a most of this time, using sodium perborate and other medication without relief. Examination reveals no rise of temperature or increase in pulse rate. The tonsils are markedly hypertrophied. The left tonsil stands out almost to the midline of the throat with a deep punched-out ulcer occupying the upper one-third of the tonsil and filled dirty, greyish, foul-smelling material. The local pathological picture seems to be out of proportion to her general condition. When the ulcer cavity was cleaned out it would easily admit the tip of the little finger.

A culture was taken with a platinum loop and prepared for a darkfield examination. The spirillum of Vincent and its fusiform bacillus were easily identified among the great array of other bacteria. No attempt was made to count them because they were too numerous. A soap solution of 1.250 dilution was prescribed with directions to rinse and gargle the mouth and throat every hour.

The next day she reported back and examination showed that the swollen tonsil had subsided about 50 per cent. The ulcer cavity contained very little gross material. Darkfield examination revealed about five to fifteen, or an average of ten, spirofusiform bacilli to the field. She was directed to continue the treatment. The second day the tonsils were about equal in size and somewhat smaller. There was no gross material in the ulcer. Darkfield revealed one to five forms to the field.

She kept up the treatment and reported ten days later. Her tonsils were now well behind the anterior pillars and no signs of inflammation were present anywhere in the mouth or throat. Darkfield examination failed to reveal any spirilla or spirofusiform bacilli.

CASE 2. –

Mrs. J.S.B., age 24 years, a school-teacher, suffering about one year with sore, swollen and bleeding gums. She was a conscientious patient and had had the best modern treatment for “trench mouth” that medical and dental care could provide. She had given up hope when brought to my attention. Examination revealed very red swollen gums, tender to touch, bleeding easily and receded. Pus was easily expressed from deep pockets. Darkfield examination showed innumerable spirofusiform bacilli, with many varieties of normal and pathological forms such as spiros, cocci, bacilli, a few unidentified amoebae and pus cells.

The standard soap solution of 1.250, prepared in the dispensary, was prescribed as a mouth wash, with definite instruction to work the solution under the gums. One week later the gums were still red but there was some subsidence of the swelling, bogginess and smaller pus pockets. Bleeding could be provoked by severe handling. Darkfield showed about five to fifteen spirofusiform bacilli per field with many dead forms observed among these. She was directed to continue the treatment and report the following week.

The gums then appeared healthier. There was some loss of tissue over the bodies of the upper central incisors. The pockets were shallow and no pus could be expressed. There was no bleeding. Darkfield examination was done on slides taken from all portions of the gum margins, both upper and lower. All cultures showed absence of the spirofusiform bacillus except the one taken from the lower left incisor, which showed an average of one to five per field of mostly dead forms. The following week the gums had healed with no spiros in evidence.

CASE 3. –

G.G., 81/2 years of age, schoolgirl. Past history shows that the patient had measles three years ago, bronchitis three years ago, cough two years ago, sore throats and earaches with myringotomy last year. The present illness began one month before admission with a sore throat, rise in temperature, nasal obstruction, dysphagia, vomiting and insomnia. Her highest temperature was 101.5 F. She improved and relapsed several times until the day before admission, when the follicles filled with material.

There was some obstruction to nasal breathing. A smear from the throat showed many spirofusiform bacilli, cocci in short chains, pneumococci, some bacilli but no diphtheria bacilli. On the next day there was moderate enlargement of the glands of the neck, with tenderness, and the exudate covered the right tonsil. The breath had a foul odour. On the second day the temperature reached 104 F. On the third day it reached 105 F., the membrane had spread, the glands were very large and tender and 20,000 units of antitoxin were given. On the fourth day the Schick test proved negative, temperature 105, pulse 128, respiration 28, and the culture was positive for Vincents. On consultation, soap solution 1.250 was given as an irrigation to the throat q.v.h.

On the fifth day the temperature dropped to 103 in the morning and to 101 in the evening. On the sixth day, forty-eight hours after beginning the soap solution irrigation, the temperature reached 98.6 and the patient asked for food. The temperature remained normal until discharge.

On the seventh day the culture was negative for Vincents. The membrane and slough had entirely cleared from the throat and the tonsillar swelling had subsided considerably. All other subsequent smears were negative for spirofusiform bacilli. The case was discharged cured after being in hospital nine days, the last five of which she was under soap therapy.

CASE 4. –

Mr. T.N., age 20 years, a musician. His chief complaint was repeated sore throat and for five days he had notice white material on the tonsils, swelling in the left tonsillar region and difficulty in swallowing. He appeared moderately sick, temperature 100 F., pharynx congested, uvula long and oedematous, both tonsils injected and hypertrophied. The left tonsil had a greenish grey necrotic material or membrane and a very foul odour. There was marked induration and swelling of the pillars and soft palate simulating a peritonsillar abscess but no fluctuation was obtained.

Teeth and gums were in poor condition but no pus pockets were found. The glands of the neck were palpable and tender on the left side. The smear from the throat showed the Vincents spirillum. Soap solution 1.250 was prescribed as a gargle. On the second day the slough and cheesy material had gone and a deep punched-out ulcer was seen. Darkfield examination showed the spirochete of Vincent and the fusiform bacillus. Three days later his temperature was 98.6 F., the ulcer being found limited to the upper pole of the left tonsil.

The next day his temperature, pulse and respiration were flat, with the glands of the neck subsiding, the ulcer healing, the smear and culture negative. On his eighth day in hospital, the infection in his tonsils had subsided, the ulcer had healed, the smears were still negative, and his temperature, pulse and respiration had been normal for six days.

Thomas B. Wood