GERMICIDAL SOAPS AND COSMETICS 1:25 of these medicated soaps when applied to the skin (4, 12). Much of the feeling of a sense of security following the use of early "germi- cidal" soaps was the direct result of the "antiseptic" odors that were imparted to these products. Realizing the tremendous poten- tialities of a soap which mechani- cally removes extraneous dirt and debris by its lathering properties and also one which contains anti- bacterial properties for the destruc- tion of micro•Srganisms and to prevent decomposition of perspira- tion, thus eliminating malodorous conditions of the latter, extensive investigational and promotional campaigns have been carried out on this problem during the past several years. Particular attention has been directed to the use of chlorinated phenols in soap bases. Of the latter group of chemicals which were found to be compatible with soaps and still effective in reducing the bacterial population of the skin is "Hexachlorophene" (bis-2- hydroxy-3,5,6-trichlorophenyl meth- ane), also known as "G-11. "© Hexachlorophene in concentrations of 1 to 3 per cent in bar or liquid soap bases has been found to be non-irritating when applied to the skin over prolonged periods of time (14). Furthermore, there are no apparent sensitizing properties imparted to individuals by the compound upon continued use of soaps containing the germicide. Since hexachlorophene is compatible © Registered trademark. with dyestuffs, perfumes and other ingredients of soaps, these products compare in pharmaceutical excel- lence with the many ordinary toilet soaps on the market. In addition to the latter application, the com- pbund is also being incorporated in surgical liquid and bar soaps, in underarm creams and lotions, footpowders, baby powders, and lotions, shaving creams, face creams, hair tonics, surgical disinfectants, etc. While there is sufficient evidence that hexachlorophene soaps will reduce the bacterial population of the skin more effectively than ordi- nary soap, the former will not give "sterile" skin surfaces. However, the marked reduction of the "tran- sient" bacterial flora upon continued or daily use of the product, with a minimum number of "resident" populations of organisms has served as the basis for the use of hexa- chlorophene soaps in surgical scrub procedures in many hospitals. Yet, there is some hesitancy on the part of many surgeons to use hexachloro- phene soaps alone for the treatment of hands and arms in the surgical scrub and the cleansing and steriliza- tion of the operative sites of pa- tients who are to undergo surgery. Thus, in many instances where hexachlorophene soaps are used in these conditions, a final treatment of skin surface with alcohol or other disinfectants has been advocated Hexachlorophene Soap in the Pre- operative Scrub. A series of studies were carried out in which hexa-

126 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS chlorophene soap was used alone in the preoperative scrub in preparing patients for surgical procedures. In addition to this treatment a group of patients were selected and following the "modified"'(16) scrub technique with hexachlorophen• soap, the operative area was treated with a tincture just prior to making the incision. Methods. The preoperative skin disinfection procedure currently em- ployed at our University Hospital is as follows: Three per cent hexa- chlorophene in a synthetic, liquid soap base (pHisoderm) *© is applied to the operative area and the latter shaved on the night before surgery. On the following day, and just prior to surgery, the area is again scrubbed thoroughly with water and the hexachlorophene-detergent prep- aration. The area is then draped with a sterile sheet and without further treatment the patient is presented for surgery. Some of the surgical services, however, spray the operative area with Tinted Tincture of Zephiran t © just prior to operation for the pur- pose of "outlining" the hexach!oro- phene-treated area. Otherwise the scrubbing technique is the same as that described above. In order to obtain a true comparison of the two surgical disinfecting procedures, pa- tients were selected in most instances who were to undergo abdominal operations. This afforded a rather *A product of Winthrop-Stearns, Inc., containing as the active detergent, sodium t-octylphenoxyethoxyethylether sulfonate. t Winthrop-Stearns, Inc. brand of alkyl~ dimethylbenzylammonium chloride. uniform texture of the skin in the bacteriological tests that followed. In all instances the disinfected areas were swabbed immediately prior to operation with cotton- tipped sterile wooded applicators moistened with sterile nutrient broth containing a quaternary am- monium germicide "inactivator" (17). The swabs were placed in a sterile test tube and refrigerated until examined bacteriologically (within one to two hours). During the initial incision a biopsy speci- men of skin was taken and placed in a tube containing sterile nutrient broth. Five milliliters of broth were added to the tube containing the swab specimen and after thor- oughly mixing the latter in the medium, 0.5 mi. and 1.0 ml. of the broth were added to individual sterile petri dishes. To one set of these plates was added melted and cooled (45øC.) beef extract agar. Another set of plates was prepared with brain-heart infusion agar to which was added 10 per cent citrated whole human blood. The plates were incubated at 37øC. for seventy- two hours and the presence or absence of colony growths recorded. Slide smears and stains were made of representative colonies developing in the medium to determine cellular morphology and staining charac- teristics of the bacteria. The biopsy specimen, contained in 10 ml. of nutrient broth, was thoroughly rinsed in the medium and approximately 2 ml. of the latter transferred to a tube con- taining 10 ml. of sterile brain-