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The purpose of this report is to present two cases in which the patients carried virulent diphtheria organisms in the middle ear and mastoid without clinical signs referable to the ear, and showed obscure but persistent general reactions. Alexander 1 observed the destruction of tissue in the tympanic and epitympanic spaces, without evident involvement of the drum membrane. In a recent thorough review Drury 2 cites briefly the facts in every case of diphtheria of the ear in the medical literature; the earliest reported depend on clinical signs for determination as virulent diphtheria; the later ones on guinea-pig inoculation, which is the absolute proof of the virulence of the organism. The two cases described here were selected from a group of cases of diphtheric infections of the mastoid, the remaining four being either secondary diphtheroid infections from wound contamination or infections not clearly primary in the middle ear space.

Closed-suction catheter drains offer many advantages over previously used systems in head and neck surgery. Occlusion of drains with either tissue fragments of thrombus, however, is a relatively common problem. Several methods have been proposed to restore flow to obstructed drains. These methods are reviewed and a new method is described that is efficacious, avoids wound contamination, and is relatively inexpensive.

• The bacteriology of the operating room with the use of the helmet-aspirator system has been discussed. The surgical team predictably contaminates the operating room. Current cotton gowns worn loosely about the neck do not serve as effective barriers to bacterial penetration. Barrier draping of the surgical team is possible with impervious materials, but requires the use of a helmet-aspirator system to dissipate the heat and particulate debris. These are commercially available and their use has been shown to decrease colony-forming particles, decrease wound contamination, and decrease wound infection. Barrier draping of the surgical team through the helmet-aspirator system is effective and is to be recommended for infection-prone cases. ( Arch Surg 114:790-792, 1979)

To the Editor.— The SPECIAL COMMUNICATION, "On the Physical Death of Jesus Christ,"1 was particularly offensive. Its overall tone was pseudointellectual and maudlin, the data base contained as much speculation as it did supercilious Latin trivia, and the illustrations were more disgusting than illuminating. What Christian, Jew, or atheist does not realize that respiration during crucifixion is agonizing? Who needs graphic drawings with vector arrows? The authors' fascination with the notion of his scourging wounds becoming "torn open" on several junctures is disturbing. Their concern that these wounds would become contaminated with dirt belies the lack of a clear point to their lugubrious article, as wound contamination is irrelevant with death just a few hours away. Furthermore, nonscientific statements such as "preshock state" and that the terminal event was a "fatal cardiac arrhythmia," which is how all of us die, detract from any serious medical acceptance of this communication. Perhaps

To the Editor: —In visiting hospitals in different parts of the country one is struck by the number of surgeons who fail to take reasonable precautions against hair and dandruff falling into the operative field. This has been noticed in pictures of operations. A common practice is to turn up the bottom edge of the cap in a neat fashion, leaving uncovered the occipital region, from which loose hair, dust, and dandruff may fall into the operative field when the surgeon leans over the table. Such wound contamination can result in infection. Wound infections of unexplained origin still occur, though the incidence is less than formerly probably because of the general use of antibiotics. In marked contrast to the careless attitude of these surgeons is that of nurses, whose hair is generally adequately covered, often with a hood. On the other hand, anesthetists not infrequently are offenders, either through thoughtlessness

Protection against airborne contamination and infection requires the development of interdependent practices not only in the operating room but in the hospital as well for (1) the isolation of infected individuals to prevent colonization of patients and personnel, (2) control of dust in the operating room by effective housekeeping and laundering practices, (3) exclusion of bacteria shed by the surgical team by proper garb, (4) ventilation with clean air at a rate sufficient to purge bacteria from the aseptic field or its equivalent in disinfection by ultraviolet radiation, and (5) terminal disinfection of the operating room. Convenience, effectiveness, and economy are the criteria that must be evaluated in the context of each hospital. Emphasis on specific practice will vary in different hospitals. To achieve a low rate of postoperative wound infection in clean cases, the concept of asepsis must be extended and expanded from direct contact alone to include air transport of microorganisms from people as the hazardous peripatetic environment.

In war and in peace, infection is the bete noire of the surgeon who handles wounds. The most vulnerable are the wounds of violence, especially when the tissue damage extends to muscle, bone, or one of the body cavities. All are contaminated, characteristically, with more than one species of pathogenic bacteria at the time of wounding or during exposure for treatment. The triad of infection which may result from these contaminations are tetanus, gas gangrene, and the pyogenic infections. The orbit around which all prophylactic measures evolve is operative handling of the wound, since no chemotherapeutic agent has yet been discovered which can, per se, sterilize a wound. Tetanus can almost always be prevented by immunotherapy, and gas gangrene, by timely and careful excisional surgery. Pyogenic infection is a consequence of septic decomposition of residual dead tissue bysecondary bacterial contaminants. often drug-resistant, and usually uninfluenced by systemic or topical antimicrobial