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JAMA 100 Years Ago
June 9, 2004


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2004;291(22):2765. doi:10.1001/jama.291.22.2765-b

It has long been recognized that saliva is an extremely dangerous medium of infection, but it has remained for de Leon1 to demonstrate just how frequently it may be responsible for the instances of so-called unavoidable surgical infection. From a long series of careful and well-controlled experiments, he has obtained some very striking results. It was found that on the average about two hundred words were spoken by the operator alone in an ordinary operation. On an average, in each drop of saliva occur 4,375 bacteria, and in the duration of an average operation 250,000 organisms may gain direct entrance to the wound. Among these, virulent organisms are constantly present, streptococci, diplococci and staphylococci, in order of their frequency. To avoid this source of contamination, de Leon devised a simple mouth mask which is efficacious and not burdensome and does not interfere with distinct articulation. Some bacteria were found to penetrate a gauze mouth covering, though the number was materially reduced. If experience has shown that wounds are usually capable of withstanding a large number of bacteria, it has also demonstrated that under suitable conditions a few bacteria may give rise to serious and even fatal infection. Inasmuch as these conditions may obtain in any wound, the logical deduction is obvious. It would be folly, indeed, to strain at the gnat of saliva and swallow the camel of dirty hands, but surgeons who have good personal technic and equally careful assistants should consider this fruitful source of infection, particularly where teaching makes more continuous and louder talking a necessity.

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