CHAPTER XXV. 

 EXAMINATION OF BUCCAL AND PHARYNGEAL MATERIAL. 



IN a preparation made from material taken by a sterile swab from 

 the region of the normal buccal and pharyngeal cavities and stained by 

 Gram's method we are struck by the variety of organisms present. 



Gram positive and Gram negative staphylococci are present, as are also strepto- 

 cocci, pneumococci, leptothrix forms, and very probably yeasts and sarcinae types 

 with many Gram negative bacilli. If pseudo-diphtheria organisms are present, 

 we have these showing a Gram positive reaction. If this material is smeared on 

 agar plates and cultured at 37 C., we are struck by the fact that the colonies on 

 the plates may be exclusively staphylococcal and streptococcal. 



FIG. 97. Vincent's angina. Spirochaeta vincenti. (Coplin.} 



* 



It is very difficult, if not impossible, to distinguish a pneumococcus colony from 

 a streptococcus one on a plate culture. The presence or absence, however, of the 

 pneumococcus is distinctly shown in the Gram-stained smear, either by its lance- 

 shaped morphology or the presence of a capsule. It has been my experience that 

 smears from about 15% of normal individuals show capsulated pneumococci. 



In diphtheria examinations we rely chiefly on the cultural findings on Lb'ffler's 

 serum. Where the process is streptococcal or due to the organisms associated with 

 Vincent's angina, the immediate examination of a smear from the suspected spot 

 or area gives greater diagnostic information. The streptococcus being so abundant 

 in cultures from normal throats, it is difficult to determine its significance in a cul- 



330 



