134 CLINICAL BACTERIOLOGY. 



In a case of noma studied personally the bacterium coli 

 commune was found. Concerning these observations the 

 same criticism may be made that has been suggested with 

 regard to the presence of Friedlander's bacillus in cases 

 of ozena and rhinoscleroma. 



ANGINA. 



In the inflamed mucous membrane of anginas pursuing 

 their course without the development of membrane staphy- 

 lococci have, as a rule, been found, as well as in the purulent 

 plugs of follicular (or lacunar) angina. The anginas char- 

 acterized by the presence of a membranous deposit are 

 frequently associated with streptococci, and often besides 

 also with staphylococci, but at times with the latter alone. 

 Finally, a considerable number of cases have been reported 

 in which only pneumococci were present. 



An attempt has been made on the basis of these bacterio- 

 logic observations to distinguish a staphylococcus-angma, a 

 streptococcus-angina, and a pneumococcus-angina, each of 

 which is held to be etiologically a distinct variety and to 

 possess its special characteristics both clinically and from 

 the diagnostic and prognostic point of view. Accord- 

 ingly, staphylococcus-angina would be a relatively harmless 

 affection, scarcely ever leading to complicating disorders. 

 Streptococcus-angina would be severer, exhibiting more 

 pronounced manifestations of intoxication (fever, glandular 

 enlargement), and possibly being followed by nephritis and 

 even general sepsis. Pneumococcus-angina, finally, would 

 be characterized by the resemblance of its clinical course to 

 that of pneumonia, by its stormy onset, possibly with a 

 chill, and by high fever, with critical defervescence. 



It must, however, be emphasized that the clinical picture 

 of these anginas is by no means a constant one, and that 

 the severity of the disease depends more upon the virulence 

 than upon the species of the bacteria present. There occur 

 staphylococcus-anginas (phlegmonous anginas), as well as 

 anginas associated with the presence of streptococci alone, 

 that pursue as mild a course as those with which the staphy- 

 lococcus alone is associated. On the other hand, severe 

 pseudo-membranous anginas, which clinically are indistin- 

 guishable from true diphtheria, and in association with 

 which only streptococci are demonstrable, are not rare. 



