256 EXAMINATION OF BUCCAL AND PHARYNGEAL MATERIAL. 



Gram stained smear, either by its lance-shaped morphology or the 

 presence of a capsule. In 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 

 Loffler's serum. Where the process is streptococcal or due to the 

 organisms associated with Vincent's angina, the immediate examina- 

 tion 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 culture ; 

 abundance of streptococci in a smear from an ulceration or bit of 

 membrane, however, is of etiological import. 



By staining with Neisser's method it is possible to make an im- 

 mediate diagnosis of diphtheria from a smear from a piece of mem- 

 brane in about 25 percent of cases. It is well, however, to always 

 culture such material. 



Material from the throat is ordinarily best obtained with a sterile 

 copper wire cotton pledget swab. The platinum loop usually bends 

 too easily. A sterile forceps may be more convenient for obtaining 

 particles of membrane. It is believed that ulcerative conditions of the 

 throat, associated with the presence of the large fusiform bacillus and 

 delicate spirillum, which make the picture of Vincent's angina, are 

 more common than is usually so considered. As a rule, only cultures 

 on serum are made and very rarely direct smears. If a smear were 

 always made and stained by Gram's method (with a contrast stain of 

 dilute carbol fuchsin) at the same time the culture was made, it is 

 probable that much information of value would be obtained. 



Direct smears are the procedure of choice in streptococcal and 

 pneumococcal anginas as well as in Vincent's angina. 



Unless very familiar with the morphology of Treponema pallidum 

 and using Giemsa's staining procedure, we should be very conserva- 

 tive in reporting such an organism from suspected syphilitic ulcera- 

 tions of the throat. 



The thrush fungus (Endomyces albicans) may be easily demon- 

 strated in a Gram stained specimen as violet mycelial structures. 



Yeasts due to food particles are not infrequently observed in smears 

 and cultures from the mouth. 



