EXAMINATION OF BUCCAL AND PHARYNGEAL MATERIAL 387 



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 Loffler'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- 

 ture; abundance of streptococci in a smear from an ulceration or bit of membrane, 

 however, is of etiological import. Streptococcal sore throats are often very toxic 

 and may be fatal often milk borne. Use blood agar plates to differentiate hjemo- 

 lyzing and "viridans" types of streptococci. 



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

 diate diagnosis of diphtheria from a smear from a piece of membrane 

 in about 25% of cases. It is well, however, to always culture such 

 material. The toluidin blue stain of Ponder is the best stain for 

 diphtheria. 



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 for- 

 ceps 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. 



In Giemsa-stained smears from the dirty membrane covering the ulcerated area 

 of Vincent's angina there are usually two types of the fusiform bacillus to be seen; 

 one rather slender, pale blue with maroon dots at either end, the other rather thicker 

 and of a uniform maroon staining. The spirilla are from 10 to 18 microns long and 

 the fusiform bacilli from 5 to 7 microns. 



As a rule, only cultures on Loffler 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. 



The B. fusiformis is an anaerobe which gives a fetid odor but cul- 

 turally has no distinct characteristics. The spirillum has not been cul- 

 tivated. It has been thought that the bacillus and spirillum are 

 different stages of the same organism. 



At times aggregations of the fusiform bacillus give the appearance of branching so 

 characteristic of diphtheria organisms. Being Gram-negative, however, the differ- 

 entiation is easily made the B. diphtheria being Gram-positive. Again the attenu- 

 ated ends of the fusiform bacillus are diagnostic. 



It is usually stated that the fusiform bacillus is nonmotile. By mounting material 

 in saliva I have noted a sluggish, but distinct motility. The fusiform bacillus 



