388 VINCENT'S ANGINA 



and spirillum are often associated with cocci and amoebae in pus from dental caries 

 or pyorrhoea and I mount such material in the patient's saliva to obtain motility 

 in the amoebae. The fusiform bacillus is not markedly Gram-negative. 



The culturing of material from the nasopharyngeal region of contacts as well as 

 patient is very important in outbreaks of cerebrospinal fever. Use a bent wire 

 applicator with sterile cotton tip and pass it to the nasopharynx avoiding the uvula. 

 Inoculate tubes of serum or blood agar immediately. 



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 

 dark field or Fontana's staining procedure, we should be very conservative in report- 

 ing such an organism from suspected syphilitic ulcerations of the throat. 



We now know that we have treponemata in the buccal cavity similar to T. pal- 

 lidum so that even with the dark field illumination I would base a diagnosis on 

 the clinical and Wassermann reactions rather than morphologically. 



The thrush fungus (Endomyces albicans) may be easily demonstrated 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. 



Actinomycosis may develop about a carious tooth and the finding of 

 the ray fungus in the granules from the pus may give the diagnosis. 



Amoebae and flagellates have been reported from the mouth. Also in the re- 

 markable disease "halzoun," flukes have been found to be the cause of the asphyxia. 



In the tropics, round worms (A scar is] may be vomited up and, lodging in the 

 pharynx, may have to be extracted. 



During the campaign of Napoleon in Egypt many cases of leech involvement of 

 the nasal and buccal cavities were noted. The parasite was the Limnatis nilotica 

 which gained access to the upper pharynx through drinking water from springs and 

 pools. Many such cases continue to be reported from the Mediterranean basin. 



