92 MEDICAL BACTERIOLOGY 



At least three distinct clinical forms are observed: 



First, acute onset, beginning as stomatitis, pharyngitis or unilateral tonsil- 

 litis, the inflamed area covered in several days by a pseudomembrane and pre- 

 senting the appearance of diphtheria after the pseudomembrane is cast off, 

 the subsequent course may be as in diphtheria or slight superficial ulceration or 

 deep ulceration may occur and persist for several days or weeks those cases 

 which at first are clinically indistinguishable from diphtheria are about 50 per 

 per cent, of the whole. 



Second, ulceration, most frequently involving one tonsil, rarely occurring 



FIG. 1 8. SPREAD FROM A CASE OF VINCENT'S ANGINA, SHOWING SPIRILLA AND FUSIFORM 



BACILLI. STAINED WITH METHYLENE BLUE. 

 (4 X Eyepiece and M2 oil immersion objective.), 



on tongue, occasionally on gum, buccal mucosa or pharynx ulcer develop- 

 ing as do syphilitic ulcers, having the punched-out appearance and other physi- 

 cal characteristics of a chancre frequently unaffected by any form of treatment 

 and persisting for weeks or months these cases which always suggest syphilis 

 constitute about 40 per cent, of the whole. 



Third, insidious onset, of months or years duration and marked by the 

 occurrence, most commonly on the gums, of one or more vesicles which develop 

 and subside repeatedly all of which contain bacilli and spirilla, occasionally 

 these vesicles ulcerate these cases form a very small per cent, of the whole. 



Diagnosis. In all cases of pharyngeal, tonsillar or buccal infection or ulcer 

 a sterile cotton swab should be passed over the inflamed area and then rubbed 

 on slides to be fixed, stained and examined microscopically. 



At the same time a tube of Loeffler's medium should be inoculated and incu- 

 bated aerobically at 37C. 



Both these procedures are advisable for the following reasons : 



If the condition be diphtheria, slides examined microscopically, frequently 



