BACTERIOLOGICAL EXAMINATION OF MOUTH AND FAUCES I25 



whether a cultural examination is necessary, and if so, what 

 medium should be used. Thus, if Gram - staining bacilli are 

 present, diphtheria is suspected, and cultures should be made on 

 blood-serum. 



Simple Angina and Follicular Tonsillitis may be due to 

 streptococci, staphylococci, pneumococci, or the Micrococcus catar- 

 rhalis. These are readily detected in the smears, the first as longer 

 or shorter chains of cocci, the second as cocci which are isolated 

 or in small groups and often contained in the leucocytes, the third 

 as pairs of cocci with a more or less marked lanceolate shape 

 and a capsule : all these stain by Gram. The M. catarvhalis 

 (Plate III., Fig. 5) is recognizable by its shape (kidney-shaped, or 

 a sphere with a segment cut off), by its being larger in size than 

 the staphylococcus, by its being frequently intracellular, and by 

 its not staining by Gram's method. Here a warning already given 

 must be repeated : it is not safe to conclude that an organism 

 does not stain by Gram because the intracellular bacteria are 

 decolorized, and extracellular ones should be sought for, and will 

 usually be found. 



If no organisms but the above cocci are found after a very 

 careful search, the conclusion is that the case is probably either 

 simple angina, follicular tonsillitis, ulcerative tonsillitis, or scarlet 

 fever. But it must be remembered that, although a good large 

 area of film has been searched, in reality but a very small volume 

 of secretion has come under observation — probably less than a 

 cubic millimetre — and that diphtheria bacilli may be present ; it 

 is therefore advisable to make a culture on blo<jd-serum before 

 giving a definite diagnosis. 



No conclusions as to the origin of the angina or as to its prog- 

 nosis can be given from the discovery of the causal organism. 

 The presence of a streptococcus renders it possible that the disease 

 is scarlet fever, but certainly does not prove it. Nor does the 

 examination give much help as to treatment. If the disease is 

 due to a streptococcus and the symptoms are severe, antistrepto- 

 coccic serum or vaccine may be given, the local treatment being 

 continued as usual, and the other infections may all be treated 

 with their appropriate vaccines. 



Vincent's Angina is a very interesting form of sore throat 

 recently described by Professor Vincent, of Paris, and is especially 

 important since (i) it closely resembles diphtheria, and the two may 

 be readily confounded, and it also may easily be confused with a 



