126 CLINICAU bacteriology and HjEMATOLOGY 



syphilitic lesion ; and (2) it is readily cured by appropriate treat- 

 ment— friction twice daily with a tampon soaked in tincture of 

 iodine. It has attracted very little attention in this country, yet 

 it does not seem to be rare; I have now seen many cases. 

 One was of great severity, and was associated with the forma- 

 tion of an abscess in the tonsil, and subsequently of another in 

 the soft palate. 



Vincent describes two forms : 



1. An ulcero-membranous variety, which commences with fever 

 and general malaise, and with redness of a tonsil or of a pillar of 

 the fauces. In a day or two a grey or yellowish false membrane 

 appears on the injected area ; it is soft and but slightly adherent, 

 and when removed the mucous membrane is found to be ulcerated. 

 As the disease proceeds the membrane increases in thickness, and 

 a deep ulcer is formed. The breath is foetid and the tongue 

 furred, salivation occurs, and deglutition is painful. The sub- 

 maxillary glands may be enlarged. In most cases the patient 

 recovers in a week or fortnight, but the affection may become 

 chronic and last a month or more. 



More severe forms occur in which the soft palate, uvula, 

 tongue, etc., are invaded, and ulceration also occurs. In some 

 cases there is a scarlatiniform rash, which might lead to the 

 diagnosis of scarlet fever. 



2. The diphtheroid form is rarer, occurring in only 2 per cent, 

 of Vincent's cases. The onset is accompanied by a little fever, 

 some difficulty in swallowing, and fcetor of the breath. Locally, 

 the mucous membrane is inflamed and injected, and a whitish 

 membrane is formed ; it is thin at first, but becomes thicker, and 

 when removed leaves an ulcerating or bleeding surface, but the 

 ulceration is less than in the other form. The disease runs a 

 shorter course, recovery occurring in four to eight days. This is 

 the form which so closely resembles diphtheria, and which, I have 

 no doubt, has often been mistaken for it, even after a superficial 

 bacteriological examination of the membrane. 



The diagnosis is made from films prepared from the swabs, 

 stained by Gram's method and counterstained by carbol fuchsin. 

 In the more common form (the ulcero-membranous) two very 

 interesting organisms will be found — a bacillus and a spirillum 

 (Plate IV., Fig. 2).* In the diphtheroid form the bacillus is 



* It is possible that these are different stages of the same organism, a 

 protozoon. 



