BACTERIOLOGICAL EXAMINATION OF MOUTH AND FAUCES I07 



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 blood-serum before 

 giving a definite diagnosis. 



No conclusions as to the cause 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 more likely 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 may be given, the local treatment being continued 

 as usual. 



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 

 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 : 



I. 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 fcetid and the tongue 



