I08 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



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 only in 2 per cent, 

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

 some difficulty in swallowing, and foetor 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 

 present, but not the spirillum ; in either form of the disease the 

 characteristic organism or organisms may be associated with 

 streptococci, staphylococci, etc., and these secondary infections 

 may give rise to grave complications. 



The B. fwsifoymis, which occurs in both forms of the disease, 

 may be found, in small numbers, as a normal inhabitant of 

 the mouth, and occurs in myriads in the disease. It varies in 

 size, but is on the whole a large bacillus, about as long as the 

 diameter of a red blood-corpuscle, or even longer. Typically it 

 has both ends pointed, giving it the shape of a greatly elongated 

 spindle, but other forms always occur, and may even constitute 

 the majority of the bacilli present. It often contains two or three 

 clear vacuoles, which may not be noticed if the staining is too 

 deep. Both the bacillus and the spirillum are usually actively 

 motile, and it is a good plan to check the results of the examina- 



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

 protozoon. 



