MATERIAL FROM THE LI V IXC SUBJECT 267 
Diplitlieria, leprosy, (r/ona, rhiiioscleroina and various coryzas are 
the common types of nasal infection, but a variety of organisms may 
be present there either transiently, or somewhat more permanently 
during bronchial infections. Thus pneumococci, influenza and per- 
tussis bacilli have occasionally been isolated from the nasal secretion 
during pneumonia, influenza or whooping cough respectively. ]\Ien- 
ingococci and parameningococci have been demonstrated both in 
patients and carriers during epidemics of cerebrospinal meningitis. 
It is not unlikely that ^Micrococcus catarrhalis has occasionally been 
incorrectly diagnosed as the meningococcus in the past, because both 
organisms are Gram-negative diplococci. Micrococcus catarrhalis is 
sometimes found in large numbers in the nasal secretion of acute coryza. 
The bacteriology of ozena is a subject of controversy. B. oza^nte 
and B. rhinoscleromatis, both members of the mucosus capsulatus 
group of bacteria, have been regarded as the etiological agents in the 
past. Recent studies by Horn and Victors^ have redirected attention 
to the "Coccobacillus fetidus ozsenae"- of Perez, an organism of con- 
siderable cultural variation, as reported by different observers. Horn 
believes it to be rather closely related to B. bronchosepticus.^ The 
subject is as yet a matter of controversy. 
The earliest lesion of leprosy appears to be a nasal ulcer, more 
frequently located at the junction of the bony and cartilaginous 
septum, hence an examination of the nasal cavity is of paramount 
importance for the early diagnosis of this disease. It should be 
remembered that the Karlinski nasal secretion bacillus, which is 
acid-fast, may be found here as well. This organism, however, grows 
upon glycerin agar. The leprosy bacillus does not. 
Tuberculous ulcerations of the nose are comparatively infrequent; 
the tubercle bacillus is readily distinguished from the lepra bacillus 
by injection of suspected material into a guinea-pig. The animal 
is very susceptible to infection with the tubercle bacillus, but refrac- 
tory to lepra bacilli. Occasionally acid-fast bacilli, which are neither 
lepra nor tubercle bacilli, have been reported as occurring in the 
nasal secretion. Karlinski's nasal secretion bacillus is one of the best 
known of the saprophytic acid-fast group. It grows promptly and with 
considerable luxuriance upon glycerin agar, which at once distinguishes 
it from the pathogenic acid-fast bacilli. 
Nasal diphtheria is not an uncommon type of infection with the 
diphtheria bacillus. The organism is readily distinguished by its 
morphology with the methylene blue stain both from the nasal secre- 
tion and from cultures upon Loffler's blood serum. When the nasal 
secretion is profuse, as, for example, in acute or subacute coryza, 
saprophytic bacteria, as B. proteus, may develop in the nasal secretion, 
causing extremely offensive odors. There is little evidence that tlje. 
1 Ann. Otol., Rhinol. and Laryngol., 1916, 25, 251. 
2 Ann. Inst. Pasteur, 1899, 13, 937. 
' Torrey and Rahe: Jour. Med. Res., 1912-191.3, 27, 291. 
