260 



important, perhaps next to disturbed nutrition, the most im- 

 portant, sign of inflammation. 



I have shown in another essay how important is the cur- 

 rent of blood-serum for the activity of movable cells. I 

 believe that the importance of exudation must be regarded in 

 a double sense. In the jirst place, the current acts as a ?ne- 

 chanical stimulus ; and secondly, the fluid of the Mood has 

 an influence as a material for nutrition. 



It did not lie in the plan of my present work to inquire 

 into the more minute processes associated with exudation, 

 and therefore I will not discuss this important question and 

 the opinions regarding it without further special inves- 

 tigations. 



Moreover, the knowledge of these processes is not indis- 

 pensably necessary for deciding the characteristics of inflam- 

 mation. For this purpose the expression " circulation dis- 

 turbance" suffices, and this we must enrol among the signs 

 of inflammation. It would be better for us provisionally to 

 make use of this general sign, than to bring forward the 

 signs " heaf^ and " redness.'''' " Heat" is not always asso- 

 ciated with inflammation. It has been proved that in cold- 

 blood animals no increase of temperature is manifested. We 

 shall avoid contention if we say, that in inflammation local 

 disturbance of circulation, increased exudation of the fluid 

 and formed elements of the blood, and disturbed nutrition, 

 together with increase of cellular elements, follow one upon 

 the other. The last link in the chain is the transition of 

 normal and relatively fixed cells into active cells, and the 

 multiplication of the latter by division or endogenous 

 generation. 



If we now ask what precedes the disturbance of circulation, 

 the answer to this question is very soon given. It must 

 follow violence to the vessels. We have seen that in trau- 

 matic keratitis the vascular nerves must intervene; in other 

 localities and under other conditions direct influences may be 

 exerted directly upon the Avails of the vessels. Whether those 

 influences are derived from causes lying within or without 

 the organism does not affect the general question of inflam- 

 mation. We say that somewhere a lesion sets up changes in 

 the local circulation, and thereupon follow the processes 

 previously alluded to. 



One of the chief reasons that induced Virchow to ascribe 

 so little importance to disturbance of circulation in the pro- 

 cess of inflammation, was the fact that hyperemia does not 

 always result in inflammation. But I assert that, among 

 those disturbances of circulation which precede inflammation. 



