INFLAMMATION. 409 



the redness, had held the first place, so now the swelling 

 occupied the foremost rank. It is only jn. the more 

 speculative views of the neuro-pathologists that the pain 

 is, as is well known, regarded as the essential and origi- 

 nal change in the act of inflammation. 



There can be no doubt, but that of these different posi- 

 tions the anatomical doctrine of the Vienna school would 

 be the most correct, if it could be demonstrated, that, as 

 the language of most of the physicians of the present day 

 would lead us to believe, an exudation really does take 

 place, in every case of inflammation ; that the swelling is 

 essentially occasioned by this exudation ; and especially, 

 that this exudation ought to be regarded as a constant 

 and typical one, and the quantity of fibrine contained in 

 it as a criterion of its inflammatory nature. 



I have already, in the previous lectures, endeavoured 

 to show you, in what a considerably restricted sense the 

 term exudation must be employed, and how essentially 

 the activity of the elements of the tissues themselves is 

 concerned in the appearance of matters, which we cer- 

 tainly must regard as derived from the vessels and depo- 

 sited in the parts aifected. A good deal is, as we have 

 seen, not so much exudation, as, if I may so express 

 myself, an educt from the vessels in consequence of the 

 activity of the histological elements themselves. 



Irritation must, I believe, be taken as the starting-point 

 in the consideration of inflammation, and it is because 

 Broussais and Andral regarded the matter in this light, 

 that I consider the views advanced by them to be the 

 most correct. We cannot imagine inflammation to take 

 place without an irritating stimulus (irritament),* and the 



* The term irritament (Reiz, which, however, sometimes means irritant, stimu- 

 lus) is intended to express the change (mechanical or chemical, palpable (anatomi- 

 cal) or molecular) which takes place in a tissue in consequence of the action of an 

 irritant a change, therefore, which is of a purely passive nature (lesion), and which 



