830 



SCIENCE. 



[N. S. Vol. V. No. 126. 



of the lymphoid cell in inflammation ap- 

 proaches solution along these lines of in- 

 vestigation. 



A burning question, and one of perennial 

 interest, relating to our subject is : How 

 far are we justified in regarding acute in- 

 flammation as an adaptive or protective 

 morbid process ? There is fair agreement 

 as to the essential facts of observation, but 

 regarding their interpretation there are 

 wide differences of opinion, and when one 

 considers the complexity of the process and 

 its still unsolved riddles it is not hard to 

 see why this should be so. Much depends 

 upon the point of view, and in this respect 

 there can be recognized a certain antag- 

 onism between the purely clinical and the 

 purely pathological and experimental views, 

 an antagonism, however, which must be 

 reconciled by a full knowledge of the sub- 

 ject. 



It is not likely that the purely clinical 

 study of inflammation would ever lead to 

 the idea that the general tendency of this 

 process is advantageous to the patient. 

 The more severe and extensive the inflam- 

 matory affection, the more serious, as a 

 rule, is the condition of the patient. The 

 surgeon sees his wounds do well or ill, ac- 

 cording to the character and extent of 

 inflammatory complication. Measures di- 

 rected to the removal of inflammatory 

 exudation, such as the evacuation of pus 

 from an abscess or an empyema, are the 

 most successful methods of treatment, and 

 their rules are embodied in ancient sur- 

 gical maxims. How can one conceive of 

 any purpose useful to the patient served by 

 filling the air-cells of his lungs with pus- 

 cells, fibrin and red corpuscles in pneu- 

 monia, or bathing the brain and spinal 

 cord in serum and pus in meningitis ? If 

 nature has no better weapons than these to 

 fight the pneumococcus or meningococcus, 

 it may be asked, " "What is their use but to 

 drive the devil out with Beelzebub?" 



But the pathologist and bacteriologist 

 sees another aspect of the picture. An in- 

 fectious micro-organism has invaded the 

 tissues, where it multiplies and where its 

 toxic products begin to work havoc with 

 the surrounding cells, and by their ab- 

 sorption to cause constitutional symptoms 

 and perhaps damage to remote parts. Is 

 the destructive process to go on without 

 any defense on the part of the body? 

 There are attracted to the injured part an 

 army of leucocytes from the bloodvessels, 

 and perhaps other cells from the neighbor- 

 ing tissues, and it has been conclusively 

 shown that these cells can pick up foreign 

 particles and remove them, and that they 

 contain substances capable of destroying 

 many micro-organisms. At the same time 

 serum accumulates in and around the 

 injured area, and this may aid in destroy- 

 ing bacteria by its chemical properties, in 

 diluting poisons, in flushing out the part. 

 Fibrin may appear, and some think that 

 this may serve in some situations as a pro- 

 tective covering. If these agencies, hos- 

 tile to the invading micro-organisms, gain 

 the upper hand, the debris is cleared away 

 by phagocytes and other means, and the 

 surrounding intact cells, which had already 

 begun to multiply, produce new tissue 

 which takes the place of that which had 

 been destroyed. The victory, however, is 

 not always with the cells and other de- 

 fensive weapons of the body. The struggle 

 may be prolonged, may be most unequal, 

 may cover a large territory, and the char- 

 acters and the extent of the inflammation 

 furnish an index of these different phases 

 of the battle. 



Such in bald outlines are two divei-gent 

 views of acute inflammation. 



I do not see how we can fail to recognize 

 in that response to injury, which we call 

 inflammation, features of adaptation. In- 

 flammation may be in some cases the best 

 response to secure the removal or destruc- 



