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On the other hand, a sensation closely resembling fluctuation may often be recognised in œdematous tissues, in certain soft, solid tumours such as fatty tumours or vascular sarcomata, in aneurysm, and in a muscle when it is palpated in its transverse axis.
At the outset in severe cases, there is elevation of temperature, labored breathing, accelerated pulse, anorexia and more or less swelling of the affected members. Swelling is very painful and when the affected legs are palpated, pain is manifested by flinching. The inguinal lymph glands are often swollen but in some cases they are not affected in any perceptible degree.
"The mind was clear; there was little pain." "The abdomen became somewhat softer, much less painful, and was readily palpated and percussed; there was a distinct resistance about the size of a hand, quite firm, and not fluctuating, and accompanied by marked dullness, around McBurney's point and downward, and only in this region severe stabbing pain; in other areas no dullness."
If the induration is well marked, the chancre can be palpated through the prepuce, and is tender on pressure. As under these conditions it is impossible for the patient to keep the parts clean, septic infection becomes a prominent feature, the prepuce is œdematous and inflamed, and there is an abundant discharge of pus from its orifice.
Only twenty four hours after "the intake of food was reduced to almost nothing" the abdomen was softer and readily palpated and percussed. Just imagine, reader, what a difference there would have been in this case if the poor, miserable victim had been allowed the quiet he so much needed if he had been left without daily bimanual examinations, food and drugs.
There are two methods of removing the body; the first and simpler method is applicable when the body can be palpated, usually in the supra-patellar pouch; it is preferably transfixed by a needle and can then be removed through a small incision; otherwise, the joint must be freely opened and explored, firstly to find the body and further to remove it.
The disease tends to spread spasmodically and irregularly, and the direction and extent of its progress may be recognised by mapping out the peripheral zone of tenderness. Red streaks appear along the lines of the superficial lymph vessels, and the deep lymphatics may sometimes be palpated as firm, tender cords. The neighbouring glands, also, are generally enlarged and tender.
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