measures. To be able to distinguish between the generalization of a
septic infection in its incipiency, and a more or less benign edema, is
largely possible by digital manipulation alone. An extremity may be
greatly swollen because of the existence of chronic lymphangitis,
influenza, or an acute septic infection occasioned by the introduction
of pathogenic and aerogenic organisms. Since the effect produced by
these dissimilar ailments are productive of conditions that may
terminate favorably or unfavorably, it becomes necessary for the
diagnostician to develop a trained, discriminating, tactile-digital
sense, in order to correctly interpret existing conditions, and handle
cases in a rational and skillful manner.

In order to ascertain the extent and exact location of a tumor, an
exostosis, or other enlargements, the diagnostician, here also, needs to
be in possession of a trained tactile sense and in addition if he be
fortified with an accurate knowledge of normal anatomy and pathology, he
is able to arrive at proper conclusions, when digital manipulations have
been employed. Fibrous tumors are sometimes located in the inferior part
of the medial side of the tarsus--exactly over the seat of bone-spavin.
Such tumors, when the affected member is supporting weight, are not to
be distinguished from exostoses; but as soon as the affected leg ceases
to bear weight, it may be passively flexed and the nature of the
enlargement recognized because it may be slightly displaced by digital
manipulation. Displacement, of course, is not possible with an
exostosis.

A necessary qualification, which the diagnostician must possess, is that
of being able to judge carefully the nearness of any given exostosis to
articular structures. Also, the extent or area of the base of an
exostosis as well as its exact position, needs be determined before one