MALIGNANT GROWTHS IN THE NASAL SINUSES. 
699 
We are told that, clinically, tumors or new growths are ma¬ 
lignant and non-malignant and differentiated by the following 
characteristics : the former are liable to recur after enucleation, 
to grow in distant parts of the body, and to be noncapsulated, 
although these conditions are subject to variations, and yet the 
growth be malignant. 
Tumors are divided according to the tissues from which they 
grow or resemble, and are therefore classified as follows : 
I. Embryonic tissue—sarcoma. 
II. Epithelial tissue—carcinoma. 
III. Connective tissue—fibroma, etc. 
IV. Higher tissue—myoma, etc. 
V. Congenital—mixed. 
It is the first two varieties to which I wish to call your atten¬ 
tion and to bring out in the discussion which is to follow suffi¬ 
cient remarks which may enable us to make a positive diagno¬ 
sis of malignancy, if not of the exact species, without the use of 
the microscope, which can be utilized later, in order to verify 
our conclusions. 
In those cases where there is simply a collection of pus in 
the sinuses, the discharge from the nostril is more like what is 
termed laudable pus and’possessed of very little odor or none at 
all and never streaked with blood ; rarely if ever is there any dis¬ 
tention of the facial bones, which only reveals dullness on percus¬ 
sion. When there are diseased molars, the above conditions are 
noted, with the addition of a very penetrating odor from the nos¬ 
tril and detection of involved tooth by the examination of the 
crowns of the teeth, which will be found diseased or show an 
increased sensitiveness. 
In those cases of which I am now about to speak and which 
are responsible for this essay, we find the foregoing conditions 
changed from a slight to a marked degree ; the discharge from 
the nostril is not of that thick pus alone, but of a mixture of 
pus, serosity and blood, and an odor far worse than that of a 
diseased tooth, a bulging of the facial bones, which is becoming 
softer than normal, and a very marked dullness on percussion, 
