700 
C. E. CLAYTON. 
and inspection of the buccal cavity is negative in the earlier 
stages, although in advanced cases we find the palate bone and 
hard palate involved and the growth extending down into the 
mouth. On trephining, which is the proper mode of procedure, 
as it enables us to make a more thorough examination, we find 
that by exploring the cavity, and the finger is the best for this 
purpose, that there is a collection of cheesy pus, together with 
a fluid of a yellowish-green color and the odor almost unbeara¬ 
ble ; we also note that the smooth walls of the normal sinuses 
are replaced by those much thicker and even of a roughened na¬ 
ture ; also the small partitions of bone dividing the sinuses are 
more pliable and thicker than normal. 
If the growth has assumed some size, it is sometimes firm 
and at others very soft, and the latter when irritated gives rise to 
extensive haemorrhage. As the trephining has removed a con¬ 
siderable pressure from the part, the increased growth from day 
to day can be easily detected. 
I have always supposed that these new growths were osteo- 
sarcomatous, for such I have heard them called until lately, 
but now believe they are either sarcomatous or carcinomatous. 
While some claim that sarcoma and carcinoma are the same, 
there must be some difference if we note the manner in which 
they invade other parts of the body, as the lymphatics are in¬ 
volved early in the latter and very rarely in the former. 
To us in making a diagnosis, as far as malignancy goes, it 
matters little which of the two it may be in relation to the ter¬ 
mination, for they both end alike, which is death either from 
exhaustion, haemorrhage, septic infection or obliteration of the 
air passages. 
It is possible to distinguish one from the other by the fol¬ 
lowing conditions—at least I do in so far as I am able. 
Sarcomata, either simple (which is rare) or of the mixed va¬ 
rieties, are firmer or more dense when of the osteoid variety, and 
this is the form usually found in this location ; they have less 
fluid, they do not bleed so easily, not so offensive an odor, 
slower in growth, and more of a nodulated mass of a pinkish- 
