. Physical diagnosis . and cretins are veryapt to keep their mouths open, whether there is enlargement of thetongue or not. Dyspnoea may compel a patient to keep his mouthopen so as to get more air. In cold weather a crack or fissure may appear, usually in thecentre of the lower lip, and in poorly nourished individuals maypersist for weeks. At the corners of the mouth fissures or cracksmay be due to chapping or cold-sores (herpes), but if they persistfor weeks in young children they are very suggestive of linear scars radiating from the corners of the mouth are pre-sumptive evid
. Physical diagnosis . and cretins are veryapt to keep their mouths open, whether there is enlargement of thetongue or not. Dyspnoea may compel a patient to keep his mouthopen so as to get more air. In cold weather a crack or fissure may appear, usually in thecentre of the lower lip, and in poorly nourished individuals maypersist for weeks. At the corners of the mouth fissures or cracksmay be due to chapping or cold-sores (herpes), but if they persistfor weeks in young children they are very suggestive of linear scars radiating from the corners of the mouth are pre-sumptive evidence of healed syphilitic lesions, oftenest congenital. 4. The mucous patches of syphilis—white, sharply boundedareas about the size of the little-finger nail—are often seen at thejunction of the skin with the labial mucous membrane, especially atthe corners of the mouth. 5. Herpes (cold sores) is due to a lesion of the Gasserianganglion, with resulting trophic disturbances of the regions sup- THE HEAD AND FACE. 19. Fig. 11.—Epithelioma of the Lip. plied by the trigeminal nerve. Appearing tirst as a cluster of vesi-cles ( water blisters ) which break and leave a small sore near themouth, herpes is to be distinguished by: (a) its distribution, nearthe terminations of some branch or branches of the trigeminal nerve( herpes frontalis, nasalis,labialis); (l>) by its lastingbut a few days; and (c) bythe absence of similar lesionselsewhere. It may be con-nected with a cold (whichis often a disease of the tri-geminus), but it frequentlyoccurs without any discov-erable cause. Herpetic stomatitis (canker sores) may accom-pany it. 6. Epithelioma of the lip and chancre should be suspected when-ever a long-standing sore is discovered there. Epithelioma occursalmost always on the lower lip in a man past middle life (see ). It lasts longer than chancre, is slower in producing glandular enlargement at the angle of the jaw,and is not associated with other syph-ilitic lesions. 7.
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