the lip
becomes swollen and indurated (Figs. 242, 243). The edges are
characteristically raised and hard, and the raw surface is extremely
painful, especially when irritated by hot food or fluids. The growth
is liable to spread to the mucous membrane and gum, and to invade the
mandible. The disease spreads early to the submental and submaxillary
glands, which are best felt with one finger inside the mouth, under
the tongue, and another outside, behind the mandible. The infected
glands tend to become fixed to the bone, and while at first extremely
hard, so much so that they simulate a bony tumour of the jaw, they
later soften, liquefy, and fungate (Fig. 244). Metastasis to internal
organs is rare. Unless removed by operation, the disease usually
proves fatal in from three to three and a half years.

[Illustration: FIG. 242.--Squamous Epithelioma of Lower Lip in a man
aet. 55.

(Mr. D. M. Greig's case.)]

[Illustration: FIG. 243.--Advanced Epithelioma of Lower Lip.]

[Illustration: FIG. 244.--Recurrent Epithelioma in Glands of Neck
adherent to mandible.]

The _treatment_ consists in early and free removal of the affected
portion of lip and of all the lymphatic connections in the
submaxillary region and neck. Recurrence in the scar is rare; it is
nearly always located in the glands.

The operation of cleaning out the glands below the mandible on both
sides in men who are advanced in years is not free from risk to life,
especially from respiratory complications which may or may not be
traceable to the anaesthetic.

In inoperable cases benefit may follow the use of the X-rays, or of
radium.

_Epithelioma of the upper lip_ is less common. It occurs with equal
frequency in the two sexes, progresses more slowly, and is, on the
whole, less malignant. It sometimes appears to be due to contact
infection from the lower lip. It is treated on the same lines as
cancer of the lower lip.

CHAPTER XX

THE MOUTH, FAUCES, AND PHARYNX

Stomatitis--Roof of mouth: _Abscess_; _Gumma_; _Tuberculous disease_;
_Tumours_--Elongation of uvula--Epithelioma of floor of
mouth--Tonsillitis: _Varieties_--Hypertrophy of
tonsils--Calculus--Syphilis and
Tuberculosis--Tumours--Retro-pharyngeal abscess.

THE MOUTH

#Stomatitis.#--The term stomatitis is applied to any inflammation of
the buccal mucous membrane. The _catarrhal_ form is often associated
with the presence of carious teeth or an infected wound; the m