A few years ago I had under observation at different times two girls aged 10 and 12 years, respectively, in whom I was struck by the marked contrast between the emaciated face with hollow cheeks and the good development of the rest of the body. These children were brought to the clinic for slight ailments and were not affected with any constitutional disease. I realized that I was dealing with a rare condition, but was at a loss to know where to search for a description of it in the literature. A paper recently published by Feer1 on "Lipodystrophia Progressiva" immediately cleared up the diagnosis. Unfortunately no detailed history, photographs or measurements were taken at the time, and the patients are no longer under observation.I had the good fortune recently to discover a typical example of this condition in the person of a mother who brought her children for treatment.. The history is briefly as follows :REPORT OF CASE History.\p=m-\Mrs.K., aged 32, Hebrew, has been married for ten years to her cousin. She had three brothers and two sisters. One sister died in childhood of pneumonia. One brother and the sister are married and have healthy children. No other member of the family has had a similar condition; neither the mother of the patient nor the other female members were unusually fat or thin, nor did any one have an increased amount of adipose tissue in the lower part of the body. There is no family history of syphilis, tuberculosis, alcoholism, diabetes or nervous diseases. The birth was normal, the patient was breast fed, and her physical and mental development during childhood was normal. At the age of 3 she had measles without complications. Since that time, with the exception of occasional headaches, her health has always been good. The change in her face was first noticed at the age of 6. It began insidiously, without any fever, pain or discomfort, and gradually became more marked, so that at 11 the fat of the face had almost entirely disappeared. Later the dystrophy spread to the neck, upper part of the chest and arms, so that these parts became distinctly thinner. When she was 11 years old the family emigrated from Russia to this country. The patient was taken to a well known New York *
What one does not look for one does not see. This is well illustrated in the case of the oral manifestations of measles. The disease is extremely common; numerous careful observers have examined innumerable patients and still the significance of certain manifestations for a long time escaped detection. I can find only three authors who have mentioned the tonsillar spots as an early manifestation of measles. Comby1 reported four cases of measles in one family and described white spots (angine pultac\l=e'\e) as being present on the tonsils of two of these cases two days before the eruption appeared. Grumann2 describes white spots or streaks about 3 mm. long which are present on the tonsils one or two days before the eruption. Miller3 reports the case of a child which, when first examined, besides a rise of temperature, had dyspnea and a reddened throat. The tonsils were swollen and on each tonsil there were a number of small bluish semitransparent elevated bodies averaging considerably less than the size of the head of an ordinary pin. The eruption appeared the following day. No Koplik's spots were observed.It is interesting to note that occasionally when these spots on the tonsils were seen, they were regarded as merely coincidental and their relation to the onset of measles not recognized. To cite one example, in von Pirquet's splendid monograph on measles two of Fried Jung's cases are quoted to illustrate an unusually long period of incubation:
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