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The author reviews what is contained in the literature about the etiology, pathology, diagnosis and treatment of noma, showing the mysteries which still remain unexplained in this disease. His personal contribution is the clinical report of the cases of 3 children, 2, 4 and 5 years of age, whom he followed and treated in Marilia, Sao Paulo, Brazil. After commenting on the different precipitating factors, such as individual tendency, cleanliness and nutrition, the author states the following conclusions:
1. Noma preferably attacks children already undermined by other diseases, such as measles and scarlet fever. 2. It is a highly lethal condition, and when the patient survives a severe scar remains, which requires plastic surgical treatment. 3. It is a disease of the poor people. 4. Contrary to the usual belief that it is a disease of the past, it still occurs at the present time in Rio de Janeiro, Minas
O Misterio do Noma (Três Casos em Marilîa).. Am J Dis Child. 1945;70(2):129. doi:10.1001/archpedi.1945.02020200073012