Hereditary deviations seldom appear singly. Owing to the variety of their combinations, each observer, influenced by his special interest in some particular phase of medicine as well as by chance, encounters certain sets of symptoms more frequently than others. After seeing several instances of a particular combination of symptoms, he may arrive at the conclusion that he has discovered a definite disease entity, which he describes as such. Thus the literature contains contributions which, valuable though they may be, often result in special emphasis on one combination of symptoms to the neglect of others. This leads to speculations on the etiology of the syndrome which cannot be substantiated when other cases with different combinations of symptoms are taken into consideration. No doubt certain syndromes do occur more frequently than others, but there are always so many transitional forms that the exceptions abrogate the rule and an exact demarcation of the
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Josef Warkany (1937) studied this question.