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DIET AND CORONARY DISEASE

which appears in this series to be associated with exacerbation of the signs and symptoms of the disease. Perhaps we may put the position a trifle more cautiously. The connexion between many. forms of skin disease and disturbances of the psyche is generally admitted. Indeed recent literature has appeared in which there is admitted bias in favour of this point of view. It would be strange indeed if a disease like scleroderma, which involves the terminal vascular structures of the skin, remained unaffected by the ups and downs of life, whether small or great. Further, it must be remembered that physical change in the appearance of the integument can and does often, perhaps indeed usually, cause keen distress to sensitive persons, and this inverse factor should not be forgotten. It would be fair to admit that a psychological appraisal of patients who are in the early stages of a disease like scleroderma would be desirable. The knowledge thus obtained might be to devise some control over the functional changes in the skin capillaries while these are reversible. So far as medical literature is concerned, we must remember that evidence must be presented judicially, and small series of cases must be regarded as suggestive only. In the present instance the presence of a dermatologist in the team would have added considerably to the objective accuracy of the descriptions.