The pathologic changes in diffuse scleroderma are not confined to skin and subcutaneous tissue alone but involve the connective tissue system throughout the entire body. Muscle, fascia, tendon, bone and at times even the endocrine glands and the internal organs participate in the disease process. Everywhere the same changes occur, namely edema followed by sclerosis of the collagenous bundles. This may occur in the connective tissue between the alveoli of the lung, the acini of the liver, the glomeruli of the kidney and the muscle fibers of the heart and within the pulp of the spleen.1 The smaller arteries within the regions involved show corresponding sclerotic degeneration and thickening of the intima which may proceed to obliteration of the lumen and subsequent focal necrosis.2The case to be presented is of interest because it has been possible to demonstrate visceral pathologic changes, namely pulmonary fibrosis or sclerosis as a clinical manifestation. A search of the literature of scleroderma has brought to light no other case in which the pulmonary manfestations of the disease were visualized by roentgenographic study.report of case History.-D. M., a Southern Negress aged 30, a housewife, entered the Morrisania City Hospital May 4, 1939, complaining of gradual loss of weight and a feeling of discomfort in the chest. During the past six months her weight had dropped from 115 to 102 pounds (52 to 46 Kg.). Since February she had noticed stiffness of her fingers and aching pains in her shoulders and arms. There was occasional cough, with expectoration of Fig. 1.-Appearance of patient, showing sclerodactyly and masklikefacies. a small quantity of thin mucoid sputum, never blood streaked. In March she noted a tightening of the skin of her face and a thickening of the skin over her hands, forearms and legs. Shortly before admission she began to complain of some difficulty in breathing because of a sensation of "tightness in the chest."The past history revealed no illnesses; she had not had pneumonia, pleurisy or frequent colds. For at least five years there had been a painless deformity of the finger tips and nails. The menses were regular, with onset at 12 years, of three days' duration. The menstrual flow had been scanty during the six Fig. 2.-Section of epidermis and corium of patient with scleroderma (low power magnification). months prior to admission. Her two children, 7 and 12 years of age, were living and well ; there had been one miscarriage at two months. Both her parents had died late in life of pneumonia.Examination.-The patient was poorly nourished, tall and thin, and not dyspneic or orthopneic. The faciès was masklike and devoid of wrinkles and furrows ( fig. 1). The skin of the face, arms and forearms, legs and feet was thickened and shiny; it was difficult to raise a fold of skin from these sites.Areas of mottled depigmentation were present over the nose, about the mouth and chin and on the anterior aspect of both legs. The thickening of the skin over the chest and abdomen was less obvious. The han...