To the Editor.—The paper by Margaretten, Esavossy, and McKay, "An Electron Microscope Study of Meningococcemia in Man", (Amer J Dis Children114:268, 1967) is thought-provoking and should stimulate the clinician to regard the precise necessities of therapy in meningococcemia, a disease which varies so tremendously in expression. It is almost impossible to accept a single explanation for its capricious manifestations and to assume that all symptoms represent a single eponymic syndrome.
For many years fulminant meningococemia, with high mortality, was called Waterhouse-Fridericksen Syndrome. The use of this term has come to imply that adrenal hemorrhage and hypoadrenalism were responsible for shock and death. The lack of consistent autopsy evidence (adrenal hemorrhage is often lacking) and the suspicions of many clinicians were followed by definite evidence that plasma cortisol levels were only rarely decreased and that treatment with hydrocortisone, especially when given to the patient in whom only the