To the Editor.—Our electron microscope study of meningococcemia in man gives the definitive proof that meningococcemia is associated with disseminated intravascular coagulation. The evidence is the presence of fibrin with its characteristic periodicity in the capillary beds of the adrenal, kidney, lungs, and skin.
The second purpose of the paper is to point out that some of the skin lesions are identical to the local Shwartzman reaction in the experimental animal. The evidence for this comes from the gross and microscopic appearance of these lesions. It should be noted that there are a variety of skin lesions in patients with meningococcemia. In all likelihood some of the petechial and echymotic lesions are manifestations of thrombocytopenia caused by the episode of intravascular clotting. These cannot be considered a local Shwartzman reaction. We have reference only to those lesions of the skin that exhibit hemorrhagic necrosis, thrombosis of the skin venules