Sir.—Thank you very much for the opportunity to respond to Professor Seringe's comments. I do not question his right to disagree with us, but I do question the validity of the information on which he has drawn to refute our conclusions.
We stated and referenced in our report that it had previously been observed but not documented that there appears to be a distinct correlation between the presence, type, and location of skin lesions and the prognosis in patients with meningococcal infection. "Patients with no skin lesions, or those with erythematous macules or petechial lesions in a generalized distribution over the trunk and extremities are said to have a better prognosis than those who present with numerous, extensive, purpuric, and ecchymotic lesions on the extremities." This has also been my general experience, but until we undertook our study to test this hypothesis, there was no previous documentation that it