Vol. 146, No. 13 1193 NATURE OF WATERHOUSE-FRIDERICHSEN SYNDROME

Abstract

The Waterhouse-Friderichsen syndrome has long been notable among infectious diseases for having a fundamentally twofold character: an acute infection together with profound circulatory collapse. It is the conjunction of these two factors that has given the syndrome an intensity and a rapidity of progression unparalleled among bacterial diseases. "No other infection slays so quickly," said Herrick.¹And Martland,²reporting from his experience as a medical examiner, was able to collect 19 cases which had been referred to his office after sudden, unexplained, and sometimes suspicious death in children and young adults. Many of these patients were found dead in their beds; others died on arrival or within a few hours after arrival at the hospital. Not only was death swift; it was also certain. In 1938 Christian,³long a close student of this disease, wrote that all known cases had been fatal, generally in less than 24