THE WATERHOUSE-FRIDERICHSEN SYNDROME

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Abstract
The earliest report of the condition now known as the Waterhouse-Friderichsen syndrome appeared in 1894, when Voelcker1 described it as a fulminating purpura in conjunction with bilateral adrenal hemorrhage. The term Waterhouse-Friderichsen syndrome is derived from the names of the two investigators who reported cases of the malady, reviewed the literature and postulated a possible bacterial causation.2 FEATURES OF THE WATERHOUSE-FRIDERICHSEN SYNDROME Etiology.—The meningococcus is recovered from the blood stream in at least 60 per cent of the cases. Other offending organisms include Streptococcus haemolyticus and rarely the pneumococcus. The blood culture is not infrequently apparently sterile. Along these lines it is interesting to note that both the meningococcus and the pneumococcus are ectodermotropic and attack the skin, the central nervous system and the adrenal medulla. As will be seen later, this characteristic helps to elucidate some of the clinical signs of the disease. Clinical Course.—The

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