on which the stellate veins are discernible. On section the tissue is very pale and has a rubbery consistency. The cortex is well defined from the medulla; the glomeruli cannot be seen. The mucosa of the pelvis is pale, and scattered over it are a few ecchymotic areas. The vessels and ureters are not remarkable.

The left kidney weighs 300 gms; it measures 15.5 by 9.3 by 4.5 cm. It is much larger than usual, and the capsule, which is thickened, is very tightly stretched. On section the organ seems to be composed of a homogenous greenish-yellow substance, and the architecture cannot be made out. In the pelvis there is a calculus 2 cm in diameter which on microscopic and chemical examination proved to be nearly pure uric acid. The vessels are greatly compressed on account of the position of the organ.

The adrenals weigh 15 gms; not remarkable.

Pancreas, esophagus, stomach and intestines, bladder, prostate and testes, show nothing unusual.

Pampiniform Plexus: On the left side many of the veins are occluded by brownish, laminated thrombi.

Femoral Veins: In the right, beginning at the bifurcation of the common iliac vein and extending to the middle of the thigh, there is found a firm, grayish-brown thrombus entirely occluding the lumen. Several of the smaller branches also contain similar thrombi. The same condition is found in the left side, but it begins in the femoral and extends down into the long saphenous as far as this can be traced. (By palpation a cord-like structure can be found as far as the internal malleolus).

The brain weighs 1230 gms. The only macroscopic changes noted are the extreme pallor and a few thrombi in the smaller vessels of the piaarachnoid. The spinal cord is not remarkable.

The penis has a slightly doughy consistency, especially noticeable in the corpora cavernosa. On section these are found to contain a yellowish, seemingly homogeneous material, from which no blood can be expressed and which completely occludes the lumina of the sinuses throughout their extent. In the corpus spongiosum, however, the sinuses are distinct and upon pressure a considerable amount of blood exudes and the remainder of the organ appears normal.

Microscopic Examination

The histological findings in the various organs are those of a leukemic infiltration, an occasional infarcted area, as in the spleen, lung and kidney, and quite commonly thrombosed vessels. The latter condition is probably the most striking feature. Throughout the sections of the different organs, affecting alike both large and small vessels, there are found dense thrombi containing little fibrin and few erythrocytes. They are composed almost entirely of agglutinated and degenerated myelocytes. In the majority of the smaller thrombosed vessels the myelocytes are fairly well preserved, and an occasional mitotic figure in these cells can be found. There are no evidences of an endophlebitis. The endothelium is intact, the walls of the vessels show moderate myelocytic infiltration, and the vasa vasorum are well preserved and contain many myelocytes.

In the femoral veins the thrombi show a considerable degree of degeneration. The centers of the thrombi are composed of a faintly basic staining, heterogeneous material in which nuclear fragments, pyknotic nuclei, and free chromatin dust are abundant.

Towards the edge of the thrombi better preserved cells are found, held in a fibrinous network. Throughout this there are also found fibroblasts and newly formed capillaries. The fusion of

the thrombi and the vessel walls is so complete that no dividing line can be distinguished. The signs of an active inflammatory condition are not present.

Quite frequently there occur in the nonthrombosed vessels small agglutinated masses of myelocytes which otherwise appear quite normal.

Fig. 3. Corpus cavernosum; showing disappearance

of original tissue, new formed vessels and a ground
substance with lymphocytes and fibroblasts.

The bone marrow of the femur shows the typical changes found in myeloid leukemia. It is composed for the most part of myelocytes, among which are found small areas in which erythrocytes and an occasional normoblast are seen.

Fig. 4. Corpus cavernosum. At A one of the
original trabeculae.

Sections of the brain and spinal cord stained by the PalWeigert method and by hematoxylin and eosin show nothing abnormal.

Penis: The sinuses of the corpus spongiosum (Fig. 1) are in most instances collapsed; a few are moderately dilated and contain a small number of erythrocytes, mononuclear and polynuclear leukocytes, and many myelocytes. The endothelium

lining them is everywhere intact. The trabeculae show nothing remarkable. The helicine arteries are conspicuous on account of their myelocytic content. The cavernous tissue of the glans show nothing unusual. The corpora cavernosa, on the other hand, present quite remarkable changes.

The sinuses are filled with a light brown material (most probably broken down erythrocytes and myelocytes), in which there are scattered quite well preserved lymphocytes. Running irregularly throughout this material there are numerous strands of young connective tissue and capillaries (Figs. 2 and 3). The trabeculae are atrophied and have a hyalin appearance (Fig. 4). Their endothelial lining has disappeared in most situations. The

cavernous artery is filled by an acid staining granular material in which fragmented nuclei are occasionally found. The arterial walls are hyalin and scarcely to be distinguished from the surrounding material. The deep fascia surrounding the corpora cavernosa is well preserved (Fig. 5).

Sections stained by Weigert's fibrin stain show only an occasional strand of fibrin. Treated by Perl's test the above mentioned yellowish material takes on a bluish color and is therefore

an ironbearing pigment (hemosiderin). Here and there are slightly larger granules of a yellowish brown color and not changed by the treatment with potassium ferrocyanide and hydrochloric acid (hemifuscin). The dorsal artery contains a mass of closely packed myelocytes and a few erythrocytes (Fig. 6). The dorsal veins contain a very little blood.

The interpretation of these changes is quite simple. The thrombus, which originally filled the sinuses of the corpora cavernosa, has been replaced by a very delicate connective tissue

Fig. 6. Dorsal artery of the penis, occluded by a
myelocytic thrombus.

fairly rich in capillaries, throughout which there are found the remains of broken down erythrocytes and a few infiltrating lymphocytes. The degenerative changes with subsequent organization again permitted a sufficient circulation to maintain the further nutrition of the tissues. This secondary change led to the disappearance of the priapism and to the transformation of the corpora cavernosa into somewhat enlarged structures of abnormal consistency.