The clinical, hematologic, and pathologic findings in 26 cases of leukemic reticuloendotheliosis are presented. A histopathologic correlation of the various forms of leukemia is suggested. Clinically the disease may follow an acute, subacute, or chronic course There is no idiopathic clinical sign or symptom, but the hematologic picture is pathognomonic and is characterized by the presence of reticulum cells in the peripheral blood and bone marrow. These cells are also present in the organs where the reticuloendothelial system predominates: spleen, liver, and lymph nodes. The study of these cases supports the concept that leukemic reticuloendotheliosis is an independent hematologic and pathologic entity.

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1. The early reaction to intravenous tubercular infection in the various organs of the rabbit reveals a pathognomonic response in the lungs within 24 hours; the specific response in the liver, spleen, lymph glands, and bone marrow, follows from the 6th to the 14th days. 2. The development and extent of the pathologic process has been analyzed in terms of the activity of monocytes and clasmatocytes. 3. The criteria for differentiating these mononuclear phagocytic cells into two strains have been analyzed and the technics discussed. 4. The clasmatocyte phagocytizes tubercle bacilli freely and fragments them, as it does all cellular and other debris. 5. The monocyte stimulated to metamorphose into the typical epithelioid and giant cell of the Langhans type retains the tubercle bacilli intact, with power to survive and multiply, over long periods of time. 6. The normal number of monocytes or the degree to which monoblasts may be stimulated to development and maturation, together with the activity of the clasmatocytes in destroying bacilli, in any particular region, would appear to be a function of the rapidity and extent of the local tubercular involvement.

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The development of the supravital technic for the study of living blood cells in vitro 1 has made available, for the first time, a simple, adequate method for the qualitative analysis of the white blood cells. It was the attempted application of this procedure to a study of the problem of the possible relationship of the white blood cells to the unexplained reactions following the transfusion of matched red blood cells that led to the results presented briefly at this time.During some experiments on rabbits, several years ago, in which two groups of individually matched animals were used for repeated transfusions of blood, it was noted that there was a marked difference in the clinical manifestations, following transfusion in certain recipients. A study of the peripheral blood at frequent intervals during the occasional, more severe, clinical reactions following the matched blood transfusions directed our attention to the white blood cells. Not only did the animals almost always show quantitative diminutions in the white count, but in the supravital preparations there was marked evidence of destruction of white blood cells in the greatly increased amount of cellular débris, obviously of such origin, in the blood.This condition was in sharp contrast to the findings in leukopenic states, caused by other experimental proce¬ dures, in which the decrease in the total white count is not accompanied by any evidence of increased cellular disintegration, the transitory nature of the leukopenia in many instances indicating simply a circulatory dis¬ turbance, with an accompanying redistribution phe¬ nomenon.When blood from a rabbit is given to a recipient, in which the serum agglutinates the red blood cells of the donor, a sudden convulsion, followed by immediate death, is the result, often while the blood is still being injected. On the other hand, the reactions that we have observed accompanying the evidences of the destruction of white blood cells come on within from half an hour to two hours of the transfusion, and are typical of foreign protein reactions in general. It was thought that if the recipient's serum should be found to be specifically leukotoxic in character, the dis¬ integrating white blood cells could conceivably form the source of the foreign protein in these reactions. As a simple, practicable and quick means of determining in vitro the probable relative toxicity of specific serums to specific white blood cells, when transfusion is contem¬ plated, the following procedure was devised and has been used for the past year and a half in both theoretical and practical determinations. TECHNIC First, it is essential that the slides and cover glasses for the supravital preparations be free of grease and neutral in reaction (nonacid). Glassware is placed in a saturated solution of potassium bichromate in concen¬ trated sulphuric acid for three or four days, and then washed in running tap water for twelve hours. It is rinsed in three changes of distilled water; the slides stand over night in the last change. It is s...