In 48 cases of active sickle cell anemia, attention is directed to the frequent occurrence of cardiac enlargement, the presence of diastolic as well as systolic murmurs of the heart, prolongation of the P-R interval, roentgenographic changes in the osseous system, rapid and marked changes in the size of the liver and spleen, neuro-psychiatric signs and symptoms especially mental deficiency, and abdominal crises. Two unusual manifestations were the demonstration by eso- phagram of auricular enlargement in 2 cases, and the relief of priapism by roentgen therapy.