In the commencement of the process there is but little diminution in the size of the organ, but the capsule is thickened and more adherent than natural, and the surface is rough and granular. The color is pale or reddish. On section, the cortical substance is found relatively diminished, the diminution being most marked towards the surface. The arteries are prominent, their walls thickened and their cavities often dilated. Even to the naked eye, and to the touch, the increased density and fibrousness of structure are evident. On the surface, and in the substance, cysts are frequently seen. Some are produced by dilatation of the Malpighian capsules, some by dilatation of the tubes, and others from morbid growth of epithelial elements. The tubes are compressed and atrophied by the new fibrous tissue. They contain little of the opaque matter found in inflammatory cases, but translucent hyaline matter is common. All these characteristics become more marked as the disease progresses. In the more advanced stages, both the kidneys are much reduced in size, but one may be more atrophied than the other. Throughout the whole course of the disease the cones are but little affected. In gouty cases a deposit of chalk-like substance is occasionally found, composed of needle-like crystals of urate of soda, situated in the stroma of the organ, as well as in the tubules. In distinguishing a cirrhotic kidney from one in the third stage of the inflammatory or of the waxy disease, besides the characteristic iodine test in the one case, the following points of comparison will be useful:—In the cirrhotic, the capsule is more thickened and more adherent than in the other two forms. In the cirrhotic, the surface is very uneven, frequently studded with cysts, and presents little or no sebaceous-looking material; in the inflammatory and the waxy, the surface is less uneven, cysts are much less common, and in both, particularly the inflammatory, sebaceous-looking material is very abundant. In the cirrhotic, the stroma is greatly increased, especially towards the surface; in the inflammatory and waxy, the stroma, although increased relatively to the other tissues, is not absolutely above the normal amount. It must also be borne in mind, that both the waxy and contracting forms may be secondarily affected with the inflammatory disease.