The kidneys are increased in size, are firm, dark red in color, with fatty streaks in the cortex. The capsule strips readily and the cortex is normal in thickness or only slightly increased. The organ offers some resistance to the knife. The microscope shows small areas scattered throughout where the glomeruli are hyalinized, the stroma full of small round cells, the tubules dilated, and the cells are almost bare of protoplasm. Naturally the tubules are full of granular cast material. Also the arterioles show extensive intimal thickening, fibrous in character, with occasional obliterating endarteritis. One gets the impression that the small sclerotic lesions are the result of anemia and gradual replacement of scattered glomeruli by fibrous tissue. For the most part the kidney, except for the chronic passive congestion, appears quite normal. One can readily understand that in such a kidney function could not have been much interfered with. Illustrative Case.--C. K., an active, stout, business man, aged fifty-six years, consulted me on account of shortness of breath and swelling of the feet in May, 1915. He had just returned from a hospital in another city, where he had gone with what was apparently cardiac decompensation. In his early manhood he had been a gymnast and a prize winner. He has worked hard, often given way to violent paroxysms of temper, has eaten heavily but drunk very moderately. The heart was greatly enlarged, the arch of the aorta dilated, a mitral murmur was audible at the apex. The radials and temporals were large, tortuous, and fibrous. The blood pressure picture ranged around 180-90-90. He was easily made dyspneic and had a tendency to swelling of the lower legs. The urine was acid, of normal specific gravity, normal in amount, normal phthalein, normal concentration of salt and nitrogen, contained albumin only when he was suffering from decompensation of the heart. Casts were always found. He finally died, after sixteen months, with all the symptoms of chronic myocardial insufficiency. The heart was enormous, a true _cor bovinum_. The kidneys were typical of this condition, possibly somewhat larger than usual. =Hypotension= When the pressure is constantly below the normal, it is called hypotension. This may be transient--as in fainting--it may be a normal state of the individual, it occurs in most fevers and in a great variety of diseases, including anemias.