George Crumb (b.1929)'s Makrokosmos is recognized as one of the masterpieces of twentieth century piano writing. Inexplicably, volume four of Makrokosmos, Crumb's only four-hand piano piece, is rarely studied by Crumb scholars. According to Crumb's program notes, his Makrokosmos is meant to be a hybrid of piano and orchestral sound. Crumb devised a list of signs and abbreviated letters to explain his specific instructions to the performers. The pianists who plan to perform Makrokosmos need to study Crumb's notations carefully in order to faithfully realize the composer's intentions. This dissertation examines the composer's treatment of four hands at the piano. In addition, a performer's analysis and practical "translation" of these techniques is provided, in the hopes of rendering this amazing piece more accessible to pianists in search of new and wonderful repertoire for piano four hands. It is also hoped that future composers will be inspired by Crumb's innovations and imaginative ideas.