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The relationship of chronic lung disease, congestive heart failure and polycythemia has been examined in 32 subjects including "normal" and "abnormal" controls. The study revealed differences and similarities between cor pulmonale and other types of heart disease. The observations demonstrated a correlation between arterial oxygen tension, as calculated from oxygen content and oxygen capacity, and pulmonary artery pressure. Lowered renal clearance was present in all instances of congestive failure, irrespective of its etiology or of the resting level of cardiac output. It seemed from this preliminary study that bleeding a polycythemic subject with chronic lung disease uncovers a state of oxygen unsaturation that may reflect the conditions which originally led to the development of secondary polycythemia. The possible significance of "oxygen transport" and of altered blood fluidity on the mechanism of heart failure in chronic lung disease is discussed.