The George E. Brown Memorial Lecture

I N ACCEPTING the honor, and the responsibility, of the George E. Brown Iect-ure- ship for 1959 I do so, niot for myself, but for a fine group of stimulating colleagues.It is their work and their thinking that will con- stitute the substanee of this lecture.This :presentation will, therefore, have a personal and restricted focus, a desirable feature in that one area and one viewpoint is examined in depth, an undesirable feature in that many pertinent investigations by others are not given the attention that they certainly nerit.Man, almost alone, develops spontaneouslv the syndrome of congestive heart failure.Ac- cordingly, the observationis to be presented have all beeni derived from mlan.They will examine the interrelationships between the two major maniifestationis of the eirculationi in congestive heart failure, namely, circula- tory congestion and reduced cardiac output.Three prinicipal areas will be considered: (1) the nature of circulatory congestion and its significance as an index of heart failure, (2) the effect of the circulatory congestion itself on the function of the heart and on the func- tion of one peripheral organ, the kidney, and (3) the relation of lowered cardiac output to circulatory congestion anid to activity and survival.