In safeguarding the health of the workers, he should make effort to gain their confidence, in order to be able to attach proper value to statement as to subjective symptoms. Suspicion in their minds that the examination is made solely in the interests of the employer militates against success, and increases inclination to conceal symptoms and to give untruthful answers as to the state of health since the last examination. In our opinion, the surgeon will best carry out the first object by attention to the second. The study of thousands of reports on cases of lead poisoning convinces us that 90 per cent. at least are due to inhalation of dust and fumes. The surgeon, therefore, should utilize the earliest sign of lead absorption to warn the occupier and inspector of conditions favourable to the development of plumbism, and due probably either to some unguarded spot in the manufacturing process whereby dust or fumes are not being removed completely, or to ignorance or carelessness (often excusable in the absence of proper instruction) on the part of the worker. He should direct, therefore, especial attention to new workers, not only because of their need for guidance as to precautions to be observed and greater liability to attack during the first year of employment, but also because development of signs in them constitutes the surest guide to defects in the process of manufacture. Occasionally symptoms in a worker may be so menacing as to demand immediate suspension, but generally before the power is exercised attempt to rectify the condition which gives rise to them should be made. The surgeon can do much by influencing the foremen and forewomen, who will necessarily come before him for examination, in insisting on the supervision by them of care and cleanliness by the workpeople under their charge. Should suspension, despite attention in the manner suggested, be necessary, he will recognize that transference to a non-lead process, if feasible, is preferable to entire cessation from work in very many cases. The surgeon, therefore, should know what departments are possible alternatives to lead work. The fact that an examination is made on factory premises, is directed to detection and prevention, treatment taking a subordinate place, and is often made on persons who, unlike hospital patients, seek to conceal their symptoms, causes it to be an examination _sui generis_. Hence the surgeon must trust his sight more than his hearing. A surgeon with experience of such work has said: “The worker in lead must be surveyed as an individual, and idiosyncrasies must be carefully studied and allowed for; the ‘personal equation’ is of vital importance”[1].