Some degree of pallor is so commonly met with in adolescence that it is the progressive development of the anæmia which the surgeon must especially watch for. As a danger signal, therefore, it has the same significance nearly as the blue line; but when lead absorption has affected the elements in the blood, progressive anæmia in new workers, attributable to the employment, and showing no tendency to improve after watching for a few months, is an indication for suspension or transference to other work. In older workers, with a duration of employment of five years or more, there may be a quasi-pathognomonic pallor which does not vary from year to year. In them it must be supposed that an equilibrium has been established, and development of other symptoms, such as tremor, wrist weakness, or albuminuria, becomes significant. Attention has already been directed to the distinct saturnine facies associated with anæmia, and characterized by loss of fat, particularly noticeable in the orbit and buccinator region of the face. “So far as the question of any worker’s suspension is concerned,” says Dr. King Alcock, “I prefer to make my instinctive _primâ facie_ distrust of a saturnine pallor the basis for action. The pallor of plumbism cannot be summed up in hæmoglobin and corpuscular content; it is the expression of a complex toxæmia resulting from defective assimilation and excretion”[3]. The knowledge the surgeon should gain of the idiosyncrasies of the workers by his periodical examination will enable him to appraise at their proper value the nature and degree of the symptoms in notified cases. Sometimes a rule is made that no lead-worker who has suffered from an attack of plumbism should be allowed to resume work. This we consider too harsh a measure. It may be true for painters, but when remedial measures, such as locally applied exhaust ventilation, can be applied, with consequent removal of the danger in the process at which the poisoning has arisen, prohibition of employment seems an unnecessarily drastic measure. The health register in general use where periodic medical examination is required in pursuance of special rules and regulations is divided into two parts, in each of which entries by the surgeon are required at each visit. PART I.