Lead is one of the oldest known and most widely studied occupational and environmental toxins. Despite intensive study, there is still vigorous debate about the toxic effects of lead, both from low level exposure in the general population owing to environmental pollution and historic use of lead in paint and plumbing and from exposure in the occupational setting. The majority of industries historically associated with high lead exposure have made dramatic advances in their control of occupational exposure. However, cases of unacceptably high exposure and even of frank lead poisoning are still seen, predominantly in the demolition and tank cleaning industries. Nevertheless, in most industries blood lead levels have declined below levels at which signs or symptoms are seen and the current focus of attention is on the subclinical effects of exposure. The significance of some of these effects for the overt health of the workers is often the subject of debate. Inevitably there is pressure to reduce lead exposure in the general population and in working environments, but any legislation must be based on a genuine scientific evaluation of the available evidence. Physiologically, it exists as an ion in the body. Inorganic lead is undoubtedly one of the oldest occupational toxins and evidence of lead poisoning can be found dating back to Roman times. As industrial lead production started at least 5000 years ago, it is likely that outbreaks of lead poisoning occurred from this time. These episodes of poisoning were not limited to lead workers. The general population could be significantly exposed owing to poorly glazed ceramic ware, the use of lead solder in the food canning industry, high levels of lead in drinking water, the use of lead compounds in paint and cosmetics and by deposition on crops and dust from industrial and motor vehicle sources. It was an important cause of morbidity and mortality during the Industrial Revolution and effective formal control of lead workers did not occur until the pioneering occupational health work of Ronald Lane in 1949. At very high blood lead levels, lead is a powerful abortifacient. At lower levels, it has been associated with miscarriages and low birth weights of infants. Predominantly to protect the developing fetus, legislation for lead workers often includes lower exposure criteria for women of reproductive capacity. Studies have shown a slowing of sensory motor reaction time in male lead workers and some disturbance of cognitive function in workers with blood lead levels >40 ig/100 ml. Peripheral motor neuropathy is seen as a result of chronic high-level lead exposure, but there is conflicting, although on the whole convincing, evidence of a reduction in peripheral nerve conduction velocity at lower blood lead levels. The threshold has been suggested to be as low as 30 ug/100 ml, although other studies have not seen effects below a blood lead level of 70 ug/100 ml. Several large epidemiological studies of lead workers have found inconclusive evidence of an association between lead exposure and the incidence of cancer. However, based on closer analysis the increase did not appear to be related to lead exposure. There was also a small but significant increase in the incidence of lung cancer, but this could have been the result of confounding from cigarette smoking or concurrent arsenic exposure. There is some evidence in humans that there is an association between low level lead exposure and blood pressure, but the results are inconsistent. Lead appears to reduce the resistance and increase the mortality of experimental animals. It apparently impairs antibody production and decreases immunoglobulin plaque forming cells. There is some evidence for suggesting that workers with blood lead levels between 20 and 85 ug/100 ml may have an increased susceptibility to colds, but a study of lead workers with blood lead levels less than 50 ug/100 ml showed no significant immunological changes. Although it is widely accepted that personal hygiene is the most important determinant of an individual's blood lead level, recent interesting information has shown that genetic polymorphism may also have an impact. The use of most of these chemicals is declining with the gradual demise of the use of lead in petrol, but lead naphthenates and stearates are still used in stabilizers for plastics and as lead 'soaps'. In fact, the only compound now produced for petrol usage is tetraethyl lead. Exposure is only seen during the production, transportation and blending of this substance into petrol and in workers involved in cleaning storage tanks that have contained leaded petrol. It is in this final group, the tank cleaners, where the highest potential morbidity and mortality may be seen. (PMID: 15020724).