In 1911 Dr Alice Hamilton, a pioneer in modern occupational medicine, along with colleagues, issued a report to the Governor of Illinois detailing the results of a survey of occupational disease in the state.1 They reported on investigations into brass chills, carbon monoxide poisoning, miner's nystagmus, and boilermaker's deafness. Hamilton described in depth the myriad uses of lead in Illinois industry and, using clinical records along with personal follow-up, documented 578 cases of lead poisoning, including many cases of wristdrop. In her memoir, Hamilton describes the steps she took to identify sources of lead poisoning: she reviewed hospital records to confirm the diagnosis, searched for the patient's home, and interviewed the patient's wife about his place of employment. Bemoaning this labor-intensive method, Hamilton relates that "[h]ospital history sheets noted carefully all the facts about tobacco, alcohol, even coffee consumed by the leaded man, though obviously he was not suffering from those poisons; but curiosity as to how he became poisoned with lead was not in the interne's mental make-up." In the decades since Hamilton's pioneering work, as a result of developments ranging from vastly improved exposure conditions to the use of biomarkers to detect subclinical illness, the clinical spectrum of occupational lead and other metal poisonings in the United States has changed dramatically. With lead, for example, wristdrop has been unheard of for decades, and concern has shifted to more subtle end points such as the effects of lead on population blood pressure and on cognition in children. Newer industrial processes have introduced new exposures, such as beryllium, and their associated diseases. As in so many other areas of medicine, modern laboratory methods have yielded new under-standing of the cellular and molecular mechanisms that underly metalrelated diseases, and the field of epidemiology has provided insight to new exposure-disease associations. Yet, as in Hamilton's day, the essence of occupational disease surveillance remains the recognition of the link between disease and occupation, and the physician often has the opportunity to make this link. Many metals can cause toxicity in multiple organ systems. We have selected some of the major illnesses associated with occupational and environmental metal exposure, topics that are either particularly timely, controversial, or of broad public health interest. The end of this chapter includes expert resources that may be helpful to clinicians in the workup of a patient with suspected metal-related disease. This review may help primary care providers recognize that a number of common diseases, suchas renal failure, asthma, and movement disorders, may result from exposure to metals. It is thus hoped that this article will help to stimulate the practicing physician's "curiosity" about possible occupational or environmental causes of common clinical findings and thereby serve as a reminder of the role of the physician in protecting both the patient's and the public's health.