or one week last harvest time, Dr. Mike Miller lived with a family on their large farm in Dooley County, Georgia, just south of Macon. Like his hosts, Dr. Miller rose at 5:30 AM, toiling in the peanut fields throughout the day and on until midnight. He helped with all the harvest chores, helping hook the peanut wagon - a large, four-wheeled empty trailer - to the tractor, hauling the crop from the field to driers that removed moisture from the nuts, and then loading the haul for market. "It was a tough week," Dr. Miller says. As a second-year resident in occupational and environmental medicine, Dr. Miller came to Dooley County to study the occupational dangers of one of the most dangerous professions in the country. A two-month agromedicine rotation took him not only to Doo ley County but across the state, where he presented lectures in rural areas on the hazards of agricultural life and collected research on the occupational risks of cotton farming. Dr. Miller is not a novice to the field. He grew up on a farm in central West Virginia, helping out at a young age: feeding livestock, operating tractors, and harvesting hay. "Our farm was small," says Dr. Miller, "only 100 acres, but we were self-suff icient. We grew our own vegetables, raised our own livestock, had our own dairy cattle and water supply." However, at age 17, Miller started down a career path that led away from agriculture and toward medicine. Like his father, he enlisted in the US Army, becoming a commissioned officer and eventually receiving the rank of major. During his Army career, h e completed a degree in optometry at Illinois College, a medical degree at the University of Health Sciences in Kansas City, and flight surgeon school. As a flight surgeon, he participated in hardship tours in Asia, Central America, and the Middle East, w here he served in the Persian Gulf during the Iran-Iraq conflict. In 1993, he left the Walter Reed Army Medical Center to study as a resident in occupational and environmental medicine in the Schools of Medicine and Public Health at Emory. According to Dr. Miller, his decision to pursue a residency in occupational medicine was a natural extension of his previous experiences. "Being a flight surgeon is in fact one type of occupational medicine," he says. "My duties included analyzing work hazards and environmental conditions and working with the flight crews to conserve hearing and vision. Those responsibilities fall within the realm of occupational medicine." At the conclusion of the clinical year of his residency, Dr. Miller will have gained practical experience in industry at Lockheed Aeronautical Systems Company, in car manufacturing and metal plating in South Korea, in civil aviation medicine at the Fed eral Aviation Agency in Oklahoma City, in administration at the Agency for Toxic Substances and Disease Registry and the National Institute for Occupational Safety and Health, and in agriculture through the Georgia Farm Bureau. Dr. Miller's rotation in agromedicine, funded by the W.K. Kellogg Foundation, allowed him to explore agriculture through a combination of service, education, and research activities. Being back on the farm after a 30-year absence, he found the work eth ic unchanged. "The farmer still works hard, has long days and a multitude of responsibilities," Dr. Miller says. "What has changed is agricultural technology. With that technology, you can do a lot."

Returning to his childhood farm roots, occupational and environmental medicine resident Mike Miller helps farmers recognize and avoid the occupational hazards of their profession, including pesticide exposure, mechanical risks, and the no nagricultural risks of smoking, diet, and stress. The operator of a cotton harvester may spend up to 12 hours a day picking the crop, going up and down monotonous rows. The labor-unintensive job can lead to boredom, and consequently, injury.

n 1994 Georgia farmers devoted more land to cotton than ever before, planting some 1 million acres. Despite cotton's importance as a money-making crop in Georgia, little research has been published on the oc cupational hazards associated with cotton farming. Dr. Miller will address those dangers in a monograph to be published in the series, Emory Agromedicine Reports. "The monograph will be what I call a 'fiber to fabric' work with narrative, tables, and photographs," Dr. Miller says. In the report, he will describe and outline the three stages of cotton production: farming, ginning, and milling, discussing the part icular risks of each process. In identifying those risks, Dr. Miller has plied the records of the University of Georgia Cooperative Extension Service, the National Cotton Council, and the Graniteville Company, which owns and operates cotton mills in Georgia. He has spent hours obse rving cotton gin processors, recording risks firsthand. He has interviewed a half-dozen farmers in the field to gather their perspectives about their occupations. He even spent one full day riding in a cotton harvester in order to understand more fully th e environment in which the farmer works. One of the hazards that cotton farmers fight is boredom, according to Dr. Miller. "These days, machines do most of the work," he says, "transforming farming from a traditional labor-intensive occupation to a labor-unintensive job." The operator of the cotton harvester, for instance, is commonly in the seat for 12 hours a day, going up and down monotonous rows until the crop is picked. In addition to boredom and fatigue, farmers are exposed to potentially dangerous chemicals contained in pesticides and to organic dust, which may lead to lung disease. They are subject to the weather, often working in adverse climactic conditions. And they face mechanical risks when they repair heavy and potentially dangerous farm equipment. Dr. Miller identified nonagricultural hazards as well: smoking, diet, and stress. "By virtue of the job," he says, "farmers have their own unique form of stress." To raise awareness for agricultural injury prevention, Dr Miller shared his knowledge of preventable farm injuries with groups throughout the state. At the Georgia Agrobusiness Council at the University of Georgia, he lectured on the risks associated w ith agriculture. At the Headstart Childcare Center in Tattnall County, Georgia, temporary home to many migrant children, he spoke to migrant farmers and their wives about the risks of pesticides. He also took his awareness campaign to county extension age nts as well as to high school classes in rural areas. "My goal is to raise awareness of all those who work on a farm," says Dr. Miller, "to prevent injuries, whether they are due to mechanical, physical, or environmental hazards." As a service project, Dr. Miller held a health screening clinic for farmers and their families in Candler County, located near Savannah. He took blood pressure readings, screened eyes for signs of glaucoma, and immunized the workers for tetanus. Throughout his educational and service efforts, he has provided farmers with specific recommendations to prevent injuries. Those recommendations often call for a change of behavior that many farmers will resist. For example, to avoid chemical contamina tion from pesticides, farmers should wear some type of protective clothing, even if they only don boots and eye protection. However, according to Dr. Miller, few embrace that idea. "As I told a farmer's wife recently," he says, "I can give a lot of advice but whether the farmer takes it or not is another matter." Although his recommendations may go unheeded, Dr. Miller has great respect for farmers. His father, in addition to being an Army officer, worked as a farmer and a county extension agent, being intimately bound to the land and people of West Virginia. D r. Miller sees farmers such as his father as "the last vestige of independent workers in this country. A farmer has to be his own electrician, carpenter, and mechanic, a jack-of-all trades. He may be America's most forgotten worker." Through the efforts o f Dr. Miller and others, however, the health of the farmer will not be forgotten.

In researching his "fiber to fabric" monograph on the hazards of cotton production, Dr. Miller studied all phases of the operation by visiting farms as well as observing gin processors and mill workers. Dr. Miller has great respect for the American farmer, whom he believes may be the country's most forgotten worker.