Book Review

Agricultural Medicine: A Practical Guide

N Engl J Med 2006; 355:964-965August 31, 2006

Article

Agricultural Medicine: A Practical Guide
Edited by James E. Lessenger. 541 pp., illustrated. New York, Springer-Verlag, 2006. $59.95. ISBN: 0-387-25425-0

In the early 18th century, Bernardino Ramazzini, an Italian physician now recognized as the father of occupational medicine, wrote that farmers “have to wrestle with unending toil and the direst poverty on another man's estate” and that the causes of their maladies “are in the main two, the weather and unwholesome food.” (Ramazzini B. Diseases of Workers. Revised, with translation by W.C. Wright from De Morbis Artificum, Diatriba, 1713. Chicago: The University of Chicago Press, 1983, p. 337.) People in industrialized nations with little knowledge of agriculture often fail to recognize the risks to the people who make possible the abundant supply of food. Over the past two decades, however, there has been an increasing awareness of the perils of agricultural life for those who live and work on farms in the United States. These perils include not only physical injury but also illnesses resulting from exposure to chemicals and farm animals and effects on mental health.

Despite dramatic improvements in production methods that have made for a more bountiful food supply, agriculture remains among the most hazardous of occupations. The annual rate of fatal occupational injuries among agricultural workers has declined only modestly in the past 10 years as compared with the rate of such injuries in other workers, and it remains five times as high as rates among other workers. Especially compelling is the persistent elevated mortality rate among young adults and children on farms.

Agricultural Medicine, a multiauthored book edited by James E. Lessenger, is a study in “agromedicine” — a term coined in the 1980s that generally refers to the integration of public health and medicine in agriculture. Agromedicine emphasizes preventive health and medical care for the benefit of agricultural workers and their families.

The book covers topics commonplace and unique to agricultural settings, offering pragmatic recommendations for diagnosis and management. But as much as it addresses medical aspects of caring for workers' physical and mental health, it also explores environmental hazards and measures that can be taken to prevent injuries to farmers and their families, veterinarians, and to a lesser degree, hired farm workers.

The contributors to Agricultural Medicine represent a diverse and multidisciplinary selection of authors who are well recognized in their fields and who address a wide range of topics, including behavioral and preventive aspects of disorders such as noise-induced hearing loss, ultraviolet-light–induced skin cancers, pulmonary disorders, heat-related illnesses and injuries, zoonotic infections (from animal diseases), exposure to pesticides, and a variety of injuries, including those related to farm equipment. The chapter by Lessenger on chemical exposure serves as a guide to thorough evaluation and intervention using case studies, an important tool in adult learning.

Forestry and fishing as areas of agriculture are not covered in any detail, but Lessenger's intended subject is farming. He and his coauthors recognize the modern context in which agricultural workers and their families live, whether the topic of discussion is health care access and insurance or farming as an industry.

In sum, Lessenger and colleagues have assembled a wealth of information that will be useful to a wide audience in understanding the health of a dynamic population of workers and their families. Agricultural Medicine belongs on the desks (and not just in the libraries) of occupational specialists, primary care physicians practicing in rural communities, and anyone else interested in the health and well-being of agricultural workers and their families.

Jeffrey L. Levin, M.D., M.S.P.H.
University of Texas Health Center, Tyler, TX 75708
jeffrey.levin@uthct.edu