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 p ro d u ce.
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 e p r o d uce.
Features in the New Editiono not r
e o n l y,d
e r s o n al us 0 - 0 9-03
P 0 2
2 that maintains the readability and real-life examples that have made previous
This edition features a more streamlined format
editions so popular. Each chapter now ends with a glossary of terms, an easy-reference summary in outline form, and updated
discussion questions. Here is an overview of new coverage:

• Chapter 1 (Introduction) includes updated examples and research along with new coverage of the World Health
Organization’s perspective on health in the context of everyday life.
e p r o d uce.
hasobeen
d tr
nosignificantly
• Chapter 2 (The Landscape for Health Communication)
e o n l y, updated with insights and tips about
navigating the health care maze.n
so The us also includes-0new9-information
alchapter 03 about health disparities and health care
reform, including anP e r 0
20as2managed care, multi-payer systems, Medicare for All, and the
explanation of concepts such
Affordable Care Act.

• Chapter 3 (Patient–Caregiver Communication) includes updated information about the impact of patient–provider
communication on health, diagnoses, satisfaction, and pain. New sections offer strategies for discussing sensitive

uce.
subjects and engaging in shared decision making.
e p ro d
l y , d not r
• Chapter 4 (Patient Perspectives) has been reorganized to focus more on patient satisfaction and identity work. New
o
a l u s e on
segments provide patients tips for talking to care providers and responding to face-threatening health concerns.
03
n
Perso features new information
0 2 0 -0 9-interprofessional
• Chapter 5 (Care Provider Perspectives)
2 about
also includes updated information about diverse career opportunities in patient care.
education and teamwork. It

• Chapter 6 (Diversity in Health Care) includes new and expanded coverage of gender identity and sexual orientation,
ethnicity and race, and the link between health and socioeconomic status. Additional skill builder tips and examples
have been added to provide diverse perspectives.

e p ro d uce.
not r
• Chapter 7 (Cultural Conceptions of Health and Illness) presents new coverage of a culture-centered approach to

on l y, d o
health communication as well as the effects of social stigma and cultural adaptability.
a l u s e 03of Life) features expanded coverage of the dialectical push
•
P e
Chapter 8 (Social o n
rsSupport, 2 0
Family Caregiving,
0 - 0 9-End
and
and pull people feel when managing 2
health concerns as well as new research about adapting to a “new normal” after a
serious health event.
• Chapter 9 (eHealth, mHealth, and Telehealth) has been updated to reflect current issues and cutting-edge research in
eHealth. Special attention has been given to emerging mobile technologies, wearable devices, and health apps.

e p r o uce.
Providers’ experiences and perspectives relevant to eHealth and telehealth are included.
d
• Chapter 10 (Health Care Administration, Human Resources,
l y, d o not r and PR) presents new and updated
Marketing,
in s
examples of communication specialists u e n and the work they do. Coverage of staffing shortages is updated
ocare
a l health
-03resources, and public relations.
Persskillon
along with communication 2 0 -0
builders related to0leadership,
2
9human
• Chapter 11 (Health Images in the Media) presents new research on the ways media can inform our reading of certain
health issues and behaviors, such as binge drinking, vaping, and sexual assault. Social media’s effect on health is
addressed, and an expanded discussion of direct-to-consumer pharmaceutical advertisements explores media’s impact
on provider–patient relationships.

p r o d u ce.
• Chapter 12 (Public Health and Crisis Communication) has been revised with a renewed focus on crisis and risk

not re
 n o t r e pro
s e o ly, 0d9o-03
communication models from the CDC and the World Health Organization. Social media’s role in crisis communication
n
nal u 2020-
is explored and recommendations are offered. Case studies have been updated to reflect current research on HIV/AIDS,
Zika, and the opioid epidemic.Perso

• Chapter 13 (Planning Health Promotion Campaigns) has been updated to reflect new research and trends in health
promotion campaigns. Special attention has been given to campaigns addressing vaping and methamphetamine abuse,
as well as those using social media. An expanded discussion on message tailoring explores multiple ways messages can
be designed for diverse audiences.

• Chapter 14 (Designing and Implementing Health Campaigns) presents research on health promotion campaigns that
extend the utility of the health belief model and transtheoretical model. Updated examples highlight the latest research
on source credibility, narrative messages, gain- and loss-frames, and affect appeals.
Overview of the Book
e p ro d uce.
l y, d o not r
n a l u s e on -03
PART I: P e r so
Establishing 0 2 0
a2Context- 0 9 for Health Communication
The first two chapters provide an introduction to health communication. Chapter 1 establishes the nature and definition of
health communication, current issues, and important reasons to study health communication. Chapter 1 also provides tips for
making the most of features such as Ethical Considerations, Theoretical Foundations, and Career Opportunities boxes that
appear throughout the book.

p ro d u ce.
ot re
Chapter 2 explores how health communication is evolving within the context of social and public issues. Understanding these
, d o n
l u s only
issues allows for deeper appreciation of topics described in the rest of the book. The chapter culminates with a look at health
e
Person
a 9 -03
care reform measures, helping students better understand how policy debates and topics in the news affect them personally.
2 0 - 0
20
PART II: The Roles of Patients and Professional Caregivers

Part II focuses on interpersonal communication between patients and health care providers. Chapter 3 describes patient–
provider communication in terms of who talks, who listens, and how medical decisions are made. It features a broader array of

p ro d ce.
providers than in the past, thanks to emerging research about nurses, pharmacists, paramedics, physical therapists, technicians,
u
, d o ot re
and others. The chapter features a discussion of narrative medicine and real-life examples of patient–provider communication.
n
s e nl y
oconsidering
o n a l u
Chapter 4 examines health communication through patients’ eyes,
s express themselves - 0 9 -03 This edition looks closely at how
what motivates patients, what they typically like
and do not like about health care, and erpeople
Phow 2 0 2 0
in health encounters.
communication is influenced by the nature of illness, patient disposition, and threats to personal identity. It includes
information about communication skills training for patients and updated information about patient narratives and self-
advocacy.

In Chapter 5, readers view health from the perspective of professional care providers. This edition explores the philosophy
behind caregiver training programs and how that has changed through the years. As in Chapter 3, coverage includes a broader

p ro d uce.
array of professionals than in the past. This chapter features coverage of mindfulness and other strategies to help care providers
e
l y, d o not r
remain emotionally resilient. It also presents tips for communicating with difficult patients, communicating when time is

a l u s e on 03
limited, and disclosing medical mistakes. It concludes with a unit on multidisciplinary teamwork. Information is provided on
n -
P e r so 2 0 - 0 9
20
more than 30 careers in medicine, dentistry, nursing, and allied health.

PART III: Sociocultural Issues

Chapter 6 focuses on diversity among patients and health professionals. It begins with a feature on intersectionality theory and
includes expanded coverage of nuanced gender identities. The chapter presents information and strategies for communicating
p ro d u ce.
ot re
effectively with people who differ in terms of social status, gender, race, language, ability, and age. The section on health
, d o n
only
literacy is substantially updated. Case studies describe the experiences of a Spanish-speaking woman in an English-speaking
a l u s e
Person
hospital and a college student coping with a physical disability.

9 03
 Pe -03
- 0 9
Chapter 7 describes social and cultural conceptions of health and healing. It presents a model of cultural competence and
2 0
20
exposes readers to ideas about health around the world, including conceptualizations of health as a balance between the
physical and spiritual, between elements of “hot” and “cold,” between different types of life energy, and more. Coverage of
holistic medicine appears in this chapter, as do diverse expectations about the roles of patients and caregivers. The chapter
includes a feature about the theory of health as expanded consciousness and many examples illustrating diverse perspectives.

r o d u c e.
PART IV: Coping and Health Resources
, d o n ot rep
l u s e only
Pewe rsmay a to maintain and regain
onuse 2 0 -0 9 -03and when that is not possible, to cope at
Part IV focuses on the array of resources
the end of life.
20 health,

Chapter 8 illustrates the importance of social support and provides tips for supportive communication. This edition features
updated coverage about the role of communication in family caregiving and end-of-life experiences. The chapter also examines
instances of social support “gone wrong”—episodes in which people’s efforts to help actually hurt, and how we can avoid
making the same mistakes. Another section within the chapter explores the notion of animals as supportive companions. The

d u ce.
chapter includes sections on transformative health care experiences and organ donation decisions.
p r o
o n oand e
t rtelehealth.
o nl y
Chapter 9 presents updated information about eHealth,, dmHealth, It presents evidence that, around the world,
l u s e
r s
more people now have mobile
P e onatechnology - 0 9-0in3their homes. We explore how health communication
than have electricity
0 2 0
2 new information resource to benefit diverse patent populations around the world.
specialists are trying to make the most of this
The chapter addresses such questions as Why and under what circumstances do people seek electronic health information? Is
eHealth information mostly helpful or counterproductive? and How does eHealth communication compare with face-to-face
interactions? Readers will learn more about the emergence of virtual hospitals, mobile devices, and health apps, and will
debate the pros and cons of telehealth in terms of health communication. Information about medical information and
technology careers is presented.

e p ro d uce.
PART V: Communication in Health l y, d o not r
Organizations
n a l u s e on - 03
P e r s o 2 0 - 0 9
20 specialists play in health. The chapter is loaded with theories
Chapter 10 presents new examples of roles that communication
and expert tips related to health care administration, public relations, being a servant leader, promoting a shared vision,
working in teams, and rewriting the rules by which health care organizations operate. The chapter culminates with tips for
service excellence from some of the best medical centers in the world. Coverage includes theories and related stories from
professionals in the field.

ro d u c e.
PART VI: Media, Public Policy, and Health Promotion
d o n o t rep
l u s e only,
Chapter 11 provides the latest informationrabout
P
a images in advertising,
e sonhealth 2 0 -0 9 -03and entertainment. It features new
news,
20
coverage about body image and social media, as well as media influence on obesity, alcohol and nicotine use, sex, and
violence. The chapter also includes a section on the international impact of entertainment-education and information about
careers in health journalism. It includes tips for reporting health news, using interactive media to present health information,
and developing media literacy.
In Chapter 12, readers explore the real-life lessons of health communication professionals involved with Ebola, AIDS, SARS,
avian flu, Zika, the opioid epidemic, and other health threats. The chapter presents advice for preventing and minimizing
crises, responding in the heat of the moment, and managing public fears and information needs. The emphasis is on
collaborative communication that is timely, data based, and culturally sensitive.

Chapters 13 and 14 guide readers through the creation and evaluation of public health campaigns. Both chapters include real-
life campaign exemplars and sample PSAs, as well as expanded coverage of campaign design resources and message framing.
An updated section discusses the lessons of the critical-cultural approach as we contemplate the ethics of persuading people in
diverse cultures to reexamine health-related behaviors. These chapters showcase careers in health promotion and health
campaign design.
 p ro d u ce.
, d o n ot re
se onl y
PA RTPeIrson a l u -0 9-03
2 0 2 0

ESTA B L I SHING A CO NTEXT

FOR H E A LTH ly, do not reproduce.
s e on
COMMPUerNso I CATION
n a l u
20 2 0 - 0 9 -03

Athena du Pré Barbara Cook Overton

p ro d u ce.
, d o n ot re
l u s e only
P erson a
2 0 -0 9 -03
20
It’s an exciting time to study health communication. To contribute in meaningful ways, we must be up to date, well informed,
and aware of the big picture. This section lays the groundwork for that. You can read the rest of the book in any order you like,
but begin with this section. In Chapters 1 and 2, you will learn about philosophical perspectives and recent events that have led

uce.
us to the current moment. Understanding that journey makes it easier to envision the future—and ways that you can make a
e p ro d
ot r
difference in it.
y, d o n
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CHAPTER 1
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2
Athena du Pré Barbara Cook Overton

In 2020, a new virus spread around the world, sickening or killing at least 2 million people. As the crisis escalated, communication
was a powerful tool for persuading people to engage in protective behavior. But the message was mixed. On the same day the World

p r o d u ce.
Health Organization declared a global health emergency, the United States president announced that the virus was “under control”

, d o ot re
and a week later said the “risk was low.” Within weeks, hospitals in hardest hit areas were overwhelmed. As officials prepared tents
n
l u s only
and auditoriums to serve as makeshift hospitals, some government leaders issued stay-at-home orders to reduce the risk of contagion,
e
P erson a
2 0 -0 9 -03
while others encouraged people to continue shopping and going to work and school.
20
Pandemics present a powerful reminder how important (and challenging) health-related communication can be. But health
communication doesn’t occur only during a crisis. It’s part of our everyday lives. We communicate about health with friends,
family members, coworkers, and health professionals. Our ideas about health are influenced by the internet, movies, public
service and announcements, and more.

In this chapter, we consider what health and health communication are all about. We examine philosophical perspectives of
health and healing. Then we focus on how and why people communicate as they do about health. The chapter concludes with

p ro d ce.
key reasons to study health communication, including particularly promising career growth. (See Box 1.1 for a list of health-
u
related careers featured throughout the book.)
, d o n ot re
l u s e only
Person
a
0 2 0 -0 9-03
BOX 1.1 2
Career Opportunities

Profiles of More Than 125 Health-Related Jobs

Career boxes throughout the book showcase careers related to health and health care. Here are some of the
jobs profiled in each chapter.

p ro d u ce.
ot re
Chapter 3 Research/Education Consultant
, d o n
l u s e only Professor

Person
a
0 2 0 - 0 9-03
Researcher
2
Chapter 4 Case manager
Patient Advocacy
Patient advocate
Patient care coordinator
Patient navigator
 Social worker

ro d u c e.
Chapter 5 Care Providers
d o n o t rep
Clinical laboratory assistant

l u se on ,
Dentallyassistant

e r s o n a 0 - 0 9 -
Dental hygienist 03
P 0 2
2Dentist
Doctor of osteopathic medicine
Emergency medical technician
Hospitalist
Licensed practical nurse
Medical doctor
Medical records technician
e p ro d uce.
Nurse practitioner
l y, d o not r
n a l u s e onhealth/safety
Occupational
- 0 3
technician
P e rs o 2 0 -0 9
20 therapist
Occupational
Pharmacist
Pharmacy technician
Physical therapist
Physician assistant
Psychiatric technician or aide
Psychiatrist
r o d u c e.
d o n t rep
Psychologist
o
l u s e only,Radiology3technologist
a 09-0 therapist
Person 2020-Registered
Recreational
nurse
Respiratory therapist
Speech-language therapist
Surgeon
Surgical technologist

duce.
Chapter 6 Diversity Diversity officer
r e p ro
l y, d not
Equal Employment Opportunity (EEO) officer
o
l u s on care interpreter
e Health
e r s o n a 0 -0 9 - 03
Chapter 7 P 0 2
2Acupuncturist
Holistic Medicine
Chiropractor
Holistic nurse
Massage therapist
Midwife
 Naturopathic physician
Nutritionist/dietician
p ro d u ce.
Reiki practitioner
, d o n ot re
s e onl y
a l u 9-03
Person
Yoga instructor
2 0 2 0 - 0
Chapter 8 Mental Heath Home health aide
Hospice/palliative care provider
Mental health counselor
Psychologist
Senior citizen services providers
Social service manager
Social worker
p ro d u ce.
, d o n ot re
s e y
onl Computer3and information systems manager
l u
Chapter 9 Medical Technology
a 9-0
Person 2 0 2 0 - 0
Health information administrator or technician
Software developer

Chapter 10 Chief financial officer

Health Care
Administration Chief operating officer
Departmental director
Director of human resources
Health information manager
p ro d u ce.
Medical director ot re
l y, d o n
u n
o office manager
se Medical
o n a l 0 9-03
Pers 2 0 2 0
Nursing -
director
President or CEO
Strategic planning director

Health Care Human Compensation and

Resources benefits manager
Customer service

ce.
representative
p ro d u
, d o n ot re manager
Human resource

s e onl y
a l u 9-03
Person 2 0 2 0 -0 Recruiter
Training and
development specialist

Advertising designer
Health Care Marketing and
Community services
Public Relations
director
In-house communication
 p ro d u ce. director

, d o n ot re
l u s e only Marketing professional

Person
a
2 0 - 0 9 -03 Pharmaceutical sales
20 representative
Physician marketing
coordinator
Public relations
professional
Strategic planning
manager

p ro d u ce.
Healthly, d o not re
Chapter 11 Health Journalism
l u se on publication 3
news editor/reporter
a -0editor
Person -0 9
Health
2 0
0 or magazine editor
2Journal
Media relations specialist
Nonprofit organization publicity manager

Chapter 12 Public Health Business or billing manager

Communication specialist
Emergency management director
ro d u c e.
Environmentalist
, d o n ot rep
s e only
Epidemiologist
l u
a
Person Fundraiser 2 0 -0 9 -03
20
Health campaign designer
Health department administrator
Health educator
Health inspector
Health researcher
Media relations professional

ro d u c e.
Nonprofit organization director

d o n o t rep
only,Nutritionist/dietician
Nurse

n a l u s e -03
P e r s o 2 0 - 0 9
20 Patient advocate or navigator
Physician
Public policy advisor
Risk/crisis communication specialist
Social worker

Chapter 13 Community health educator

Health Promotion and
e.
produc
 e p ro d uce
not r
Education Corporate wellness director
l y , d o
n a l u se on
Fitness instructor
- 3
0designer/manager
P e r s o Health0
02 - 0 9
campaign
2Health information publication designer
Hospital-based health educator
Patient advocate or patient navigator
School-based health educator

Chapter 14 Health Campaigns Communication director

Director of nonprofit organization
Media relations specialist
Professor/educator
Public relations specialist
Publication designer
The Importance of Health Communication p r o d u ce.
, d o n ot re
s e onl y
a l u
soanhospital patient,2she0felt 03
09-comforted
Perwas
While Lisa Suennen 20“at-times and at other moments abandoned.” Some care providers were
thoughtful, attentive, and helpful. However, others failed to listen to her, explain procedures, or communicate well with one another
(Suennen, 2015). Some nurses told her they were too busy to respond when she rang the bell for help, diagnostic tests weren’t ordered
on time, and her insurance claim was denied after paperwork was mishandled.

During a health care experience, communication is more than a nicety. It can enhance healing via a two-way exchange of

p ro d ce.
information, comfort, stress reduction, trust, and mutually satisfying solutions (Street, Makoul, Arora, & Epstein, 2009). By
u
, d o ot re
contrast, ineffective health communication often leads to increased anxiety, errors, mistrust, and poor decisions. For these
n
l u s only
reasons, dissatisfying interactions are linked to adverse health outcomes and to burnout among health care professionals (e.g.,
e
Person
a 0 - 0 9 -03
Clayton, Iacob, Reblin, & Ellington, 2019; Kodjebacheva, Estrada, & Parker, 2017). And the effects go both ways. Burnout
2
20
tends to lead to worse communication, causing an even steeper downward spiral (Clayton et al., 2019).

Interpersonal interactions are only part of the picture. They occur in the context of culture, economics, environmental
conditions, and public policy. As you will see throughout the book, communication is often the vehicle through which these
factors are realized and negotiated. A great deal is at stake. As health communication scholar Gary Kreps (2005) observes,

uce.
“many of the people who are most at risk for poor health outcomes from cancer and other serious health problems are members

ep ro d
ot r
of underserved populations” (p. S68). In the United States, people of low socioeconomic status are five times more likely to be

y, d o n
onl
in poor health than affluent individuals are (Khullar & Chokski, 2018, para. 5).
a l u s e 03 States has a chronic health condition
There is no “us” and “them” when itP n About 1 in 4 people
erstoohealth. 0 2 0 - 0 9-United
comes
2 in the
such as heart disease, mental illness, depression, or diabetes (“National Health Council,” 2014). Medical costs escalate when
these conditions are not well managed. There is also a price to pay in terms of pain, stress, and lost productivity. People with
chronic illnesses are six times more likely than others to miss work regularly (Fouad et al., 2017). Experts say we could save
trillions of dollars (and untold suffering) worldwide by helping people prevent and manage long-term health concerns (“Heart
Disease,” 2015; National Alliance on Mental Illness, 2019; “National Diabetes,” 2017; Rapaport, 2018).

p ro d u ce.
n
The good news is that along with challenges come new possibilities.
o re future may belong to those who not only improve
ot The
health care but fundamentally reimagine the o , d
nlityis provided. “Health in 2040 will be a world apart from what we have
a l u s e way
4).-03
Pe sonBetts, & Davis,
now,” predict analystsr(Batra,
20 2 0 - 0
2019, para. 9
For one thing, technology is changing the health information available to everyday citizens. To return to our opening example,
Suennen might realize in the future that her heart is malfunctioning even before she feels symptoms or visits a doctor.
Wearable devices such as smartphones can now monitor people’s health and alert them to seek care when needed. This has
already saved a number of lives (Smith, 2018). And the trend is growing. Before long, it may be possible to equip your

uce.
bathroom mirror and other features of daily life to monitor key health indicators (Batra et al., 2019). At another level, the days
e p ro d
not r
of one-way communication from health experts to health care consumers are giving way to more collaborative models in
l y, d o
e on
which patients can more easily ask questions and share health data with care providers, even when they cannot be with them in

o n a l u s 9 -03
Pe s 20 2 0 - 0
person. We talk more about the impact of health information technology in Chapter 9.
r
Another change involves the way that health care services are provided. Clinics and hospitals aren’t going away, but additional
services are emerging that embed health care more into everyday life. For example, many neighborhood pharmacies now
function as “health hubs” that offer vaccinations and nutrition counseling and monitor people’s blood pressure, diabetes,
cholesterol, and more. Considering that the United States spends 90% of its health care money on chronic conditions,

p ro d ce.
affordable and convenient care is crucial to moderating costs (“Health and Economic,” 2019).
u
, d o n ot re
l u s e only
Person
a
2 0 - 0 9 -03
20

p ro d u ce.
, d o n ot re
se onl y
a l u 9-03
Person 2 0 2 0 -0
Some neighborhood pharmacies now serve as “health hubs” where people can have their blood pressure and other health
indicators monitored without a trip to the doctor’s office.
Have you ever asked a pharmacist for advice or assistance? If so, were you satisfied with the interaction? Why or
why not?

Of course, these new resources are only helpful if you can readily use them. In Chapter 2 we talk about the cost of receiving
care, and in Chapter 6 about literacy challenges that make it difficult for many people to understand and use health
communication.
 .
A Systems-Level Approach ot reproduce
l y, d o n
u se o n
r s o n a l -0 9-03
P e 0 2 0
2 that, we explore health communication from a systems perspective in this
No facet of health occurs in isolation. Recognizing
book. Health care is a system in that it consists of interrelated elements that influence and rely on one another to function as a
cohesive whole (von Bertalanffy, 1968). Your family is a system, as are your university, your workplace, and the larger
industries and cultures that influence you.

Health care is an overarching system composed of many subsystems, such as clinics, pharmaceutical firms, nonprofit

p ro d u ce.
organizations, hospitals, community groups, and more. The implications of a systems approach, as we will apply it, are

, d o n ot re
only
captured well by management theorist Peter Senge (2006). Here are four tenets of systems theory as he explains them that will
l u s e -03
ersona
help you develop a sophisticated understanding of health communication.
P 2 0 - 0 9
20
The structure of a system influences the people within it. As Senge (2006) observes, “when placed in the same system, people,
however different, tend to produce similar results” (p. 42). That’s not to say that people have no choice about their behavior.
But it reminds us of the larger reality—that our choices are strongly influenced by the relationships, structures, and norms in
which we find ourselves. To return to the example that opens this chapter, the care providers who communicated poorly with
Suennen may have been careless or indifferent. On the other hand, they may have been stressed, burned out, or struggling to
keep up in understaffed units.
ep ro d uce.
, d o n ot r
s e onl y
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it. In systems theory, the law of unintended consequences points out that even well-intentioned solutions may have undesirable
effects. To avoid simplistic assumptions that may cause more problems than they solve, look below the surface. Former health
care executive Robert Hugin (2018) makes the case, saying that “to produce the right solutions, we must ask the tough
questions, and not grasp at quick fixes just because they seem popular or convenient” (para. 6).
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is likely to meet the same fate). However much we may wish for sudden, sweeping changes in health care, truly long-term
solutions are likely to be achieved gradually.

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wellness. Health campaigns designed by outsiders are often ineffective at changing a target audience’s attitudes and behaviors.
However, when professionals work with members of a particular culture to identify their health-related goals and culturally
acceptable options, the outcomes may be more successful (Dutta & de Souza, 2008; D. B. Friedman, Hooker, Wilcox,
Burroughs, & Rheaume, 2012).

All in all, Senge (2006) points out, “systems thinking is both more challenging and more promising than our normal ways of
dealing with problems” (p. 63). Improving health communication is not as simple as saying “Do better!” By the same token,
blaming individuals seldom gets us far. But a sophisticated understanding of the underlying factors at play can help reveal
leverage points with lasting impact.
Philosophy of This Book d u ce.
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and respectful to the people involved. The 2
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we understand health communication from a wide range of perspectives—cultural, physical, interpersonal, social,
organizational, and political.

Here are some examples of what can go wrong when people focus on one area of communication but neglect others:

• Patients are well treated, but their families feel distraught and uninformed.

o d u c e.
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contradictory information.
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organizational constraints that may limit people’s options.

p ro d u ce.
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, d o n ot re
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s e onl y
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then broaden the scope in Part III to consider the influence of diversity and culture. Part IV explores health care resources,
including social support and technology. In Part V, we consider the ways that people in health care organizations use
communication to lead, inspire, and support team members, and to partner with the community. The book concludes in Part VI
with coverage of health communication in the media, public health, and health care campaigns. In real life, of course, we
encounter these factors simultaneously rather than one by one. Keep the interplay between them in mind.

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Here are some ways to get the most from this book:

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in the ability to link abstract ideas to actual practices, is one of the most useful ways to put what you learn to
critical
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Another random document with
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square block of snow was placed on the stone, and, as the hot
smoke circled round it, the seal-skin saucer caught the water that
dripped from the edge. They had no vessel for boiling; what they did
not eat raw they baked upon a hot stone. A solitary coil of walrus-
line, fastened to a movable lance-head (noon-ghak), with the well-
worn and well-soaked clothes on their backs, completed the
inventory of their effects.”
The Eskimos entertained Dr. Kane and his companions with a
choral performance, singing their rude, monotonous song of “Amna
Ayah” till the unfortunate white men were almost maddened by the
discord. They improvised, moreover, a special chant in their honour,
which they repeated with great gravity of utterance, invariably
concluding with the sonorous and complimentary refrain of “Nalegak!
nalegak! nalegak-soak!”—“Captain! captain! great captain!” The
chant ran as follows:—

Am-na-yah! Am-na-yah! Am-na-yah! Am-na-yah!

[Listen]
In the early spring the Eskimos resume their hunting expeditions,
and their snow-covered huts are transformed into scenes of the
liveliest activity. Stacks of jointed meat, chiefly walrus, are piled upon
the ice-foot; the women stretch the hide for sole-leather, and the men
collect a store of harpoon-lines for the winter. Tusky walrus heads
stare at the spectacle from the snowbank, where they are stowed for
their ivory; the dogs are tethered to the ice; and the children, each
one armed with the curved rib of some big walrus or seal, play ball
and bat among the snow-drifts.
The quantity of walrus meat which the Eskimos accumulate
during a season of plenty should certainly raise them above all risk
of winter want; but other causes than improvidence render their
supplies scanty. They are never idle; they hunt incessantly without
the loss of a day. When the storms prevent the use of the sledge,
they occupy themselves in stowing away the spoils of previous
hunts. For this purpose they dig a pit either on the mainland, or,
which is preferred, on an island inaccessible to foxes, and the jointed
meat is stacked inside, and covered with heavy stones.
The true explanation of the scarcity from which these people so
frequently suffer is the excessive consumption in which they indulge
during the summer season. By their ancient laws all share in
common; and since they migrate in numbers when their necessities
press them, the tax on each separate settlement is excessive. The
quantity which the members of a family consume seems excessive
to a stranger; yet it is not the result of inconsiderate gluttony, but due
to their peculiarities of life and organization. In active exercise, and
under the influence of exposure to a severe temperature, the waste
of carbon must be enormous.
When in-doors, and at rest, engaged upon their ivory harness-
rings, fowl-nets, or other household gear, they eat, as many eat in
more civilized lands, for mere animal enjoyment, and to pass away
the time. But when engaged in the chase, they take but one meal a
day, and that not until the day’s labour is ended. They go out upon
the ice without breakfast, and seldom eat anything until their return.
Dr. Kane estimates the average ration of an Eskimo in a season of
plenty at eight to ten pounds of meat a day, with soup and water to
the extent of half a gallon. Such an allowance might almost have
satisfied the appetite of Gargantua!

Dr. Hayes, in the course of his adventurous Arctic boat-journey,

held much intercourse with the Eskimos, and his impressions, on the
whole, would seem to have been highly favourable.
His sketch of a couple whom he met in the neighbourhood of the
Eskimo colony of Netlik is very amusing.
He describes them as a most unhuman-looking pair. Everything
on and about them told of the battle they fought so gallantly and
patiently with the elements. From head to foot they were invested in
a coat of ice and snow. Shapeless lumps of whiteness, they
resembled the snow-kings or statues which boys delight in making,
except that they possessed the faculty of motion. Their long, heavy
fox-skin coats, reaching nearly to the knees, and surmounted by a
hood, covering, like a round lump, all of the head but the face, the
bear-skin pantaloons and boots and mittens were saturated with
snow. Their long, black hair, which fell from beneath their hoods over
their eyes and cheeks, their eyelashes, the few hairs growing upon
their chins, the rim of fur around their faces, all glittered with white
frost—the frozen moisture of their breath. Each carried in his right
hand a whip, and in his left a lump of frozen meat and blubber. The
meat they flung down on the floor of Dr. Hayes’ hut; then, without
pausing for an invitation, they thrust their whipstocks under the
rafters, and divesting themselves of their mittens and outer
garments, hung them thereon. Underneath their frosty coats they
wore a warm, close shirt of bird-skins.
In the same bold explorer’s narrative of his voyage of discovery in
1860, two other Eskimos figure very conspicuously; and one of
these, named Hans, would seem to have been a very fair type of the
Eskimo character. Hans, we may observe, had originally served in
Dr. Kane’s expedition, and had then gained the confidence of Dr.
Hayes; so that when the latter undertook his own memorable
voyage, he became anxious to secure the Eskimo’s services.
When his ship had crossed Melville Bay, and lay in the grim
shadows of Cape York, Dr. Hayes bethought himself of the Eskimo
hunter. He remembered to have heard that Hans had fallen in love,
and taken a wife, and repaired, with her at his side, to share the
fortunes of the wild Eskimos who inhabit the remote northern shores
of Baffin Bay.
But Dr. Hayes felt confident that the hunter, having known
something of the superior comfort and happiness of the social life of
civilization, would soon weary of his voluntary banishment, and of
the penury and hardships of the existence of the Eskimo nomads.
He made up his mind that Hans would return to Cape York, and
there take up his residence, in the hope of being picked up by some
passing ship.
 So Dr. Hayes stood close in-shore, to find that his conjectures
were completely realized. As he sailed along the coast he
discovered a group of human beings eagerly endeavouring by signs
and gestures to attract attention. Heaving the schooner to, he and
his second in command, Mr. Sountag, went ashore in a boat, and
there was Hans! The Eskimo recognized both of them immediately,
and called them by name.

DR. HAYES FALLS IN WITH HANS THE HUNTER.

 We may adopt the remainder of Dr. Hayes’ interesting little
episode, because it illustrates the ingrained selfishness, or self-
concentration, of the Eskimo character.
Hans had deteriorated greatly during his residence with the wild
Eskimos, and he had sunk to their level of filthy ugliness. He was
accompanied by his wife, who carried her first-born in a hood upon
her back; his wife’s brother, a quick-eyed boy of twelve years; and
his wife’s mother, “an ancient dame with voluble and flippant
tongue.” They were all attired in the usual Eskimo dress of skins;
objects of interest and curiosity, but not “things of beauty.”
Hans led his visitors, over rough rocks and through deep drifts of
snow, to his rude hut, which stood on the cold hill-top, about two
hundred feet above the sea-level. An excellent position for a “look-
out,” but as inconvenient for a hunter as can well be imagined. Here
he had watched and waited for many a dreary month; surveying the
sea day after day, in the faint hope of discovering some European
vessel. But none came; summer passed into winter, and winter
lengthened into summer; and still Hans watched and waited,
yearning after his southern home and the friends of his youth.
His tent—for it was rather a tent than a hut—was made of seal-
skins, and its capacity was scarcely sufficient to accommodate his
little family.
Dr. Hayes asked him if he would accompany the expedition.
“Yes.”
Would he take his wife and baby?
“Yes.”
Would he go without them?
“Yes.”
This last answer reveals the curious unimpressionableness of the
Eskimo, who endures with calmness, nay, even with indifference,
those partings which try the heartstrings of the European. It is,
perhaps, a result of the constant warfare he maintains against an
uncongenial and austere Nature that he comes to regard himself as
his first and chief, as almost his only concern. So long as his wife
and children surround him, he shows no evident want of affection;
but he has no objection to part from them, if the separation will prove
to his individual interest.
As Dr. Hayes had no leisure to examine critically into the state of
his mind, and as he cherished a conviction that the permanent
separation of husband and wife was to be regarded as a painful
event, he determined on giving the Eskimo mother the benefit of this
conventional suspicion. Both husband and wife, therefore, were
carried on board the schooner, as well as their baby, their tent, and
all their household goods. The bright-eyed boy and the ancient dame
cried to accompany them; but Dr. Hayes had no further room, and
was compelled to leave them to the care of their tribe, who, about
twenty in number, had discovered the schooner, and with a merry
shout had come across the hill. After bestowing upon them some
useful gifts, Dr. Hayes returned to his vessel.
He adds that Hans was the only unconcerned person in the party.
At a later period the thought crossed his commander’s mind that he
would by no means have been displeased had wife and child been
left to the charity of their savage kin: while Dr. Hayes had abundant
reason, during the course of the expedition, to wish that he had left
the selfish and indolent Eskimo to linger in his seal-skin tent among
the hills and rocks of Cape York.

The same traveller describes the hunting equipment of a party of

Eskimos setting out in pursuit of bears.
First, the dogs. These were picketed, each team separately, on a
convenient area of level ground; and on the approach of Dr. Hayes
and his companions they sprang up from the knotted heap, in which
they had been lying through the night, with a wild, fierce yell, which
died away into a low whine and impatient snarl. They evidently were
hungry, and their masters seemed desirous of feeding them; for,
going to their sledges, each one brought up a flat piece of something
which looked singularly like plate-iron, but, upon examination, was
found to be walrus-hide, three-quarters of an inch thick, and frozen
intensely hard. Throwing it upon the snow a few feet in advance of
their respective teams, they drew their knives from their capacious
boots, and attempted to cut up the skin; but its hardness defied all
their efforts, and Dr. Hayes had to fetch hatchet and saw before the
work of division could be completed.
During the few minutes thus occupied, the dogs had become
almost frantic. They endeavoured to break loose; pulling on their
traces, running back and springing forward, straining and choking
themselves until their eyes shot fire, and the foam flew from their
mouths. The sight of food had stimulated their wolfish passions, and
they seemed ready to eat each other. Not a moment passed that two
or more of them were not flying at each other’s throats, and,
grappling together, rolled, and tossed, and tumbled over the snow.
The Eskimos looked on apparently unconcerned, except when
there appeared a risk of one of the dogs being injured, and then they
secured a temporary calm by uttering an angry nasal “Ay! Ay!”
When at length the food was thrown, the dogs uttered a greedy
scream, which was followed by a moment’s silence while the pieces
were falling, then by a scuffle, and the hard, frozen chunks had
vanished. How they were swallowed, or how they were digested,
was, to the spectator, inexplicable! Enough to say that “the jaws of
darkness did devour them up,” and calm instantaneously succeeded
to the storm.
The Eskimo dog is of medium size, and squarely built; in fact, he
is a reclaimed wolf, and exhibits that variety of colour which, after a
few generations, generally characterizes tame animals. Gray, which
is often seen, was probably at one time the predominating colour.
Some of the dogs are black, with white breasts; some are wholly
white; others are reddish or yellowish; but, indeed, almost every
shade may be seen amongst them. Their skin is covered with a
coarse, compact fur, and is much valued by the natives for the
purposes of clothing. In the form of the animals the variety is
considerable; but the general characters would seem to be a pointed
nose, short ears, a cowardly, treacherous eye, and a hanging tail.
But exceptions occasionally occur, and one figures in Dr. Hayes’
narrative under the name of Toodlamik, or, more briefly, Toodla.
He differed from his kind in having a more compact head, a less
pointed nose, an eye denoting affection and reliance, and an erect,
bold, fearless carriage. Dr. Hayes, however, expresses some doubt
as to his purity of blood. From the beginning to the end of the cruise
he was master of all the dogs that were brought to the ship. In this
connection it is worthy of remark, that in every pack one dog
invariably attains the mastership of the whole—a kind of major-
generalship; and in each team, one who is master of his comrades, a
general of brigade. Once master, always master; but the post of
honour is gained at the cost of many a lame leg and ghastly wound,
and is held only by doing daily battle against all comers. These could
easily gain the ascendancy in every case, but for their own petty
jealousies, which often prevent their union for such a purpose. If a
combination, however, does happen to be brought about, and the
leader is hopelessly beaten, he is never worth anything afterward;
his spirit is completely prostrated, the poor fellow pines away, and
dies at last of a broken heart.
 ESKIMO DOGS.
Toodla, says Dr. Hayes, was a character in his way. He was a
tyrant of no mean pretension. Apparently he thought it his special
duty to attack every dog, great or small, that was added to the pack:
if the animal was a large one, in order, probably, that he might at
once be forced to feel that he had a master; if a small one, in order
that the others might hold him in the greater awe. It was sometimes
quite amusing to see him set off in pursuit of a strange dog, his head
erect, his tail curled gracefully over his back; slowly and deliberately
he went straight at his mark, with the confident, defiant air of one
who recognizes the power and importance of his office. Leagues and
conspiracies were not unfrequently formed against him, induced, no
doubt, by a feeling of despair; but he always succeeded in
overthrowing them,—not, it is true, without occasional assistance
from “without;” for the sailors, who petted him greatly, would
sometimes take his part when the struggle was manifestly unequal.

But we must leave the dogs, and turn to the sledge.

This was, in very truth, an ingenious specimen of native
mechanical skill. It was made wholly of bone and leather. The
runners, which were square behind and rounded upward in front,
and about five feet long, seven inches high, and three-fourths of an
inch thick, were slabs of bone; not solid, but made up of a number of
pieces of various shapes and sizes, dexterously fitted and tightly
lashed together. Some of these were not larger than one’s two
fingers; some were three or four inches square; others were as large
as one’s hand, and triangular in shape; others, again, were several
inches in length, and two or three in breadth. They all fitted into their
several places as exactly as the blocks of a Chinese puzzle. Near
their margins ran rows of little holes, and through these strings of
seal-skin were inserted, by which the blocks were fastened together,
until the whole was as firm as a board.
The marvel of the thing is that all these pieces are flattened and
cut into the required shape, not with nicely contrived instruments and
tools, but with stones. The labour must be immense. The grinding
needed to make a single runner must be the work of months. The
construction of an entirely new sledge would probably occupy the
lifetime of a generation; and hence a vehicle of this kind becomes a
family heirloom, and is handed down from father to son, and son to
grandson, and is constantly undergoing repair and restoration; a new
piece here, another there, until as little remains of the original
structure as of the sailor’s old knife, when it had had a new blade
and a new handle! The origin of some of the Eskimo sledges is lost
in the mists of a remote antiquity.
 The runners are usually shod with ivory from the tusk of the
walrus. The said ivory had likewise been ground flat, and its corners
made square, with stones; and it was fastened to the runner by a
string looped through two counter-sunk holes. The pieces of which it
was composed were numerous; but the surface was wonderfully
uniform, and as smooth as glass.
The runners stood about fourteen inches apart, and were
fastened together by bones, tightly lashed to them; the bones used
being the femur of the bear, the antlers of the reindeer, and the ribs
of the narwhal. Two walrus-ribs, lashed one to the after-end of each
runner, served as upstanders, and were braced by a piece of
reindeer antler, secured across the top.

Having thus disposed of the team and the sledge, we now come
to the equipment.
First, one of the Eskimo hunters spread a piece of seal-skin over
the sledge, fastening it securely by little strings attached to its
margin. On this he placed a small piece of walrus-skin, as a
provision for the dogs; a piece of blubber for fuel; and of meat for his
own lunch. During his absence he would cook no food, but he would
want water; and therefore he carried his kotluk, or lamp—namely, a
small stone dish; a lump of mannek or dried moss, designed for the
wick; and some willow-blossoms (na-owinals) for tinder. To ignite the
tinder, he had a piece of iron-stone and a small sharp fragment of
flint.
 ESKIMO SLEDGE AND TEAM.
We may follow him on his route, and ascertain the use he makes
of these appliances. When he grows thirsty, he halts; scrapes away
the snow until he lays bare the solid ice beneath; and painfully
scoops in it a small cavity. Next, he fetches a block of fresh-water ice
from a neighbouring berg, lights his lamp, and, using the blubber for
fuel, proceeds to place the block on the edge of the cavity. As it
slowly thaws, the water trickles down into the hole; and when the
Eskimo thinks the quantity collected is sufficient to quench his thirst,
he removes the rude apparatus, and, stooping down, drinks the soot-
stained fluid. If he feels hungry, he breaks off a few chips from his
lump of frozen walrus-beef, cuts a few slices from the blubber, and
enjoys his unsatisfactory meal. The inhabitant of the Arctic desert
knows nothing of epicurean tastes; and if he did, he has no means of
gratifying them.
 To return to the equipment. The hunter carried with him an extra
pair of boots, another of dog-skin stockings, and another of mittens,
to be used in case he should be unfortunate enough to get on thin
ice, and the ice should break through.
The entire equipment being placed upon the sledge, he threw
over them a piece of bear-skin, which was doubled, so that, when
opened, it would be large enough to wrap about his body and protect
it from the snow, if he wished to lie down and rest. Then he drew
forth a long line, fastened an end of it through a hole in the fore part
of one of the runners, ran it across diagonally to the opposite runner,
passed it through a hole there, and so continued, to and fro, from
side to side, until he reached the other end of the sledge. There he
made fast the line, and thus the cargo was secured against all risk of
loss from an upset. Next he hung to one upstander a coil of heavy
line, and to the other a lighter coil, tying them fast with a small string.
The former was his harpoon-line for catching walrus; the latter, for
catching seal. His harpoon staff was made from the tusk of the
narwhal; measured five feet in length, and two inches in diameter at
one end, tapering to a point at the other.
All being ready, the team, consisting of seven dogs, was brought
up. The harness was of a very primitive description. It consisted of
two doubled strips of bear-skin, one of which was placed on either
side of the animal’s body, the two being fastened together on the top
of the neck and at the breast, so as to form a collar. Thence they
passed inside of the dog’s fore legs and up along his flanks to the
tail, where the four ends meeting together were attached to a trace
eighteen feet in length.
The trace was connected with the sledge by a line four feet long,
of which one end was attached to each runner. And to the middle of
the line a stout string was fastened, running-through bone rings at
the ends of the traces, and secured by a slip-knot, easily untied—an
arrangement designed with the view of ensuring safety in bear-
hunting. The bear is hotly pursued until the sledge arrives within
about fifty yards; the hunter then leans forward and slips the knot;
the dogs, set loose from the sledge, quickly bring the brute to bay. If
the knot gets fouled, serious accidents are not unlikely to occur. The
hunter vainly endeavours to extricate it, and before he can draw his
knife to cut it—supposing he is fortunate enough to have such an
instrument—man, and dogs, and sledge are all among the bear’s
legs, in a huddled and tangled heap, and at the mercy of the
enraged monster.
The dogs were cold, and eager to start. In a moment they were
yoked to the sledge; the hunter with his right hand threw out the coils
of his long whip-lash, with his left he seized an upstander, and
propelling the sledge a few paces, he uttered at the same moment
the shrill starting-cry, “Ka! ka!—ka! ka!” which sent the dogs in a
bound to their places, and away they dashed over the rugged ice.
The hunter skilfully guided his sledge among the hummocks,
moderating the impetuosity of his team with the nasal “Ay! ay!” which
they perfectly understand. On reaching the smooth ice, he dropped
upon the sledge, allowed his whip-lash to trail after him on the snow,
shouted “Ka! ka!—ka! ka!” to his savage team, and disappeared in
as wild a gallop as ever was taken by the demon huntsman of
German legend!

It does not appear that the Eskimos have magistrates or laws, yet
the utmost good order prevails in their communities, and quarrels are
rare. When these do occur, one or other of the dissatisfied parties
collects his little store, and migrates to a different settlement. The
constitution of their society is rightly described as patriarchal, but the
ruler does not seem to be elected: he attains his post by proving his
possession of superior strength, address, and courage. As soon as
his physical powers give way, or old age enfeebles his mind, he
deposes himself, takes his seat in the oomiak, or woman’s boat, and
is relegated by common consent to female companionship. Like all
savage tribes, the Eskimos have their mystery-men, or angekoks,
who resort to the usual deceptions to acquire and retain supremacy,
swallowing knives, resorting to ventriloquial artifices, and conversing
in a mysterious jargon, unintelligible to “the common herd.” They
profess to hold intercourse with certain potent spirits, and to employ
their agency in rewarding or punishing their dupes; and even the
influence of the Christian missionaries has hardly rooted out the
belief in the superstitions originated and fostered by these men.
Notwithstanding the hard conditions of their life, and the
dreariness of the region which they inhabit, the Eskimos are a
cheerful people. They are keenly sensible of the charms of music,
though their own vocalization is inconceivably melancholy; and they
are partial to many rude pastimes, mostly of a gymnastic character.
Their good nature has been praised by many travellers; but they
show the usual inhumanity of the savage towards the aged and
infirm. Weakness is no title to the sympathy of the Eskimo; he
respects strength, but he utterly disregards and cruelly oppresses
the feeble. He is ungrateful towards his benefactors, and in his
intercourse with strangers his fidelity can be relied upon only so long
as he knows that any breach of faith will be severely punished. He
does not steal from his own people, and “Tiglikpok,” “he is a thief,” is
a reproach among the Eskimos as among ourselves; but no shame
attaches to him if he robs the white man, though the latter may have
loaded him with favours.
If we add that they display a strong affection for their children,
and that the children are singularly docile and obedient to their
parents, we shall have said enough to assist the reader in forming an
accurate conception of the characteristics of the inhabitants of the
Eskimo Land.
 CHAPTER VIII.
LAPLAND AND THE LAPPS.

apland, or the Land of the Lapps, which the Lapps themselves

call Sameanda or Somellada, forms the north and north-
eastern portions of the Scandinavian peninsula, and is divided
between Sweden and Russia. Norwegian Lapland includes the
provinces of Norrland and Finmark; Swedish, of North and South
Bothnia; and Russian, of Kola and Kemi. The last-named has an
area of 11,300 square miles, with a population of 9000; Swedish
Lapland, an area of 50,600 square miles, with 4000 inhabitants; and
Norwegian, an area of 26,500 square miles, with a population of
5000. We are here referring to the number of true Lapps; in each
division the population would be largely increased if we included
Finns, Russians, Swedes, Norwegians.
Lapland, for nine months in the year, is blighted by the rigour of a
winter climate. The summer months, when the sun does not set for
several weeks, are July and August; and these are preceded by a
brief spring, and followed by even a briefer autumn. Cereals do not
thrive higher than the sixty-sixth parallel, with the exception of barley,
which is cultivated as far north as the seventieth. The greater part of
the country comes within that wooded zone which we described in
an earlier chapter, and the forests, consisting of birch, pine, fir, and
alder, spread over a very extensive area. On the mosses and lichens
which grow abundantly in their shelter, are fed the immense herds of
reindeer which constitute the principal wealth of the inhabitants.
The Lapps may almost be regarded as a nation of Lilliputians.
Their men seldom exceed five feet in height, while the majority are
some inches below that very moderate stature; and the women are
even shorter. They are, however, a robust race, with muscular limbs,
and unusual girth of body, the circumference of their chest being
nearly equal to their height. Their complexion is dark, tawny, or
copper-coloured; their dark, piercing, deep-sunken eyes are set very
wide apart, so as to communicate a peculiar character to the
physiognomy. The wild, strange effect is further increased by the
unkempt masses of dark, lank, straight hair which droop on either
side of the whiskerless, beardless face. The cheek-bones are
prominent, like those of a Celtic Highlander; the nose is flat; the
mouth wide, with thin compressed lips. It may be supposed that the
Lapps, from these indications, are not models of masculine or
feminine beauty; and Dr. Clarke asserts that, when aged, many of
them, if exposed in a menagerie, might be mistaken for the long-lost
transitional form intermediate between man and ape. And, certainly,
there is something repulsive in the constant blinking of eyes
rendered sore by the pungent smoke of their huts, or the white glare
of the snow, as well as in the expression of obstinacy and low
cunning which one reads in every feature.
An aristocrat might be proud of their small and finely-shaped
hands; but their arms, like their legs, are disproportionately short,
clumsy, and thick. Clumsy, we mean, in shape; certainly not in
movement, for the extraordinary flexibility of their limbs is one of the
traits by which a Lapp is easily distinguished.
Of the dress of the Lapps it is needless to say much. In winter it
consists of bears’ skins, in which both male and female wrap
themselves up, with the fur outward. In summer the men wear a sort
of tunic, the poesk, made of coarse light-coloured woollen cloth,
depending to the knee, but bound about the waist with a belt or
girdle. Their head-gear consists of a kind of fez, made of wool, and
adorned with a red worsted band round the rim, and a bright red
tassel. Their boots or shoes are cut from the raw skin of the reindeer,
with the hair outwards, and they are peaked in shape. They are thin,
and they have no lining; but the Lapp defends his feet and ankles
from the cold by stuffing the vacant space of the boot with the broad
leaves of the Carex vesicaria, or Cyperus grass, which he cuts in
summer, rubs in his hands, and dries before using. The female
costume resembles that of the males, but their girdles are gayer with
rings and chains.
The Lapps are a superstitious race. Like all the Norse tribes, they
believe in witchcraft; and of old the Lapland witches had a reputation
which extended to England, for being able to ward off rain or
disperse storms. The English seamen trading to Archangel
frequently visited their coast in order to buy a favourable wind.
Many of the Lapps claim the ability to foretell future events, and
fall, or pretend to fall, into a trance or ecstasy, during which they see
visions, utter prophecies, and unlock the secrets of those who trust
to their divination. They also read the fortunes of inquiring dupes by
means of a cup of liquor, or by the vulgarest jargon of palmistry.
Superstition is the daughter of Ignorance. It is also the sister of Fear,
for the superstitious are invariably prone to see supernatural signs
and wonders in the appearances of the heavens, or to hear
unearthly voices borne upon the midnight wind, and in everything
they cannot understand to imagine the presence of some
antagonistic power. As the American natives were panic-stricken at
the occurrence of an eclipse, so the Lapps are filled with dread when
the sky glows with the coruscations of the aurora.
These superstitions prevail in spite of the exertions of priests and
schoolmasters. They are nourished in secret even when they are not
openly proclaimed; and the Lapp, after listening devoutly to the
harangue of his pastor, will return home to offer homage to his
saidas, or wooden idols; to cower at the name of Trolls, the evil spirit
of the forest; and to be deluded by the artifices of any so-called witch
or fortune-teller.
There are Lapps, and Lapps; each, according to the region he
inhabits, bearing his distinctive characteristics, and preserving his
individual habits. Thus, there are the Fjälllappars, or Mountain
Lapps; the Skogslappars, or Wood Lapps; and the Fisherlapps.
From the nature of the country the reader will expect, and will be
right in expecting, that the Fjälllappars form the most numerous
section. They are the nomads of Lapland, and their mode of life is
entirely pastoral. As the Arabs with their flocks move from one oasis
to another, or the Tartars with their cattle, so the Lapps migrate from
place to place, compelled by the necessity of finding sustenance for
their herds of reindeer. The mosses and lichens on which these
animals feed are soon exhausted, and some time elapses before the
half-frozen soil replaces them. The same cause operates to prevent
the Lapps from assembling in large communities. Seldom more than
three, four, or five families encamp in the same neighbourhood.
It will not be supposed that the temporary abode of a nomad
exhibits any architectural completeness. Their tuguria, or huts, are of
the rudest construction. They raise a conical framework, composed
of the flexible stems of trees, and this they cover with a coarse kind
of canvas, and in winter with the skins of reindeer and other animals.
No doorway is required, and egress and ingress are provided for by
turning up a portion of the canvas at the bottom, so as to form a
triangular gap; and the portion so turned up is let down again at
night. In the centre of the interior some large stones are piled
together for a fireplace, and a square opening in the roof above
carries off the smoke, and lets in the light and air—not to say rain,
snow, and fog, when these prevail.
The tent or hut we have described generally measures about six
feet in diameter, and eighteen to twenty in circumference. It does not
exceed ten feet in height. There is no floor, but the ground is covered
with reindeer skins, and upon these the inhabitants sit or crouch by
day, and huddle themselves up at night. The household utensils,
implements, and weapons are suspended from the sides of the hut;
and the clothing of the family, no very extensive stock, is preserved
in a chest.
On a shelf or platform, raised high above the reach of dogs and
wolves, between two neighbouring trees, the Lapp keeps his store of
dried reindeer flesh, and cheese, and curds; for his diet is as plain as
his general habit of living. His herd of reindeer he puts up at night, or
when they are required for milking, in a large enclosure, about four
hundred to five hundred feet in circuit, formed by a barrier of posts
and stumps of trees, supporting a row of horizontal poles. Against
the latter birch poles and branches of trees are placed diagonally,
forming a kind of abattis, which is found to be a sufficient security
against the attacks of wolves.
It is said that the milking of a herd of reindeer affords a lively and
picturesque spectacle. When they have been driven within the area,
and all the outlets closed, a Lapp, selecting a long cord or thong,