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The Sociology of Health,
Illness, and Health Care
A Critical Approach
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The Sociology of Health,
Illness, and Health Care
A Critical Approach
EIGHTH EDITION
ROSE WEITZ
Arizona State University
Australia ● Brazil ● Mexico ● Singapore ● United Kingdom ● United States
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In memory of my mother, Lilly Weitz, with love
Brief Contents
PA R T I Social Factors and Illness 1

Chapter 1 The Sociology of Health, Illness, and Health Care 3
Chapter 2 The Social Sources of Modern Illness 18
Chapter 3 The Social Distribution of Illness in the
United States 46
Chapter 4 Illness and Death in the Less Developed Nations 69
PA R T II The Meaning and Experience of Illness 93

Chapter 5 The Social Meanings of Illness 95
Chapter 6 The Experience of Disability, Chronic Pain, and
Chronic Illness 116
Chapter 7 The Sociology of Mental Illness 139
PA R T III Health Care Systems, Settings, and Technologies 169

Chapter 8 Health Care in the United States 170
Chapter 9 Health Care Around the Globe 195
Chapter 10 Health Care Settings and Technologies 221
PA R T IV Health Care, Health Research, and Bioethics 247

Chapter 11 The Profession of Medicine 248
Chapter 12 Other Mainstream and Alternative Health Care
Providers 276
Chapter 13 Issues in Bioethics 303
GLOSSARY 325
REFERENCES 340
INDEX 381
vi
Contents
PREFACE xvi
ABO UT THE AUTHO R xxvi
PA R T I Social Factors and Illness 1
Chapter 1 The Sociology of Health, Illness, and Health

Care 3
The Sociology of Health, Illness, and Health Care: An Overview 5
The Sociological Perspective 6
A Critical Approach 8
A Brief History of Disease 10
The European Background 10
Disease in the New World 11
The Epidemiological Transition 11
Understanding Research Sources 13
Evaluating Research Sources 13
Evaluating Research Data 14
Summary 15
Review Questions 16
Critical Thinking Questions 17
Chapter 2 The Social Sources of Modern Illness 18

An Introduction to Epidemiology 20
The Modern Disease Profile 22
vii
viii CONTENTS
The New Rise in Infectious Disease 22

Today’s Top Killers 23
The Social Sources of Premature Deaths 24
Diet, Exercise, and Obesity 25
Tobacco 27
Medical Errors 28
Alcohol 29
Bacteria and Viruses 30
Toxic Agents and Risk Societies 31
Firearms 32
Motor Vehicles 32
Sexual Behavior 33
Illicit Drug Use 34
The Health Belief Model, Health Lifestyles, and Health
“Projects” 37
The Health Belief Model 37
Health Lifestyles 37
Health Projects 40
Social Stress and Social Networks 40
Social Stress 40
Gender, Race, Class, and Social Stress 42
Social Networks 42
Implications 43
Summary 43
Review Questions 44
Chapter 3 The Social Distribution of Illness in the

United States 46
Social Class 48
Overview 48
The Sources of Class Differences in Health 49
Race and Ethnicity 52
African Americans 53
Hispanic Americans 56
Native Americans 57
CONTENTS ix
Asian Americans 57
Case Study: Environmental Racism 59
Age 59
Overview 59
Sex and Gender 60
Overview 60
Case Study: Intimate Partner Violence and Health 62
Transgender Health Issues 63
Intersex Health Issues 64
Social Capital 65
Implications 66
Summary 66
Review Questions 67
Chapter 4 Illness and Death in the

Less Developed Nations 69
Setting the Stage: Key Concepts 71
Understanding Development Patterns 71
Understanding Globalization 73
Understanding Global Health 73
Explaining Death and Disease in Less Developed Nations 74
Chronic Disease 74
Poverty, Malnutrition, and Disease 75
Infectious and Parasitic Diseases 77
Neglected Tropical Diseases 81
Infant Mortality 82
Maternal Mortality 83
Respiratory Diseases 86
War 87
Disasters 87
Structural Violence 88
Implications 89
Summary 90
Review Questions 91
x CONTENTS
PA R T II The Meaning and Experience of Illness 93
Chapter 5 The Social Meanings of Illness 95

Explaining Illness Across History 97
Models of Illness 98
The Medical and Sociological Models of Illness 98
Medicine as Social Control 102
Creating Illness: Medicalization 103
Genetic Research and Social Control 108
Social Control and the Sick Role 110
Implications 113
Summary 113
Review Questions 115
Chapter 6 The Experience of Disability, Chronic Pain,

and Chronic Illness 116
Understanding Disability 118
Defining Disability 118
People with Disabilities as a Minority Group 119
The Social Distribution of Disability 120
Understanding Chronic Pain 122
Living with Chronic Pain 122
Gender, Ethnicity, Class, and Chronic Pain 123
Living with Disability and Chronic Illness 123
Responding to Initial Symptoms 123
Managing Health Care and Treatment Regimens 126
Managing Social Relationships and Social Standing 131
Implications 135
Summary 136
Chapter 7 The Sociology of Mental Illness 139

The Epidemiology of Mental Illness 141
The Extent of Mental Illness 141
Social Stress and Mental Illness 142
CONTENTS xi
Ethnicity, Gender, Social Class, and Rates of Mental Illness 142

Social Capital and Mental Illness 144
Defining Mental Illness 145
The Medical Model of Mental Illness 145
The Sociological Model of Mental Illness 146
The Problem of Diagnosis 148
The Politics of Diagnosis 149
A History of Treatment 150
Before the Scientific Era 150
The Rise and Decline of Moral Treatment 151
Freud and Psychoanalysis 153
The Antipsychiatry Critique 154
Deinstitutionalization 155
The Rise of Managed Care 157
The Remedicalization of Mental Illness 158
Mental Health and the Affordable Care Act 160
Recent Challenges to Medical Diagnoses and Treatment 160
The Experience of Mental Illness 161
Becoming a Mental Patient 161
Mental Illness and Identity 164
Implications 164
Summary 165
PA R T III Health Care Systems, Settings, and Technologies 169
Chapter 8 Health Care in the United States 170

A History of U.S. Health Insurance 172
The Birth of U.S. Health Insurance 172
The Government Steps In 173
The Rise of Commercial Insurance 174
The Rise (and Partial Fall) of Managed Care 174
The Attempt at “Health Care Security” 175
The 2010 Patient Protection and Affordable Care Act 176
Passing the Affordable Care Act 176
Understanding the Affordable Care Act 176
xii CONTENTS
The ACA Under Attack 177

The Impact of the ACA 178
The Continuing Crisis in Health Care Costs 178
The Myths of Health Care Costs 178
Understanding Health Care Costs 180
Health Care Costs and the ACA 183
Health Care Costs and “Big Pharma” 183
The Continuing Crisis in Health
Care Access 188
Uninsured Americans 188
Underinsured Americans 189
The Consequences of Underinsurance and Lack of Insurance 189
The Prospects for State-Level Reform 190
Implications 191
Summary 192
Chapter 9 Health Care Around the Globe 195

Evaluating Health Care Systems 197
Universal Coverage 197
Portability 198
Geographic Accessibility 199
Comprehensive Benefits 200
Affordability 200
Financial Efficiency 201
Consumer Choice 201
Health Care in Other Countries 201
Germany: Social Insurance for Health Care 203
Canada: National Health Insurance 205
Great Britain: National Health Service 207
China: Promises and Perils 210
Mexico: Moving toward Equitable Health Care 213
Democratic Republic of Congo:When Health Care Collapses 216
Implications 217
Summary 218
CONTENTS xiii
Chapter 10 Health Care Settings and Technologies 221

The Hospital 223
The Premodern Hospital 223
Beginnings of the Modern Hospital 224
The Rise of the Modern Hospital 225
Hospitals Today 225
The Hospital–Patient Experience 226
The Shift Away from Hospitals 227
Nursing Homes 227
Gender, Age, Ethnicity, Class, and Nursing Home Usage 227
Financing Nursing Home Care 228
Working in Nursing Homes 229
Life in Nursing Homes 229
Hospices 231
Origins of Hospice 231
Modern Hospices 231
Use of Hospice 233
Outcomes of Hospice Care 234
Home Care 234
The Nature of Family Caregiving 235
Easing the Burdens of Caregiving 236
Health Care Technologies 237
The Nature of Technology 237
The Social Construction of Technology 239
The Technological Imperative 240
Technology and the Changing Nature of Health Care 241
Implications 242
Summary 243
PA R T IV Health Care, Health Research, and Bioethics 247
Chapter 11 The Profession of Medicine 248

American Medicine in the Nineteenth Century 250
The Rise of Medical Dominance 253
The Flexner Report and Its Aftermath 253
Doctors and Professional Dominance 254
xiv CONTENTS
The Threats to Medical Dominance 255

The Rise of Corporatization 255
The Rise of Government Control 256
The Decline in Public Support 258
The Decline of the American Medical Association and Countervailing
Powers 258
The Continued Strength of Medical Dominance 259
Medical Education and Medical Values 261
The Structure of Medical Education 261
Ethnicity, Sex, Class, and Medical Education 262
Learning Medical Values 263
The Consequences of Medical Values 267
Patient–Doctor Relationships 268
Power and Paternalism 269
Ethnicity, Class, Gender, and Paternalism 269
Paternalism as Process 270
Shifting Patient Roles and the Decline of Paternalism 271
Reforming Medical Training 271
Implications 272
Summary 273
Chapter 12 Other Mainstream and Alternative Health

Care Providers 276
Mainstream Health Care Providers 278
Nursing:The Struggle for Professional Status 278
Osteopathy: A Parallel Profession 284
Dentistry: Maintaining Independence 288
Alternative Health Care Providers 289
Chiropractors: From Marginal to Limited Practitioners 290
Direct-Entry Midwives: Limited but Still Marginal 292
Curanderos 296
Acupuncturists 298
Implications 299
Summary 300
CONTENTS xv
Chapter 13 Issues in Bioethics 303

History of Bioethics 305
The Nazi Doctors and the Nuremberg Code 306
The Rise of Bioethics 308
Contemporary Issues in Bioethics 311
Reproductive Technology 311
Enhancing Human Traits 312
Resource Allocation and the Right to Refuse to Treat 313
CRISPR Technologies 314
Athletes and Concussions 314
Institutionalizing Bioethics 316
Hospital Ethics Committees 316
Institutional Review Boards 316
Professional Ethics Committees 317
Community Advisory Boards 317
The Impact of Bioethics 317
The Impact on Research 318
The Impact on Medical Education 320
The Impact on Clinical Practice 321
Implications 322
Summary 323
GL O S S ARY 325
REF ERENCES 340
I NDEX 381
Preface
The sociology of health, illness, and health care has changed dramatically over the
past few decades.The field was started primarily by sociologists who worked closely
with doctors, taking doctors’ assumptions about health and health care for granted
and primarily asking questions that doctors deemed important. By the 1970s, how-
ever, the field had begun shifting toward a decidedly different set of questions. Some
of these new questions challenged doctors’ assumptions, whereas others focused on
issues that lay outside most doctors’ areas of interest or expertise such as how poverty
affects health or how individuals develop meaningful lives despite chronic illness.
I entered graduate school during this shift, drawn by the opportunity to study
how health and illness are socially created and defined and how gender, ethnicity,
social class, and power affect both the health care system and individual experi-
ences of health and illness. As a result, over the years I have researched such topics
as how medical values affect doctors’ use of genetic testing, how midwives and
doctors have battled for control over childbirth, and how social ideas about AIDS
affect the lives of those who live with this disease.
Although I had no trouble incorporating this new vision of the sociology of
health, illness, and health care into my research, I consistently found myself frus-
trated by the lack of a textbook that would help me incorporate it into my teach-
ing. Instead, most textbooks still seemed to reflect older ideas about the field and
to take for granted medical definitions of the situation. Most basically, the books
assumed that doctors define illness according to objective biological criteria, so
they failed to question whether political and social forces underlie the process of
defining illnesses. Similarly, most textbooks ignored existing power relationships
rather than investigating the sources, nature, and health consequences of those
relationships. For example, the textbooks gave relatively little attention to how
doctors gained control over health care or how the power of the more developed
nations has affected health in less developed nations. As a result, these textbooks
used sociology primarily to answer questions posed by those working in the health
xvi
P R E FA C E xvii
care field, such as what social factors lead to heart disease and why patients might
ignore their doctors’ orders. Consequently, these textbooks often seemed to offer
a surprisingly unsociological perspective with their coverage of some topics differ-
ing little from coverage of those topics in health education textbooks.
Because the textbooks available when I first began working on this book
often avoided critical questions about health, illness, and health care, they seemed
unlikely to encourage students to engage with the materials and to question either
the presented materials or their own assumptions such as the belief that the United
States has the world’s best health care system, that medical advances explain the
modern rise in life expectancy, or that all Americans receive the same quality of
health care regardless of their ethnicity, gender, or social class. Instead, the text-
books primarily gave students already-processed information to memorize.
My purpose in writing this textbook was to fill these gaps by presenting a
critical approach to the sociology of health, illness, and health care. This did not
mean presenting research findings in a biased fashion or presenting only research
that supported my preexisting assumptions, but it did mean using critical skills to
interpret the available research and to pull it together into a coherent “story” in
each chapter. In addition, I hoped to tell these stories in a manner that would en-
gage students—whether in sociology classes, medical schools, or nursing schools—
and encourage them to learn actively and think independently. These remain the
primary goals of this eighth edition. Both of these goals led me to decide against
trying to please all sides or cover all topics because I believe such a strategy leads
to a grab-bag approach that makes textbooks hard to follow and to an intellectual
homogenization that makes them seem lifeless.
THE CRITICAL APPROACH
The critical approach, as I have defined it, means using the “sociological imag-
ination” to question taken-for-granted aspects of social life. For example, most
of the available textbooks in the sociology of health, illness, and health care still
view patients who do not comply with prescribed medical regimens essentially
through doctors’ eyes, starting from the assumption that patients should comply.
More broadly, previous textbooks have highlighted the concept of a sick role—a
concept that embodies medical and social assumptions regarding “proper” illnesses
and “proper” patients and downplays all aspects of individuals’ lives other than the
time they spend as patients.
In contrast, I emphasize recent research that questions such assumptions. For
example, I discuss patient compliance by examining how patients view medi-
cal regimens and compliance, why doctors sometimes have promoted medical
treatments (such as hormone therapy for menopausal women) that later proved
dangerous and how doctors’ tendency to cut short patients’ questions can foster
patient noncompliance. Similarly, this textbook explains the concept of a sick role
but pays more attention to the broader experience of illness—a topic that has gen-
erated far more sociological research than the sick role has over the past 20 years.
xviii P R E FA C E
CHAPTER ORGANIZATION
This textbook demonstrates the breadth of topics included in the sociology of

health, illness, and health care. Part I discusses the role that social factors play in
fostering illness and in determining which social groups experience which ill-
nesses. Chapter 1 offers an introduction to the field, the sociological approach, and
the history of disease. Chapter 2 describes the major causes of preventable deaths
in the United States, demonstrating how social as well as biological factors affect
health and illness. Building on this basis, Chapter 3 describes how age, sex, gender,
social class, race, and ethnicity affect the likelihood, nature, and consequences of
illness in the United States. Finally, Chapter 4 explores the nature and sources of
illness in the poorer countries of Asia, Africa, and Latin America.
Part II analyzes the meaning and experience of illness and disability in the
United States. Chapter 5 explores the social meanings of illness and social ex-
planations for illness as well as the social consequences of defining behaviors and
conditions as illnesses. With this as a basis, Chapter 6 first explores the meaning of
disability and then offers a sociological overview of the experience of living with
chronic pain, chronic illness, or disability, including the experience of seeking care
from both medical doctors and alternative health care providers. Finally, Chapter 7
provides a parallel assessment of mental illness.
Part III moves the analysis to the macro level. Chapter 8 describes the U.S.
health care system, the battles surrounding the 2010 Patient Protection and
Affordable Care Act, and the continuing crises in health care costs and accessibil-
ity. Chapter 9 offers some basic measures for evaluating health care systems and
then uses these measures to evaluate the systems found in Canada, Great Britain,
Germany, the People’s Republic of China, Mexico, and the Democratic Republic
of Congo. Finally, Chapter 10 examines four common health care settings—
hospitals, hospices, nursing homes, and family homes—and provides a social
analysis of the technologies used in those settings.
Part IV shifts the focus from the health care system to health care providers.
Chapter 11 analyzes the nature and source of doctors’ professional status as well
as the threats to that status. The chapter also describes the process of becoming a
doctor, the values embedded in medical culture, and the impact of those values on
doctor–patient relationships. Chapter 12 describes the history and social position
of various health care occupations, including dentistry, nursing, osteopathy, and
acupuncture. Finally, Chapter 13 presents a sociological overview of bioethics.
COVERAGE
Although I have tried in this book to present a coherent critical view, I have not
sacrificed coverage of topics that professors have come to expect. Consequently,
this book covers essentially all the topics that have become standard over the years,
including doctor–patient relationships, the nature of the U.S. health care system,
P R E FA C E xix
and the social distribution of illness. In addition, I include several topics that until
recently received relatively little coverage in other textbooks in the field, includ-
ing bioethics, mental illness, the medical value system, the experience of illness
and disability, and the social sources of illness in both more and less developed
nations. As a result, this text includes more materials than most teachers can cover
effectively in a semester. To assist those who choose to skip some chapters, each
important term is printed in bold the first time it appears in each chapter, alerting
students that they can find a definition in the book’s Glossary. (Each term is both
printed in bold and defined the first time it appears in the book.)
In addition, reflecting my belief that sociology neither can nor should exist in
isolation but must be informed by and in turn inform other related fields, several
chapters begin with historical overviews. For example, the chapter on health care
institutions discusses the political and social forces that led to the development of
the modern hospital, and the chapter on medicine as a profession discusses how
and why the status of medicine grew so dramatically after 1850. These discussions
provide a context to help students better understand the current situation.
CHANGES IN THE EIGHTH EDITION
Throughout the textbook, I have worked to update statistics as well as reviews of

topical issues and theoretical issues.Two-thirds of references in this new edition are
from the last 10 years, and fewer than 10% are from books or articles written be-
fore 1990—a level of timeliness that significantly surpasses that of most textbooks.
The reader can thus safely assume that, wherever possible, the statistics, policy
summaries, and legal information are the latest available.
New and Updated Chapter Topics

Chapter 2
■ E-cigarettes
■ Distracted driving and rise in automobile fatalities and distracted driving
■ The opioid epidemic
■ Updated discussion of premature causes of death
Chapter 3
■ Climate change, poverty, and ill health
■ Transgender health
■ Mass incarceration and health
Chapter 4
■ Neglected tropical disease
■ Zika virus
xx P R E FA C E
Chapter 7
■ Recent challenges to psychiatric diagnosis
■ Mental health and the Affordable Care Act
Chapter 8
■ The impact of the ACA
■ The ACA under attack
Chapter 9
■ Updated statistics and descriptions of health care in five nations
Chapter 10
■ Technology, terrorism and public health
■ Updated statistics on hospice care, hospitals, nursing homes, and home care
Chapter 11
■ “Boutique medicine”
Chapter 12
■ Updated statistics on each health care occupation
Chapter 13
■ CRISPR technologies
New or Revised Tables and Figures
■ Map 2.1 Overdose Deaths Per 100,000 Persons, United States
■ Table 2.1 Main Causes of Deaths, 1900 and 2016
■ Table 2.2 Underlying Causes of Premature Death in the United States, 2010
■ Figure 3.1 Life Expectancy by Race and Ethnicity and Sex
■ Table 3.1 Infant Mortality Rates in Different Nations and U.S. Ethnic Groups
■ Table 3.2 Top Causes of Death by Ethnicity
■ Table 4.1 Life Expectancy and Infant Mortality by Development Level
■ Table 4.2 Leading Causes of Death around the World
■ Table 6.1 Percentage of Americans with Basic Activity Limitations
■ Table 7.1 Sex, Ethnicity, and Social Class Groups with the Highest Lifetime
Risks of Specific Mental Illnesses
■ Figure 7.1 Antidepressant Use in the Past 30 Days, United States
■ Figure 8.1 Health Expenses and Inpatient Days in Acute Care Hospitals in
30 Nations
■ Figure 8.2 Health Expenses and Number of Doctor Visits in 30 Nations
■ Figure 8.3 Health Expenses and Life Expectancy in 30 Nations
■ Table 9.1 Characteristics of Health Care Systems in Seven Countries
■ Figure 11.1 Median Salaries by Percentage Women in Specialty
P R E FA C E xxi
PEDAGOGICAL FEATURES FOR STUDENTS
Learning Objectives
Each chapter opens with a list of learning objectives matched to the chapter’s main
sections. These objectives help students focus their studying by alerting them to
the chapter’s main themes.The objectives also can help students demonstrate their
ability to apply what they have learned and can help both students and faculty
assess students’ understanding.
Chapter Openings
Unfortunately, many students take courses only to fill a requirement. As a result, the
first problem professors face is interesting students in the topic. For this reason, the
main text of each chapter begins with a vignette taken from a sociological or literary
source that is chosen to spark students’ interest by demonstrating that the topic has
real consequences for real people—that, for example, stigma is not simply an abstract
concept but something that can cost ill persons their friends, jobs, and social standing.
Chapter “Road Maps”

To help orient students to the chapters, each chapter’s introductory section ends
with a brief overview of what is to come.
Contemporary Issues
To further raise student interest and add to their knowledge, most chapters include
a boxed discussion of a relevant topic taken from recent news reports. Topics in-
clude the debate over full-body computed tomography scans and the decline of
primary care. These boxes should spark student interest while helping them make
connections between textbook topics and the world around them.
Ethical Debates
To teach students that ethical dilemmas pervade health care, most chapters include
a discussion of a relevant ethical debate.The debates are complex enough that stu-
dents must use critical thinking skills to assess them; teachers can use these debates
for classroom discussions, group exercises, or written assignments.
Key Concepts
To help students understand particularly important and complex topics, such
as the difference between the sociological and medical models of illness or the
strengths and weaknesses of the sick role model, I have included Key Concepts
tables or boxes in several chapters.
xxii P R E FA C E
Implications Essays
Each chapter ends with a brief essay that discusses the implications of the chapter
and points the reader toward new questions and issues. These essays should stimu-
late critical thinking and can serve as the basis for class discussions.
Chapter Summaries
Each chapter ends with a detailed, bulleted summary that will help students to
review the material and identify key points.
Review Questions and Critical Thinking Questions

Each chapter includes both Review Questions that take students through the
main points of the chapter and Critical Thinking Questions that push students to
extrapolate from the chapter to other issues or to think more deeply about issues
discussed within the chapter.
Glossary
The book includes an extensive Glossary that defines all important terms used
in the book. Each Glossary term is printed in bold and defined the first time it
appears in the text. In addition, each term is also printed in bold the first time it
appears in each chapter, so students will know that they can find a definition in
the Glossary.
SUPPLEMENTAL AND PEDAGOGICAL FEATURES

FOR FACULTY
Instructor’s Manual with Test Bank

For each chapter, the Instructor’s Manual contains a detailed summary, a set of
multiple-choice questions, and a list of relevant books, narrative films, and docu-
mentaries. In addition, the Instructor’s Manual includes several questions for each
chapter that require critical-thinking skills to answer and that teachers can use
for essay exams, written assignments, in-class discussions, or group projects. The
manual also includes for each chapter a set of Internet exercises designed both to
familiarize students with materials available on the Web and to facilitate critical
reading and use of those materials. Finally, the manual lists for each chapter a few
relevant nonprofit organizations. Organizations listed in the manual can serve as
sources for more information or as sites for out-of-class assignments.
The Test Bank contains up to 20 multiple-choice questions, five true/false
questions, and five essay questions per chapter, all fully updated according to match
the eighth edition’s content.
P R E FA C E xxiii
To guarantee the quality of the Instructor’s Manual with Test Bank, I wrote ev-
erything in it rather than relying on student assistants. The manual is available for
downloading at http://login.cengage.com.
PowerPoint Lectures
PowerPoint lectures for each chapter, including all tables and figures, can be down-
loaded from http://login.cengage.com. These lectures should prove useful both
for new adopters and for past users who would like to incorporate more visual
materials into their classrooms. As with the Instructor’s Manual, I put these lectures
together myself to ensure their quality.
Critical Thinking
In this textbook, I have aimed not only to present a large body of data in a coher-
ent fashion but also to create an intellectually rigorous textbook that will stimulate
students to think critically. I have tried to keep this purpose in mind in writing
each chapter. Debates discussed within the chapters, as well as the various chapter
features, all encourage students to use critical thinking, and all serve as resources
that teachers can use in building their class sessions.
ACKNOWLEDGMENTS
In writing this textbook, I have benefited enormously from the generous assis-
tance of my colleagues. I am fortunate to have had several exceptional scholars
as colleagues over the years—Victor Agadjanian, Jill Fisher,Verna Keith, Bradford
Kirkman-Liff, Jennie Jacobs Kronenfeld, and Deborah Sullivan—who shared my
interest in health issues and helped me improve various chapters. I am also excep-
tionally fortunate to have had the assistance of several research assistants—Natasha
McLain, Allex Raines, Ashley Fenzl, Allison Hickey, Ann Jensby, Melinda Konicke,
Christopher Lisowski, Stephanie Mayer, Leslie Padrnos, Zina Schwartz, Diane
Sicotte, Lisa Tichavsky, Caroleena Von Trapp, and especially Karl Bryant, Lisa
Comer, and Amy Weinberg, who worked on the first edition.
Because, of necessity, this textbook covers a wealth of topics that range far
beyond my own areas of expertise, I have had to rely heavily on the kindness of
strangers in writing it. One of the most rewarding aspects of writing this book
has been the pleasure of receiving information, ideas, critiques, and references
from individuals I did not previously know. This edition was undoubtedly
improved by suggestions from Ellen Annandale (University of York), Maria
Dolores Corona (Universidad Autónoma de Nuevo León), Georgiann Davis
(University of Nevada, Las Vegas),Victoria Fan (University of Hawai`i at Mānoa),
Siegfried Geyer (Hannover Medical School), Lei Jin (Chinese University of
Hong Kong), Tey Meadow (Harvard University), Melissa A. Milkie (University
of Toronto), Jiong Tu (Sun Yat-sen University), Carla A. Pfeffer (University of
xxiv P R E FA C E
South Carolina), Helen Rosenberg (University of Wisconsin-Parkside), Ian Shaw

(University of Nottingham), Lisa Strohschein (University of Alberta), and Diane
Kholos Wysocki (formerly of University of Nebraska–Kearney).
In addition, I would like to once again thank those who gave me the ben-
efit of their expert advice on previous editions: Astrid Eich-Krohm (Uni-
versity Hospital Magdeburg), Krista Hodges (University of Hawaii), Michael
Polgar (Penn State University), Jennifer Schumann, Ian Shaw (University of
Nottingham), Julia Stumkat, and Wei Zhang (University of Hawaii), Emily Abel
(University of California–Los Angeles); James Akré (World Health Organization);
Ellen Annandale (University of Leicester); Ofra Anson (Ben Gurion University
of the Negev); Judy Aulette (University of North Carolina; Charlotte); Miriam
Axelrod; James Bachman (Valparaiso University); Kristin Barker (University of
New Mexico); Paul Basch (Stanford University); Phil Brown (Brown Univer-
sity); Peter Conrad (Brandeis University); Timothy Diamond (California State
University–Los Angeles); Luis Durán (Mexican Institute of Social Security);
Elizabeth Ettorre (University of Liverpool); Michael Farrall (Creighton Uni-
versity); Kitty Felker; Arthur Frank (University of Alberta); María Hilda García-
Pérez (Arizona State University); Alya Guseva (Boston University); Frederic W.
Hafferty (University of Minnesota–Duluth); Harlan Hahn (University of Southern
California); Ida Hellander (Physicians for a National Health Program); Paul
Higgins (University of South Carolina); Allan Horwitz (Rutgers University);
David J. Hunter (University of Durham); Joseph Inungu (Central Michigan
University); Michael Johnston (University of California–Los Angeles); Stephen
J. Kunitz (University of Rochester); Donald W. Light (University of Medicine
and Dentistry of New Jersey); Judith Lorber (City University of New York);
William Magee (University of Toronto); Judy Mayo; Peggy McDonough (Uni-
versity of Toronto); Jack Meyer (Economic & Social Research Institute); Cindy
Miller; Jeanine Mount (University of Wisconsin); Marilynn M. Rosenthal (Univer-
sity of Michigan); Beth Rushing (Kent State University); C. J. Schumaker (Walden
University); Wendy Simonds (Georgia State University); Teresa Scheid (University
of North Carolina at Charlotte); Clemencia Vargas (Centers for Disease Con-
trol and Prevention); Olaf von dem Knesebeck (University of Hamburg); Robert
Weaver and his students, especially Cheryl Kratzer (Youngstown State University);
Daniel Whitaker; David R. Williams (University of Michigan); Irving Kenneth
Zola (Brandeis University); and Robert Zussman (University of Massachusetts–
Amherst). This book undoubtedly would have been better if I had paid closer
attention to their comments. I apologize sincerely if I have left anyone off this list.
Similarly, I am deeply grateful for the advice received from reviewers of this
edition: Andrew Bedrous (Kansas Wesleyan University), DeAnna Gore (Univer-
sity of South Carolina, Aiken), Muhammad Haque (McNeese State University),
Caroline Hartnett (University of South Carolina), Marta Jankowska (San
Diego State University),Yushi Li (Northern Kentucky University), Elgin Mannion
(Western Illinois University), Jewrell Rivers (Abraham Baldwin Agricultural
College), Sharon Sassler (Cornell University), and Paul Sutton (University of
Denver).
P R E FA C E xxv
I also remain grateful for the suggestions from reviewers on previous edi-
tions: Jennifer Bulanda (Miami University), Benjamin Drury (Indiana Univer-
sity at Columbus), Jamie Gusrang (Community College of Philadelphia), David
Mullins (University of Saint Francis), Claire Norris (Xavier University of Louisiana),
Michael Polgar (Penn State University), Richard Scotch (University of Texas at
Dallas), Nicole Vadino (Community College of Philadelphia, Thomas Allen (Uni-
versity of South Dakota), Karen Bettez (Boston College), Linda Liska Belgrave
(University of Miami), Pamela Cooper-Porter (Santa Monica College), Karen
Frederick (St. Anselm College), Stephen Glazier (University of Nebraska), Linda
Grant (University of Georgia), Janet Hankin (Wayne State University), Heather
Hartley (Portland State University), Alan Henderson (California State University–
Long Beach), Simona Hill (Susquehanna University), Frances Hoffman (Uni-
versity of Missouri), Joseph Kotarba (University of Houston), Lilly M. Langer
(Florida International University), Christine Malcom (Roosevelt University),
Keith Mann (Cardinal Stritch University), Phylis Martinelli (St. Mary’s College
of California), Dan Morgan (Hawaii Pacific University), Larry R. Ridener
(Pfeiffer University), Susan Smith (Walla Walla University), Kathy Stolley
(Virginia Wesleyan College), Deborah Sullivan (Arizona State University), Gary
Tiedman (Oregon State University), Diana Torrez (University of North Texas),
Linda Treiber (Kennesaw State University), Robert Weaver (Youngstown State
University), and Diane Zablotsky (University of North Carolina–Charlotte).
Finally, I would like to express my appreciation to the current and former
Cengage staff who made the process of revising this book for its eighth edition as
smooth as possible: Sharib Asrar, Mike Bailey, Julie Dierig, Deanna Ettinger, Ava
Fruin, Jayne Stein, Wendy Huska, and Jenny Ziegler.
About the Author
Rose Weitz received her doctoral degree in sociology fromYale University in 1978.
Since then, she has carved an exceptional record as both a scholar and a teacher.
She is the author of numerous scholarly articles, the book Life with AIDS, and the
book Rapunzel’s Daughters: What Women’s Hair Tells Us About Women’s Lives. She
also is coauthor of Labor Pains: Modern Midwives and Home Birth and coeditor of The
Politics of Women’s Bodies: Appearance, Sexuality, and Behavior.
Professor Weitz has won several teaching awards (including the Pacific So-
ciological Association’s Distinguished Contributions to Teaching Award, the ASU
Last Lecture Award, and the ASU College of Liberal Arts and Sciences Outstand-
ing Teaching Award) and has served as director of ASU’s graduate and under-
graduate sociology and gender studies programs. In addition, she has served as
president of Sociologists for Women in Society, as chair of the Sociologists AIDS
Network, and as chair of the Medical Sociology Section of the American Socio-
logical Association.
xxvi
PA R T
I
Social Factors and Illness
Chapter 1 The Sociology of Health, Illness, and Health Care
Chapter 2 The Social Sources of Modern Illness
Chapter 3 The Social Distribution of Illness in the United States
Chapter 4 Illness and Death in the Less Developed Nations
Illness is a fact of life. Everyone experiences illness sooner or later, and everyone
eventually must cope with illness among close friends and relatives.
To the ill individual, illness can seem a purely internal and personal experi-
ence. But illness is also a social phenomenon with social roots and social conse-
quences. In this first part, we look at the role that social factors play in fostering
illness within societies and in determining which groups in a given society will
experience which illnesses with which consequences.
Chapter 1 introduces the sociological perspective and illustrates how sociol-
ogy can help us understand issues related to health, illness, and health care. The
chapter also provides a brief history of disease in the Western world, which high-
lights how social factors can foster disease. In the subsequent chapters, we explore
the role social forces play in causing disease and in determining who gets ill in
the modern world. In Chapter 2, we review the basic concepts needed to discuss
diseases and look at modern patterns of disease. After that, we look at the social
sources of illness in the contemporary United States and at some social factors that
help predict individual health and illness. In Chapter 3, we investigate how four
social factors—age, sex and gender, social class, and race or ethnicity—affect the
1
2 PA RT I
distribution of illness in the United States and explore why some social groups
bear a greater burden of illness than others. Finally, in Chapter 4, we analyze the
very different pattern of illnesses found in poorer countries and explain how social
forces—from the low status of women to the rise of migrant labor—can foster
illness in these countries.
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A TRESTLE BRIDGE, NO. 2.
When a line of works was laid out through woods, much slashing,
or felling of trees, was necessary in its front. This was especially
necessary in front of forts and batteries. Much of this labor was done
by the engineers. The trees were felled with their tops toward the
enemy, leaving stumps about three feet high. The territory covered
by these fallen trees was called the Slashes, hence Slashing. No
large body of the enemy could safely attempt a passage through
such an obstacle. It was a strong defence for a weak line of works.
The Gabions, being hollow cylinders of wicker-work without
bottom, filled with earth, and placed on the earthworks; the Fascines,
being bundles of small sticks bound at both ends and intermediate
points, to aid in raising batteries, filling ditches, etc.; Chevaux-de-
frise, a piece of timber traversed with wooden spikes, used
especially as a defence against cavalry; the Abatis, a row of the
large branches of trees, sharpened and laid close together, points
outward, with the butts pinned to the ground; the Fraise, a defence of
pointed sticks, fastened into the ground at such an incline as to bring
the points breast-high;—all these were fashioned by the engineer
corps, in vast numbers, when the army was besieging Petersburg in
1864.
A LARGE GABION.
But
the
crownin
g work
of this
corps,
as it
always CHEVAUX-DE-FRISE.
seeme
d to
me, the department of their labor for which, I
believe, they will be the longest remembered, was
that of ponton-bridge laying. The word ponton, or
pontoon, is borrowed from both the Spanish and
French languages, which, in turn, derive it from the
parent Latin, pons, meaning a bridge, but it has now
come to mean a boat, and the men who build such
bridges are called by the French pontoniers. In fact,
the system of ponton bridges in use during the
FASCINES. Rebellion was copied, I believe, almost exactly from
the French model.
The first ponton bridge which I recall in history was built by Xerxes,
nearly twenty-four hundred years ago, across the Hellespont. It was
over four thousand feet long. A violent storm broke it up, whereupon
the Persian “got square” by throwing two pairs of shackles into the
sea and ordering his men to give it three hundred strokes of a whip,
while he addressed it in imperious language. Then he ordered all
those persons who had been charged with the construction of the
bridge to be beheaded. Immediately afterwards he had two other
bridges built, “one for the army to pass over, and the other for the
baggage and beasts of burden. He appointed workmen more able
and expert than the former, who went about it in this manner. They
placed three hundred and sixty vessels across, some of them having
three banks of oars and others fifty oars apiece, with their sides
turned towards the Euxine (Black) Sea; and on the side that faced
the Ægean Sea they put three hundred and fourteen. They then cast
large anchors into the water on both sides, in order to fix and secure
all these vessels against the violence of the winds and the current of
the water. On the east side they left three passages or vacant
spaces, between the vessels, that there might be room for small
boats to go and come easily, when there was occasion, to and from
the Euxine Sea. After this, upon the land on both sides, they drove
large piles into the earth, with huge rings fastened to them, to which
were tied six vast cables, which went over each of the two bridges:
two of which cables were made of hemp, and four of a sort of reeds
called βιβλος, which were made use of in those times for the making
of cordage. Those that were made of hemp must have been of an
extraordinary strength and thickness since every cubit in length
weighed a talent (42 pounds). The cables, laid over the whole extent
of the vessels lengthwise, reached from one side to the other of the
sea. When this part of the work was finished, quite over the vessels
from side to side, and over the cables just described, they laid the
trunks of trees cut for that purpose, and planks again over them,
fastened and joined together to serve as a kind of floor or solid
bottom; all which they covered over with earth, and added rails or
battlements on each side that the horses and cattle might not be
frightened at seeing the sea in their passage.”
Compare this bridge
of Xerxes with that
hereinafter described,
and note the points of
similarity.
One of the earliest
pontons used in the
ABATIS.
Rebellion was made of
India-rubber. It was a
sort of sack, shaped not
unlike a torpedo, which had to be inflated before use. When thus
inflated, two of these sacks were placed side by side, and on this
buoyant foundation the bridge was laid. Their extreme lightness was
a great advantage in transportation, but for some reason they were
not used by the engineers of the Army of the Potomac. They were
used in the western army, however, somewhat. General F. P. Blair’s
division used them in the Vicksburg campaign of 1863.
Another ponton which
was adopted for bridge
service may be
described as a skeleton
boat-frame, over which
was stretched a cotton-
canvas cover. This was
a great improvement THE FRAISE.
over the tin or copper-
covered boat-frames,
which had been thoroughly tested and condemned. It was the variety
used by Sherman’s army almost exclusively. In starting for
Savannah, he distributed his ponton trains among his four corps,
giving to each about nine hundred feet of bridge material. These
pontons were suitably hinged to form a wagon body, in which was
carried the canvas cover, anchor, chains, and a due proportion of
other bridge materials. This kind of bridge was used by the volunteer
engineers of the Army of the Potomac. I recall two such bridges.
One spanned the Rapidan at Ely’s Ford, and was crossed by the
Second Corps the night of May 3, 1864, when it entered upon the
Wilderness campaign. The other was laid across the Po River, by the
Fiftieth New York Engineers, seven days afterwards, and over this
Hancock’s Veterans crossed—those, at least, who survived the
battle of that eventful Tuesday—before nightfall.
But all of the long bridges, notably those crossing the
Chickahominy, the James, the Appomattox, which now come to my
mind, were supported by wooden boats of the French pattern. These
were thirty-one feet long, two feet six inches deep, five feet four
inches wide at the top, and four feet at the bottom. They tapered so
little at the bows and sterns as to be nearly rectangular, and when
afloat the gunwales were about horizontal, having little of the curve
of the skiff.
A CANVAS PONTOON BOAT. FROM A PHOTOGRAPH.
The floor timbers of the bridge, known as Balks, were twenty-five

and one-half feet long, and four and one-half inches square on the
end. Five continuous lines of these were laid on the boats two feet
ten inches apart.
The flooring of the bridge, called chesses, consisted of boards
having a uniform length of fourteen feet, a width of twelve inches,
and a thickness of one and a half inches.
To secure the chesses in place, side-rails of about the same
dimensions as the balks were laid upon them over the outer balks, to
which the rails were fastened by cords known as rack-lashings.
The distance between the centres of two boats in position is called
a bay. The distance between the boats is thirteen feet ten inches.
The distance between the side-rails is eleven feet, this being the
width of the roadway.
AN ANGLE OF FORT HELL (SEDGWICK) SHOWING GABIONS, CHEVAUX-DE-

FRISE, ABATIS AND FRAISE. FROM A PHOTOGRAPH.
An abutment had to be constructed at either end of a bridge, which

was generally done by settling a heavy timber horizontally in the
ground, level with the top of the bridge, confining it there by stakes.
A proper approach was then made to this, sometimes by grading,
sometimes by corduroying, sometimes by cutting away the bank.
The boats, with all other bridge equipage, were carried upon
wagons, which together were known as the Ponton Train. Each
wagon was drawn by six mules. A single boat with its anchor and
cable formed the entire load for one team. The balks were loaded on
wagons by themselves, as were also the chesses, and the side-rails
on others. This system facilitated the work of the pontoniers. In
camp, the Ponton Train was located near army headquarters. On the
march it would naturally be in rear of the army, unless its services
were soon to be made use of. If, when the column had halted, we
saw this train and its body-guard, the engineers, passing to the front,
we at once concluded that there was “one wide river to cross,” and
we might as well settle down for a while, cook some coffee, and take
a nap.
In order to get a better idea of ponton-bridge laying, let us follow
such a train to the river and note the various steps in the operation. If
the enemy is not holding the opposite bank, the wagons are driven
as near as practicable to the brink of the water, unloaded, and driven
off out of the way. To avoid confusion and expedite the work, the
corps is divided up into the abutment, boat, balk, lashing, chess, and
side-rail parties. Each man, therefore, knows just what he has to do.
The abutment party takes the initiative, by laying the abutment, and
preparing the approaches as already described. Sometimes, when
the shore was quite marshy, trestle work or a crib of logs was
necessary in completing this duty, but, as the army rarely
approached a river except over a recognized thoroughfare, such
work was the exception.
While this party has been vigorously prosecuting its special labors,
the boat party, six in number, have got a ponton afloat, manned it,
and ridden to a point a proper distance above the line of the
proposed bridge, dropped anchor, and, paying out cable, drop down
alongside the abutment, and go ashore. The balk party are on hand
with five balks, two men to each, and having placed these so that
one end projects six inches beyond the outer gunwale of the boat,
they make way for the lashing party, who lash them in place at
proper intervals as indicated on the gunwales. The boat is then
pushed into the stream the length of the balks, the hither ends of
which are at once made fast to the abutment.
A WOODEN PONTOON BOAT. FROM A PHOTOGRAPH.
The chess party now step to the front and cover the balks with
flooring to within one foot of the ponton. Meanwhile the boat-party
has launched another ponton, dropped anchor in the proper place,
and brought it alongside the first: the balk party, also ready with
another bay of balks, lay them for the lashing party to make fast; the
boat being then pushed off broadside-to as before, and the free end
of the balks lashed so as to project six inches over the shore
gunwale of the first boat. By this plan it may be seen that each balk
and bay of balks completely spans two pontons. This gives the
bridge a firm foundation. The chess party continue their operations,
as before, to within a foot of the second boat. And now, when the
third bay of the bridge is begun, the side-rail party appears, placing
their rails on the chesses over the outside balks, to which they firmly
lash them, the chesses being so constructed that the lashings pass
between them for this purpose.
The foregoing operations are repeated bay after bay till the bridge
reaches the farther shore, when the building of another abutment
and its approaches completes the main part of the work. It then
remains to scatter the roadway of the bridge with a light covering of
hay, or straw, or sand, to protect it from wear, and, perhaps, some
straightening here and tightening there may be necessary, but the
work is now done, and all of the personnel and matériel may cross
with perfect safety. No rapid movements are allowed, however, and
man and beast must pass over at a walk. A guard of the engineers is
posted at the abutment, ordering “Route step!” “Route step!” as the
troops strike the bridge, and sentries, at intervals, repeat the caution
further along. By keeping the cadence in crossing, the troops would
subject the bridge to a much greater strain, and settle it deeper in the
water. It was shown over and over again that nothing so tried the
bridge as a column of infantry. The current idea is that the artillery
and the trains must have given it the severest test, which was not the
case.
In taking up a bridge, the order adopted was the reverse of that
followed in laying it, beginning with the end next the enemy, and
carrying the chess and balks back to the other shore by hand. The
work was sometimes accelerated by weighing all anchors, and
detaching the bridge from the further abutment, allow it to swing
bodily around to the hither shore to be dismantled. One instance is
remembered when this manœuvre was executed with exceeding
despatch. It was after the army had recrossed the Rappahannock,
following the battle of Chancellorsville. So nervous were the
engineers lest the enemy should come upon them at their labors
they did not even wait to pull up anchors, but cut every cable and
cast loose, glad enough to see their flotilla on the retreat after the
army, and more delighted still not to be attacked by the enemy
during the operation,—so says one of their number.
One writer on the war speaks of the engineers as grasping “not
the musket but the hammer,” a misleading remark, for not a nail is
driven into the bridge at any point.
A PONTOON BRIDGE AT BELLE PLAIN, VA. FROM A PHOTOGRAPH.

When the Army of the Potomac retreated from before Richmond in
1862 it crossed the lower Chickahominy on a bridge of boats and
rafts 1980 feet long. This was constructed by three separate working
parties, employed at the same time, one engaged at each end and
one in the centre. It was the longest bridge built in the war, of which I
have any knowledge, save one, and that the bridge built across the
James, below Wilcox’s Landing, in 1864. This latter was a
remarkable achievement in ponton engineering. It was over two
thousand feet long, and the channel boats were firmly anchored in
thirteen fathoms of water. The engineers began it during the
forenoon of June 14, and completed the task at midnight. It was built
under the direction of General Benham for the passage of the
wagon-trains and a part of the troops, while the rest crossed in
steamers and ferry-boats.
But ponton bridges were not always laid without opposition or
interference from the enemy. Perhaps they made the most stubborn
contest to prevent the laying of the bridges across the
Rappahannock before Fredericksburg in December, 1862.
The pontoniers had partially laid one bridge before daylight; but
when dawn appeared the enemy’s sharpshooters, who had been
posted in buildings on the opposite bank, opened so destructive a
fire upon them that they were compelled to desist, and two
subsequent attempts to continue the work, though desperately
made, were likewise brought to naught by the deadly fire of
Mississippi rifles. At last three regiments, the Seventh Michigan, and
the Nineteenth and Twentieth Massachusetts, volunteered to cross
the river, and drive the enemy out of cover, which they did most
gallantly, though not without considerable loss. They crossed the
river in ponton boats, charged up the steep bank opposite, drove out,
or captured the Rebels holding the buildings, and in a short time the
first ponton bridge was completed. Others were laid near by soon
after. I think the engineers lost more men here—I mean now in
actual combat—than in all their previous and subsequent service
combined.
POPLAR GROVE CHURCH.
Ponton bridges were a source of great satisfaction to the soldiers.

They were perfect marvels of stability and steadiness. No swaying
motion was visible. To one passing across with a column of troops or
wagons no motion was discernible. It seemed as safe and secure as
mother earth, and the army walked them with the same serene
confidence as if they were. I remember one night while my company
was crossing the Appomattox on the bridge laid at Point of Rocks
that D. Webster Atkinson, a cannoneer, who stood about six feet and
a quarter in boots—dear fellow, he was afterwards mortally wounded
at Hatcher’s Run,—being well-nigh asleep from the fatigue of the all-
night march we were undergoing, walked off the bridge. Fortunately
for him, he stepped—not into four or five fathoms of water, but—a
ponton. As can readily be imagined, an unexpected step down of two
feet and a half was quite an “eye-opener” to him, but, barring a little
lameness, he suffered no harm.
The engineers, as a whole, led an enjoyable life of it in the service.
Their labors were quite fatiguing while they lasted, it is true, but they
were a privileged class when compared with the infantry. But they
did well all that was required of them, and there was no finer body of
men in the service.
The winter-quarters of the engineers were, perhaps, the most
unique of any in the army. In erecting them they gave their
mechanical skill full play. Some of their officers’ quarters were
marvels of rustic design. The houses of one regiment in the winter of
’63-4 were fashioned out of the straight cedar, which, being
undressed, gave the settlement a quaint but attractive and
comfortable appearance.
Their streets were corduroyed, and they even boasted sidewalks
of similar construction. Poplar Grove Church, erected by the Fiftieth
New York Engineers, a few miles below Petersburg, in 1864, still
stands, a monument to their skill in rustic design.
CHAPTER XXI.
TALKING FLAGS AND TORCHES.
“Ho! my comrades, see the signal

Waving through the sky;
Re-enforcements now appearing,
Victory is nigh.”
Yes, there were flags in the army which talked for the soldiers, and
I cannot furnish a more entertaining chapter than one which will
describe how they did it, when they did it, and what they did it for.
True, all of the flags used in the service told stories of their own.
What more eloquent than “Old Glory,” with its thirteen stripes,
reminding us of our small beginning as a nation, its blue field,
originally occupied by the cross of the English flag when Washington
first gave it to the breeze in Cambridge, but replaced later by a
cluster of stars, which keep a tally of the number of States in the
Union! What wealth of history its subsequent career as the national
emblem suggests, making it almost vocal with speech! The corps,
division, and brigade flags, too, told a little story of their own, in a
manner already described. But there were other flags, whose sole
business it was to talk to one another, and the stories they told were
immediately written down for the benefit of the soldiers or sailors.
These flags were Signal flags, and the men who used them and
made them talk were known in the service as the Signal Corps.
What was this corps for? Well, to answer that question at length
would make quite a story, but, in brief, I may say that it was for the
purpose of rapid and frequent communication between different
portions of the land or naval forces. The army might be engaged with
the enemy, on the march, or in camp, yet these signal men, with their
flags, were serviceable in either situation, and in the former often
especially so; but I will begin at the beginning, and present a brief
sketch of the origin of the Signal Corps.
The system of signals used in both armies during the Rebellion
originated with one man—Albert J. Myer, who was born in Newburg,
N. Y. He entered the army as assistant surgeon in 1854, and, while
on duty in New Mexico and vicinity, the desirability of some better
method of rapid communication than that of a messenger impressed
itself upon him. This conviction, strengthened by his previous lines of
thought in the same direction, he finally wrought out in a system of
motion telegraphy.[2]
[2] These facts are taken from a small pamphlet written by

Lieutenant J. Willard Brown of West Medford, Mass., and issued
by the Signal Corps Association. Other facts pertaining to
signalling have been derived from “A Manual of Signals,” written
by General Myer (Old Probabilities) himself, since the war.
Recognizing to some extent the value of his system, Congress

created the position of Chief Signal Officer of the army, and Surgeon
Myer was appointed by President Buchanan to fill it. Up to some time
in 1863 Myer was not the Chief Signal Officer alone, but the only
signal officer commissioned as such, all others then in the corps—
and there were quite a number—being simply acting signal officers
on detached service from various regiments.
One of the officers in the regular army, whom Surgeon Myer had
instructed in signalling while in New Mexico, went over to the enemy
when the war broke out and organized a corps for them.
From this small beginning of one man grew up the Signal Corps.
As soon as the value of the idea had fairly penetrated the brains of
those whose appreciation was needed to make it of practical value,
details of men were made from the various regiments around
Washington, and placed in camps of instruction to learn the use of
the “Signal Kit,” so called. The chief article in this kit was a series of
seven flags, varying from two feet to six feet square. Three of these
flags, one six feet, one four feet, and one two feet square, were
white, and had each a block of red in the centre one-third the
dimensions of the flag; that is, a flag six feet square had a centre two
feet square; two flags were black with white centres, and two were
red with white centres. When the flags were in use, they were tied to
a staff, whose length varied with the size of the flag to be used. If the
distance to signal was great, or obstructions intervened, a long staff
and a large flag were necessary; but the four-foot flag was the one in
most common use.
It will be readily inferred that the language of these flags was to be
addressed to the eye and not the ear. To make that language plain,
then, they must be distinctly seen by the persons whom they
addressed. This will explain why they were of different colors. In
making signals, the color of flag to be used depended upon the color
of background against which it was to appear. For example, a white
flag, even with its red centre, could not be easily seen against the
sky as a background. In such a situation a black flag was necessary.
With green or dark-colored backgrounds the white flag was used,
and in fact this was the flag of the signal service, having been used,
in all probability, nine times out of every ten that signals were made.
Before the deaf and dumb could be taught to talk, certain motions
were agreed upon to represent particular ideas, letters, and figures.
In like manner, a key, or code, was constructed which interpreted the
motions of the signal flag,—for it talked by motions,—and in accord
with which the motions were made. Let me illustrate these motions
by the accompanying cuts.
Plate 1 represents a member of the Signal Corps in position,
holding the flag directly above his head, the staff vertical, and
grasped by both hands. This is the position from which all the
motions were made.
PLATE 1.
Plate 2 represents the flagman making the numeral “2” or the letter
“i.” This was done by waving the flag to the right and instantly
returning it to a vertical position. To make “1” the flag was waved to
the left, and instantly returned as before. See plate 3. This the code
translated as the letter “t” and the word “the.” “5” was made by
waving the flag directly to the front, and returning at once to the
vertical.
PLATE 2.
PLATE 3.
The signal code most commonly used included but two symbols,
which made it simple to use. With these, not only could all the letters
of the alphabet and the numerals be communicated, but an endless
variety of syllables, words, phrases, and statements besides. As a
matter of fact, however, it contained several thousand combinations
of numerals with the significance of each combination attached to it.
Let me illustrate still further by using the symbols “2” and “1.”
Let us suppose the flagman to make the signal for “1,” and follow it
immediately with the motion for “2.” This would naturally be read as
12, which the code showed to mean O. Similarly, two consecutive
waves to the right, or 22, represented the letter N. Three waves to
the right and one to the left, or 2221, stood for the syllable tion. So
by repeating the symbols and changing the combinations we might
have, for example, 2122, meaning the enemy are advancing; or
1122, the cavalry have halted; or 12211, three guns in position; or
1112, two miles to the left,—all of which would appear in the code.
Let us join a signal party for the sake of observing the method of
communicating a message. Such a party, if complete, was
composed of three persons, viz., the signal officer (commissioned) in
charge, with a telescope and field-glass; the flagman, with his kit,
and an orderly to take charge of the horses, if the station was only
temporary. The point selected from which to signal must be a
commanding position, whether a mountain, a hill, a tree-top, or a
house-top. The station having been attained, the flagman takes
position, and the officer sweeps the horizon and intermediate
territory with his telescope to discover another signal station, where
a second officer and flagman are posted.
Having discovered such a station, the officer directs his man to
“call” that station. This he does by signalling the number of the
station (for each station had a number), repeating the same until his
signal is seen and answered. It was the custom at stations to keep a
man on the lookout, with the telescope, for signals, constantly.
Having got the attention of the opposite station, the officer sends his
message. The flagman was not supposed to know the import of the
message which he waved out with his flag. The officer called the
numerals, and the flagman responded with the required motions
almost automatically, when well practised.
At the end of each word motion “5” was made once; at the end of
a sentence “55”; and of a message “555.” There were a few words
and syllables which were conveyed by a single motion of the flag;
but, as a rule, the words had to be spelled out letter by letter, at least
by beginners. Skilled signalists, however, used many abbreviations,
and rarely found it necessary to spell out a word in full.
So much for the manner of sending a message. Now let us join the
party at the station where the message is being received. There we
simply find the officer sitting at his telescope reading the message
being sent to him. Should he fail to understand any word, his own
flagman signals an interruption, and asks a repetition of the message
from the last word understood. Such occurrences were not frequent,
however.
The services of the Signal Corps were just as needful and
valuable by night as in daylight; but, as the flags could not then talk
understandingly, Talking Torches were substituted for them. As a
“point of reference” was needful, by which to interpret the torch
signals made, the flagman lighted a “foot torch,” at which he stood
firmly while he signalled with the “flying torch.” This latter was
attached to a staff of the same length as the flagstaff, in fact, usually
the flagstaff itself. These torches were of copper, and filled with
turpentine. At the end of a message the flying torch was
extinguished.
The rapidity with which messages were sent by experienced
operators was something wonderful to the uneducated looker-on. An
ordinary message of a few lines can be sent in ten minutes, and the
rate of speed is much increased where officers have worked long
together, and understand each other’s methods and abbreviations.
Signal messages have been sent twenty-eight miles: but that is
exceptional. The conditions of the atmosphere and the location of
stations were seldom favorable to such long-distance signalling.
Ordinarily, messages were not sent more than six or seven miles,
but there were exceptions. Here is a familiar but noted one:—
In the latter part of September, 1864, the Rebel army under Hood
set out to destroy the railroad communications of Sherman, who was
then at Atlanta. The latter soon learned that Allatoona was the
objective point of the enemy. As it was only held by a small brigade,
whereas the enemy was seen advancing upon it in much superior
numbers, Sherman signalled a despatch from Vining’s Station to
Kenesaw, and from Kenesaw to Allatoona, whence it was again
signalled to Rome. It requested General Corse, who was at the latter
place, to hurry back to the assistance of Allatoona. Meanwhile,
Sherman was propelling the main body of his army in the same
direction. On reaching Kenesaw, “the signal officer reported,” says
Sherman, in his Memoirs, “that since daylight he had failed to obtain
any answer to his call for Allatoona; but while I was with him he
caught a faint glimpse of the tell-tale flag through an embrasure, and
after much time he made out these letters
‘C’ ‘R’ ‘S’ ‘E’ ‘H’ ‘E’ ‘R’
and translated the message ‘Corse is here.’ It was a source of great
relief, for it gave me the first assurance that General Corse had
received his orders, and that the place was adequately garrisoned.”
General Corse has informed me that the distance between the two
signal stations was about sixteen miles in an air line. Several other
messages passed later between these stations, among them this
one, which has been often referred to:—
Allatoona, Georgia, Oct. 6, 1864—2 p.m.

Captain L. M. Dayton, Aide-de-Camp:—
I am short a cheek-bone and an ear, but am able to whip all
h—l yet. My losses are heavy. A force moving from Stilesboro
to Kingston gives me some anxiety. Tell me where Sherman
is.
John M. Corse, Brigadier-General.

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PA R T I Social Factors and Illness 1

PA R T II The Meaning and Experience of Illness 93

PA R T III Health Care Systems, Settings, and Technologies 169

PA R T IV Health Care, Health Research, and Bioethics 247

PA R T I Social Factors and Illness 1

Chapter 1 The Sociology of Health, Illness, and Health

Chapter 2 The Social Sources of Modern Illness 18

The New Rise in Infectious Disease 22

Chapter 3 The Social Distribution of Illness in the

Chapter 4 Illness and Death in the

PA R T II The Meaning and Experience of Illness 93

Chapter 5 The Social Meanings of Illness 95

Chapter 6 The Experience of Disability, Chronic Pain,

Chapter 7 The Sociology of Mental Illness 139

Ethnicity, Gender, Social Class, and Rates of Mental Illness 142

PA R T III Health Care Systems, Settings, and Technologies 169

Chapter 8 Health Care in the United States 170

The ACA Under Attack 177

Chapter 9 Health Care Around the Globe 195

Chapter 10 Health Care Settings and Technologies 221

PA R T IV Health Care, Health Research, and Bioethics 247

Chapter 11 The Profession of Medicine 248

The Threats to Medical Dominance 255

Chapter 12 Other Mainstream and Alternative Health

Chapter 13 Issues in Bioethics 303

THE CRITICAL APPROACH

This textbook demonstrates the breadth of topics included in the sociology of

CHANGES IN THE EIGHTH EDITION

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PEDAGOGICAL FEATURES FOR STUDENTS

Chapter “Road Maps”

Review Questions and Critical Thinking Questions

SUPPLEMENTAL AND PEDAGOGICAL FEATURES

Instructor’s Manual with Test Bank

South Carolina), Helen Rosenberg (University of Wisconsin-Parkside), Ian Shaw

Social Factors and Illness

Chapter 1 The Sociology of Health, Illness, and Health Care

Chapter 2 The Social Sources of Modern Illness

Chapter 3 The Social Distribution of Illness in the United States

Chapter 4 Illness and Death in the Less Developed Nations

A CANVAS PONTOON BOAT. FROM A PHOTOGRAPH.

The floor timbers of the bridge, known as Balks, were twenty-five

AN ANGLE OF FORT HELL (SEDGWICK) SHOWING GABIONS, CHEVAUX-DE-

An abutment had to be constructed at either end of a bridge, which

A PONTOON BRIDGE AT BELLE PLAIN, VA. FROM A PHOTOGRAPH.

Ponton bridges were a source of great satisfaction to the soldiers.