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DOING QUALITATIVE RESEARCH
DOING QUALITATIVE RESEARCH
Third Edition

Benjamin F. Crabtree

Rutgers, The State University of New Jersey

William L. Miller

Lehigh Valley Health Network, Pennsylvania

Los Angeles

London

New Delhi

Singapore
Washington DC

Melbourne
 Copyright © 2023 by SAGE Publications, Inc.

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Title: Doing qualitative research / Benjamin F. Crabtree, William L. Miller.

Identifiers: LCCN 2022011299 | ISBN 9781506302812 (paperback; alk. paper) |

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Subjects: LCSH: Primary care (Medicine)—Research—Methodology. | Social

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Qualitative research.

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BRIEF CONTENTS
Preface
Acknowledgments
About the Authors
Introduction
Part I Read Me First: Overview of Qualitative Research
Chapter 1 Clinical Research: A Qualitative Trail Map Within a
Mixed-Methods World
Chapter 2 Creating Collaborative Space and Research
Teams
Chapter 3 Reflexivity
Chapter 4 Research Design: Start With the Stories
Part II Discovery: Data Collection Strategies
Chapter 5 Depth Interviews
Chapter 6 Group Interviews and Focus Groups
Chapter 7 Observation
Chapter 8 Key Informant Interviews
Chapter 9 Material Artifacts
Part III Analysis and Interpretation Strategies
Chapter 10 The Dance of Interpretation and Frustrations of
Sisyphus
Chapter 11 Editing Organizing Style of Analysis
Chapter 12 Template Organizing Style of Analysis
Chapter 13 Immersion/Crystallization Organizing Style of
Analysis
Chapter 14 Computers and Data Management
Part IV Special Applications
Chapter 15 Case Studies
Chapter 16 Qualitative Methods in Intervention Studies
Chapter 17 Qualitative Methods in Participatory Healthcare
Research
Part V The Rest of the Story
Chapter 18 Doing Good Qualitative Research
 Chapter 19 Getting Funded and Getting Published
Chapter 20 The Future of Qualitative Methods in a Mixed-
Methods World
References
Index
DETAILED CONTENTS
Preface
Acknowledgments
About the Authors
Introduction
Part I Read Me First: Overview of Qualitative Research
Chapter 1 Clinical Research: A Qualitative Trail Map Within a
Mixed-Methods World
What’s Coming?
A Mixed-Methods Research Approach
Research Aims
Worldviews, Paradigms, and Theory
Choosing a Research Style and Methods
Qualitative Methods: A Map, Sampling, and Design
Overview
Sampling
Collecting Data
The Interpretive Process
From Whence It Came: Qualitative Research Traditions
Summary
Questions at the Edge
Chapter 2 Creating Collaborative Space and Research
Teams
What’s Coming?
A Typology of Cross-Disciplinary Research
A Collaborative Team Story
Creating Collaborative Space and Research Teams
Developing Collaborative Research Relationships
Barriers to Collaborative Process
Clearing the Flow for Collaborative Conversations
Summary
Questions at the Edge
Chapter 3 Reflexivity
 What’s Coming?
Tools for Doing and Teaching Reflexivity
Traps of Perception and Understanding
Reflexivity Tools
Reflexivity Before the Fieldwork Begins
Reflexivity During Data Collection
Reflexivity During Analysis and Interpretation
Reflexivity During Dissemination
Summary
Questions at the Edge
Chapter 4 Research Design: Start With the Stories
What’s Coming?
A Clinical Story
Anomalies and Research Questions
How Are Healing Relationships Developed and
Maintained in Primary Care?
What Are Patient Preferences Regarding the Role
of the Primary Care Physician in Their Extended
Cancer Follow-Up Care?
How Do Exemplar Primary Care Practices Deliver
Care for Cancer Survivors Like Mrs. Brown?
What Are the Experiences of Early Implementers
of Primary Care-Focused Cancer Survivorship
Delivery Models?
What Are Practices Experiences When Participating
in a Quality Improvement Intervention?
Summary
Questions at the Edge
Part II Discovery: Data Collection Strategies
Chapter 5 Depth Interviews
What’s Coming?
Partnership, Communicative Performance, and
Conversational Journey
Depth Interviews
Preparing for the Journey: The Literature and
Beyond
 Designing: Selecting the Actors and Creating the
Script
Preparing: Staging the Scene
Interviewing: Let the Improvisation Begin
Debriefing: Capturing Context
Transcribing: The Final Script
A Plethora of Primary Care Examples
Interviewer Training
Consent and Ethical Considerations
Summary
Questions at the Edge
Chapter 6 Group Interviews and Focus Groups
What’s Coming?
The Larger Genre of Group Interviews
Focus Groups
What Types of Questions Are Best for Focus
Groups?
Sampling in Focus Groups
Recruitment of Participants
Number of Groups
Group Size
Length of Focus Groups
The Role of the Moderator
Developing the Interview Guide
Recording and Other Logistics
Moderating Focus Groups
Transcription Options
Analysis and Interpretation Is Tricky
Reporting Focus Group Findings
Consent and Ethical Considerations
Summary
Questions at the Edge
Chapter 7 Observation
What’s Coming?
Why Participant Observation?
A Primer on Participant Observation
 Overview of the Project
Into the Field and Gaining Entry
Initial Contact
Establishing Rapport
The Mechanics of Observation
The Participation Continuum
Informants
Fieldnotes: A Dialogue With Self
What: The Content of Fieldnotes
How: The Form of Fieldnotes
When: The Process of Writing Fieldnotes
Technologies for Recording and Managing Fieldnotes
Individual Versus Team Research
Some Tips on Training and Skill Building
Informed Consent and Ethics
Summary
Questions at the Edge
Chapter 8 Key Informant Interviews
What’s Coming?
What Are Key Informant Interviews?
Why Use Key Informants?
Who Is a Key Informant?
How to Select Key Informants?
Learning From Key Informants
Questioning
Language
Texts and Sources
Ethical Considerations
Applications in Primary Care
Key Informants Within an Ethnographic Study
Key Informants in Case Study Research
Key Informants as Sole Source of Data
Key Informant to Enhance a Depth Interview
Guide
Limitations of Key Informant Interviews
Summary
 Questions at the Edge
Chapter 9 Material Artifacts
What’s Coming?
Analyzing and Interpreting Television Commercials
Photographs as Artifacts
Collecting and Analyzing Online Artifacts
Collecting Documents in a Case Study
Summary
Questions at the Edge
Part III Analysis and Interpretation Strategies
Chapter 10 The Dance of Interpretation and Frustrations of
Sisyphus
What’s Coming?
Where Are We?
Interpretation as Dance
Who Are the Dancers?
How to Dance?
Describing
Organizing
Connecting
Corroborating/Legitimating
Representing the Account
Tools for the Dance
Selecting the Tools
Principles, Pitfalls, and Pearls
Questions at the Edge
Chapter 11 Editing Organizing Style of Analysis
What’s Coming?
Stepping Through the Process
Step 1: Text Segment Identification and Making
Comments
Step 2: Expansion of Comments
Step 3: Comparison of Expanded Comments
Step 4: Theme Development
Step 5: Comparison of Interview Themes
Published Examples
 Three Focus Groups Is a Piece of Cake
Editing Also Possible With Many More Interviews
Dancing With Your Data: Immersion Before Editing
More Dancing Using All Three Styles: Editing,
Template, and Immersion
Using an Editing Organizing Style Within a Large
Dataset
Summary
Questions at the Edge
Chapter 12 Template Organizing Style of Analysis
What’s Coming?
The Dance and Use of Codes in Template and Editing
Styles
Examples of Template Organizing Style
Using an A Priori Codebook
Creating and Using an Evolving Codebook
Using a Post Hoc Confirmatory Codebook
The Mechanics of a Template Organizing Style
Approaches for Developing a Codebook or Code
Manual
Codebook Illustration
Coding Text
Sorting Segments
Connecting and Corroborating/Legitimating
Summary
Questions at the Edge
Chapter 13 Immersion/Crystallization Organizing Style of
Analysis
What’s Coming?
The Requirements
The Core Process of Immersion/Crystallization
Initial Engagement With the Topic and Reflexivity
Crystallization During Gathering Process
Immersion and Crystallization of Insights During
Interpretive Process
 Corroboration/Legitimation and Alternative
Interpretations
Representing the Account
Immersion/Crystallization Variations, Influences, and
Pitfalls
Variations and Influences
Pitfalls
Summary
Questions at the Edge
Chapter 14 Computers and Data Management
What’s Coming?
Types of CAQDAS Programs
A Brief Summary of Five Common CAQDAS Programs
To the Field!
Pearls and Pitfalls
Summary
Questions at the Edge
Part IV Special Applications
Chapter 15 Case Studies
What’s Coming?
Background
Preparing for the Journey
Setting the Context
Living It
Getting Ready
Sampling: Finding a Place
Entering the Field
Collecting Data
Gathering Additional Data
Processing and Managing Data
Comparative Case Analysis Strategies
Spelunking: The Dark Side
Crawling Toward Light: Turns and Decisions
Single Case Studies
Summary
Questions at the Edge
 Chapter 16 Qualitative Methods in Intervention Studies
What’s Coming?
Using Qualitative Assessments to Tailor Interventions
Conducting Process Evaluations During Interventions
Conducting Independent Evaluations of Research
Initiatives/Programs
Qualitative Input on Intervention Design and on a
Learning Evaluation
Summary
Questions at the Edge
Chapter 17 Qualitative Methods in Participatory Healthcare
Research
What’s Coming?
Participatory Research: Typical Forms, Assumptions,
and Issues
Participatory Research in Health Care
Challenges
Doing Participatory Research: Four Examples
Designing a Knowledge Workshop in Participatory
Action Research
Boot Camp Translation in a PBRN Using a CBPR
Framework
Using Online Community Salons With Community
Organizations
Using Photovoice in Participatory Research
The Way Beyond
On Participation
What’s in a Name?
Summary
Questions at the Edge
Part V The Rest of the Story
Chapter 18 Doing Good Qualitative Research
What’s Coming?
Seven Essentials for Good Qualitative Research
Question/Design Match
Information-Rich Sampling
 Iteration
Context
Incongruous Evidence
Self-Reflexivity
Group Reflexivity
Rules Are Written for the Novice
Summary
Questions at the Edge
Chapter 19 Getting Funded and Getting Published
What’s Coming?
Getting Funded
Writing the Cancer Survivor Care Application
Significance: Start With the Story
Investigators: Promoting Yourself and Your
Team
Innovation: What’s New and Unique Here?
Approach: Avoid Jargon and Give Details
Environment: No Place Like Home
Some Final Thoughts on Getting Funded
Getting Published
Finding the Right Journal
What Should Be in Your Journal Article
Relevance
Question/Design Match
Information Rich Sampling
Iteration
Context
Accounting for Incongruous Evidence
Reflexivity: Self and Group
Believability
Summary
Questions at the Edge
Chapter 20 The Future of Qualitative Methods in a Mixed-
Methods World
What’s Coming?
Training for the Future
 Keeping Up With Accelerating Change
Technology, the Locations of Social Space, and
Politics
Climate Change, Ecology, and Health
Ways of Knowing, Research Design, and Knowledge
Democracy
Mixed-Methods Imperative and Real Integration
Changing the Evidence: Round Tables, Solidarity
Research, and Knowledge Democracy
Final Thoughts
Questions at the Edge
References
Index
PREFACE
When does a text about research become a book about passion and
joy? Here and now! Welcome to the third edition of Doing Qualitative
Research. We love doing, learning, and teaching qualitative research
in the context of our clinical mixed-methods world. We love the
excitement of discovery, the developing depths of understanding,
the surprises, the dilemmas, the uncertainties that emerge, the
relationships that grow from working together, the creativity, the
magic of exploring new settings and meeting new people, and the
insights about self and other that arise. Join us for the adventure
and cocreate your own inspired research stories.
PURPOSE
The global COVID-19 pandemic has accelerated both the uncovering
of vulnerabilities and deficiencies in our healthcare systems and
dramatic changes in the platforms and structures of care delivery,
especially at the level of primary health care. The need for
exceptional qualitative clinical research within a mixed-methods
context has never been greater. Enter this book. As a result, this
third edition of Doing Qualitative Research is substantively a new
volume. The goal of the first two editions was to introduce
qualitative methods to those hoping to begin and do qualitative
research in primary care settings. In those first two editions, we
sought to honor the past traditions of qualitative research while also
finding a way to make it actionable and accessible to primary care
researchers. The third edition goes beyond those goals and seeks to
expand the use of qualitative methods in clinical research, to
improve the quality of that research and to better align with those
we study.

Now, 23 years since the second edition, so much has transpired and
changed. We are no longer novice researchers and have personally
completed or participated in multiple clinical studies with multiple
collaborators across the qualitative research spectrum. Qualitative
approaches have not only thrived on their own with many supporting
journals and journal review panels, but their use has expanded with
the rapid growth of mixed-methods strategies in clinical research.
And yet, something feels amiss, something more than simplification,
sloppiness, and superficial acceptance. We began the adventure into
qualitative research by searching for methods to answer the
questions arising in our lives. We wanted to give voice to those not
being heard, to recover the importance of context, to disrupt the
powerful hierarchies in health care, and to change the conversation
about the meaning of evidence that matters. Little of that has
happened and was made worse by the global pandemic. We decided
to write this third edition in hopes of revitalizing the hidden potential
for excellent qualitative research.
AUDIENCES
We wrote this book for a target audience of investigators actively
conducting clinical research, particularly the rapidly growing number
of clinical researchers engaged in mixed-methods research. Many
(perhaps most) have little or no formal training or foundation in
qualitative research, so this book is designed as a resource for them.
We hope the book will also be a useful and practical resource for
Master of Public Health (MPH) or graduate level programs or for
short courses like those hosted by the National Institutes of Health
(NIH).

This third edition of Doing Qualitative Research can also serve as a

core text for a wide range of healthcare disciplines, including public
health, primary care medicine, nursing, social work, behavioral
health, medical anthropology, medical sociology, and health services
research. As a pragmatic qualitative methods text written within a
mixed-methods framework, this third edition serves as a strong
companion text to other SAGE publications on mixed-methods
designs. Because both qualitative and mixed-methods research are
rapidly emerging in the health sciences, this book, with its clear and
concise descriptions of the most widely used qualitative methods
and its pragmatic suggestions for writing grant applications and
journal publications, is particularly relevant to many researchers. The
generous use of relevant published clinical research examples, many
from studies conducted by the authors, distinguishes this book from
others currently available that deal with the same or similar topics.
WHY THIS THIRD EDITION
The goal of the earlier edited editions of Doing Qualitative Research
was to encourage primary care clinical researchers to take up
qualitative methods. We felt that many investigators doing clinical
research were never going to have time to go back and get the
thorough disciplinary training upon which qualitative work is based.
When we put the first edition together, we were novice researchers
brimming with enthusiasm and collaborated with others to organize
a pre-conference on qualitative methods at the May 1991 Annual
Meeting of the North American Primary Care Research Group
(NAPCRG) in Quebec City. SAGE published a series of six edited
volumes on primary care research, with Doing Qualitative Research
being the third in the series. Several chapters related to qualitative
research were in other volumes in that series, so we worked with
SAGE to publish a more comprehensive second edition in 1999.

No longer editors, we are now the sole authors for all chapters in
this third edition. Everything is revised based not only on the growth
and development within the field but also on what we have learned
during our 35 years of extensive experience doing qualitative
research. Seven chapters from the previous edition were dropped
and eight new chapters added. We comprehensively revised and
updated second edition chapters originally written by us and
included new examples and references. Several of the chapters from
the second edition originally written by other authors are also
substantially revised by us and now include fresh examples and
updated references. Some of the material from several second
edition chapters that were dropped is incorporated into other
chapters of this new edition.

We feel the first four chapters in this third edition are critical reading
and set the stage for both those new to qualitative research and
established researchers. They are intended to address the concerns
raised earlier about the superficiality of some published qualitative
work. Chapter 1 grounds qualitative research and qualitative
methods within the larger research enterprise including an overview
of the diverse traditions from which they arose and more detail on
theory. In this book, we repeatedly stress the critical and essential
role of collaborative teams and ensembles (Chapter 2), reflexivity
(Chapter 3), and tailoring research methods and designs to the
question and not vice versa (Chapter 4). We also note that parts of
Chapter 2, “Creating Collaborative Space and Research Teams,” were
previously published in the edited volume from SAGE Publications,
Exploring Collaborative Research in Primary Care (Crabtree et al.,
1994). In addition, some of Chapter 11, “Editing Organizing Style of
Analysis,” was previously published in the edited volume from SAGE
Publications, Tools for Primary Care Research (Stewart et al., 1992).
MAJOR FEATURES AND BENEFITS
In writing this new volume, we tap into our wide-ranging experience
as clinical mixed-methods and qualitative researchers to target the
specific needs of researchers working in health-related disciplines.
We believe we have made this third edition a more coherent whole
by being sole authors, by drawing on projects we personally
participated in so we can share the back stories, and by better
connecting key concepts and ideas across chapters. The generous
use of relevant published clinical research examples, many from
studies conducted by us and many that were an integral part of
larger mixed-methods investigations, distinguish this book from
others currently available that deal with the same or similar topics.
The detailed chapters filled with practical tips on team and ensemble
development (Chapter 2), reflexivity (Chapter 3), improvising
research design (Chapter 4), and getting funded and getting
published (Chapter 19) also differentiate this book from others.

This text reflects the diverse lived experiences and perspectives of a

career-long partnership of a full-time medical anthropologist
researcher and a practicing family physician, administrator in a large
health system and educator of family medicine residents and medical
students. Combined, we have done the research, incorporated it into
our teaching, and used the findings to try to change health care and
improve the health of those we serve. Everything is this book is
grounded in those experiences and filled with our passion and joy
for this work. We hope that grounding helps this book feel more
alive.
PEDAGOGICAL FEATURES
As a core or supplemental text, this book will especially appeal to
teachers who value creativity, adult learning, and tailoring to each
learner, and who prefer an experiential learning style (Kolb, 1984).
Each chapter is written with Kolb’s learning cycle in mind. They
begin with the sharing of a concrete experience, either a clinical
story or a research case. Interspersed throughout are questions for
prompting reflective observation and quickly shadowed by
presentation of the tools and concepts, the abstract
conceptualizations, needed to help investigate the dilemmas of the
story. Multiple examples of others actively experimenting with the
tools and concepts follow and urge the reader to experiment
themselves. We encourage using this cycle in your own face-to-face
or virtual classrooms.

All the chapters share numerous cases, and, usually, multiple tables
and figures to enhance the practical value of the material. Each
chapter begins with “What’s Coming,” a quick synopsis based on the
detailed table of contents to help educators and learners easily see
what’s coming and where to anticipate it in the chapter. The
chapters end with a few of what we call, “Questions at the Edge.”
These are questions that often don’t have simple or final answers.
They are intended to encourage exploring and expanding the
material just covered at the edge of shared understanding.
Anticipate exciting conversations.
START DOING
We hope this third edition of Doing Qualitative Research inspires and
emboldens more clinical researchers to do qualitative research in our
new mixed-methods world. We also hope it helps all of us do better
research and serves as a trail map for embarking on new qualitative
research adventures. Discovering ourselves, working together,
improvising in support of meaningful questions, empowering those
who participate in the research, and doing it all well motivated our
work. We hope yours as well. Read on, join the adventure, start
doing qualitative research, and help change the conversation in
health care.
ACKNOWLEDGMENTS
We put together and edited the first two editions of this book with
the help and partnerships of many friends and collaborators. They
motivated and inspired us to begin and to persist on the lifetime
adventure of doing qualitative research. We appreciate first edition
authors for getting us started and joining us on this qualitative
research journey: Anton Kuzel, Stephen Bogdewic, Valerie Gilchrist,
Richard Addison, Alfred Reid, Jr., Moira Stewart, Miguel Bedolia,
Howard Brody, Dennis Willms, Nancy Arbuthnot Johnson, Norman
White, David Morgan, Stephen Zyzanski, Ian McWhinney, and Robin
Blake. Many of these same authors continued with us on the journey
onto the second edition and were joined by Robert Williams, Judith
Belle Brown, Jeffrey Borkan, Lynn Meadows, Diane Dodendorf,
Jessica Muller, Virginia Elderkin-Thompson, Howard Waitzkin, Virginia
Aita, Helen McIlvain, Janecke Thesen, Kirsti Malterud, Richard
Frankel, Lucy Candib, Kurt Stange, and Wendy Levinson. We are
profoundly grateful for the insights, friendship, and collaboration you
provided us. We cannot thank you all enough. Since the second
edition was published in 1999, we expanded on the foundation laid
by these collaborations and continued our voyage over a clinical
ocean filled with a bounty of new friends and a multitude of
qualitative and mixed-methods studies that are brought to life in this
third edition.

We want to use this opportunity to gratefully acknowledge several of

the people who significantly influenced and supported our early
emotional and intellectual development. Dr. David Evans at Wake
Forest University was a patient and creative shepherd for Will during
his undergraduate and graduate school years. J. Jerome Smith at the
University of South Florida and Pertti J. Pelto of the University of
Connecticut served similar roles for Ben. Will’s first adventures into
family practice were nurtured by his practice partners, Mike Abgott,
Dale Grove, and his dad, Warren Miller. The late David Schmidt, MD,
brought us together at the Department of Family Medicine,
University of Connecticut, where along with our remarkable
colleagues and Director of Research, Patrick J. O’Connor, we began
exploring the exciting opportunities of collaborative, qualitative, and
mixed-methods primary care research. We have also been blessed
with wonderful research companions at the University of Nebraska
Medical Center, Rutgers Robert Wood Johnson Medical School, and
Lehigh Valley Health Network. Just when we needed it, we were
fortunate to be introduced to the late Reuben R. McDaniel, Jr. who
motivated us with the metaphor “drink good whiskey” and
continually reminded us not to waste time doing trivial things. A
special thanks to all for your friendship and support.

We are particularly appreciative of Kurt Stange, Carlos Jaén, Robin

Gotler, and Paul Nutting who, as close friends and collaborators for
over 20 years, created a transdisciplinary space for creative thinking
and reflection. Together, and with funding from the American
Academy of Family Physicians, we created the Center for Research in
Family Medicine and Primary Care that allowed us to hold regular
working retreats for sharing ideas and developing projects. We
became a true ensemble performing some amazing improvisational
jazzy research, and we supported and nurtured each other like a
second family. While the Center is no longer active, the friendships,
support, and research partnerships persist. Its memory inspires us to
encourage others to build their careers and lives upon meaningful
relationships and not climbing ladders toward individual
achievement.

We also thank SAGE acquisitions editor, Leah Fargotstein, who has

shown incredible patience as we struggled through career transitions
and the COVID-19 pandemic to write this volume.

As we wrote the chapters for the third edition, we continually sought

input and feedback from kindred souls who reviewed early drafts of
chapters. Kurt Stange showed considerable patience and support as
Ben repeatedly shared ideas and drafts of chapters for months on
end. We specifically recognize Ellen Rubinstein who carefully
reviewed draft chapters and added personal touches describing her
experiences in the field working on the comparative case study on
care of cancer survivors in primary care used as an example in many
chapters. Sarah Ono and Jack Westfall graciously provided materials
on their work in participatory research and reviewed drafts of the
chapter. Rutgers colleagues Jenna Howard and Jennifer Hemler read
and provided feedback on several chapters. The weight of writing
this volume was greatly lightened knowing who was helping us along
the way.

At the heart of creative abundance rests the mysterious and gracious

nest of kith and kin. Our families are the deep well from which we
draw our water and to which our energies and love returns. We offer
our profound thanks to our very significant partners, Eiko Crabtree
and Deb Miller, and to our children, Martin, Mari, and Christina
Crabtree and Ethan and his partner Kate and Lindsay Miller, and,
especially, to Will’s grandson Loren. Being home together, as we
relearned during the COVID-19 pandemic, can be messy and
challenging like qualitative research, and it is the real garden of love
and delight. Thanks everyone!

SAGE and the authors are grateful for feedback from the following
reviewers in the development of this text:

Brittany Anne Chozinski, Our Lady of the Lake University

Carly Levy, Massachusetts College of Pharmacy and Health Sciences

Victoria Sherif, Wichita State University

ABOUT THE AUTHORS
Benjamin F. Crabtree,
PhD, MA, is a medical anthropologist and Distinguished Professor in
the Department of Family Medicine and Community Health, Rutgers
Robert Wood Johnson Medical School. He is a full member of the
Rutgers Cancer Institute of New Jersey in the Cancer Prevention and
Control Research Program. Ben earned his Master’s Degree in
Applied Anthropology from the University of South Florida and his
Doctorate in Medical Anthropology from the University of
Connecticut. Prior to his current appointment, Ben was on the
faculty of the Departments of Family Medicine at the University of
Connecticut and the University of Nebraska Medical Center.
Ben has collaborated on many in-depth interview and focus group
studies where he’s learned to appreciate the experiences of illness
and health care from the perspectives of both clinicians and patients.
Ben’s recent research focuses on quality of healthcare delivery,
primary medical care practice organization, and organizational
change. He has been principal investigator on five National Institutes
of Health R01 grants that used qualitative methods and mixed-
methods for enhancing quality of care in primary care practices. His
current National Cancer Institute R01 grant engages diverse
stakeholders in identifying actionable, practice-based activities for
provision of long-term breast cancer survivorship care using depth
interviews and then implements and evaluates an intervention for
delivering care for breast cancer survivors in primary care. Ben has
contributed to more than 225 peer-reviewed journal articles and
numerous book chapters, and served as coeditor on two books,
Doing Qualitative Research and Exploring Collaborative Research in
Primary Care. In 2014, Ben and coauthor Will Miller were jointly
awarded the prestigious Curtis G. Hames Research Award for lifetime
contributions to family medicine research. Ben volunteered twice
with the United States Peace Corps, first in the Ethiopian Smallpox
Eradication Program and then in the Korean National Tuberculosis
Program. He completed his dissertation research in Korea conducting
a mixed-methods study of rural birthing practices in the face of
modern medicine. He and his wife Eiko travel extensively in Japan
and enjoy taking long walks and gardening.

William L. Miller,
MD, MA, is a family physician anthropologist and Chair Emeritus at
the Lehigh Valley Health Network (LVHN), Department of Family
Medicine in Allentown, Pennsylvania, and a Professor of Family
Medicine at the University of South Florida Morsani School of
Medicine for which LVHN serves as a branch campus. Will earned a
Master’s Degree in Medical Anthropology from Wake Forest
University and received his Medical Degree from the University of
North Carolina School of Medicine. After completing his family
medicine residency at Harrisburg Hospital, Will entered private
practice in Bethlehem, Pennsylvania, where he honed his craft for
four years. Prior to joining Lehigh Valley Health Network as the first
Leonard Parker Pool Endowed Chair of Family Medicine, he was on
the faculty in the Department of Family Medicine at the University of
Connecticut.
Will has been aptly nicknamed “coyote” for his propensity for
“pushing the envelope,” not only as an organizational leader, teacher,
and clinician but also in his research focused on observing,
implementing, and evaluating NIH-funded national primary care
practice improvement efforts along with investigations of healing
relationships and the clinical encounter, collaborative care, and
professional socialization. Some of this work has focused on how
primary care practices respond to new innovations in care, with one
of the outcomes being the development of the relationship-centered
Practice Change Model. He was founding consulting editor for the
Annals of Family Medicine, served as co-editor on two books, Doing
Qualitative Research and Exploring Collaborative Research in Primary
Care, and received, along with Ben Crabtree, the 2014 Curtis G.
Hames Research Award for lifetime achievement in family medicine
scholarship. He was an advisor and evaluator for the American
Academy of Family Physicians’ Future of Family Medicine National
Demonstration Project of the patient-centered medical home and the
American Board of Family Medicine-funded national family medicine
residency redesign initiative. His special joys are family, getting lost
in the woods with his grandson, cross-country skiing, and music.
INTRODUCTION
“Everything feels hopeless!” This is an emotion shared by many
patients, families, clinicians, clinics, and healthcare systems. Puzzles
and troubles abound. They keep disturbing the waters in which we live.
These disturbances and the rough waters are the source of our clinical
research questions. The story of an Iraqi war veteran and his wife
suffering through traumatic brain injury in the middle of the COVID-19
pandemic illustrates the situation.

Joseph Williams waits with his wife, Alicia, in the cramped

exam room hoping for some relief from his persistent
headaches. After the medical assistant leaves the room, Alicia
reaches into her purse and pulls out her iPad with notes of the
couple’s recent experiences. When Dr. Radcliffe enters the
room, he quickly says hello to Mrs. Williams before looking at
Joseph and asking, “How are you doing with the headaches?”
This is the 15th visit in the past two years for this 46 year old
Iraqi war veteran with complicated chronic concerns of
dizziness, persistent headaches, memory problems, and
depression. He has seen many specialists at the Veterans
Administration, and despite the prescription medication, the
headaches continue. Joseph looks up, but Alicia immediately
shows Dr. Radcliffe her iPad that spells out the exact times,
circumstances, and descriptions of recent headaches and
seizures. The doctor briefly glances at the iPad but then
quickly turns to ask Joseph about other concerns. Mrs.
Williams tries to interrupt, but Dr. Radcliffe continues with
questions about other physical complaints and depression. Mr.
Williams leaves with yet another prescription, another referral,
and is asked to return in two weeks after trying the new
prescription. None of these three are happy with what is
happening. “Everything feels hopeless!”
What questions arise from this story? What are the qualitative and
mixed-method research approaches that can answer these questions?
What goes on when primary care practitioners and patients meet in the
clinical encounter? What happens afterwards? What goes on in the
clinic? How does it facilitate and/or impede the process of care? How is
it organized? How do patients get to the clinic? How can health-seeking
behavior be understood? How do patients’ lives affect their healthcare
decisions and experiences? What are community level health issues?
What are the healthcare concerns at a regional level? What is going on
with healthcare services across multiple levels and sectors of care?
These are all questions begging for qualitative research!

The landscape of primary care and healthcare research is represented

in Figure I.1. The knowledge and relationships that inform and are
informed by the above questions are localizable on this ecological
clinical system map. This map depicts a nested web of relationships
where no aspect can be fully understood without accounting for the
whole. Bringing qualitative methods and new paradigms of inquiry to
the questions that arise from within this web greatly enhances our
prospects for better, more helpful, answers. The studies used to
illustrate the qualitative methods described in this book touch on many
of the spaces and connections on the map.
Description

Figure I.1 The Ecological Clinical System Map of

Primary Care
Researching the complex web of relationships depicted in Figure I.1
requires the primary care research team be familiar with a multiplicity
of research methods. Historically, primary care and other clinical
researchers relied on epidemiology and randomized controlled trials
(RCTs) for studying measurable associations between variables or
testing if one treatment was more effective than another. But
increasingly, primary care problems and questions seek to understand
what is important and why, the variations that exist, lived experiences,
and differences in the occurrences of patterns. These questions are
best addressed with qualitative data collection, analysis, and
interpretation methods such as those described in this book. The
knowledge base of primary care and clinical research (Figure I.2)
includes four quadrants depicting the types of knowledge for different
Other documents randomly have
different content
gaseous vapors, that while coarser particles scatter rays of every
color — in other words scatter white light — finer particles scatter
fewer rays from 13
 194 THE SOURCES OF LIGHT. the red end of the spectrum,
while the finest scatter only those from the blue end. And in
accordance with this law> clouds are white, clear sky is blue."
(Polarization of Light, p. 82J. 3. Tyndall, Briicke, and other scientists
give accounts of experiments in which different particles of floating
matter tend to produce different color effects, and are of the opinion
that the bacteria or infinitessimal insects that exist so abundantly in
the atmosphere, especially in that which is warm, add very
materially to the illuminating effect. This is doubtless true, as these
animalcules are endowed with the special activities that belong to
life. Tyndall and others show that the finer particles of matter tend
to induce the colors of the violet end of the spectrum, while the
coarser induce those of the red end. This is doubtless correct as we
have already seen, so far as it applies to the ethers which constitute
the material portion of colors. Prof. Lommel and most other
scientists admit that ordinary coal gas, oil-lamps, etc., owe their
principal luminosity to ignited solid particles of carbon. But what are
the solid particles of the atmosphere which are thus kindled into
light as the solar ethers sweep through them. To answer this we
must look somewhat into the XVI. Constitution of the Atmosphere.
1. The usual composition of the atmosphere, as given by chemists, is
as follows : — Oxygen (slightly magnetic) number of per cent 20.61
Nitrogen (diamagnetic) 77-95 Carbonic Acid (C02) a chemical
combination .04 Aqueous vapor (PLO) " " 1.40 Nitric acid (N2Os) " "
\ Ammonia (NH3) " " > Traces. Carburetted Hydrogen (CH4) " " ) 2.
But we have seen (VII, 3) that nearly, if not quite every substance of
the earth is floating in a refined form through the atmosphere, as
shown by Tissandier, Nordenskica, and by deductions from the
general laws of matter. We see by the above that while oxygen and
nitrogen are the ruling elements of the atmosphere, carbon, as in
the carbonic acid, and hydrogen as in the vapor, and ammonia and
marsh gas or carburetted hydrogen are also ingredients. Hydrogen
being the champion heat atom
 CONSTITUTION OF THE ATMOSPHERE. 1 95 of the world,
must be the enkindler of flame and a great promoter of
incandescence and luminosity in the contiguous atoms. Sodium is
also revealed by the spectroscope as an ubiquitous element of the
air. " There is not a speck of dust, or mote in the sunbeam,'' says
Prof. Roscoe, " which does not contain chloride of sodium (salt).
Sodium is a prevailing element in the atmosphere, we are constantly
bathing in portions of this elementary substance together with the
air which we inhale. Two thirds of the earth's surface is covered with
salt water, and the finespray which is being carried up into the air
evaporates, leaving the minute specks of salt which we see dancing
in the sun." This sodium among other elements has a grand mission
to fill for when ignited, constantly gives out yellow light, the central
principle of luminosity, by which the universe is revealed. Under the
head of Chromo-Dynamics, definite facts will be given to show that
all objects throw off their volatile elements into the atmosphere. So
we have the oxygen as a prominent principle, giving off when
ignited, as shown by the spectroscope the blue, red, violet, yellow,
indigo, green, etc., and most abundant of all the nitrogen, which
gives more or less of all the colors, and other gases. 3, But fine
ignited gases are not sufficient except when highly compressed as in
chemical combinations, to give out light for practical purposes, and
consequently it is necessary to have solid particles or chemical
compounds including carbonic acid, sodium, chloride, etc., to help in
the process of lighting the world. These particles when struck by the
solar rays, or by artificial light, become ignited and constitute
diminutive fire-balls which may be called lumincllcs (little lights).
These luminelles may consist of hollow globules of vapor, molecules
of carbonic acid, or perhaps larger masses consisting of several
molecules of different solid substances, or the bacteria before
spoken of. 4. Frankland has endeavored to prove that there is no
glowing solid matter necessary for the production of light, simply
because he can place gases under a pressure of ten to twenty
atmospheres, and cause a light which one can read by. Of course a
large number of atoms or fiery particles in a given space would be
more luminous than a small number. But ordinary light is produced
under no such compression. He says the light of coal
 I96 THE SOURCES OF LIGHT. gas or candles is not
produced by solid particles of carbon, but " by the ignition of highly
condensed gaseous hydrocarbons." He may call them gaseous if he
pleases, but these gases must have countless luminelles, as will be
shown by millions of black particles which gather on a brass or a
silver knob held in the flame for a few moments. The luminelles
which float in the atmosphere at an ordinary heat and pressure must
be much more minute and refined than these carbon luminelles of
the flame, for they are ignited or cooled off by the solar ethers
instantaneously, and their heat is usually so soft as to give no painful
impression to the eye or to the skin as it falls upon us. But just how
are luminelles set on fire so as to afford us light and color of various
kinds ? Before considering this we must learn XVII. How Color
Effects are Produced. 1. We have already seen in Chapter Third, how
different colors are formed by different sized spirals in connection
with the different grades of ethers which pass through these spirals.
But what causes gold to appear yellow, or coal black, or snow white,
for instance ? Gold is yellow because it has one spiral of the right
grade to repel or reflect the yellow-forming ether while it has other
spirals which receive the other color ethers more or less within
themselves and thus hide them. If all of the spirals had such an
affinity for the other color-ethers, and their atoms could become
polarized in such a way that these ethers could be transmitted
entirely through them, it would be transparent like the air or nearly
like clear glass. If its spirals should briskly repel all of the color-
ethers into our eyes it would give us the effect of white ; if they
affinitize with them sufficiently to draw them all within its surface,
the effect would be black ; if they should absorb a part of each
color-ether and reflect a part, the effect would be normal gray ; if a
majority of each color-ether is reflected, light gray would result, and
if a majority absorbed, dark gray would appear. If the red and part
of the other colors should be reflected it would cause red-gray, and
the same principle applies to the other grays. If nearly the whole of
the red or the blue should be transmitted, while the other colors
were absorbed, reflected, or slightly transmitted, we should have the
 HOW COLOR EFFECTS ARE PRODUCED. I ()/ effect of red-
glass, or blue-glass, or any other colored glass according to which
color predominates. 2. Let us see, then, how rays of luminous ether
can produce the effect of light. Take the yellow ray, for instance, the
center of luminosity. Sodium, magnesium, iron, and other
substances, when under the terrific heat at or near the burning
surface of the sun have a tremendous repulsive action upon all
yellow-forming ethers including fine particles of their own substance,
and project them into space. Before getting entirely away from the
solar atmospheres, however, the coarser part of these ethers is
strained off while the finer part proceeds through space and strikes
our atmosphere. According to the principles of chemical affinity
already explained (Chapter Third, XXXVII, 10), the atoms of both
nitrogen and oxygen must have an especial affinity for the principal
yellow-forming ethers, as they are strong in violet, and thus become
ignited as they pass through, aided in this ignition by proximate
particles of hydrogen, which are so quick to take fire, and which
constitute an ingredient of vapor. So far the globules of vapor are
the principal sources of light, but that is not sufficient. All luminelles
of materials like themselves, such as sodium, magnesium, etc., must
be repelled at their touch, ignited by their impact against them, and
many of them driven on to the earth before their power. Violet-
colored luminelles having a chemical affinity for them will transmit
them freely and become incandescent thereby, and luminelles of
various colors will be met and penetrated in the same way, for, as
Isaac Newton has shown, all styles of matter, however opaque or
however colored, become more or less transparent to light, in case
they are in very minute masses. The same principle holds true with
reference to the other color-forming ethers, the violet ethers
sweeping with special ease through luminelles of sodium,
magnesium, etc., in which yellow is active, the blue ethers sweeping
with especial ease through the hydrogen of vapor luminelles, in
which the red principle in the spectrum is active, as well as through
many other substances, such as carbon, lithium, nitrogen, etc., and
so on with all the other colors, each of which drives before it certain
ethereal atoms like itself in a common tide to the earth, and each
does jts part in setting the whole atmosphere on fire and thus filling
the world with light.
 I98 THE SOURCES OF LIGHT. XVIII. Shadow is an Entity. 1.
Shadow is supposed to be the absence of light, just as cold is
supposed to be the absence of heat, and just as black was formerly,
and is sometimes yet called the absence of color. We have seen in
Chapter Third, that cold is as distinct a law of motion as heat, and
we have seen also that, although black is caused by the absorption
of "all the color ethers, it is caused practically, as seen in the union
of pigments, by the combination of all colors, only in a different
proportion from that required to form white. 2. We shall find that
there arc no nihilities in the universe, no vacuums ; even space and
time being the measurement of extension and of duration in the
abstract, while considered concretely, space is filled with ethers,
nebulas, comets, suns and worlds, and time is the everlasting
succession of events. 3. Again there is no such thing as absolute
silence or absolute rest in the known universe, for all that these
terms can signify when philosophically considered, is that the infinity
of vibrations, pulsations, waves, and movements which are in
ceaseless operation everywhere, have simply subsided sufficiently
not to affect human sensation, possessing too great a degree of
fineness or coarseness to be perceived. 4. Another of these negative
conditions is shadow, which is simply darkened or cooled off
luminelles, already described. These luminelles or atmospheric
particles, when struck by luminous ethers from the sun, or from
artificial light, immediately become ignited and luminous, but when a
screen is interposed to shut off these rays, there is not sufficient
action among the particles to keep them incandescent, and a darker
appearance which we call shadow is the result. In the day time this
shadow is but feeble, as reflected light from all quarters keeps them
more or less luminous. In the night, however, when the reflected
light is small, the luminelles become much more cooled off, and
consequently the shadows are much deeper. When a very brilliant
light is used, like the calcium or magnesium, the shadow seems
darker by contrast with the light. The black luminelles, such as those
of carbon, are perhaps a more decided principle of shadow than the
lighter colored ones when they are but slightly kindled into action.
Under the head of Chromo Chemistry (XX., 21), I
 THE MOON. I99 shall show how these darker luminelles can
be photographed upon chemically prepared paper as well as
luminelles and ethers of different colors. XIX. The Moon. 1. Our
satellite is known by astronomers to be what is called a dead world,
from having cooled off too much to sustain an atmosphere or other
necessary conditions for human life, and yet it is an important
source of light. Although it has nothing to live for within itself, it
kindly holds up its burnished shield to the sun, and reflects all the
luminous rays it possibly can upon our world, thus giving us many a
night of soft and subdued brilliance. Its size is about 49 times less
than its parent earth, and its mean distance from us about 240,000
miles, or more exactly, as determined by Prof. Adams, 238,793
miles. It moves through its elliptical orbit around the earth from west
to east about thirteen times every year, and is so one-sided as to
hold the same face ever towards the earth, having some special
reason for not showing its other side. Judging by analogies it must
have been cooled off, refined and inhabited by intelligent beings,
vast ages before such a process could take place on our larger earth,
possibly before our world left its crude sun-condition. Does it make
us sad to think how the moon's people must have suffered with cold
during the ages in which it was cooling ? It need not, for nature,
working ever on the law of kindness, easily adapts mail for the
changes necessary to a planet, until the interior of the planet itself
becomes cooled to a certain extent, when in an instant, the whole is
exploded and nobody is hurt. Nobody is hurt, simply because life is
taken too quickly for any sensation to be produced, and the planet
ceases forever to be the home of immortal beings. That the moon is
an exploded or fragmentary orb, some fully believe, and it may be
profitable to spend a moment in considering hozv a zvorld naturally
comes to its end. 2. We have seen (_X. 2 of this Chapter,) that there
must be a large layer of molten iron, at some distance below the
surface of a planet, that above this must be a still lighter mass of
minerals and earths which are molten and form the matter for
volcanoes, while above this still, is the cooled off crust, including
large masses of cool iron, which constitute the basis of magnetic
 200 THE SOURCES OF LIGHT. action for the whole planet.
We, of course, do not know how thick the layer of molten iron must
have been in the moon, but being the most abundant of metals we
are probably safe in putting it at ioo miles, the whole distance from
the surface of the moon to its centre being 1080 miles. What would
be the effect now if this metal, which in its crude state is carburetted
and brittle, should cool off and crystallize into a solid condition more
rapidly on one side than on the other ? What is the effect when cold
and heat are brought unequally upon glass, but to burst it into
pieces ? My opinion is that the lower portion of this iron layer must
cool off faster than the upper as the powerful magnetism of the
earth's crust must generate an immense amount of heat over the
whole outer portion of the earth by arousing the chemical affinities
of all surrounding elements. This would make the interior ' part of
the layer expand faster than the exterior, for iron is one of the
metals that expand as they cool off and crystallize. The rupture of
such a vast mass of iron in the moon, must have been inconceivable
in its tremendous power, throwing portions of its globe into space to
revolve as minute asteriods around the larger portion that may be
left or possibly directly around the earth itself. 3. And now the
reader may ask, is this the destiny of all worlds ? Have you not told
us that the progress of the universe is upward rather than, thus
downward into ruin ? Yes, forever upward, for what is thus
seemingly a work of ruin takes place only after a world has
accomplished its highest purpose under existing conditions, and is
merely a process of changing its elements into that which is finer
and better. Thus the moon, under the impact of sunbeams, and
under the play of its own chemical and ethereal forces, is becoming
more refined, eliminating its best elements into space, and wafting
them, either directly to some other planet or to some distant
nebulous mass where it shall eventually be crystallized and
aggregated into a more beautiful world. 4. We may see then why it
is that the moon always presents the same side to the earth. One
side of its mass and its interior molten part being blown away, it
must have a heavier and a lighter side. The earth's gravitation must
hold its round and heavier side unchangably toward itself otherwise
why does it not revolve on its axis and show its various sides, as is
done in all other known worlds ? I have not seen any attempt on the
 THE MOON. :oi part of astronomers to explain this
phenomenon, but the above explanation, including its method of
destruction, seems to me entirely rational. If the igneous central
portion had been ejected into space, gravitation would at once draw
the oceans into this centre and all things having become frigid, no
clouds, or water, or atmosphere could ever more make their
appearance upon the surface of the disabled world, which condition
is found to be verified by astronomers. 5. Fig. 158 gives a
condensed view of the full moon as seen Fig 15S. The Full moon. Fig
1 59. The Crescent. through a telescope and fig. 1 59, of the
crescent and what is called the earth-shine which is the dimmer
portion that appears on account of the light reflected from the earth.
Before the first quarter, when the half moon appears, this earth
shine generally becomes invisible until the moon becomes small
again. 6. Eclipses of the Sun and Moon and Phases of the Moon may
be illustrated by fig. 160. In the first place notice that the greater
size of the sun causes the earth and moon to throw diminishing
shadows in the form of a cone some distance into space, the darker
central portion of which constitutes what is called the umbra, the
lighter portion the penumbra. Generally the moon in passing around
the earth does not throw its shadow upon the earth or get into the
earth's shadow, but sometimes it comes so exactly between the sun
and earth, as in the position between 11 and 6, that it hides the
solar orb and throws a dark shadow on the earth at 12, thus
producing a total eclipse of the sun. At other times it comes into the
range of the earth's shadow at 9, and we call it an eclipse of the
moon. In most cases, however, when the moon gets around on the
side of
 202 THE SOURCES OF LIGHT. the earth opposite the sun,
as at 9, it does not enter the earth's shadow and shows its sun-lit
side to persons standing at 3 or 4 as a full 'moon. In most cases also
it does not hide the sun and cause an eclipse when it reaches the
point between 1 1 and 6, but having its shady side next to us it
becomes itself invisible. When it reaches 1 1 it begins to appear as a
very new moon, at 7 we call it a quarter moon, at I a half moon and
say it has reached its first quarter, at 8, it shows about three fourths
of its size, at 9 it becomes a full moon, at 1 o a threequarter moon,
at 2 a halfmoon and has reached its last quarter, at 5, a quarter
moon, at 6 it begins to fade out. The moon is sometimes said to be
a crescent at 7 and 5, and is called gibbous at 8 and 10. 7. The
Asteroids which are generally considered by astronomers to be
fragments of worlds, are doubtless portions of small planets which
have cooled off and exploded in the same way as our moon. Fig.
160. Eclipses and Phases of the Moon. XX. The Planets and Fixed
Stars, I. Though adding greatly to the cheerfulness of our nights,
still all combined give but a feeble light as compared with that of our
sun. The fixed stars are self-luminous and shine with a twinkling
light. The planets shine with a steady and reflected light, Venus,
sometimes the morning and sometimes the evening star, is the
brightest of the planets to us, and Jupiter next.
 COMBUSTION. 203 Sirius, the brightest of the fixed stars,
gives us, as signified by the photometer, 20,000,000,000 times less
light than the sun. 2. The Milky Way under the revelations of the
telescope, is presumed to consist of several millions of fixed stars,
each of which is a vast solar system and one of which is our own
solar system. But telescopes of great power reveal thousands of
such clusters of stars, each of which is a Milky Way. Verily the
mightiest imagination of man, can reach but a finger's length into
the infinities of this universe ! Looking at such a fact with a view of
our present littleness, it is due cause for humility on our part. On the
other hand, we may be exultant, for our souls kindled with the deific
spark, must of themselves be among the grandest of all infinities,
having capacities for mounting ever upward and onward through this
very universe ! Fig. 161, will give William Herschel's earlier
conception of the Milky Way or Galaxy. Assuming that the stars are
about equally distributed, he concluded that the great mass of stars
which appear in certain portions of the sky and which we call the
Milky Way, result from viewing the cluster longitudinally instead of
laterally. Thus if we stand at S which represents the position of the
solar system in the Milky Way, and look in the direction of A or B or
C, the stars must present a more dense appearance than they would
if viewed in the directions of E, D or F. Later in life, however, he
began to believe that the greater number of stars which appeared in
certain directions may have resulted more or less from their being
placed more closely together in certain directions than in others.
Astronomers assert that all the stars in the whole heavens which
appear Fig. 161. to the naked eye belong to the Milky WTay. The
Milky Way. XXI. Combustion Is intense chemical action attended with
heat and generally with light, although physiologists sometimes
speak of processes of combustion brought about by oxygen, etc., in
connection with
 204 THE SOURCES OF LIGHT. animal life, when of course
no light is evolved. // can never be produced without combining
some kind of electrical atoms like oxygen, chlorine, sulphur, etc.,
with some kind of thermal or alkaline atoms, such as hydrogen,
carbon, potassium, magnesium, calcium, etc. Oxygen has sometimes
been called the supporter of combustion, but it would be quite
powerless without some affinitive elements to draw out its action.
Prof. Draper has well said that " no substance is, in itself, a
supporter of combustion, nor is anyone intrinsically a combustible
body. If a jet of hydrogen will burn in an atmosphere of oxygen, so
also will a jet of oxygen burn in an atmosphere of hydrogen gas."
Thus we see again this ubiquitous law of duality as the ever
recurring principle of all force. XXII. Flame. i. Flame always requires
a gaseous combination of affinitive elements, and a thoroughly
luminous flame must have an abundance of luminelles. The most
practical of all substances, out of which luminelles may be formed, is
carbon, ist, because it exists abundantly in wood, forms nearly the
whole of coal, much of oil, and a fair amount of illuminating gas, and
2dly, it is one of the most infusible of all substances, and
consequently its particles retain their solid condition longest without
becoming disintegrated. The constituents of ordinary flame, then,
are hydrogen as the thermal, inflammable element, oxygen as an
electrical substance to bring this hydrogen into full action, and
carbon, which is also vitalized by the oxygen and whose particles are
of the right size to constitute luminelles. These luminelles are
eliminated from the solid mass by the aid of the combined oxygen
and hydrogen, and being larger than any particles connected with
these two gases, produce a far greater illuminating power. These
elements constitute a hydrocarbon, or a compound of corbonic acid
gas (C02) and hydrogen. " Is not flame a vapor, fume or exhalation,"
says Isaac Newton, " heated red-hot, that is, so hot as to shine ?" A
lighted lamp or candle is a kind of a gas factory, as a flame cannot
be kindled until more or less of gas has been generated, and
whenever a flame sways about it is simply the movement of gases
whose luminelles have been made red-hot or yellow-hot by the rush
of chemical forces. I say
 FLAME 205 yellow-hot, but if the action becomes
sufficiently intense, so that the heat shall be great, they will become
white-hot, or nearly so, as in the case of a calcium light. Thus the
flame of a candle, as compared with that of the hotter gas, seems
yellow, with some reddish tint, and the gas, as compared with the
calcium light, presents the same appearance, while the sun light is
still whiter than the calcium light. In the ordinary illuminating or coal
gas, the hydrogen, carbon and other substances are already
manufactured into gas, and hence the ease with which a brilliant
flame is produced. 2. An ordinary jlame of a candle, lamp or gas,
consists of three layers, as shown in fig. 162 ; a blue electrical flame
at the bottom where the oxygen of the air sweeps up from below,
and acting first upon the excitable hydrogen of the oil or gas, ignites
it, and acting also upon the carbon of the same, converts it into
carbonic acid, which with its newly liberated particles forms the dark
centre b. Almost in a twinkling these dark particles become radiant
with heat as the inrushing oxygen makes more and more intense the
action of the hydrogen and the contiguous carbon. This carbon
which at first is converted into carbonic oxide (CO), on receiving a
larger share of oxygen, assumes the more intense form of carbonic
acid (C02), and becoming ignited and volatile with heat, spreads out
into the luminous portion c. The very thin, almost invisible, bluish
envelope e, e, is caused by the inward rush of the oxygen as it seeks
its affinitive uprising hydrogen. This may be seen best by viewing a
flame in its narrow direction. If the upper and more luminous part of
the flame should be hidden by the hand or some other object, the
exquisite blue, merging into indigo and violet, may be seen very
distinctly. The same will appear in the flames made by burning
wood, coal, paper, matches, and other objects, where the flame
joins the lower part of these objects, as no elimination of luminelles
can take place without the electrical flow. 3. In the case of
magnesium light, particles of magnesia (MgO) constitute the
luminelles, in the calcium light, particles of lime (CaO), in burning
strontium, particles of strontia (SrO). whose Fie. 162.
 206 THE SOURCES OF LIGHT. luminelles are red, in burning
sodium, particles of Soda (Na20) whose luminelles are yellow-
orange, and so with other substances, as will be shown in the next
chapter. As I have said before, however, carbon is by far the most
common basis of luminelles for practical illuminating purposes. 4.
Why do the luminelles of a flame when brought into contact with a
person cause so much more pain than the usual atmospheric
luminelles as ignited by the sunlight ? Because they are coarser, far
more condensed, and emit a ruder grade of heat. This will also
explain why the luminelles of an ordinary flame or torch remain dark
in the center for a moment, while those of the atmosphere are
kindled without any appreciable length of time, as the larger ones
require more time to become ignited than the smaller ones. Nature
has kindly spread out through the atmosphere, those exquisite
particles which may convey a suitable amount of light to us without
burning either the eye or the skin. XXIII. Smoke. When a flame, as
that of a lamp, is not supplied with a sufficient draft of oxygen to
ignite all of its luminelles, and decompose them to a certain extent,
they are carried up into the air in a dark condition which we call
smoke. This smoke includes a certain amount of carbonic acid which
is poisonous when inhaled, or carbonic oxide which is still more
poisonous. Smoke consuming arrangements have been devised, but
when they can be made so simple, cheap and effective as to be
universally adopted, the great black cities where bituminous coal is
used, such as London, Birmingham, Glasgow, and Pittsburg, will
become comparatively clean and beautiful, will utilize much fuel and
become more healthful. XXIV. Non-Luminous Flames. A jet of
burning hydrogen, though very hot, is barely visible in the day-time.
Alcohol emits but little light while burning. The intense heat of the
oxyhydrogen blow-pipe causes a olue flame which is but feebly
visible. These and some other very intensely hot flames, such as
that of Bunsen's burner which combines air with gas, etc., give but a
feeble light, and that gen 
 KEROSENE OK COAL OIL. IOJ erally of a bluish electrical
character, thus showing a strong chemical action. We have already
seen that these non-luminous flames come from a lack of luminelles
or of some solid substance which may become incandescent. Solid
matter becomes luminous in the day-time at a heat of 9000 or
10000 F., but gases become only feebly visible at 20000. XXV. Coal-
Gas. The ordinary illuminating gas is made from bituminous coal,
although gas of still higher illuminating power may also be made
from oil, fat or resin. The most abundant ingredient of gas is light
carburetted hydrogen (marsh gas), although a more highly
illuminating part from its having twice as many carbon luminelles, is
the heavy carburetted hydrogen (defiant gas). The leading
ingredients of coal gas are as follows, together with their specific
gravity (weight as compared with air) : — Specific Gravity. Light
carburetted hydrogen (CH4) .552 Olefiant gas, or heavy carburetted
hydrogen(C2H4) .987 Sulphuretted hydrogen (H 2 S) .1192 Carbonic
oxide (CO) .96 Nitrogen .97 1 3 Besides these, there is a small
amount of bisulphide of carbon, and some combustible
hydrocarbons. It is highly important that it should be well purified of
ammonia, sulphuretted hydrogen, and other deleterious ingredients.
XXVI. Kerosene or Coal Oil. In its crude form this is called Petroleum
or Rock Oil, and has become a vast source of home illumination. It is
composed almost wholly of hydrogen and carbon. It is very
important that it should have its benzine and other volatile elements
so eliminated from it that it shall not be too light and combustible,
as too many lives have been lost from the careless use of the
cheaper and more impure oils. Kerosene oils ought to be able to
endure from 1300 to 1500 of heat without combustion. An intelligent
gentleman, skilled in its use, says that some of the worst explosions
are caused by turning the light down low and letting it burn thus, by
which means the metals around the burner become especially
heated,
 208 THE SOURCES OF LIGHT. and through them the oil
below is converted partially into gas which makes it doubly
inflammable. With care, however, there should almost never be any
danger from the use of this admirable and steady-burning kerosene
flame whose illuminating power has been estimated at 7 times that
of an ordinary candle, just as an average gas light is equal to 20
candles. The purest oil has almost the transparency of water, is
almost odorless, is the least inflammable of all, and, when supplied
with a shade, especially one which has some blue tint, is highly
protective to the eyes and is well adapted for study, writing or
sewing. XXVII. The Oxyhydrogen Blow-Pipe Consists of two
gasometers, the one with oxygen, the other with hydrogen gas,
which are brought in separate tubes and made to meet at the
extremity where the two gases are joined in a single stream and
lighted. The heat thus produced is the greatest known to man, with
the exception of that which is developed through the agency of
electricity, and in it metals will burn like wood or wax, iron sending
off its brilliant luminelles, or scintillations ; copper, its green
luminelles, and other metals their own special color of flame. Wood
or coal burn easily by the addition of mere oxygen, because they
have hydrogen as well as carbon ; but metals lacking the hydrogen
in themselves will burn with a flame only when both hydrogen and
oxygen are added, their own particles answering as luminelles. The
electrical flame uses the hydrogen and oxygen in the vapor of the
atmosphere in connection with the metals. The temperature of the
oxyhydrogen flame, as shown by Deville and Bunsen, is from 45000
to 60000 F. XXVIII. Calcium Light, or Lime Light. When the feebly
luminous flame of the oxyhydrogen blowpipe is directed upon a
cylinder of lime, which is oxygen and calcium combined, a most
dazzling light is produced unequaled by any artificial flame excepting
that developed by electricity. This is caused slightly by the luminelles
of lime, but mainly by the intensely incandescent lime itself. Huggins
discovered particles of lime in the spectrum of limelight. It is
sometimes called the Drummond light, from the inventor.
Magnesium light is made on the same principle, and is more
permanent, as the magnesium
 ELECTRIC LIGHT. 209 does not waste away as does the
lime. Coal gas is sometimes used in the place of the blow-pipe, and
is generally sufficient for illustrating spectrum analysis before a
popular audience. XXIX. Electric Light. 1. If a current of galvanic
electricity be allowed to pass between points of charcoal which are
attached to the two poles and held near each other, an intensity of
light will be generated which will be almost unsafe to look upon,
together with a heat that no scale at present known to man is
capable of measuring. Faraday ascertained beyond dispute that
electric sparks, flames, etc., consist of particles of the metal or
charcoal which form the electrodes of the battery and the medium
through which it passes, while the spectroscope clearly reveals as
the component parts of the electric flame, the substance of the
electrodes themselves, together with the hydrogen, oxygen, nitrogen
and sodium of the atmosphere. We thus have luminelles from the
electrodes and also from the atmosphere to aid in both the heat and
light, while the currents of electricity, sweeping with inconceivable
velocity, eliminate more or less of charcoal or other atoms, and
driving them especially from the positive towards the negative pole,
and somewhat from the IS" ! 3' lg' 1 4' negative to the positive pole,
which poles are kept at a brief distance apart, kindle the atmosphere
into a flame that will immediately melt away and vaporize solid
metals, which may be placed in it. The electrodes are first placed
near each other and then drawn apart a short distance, when the
light will assume magnetic curves called the Voltaic arc, as in figs.
163, 164. Carbon, especially of the coke variety, is the best material
for the points of the electrodes, 1st, because it is less apt to melt
than metals, and, 2dly, its diverse lines of polarization do not allow
the electricity to pass off too rapidly, but hold it until its tension is
powerful, so that when it bursts over to the opposite pole from -f- to
— it makes the more intense flame, and 3dly, a rough black
substance is favorable for radiating light and heat. 2. The electric
arc-light being white like sunlight, gives the color of objects
correctly. Most artificial lights give an orange or yellowish tinge to
whatever they touch. 14
 THE SOURCES OF LIGHT. 3. Electric Arc-lights for healing
purposes evidently surpass everything excepting sun-baths in their
vitalizing and upbuilding character. The incandescent electric lights
have performed good cures both in Spain and this country, but they
have a reddish cast like gas-lights, and are far less penetrating and
pure in their influence than the arc-light or sunlight. Prof. Siemens of
England, by use of the arc-light, caused grapes and strawberries to
ripen with a very fine flavor, and in less time than is usually required
by sunlight, and the Cornell University has made extensive
experiments in growing fruits, flowers, etc., by the same means.
Having then a pure flame like the sunlight and with a searching
power which thus builds up the processes of life, it is evident that it
must become one of the great curative agencies of the world. By aid
of an instrument which encloses the patient, modifies the color
forces for different parts of the body, and concentrates the light
powerfully by a large plated reflector, healing becomes a
physiological science quite in advance of Turkish or Russian baths,
which are lacking in vitalizing power, and which throw hot and cold
forces over every part of the system nearly alike. For this reason, the
luminous sweat-bath, which places the head in the cool air, and the
rest of the body under warm or cold colors, as its needs may be,
must come into universal use. 4. The Niagara Falls are now being
utilized successfully as a generator of electricity, which by a proper
system of wires can be converted into heat, light and motive power
for hundreds of miles around. To have our homes lighted and heated
better and more cheaply than at present, will be delightful, and to
have the noisy, smoky and sometimes dangerous power of steam in
our factories and railways, superseded by electricity will be a boon to
mankind. Incandescent lights will be the most appropriate for home
use, but the arc-light is much better for great halls, mercantile
establishments and streets where great power and long distances
are to be dealt with. Cities that get up their own electric lights,
according to F. G. R. Gordon in the Twentieth Century, get each light
at $52.12 per year, while the cities that stupidly allow private
capitalists to furnish them have to pay $105. 13 per light, or twice as
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