his houses by alternative designs or by cutting comers in construction. on the other hand, much could be gained by the developer who shopped in the metropolitan market for land. land always ranged widely in price, in accordance with numerous variables, so that the developer who took his profit by marking up the land in the lot - house package rather than by alienating the buyer by radical alterations in the structure enriched himself, while he simultaneously catered to a mass middle - income market. the consequences of this strategy in private development have been an array of relatively generous structures and pinched and inflexible land divisions. from such practices came the handkerchief front lawns, dark and narrow side yards, garage - lined alleys, solid blocks without parks or playgrounds, and the apartment - walled streets that are common to all our cities. in their day such areas were to achieve aesthetic success through the softening of awkward structures by means of trees planted between sidewalk and street and the visual merging of one tiny lawn with its neighbor. although each lot might be small, the overall effect of the block would be the relief of repeated buildings by continuous bands of green. moreover, land covenants and later zoning ordinances against particular uses were designed to protect the residential grids from the encroachment of commerce and industry by confining these activities to a corner store, strips along the main thoroughfare, or bands on each side of railroad tracks. over time such expectations and achievements have been severely eroded by the coming of the automobile and also by the inherent rigidity of the social and economic requirements of the land plan. these grids were not designs for future growth and inevitable change ; they were static layouts, and this in a country with a long history of racing urban transformation. sheer crowding of the streets and yards by automobiles since world war ii has destroyed the trees, hedges, and lawns, and since side and rear yards were small ( or nonexistent on apartment blocks ) cluster parking could not be introduced except by tearing down some houses and apartments. with the coming of the automobile the old residential areas of american cities have irrevocably lost their earlier pleasant qualities. such crowded and unwalled land presupposed adequate incomes and a neighborhood consensus for the private maintenance of what were in function the public amenities of the block. children had continually to be restrained ; lawns, hedges, and trees tended and replanted ; janitors, tenants, and homeowners had to be fussy about trash ; home businesses and car


in function the public amenities of the block. children had continually to be restrained ; lawns, hedges, and trees tended and replanted ; janitors, tenants, and homeowners had to be fussy about trash ; home businesses and car repairs had to be excluded ; and the city had to be vigilant in its cleaning, policing, and planting if the fragile green strips were to be preserved. declining incomes of old people, lowered wealth of successors to the first settlers, crowding by the poor, small businesses, multiple occupancy, multiplication of automobiles, loss of political status at city hall, and impoverishment of municipal governments made such a demanding neighborhood performance impossible of perpetuation. high walls and enclosed gardens and courtyards in the european manner would have enabled american residential neighborhoods to be used more comfortably by people of varying incomes and ways of life, but to modernize our inherited gray areas in such patterns and also to make room for automobiles would require a heavy investment, to say nothing of tearing down structures to make parking places. all in all, such modernization will demand an investment in landscape construction which far exceeds that allotted to our common open urban and suburban styles. residential areas are not alone in suffering from the real - estate practices of the past. the developer ' s goal of selling every last lot meant that commercial and industrial strips were cut up and filled without regard for a reserve of space needed for the future. today narrow strips of stores laid out to serve pedestrian and streetcar traffic cannot be readily adapted to automobile traffic. no land was set aside for commercial and industrial expansion, so that firms that prosper in old sections of the metropolis must move, much to the detriment of the local economy, to find adequate space. the inner city and gray areas thus become, by a kind of anti - darwinian selection, the sites of the old - fashioned and least successful enterprises. finally, the new environment of 1880 - 1920 was more a machine for social mobility than a model for urban communities. the sociability of americans, especially housewives and their children, did create friendly neighborhoods within the ever - expanding grids of streets and houses, but these important interactions took place despite, not because of, the land plans. the shopping strips, scattered churches and schools, and grid streets did not focus the paths of neighboring and daily errands in a way that made it possible for groups of people living within the same few blocks to know or recognize each other. this absence of widespread acquaintanceship caused by disparate


and grid streets did not focus the paths of neighboring and daily errands in a way that made it possible for groups of people living within the same few blocks to know or recognize each other. this absence of widespread acquaintanceship caused by disparate daily paths has hindered the informal policing of old urban and suburban neighborhoods. such sociability networks as did establish themselves were hardly a match for the contrary impulsion toward anonymity which american mobility patterns foster. we use housing as an expression of family status and affluence, to move out when we move up, or to shift houses in a restless search for better jobs. the inevitable consequence of these habits has been very high levels of neighborhood turnover, with all the social stresses and threats to stable property maintenance and values that such behavior entails. the instability of residential property, the customary failure of builders to lay out or maintain a gardenlike neighborhood, and the universal lack of community solidarity led some wealthy nineteenth - and twentieth - century americans to experiment with communities planned to overcome these failings and to protect suburbs from the usual processes of urban growth. the earliest experiment, llewellyn park, new jersey ( 1853 - 69 ), had a single - gated entrance which opened to a sinuous ribbon of streets laid out along the contours of a hilly site. four hundred acres were subdivided into one - acre sites abutting an interior fifty - acre park. the park was to be controlled and maintained by the homeowners as common land. thus the enjoyment of a country gentleman ' s park in the then - popular romantic style became possible for several hundred families, each of whom was responsible individually for the upkeep of only one acre. a similar design for sixteen hundred acres in suburban chicago was laid out by new york city ' s central park designers, frederick l. olmsted and calvert vaux, in 1868 - 69. here an entire residential community was contemplated. the commuters ' railroad station and the town stores served as the community center, while curved streets sunk below the grade of the house lots, reserved parkland, and subtle alterations in the des plaines river created the garden effect. in this case the subdivision — riverside, illinois — constituted a single political unit, so that the regular political machinery of local government could be employed for the maintenance of public spaces and for the policing of the subsequent development of the town. the enthusiasm for golf, which seized the rich in the late 1880s, offered new devices for community planning of wealthy subdivisions. the golf club with its


could be employed for the maintenance of public spaces and for the policing of the subsequent development of the town. the enthusiasm for golf, which seized the rich in the late 1880s, offered new devices for community planning of wealthy subdivisions. the golf club with its expensive lawns and plantings could serve as a park in its own right and also as a barrier to later encroachment by smaller houses and apartments. it could in addition serve as a powerful mechanism for controlling the social unity of the area, and with such merits the golf club became the most widespread tool of suburban community design in the american metropolis. its failings of course lay in the substitution of private club for public community and in the extreme class, race, and ethnic segregation it inevitably imposed. the largest and most successful of all these upper - income residential communities has been the country club district of kansas city, begun in 1905. one firm has since continued to develop a succession of subdivisions that fan out from the axes of two main streets that join at a shopping center. an extensive list of covenants between the developer and the purchaser including for many years covenants against black purchase — and active homeowners ' associations have been used to control the siting of the houses and the type of structure built and to maintain the public services of the streets and district. in 1911 the russell sage foundation attempted to demonstrate in its forest hills, long island, project that these examples of design of suburban communities for the wealthy could be adapted for middle - income housing. the experiment, taking place within the municipal boundaries of new york city, attracted a great deal of attention and was a considerable success in the field of design, but it also conclusively proved that the conventional subdivision was more profitable. the lesson forest hills taught the infant city - planning profession was that the community planning features of curvilinear streets, cul - de - sacs, playgrounds, parks, and unified shopping centers would be adopted by subdividers only if local government regulations required them. this lesson has been well learned, and much of the superiority of post - 1920 suburban subdivisions over their predecessors comes from the imposition of such rules for land platting by professional planners employed by the local governments of the american metropolis. in particular the neighborhood unit scheme, derived from nineteenth - century planned community experiments and advocated by russell sage foundation executive clarence perry, proved a flexible device. the neighborhood unit idea, modeled in part at forest hills, was an institutional and traffic design program for promoting the social organization of new suburbs. each


nineteenth - century planned community experiments and advocated by russell sage foundation executive clarence perry, proved a flexible device. the neighborhood unit idea, modeled in part at forest hills, was an institutional and traffic design program for promoting the social organization of new suburbs. each neighborhood was to be defined by one primary school, situated in a central park. the borders of the neighborhood were to be set off by main traffic arteries. in this way only neighborhood - serving and local residents ' traffic would move through the area, while the schoolchildren and their after - school play would bring resident families into contact with one another. service stores were to be so placed as to make for social unification, and the daily round of errands would also promote acquaintanceship. in varying modifications the neighborhood - unit idea for suburban planning has been promoted by professional planners and widely adopted in middle - class subdivisions across the nation. gans ' s study of levittown, new jersey, demonstrates that school, street, and errand planning do not make communitarians out of america ' s nuclear and highly mobile families, but such designs do reduce traffic accidents and provide an informal atmosphere in which to raise children. only in cases where subdivisions of limited class range have coincided with local political boundaries do strong suburban communities seem to develop in the metropolis. in such cases the positive effects of the promotion of public facilities, high levels of maintenance, and innovative municipal services manifest themselves, but so also do the negative effects of racial and class exclusiveness. for the preponderance of americans, neither the old grids nor the community - planning experiments of the nineteenth century seem to create an adequate urban environment — an environment able to roll with the social impacts of a rapid rate of urban development and at the same time to fill the gap between family isolation and the goal of an open democratic community life. if the environment of 1880 - 1920 is the physical inheritance of our cities, it was the medical responses of that same era that fashioned the basic set of institutions established to protect the health of our urban populations. the staying power and rigidity of this legacy derives from its extraordinary successes in its own time. armed with new scientific discoveries and techniques, these medical institutions scored an undreamed - of victory over the epidemic and mortality crises of the nineteenth - century city. simultaneously doctors, hospitals, dispensaries, and public - health units offered a broad range of acute - care services which met many of the day - to - day needs of the upper two - thirds of the population. such remarkable accomplishments so


. simultaneously doctors, hospitals, dispensaries, and public - health units offered a broad range of acute - care services which met many of the day - to - day needs of the upper two - thirds of the population. such remarkable accomplishments so raised the status and popularity of doctors and their institutions that not until our own time have the shortcomings of these arrangements from the past come under scrutiny. yet today ' s problems were also those of the years of first triumph : a badly skewed delivery of health - care services that favored city dwellers, whites, men, and the well - to - do ; an arrested environmentalism that neglected nutrition, housing, community, family life, and preventive care ; narrow specialization and bureaucratization which de - humanized the patient ; an overemphasis on drugs, surgery, and advanced instrumentation which drew scarce resources from the essential, if less heroic, long - term physical and mental therapies ; a general self - satisfaction on the part of the medical fraternity which isolated it from a range of overlapping professions in education, engineering, planning, and social science. the sustained contagious - disease and mortality crises of giant nineteenth - century cities manifested themselves most ominously in the old environment, the quarters of the poor untouched by or only partially improved by the new patterns of city building or the new sanitary services of the 1880 - 1920 metropolis. here society had proved unwilling or unable to extend its environmental remedies, but fortunately the nation was spared the endless recurrence of the ancient disabilities of great cities because the discoveries of medical science were able to deal with a select list of disease and thereby reach out to protect almost the entire urban population. in addition, such was the new wealth of these cities that the adequate - income majority was able to purchase a greatly enlarged range of services for its routine health care. in the 1820s, at the onset of rapid urbanization, american cities were virtually defenseless against both epidemics and the normal incidence of disease. the art of medicine could do little but set bones, amputate limbs, pull teeth, vaccinate against smallpox, and assist births. the few drugs doctors prescribed were unspecific and often given in debilitating dosages. worse still, the contemporary custom of drawing blood and purging bowels was actually injurious to the ill. in these early nineteenth - century years the best medical care consisted of commonsensical home nursing by relatives and the family physician so that nature ' s own cures could most


and purging bowels was actually injurious to the ill. in these early nineteenth - century years the best medical care consisted of commonsensical home nursing by relatives and the family physician so that nature ' s own cures could most effectively take place. for the ordinary citizen the comfort of one ' s own family and the attendance of the solo practitioner were the normal recourse in times of accident or sickness. for those outside the ministrations of family comfort, the largest cities like philadelphia, new york, and boston had established hospitals open to migrants, sailors, the old, mentally ill, and the sick poor. despite good intentions, extreme class segregation inevitably undermined these institutions. as custodians of outsiders and castoffs, these early hospitals fell far short of contemporary home standards. except in the few hospitals staffed by catholic orders, nurses were those with the lowest status and little opportunity for other employment and were sometimes even superannuated prostitutes and former felons. only when the middle class itself experienced hospital conditions, as thousands did as soldiers and volunteer nurses during the civil war, did the importance of hospital nursing impress itself on the consciousness of the mainstream of the society. hospital funds were always short, rooms overcrowded, bedding dirty ; in the absence of special operating rooms and anesthesia, the screams of the patients echoed through the wards. under such conditions, alcohol, then a major hospital remedy, was perhaps the most humane prescription. in the early nineteenth century, hospitals deserved their popular reputation as places where shiploads of sick immigrants were dumped, and where the poor and the unfortunate went to die. a more successful institution of these early years was the dispensary, a neighborhood clinic where medicines and advice were given to poor patients. since dispensaries held no resident patients, they escaped some of the effects of ward contagion. they were cheap to run, and they also enjoyed a measure of public support as the one medical institution that could help the city in its continuing struggle against smallpox. the common council of new york, for instance, frequently voted funds to the dispensaries for immunization, but popular distrust of vaccination limited their effectiveness. though charities, the dispensaries rose above some of the worst degradation of philanthropy because the needs of the medical profession elevated the quality of their services. there were few medical schools in those days and even less clinical supervision, so that ambitious young doctors who wanted to extend their apprenticeship sought dispensary positions much as today


of philanthropy because the needs of the medical profession elevated the quality of their services. there were few medical schools in those days and even less clinical supervision, so that ambitious young doctors who wanted to extend their apprenticeship sought dispensary positions much as today they seek hospital residencies. with such diverse roots of support, city dispensaries multiplied during the years before the civil war ; new york ' s first dispensary opened in 1791, and by 1866 there were ten. altogether, family nursing, the private practitioner, the hospital and the dispensary were but a tenuous defense against accident and disease. today the national death rate stands at about 9. 5 per thousand inhabitants ; in 1900 it was 17. 2 ; in new york prior to the civil war, so far as records tell, it fluctuated between 26. 1 and 40. 7. infants and children dwelt in greatest jeopardy, suffering about two - thirds of each year ' s deaths. yet public concern did not then, nor did it earlier, focus on childbirth and child care, or even on the major day - to - day causes of adult death and morbidity : ' tuberculosis, typhoid, and dysentery. the public accepted these diseases as the hazards of life itself, though statistics seem to show that in the nineteenth - century urban environment such dangers to life increased with city size. rather it was the dramatic summer incursions of epidemics of yellow fever, asiatic cholera, and to a lesser extent typhus ( a disease the well - to - do could ignore as the special providence of poverty - stricken immigrants ) that mobilized public opinion. these epidemics called forth the nation ' s earliest environmental public - health programs : quarantines, emergency and immigrant pesthouses, disinfection of the rooms and houses of the stricken, and attacks on nuisances and filth. although the causes of the epidemics were unknown at the time, european sanitarians had conclusively shown ( and american investigators confirmed ) that overcrowding and bad sanitary conditions were correlated with a high incidence of such cases. landmark studies were lemuel shattuck ' s census of boston ( 1845 ) and his report of a general plan for the promotion of public and personal health ( 1850 ), john h. griscom ' s the sanitary conditions of the laboring population of new york ( 1845 ), and the american medical association ' s multi - city investigations of 1849. the net effect of these measures and of the


( 1850 ), john h. griscom ' s the sanitary conditions of the laboring population of new york ( 1845 ), and the american medical association ' s multi - city investigations of 1849. the net effect of these measures and of the water and sanitary constructions which accompanied them seems to have been to stem the potential for an ever - rising death rate, which unattended urban growth would have unleashed. until the new medical science arrived high mortality could not be turned back, but the early environmentalists did at least succeed in holding the half - dozen largest cities of 250, 000 to 2, 000, 000 inhabitants to levels of safety commensurate with those of less than 100, 000. the rapid succession of medical discoveries which began to accelerate after 1870 led to a proliferation of medical institutions whose innovative services were as important to urban living as the sanitary engineering of the former big - city era had been. the discoveries of bacteriology made possible the specific identification of an impressive list of common diseases like pneumonia, typhoid, tetanus, dysentery, whooping cough, tuberculosis, and numerous wound infections. parallel discoveries in chemistry, pathology, and endocrinology allowed the effective intervention by doctors in a considerable number of both children ' s and adults ' illnesses. thanks to the new science, by 1900 the profession of medicine was rushing forward from its previous statistical observations and commonsensical nursing toward active intervention both in individual cases and in the urban environment. the new capabilities manifested themselves in traditional and novel forms alike : in the private practice of the single physician, in the totally refashioned institution of the voluntary hospital, in the expanded private and municipal public - health clinics and dispensaries, and in new regulatory programs. for the majority of urban dwellers, the most obvious gift of the new science appeared in the augmented effectiveness of the neighborhood physician. in 1900, solo practitioners ' training and equipment were still quite primitive. nevertheless those who kept abreast of recent discoveries could carry a few efficacious drugs and vaccines in their black bags, by now knew enough pharmacology to avoid the destructive dosages of unspecific drugs, owned a small table - top laboratory where they could perform a few simple urine and blood tests, had a systematic method for examining patients to detect their symptoms, and possessed sufficient knowledge and technique of asepsis to treat minor injuries, deliver babies, and handle contagious disease without endangering their patients. furthermore, now that the scientific foundations of medicine had


method for examining patients to detect their symptoms, and possessed sufficient knowledge and technique of asepsis to treat minor injuries, deliver babies, and handle contagious disease without endangering their patients. furthermore, now that the scientific foundations of medicine had been established beyond cavil, it became possible to standardize the norms of competence and to extinguish the professional conflicts that had raged among believers in various causes of disease and different methods of therapy. the nineteenth - century hodgepodge of quacks and of physicians trained in commercial medical schools as well as in universities was soon placed under strict licensing and educational standards. by 1920, city dwellers who could pay a private doctor ' s fee could expect a fair level of competence in the treatment of a considerable list of common diseases and injuries. this new effectiveness, achieved in the lifetime of one generation, raised the status of the family physician to a position of extraordinary popularity. the private practitioner became that legendary figure of healer, father, and family guardian which enabled the medical profession to defend itself against major reform in our own time. in the late nineteenth and early twentieth centuries a wholly new kind of institution, the voluntary general hospital, served as the social agent of medical progress and the adjuvant, teacher, and disciplinarian of the private city physician. by ceasing to be merely the repository for the unfortunate and becoming instead the home of the new advanced practice and the servant of the middle class, it moved from the periphery to the center of medical care. in the years after the civil war, everything about the hospital changed. the discovery and perfection of techniques of asepsis made it a reasonably safe place to go for treatment of serious illness or severe accidents. surgery became reliable and effective. with the growth of science and the shift in hospital clientele, nursing ceased to be the resort of undesirables or a province of religious orders. it matured instead into a suitable lay occupation for those educated middle - class and working - class girls who were seeking independent roles in a society that had formerly offered little outside the factory, shop, school, or home. finally, the hospital became the center of scientific progress. only the large hospital could afford the expensive equipment and laboratories required for complicated techniques ; only the large hospital could provide the variety of cases essential to research and medical education. these science - based changes in the hospital engendered a new fusion — the union of university medical schools, voluntary general hospitals, medical researchers and specialists, private practitioners, and their middle - class clients.


of cases essential to research and medical education. these science - based changes in the hospital engendered a new fusion — the union of university medical schools, voluntary general hospitals, medical researchers and specialists, private practitioners, and their middle - class clients. such a fusion was a reflection of the social structure and economic power of the industrial metropolis. the fabulous fortunes of the late nineteenth and early twentieth centuries were represented on the governing boards of general hospitals and universities. the urban rich, as yet but minimally taxed for public programs, expressed their enthusiasm for the new science, and often their gratitude for medical care, by endowing chairs of medicine and furnishing the capital for new universities, new hospitals, and numerous additions to existing facilities. on these boards representatives of wealthy families met with fashionable practitioners and distinguished specialists to determine the broad policies of medical schools, hospitals, and research. here lay the source and direction of pre - world war i medical capital. the middle - class patient, too, made his contribution. hospital fees began to be levied for service, and these fees provided a major fraction, or even the entire funding, of the day - to - day operation of the hospital. the working class and the poor, here as in the city at large, were subject to means tests to set the degrees of remission of their charges. moreover, as charity cases they were subject to crowding, segregation in the wards and outpatient clinics, and a cheapening of service that paralleled their outside lives as residents of the city and as low - income consumers. nevertheless, analogous to the rising living standards of the industrial metropolis itself, the new general hospital did give the poor access to an unprecedented level of medical care. the economic formula of the new voluntary hospital, altered by the omission of expensive charity, research, and training by proprietary hospitals but emulated in the best municipal hospitals by the substitution of the city ' s funds for the wealthy donor, proved so successful that hospitals multiplied at exceptional rates in the late nineteenth and early twentieth centuries. in 1873 there were only 178 hospitals in the united states ; by 1909 there were 4, 400 ; by 1918, when the number of non - federal institutions peaked, there were 7, 000. a totally unplanned growth, which was the outcome of the potentials of new science and the wealth of industrialization, had produced the social structure of the hospital - based medical profession that has proved to have serious consequences for our own time. in the early years, when research was first lifting the


outcome of the potentials of new science and the wealth of industrialization, had produced the social structure of the hospital - based medical profession that has proved to have serious consequences for our own time. in the early years, when research was first lifting the veil of ignorance and when new techniques and new hospital practices constituted such tremendous advances over what had prevailed, the gifts of the rich and the making of decisions by the wealthy and the professional elite seemed natural and beneficent. yet the failure of the american medical structure to represent either the middle - class or low - income patient in what were in fact public policy decisions has badly distorted our medical undertakings. ever more expensive research, ever more elaborate techniques, and the concentration on surgery at the expense of long - term care for the old were some of the most obvious results of the exclusive representation of wealthy donors and the medical elite. environmental and preventive measures, chronic diseases, dentistry, the day - to - day rendering of service, and what might be termed throat - stick medicine have been relatively neglected. moreover, with the rapid advance of science the solo practitioner became more and more closely allied to the hospital because it was the source of personal prestige and advanced knowledge and technique. as a result, neighborhood practice almost disappeared from poor districts, and the working class has come to be dependent upon the accident of location of hospital outpatient facilities. in 1920 the future of increasing medical specialization and the class, racial, and neighborhood consequences of the hospital structure of american medicine were only beginning to be perceived, but the seeds of our current difficulties had been sown. not that the industrial metropolis ignored the public - health possibilities of the new science ; it pursued them vigorously, constructing the institutional framework and practices that still supplement our practitioners and hospitals. indeed, the totality of environmental services and health - care institutions succeeded at last in bringing an end to the historic linkage of large cities and death. in new york, despite its gigantic size, and despite some of the most densely crowded wards in the world, the death rate had already by 1900 been brought below its lowest nineteenth - century levels, and it continued to fall in the big cities almost every year thereafter so that in our own time urban and rural death rates have at last converged. but at such a moment we face a familiar historical crisis — the institutions of the past fail to adapt to the needs of the present. as our health concerns have shifted from mortality to morbidity, we begin to experience all the failings of our old health - delivery structure. the


a familiar historical crisis — the institutions of the past fail to adapt to the needs of the present. as our health concerns have shifted from mortality to morbidity, we begin to experience all the failings of our old health - delivery structure. the discoveries of bacteriology reinforced the nineteenth - century campaign of urban sanitarians. water departments introduced filtration and chemical purification in the early years of the twentieth century. the identification of both human and animal tuberculosis bacilli led to the testing of herds and the certification and pasteurization of milk, which had been a major source of child - killing infections. the precision of modern chemistry, coupled with the new large - scale marketing of meat, food products, and drugs, made it possible for the federal government to augment ineffective municipal market inspections by nationally enforced standards for purity in foods and drugs that moved in interstate commerce. the ability of the new science to explain how vaccination gave immunity even made it possible for cities and states to overcome hoary public prejudice and to institute safe, effective, compulsory smallpox vaccination for schoolchildren. finally, by shifting the focus of attention in the campaigns to remedy the ills of slum housing, the new science brought the regulatory effort to its peak and logical stopping place. the " fever nest " slum blocks, with their high incidence of cholera and typhus mapped by the early sanitarians, had spurred the public to establish municipal boards of health and to support their pioneering programs for the removal of nuisances and for cleanup and disinfection. in new york such expert reforms had been given impetus by the frightening experience of the draft riots of 1863, and the city enacted the nation ' s first tenement - house regulation. but when quarantine measures ended the plagues, the working - class and middle - class voters lost their fright and with it their enthusiasm for aggressive public - health measures. housing reformers were forced to fall back more and more on appeals for public support on the grounds that overcrowding led to drink, crime, and prostitution, rather than urging a community of interest in safety from disease. the threads of moral horror and the community of health have always been intertwined in american housing proposals, and the early twentieth - century tuberculosis and well - baby campaigns did aid housing reform by contributing a set of causes for which there was broad popular experience and sympathy. as a result of the intensification of the sanitary attack on slum housing, by world war i all of the nation ' s large cities


campaigns did aid housing reform by contributing a set of causes for which there was broad popular experience and sympathy. as a result of the intensification of the sanitary attack on slum housing, by world war i all of the nation ' s large cities had modern housing codes specifying permissible room density, ventilation, and sanitation. these laws were an important achievement in ensuring that all future construction would conform to decent minimum standards. but regulation of housing cannot by definition expand the supply of housing, and indeed it tends to raise rents when it is enforced. also, it offers no remedy for the common situation where poor tenants and poor landlords meet. much slum property is owned by slum dwellers, not by rich corporations. many slum owners scrape their way into a heavily mortgaged landlord status. neither they nor their tenants welcome the news that costly repairs must be undertaken to bring their old buildings up to modem standards. the nineteenth - and early twentieth - century housing - regulation movement was after all the achievement of sanitary specialists and wealthy philanthropists, both of whom were unwilling to disturb the basic property and income relationships of the society. therefore however well - meaning, and despite its long - term contributions, the regulatory movement often appeared in poor neighborhoods as an exercise in harassment of the poor, against which petty bribes and aid from the ward boss in inducing inspectors to wink at violations were the best defense. housing reform shed some of its early philanthropic incubus thereafter, and in the thirties it picked up labor support when it was recast in the form of public construction and appeared as an aid to full employment for building - trades workers. the wealth of the industrial metropolis and the efficacy of the new science also enabled the cities of the nation to establish a series of institutions that would offer specialized medical services to supplement the basic system of private practitioners and hospitals. unfortunately for the public welfare, the urban health - delivery system was weakest in low - income areas, as housing regulations also had been, and it was in these areas that the incidence of disease and accidents rose most sharply. infants and children of the poor lived in the greatest danger. in the summer of 1893, dr. abraham jacobi and the philanthropist nathan straus opened a milk station, where boiled milk and advice on infant care were offered free to mothers of slum children. the immediate success of the project in preventing deadly summer fevers led to imitation and the rapid maturing of municipally managed well - baby clinics. soon clinics for tuberculosis and venereal disease were added to the public list.


of slum children. the immediate success of the project in preventing deadly summer fevers led to imitation and the rapid maturing of municipally managed well - baby clinics. soon clinics for tuberculosis and venereal disease were added to the public list. the new medicine encouraged the multiplication of dispensaries, both in the old form of the freestanding clinic located in a poor neighborhood and in the new form of the outpatient departments of public and voluntary general hospitals. by 1920 new york city possessed 228 dispensaries and clinics. there were 60 baby - health stations ; 21 tuberculosis clinics ; 12 venereal - disease clinics, only two of which offered treatment ; 26 municipal single - purpose clinics for treatment of eyes, teeth, rabies infection, and occupational hazards ; 34 independent dispensaries ; 65 outpatient departments of hospitals ; four children ' s dental clinics in schools ; and even six dispensaries for college students. a fourth of new york ' s eight thousand physicians put in some of their time staffing these institutions, at which approximately 1, 250, 000 patients were treated annually. although these statistics of institutional growth, doctor participation, and patient use were impressive when held against the light of the preceding half century, the deficiencies of these supplements to private fee - paying doctor and hospital care had already revealed themselves. they were second - rate charitable supplements and as such were bound to atrophy in a society that honored self - help and responded most positively to fee - paying patients. the entire list of clinics and dispensaries was not regarded by doctors as a group of institutions on their way to the provision of complete neighborhood care. instead they were viewed as charities for the improvident and the unfortunate or as a restricted concourse of specialists who would not compete with the private doctor ' s general practice. the new york dispensary law required that all patients be subjected to a means test to determine medical indigency before treatment, granting exceptions only for a few contagious diseases, notably tuberculosis and venereal disease. numerous studies were conducted, as in welfare today, to detect cheating by patients who could afford to pay the normal rates. the baby - health stations could administer only to well babies, while sick babies had to be taken to a general practitioner, dispensary, or outpatient department of a hospital. the public acquiesced in these constraints, and the network of supplementary institutions was used by the working class and the poor as their means of access to specialists and to doctors


practitioner, dispensary, or outpatient department of a hospital. the public acquiesced in these constraints, and the network of supplementary institutions was used by the working class and the poor as their means of access to specialists and to doctors essential in cases of serious accidents or of sicknesses they could not neglect. the whole charitable nature of these institutions prevented their maturing into adequate general - care centers. the doctors who staffed them were either ill - paid or, in the majority of cases, contributed their services. dispensary and clinic work carried no prestige ; such jobs were either the doctor ' s tithe or were sought by young men hoping for an entree to a regular hospital appointment by way of clinic duty. although dealing with a public which suffered special hardships from the loss of working hours or days, only 2. 5 percent of the total new york clinics ' time was scheduled outside the normal business day. patients had to wait in long lines. there was a shortage of supplementary personnel for the routing of patients, follow - up of cases, handling of records, and the offering of social services. diagnosis was weak, records fragmentary and often illegible ; tests were neglected and treatment haphazard. " among cases of syphilis studied in only 50 percent was an indication found that the patient had been given the proper treatment, " one study reported. even the outpatient departments of general hospitals, where the latest equipment and laboratories at least existed within the same building, suffered because such facilities were planned and scheduled for resident patients. the outpatient service was the stepchild of the hospital, its trustees, its administrators, and its doctors. all in all, despite its lusty growth from 1870 to 1920, the system of clinic and dispensary was poor man ' s medicine. the important public consequences of this charitable incubus lay in the withdrawal of popular support for all kinds of group and socialized medicine. as in the case of public housing, promising reforms directed to the social consequences of the unequal distribution of personal income went unsupported by working - class organizations because of their experience with services which departed from the normal private market form. in medicine the urban dispensary and clinic did not grow into a successful neighborhood or district institution, and the campaigns for health insurance faced opposition or apathy from organized labor. similarly, the federal government ' s promising demonstration of non - charity public housing during world war i died as suddenly as it appeared. in both cases small groups of professionals and intellectuals


and the campaigns for health insurance faced opposition or apathy from organized labor. similarly, the federal government ' s promising demonstration of non - charity public housing during world war i died as suddenly as it appeared. in both cases small groups of professionals and intellectuals had demonstrated that they had fully mastered the logic of the industrial metropolis ' s housing and health structures, but many more years of investigations, reports, and social failures would be required before major segments of the public would mobilize for change. the extreme shortage of housing near war plants and navy yards forced a reluctant federal government into its first venture in civilian public housing. prior to the war the housing - reform movement had been 102. row house yards, south and iranistan avenues, bridgeport, connecticut, 1919. the u. s. housing corporation employed the most advanced land - planning practices of its day. on an expensive 25 - acre site, using the smallest two - bedroom units of any project, designers mixed a colonial american building style with contemporary english garden city site planning to provide these generous garden spaces. national archives 103. war workers ' housing, madison street, waterbury, connecticut, 1919. english cottage version of contemporary suburban styles employed by the federal government in its first public housing venture. these duplexes, pairing five - and six - room units, were erected for skilled brass workers. national archives 104. war housing twenty years later, off lincoln street, bath, maine, 1940. because the sites were well planned and the architecture met the local consensus about what constituted decent housing, the u. s. housing corporation ' s work remained popular and aged well. library of congress 105. country club plaza, kansas city, ca. 1930. since 1905 the j. c. nichols company has been managing the nation ' s only continuously planned residential development. the basic strategy has been to follow the city ' s growth by subdividing land in an ever - widening triangle. houses and lots are sold, but the company keeps the shopping centers it builds. this is the first ( 1923 ), at the intown apex of the development triangle. nearby apartments helped to get the shopping center started. j. c. nichols company 106. grand drive from 53rd terrace, country club district, kansas city, ca. 1914. following contemporary examples of other upper - middle - class suburbs, especially roland park, baltimore, the company gave special attention to site preparation and landscaping. small parks, winding streets, and generous plantings are its hallmarks. with each subdivision homes associations are formed to maintain the


other upper - middle - class suburbs, especially roland park, baltimore, the company gave special attention to site preparation and landscaping. small parks, winding streets, and generous plantings are its hallmarks. with each subdivision homes associations are formed to maintain the local common grounds. j. c. nichols company 107. belinder avenue, country club district, kansas city, 1963. uniform setbacks of the houses, careful plantings and maintenance produce the epitome of the american residential street. photograph taken twenty - five years after first development. j. c nichols company 108. parking garage, 47th street, country club plaza, kansas city, ca. 1948. by keeping title to the shopping centers the developers can control and finance continuous modernization. here a former parking lot was converted into a free parking structure for 400 cars. in contrast to the pains of urban renewal, the country club plaza stands as a convincing argument for municipal ownership and management of the commercial and industrial land of the metropolis. j. c. nichols company 109. homestead country club, country club district, kansas city, 1954. since full - amenity development to high standards can only be profitable for middle - to - upper - income families, the entire country club district is a city planning triumph but a social disaster for kansas city. only public financing and control of land and housing development could have prevented the inevitable side effects of class and racial segregation. j. c. nichols company 110. public housing, holyoke, massachusetts, 1941. controls against giving too much to the poor reduced new deal housing to levels below that of the world war i projects, thereby ensuring that the gap between the rewarded poor and the middle class would widen disastrously once the depression ended. nevertheless, in small cities across the nation where land costs were low and projects not too large, substantial gains were made over local slum conditions. compare these new two - story row - house apartments to the four - story wooden tenements in the background. library of congress 111. subsistence homesteads, el monte, los angeles, 1936. a resettlement administration demonstration project of farm homes for clerks and industrial workers employed in the city. the three - quarter - acre lots and locally designed five - room houses successfully captured a broad popular demand. two thousand families applied initially for the planned 140 units. houses were ultimately sold to their occupants without loss to the government because the project was sensibly located along one axis of metropolitan growth. library of congress 112. ida b. wells housing project, pershing road and martin luther king


planned 140 units. houses were ultimately sold to their occupants without loss to the government because the project was sensibly located along one axis of metropolitan growth. library of congress 112. ida b. wells housing project, pershing road and martin luther king drive, chicago, 1942. typical new deal big - city federal housing project — barracks for 1, 655 black families. white antipathy to public housing outside the established ghetto forced enlargement of the project in 1955 and 1961 so that it is now an all - black philanthropic city of 12, 000 inhabitants. library of congress 113. lakeview terrace, whiskey island, cleveland, ca. 1936. local housing authorities, unwilling and unable to see housing as an opportunity to let the poor move to modern neighborhoods and closer to the growing sectors of the metropolitan economy, frequently repackaged the poor in old slum sites. here, 620 families were settled in an industrially impacted neighborhood. subsequently an interstate highway has further blighted one edge of the project. urban archives, temple university 114. lafayette park, detroit, ca. 1962. a 164 - acre urban - renewal project one mile east of the downtown. conceived first in 1949 as a public housing program, it was redesigned when urban - renewal legislation offered a tax - hungry city the opportunity to clear land and build for the wealthy. low - income property on the site was leveled without adequate relocation measures and luxury row houses and apartment towers were built. completed 1971. u. s. department of housing and urban development 115. prefabricated housing experiment, akron, ohio, 1971. mistaking a social and economic problem for a technological one, the u. s. department of housing and urban development recently launched a high - publicity program for factory - made homes. scarcity and costs of well - prepared land, class and racial segregation, and the financing of adequate social and educational services to housing, not the structures themselves, have been the real problem. u. s. department of housing and urban development 116. scattered - site public housing, mount clemens, michigan, ca. 1964. occasionally public housing meets the popular norms for decent living. here 160 units for blacks, whites, and the elderly were mixed within a small metropolitan satellite city ' s urban - renewal program. eight sites were scattered over 485 acres so as not to disturb the existing neighborhood fabric. tenants paint their own apartments and keep up their own lawns and gardens. problems so far : kitchens too small, not enough closet space! u. s. department of housing and


over 485 acres so as not to disturb the existing neighborhood fabric. tenants paint their own apartments and keep up their own lawns and gardens. problems so far : kitchens too small, not enough closet space! u. s. department of housing and urban development fully occupied with building regulations, the brand - new controls of zoning, and experiments with philanthropic and limited - dividend model - tenement housing. continental and british examples had begun to attract attention in advanced professional circles, and massachusetts had tried a small experiment, but to most americans governmental construction of houses seemed to represent a dangerous step toward socialism and a direct threat to the genius of the republic. despite successive reports of an inability to attract and hold skilled workers without the provision of some decent accommodation for their families, congress delayed authorization of public war housing. the fact that such an undertaking resembled german socialism more than anything else made it doubly unpalatable to congress. yet skilled workers would not tolerate for long the boardinghouses, barracks, and made - over garages that unskilled men and women accepted. therefore, five months before the armistice, a public - housing program for skilled workers was at last authorized, subject to the strict condition that all housing so built be sold to private persons at the war ' s end. two federal agencies, the emergency fleet corporation and the u. s. housing corporation, undertook the rush task and together they built or subsidized the construction of more than fifteen thousand dwelling units at seventy - nine project sites across the country. the final report of frederick law olmsted, jr., planner of forest hills and manager of the town planning division of the u. s. housing corporation, is of exceptional interest because it demonstrates that professionals had early thoroughly understood the mechanisms and limitations of the private housing market and the remedies needed to maximize the social benefits of private construction. the report also shows that the u. s. housing corporation had demonstrated how a model public - housing program should be managed if the government should ever have wished to move beyond the limitations of the private market. first, the summary report recognized the basic trickle - down nature of american housing. new housing is built for the middle class and the upper levels of the working class, and all others inherit what is vacated by these. thus the quality of housing in a given city depends directly upon its quantity. if there is a shortage of housing, olmsted stated, then those least able to pay rents must double up and occupy unfit structures, and the immediate result is " slum conditions


quality of housing in a given city depends directly upon its quantity. if there is a shortage of housing, olmsted stated, then those least able to pay rents must double up and occupy unfit structures, and the immediate result is " slum conditions unfavorable to that self - respecting family life upon which the security of our democracy rests. " second, he recognized local housing conditions to be a national and not a local problem, because of the crucial role played by the national flows of mortgage capital. thus during the years from 1914 to 1918 rising building costs and more lucrative opportunities for investment elsewhere had driven capital away from new construction, so that a housing shortage existed even prior to our entry into the war in 1917. as a permanent remedy for the inevitable periodic shortage of money for home construction, olmsted recommended federal intervention in the capital - supply market along the lines that had recently been followed by the 1916 farm loan act. under this program the government lent money to local cooperative banks, and they in turn extended cheap long - term mortgages to farmers. in 1933, with the crisis of the great depression, the home owners loan corporation was created exactly along such lines. this act, plus subsequent new deal additions, established the basic american housing strategy : to encourage the private trickle - down housing market through government intervention and government support for the supply of mortgage funds. olmsted noted that the u. s. housing corporation had " dealt but little with the more difficult problem of satisfactory and economical housing for the families of unskilled and relatively low paid workers. " yet looking back on the pioneering work of this agency and assessing its accomplishment in the light of america ' s subsequent public - housing disasters, one can appreciate these world war i construction projects as model programs that defined the basic conditions under which any successful public - housing policy must proceed. the essence of the corporation ' s work lay in its adoption of a contemporary consensus for standard new housing. in designing for skilled workers who were engaged in a common patriotic enterprise, the corporation ' s program was not obliged to lower its standards to a level below that of private housing. it did not have to avoid offending the sensibilities of private tenants and homeowners by offering less than the equivalent housing to its recipients of public welfare. on the contrary, the central office in washington set normal prevailing standards, called together mixed planning and archi - tectural teams, and turned them loose to do as good a job as they could. the result varied from the ordinary to the excellent. many projects


, the central office in washington set normal prevailing standards, called together mixed planning and archi - tectural teams, and turned them loose to do as good a job as they could. the result varied from the ordinary to the excellent. many projects used the latest traffic, curvilinear - street, park - reservation, and community - center devices of the best english garden city and wealthy american garden - suburb practice. taste was not regimented. there were colonial and tudor houses in the east, stone houses in ohio, spanish stucco in california, and neat wooden bungalows in the state of washington. moreover by a strong emphasis on site planning these projects enjoyed the lasting advantage of having their utilities, streets, and services finished and located in a way that would enhance the long - term use and maintenance of the homes, instead of leaving newcomers stranded and struggling for city services, as had so often happened in low - cost outlying private developments and would occur later in public housing. when the federal government did finally enter on public housing during the new deal, it violated ( except in its three controversial greenbelt towns ) the basic world war i conditions of success. instead of building to the standard of middle - class private consensus it built second - class philanthropic housing. by so doing it drove off local architectural and planning talent, erected obsolete structures that would have to be lived in for fifty years, and stigmatized the beneficiaries as second - class citizens. the health - insurance reformers of the pre - world war i era also displayed a competent perception of the shortcomings of the existing medical structure. the remedies they proposed, like those of the u. s. housing corporation group, were essentially conservative — designed to use government to make the private system more effective, not to institute a novel public organization. the health - insurance movement began in europe and was carried to america by intellectuals, and accordingly it was never a campaign of the medical practitioners. it commenced with a concern for the maintenance of income for injured workers ' families, and then as it gained momentum it moved on to proposals for insurance against everyday medical expenses. as the campaign progressed from legal and industrial reform to contact with medical practitioners and conflict with private insurance companies, it encountered a paranoid counterattack which defended the recently developed institutional struc - ture of medicine as if it were the last bastion of american free enterprise and the most sacred of the nation ' s ancient traditions. the first phase of reform, employers ' liability laws and workmen ' s compensation insurance, advanced smoothly because


provisions for medical charges were added to the original wage - based cash benefits, the restriction of the program to work - related health problems seems to have prevented practitioners from perceiving this insurance scheme as a threat to private doctor - patient relationships. hospitals did, however, receive direct payments from insurance companies for treatment of accident cases, and this innovation seems to have softened hospital administrators toward insurance schemes in general. again it was europe that pioneered in payments for sickness and accidents not related to the job. here the issue concerned income maintenance for workers ' families when the wage earner could not work, payments for medical care, and funeral expenses. as early as 1883 germany had begun contributory employer - employee local insurance funds, and in subsequent years the number of industries to undertake such coverage was steadily expanded. great britain followed a parallel course in enacting in 1911 a national insurance act, which established compulsory unemployment and health insurance. workers were to receive some measure of protection against the inevitable occurrence of periodic unemployment as well as some assistance to defray the costs of health maintenance. a special feature of the british scheme was its accommodation of existing benefit associations and insurance companies. the government promulgated a list of approved insurance societies, and these were to receive the joint payments of workers, employers, and the government. local boards of doctors, insurance representatives, and government officials were to oversee the payments. reformers in the united states were primarily academicians organized in the american association for labor legislation. in 1914 the association reported on its studies of european precedents and opened a campaign for medical insurance at the federal and state levels. the association did not contemplate total unemployment compensation. the reformers hoped to insure industrial workers against the expenses of childbirth, accidents, sickness, and funerals so that the working class could become full - paying patients of the private medical - care system. as in great britain, government, employer, and employee would all contribute to funding the compulsory insurance pools. the aall report also allowed self - employed persons not covered by the legislation to join such programs on a voluntary basis. either state or private insurance carriers were envisaged as insurers, and the schedule of payments was to be administered by employer - employee boards supervised by the government. the report also expressed the hope that such an insurance scheme would encourage physical examinations, early diagnosis, and such general preventive health practices as well as finance the care of acute illness. from 1916 to 1920, bills for federal investigation of health insurance and bills for state programs were put forward. the american hospital


scheme would encourage physical examinations, early diagnosis, and such general preventive health practices as well as finance the care of acute illness. from 1916 to 1920, bills for federal investigation of health insurance and bills for state programs were put forward. the american hospital association and the three nursing associations reviewed the question and issued reports calling such a step inevitable and urging hospital administrators to be sure that the scheduled fees were adequate even as they prepared for increased case loads. the national association of manufacturers, pleased with its workmen ' s compensation experience and safety - first campaigns and impressed by german business practice, expressed itself at first as favorable and then moved to a position of supporting private insurance only. organized labor offered weak support at best along with some opposition, with the a f of l executive committee unable to agree on a position. president samuel gompers testified before congress that such schemes would lead to federal spying on the homes of workingmen. the treasurer and a vice - president of the same union testified in favor, as did the railroad conductors. the poor quality of medical service offered by practitioners working for british insurance funds there created unfavorable publicity, but the medical insurance campaign here did not in any case call for group practice or any other alteration in the delivery of medical care. the low quality of american clinic practice may also have entered the minds of union leaders, since one of their major goals at the time was to achieve full equality of status for the american workingman. but the violent opposition came from a coalition of private insurance companies and doctors. one insurance executive campaigned full - time against the legislation. once again the war inflated the specter of german socialism. " when compulsory health insurance enters the united states, socialism will have its feet upon the throat of the nation, " he said. in 1917, private insurance companies had written industrial policies covering in some way 37, 500, 000 workers. conservative doctors in the american medical association repudiated the early stand of its leadership in favor of insurance and in a fit of wartime xenophobia voted the " do - gooders " out of office. everywhere the state bills were defeated and the isolated reform intellectuals faced heated doctor, insurance and even christian science opposition. the turning back of medical insurance proved more than a temporary setback for an idea whose time had not yet come. the campaign took place during the wave of reaction that swept the country during and immediately after world war i. in this climate the american medical association, an institution that had begun its organized life with an advanced survey of urban slum conditions, confused the


in the discussion below, we describe our emergent understanding of elements of the andean worldview and ceremonial tobacco use in the pachamama ceremony and how each of these thematic constructs might be used in smoking prevention strategies. we discuss four emergent themes below : historical continuity, cosmological beliefs ( holism, reciprocity, and balance ), the hierarchy of social relations and respect for elders and tradition, and norms governing ceremonial tobacco use. these results are summarized in. we then turn to a discussion of how youth characterize secular, recreational use of tobacco in contrast to ceremonial use and close with a discussion of how our results can be integrated into smoking prevention programs for andean youth. ceremonial and recreational smoking among andean youth andean youth are reared with an understanding of the ancient origin and historical continuity of the pachamama ceremony. as these young men indicate, offerings to pachamama transcend time and ensure the continuity of life across generations. i was told that it is a ritual that comes from long time ago. ( rural male, age 18, smoker ) pachamama, i have heard that it comes from generation to generation. people get together, feed mother earth, praise her, and pray to have good fortune and progress for the coming year. ( urban male, age 17, non - smoker ) youth perceptions of the historical continuity of the pachamama ceremony are relevant since they provide a sense of coherence and belonging, a critical factor in the establishment of group identity during adolescence ( phinney 1990 ). this kind of identity has been described as a feeling of being at home in your body, knowing where you are going, and experiencing an inner assuredness of recognition from those who are important to you ( erickson 1968 ). group identity plays a role in behavioral patterns of substance use among youth. in particular, ethnic or cultural identity can foster the development of anti - drug use norms ( love 2006 ; marsiglia et al. 2004 ) or increased drug use ( james et al. 2000 ), indicating that its effect may be mediated by other factors like social and familial influences or peer subcultures ( dornelas 2005 ; jessor et al. 1998 the andean world view encompasses several core constructs that include the unity of material and spiritual realms, social reciprocity, and the complementary nature of opposite forces such as the interplay of good and evil or hot and cold ( van den berg 1992 ). these core elements of the andean worldview emerge from young


of material and spiritual realms, social reciprocity, and the complementary nature of opposite forces such as the interplay of good and evil or hot and cold ( van den berg 1992 ). these core elements of the andean worldview emerge from young people ’ s descriptions of the pachamama ceremony. the accounts of different respondents about the experience and meaning of the ceremony demonstrate coherence and convergence, providing evidence that their beliefs about traditional ceremonies are grounded in a core set of collectively constructed and shared meanings about holism, reciprocity, health and illness, hierarchy, and respect each of which is discussed below. there are no inanimate objects in the andean worldview. rather, material and spiritual aspects coexist in each and every element of the universe – including human beings, animals, plants, and minerals and this embodies holism ( polia meconi 1996 ). the land, pachamama, provides material sustenance, but it also possesses the attributes of a deity or a spiritual entity that can fill a person with joy : “ pachamama means time and space, the time of our lives and the space we occupy … each of us has her in our own being … she makes me feel happy, ” ( rural male, age 18, smoker ). in andean societies, the activities of daily life are infused with spiritual meaning. the offerings used in propitiatory practices, including tobacco, are perceived to posses both a material and a spiritual nature. this belief in the dual nature of tobacco stands in stark contrast to its treatment as a commodity in western society, providing a basis for critique of its portrayal in advertisements and the profit - making aims of tobacco companies. households in the andes rely on family members to provide labor and skills for subsistence activities. andean institutions that ensure mutual assistance have existed for thousands of years. such reciprocity and solidarity take on a variety of forms ( osorio acuna 1992 ). the ayni is a system of reciprocity involving an exchange of labor that cannot be reciprocated with money, only with work ( harris 1987 ). reciprocity is a core concept in the andean belief system that provides the social basis for the pachamama we give things to the earth, we venerate her, because the majority of the people believe that in doing so we will receive more food, all things come from her, our crops. ( urban female, age 15, smoker ) thus, the pachamama ceremony reinforce


we venerate her, because the majority of the people believe that in doing so we will receive more food, all things come from her, our crops. ( urban female, age 15, smoker ) thus, the pachamama ceremony reinforces the pervasive theme of reciprocity and interrelatedness of the land, the people, and the cosmos. among andean peoples this results in an emphasis on the common good over individual success, a construct that could be enlisted to justify the protection of non - smokers from exposure to second hand smoke. the complementary nature of opposite forces, much like the concept of yin and yang in chinese philosophy, explains the dynamics of the ever - changing life energy in the universe. respondents explained the dual nature of good and evil and the need to balance such forces. pachamama is a ritual to keep the house in harmony, so you feel better, so evil will go away. that is what one believes, and one feels better. ( urban male, age 14, smoker ) the idea of balance is crucial to the health belief system. in the andes, as in many cultures, health is conceived as the maintenance of a state of harmony with nature and the universe within the context of a constant interplay of the forces of good and evil and hot and cold. thus, pacha, mother earth, is both a source of healing and of illness. this is also true for the ceremonial offerings made to her, including tobacco. health is also contingent on maintaining harmony in social relationships by observing social norms and meeting social obligations. maintaining harmony with nature especially through ritual offerings is especially important, hence the importance of the pachamama ceremony. in this world view, the land provides life and sustenance but it can also take life away if it is not properly appreciated and attended to through rituals and offerings : sometimes the earth takes you away, takes your life away. ( rural male, age 13, smoker ) these cosmological beliefs can be enlisted in prevention of tobacco use by highlighting the interplay between good and evil forces. each ritual element has a power that cures and a power that kills ( polia meconi 1996 ). this concept can be used to explain the positive and negative aspects of using psychoactive substances such as tobacco and to modify beliefs about the social acceptability of recreational smoking. tobacco could be framed dualistically as a substance that can have negative health effects when used outside of the ritual context. hierarchy and respect youth refer to two elements in the pac


as tobacco and to modify beliefs about the social acceptability of recreational smoking. tobacco could be framed dualistically as a substance that can have negative health effects when used outside of the ritual context. hierarchy and respect youth refer to two elements in the pachamama ceremony that manifest their knowledge and acceptance of the hierarchical social relations of andean society, adult leadership and age - based participation order as the following passage illustrates. my grandmother, she starts praying, she prays for everybody. then, she starts giving ( pachamama ) the food, then the drinks, then she lights a cigarette. that is the ritual that we do. ( urban male, age 17, smoker ) although all participants must take a turn giving offerings to mother earth, there is a strict ordering sequence ; elders first, adults next, and children last. the acceptance of the hierarchical order of the ceremony could serve to reinforce the authority of adult family members in conducting family life. enlisting the aid of ceremonial leaders, elders, and parents could be used to legitimate campaigns to change perceptions of tobacco and its recreational use. study respondents said that they approach the pachamama ceremony with a respectful attitude. this is a cultural practice that has been internalized with a positive affect. with my family i always ask something from pachamama. i simply ask that she helps me and i respect her at the time when i am doing these things. ( urban female, age 16, smoker ) an attitude of respect facilitates compliance with the norms and rules that guide the ceremony and the use of its ritual elements. respect for the ancestors and tradition is related to historical continuity and contributes to the maintenance of a sense of coherence and belonging. it is likely that youths who profess respect might be more prone to value the teachings of adults and role models. ceremonial tobacco use in the ritual context, tobacco acquires magical and supernatural characteristics. the power of tobacco is visualized, felt, and internalized as adults perform the rituals or, on occasion, explain the properties of tobacco. lit cigarettes set around the ceremonial opening provide a venue for communication with mother earth. at this time the magical forces of tobacco are released in the smoke and require respect and care in handling. as the smoke diffuses upward, it carries messages to and from the spiritual world. humans ask for good fortune, and the response of the spirits materializes in the shape of the ashes. elders have the knowledge to interpret the ashes and decipher their signs to foretell the future. the tradition is to set the cigarette


world. humans ask for good fortune, and the response of the spirits materializes in the shape of the ashes. elders have the knowledge to interpret the ashes and decipher their signs to foretell the future. the tradition is to set the cigarette standing around the opening. according to my father if it burns to the bottom you are going to be fine. if the cigarette is not burning it is a bad omen. ( urban male, age 17, non - smoker ) my grandmother would help us set the cigarettes on the earth and when they were consumed she would read ( in the ashes ) how long you were going to be alive. ( rural female, age 16, non - smoker ) this ritual use of cigarettes is far removed from the secular and careless manner in which cigarettes are used in recreational settings for the simple goal of immediate pleasure seeking. polia meconi ( 1996 ) asserts that the ritual use of psychotropic substances among indigenous peoples in the americas is based on their refusal to accept western ideas about matter being the only form of reality and sensory and rational perception. it is based on a theory of natural law that is different from scientific understandings ( fiske and shweder 1986 ). the belief that tobacco is a means of communication with the supernatural might discourage its secular use. highlighting the misuse of tobacco ' s power to seek material pleasure rather than spirituality might inhibit smoking uptake by youth. smoking is permitted only among adults during the pachamama ceremony. however, the age at which youths are allowed to smoke ceremonially varies by each family ’ s perception about when young people reach adulthood. interviewer : how old does someone have to be to be considered a child? respondent : it depends, for example in my family to be a child is to be younger than eighteen years. ( rural male, age 16, non - smoker ) control over cigarettes is also maintained by adults during the ceremony, interviewer : did you ever light the cigarette? respondent : no, children never have to light it, only the adults. ( rural male, age 15, smoker ) my father lights it for me ( the cigarette ) and i set it there, i bury it. ( urban male, age 17, non - smoker ) thus, adults oversee and guide cigarette manipulation by children and youth, as they do with all the ritual elements of the ceremony. youth have a clear understanding of ceremonial smoking rules whether or not they are recreational smokers. they consistently reported that they had received repeated messages from


oversee and guide cigarette manipulation by children and youth, as they do with all the ritual elements of the ceremony. youth have a clear understanding of ceremonial smoking rules whether or not they are recreational smokers. they consistently reported that they had received repeated messages from their elder tutors that children are prohibited from smoking during the ceremony. while young people who smoke talked freely about their smoking behavior in recreational contexts, they denied smoking during the pachamama ceremony in the presence of adults. the norm that it is not appropriate for children and adolescents to light cigarettes or to smoke in ceremonial contexts can be enlisted to prevent smoking initiation and to counter the social acceptability of recreational tobacco use in the wider social context. none of the participants linked the meaning of ceremonial and recreational smoking either directly or indirectly. reference to ceremonial smoking emerged only when youth were asked to describe the pachamama ceremony. a pervasive explanatory factor for recreational smoking initiation among youth interviewed was peer pressure ( stewart - knox et al. 2005 ). this occurred in a variety of settings outside of the home and away from parents - - at school, in the streets, and very often in dance halls where flirting adds sexual drama and exposure to the social cues for smoking. the youth in this study shared common experiences of peer - induced smoking experimentation. some resist the pressure : interviewer : who offered you cigarettes? respondent : my friend from around the corner. interviewer : how old is your friend? respondent : seventeen. but i did not want to smoke. ( urban male age 11, non - smoker ) others give in to pressure from their peers : we went to the dance. then they lit a cigarette and all started smoking and started telling me things, insulting me, and i left and returned after a while but they kept insisting and at the end, i gave in because i could not take it anymore. interviewer : if you want to be their friend, do you have to smoke? respondent : i would think so, because if anybody is part of the group, after a while they are smoking. ( urban male, age 14, smoker ). these accounts are illustrative of the social context and reasons for recreational tobacco use. they highlight the difference between secular and ceremonial motivations and behaviors that are clearly conceptualized as separate issues in the minds of young people. ceremonial tobacco use takes place in the controlled context of mystical ceremonies linking human beings to the physical and supernatural world. in the secular world, tobacco is used to ease social interactions and to assist young


the field of data science is heating up fast. the following list of educational resources will let you join the data revolution by getting up to speed with data science. data science — and the driving force behind it, machine learning — is the process of deriving added value from data assets. commerce and research are being transformed by data - driven discovery and prediction. skills required for data analytics at massive levels span a variety of disciplines and are not easy to obtain through conventional curricula. these include algorithms for machine learning ( e. g., neural networks and clustering ), parallel algorithms, basic statistical modeling ( logistic regression and linear / non - linear regression ), and proficiency with a complex ecosystem of tools and platforms. a good place to start is with meetup groups. two of my favorite data science groups deal with the primary ingredients of data science work : r, which is the programming environment of choice for building algorithms, and machine learning. the la area r user group is excellent ; try to find one near you. the la machine learning group has regular meetings that are extremely useful. the massive open online course ( mooc ) movement is very active in the data science space and constitutes a superb educational resource. these free courses ( some offer certifications ) offer an excellent path toward obtaining the requisite background for becoming a data scientist. i ’ ve put together a radical data science “ pseudo degree program ” for you to follow. free data science books to go along with the coursework, there also are a number of excellent free books available : mining of massive datasets bayesian reasoning and machine learning ( pdf ) information theory, inference, and learning algorithms gaussian processes for machine learning ( pdf ) the elements of statistical learning introduction to machine learning ( pdf ) think bayes ( pdf ) as the interest in data science continues to grow, and as the shortage in talent becomes apparent, the timing is excellent to retool yourself and climb aboard the data science gravy train. if you know of any other good educational resources for data science and machine learning, please leave a note for all of us. this article is the first of a series of using r to answer typical business questions that can be answered with data science solutions. the question answered here is : what is prediction and how does it work? in order to demonstrate this concept, i ’ ve chosen one of the oldest statistical techniques used for predicting the future – linear regression. our example will use a widely available data source along with the r statistical language to show how it ’


does it work? in order to demonstrate this concept, i ’ ve chosen one of the oldest statistical techniques used for predicting the future – linear regression. our example will use a widely available data source along with the r statistical language to show how it ’ s done. there ’ s no room here to give a class on statistics or r, but i ’ ll provide a couple of resources for educating yourself on each. our test case will involve all the commonly used ingredients of a data scientist building a prediction model : finding an appropriate data set, doing a little exploratory analysis to fully understand the data, defining a linear model, fitting a regression line, making plots, and using the model for prediction. the only thing we won ’ t do here is “ data munging, ” the often tedious exercise of massaging a dirty data source into a clean version for machine learning purposes. for our example, we ’ ll use an already - clean data set. the data set and exploratory analysis let ’ s start by looking at the data set for our simple example. we ’ ll go way back to early thinking in linear regression – the 1885 galton study to define a relationship between a parent ’ s height and their children ’ s. the data set is available with the “ usingr ” package ( http : / / cran. r - project. org / web / packages / usingr / index. html ). the r statistical software ( http : / / www. r - project. org / ) is available as open source software. you should also download the free rstudio development environment ( http : / / www. rstudio. com / ). here is the r code required to install the package, and open the data set : the data set consists of 928 pairs of child and parent heights in inches. for unfamiliar data sets you typical explore the data with one or more of the following r commands ( although there are many more ways to explore data sets in r ) : head ( galton ) # show first few records tail ( galton ) # show last few records summary ( galton ) # statistical summary table ( galton ) # show a distribution of values hist ( galton $ child ) # a visual distribution of values we also can do a simple scatter plot of child height versus parent height. this plot exhibits an ideal case for using regression – a cloud shaped collection of data points. plot ( galton $ parent, galton $ child, pch = 19, col


can do a simple scatter plot of child height versus parent height. this plot exhibits an ideal case for using regression – a cloud shaped collection of data points. plot ( galton $ parent, galton $ child, pch = 19, col = ” blue ” ) fitting a linear model next, we can fit a line to the galton data using a simple linear model. in r this is very easy to do, just use the lm function where parent is the explanatory variable ( independent variable ), and child is the response variable ( to be predicted ). lm1 < - lm ( galton $ child ~ galton $ parent ) if you display the contents of the lm1 model variable ( just type lm1 at the rstudio command prompt ), you ’ ll see it contains a number of items including the coefficients of the linear model : the intercept 23. 942 and the slope 0. 646. these values are stored in a 2 element vector lm1 $ coeff. this means that an increase in parent ’ s height by 1 inch, you increase the child ’ s height by 0. 646 inch. in other words, think back to high school algebra class when you graphed a line. it is as simple as that! now let ’ s complete the picture by adding the regression line to the plot using the vector of fitted values found in lines ( galton $ parent, lm1 $ fitted, col = ” red ”, lwd = 3 ) you can also plot the residual values ( response values minus fitted values ) using : plot ( galton $ parent, lm1 $ residuals, pch = 19, col = ” blue ” ) using the model to predict now you can use the model to make predictions using new data. for example, say you have a parent height of 80 ( which is outside the range of the data set we used to train the model ) and you want to predict child height. just use the coefficients of the model : lm1 $ coeff + lm1 $ coeff * 80 the predicted answer you get is 75. 6 for the child. you can improve model accuracy by using a larger training set and reevaluating the linear model. uses of linear regression businesses use linear regression forecasting techniques in a multitude of ways. for example, you can model google pay - per - click advertising costs versus sales ; just download your cost data from google adsense and built an excel spreadsheet


uses of linear regression businesses use linear regression forecasting techniques in a multitude of ways. for example, you can model google pay - per - click advertising costs versus sales ; just download your cost data from google adsense and built an excel spreadsheet that matches up the sales based on time period. another example might be using the linear model to predict productivity gains resulting from a training program. uses of linear regression are very broad : manufacturing, supply chain, real estate, financial sector, and much more. to supplement this article, here are a couple of excellent resources for you to learn more about general statistics and r. • the art of r programming ( http : / / heather. cs. ucdavis. edu / ~ matloff / 132 / nsppart. pdf ) • openintro statistics ( http : / / www. openintro. org / stat / textbook. php ) much has been debated about the validity of p - values in determining statistical relationships between data elements. here is a long list of 402 citations questioning the indiscriminate use of null hypothesis significance tests in observational studies. and here is a current and measured contribution to the debate appearing over at the simply statistics blog. how do you weigh in? do you feel the use of p - values produces the kind of false positives we always see in the mainstream press? here is a new webinar from revolution analytics that introduces the use of the r statistical programming environment for doing data mining. presented by joe rickert, the seminar demos several examples of data mining with various r packages. rickert ’ s slides can be downloaded here. enjoy! i had another scintillating evening with the los angeles area r user group, january 24, 2013. i always have a good time at this meetup, which has become my favorite, but i was particularly intrigued by the theme – a panel of distinguished data scientist talking about “ data science. ” fun to be sure! the r group meetings are free along with free validated parking and all the pizza and drinks you can navigate. once again held at adconion media group in santa monica, the panel consisted of : avram aelony, eric kostello, yasmin lucero, szilard pafka, ryan rosario, and oliver will ( see inset photo i took with my new iphone 5 ). the first order of business was panelist introductions. it appears that all but one held a ph. d. which led to the first discussion topic


, ryan rosario, and oliver will ( see inset photo i took with my new iphone 5 ). the first order of business was panelist introductions. it appears that all but one held a ph. d. which led to the first discussion topic – do you need a ph. d. to be a data scientist? although contrary to what ’ s mentioned above, the consensus was you don ’ t. i agree in a sense, but i think a ph. d. in a related field like statistics, computer science, mathematics or even physics would certainly propel your career. a lot of the hour - and - a - half discussion dealt with defining “ data science ” along with what a typical data scientist actually does. i found this dialog enlightening because i always like to better understand how my fellow data scientists view themselves and our field. the panel seemed to agree that the term ” data science ” is relatively new and maybe somewhat overhyped by some, but many of its methods have seasoned and sound foundations in statistics, computer science and their various related fields, e. g. machine learning, databases, distributed computing, visualization, etc. ). questions from the audience were welcome ( nearly 100 in attendance ) so i brought up a point about how many of the job descriptions being floated these days for data science positions seem to be overly heavy with qualifications to the point where the successful candidate needs to fill the role of cto, vp engineering, system admin, and coder all at once. heck, if the employer is looking for a one - person company why didn ’ t they say so! the panel ’ s response was that many times, the employer has no idea what a data scientist is, so they just google a bunch of terms and throw them into the job description. a statistically insignificant number of candidates will have all the qualifications, so the point was – just go in and talk to them and see what sticks. the discussion eventually moved into more technical subjects such as using r version control and processing environments such as hadoop and amazon ec2. i thought there was a good balance between technical and non - technical material, but the organizer szilard pafka had so many other topics to cover he ’ s already schedule a part 2 panel for march. after walking away from the thought provoking panel discussion, i stopped to think that this is an excellent time for a technical person to retool herself to get aboard the data science gravy train. this is why i put together a list


. after walking away from the thought provoking panel discussion, i stopped to think that this is an excellent time for a technical person to retool herself to get aboard the data science gravy train. this is why i put together a list of free data science educational resources over at big data republic. it is a mighty good time to be a data scientist, and being part of the silicon beach data science scene is pretty energizing. i hope to see you all at the next meetup! i guess it had to happen eventually, but this soon? “ big data ” is an awfully hot buzz word seen in mainstream publications like the new york times and harvard business review, but a coffee table book? yes indeed, the human face of big data is a 5 lb. hardcover published in nov. 2012 with authors rick smolan and jennifer erwitt. rumor has it that the book is landing on the desks of world leaders, dignitaries and other notable people around the world. among others, the list includes : president obama, the dalai lama, pope benedict xvi and chinese premier wen jiabao, and also twitter ceo jack dorsey ; daniel tunkelang, chief data scientist at linkedin ; and actor robin williams. among the images in the book ’ s 224 pages is the blended image of 1, 400 different shots of new york ’ s times square taken across 15 hours. in an abstract sense, big data is about people : what they do, where they go, who they know and so on. the stories about how data, once harnessed, solves problems and in some ways creates new ones, is its overarching theme. the perfect holiday gift from a data scientist! i ’ d like to offer the following slide presentation on combining the power of r with the hadoop platform. this presentation was made by jeffrey breen of the chicago area hadoop users group and chicago area r users group in august 2012. it is a great overview for anyone considering placing an r - based application in a production computation environment. on dec. 6, 2012 i attended another great evening event with the los angeles area r user group. this was my second meeting with the group and i was looking forward to the topic matter : “ real - time dashboards with node and r. ” as a data scientist, my development environment of choice is r ( with a little octave thrown in for good measure – octave is an open source matlab derivative ), so i ’ m always looking for ways to extend my knowledge of r


r. ” as a data scientist, my development environment of choice is r ( with a little octave thrown in for good measure – octave is an open source matlab derivative ), so i ’ m always looking for ways to extend my knowledge of r and different ways to apply it to machine learning. this meeting served this purpose very well. i arrived at the meeting venue early over at adconion media group in santa monica. silicon beach, of which santa monica is part, is really heating up with interest in big data. adconion is a fantastic meetup venue, easily accessible, great parking, high tech appeal, and somewhat recognizable if you ever watched “ curb your enthusiasm ” since this is the same office park where larry david ’ s office is located. adconion supplied the wide selection of pizza and soft drinks ( thank you! ). the first hour is a meet - and - greet with all the attendees ; 74 registered this time. i met a bunch of like - minded data scientists like a caltech ph. d. candidate in computational neuroscience, and another who uses r for sentiment analysis on publicly traded companies for investment managers. once the lecture began, the group was led through a fast - paced example of using node and google chart tools along with a twitter sentiment analysis algorithm in r to yield a “ happiness ” indicator for countries around the world. the globe map used color coding to indicate general “ happiness. ” click here for a demo that presents “ how popular is fast food. ” the presenter, dr. dirk neumann was a data scientist and founder of social supercomputing startup opani. he received a ph. d. in computation and neural systems from caltech. as i mentioned in my previous field report for this group, i highly recommend it for anyone in the field. the presentation content tends to be fairly complex, but it ’ s a good way to push your personal envelope. as a data scientist, i ’ m continually amused with the on - going misuse of the principle of linear regression. you see it all the time in the press. lately, regression theory is underlying much of the talk surrounding the demise of american entitlement programs like medicare and social security. forecasts abound, saying that the country can no longer afford retirement benefits and elder healthcare coverage. but you must stop to ask what these so - called forecasts are based on? many forecasts unwisely project healthcare costs far into the future by assuming that the trends of the past would continue unaltered. but this mental