Teaching Cleveland Digital

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Hospitals and Health Planning in Cleveland

From the Encyclopedia of Cleveland History

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HOSPITALS & HEALTH PLANNING. In the U.S., the hospital attained its “modern” institutional form by 1900-10, having passed through 3 more or less distinct stages. During the 19th century, the hospital began as an agency of social control and welfare, gradually became the principal provider of minimal medical care for the indigent and unfortunates of society, and emerged, ultimately, as the medical center for all classes of society, as well as the locus of medical training, research, and innovation. The institutional care of the sick originated in the incidental medical facilities provided for inmates of almshouses, jails, or, as in Cleveland, military posts. Here the first “hospital” was little more than a temporary barracks at FORT HUNTINGTON, situated near the mouth of the CUYAHOGA RIVER on Lake Erie. A log structure built in 1813, it furnished sparse accommodations to treat sick or injured soldiers of the War of 1812. DAVID LONG† was then the sole physician in the village of Cleveland. After this makeshift hospital closed in 1815, no other institution aided the sick until 1826, when the township erected a poorhouse adjacent to the ERIE ST. CEMETERY. In 1837, following the incorporation of Cleveland as a city, the poorhouse became the City Hospital. Not a hospital in the modern sense of the word, it, like other “hospitals” of the time, functioned chiefly to relieve pauperism.

In the second phase of their 19th-century development, hospitals became specifically medical institutions but limited their services to persons who could not afford the cost of treatment and convalescence in their homes. The opening of the U.S. MARINE HOSPITAL and ST. JOSEPH HOSPITAL in 1852 marked the beginning of this period in Cleveland. The U.S. Marine Hospital, financed and managed by the federal government, cared for merchant sailors and their families and for civilian and military personnel of the government. St. Joseph, operated by the SISTERS OF CHARITY OF ST. AUGUSTINE, briefly served a growing community of Irish laborers in the city. During this period, the city and state governments also reorganized their medical facilities for the poor. The City of Cleveland tore down City Hospital in 1851 and erected a new building, the City Infirmary, in 1855. The same year, the State of Ohio opened the Northern Ohio Lunatic Asylum, later known as CLEVELAND STATE HOSPITAL, in nearby NEWBURGH. Despite these improvements, most people still viewed hospitals as refuges for the infirm poor. With prevailing low standards of medical care, the hospitals of mid-19th century Cleveland were little better than the dreaded “pesthouses” of the past.

During the last third of the 19th century, hospitals were transformed by a combination of scientific and technical advances that together amounted to a revolution in medical thought and practice. The discovery of ether, chloroform, and nitrous oxide for anesthesia in the 1840s opened new realms for the surgeon, while the germ theory introduced by Louis Pasteur and applied to medical practice by Joseph Lister in the 1860s gave a clearer understanding of disease communication and prevention. These innovations could be implemented most successfully in the controlled environment of the hospital, and medical practice shifted progressively from homes to hospitals. In Cleveland, this transfer accelerated in the closing years of the 19th century. At mid-century, there were only 3 hospitals in Cleveland. Two decades later, 1870-75, 7 were in operation: 3 under municipal, state, and federal management, 2 maintained by Catholic religious orders (see CATHOLICS, ROMAN), and 2 voluntary hospitals under the control of lay trustees. By 1890-96 this number had more than doubled, including 8 hospitals under the care of religious denominations, 5 voluntary institutions, and the 3 existing public facilities. In addition, the Cleveland medical scene was also populated by a growing assortment of dispensaries opened by medical colleges in the city, small private hospitals operated as business ventures by enterprising doctors, and several private sanatoriums for the care of patients with emotional or drug- and alcohol-related health problems.

Hospitals ceased to be merely dormitories for the destitute. The first hospital designed to serve medical needs and not just to perform custodial functions was St. Vincent de Paul Hospital (1865, see SAINT VINCENT CHARITY HOSPITAL AND HEALTH CENTER). Its central section housed offices, a chapel, a pharmacy, and staff apartments, with kitchen, dining, and storerooms in the basement. This section was flanked by 2 wings, each occupied by separate male and female wards for 56 charity cases on the ground floor, while the second floor of both wings was divided into private rooms for 24 paying patients. Absence of separate surgical facilities was remedied by construction in 1872 of an amphitheater–the first in any hospital in Cleveland. This general pattern prevailed in the design of other local hospitals until the end of the 19th century. The first major change in the design of Cleveland hospitals came with the construction of Lakeside Hospital (see UNIVERSITY HOSPITALS CASE MEDICAL CENTER). Like many hospitals in the city, Lakeside began its institutional life in a private residence converted to accommodate patient beds. Between 1876-96, Lakeside occupied the U.S. Marine Hospital; it was finally compelled to erect a new building upon expiration of its lease. In 1891 and 1895, trustees visited major hospitals in metropolitan centers east of the Mississippi and subsequently adopted a pavilion or “cottage” plan modeled on Johns Hopkins Hospital (1885) in Baltimore, then the most respected teaching hospital in America. The pavilion plan of the new Lakeside Hospital, located at E. 12th St. and Lakeside Ave., offered the ventilation and drainage deemed essential for proper SANITATION. Central administrative, kitchen, and laundry services were housed in separate buildings connected to wards, surgical buildings, and dispensary and nurses’ quarters by long corridors. The only structure that stood apart from the whole was the “autopsy building,” which accommodated pathology and clinical microscopy laboratories after 1901. The overall layout of the hospital was dictated by the new appreciation of the role that germs played in disease, with isolation and ventilation the most important features of any hospital plan.

Hospitals in Cleveland first became educational institutions, helping to train physicians, when Dr. GUSTAV WEBER† founded Charity Hospital Medical College in 1864. Weber, a prominent surgeon, launched the new school with the full cooperation of St. Vincent de Paul Hospital. Each party benefited: Weber enjoyed privileged access to cases for clinical instruction, while St. Vincent engaged a competent medical staff at little or no cost. Although the college closed in 1870, St. Vincent had set a local precedent for close cooperation between hospitals and medical schools. The first university hospital in Cleveland came into being in 1897-98 with the opening of Lakeside Hospital. Since 1869, Lakeside had given WRU teaching privileges, shared with the Wooster Univ. Medical Department (1870-84): each school held its clinical sessions at different seasons of the year. After 1884, WRU acquired exclusive control of teaching privileges at Lakeside. Beginning in 1898, the WRU Medical Department also nominated resident staff and furnished visiting physicians and surgeons. The first university hospital in Cleveland, Lakeside ranked among the first 10 such institutions in the U.S.

Hospitals constituted the sole training ground for NURSING in Cleveland from 1884, when HURON RD. HOSPITAL opened the first training school for nurses in Ohio, until the establishment of a nursing degree by WRU in 1921. In the interval, several Cleveland hospitals, most notably Cleveland General (now SAINT LUKE’S MEDICAL CENTER), Lakeside, and St. Vincent, created their own schools. In the early years of these programs, young women received in-service training in “practical nursing” and little formal instruction. Only at Lakeside, through the efforts of national expert ISABEL HAMPTON ROBB†, did nursing education emphasize instruction in the theoretical and scientific side of nursing as well as the practical. Scientific medicine, particularly the laboratory-based specialties of pathology, bacteriology, and physiology, entered the institutional setting of Cleveland hospitals after 1890. The most notable example of this influence was the establishment of a bacteriology laboratory at City Hospital. Dr. William Travis Howard, a young pathologist trained at Johns Hopkins and professor of pathology at WRU, headed the laboratory and initiated scientific postmortem examinations at City Hospital.

By the turn of the century, many hospitals in Cleveland attracted a more affluent class of patients. Some hospitals actively courted paying patients by offering comfortable, if not luxurious, accommodations. While no Cleveland hospitals abandoned their original charitable obligations, the poor increasingly patronized out-patient dispensaries operated by the medical departments of WRU, the Cleveland College of Physicians & Surgeons (Ohio Wesleyan Univ.), and the CLEVELAND HOMEOPATHIC HOSPITAL College. Following expansion and modernization in 1889, City Hospital undertook a greater role in providing medical care for the indigent throughout the city. Later, it also erected a tuberculosis sanatorium and a hospital for contagious diseases, allowing other local hospitals to present themselves as “safe” havens for sick persons of all social classes, free from dreaded communicable illnesses. In addition to improving the attractiveness and safety of private rooms for paying patients, some hospitals permitted nonstaff doctors to visit and treat patients in the hospital setting. Lakeside Hospital, for example, relaxed its rules to accommodate physicians who brought private paying patients, opened a specially designated operating room for use by physicians and surgeons not officially affiliated with the institution, and appointed a resident staff officer for patients of such physicians and surgeons.

The principal institutional developments in Cleveland hospitals between 1910-50 included the emergence of the group-practice hospital, the move of several hospitals to the SUBURBS, and the advent of health insurance programs. The CLEVELAND CLINIC FOUNDATION, incorporated in 1921, was the first and by far the most successful group-practice hospital in Cleveland. Its founders, particularly Drs. GEORGE W. CRILE†, FRANK E. BUNTS†, andWILLIAM E. LOWER†, derived their inspiration from the example of the Mayo Clinic and from experience as members of the LAKESIDE UNIT, WORLD WAR I. They combined the practice of surgery and medicine with new diagnostic procedures and ongoing medical research. Organized as a not-for-profit foundation staffed by salaried physicians, the Cleveland Clinic overcame the onus heaped on group clinics by individualistic private practitioners who perceived a threat to the prevailing free-market economy in American medicine.

By 1920, as noted in the Cleveland Hospital and Health Survey, local hospitals could be categorized according to the strength of their community orientation. One group, comprising FAIRVIEW HOSPITAL, ST. JOHN HOSPITAL, Glenville Hospital, Lutheran Hospital (see LUTHERAN MEDICAL CENTER), Provident Hospital, Grace Hospital (see GRACE HOSPITAL ASSN.), St. Ann’s Hospital (see SAINT ANN FOUNDATION), and ST. ALEXIS HOSPITAL MEDICAL CENTER, drew the majority of their cases from their own vicinity. A second group, which included Huron Road, Lakeside, City, Mt. Sinai (see MT. SINAI MEDICAL CENTER), St. Luke’s, and St. Vincent’s, no longer served just their immediate neighborhoods but drew patients from all regions of Cleveland. Together these last 6 hospitals contained 60% (1,812 beds) of the total capacity (3,088 beds) of the 20 hospitals belonging to the Cleveland Hospital Council (see CLEVELAND HOSPITAL ASSN.) in 1920. Several hospitals in this second group led the move toward the suburbs between 1915-35. They were prompted by the need to renew aging physical plants and lured by locations closer to a middle-class clientele better able to pay for hospital care. Mt. Sinai initiated this relocation in 1916, moving to the present UNIVERSITY CIRCLE area. It was followed by WOMAN’S GENERAL HOSPITAL, Lakeside, Maternity (later MacDonald), and Rainbow hospitals, which had all opened new buildings adjacent to WRU by 1931. This first wave of urban flight culminated with the relocation of St. Luke’s on Shaker Boulevard (1927) and Huron Road in EAST CLEVELAND (1935).

During the Depression, Cleveland hospitals confronted economic uncertainties by turning to a group medical insurance plan now known as Blue Cross (seeBLUE CROSS OF NORTHEAST OHIO). Under early versions of Blue Cross, first instituted in Dallas, TX, in 1929, individual hospitals concluded contracts with subscribing groups to provide hospitalization in return for a set annual fee. In Cleveland, no single hospital plan took hold. Instead, in 1934 the Cleveland Hospital Council initiated a citywide plan in which cooperating hospitals agreed to provide service on a prepaid basis. By this arrangement, Blue Cross enabled voluntary hospitals in Cleveland to maintain a steady level of bed occupancy while also preventing competition for patients among member hospitals. In 1938 Cleveland’s Blue Cross became the first prepayment plan in the U.S. to reimburse hospitals on the basis of cost, a move made possible by the growth of its subscriber group to over 100,000. Over the following decades, Blue Cross emerged as the dominant form of hospitalization insurance in Greater Cleveland, covering 70% of Cuyahoga County hospital patients on the eve of Medicare in 1965.

The economic stability provided by Blue Cross, combined with advances in surgery and diagnostic technologies, encouraged considerable expansion of hospitals in Cleveland following World War II. The number of beds in general medical-surgical and maternity hospitals in Cuyahoga County grew 20% between 1952-60 (from 5,197 to 6,636) and 30% between 1960-75 (from 6,636 to 9,666). The enlargement of existing facilities and the creation of new hospitals (PARMA COMMUNITY GENERAL HOSPITAL, BRENTWOOD HOSPITAL, FOREST CITY HOSPITAL, and SUBURBAN COMMUNITY HOSPITAL) were financed by bond issues in the case of publicly supported hospitals and by individual, corporate, and foundation contributions and reserve funds for depreciation in the case of voluntary hospitals. Federal grants, available chiefly through the provisions of the Hospital Survey & Construction Act (1946, known as the Hill-Burton Act in honor of its legislative sponsors, Senator Harold Burton of Ohio and Senator Lister Hill of Alabama) [PL 79-725, Title VI of the Public Health Service Act], played only a supplementary role in hospital growth in Cleveland and Cuyahoga County before the mid-1960s. However, federal assistance in the form of Medicare and Medicaid did become an important source of general revenue for Cleveland hospitals after 1965; by 1980 Medicare and Medicaid constituted 41% of hospital patient revenues in Cleveland and 38% in the suburban sections of the county. At the same time that hospitals underwent physical expansion, population growth slowed and then declined in Cleveland and the vicinity. Between 1960-70, population in Cuyahoga County grew only 4% (from 1,647,895 to 1,721,300), then declined 7% between 1970-80 (from 1,721,300 to 1,499,167). The net result was that the county, and especially the City of Cleveland, had a surplus of hospital beds, which often fell below the 85% occupancy rate considered optimal for voluntary hospitals. Low occupancy, together with the financial burden of construction or renovation and the cost of maintaining specialized services, led to a steady increase in per diem hospital costs to patients or their insurers. The average cost per patient day in Cleveland hospitals rose from $28.40 in 1957 to $268 in 1980. The hospitals of Cleveland and related agencies confronted spiraling health costs in a number of ways, especially with regional hospital and health planning, the imposition of cost ceilings by third-party insurers (Blue Cross and others), and the creation of health maintenance organizations (HMOs).

Regional hospital planning in Cleveland began with the formation of the Cleveland Hospital Council in 1916. This organization engaged Haven Emerson, health commissioner of New York City, to investigate and report on the institutional network responsible for health care in Cleveland. His findings were presented in the Cleveland Hospital and Health Survey (1920), a landmark study in the field. However, this publication did not result in any coherent program of health care planning; area hospitals continued to pursue separate institutional goals without coordination. The next major attempt to institute regional planning came in 1941, when HAROLD BURTON†, mayor of Cleveland, appointed the Joint Hospital Committee. Created to consider the anticipated resurgence of hospital construction following World War II, the committee included representatives of the city of Cleveland, the Cleveland Welfare Federation, and the Cleveland Hospital Council. The role of this local body was soon effectively eclipsed by state agencies, which were given principal health-planning responsibilities under the Hospital Construction & Survey Act in 1946. The concept of regional planning was not revived until 1966, when the Comprehensive Health Planning Act returned planning responsibilities to local agencies. In northeast Ohio this role was assumed by the Comprehensive Health Planning Agency (CHPA), which served Cuyahoga, Lake, Geauga, and Medina counties. The CHPA, later known as theMETROPOLITAN HEALTH PLANNING CORP., commissioned studies of existing health-care facilities, determined the strengths and weaknesses of the region’s hospital system, and assessed the validity of requests by area hospitals for expansion of facilities, particularly regarding state and federal funding for new construction. Although the MHPC initially acted in a consultative capacity, its designation by the federal government as a Health Systems Agency increased its influence and power in regional health planning.

Imposition of cost ceilings upon Cleveland-area hospitals has come from 2 principal sources since the advent of Medicare in 1965. At first, Blue Cross reimbursed hospitals on the basis of cost instead of a schedule of negotiated rates. This arrangement was altered by state legislation in 1972 and 1976 that prohibited hospitals from controlling the boards of Ohio Blue Cross plans and that admonished such plans to eliminate waste and unnecessary services. In 1987 Blue Cross and Blue Shield of Ohio, along with other state health insurers, won further leverage in their efforts to contain costs with passage of the state Hospital Insurance Reform Act, which gave them the right to negotiate rates with hospitals. A second, more far-reaching challenge to hospital-determined costs for medical care came in Oct. 1983, when Medicare began the transition to a payment schedule based on diagnosis-related groups (DRGs), instead of actual costs incurred for hospital care. The intent of the DRG program was to curb inflationary trends by basing payment on the characteristics of the patient’s illness, rather than on the demands of hospitals.

It is still too soon to assess all the consequences of these changes in hospital administration and finance, but one trend is already apparent: the shift to health maintenance organizations (HMOs) as a means for hospitals to introduce or cooperate with a prepaid group plan for payment of medical costs. HMOs were preceded by the prepaid group practice, with origins in the health-care programs of INDUSTRY and RAILROADS. These employers engaged profit-making firms of physicians and surgeons to provide medical services at clinics and small hospitals financed by industrialists’ subscriptions and workers’ salary deductions. Corporate sponsorship of such prepaid programs began in America ca. 1910 in the Pacific Northwest and did not spread to other regions until 1930. In Cleveland, employers did not have to resort to this form of “welfare capitalism,” since many hospitals readily accommodated the industrial workforce under Blue Cross plans. Organized labor, however, saw the desirability of a prepaid group plan for workers, and in 1964 labor unions in Cleveland formed the Community Health Foundation. This HMO provided routine medical care in the offices of several private physicians and hospital care in cooperating local institutions. In 1969 the Community Health Foundation joined with the KAISER PERMANENTE MEDICAL CARE PROGRAM to form the Kaiser Community Health Foundation. By 1974 Kaiser Permanente comprised 3 separate hospital facilities in Cleveland, and by 1985 the system had become the largest HMO in the U.S., encompassing some 4.6 million members in 9 geographic regions.

In 1970 there were only 33 HMOs nationwide; by 1977 the number had grown to 183, with 6.85 million persons enrolled; by 1985 there were 323 HMOs in the U.S., with a total enrollment of 15 million. In Cleveland and the immediate vicinity of Cuyahoga County, the number of HMOs increased from 1 in 1970 (Kaiser-Permanente) to 8 in 1985.

In the 1990s, continued competition for patients and the debate over national and state health care reform gave further impetus to the shift to HMOs and set off a wave of mergers, acquisitions and affiliations. The trend in this activity was toward the vertical integration of the region’s health care industry into large, self-contained units consisting of insurers, physicians, hospitals and out-patient facilities that could offer a complete health care package to employers or groups of employers. By 1995, three prominent groups had emerged: Blue Cross and Blue Shield of Ohio, which, in addition to its health insurance and Super Blue HMO, had controlling interest in a joint venture with the four hospitals in the MERIDIA HEALTH SYSTEM, and affiliations with St. Luke’s Medical Center and Riverside Hospital in Toledo, OH; the University Hospitals Health System, which had affiliations with four hospitals and offered a broad range of outpatient services as well as the Qualchoice health insurance plan; and the Health Cleveland Network, consisting of 11 hospitals, including the Cleveland Clinic and the MetroHealth Medical Center.

By 1995, however, the Clinton administration’s plan for managed care was dead, leaving prospects for national reform uncertain at best, and Governor Voinovich’s proposal to move 1.4 million poor Ohioans into a network of HMOs paid for by Medicaid faced critical funding problems as the U.S. Congress considered turning Medicaid into a block grant program. Moreover, despite the frenzy of mergers, acquisitions and affiliations, the area’s health care providers had not yet dealt with the underlying problem of the over-capacity of hospital facilities. Given the uncertainty of governmental health care reform, it was not clear whether the vertical integration of the region’s health care system represented a step toward a managed care system, or protection of the traditional fee-for-service payment structure under the shelter of a privately operated system of prepayment.

James Edmonson

Dittrick Museum of Medical History

Cuyahoga County Government History Through 1980s

From the Encyclopedia of Cleveland History

The link is here

CUYAHOGA COUNTY GOVERNMENT. On 16 July 1810, the General Assembly of Ohio approved an act calling for the organization of the county of Cuyahoga. The state constitution had established that the general assembly would provide, by general law, for the government of all Ohio counties according to the same organization. Today, the center of county government in Ohio is a board of three commissioners, first provided for by statute in 1804. The commissioners serve as the county’s executive and legislative branches of government and conduct business in concert with 8 independently elected administrative officials. These officers, the auditor, clerk of courts, coroner, engineer, prosecuting attorney, recorder, treasurer, and sheriff, elected for 4-year terms, derive their power and receive their duties from the state. The Court of Common Pleas, the “backbone” of the state’s judicial system, assumes the primary responsibility, with the assistance of the prosecuting attorney, clerk of courts, sheriff, and coroner, for the administration of justice in the county.

Under Ohio law, Cuyahoga County government has always provided a middle level of governance between the State of Ohio and its citizens. With three elected county commissioners in charge, it was authorized to function as the state’s administrative arm. Ohio’s new constitution of 1851 expanded the number of independent elected county officers to carry out specific functions, and in 1857 the Ohio Supreme Court differentiated between counties and cities by designating the city as a municipal corporation created for the convenience of a given locality and the county as a quasi-municipal corporation created to administer the policy of the state.

Cuyahoga County has retained its original form of government; however, as the county grew, particularly in the period following World War I, this standard structure has been greatly modified to meet the needs of an increasingly urban area. Within a constant framework, each elected official has separate and distinct responsibilities, largely carried out by administrative, professional, and clerical staffs; however, the historical development of each of Cuyahoga County’s offices has been similar in many ways. All of the county’s elected officers have identifiable predecessors that served under English law or under the laws of the Northwest Territory. All of the offices, with the exception of the coroner and sheriff, were originally occupied by individuals appointed to the position, by either the state legislature or the courts, and only gradually did state law require that officeholders be elected by the people for terms that would vary in their duration during the 19th and 20th centuries. The offices of the sheriff and coroner were specifically provided for in the 1802 Ohio Constitution and made elective, originally for terms of 2 years. This structure remained fundamentally the same throughout most of the 19th century, as did the basic duties and responsibilities originally assigned to the offices. The activities of these major departments, however, gradually increased and broadened as the business of governing became more complex. The first real modifications in the basic structure of county government did not occur until the late 19th century, and by 1913 several new offices and agencies had been added. In the years that followed the growth of government was steady as the county, particularly through the action of the Board of Cuyahoga County Commissioners, responded to problems posed by a growing urban population and an increasingly complex industrial society. New agencies and institutions in the fields of health, human services, justice affairs, PUBLIC SAFETY, andTRANSPORTATION were created.

By 1913 the organization of the court system had been modified to include courts of appeal (1912) and insolvency (1896), as well as a juvenile court. TheCUYAHOGA COUNTY JUVENILE COURT, created by state legislation passed in 1902 represented the second such entity in the U.S. The provisions of the Ohio measure made it applicable to Cuyahoga County only, and the legislation was promoted and supported by local-interest groups who advocated the formation of a separate court, and thus distinction in treatment for the juvenile offender. The juvenile court was linked to a detention home for minors made possible by state legislation passed in 1908 granting the commissioners authority, with the advice and recommendation of a duly authorized judge, to establish an institution for delinquent, dependent, or neglected youth. The juvenile court also presided over the Mothers’ Pension program, created by state law in 1913, which allowed a stipend to women with children under the age of 16 who lacked traditional means of support.

The responsibilities of the probate court, originally established under the provisions of the Ohio Constitution of 1851, had also expanded to include, by 1913, the power to appoint four county residents to constitute a board of park commissioners known in Cuyahoga County as the County Park Commission. In 1913 the probate judge also received the power to appoint the county board of visitors, a body authorized by the Ohio general assembly in 1882 to keep apprised of the conditions and management of all charitable and correctional facilities supported in whole or in part by county or municipal taxation. By 1913 the Court of Common Pleas also had its authority expanded to include jurisdiction over a jury commission (1894) and the SOLDIERS’ & SAILORS’ RELIEF COMMISSION. The County Commissioners also had new departments to supervise, including divisions of blind relief and soldiers’ and sailors’ burial, as well as assuming the duties of a purchasing agent. Through the activities of two of these new agencies, the commissioners became involved in the business of providing assistance to the needy, a responsibility that would grow through the years. In 1884, for example, the general assembly empowered the commissioners to appoint three persons in each township of their county to provide for the burial of any honorably discharged soldier, sailor, or marine who died without the means to pay his funeral expenses. In 1913 the commissioners also assumed the duties of administering state aid to visually handicapped citizens through the operation of the blind relief division.

After 1913 county responsibilities continued to expand. By 1936 a number of new agencies, boards, and divisions had been integrated into the county system. The business of the Court of Common Pleas attained an increasing level of professionalization during the 1920s with the establishment of a criminal-record department to systematically compile individual crime records for ready reference; a probation department; and a psychiatric clinic to furnish the trial judge with a report on the mental condition of a prisoner, to assist him in determining whether hospitalization was preferable to punishment. The addition of a domestic-relations bureau to the Court of Common Pleas reflected a continuing trend toward specialization in legal matters. Although the bureau was organized in 1920, it was not until 1929 that the litigation pertaining to divorce and domestic-relations matters was actually segregated and given to one judge for disposition (see CUYAHOGA COUNTY DOMESTIC RELATIONS COURT).

By 1936 there were 13 divisions under the direct authority of the county commissioners. Two of these departments were created to alleviate the hardships brought to county residents by the Depression. The Cuyahoga County Relief Administration (CCRA) served as the agency for the disposition of public-relief funds in the county; while under the provisions of state legislation passed in 1933, the commissioners were authorized to administer funds for housing relief in the county. A third agency, the recreation division, was formed directly by the commissioners to see that funds were distributed to the best advantage on work relief projects related to recreation, including playground, MUSIC, and theatrical projects. These actions were not solely a temporary commitment made necessary by the conditions of the era. The activities of the CCRA were terminated in 1937 with the expiration of the Ohio State Emergency Relief Law; however, the county commissioners continued their responsibility in the area of public welfare by accepting control of the “Central Bureau” from the City of Cleveland that year. By this action, the new County Relief Bureau assumed the duty of providing for the transient, paupers, and the disabled, with an administrative staff to coordinate and organize its actions. The Relief Bureau remained part of the county structure until 1947, when the commissioners, by authority granted to them by state law, created the County Welfare Department. In the tradition of the CCRA and the County Relief Bureau, the new department assumed responsibility for the welfare services provided by the board. In 1952 the child welfare board, established in 1929 to care for neglected and dependent children, was transferred to the County Welfare Department, and in 1953 its name was changed to the Division of Child Welfare.

The county commissioners also became involved in the care of the elderly and chronically ill by establishing a county nursing home in 1938. This responsibility increased during the 1940s and 1950s as the county assumed duties formerly handled by the City of Cleveland. In 1942 the Sunny Acres tuberculosis sanitarium was deeded from the city to the county, and in 1953 Highland View Hospital for the chronically ill was opened as a county facility. In 1958 the county assumed control of Cleveland City Hospital which, along with Highland View Hospital, became the nucleus of the quasi-independentCUYAHOGA COUNTY HOSPITAL SYSTEM (CCHS). The postwar years witnessed the creation of additional agencies. In 1946 the commissioners took the first step toward the development of additional airport facilities, recognizing that with the development of airline travel as a major mode of private and commercial transportation, it was necessary for Cuyahoga County, as an important urban area, to supply adequate landing fields and air terminals. TheCUYAHOGA COUNTY AIRPORT on Richmond Rd. was officially opened and dedicated in 1950.

During the Cold War years, the county became actively involved in CIVIL DEFENSE IN GREATER CLEVELAND. In 1952 the commissioners empowered their board president to enter into agreements with the various municipalities to coordinate civil-defense activities. Additional postwar cooperation between the county and its surrounding municipalities was also made necessary by the high rate of urban development. In 1947 the county commissioners agreed to cooperate with area municipalities in the creation and maintenance of a Regional Planning Commission to work toward rational planning for local growth. Another legacy of the postwar period was the county’s involvement in coordinating housing for returning veterans. In 1946, under authority granted by the Ohio general assembly, the commissioners provided for the establishment of the Cuyahoga County Veterans Emergency Housing Project and appointed an administrator to take charge of the “acquisition, planning, construction, operations and maintenance” of such a project. The creation of these new offices and agencies imposed upon the board an increasing number of administrative duties. To assist them in carrying out their responsibilities, the commissioners were the first in the state to establish the position of the county administrative officer, in 1952. They assigned a variety of tasks to the county administrator, which included the daily supervision of the county’s offices, departments, and services and the responsibility of assisting the board in administering and enforcing its policies and resolutions. This move enabled the commissioners to deal more effectively with its growing responsibilities and exercise stronger fiscal planning and control in all areas. In the process of budgeting and appropriating available funds, the commissioners must decide the services, activities, facilities, and projects which comprise its program. The commissioners also have responsibility for the management of county facilities; and in the personnel area the commissioners appoint key departmental staff and line positions as well as board members who are responsible by state law for particular functions.

Following 1952, county structure continued to change as some obsolete departments were abolished and new ones were created to meet changing circumstances. In 1958 the county’s veterans’ housing program was terminated, as it no longer rendered a vital service. In 1975 the commissioners approved the establishment of an archival agency to give life to the county’s largely moribund records commission; to control the growing mountain of paperwork by offering records-management services to the various county offices and agencies; and to make the county’s documentary heritage available to the public. Earlier, the commissioners had attempted to improve their system of information gathering by forming a data-processing board in 1967. This board, consisting of the auditor, treasurer, and one of the commissioners, approved the acquisition of automatic data-processing equipment and is authorized to establish a centralized data-processing system for all county offices. In the area of justice services, the commissioners created a public defender’s commission in Nov. 1976 with the goal of its becoming the “principal source of representation . . . of those persons eligible for publicly provided counsel in criminal, juvenile, and probate proceedings.” By Mar. 1978, a public defender was hired, assisted initially by a staff of 16 attorneys.

Additional changes during the post-World War II period occurred when older agencies were reorganized, but retained their basic functions. The Welfare Department, established in 1948, was known as the CUYAHOGA COUNTY DEPARTMENT OF HUMAN SERVICES by 1986. The services offered by the department had so increased that in 1991 the department was restructured and divided into four separate and autonomous departments, each with its own director and reporting to a Deputy County Administrator for Health and Human Services. Beginning in Jan. of 1992, Health and Human Services included the departments of Entitlement Services, Family and Children’s Services, Senior and Adult Programs, and Employment Services. The Child Support Enforcement Agency is also under the aegis of Health and Human Services. The civil defense activities of the 1950s, marked by the establishment of fallout shelters and the regular testing of air-raid sirens, were outdated by the 1980s. However, the county’s charge to preserve public safety during times of emergency continued, and in 1994 Emergency Management, a division under the Department of Community Services, developed and administered an emergency plan providing for the organization and coordination of the resources needed in a major emergency or disaster. Other divisions of the Department of Community Services include Sanitary Engineering, general aviation at the County Airport, the Emergency Medical Services (CECOMS) and the Regional Information System (CRIS).

By the 1980s, services to the chronically ill had been expanded and reorganized. The county merged the Highland View chronic hospital with Metropolitan General Hospital in 1979, and in June of that year the Highland View chronic and rehabilitation hospital on the campus of Metro General was formally dedicated. In 1994 the MetroHealth System included the Medical Center, a Center for rehabilitation, a Center for Skilled Nursing Care, the Clement Center for Family Care, the West Park Medical Bldg., and the Downtown Center. The county’s work with the elderly continued to expand to meet the needs of the growing segment of older people in the general population. The Department of Senior and Adult Programs, part of Health and Human Services, currently provides both protective and supportive services to consenting elderly and disabled adults to shield them from neglect, abuse, or exploitation. The County Nursing Home of the 1990s is a 177-bed facility that continues to provide specialized services to the elderly, including long term care and rehabilitation, and gives particular consideration to those individuals not able to pay for that care. The Advisory Council on Senior and Adult Services advises both the Director of Senior and Adult Services and the board of county commissioners. In 1968 the NORTHEAST OHIO AREAWIDE COORDINATING AGENCY was established, governed by the elected officials, including the three commissioners, from Cuyahoga, Geauga, Lake, Lorain, and Medina counties. It is designated the Metropolitan Planning Agency, with responsibility for federally mandated long- and short-range transportation planning; and is also named the Area Clearinghouse for the review of federal aid applications that impact the region. By the 1990s NOACA’s other responsibilities included planning in the areas of transportation-related air quality and water quality as necessitated by federal law. The years after World War II also witnessed the development of several substantially autonomous local government agencies that, although not directly controlled by the electorate, developed out of a need for special services in the areas of health, transportation, education, and library facilities. By 1994 there were approx. 40 boards and commissions, either advisory or policy making in nature, whose membership included at least one individual appointed by the county commissioners. These included the Board of Mental Retardation and Developmental Disabilities, the CLEVELAND-CUYAHOGA COUNTY PORT AUTHORITY, the CUYAHOGA COMMUNITY COLLEGE Board of Trustees, the Cuyahoga County Community Mental Health Board, and the GREATER CLEVELAND REGIONAL TRANSIT AUTHORITY (RTA) Board of Trustees.

The growing complexity of Cuyahoga County’s governmental structure and the proliferation of the services it provides were a natural product of the overall growth of the area during the 20th century and reflected the need to provide uniform, coordinated services to meet the common needs that may formerly have been met by individual municipalities. This evolution of responsibility has been used by advocates of a regional governmental structure to illustrate the necessity of such a structure. However, by the early 1980s all formal efforts to achieve regional government had been defeated, and the expansion of county services to meet common area needs seemed destined to continue.

Judith G. Cetina

Cuyahoga County Archives

Americanization from the Encyclopedia of Cleveland History

Written by Edward M. Miggins

The link is here

AMERICANIZATION. The heavy influx of immigrants into cities such as Cleveland before and after the Civil War tested the belief that America could easily assimilate foreign newcomers. Hector Crevecoeur, an 18th-century French writer, had popularized the image of America as a mix of races and nationalities blending into and forming a new culture. On the other hand, nativists who had organized the Know-Nothing Party before the Civil War feared that the foreign customs and “vices” of non-Anglo-Saxon people would destroy America. Anglo-conformists with a similar concern believed in less drastic solutions to make immigrants shed their foreign customs and assimilate into the Protestant, middle-class American mainstream. The public schools were especially burdened with this task.

One of the primary objectives of the CLEVELAND PUBLIC SCHOOLS since their beginning in 1836 has been the assimilation of foreign-born immigrants into American society. The leaders of the city’s schools before the Civil War were transplanted New Englanders who believed that the public or common school was a panacea for the social and economic ills of American society. They claimed, like educator Horace Mann of Massachusetts, that the compulsory attendance of all children in the public schools would educate children not only in the “three Rs,” but also in the cultural values of Anglo-Saxon America. In 1835 Calvin Stowe, one of the most influential leaders of Ohio’s public-school movement, told teachers that it was essential for America’s national strength that the foreigners who settled on our soil should cease to be Europeans and become Americans. But the public school found that immigrant children needed specialized programs to succeed in the classroom. In Mayflower School, built at the corner of Mayflower (31st St.) and Orange in 1851, the majority of students came from Czech families (see CZECHS), and only 25% of the pupils could speak English by the 1870s. Teachers spent a portion of each day providing special lessons in the English language. In 1870 superintendent ANDREW RICKOFF† and the school board instituted the teaching of German, to successfully enroll the majority of the more than 2,000 children of German parentage (see GERMANS) who had previously attended PRIVATE SCHOOLS that taught subjects in German. Educational leaders in Cleveland before the turn of the century believed that the addition of different nationalities would strengthen Anglo-Saxon America, as long as the newcomers conformed to the dominant culture. The goal of mixing nationalities in the common schools was not endorsed by all immigrant groups in the 19th century. Cleveland’s Irish Catholics followed the advice of Bp. RICHARD GILMOUR†, who condemned the public schools as irreligious and told his congregants that they were Catholics first and citizens second (see CATHOLICS, ROMAN). By 1884 123 parochial schools had enrolled 26,000 pupils (see PAROCHIAL EDUCATION (CATHOLIC)). Nationality churches served over 200,000 people by the turn of the century. Parochial schools of the Catholic diocese that taught foreign languages and customs flourished as Cleveland became the home of newcomers from Southern and Eastern Europe. Described as “the new immigrants,” they increased from 43,281 to 115,870 people between 1900-10.

School reformers questioned the effectiveness of the policy of Anglo-conformity in the face of the growing cultural diversity of the student population. Some celebrated the philosophy of the “melting pot,” or the mixing of nationalities together. Brownell School on Prospect Ave. had enrolled, for example, over 30 different nationalities by the turn of the century. SETTLEMENT HOUSES, such as HIRAM HOUSE in the Central-Woodland neighborhood of Eastern European Jews and ITALIANS, provided the city’s first citizenship and vocational-education programs, and became the social-service model for Cleveland’s immigrants. In doing so, the settlements carried forward citizenship programs that had been instituted early in the century by patriotic societies such as the Daughters of the American Revolution. In 1901 Harmon School provided “steamer classes,” language instruction for foreign-born children. Evening schools taught adult immigrants civics and English, to help them pass naturalization exams. Schools also expanded social-welfare programs to meet the needs of immigrant, working-class children and youth. In 1907 a medical dispensary, the first of its kind, opened in LITTLE ITALY. Despite these efforts to reach immigrants, the CLEVELAND FOUNDATION‘s school survey of 1915 criticized the school system for not providing enough steamer classes and other specialized programs: among public school students, over 50% came from homes in which a foreign language was spoken. It was estimated that over 60,000 unnaturalized immigrants lived in Cleveland and that two-thirds of the student population left school before the legally required age of 16 for girls and 15 for boys.

The entrance of America into World War I increased anxiety over the effectiveness of the public schools’ Americanization program in securing the loyalty of foreign-born immigrants and their children. RAYMOND MOLEY†, a political science professor from Western Reserve Univ. (see CASE WESTERN RESERVE UNIVERSITY.), was hired to direct its activities. On 6 April 1917, Mayor HARRY L. DAVIS† appointed the MAYOR’S ADVISORY WAR COMMITTEE, which created a “Committee of the Teaching of English to Foreigners,” with business leader HAROLD T. CLARK† as chair. Renamed the Cleveland Americanization Council, the organization coordinated 68 local groups and worked with state and federal programs. The Board of Education trained language teachers, and the Citizens Bureau at city hall supplied instructors of naturalization. Both programs were offered at schools, factories, libraries, social settlements, churches, and community centers. Naturalization classes enrolled 2,067 students during the fall of 1919. The council launched a citywide publicity campaign, which included posters in different languages and advertisements in 22 nationality newspapers. The ideology of social efficiency, often used with employers, stressed that the Americanization of foreign workers would increase their punctuality, orderliness, and productivity. Moley wrote Lessons in Citizenship, a civics handbook, to help immigrants pass naturalization exams. The War Advisory Committee asked ELEANOR LEDBETTER†, a foreign-language librarian for the CLEVELAND PUBLIC LIBRARY (CPL), and other researchers to write a series of sympathetic studies of the city’s nationality cultures and neighborhoods. The library also provided newspapers and books in over 20 different languages to reach the foreign-born. Despite this advocacy of cultural pluralism as the basis for mutual exchange and respect, the bitter controversies and feelings aroused during wartime America caused many Americans to lose faith in public school assimilation.

Superintendent FRANK SPAULDING† and the majority of the school board supported the removal and prosecution of a socialist board member who publicly opposed America’s participation in World War I, under the Espionage Act of 1917. The board also terminated the teaching of German and required a loyalty oath from teachers as part of the wartime campaign for “100% Americanism.” Events surrounding the MAY DAY RIOTS and Red Scare of 1919-20 aroused public anger against foreign immigrants who supported radical or progressive causes. On 1 May 1919, the Socialist party’s march in support of the Russian Revolution on Cleveland’s PUBLIC SQUARE incited a riot and the arrest of 116 demonstrators. Local newspapers quickly pointed out that only 8 of those arrested had been born in the U.S. The city government immediately passed laws to restrict parades and the display of red flags. Newspapers and business, labor, and civic organizations called for the deportation of foreigners not wanting to become Americans. Others called for stronger Americanization programs.

Harold T. Clark asked for the passage of a law to compel young people to attend school until the age of 21, and for the adoption of methods used by the army to teach soldiers English. Allen Burns, former director of the CLEVELAND FOUNDATION‘s survey program, conducted a series of studies to improve Americanization programs for the Carnegie Foundation. Cleveland educators and social workers complained about the postwar financial cuts in citizenship training. The PLAIN DEALER alarmingly reported that the city’s immigrant population contained over 85,000 unnaturalized men, and if their families were counted, the number of unnaturalized foreigners rose to approx. 212,000 out of a total residential population of 796,841. The postwar arrival of millions of Southern and Eastern Europeans created a sense of panic throughout America. Schools were judged incapable of assimilating what were seen as biologically inferior groups of immigrants. In 1924 Congress passed a quota law that drastically reduced the number of immigrants from Southern and Eastern Europe to 3% of their prewar level, and in effect banned Asians from coming to America.

Throughout the 1920s and 1930s, immigrant neighborhoods and organizations responded to the needs of the second generation. Often the American-born and -educated children clashed with the values and customs of their parents and moved from their ethnic neighborhoods. Intermarriage between individuals of the same religious faith but different ethnic background created the triple melting pot among Catholics, Jews, and Protestants (see RELIGION). Ethnic parishes and newspapers began to communicate in English as the second and third generations lost the urgency to speak their mother tongue. LA VOCE DEL POPOLO ITALIANO, an Italian nationality newspaper, advertised in English and urged its readers to naturalize. Some ethnic groups controlled assimilation by modifying and adapting their organizations. The Polish immigrant parish gradually changed, for example, to the hyphenated parish of the Polish-American community, and finally to the American parish of Polish ancestry (see POLES). The nationality parish declined in membership in the central city and became a rarity in the SUBURBS because of restrictive immigration laws and demographic changes. Between 1930-40, Cleveland’s foreign-born population decreased by 51,763, or 22.2%, and dropped to a total of 179,183. The proportion of foreign-born in the city’s total population declined from 30.1% in 1920 to 14.5% in 1950. As the second and third generations became more successful economically and more Americanized, or less dependent on nationality organizations, they moved into what were once Protestant-dominated suburbs after World War II.

Different generations of immigrants continued to search for an identity that balanced both their ethnic heritage and the American environment. A conscious celebration of nationality cultures counteracted American ethnocentrism. Folk festivals, sponsored by the CLEVELAND FOLK ARTS ASSN., nationality holidays, fraternal organizations, the All Nations Festival, and the CLEVELAND CULTURAL GARDEN FEDERATION all celebrated immigrant contributions to the city. In 1948 the Mayfield Merchants’ Assn. in LITTLE ITALY sponsored a banquet to honor Miss Florence Graham. Of Irish descent, she had faithfully served and fought discrimination against the city’s Italian-American community since 1908, during her tenure as teacher and principal in the neighborhood’s Murray Hill School. The Intl. Institute of the YOUNG WOMEN’S CHRISTIAN ASSN. (YWCA), organized in 1916, trained older immigrants to work with recent arrivals. The Citizens Bureau, with the support of the Welfare Federation, supplied aid, advice, and naturalization classes. The bureau also cooperated with the citizenship and English classes for foreign-born pupils in the public schools, classes which 130,000 foreign-speaking students had attended by 1929.

Eleanor Ledbetter, in addition to building a foreign-language collection at CPL, compiled a volume of Czech fairytales and a bibliography of Polish literature. HELEN HORVATH†, who had immigrated from Hungary in 1897, began mothers’ clubs and educational programs for foreign newcomers. The public schools asked to incorporate her efforts, and she spoke about immigrant education at many universities. John Dewey, the leading philosopher and proponent of progressive education, praised the work of Verdine Peck Hull, who had pioneered a course in interracial tolerance in the public schools in 1924. He declared that the program’s emphasis on mutual understanding represented true Americanism. In 1973 the city created Senior Ethnic Find, a program to help elderly immigrants use available social services. The Nationalities Services Center (see INTERNATIONAL SERVICES CENTER), created by a merger of the Intl. Institute and the Citizens Bureau in 1954, and the LEAGUE FOR HUMAN RIGHTS (est. 1934) helped immigrants displaced by totalitarian regimes and World War II. The Cleveland Immigration & Naturalization Service has helped residents sponsor the immigration of relatives, friends, and refugees from other countries and assisted newcomers in becoming citizens.

With the decline in European immigration after World War I, Cleveland employers looked to the American South as a source of cheap labor. Over 100,000 Appalachians and 200,000 blacks migrated to the Greater Cleveland area in the ensuing years (see AFRICAN AMERICANS). The URBAN LEAGUE OF GREATER CLEVELAND helped blacks find jobs and housing and, assisted by the NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE (NAACP), to fight discrimination. A plethora of black churches, KARAMU HOUSE, and fraternal organizations helped rural black newcomers adjust to the urban environment. In the 1960s, public schools began remedial and special education programs for minorities or others described as culturally disadvantaged. Cleveland’s post-World War II population became even more diverse with the addition of Asians, Russian Jewish refugees (seeJEWS & JUDAISM), and Spanish-speaking people from Puerto Rico and Central or South America, Cuba, and Mexico (see HISPANIC COMMUNITY). Displaced persons from Eastern Europe were the major foreign group in English classes, which enrolled over 2,000 students in the public schools in 1949. The Nationalities Service Center flew 270 Cuban refugees into the city as thousands fled Fidel Castro’s victory in 1959.

In 1965 Congress changed the immigration law. With ethnic origin no longer a factor in admittance to the U.S., preferential treatment was given to people with relatives living in America or occupational skills that America needed and refugees from Communism. People from the Far East and India were allowed to enter in large numbers. By the mid-1970s, almost one-third of America’s immigrants came from Asia. Filipinos (see ), Chinese, KOREANS,VIETNAMESE., and Cambodians swelled the population of cities. In 1975 the greatest proportion of the 400,000 immigrants came from the West Indies and Mexico. New and old organizations developed programs to meet the needs of Cleveland’s changing immigrant population. Cleveland’s Islamic Center (see ISLAMIC CENTER OF CLEVELAND) built a mosque in PARMA to serve the needs of the Arab community. The city’s Vietnamese people opened a Buddhist Temple in Cleveland’s near west side. A refugee resettlement office was started to serve approx. 1,500 Vietnamese as well as Laotian and Cambodian immigrants by providing social, employment, and translating services. Approximately 10,000 Asian Indians, of whom the majority were educated professionals, were dispersed throughout the metropolitan region. Cleveland’s Asian community constructed a new addition to the city’s Nationality Gardens in Rockefeller Park near UNIVERSITY CIRCLE and held an annual festival celebrating the diversity of their cultures. The U.S. State Dept. asked the JEWISH FAMILY SERVICE ASSN. to adapt its methods of resettlement to other groups. JFS helped more than 600 Indo-Chinese as well as 1,500 Russian refugees to resettle locally.

By the 1980s, Cleveland’s Spanish-speaking groups had more than 30,000 members in Cleveland. Already citizens of the U.S., Puerto Rican migrants were the largest group. They were assisted by a variety of civic and fraternal organizations, the Spanish American Committee (see SPANISH AMERICAN COMMITTEE), an official liaison at city hall, and an employment-service bureau. Spanish Catholics established SAN JUAN BAUTISTA on the city’s near west side. The Hispanic community helped their young adults with scholarships and educational or cultural programs through the ESPERANZA, INC., Program and the Julia de Burgos Cultural Center. Fifteen hundred Spanish-speaking students constituted the major group in the “English as a Second Language” program in the Cleveland public schools. Over 100 Vietnamese children were also enrolled in the bilingual course.

The PACE ASSN. (Program for Action by Citizens in Education), organized in 1963, developed a human-relations curriculum and trained teachers to increase multicultural understanding. The public schools also developed curriculum to promote an awareness of the history and contributions of minority groups. To combat prejudice against the city’s newest immigrant groups, the Bilingual and Multicultural Education Program of the Cleveland Public Schools helped foreign newcomers learn English and to celebrate their cultural backgrounds. In 1981 it started an annual conference to promote multicultural education as part of the curriculum of the public schools. The program helps students live in a pluralistic world by fostering an appreciation and respect for people of different backgrounds.

Historically, the reaction of Clevelanders to immigrants and migrants has paralleled that of the country in general. Important differences between and among nationality groups have shaped their responses to the culture of the host country. “Birds of Passage,” immigrants who came to America to earn as much money as quickly as possible before returning home, had little interest in becoming citizens or in being Americanized. Programs to assimilate immigrants depended heavily on the immigrants’ reasons for coming to America, as well as the public’s attitudes toward newcomers. When the economy of the city was expanding and in need of cheap labor, immigrants were seen as a vital part of the labor force and capable of becoming American. When the economy slumped in the 1890s and 1930s, or when the public became inflamed over patriotic unity, as occurred in the post-World War I and VIETNAM WAR eras, immigrants were viewed as threats to social harmony and incapable of assimilating. Native-born fears about new immigrants revealed a deep insecurity about American social life and were connected directly to cycles of economic growth and decline. Resentment against the racial backgrounds and illegal entry of foreign newcomers, job losses, and the rising cost of social-welfare and educational services also increased in the 1980s, as approx. 9 million immigrants arrived in America. The total surpassed all previous decades in American history.

Since the 1970s, the American public has seen the rise of a “new ethnic consciousness,” a movement celebrated in Michael Novak’s The Rise of the Unmeltable Ethnics. Novak believes that millions of ethnics who tried to become Americanized according to the norms of the dominant culture were delighted to find that they no longer had to pay that price. Ethnic pride in cultural differences provided not only a stronger sense of community for immigrant groups, but also an antidote to an age in which modern systems of communication and commerce emphasized the greatest common denominators for a mass audience of supposedly like-minded individuals. This new attitude of cultural pluralism was quickly manifested in cities such as Cleveland. During the 1970s and 1980s, a series of programs began, including the Greater Cleveland Ethnographic Museum, Peoples & Cultures, the WESTERN RESERVE HISTORICAL SOCIETY‘s Cleveland Regional Ethnic Archives Program, the Public Library’s Cleveland Heritage Program, and CUYAHOGA COMMUNITY COLLEGE‘s Community Studies Program and Oral History Center, that reflected this change in American attitudes. They continued the celebration of regional cultural vitality begun by people such as Eleanor Ledbetter and Helen Horvath, who created a sympathetic understanding of immigrants as the basis for the Americanization of Cleveland.