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At a time when the discipline of public health as practiced in the United States is reinventing itself to better meet its mission of health promotion and disease prevention, it is appropriate to look back and remember on whose shoulders we stand as we look ahead to the future. The Akron Health Department is playing its role in this period of public health renaissance, and, thanks to Shirley Angiulo of our Division of Health Promotion, we also have a better sense of where we've been.

This History of the Akron Health Department, 1881-1999, is necessarily incomplete, as are all histories. The written record is often sketchy and memories are notoriously short and inaccurate in detail. Shirley Angiulo has relied heavily on writings of Dr. M.D. Ailes, Director of Health from 1927 to 1955, and minutes from Akron Health Commission meetings to craft a document that describes many of the major issues faced by the department over the years, and catalogue changes in the size and nature of Akron's public health workforce as the department's responsibilities and capacities evolved.

She reveals a history of ups and downs - good times and bad times for the department. She also describes a steady trend of growth in budget, responsibility and sophistication over the decades that clearly demonstrates this community's commitment to improving the health of its citizens. Those interested in Akron and public health will find this History to be an interesting read.

C. William Keck, M.D., M.P.H.
Director of Health

1881-1916

A health department is developed in 1881, with Dr. A.A. Kohler as its first Health Officer, who worked part-time from 1881-1916. (This predates the Ohio Department of Health which was established in 1886.)

During the early 1900's, the record system is sketchy and statistical reporting poor. Fire demolished the City Building on August 22, 1900, when an infuriated mob set fire to City Hall, and all records of Akron's public health services are destroyed.

Between 1900-1908 birth and death records were poorly reported, and part of the time, tax assessors were assigned the duty of making birth reports to the health department. The reporting of births and deaths began in 1908; the chief work of the department by 1910 is attending to complaints on nuisance, garbage, outside toilets, and dirty yards. Very little, if any, consideration is given to handling of milk or other foods.

By 1915, the personnel of the health department consists of: the Health Officer, Clerk, Registrar of Vital Statistics, a City Chemist, two Sanitary Policeman, a Dairy and Food Inspector, and a Dog Catcher.

Some industrialists and businessmen realize the losses sustained through the frequent illness and absenteeism of employees. Their efforts and the need for better public health services for all people is the initiative that brings about the development of a modern type of health department in 1916, with Dr. J.J. McShane as the first full-time Health Officer.

Prior to this time, only routine services were offered. Now, prevention is encouraged; placarding for communicable diseases is done. Attempts are being made to initiate some kind of milk inspection; the Division of Child Welfare (later to be known as the Public Health Nursing Division) is developed, with Miss Olive Beason as its first director.

An Epidemiologist and a Bacteriologist are employed. Contagious disease is supposed to be reported for the purpose of quarantine. However, very often more deaths occur from a specific disease than the total active cases reported for the same period. In some years, it was found there were as high as three times the number of deaths from tuberculosis as there were cases reported.

Seeing the tremendous economic loss that was occurring in Akron due to needless illness and deaths, steps are taken to prevent the loss of time and money because of sickness, to save hundreds of lives being lost through lack of adequate control over disease, and to make Akron a healthier place to live.

In published reports of 1910, the death rate for Akron is 14.2 per 1000 population. In 1917, it is exactly the same. But in 1920, it has been cut to 11.7 per 1000.

In 1910, in a study of infant deaths (babies under one year of age), there are 132 to each 1000 live births. In 1917, there are 130, and by 1920, it has been reduced to 75.

The average infant death rate for the 1910-1920 period is 155 to each 1000 births; for 1920-1930, there are 68; saving from 300 to 400 babies each year in the city.

Prior to 1918, the work of the health department was mostly routine; the work being directed chiefly to the abatement of nuisances, the placarding of houses for communicable disease if some doctor chose to report a case, the burning of sulphur formaldehyde in the name of fumigation, the recording of births and deaths, and attempting a "primitive" sort of milk inspection.

Health hazards are recognized through the efforts of Mr. E. C. Shaw, who is a high official in the B.F. Goodrich Company, and his associates. Through these efforts, the Goodrich Company was one of the first companies in the United States to establish a welfare department for the supervision of the health of its employees.

This activity soon brings Shaw and his associates to a realization that they have control of the health needs of their employees during a comparatively brief period of each working day, and that during the remaining hours, their people were subjected to all the health hazards existing in the community.

At the instigation of Mr. Shaw, Professor Ogden of Cornell University is brought to Akron to make a preliminary survey for the reorganization of the health department. Following Ogden's report for the need of reorganization functioning along modern lines, Mr. Shaw began a series of conferences with a number of prominent citizens and officials of other companies employing large numbers of men. Then the Mayor, the

Board of Health, and City officials meet to determine if everyone could cooperate in expansion of the health department's work. Everyone agrees and Mr. Shaw proposes that if Council would appropriate all the money the City could afford for health purposes, he would raise an additional sum from private sources to provide a budget of $50,000 if necessary.

While $7,688 has been appropriated for health work from January through June in 1916, the sum of $32,288 is allocated for the second six month period. Of this, $12,500 is donated by citizens. In 1917, the health department is given $65,488, of which $2,500 was donated by citizens. By 1918, the total cost is taken over by the municipality. It requires three years for the reorganization and adjustment to provide results that are evidence of an improvement.

Dr. J.J. McShane, who was employed as the first full-time health officer in 1916, resigns in 1917 and Dr. C. T. Nesbit is appointed, and he completes the reorganization. Nursing staff consists of a Director and twenty nurses. Child Care Clinics are established at Bowen, Allen, and Grace schools. Thirty-one public and five parochial schools are visited by Public Health Nurses in a specialized program.

By 1918, the health department has increased to six divisions: Administration, Epidemiology, Nursing, Laboratory, Dairy and Food Sanitation, and Vital Statistics. The process of pasteurizing milk begins.

Excellent work is accomplished, yet the program being contemplated is interrupted by the great "flu" epidemic that came in the fall of 1918, and lasts though March or April of 1919.

Three hundred and forty-four patients are cared for in the Armory, of which 283 are released, having fully recovered. Forty-eight deaths occur. Thirteen patients are sent to local hospitals.

A Venereal Disease Clinic is established in 1919, with a full-time Public Health Nurse assigned. Miss Elizabeth Yost becomes Director of Nursing and her staff consists of 38 nurses.

In 1919, the state passes the Hughes-Griswald Law, which enables health districts in cities as well as counties to have health departments, if sufficient funds are provided by the Finance Department and City Council.

At the end of 1920, Dr. Nesbit is succeeded by Dr. D.D. Shira.

The Early to Mid 20's

By 1920, 99% of all milk used in Akron is now pasteurized. The rest at least comes from tested cattle. The Divisions have now become 9, instead of 6. The work is done in accord with the new state law. Reporting of communicable disease becomes compulsory. Examination of school children begins in accordance with the law. Antitoxin for diphtheria is given to school children in 1923. New regulations for the control of markets and restaurants and control of milk supplies is adopted. Meat inspection is demanded but not secured.

During this period, the city grows rapidly, and the demands on the Health Department increase to the extent that without increase in personnel, equipment and room, the health services can't keep pace. By 1927, it becomes necessary to reduce the sanitary inspectors to 2 when 6 or more are needed; the dairy and food inspectors to 4 when at least 7 are needed; the nurses from 38 to 32.

Due to lack of funds, the orthopedic and crippled children's work that has been done since 1921 is transferred, along with three nurses, to Children's Hospital in 1925. However, the department opens the Allen Prenatal Clinic in 1920 and the Community House

Prenatal Clinic in 1922. The Venereal Disease Clinics for men and women, which has been operated by non-official agencies, is taken over by the Communicable Disease Division, and such service is also given regularly at the Women's Detention Home.

A systematic follow-up system of reported tuberculosis cases is inaugurated by the Nursing Division under Miss Yost, and much is done to systemize all the department work. The cramped quarters gave way to adequate room when the 7th floor of the new Municipal Building is occupied by the department in 1926.

Akron's public health services generally improve from 1916 to 1924; then, perhaps through complacency, begin to wane, and by 1926, are extremely poor. The budget is lower than it had been in the past 8 years. In 1926, the population is 200,000; the area is 20 square miles. The death rate: 10.6; infant mortality: 80.8.

The Late 1920's to Early 30's

Early in 1927, Mayor D.C. Rybolt and the Health Commission begin an effort to revitalize the department. There have been four Health Officers up to this time and the last one had resigned. Dr. M.D. Ailes is then selected as Director of Health and begins on April 16, 1927. He is given full authority and support from the Health Commission, the Mayor, and most of the councilmen.

City funds are short due to high bond requirements, but (until 1944) the city's health needs are properly considered, and the best budgets possible provided. There are not sufficient funds to provide all the health services that would benefit the city, but they enable the department to make progress. During the three years following 1927, the city increases in population from 200,000 to almost 260,000; in area from 29 to 40 square miles; in school attendance (public and parochial) form approximately 49,000 to 60 pupils.

Food establishments increase from 2,500 to 4,000.

Health Department personnel have been increased by one sanitary inspector, two food inspectors, four nurses, one physician, three clerks, and a meat division (1929), with two veterinarians and one inspector.

Nurses begin delivering birth certificates in 1928 and W.R. Dodd is registrar. New ordinances and regulations are written and passed by the Health Commission. In 1920, the Board of Education passes a regulation requiring smallpox vaccination for all children beginning school. The Red Pepper Fund is available to provide glasses; general services are available to the public in a specialized manner.

Eradication of tuberculosis in the cattle supplying Akron with milk is secured. Many new public health procedures and services are provided, many of which Akron is first in the state to provide. Akron is also among the first to put on sanitary training courses for milk producers, restaurant employees, and food handlers.

In 1927, it becomes necessary to close the old contagious disease hospital. In 1928, the people vote down a bond issue for a new one and the city is without any hospital facilities for contagious diseases.

Complete cooperation, where none has existed before, is secured between the Health Department and the public and parochial schools; Medical and Dental Societies, the Tuberculosis Association and other such agencies; the milk producers and distributor; the Restaurant and Grocery Association; and Welfare Agencies. In a few years, the Akron public health services are rated by state and national authorities as among the best in the nation. In fact, it is about the healthiest city of over 100,000 people in the world!

SYNOPSIS OF 1917-1950's

The Health Department comes under Civil Service classifications in 1934.

By 1939, the yearly health department budget has grown to $124,825. The health department offers the following services: Sanitarian, Quarantine, Dairy & Food, Public Health Nursing, Communicable Disease, Laboratories, and Venereal Disease Clinic. The V.D. Clinic is located on the second floor of a building owned

by the Goodrich Company, located at 11 E. Exchange St. The space is limited to 1,236 square feet. The hall and waiting room take up 537 square feet. The space left accommodates three treatment rooms, has no toilets for clients and the only heat consists of four small open flame gas stoves. The clinic serves 30-40 patients in the morning and 65-80 in the evening, once or twice a week.

By 1942, Elizabeth Park Well Baby Clinic is established in the Elizabeth Park housing project.

In 1943, Akron's population is 275,000; its area is 54 square miles; the death rate, 7.7 per 1000 population; the infant mortality, 38.6 per thousand.

From 1940-45, the Communicable Disease and Quarantine divisions consolidate. The Florence Crittinden Home, Green Cross Hospital and People's Hospital are added to the list of approved maternity hospitals. Dr. Ailes is still director.

In 1948, a specialized Premature Baby program and the Beacon Journal Fund, previously known as the Red Pepper Fund, begin.

1944-1953: An Up and Down Period

Since 1944, satisfactory progress has been prevented by inability to obtain sufficient funds. The budgets finally provided are not based on the City's growth and public health needs and possible improvements, but on "what we got by with before." Yet, the Department has endeavored to continue most of the services previously provided. Two much-needed physicians retire and are not replaced. A Rat Control Section, with three employees, is added in 1945. Costs of supplies increase and across-the-board salary increases are given, so the budget figures are larger, but don't provide the needed increased services.

The 1952 budget requests include items for the replacement of several worn out and junked cars. This was not granted, and several employees of the Dairy and Food and Nursing Divisions, without proper transportation, are seriously handicapped in the services they can give. Essential salary items are also cut; valuable personnel lost. Although about half of the salary cuts are restored later in the year, the positions have been vacant and programs have suffered. Whatever the cause, the 1952 death rate goes from 7.7 to 10.1 and the Infant Mortality rate from 22.2 to 27.9. No cause for the increases is determined.

Akron's population is constantly increasing. Its births have more than doubled since 1926. (In 1927, live births numbered 4,885; in 1947 there were 10,559; and in 1952, 10,176 live births). All of this requires increased public services.

With more knowledge of early detection and prevention of chronic diseases, much more illness and distress can be prevented and healthy useful life extended, especially among the productive age groups. The consensus of this period is that with proper public health funds, Akron can be made a still healthier, happier place in which to live.

In 1953, a new state law relating to Food Service Operations, and a New State Public Health Council regulating food service operations, go into effect, creating annual licensing of certain food service operations.

PERIOD SYNOPSIS

If Akron had its 1917 death rate in 1951, there would be an average of 154 more funerals then there are. If it had its 1926 death rate, the average number of deaths in 1951 would be 60 per month more than there are. If the average 1951 resident death rate of the other cities of over 100,000 population in Ohio occur, Akron would have an average of 70 deaths more each month.

In former years, Akron's death rate has been about the average of other cities. From 1920 to 1951, it has been lower than any other city. The only cause would seem to be the type and quality of Akron's Health Department services.

Mid 1950's: Difficult Times and 3 Health Directors

Russell Bird was Mayor in 1953 and Leo Burg became Mayor in 1954. The same year sees Miss Yost resign as Director of Nursing and Dr. Ailes, Director of Health, is scheduled to retire from a position he has held since 1927. Because he is over 70 years of age, newspaper accounts indicate he is forced to resign, although he has passed exams that certify him to be capable of performing his duties. He stays until July 1955. During this period, there is discussion of the possibility of consolidation of the three health departments in Summit County. Meanwhile, placarding of Communicable Diseases is discontinued, as is delivering of birth certificates by the Nursing Division in 1954.

On February 18, 1954, J.R. Pascoe was to begin work as a Sanitarian, having made the highest grades and deemed the best qualified by the Civil Service. However, a complaint has been filed that he did not live in Akron, but in Cleveland, where he has received his training at the Cleveland Health Department. Civil Service considers the complaint and directs that his name be taken off the certified list. The State Laws, State Attorney Generals opinions, and cases decided in the State Courts, including the State Supreme Court, attest to the fact that the reason for eliminating Mr. Pascoe isn't VALID. Therefore, the proceedings, as recorded, state that Mr. Pascoe is then hired with the legal references that the Health Department is not a city-subdivision, but a State District Department, under State Civil Service administered locally; it is not governed by city regulations or charters, and therefore, the Civil Service action to substitute another name for that of Mr. Pascoe on the accredited list, on the basis of city requirements of residence, is not in order.

Polio vaccination field trials in Akron and Summit County are approved to begin in April 1954. However, a vaccine is not available until later, which would mean the vaccination program cannot be completed before schools are out. The program is scrapped.

Dr. M.D. Ailes - April 1927 - July 1955

Dr. Ailes history of the early origins of Akron's public health and his own 28-year tenure as Director, provides most of the history to this point.

1955 With Dr. James; 1956 With Dr. Morley

Among the applicants for the new health director to replace Dr. Ailes is Dr. John Morley, Deputy Health Commissioner in Grand Rapids, Michigan. However, Dr. George James becomes the sixth Director of Health on February 15, 1955.

On April 1, 1955, the Akron Health Commission adopts a "code of behavior for commissioners" resolution that defines the relationship between the health department employees, the commission and the new Health Director, Dr. James. According to Beacon Journal accounts, this is an attempt to curb unauthorized probing activities by one of the commissioners, Margaret Stevens, that affects the powers of the Director of Health. The resolution specifies that the Health Commission shall have full legislative powers and the Director of Health shall have full administrative powers, subject to the direction and control of the Health Commission. The same article quotes Dr. Ailes, the former Health Director, as having his difficulties and said: "There's only room for one health director."

During Dr. James' brief tenure (19 months), the Salk vaccine (polio) program is initiated. Ellet Baby Clinic opened in the First Presbyterial Parish House, Jean Harper becomes Director of Nursing, and a generalized program is begun in the Kenmore area with one supervisor and seven nurses.

There is also mass blood testing for syphilis. The Shoe-Fitting Fluoroscope Survey ends with most stores voluntarily removing the x-ray machines due to the dangers detected in the survey. Rheumatic Fever Prophylaxis programs are initiated; a Diabetes detection program, Streptococcal Sore Throat study, and the Dental Health fund are established. The Health Commission approves plans to issue annual reports in newspaper form for the first time.

Dr. James resigns on September 26, 1956, to accept a position in New York City as Department of Health Commissioner and an Associate Professor of Public Health Research at Columbia University School of Public Health. On the same day, a fluoridation forum sponsored by the Adult Education Council is held at Akron's Central High School.

In 1956, Mrs. Ruth Holechek becomes Registrar in Vital Statistics. Dr. John Morley becomes the seventh Health Director on October 8, 1956. The position of Education Director in the Public Health Nursing Division is filled by Sarah Finnigan. All Akron Health Department services are generalized at this time. Mayor Leo Berg asks the health department to consider setting up an Air Pollution Control Division. Akron is also approved by the U.S. Public Health Service to become a Yellow Fever vaccine center.

In 1957, the Health Educator position is again discussed with no action taken. The Bowen Baby Clinic is discontinued; the Public Health Clinic is held at 3 South High Street. By March of this year, Dr. Morley is authorized to investigate possible future quarters for a new building for the health department; the Ohio State University student program of four students is initiated.

In 1958, the Kenmore office that was opened in 1955 closes and the entire staff is moved to the central office. A polio program for children begins, and in 1959, questions as to whether pollen counts should be taken is discussed.

Again in 1959, consolidation of the health departments is a major focus; talk of setting up a health educator position is again tabled. The Nursing Division consists of a director, one educational director, four generalized supervisors, two clinic nurses, thirty-three full time and two part-time staff nurses. By 1960, an acute shortage of nurses persists.

Finally, in 1961, the Health Commission is to establish the position of a Health Educator and fill the position only if the salary will be subsidized by the Ohio Department of Health (ODH) for at least two years. However, no immediate action is taken. The same year, Robert Charlton is named Alcoholism Program Director. (Akron was the only large city health department in Ohio that did not have an Alcoholism Program by this time).

The 60's Era

The Beacon Journal headlines of 12/18/63 read: Akron and Summit County Officials Agree on Health Center as City-County Project." Officials talk of a building costing around $1,250,000 with $400,000 coming from a Federal Hill-Burton grant, $650,000 from the City that is already budgeted from income tax revenue; $200,000 coming from the County, which would constitute a merger of the Akron and Summit County health department into one building.

On July 8, 1964, the Summit County Board of Health turns down this proposal, and since Akron already has $1.4 million for the building, it is decided that Akron will build its own structure before the end of the year. Mayor Erickson discards plans for erecting the proposed new health building on the State-owned Akron Armory site, due to opposition from various music groups; thus, the site has to be changed.

Meanwhile, fluoridation of the public water supply has its first reading, is adopted and becomes a contested court case. Noble Sherrard is promoted to Chief of Administration and Public Health Planning; the U.S. Public Health Service Milk Code ordinance (adopted in 1952) is used as a guide in granting of frozen dessert permits in the city.

The loss of the 3-mill property tax reduction from the General Fund resulted in a $2,600,000 deficit. As a result, layoffs and resignations occur. Thirteen nursing positions are lost and the school health services are eliminated. The 1965 budget is reduced by $86,000. The filling of vacancies is delayed and no promotions are made. The Summit County Health Department assists in staffing the TB clinic.

The formation of a Regional Air Pollution Control Advisory Board is discussed in 1965 and a fluoridation hearing is held in the Summit County Court of Common Pleas in February. In May, Common Pleas Judge Robert Cook rules that: "Only the legislative body has power to order fluoridation; that no finding was ever made by the Health Commission that fluoridation was necessary for the general health of the community."

The health department begins to work with the Akron Public Schools, along with the Summit County Medical Society and the Akron Dental Society, on an Anti-Poverty Program. The need for maternal and child health programming is discussed and Dr. Morley is instructed to investigate all possibilities for such a program. The application is dropped due to the lack of

Economic Opportunity Act funds. In November, the Summit County Medical Society proposes to act as contracting agency in providing child day care centers for 210 pre-kindergarten children in Twinsburg, Barberton and Akron.

Land is finally acquired for the new health department building that is now estimated to cost $1,650,000. Mayor Erickson requests the transfer of the Housing Inspection Program from the building department to the health department. H.D. ordinance 2-1965 creates and establishes positions within the health department to conform to Civil Service recommendations and classifications. One hundred-twenty positions are created.

New Health Center Building is Finally a Reality

It's no secret in 1966, but apparently very few Akronites know that the new City Health Building now being erected at 177 South Broadway will face the railroad tracks, as part of the City's University Concourse Urban Renewal project. If Federal authorities approve the project, a concourse would be constructed over the railroad tracks to link downtown Akron with the University. The Health Building is one of several structures planned to surround the concourse. When completed, the 44,000 square foot building with an auditorium that will seat 264, will become known as the Morley Health Center.

In early March 1966, the health department receives a $43,060 grant to conduct a limited type of school health and family health education services to 750 four-year-olds. The budget for 1966 is $577,313, with no increase in appropriations. In 1967, Noble Sherrard is appointed Deputy Director of the Health Department, and special TB testing for first grade pupils begins.

By 1968, the budget grows to $1,087,796.The measles vaccine is added to the list of immunizations required for initial entry to school. City employees strike from May 1 - 8. A resolution to support adding fluorides to the drinking water is accepted and a fluoride referendum is passed in November.

With the new health building still under construction, Dr. Morley requests a receptionist for the new building. The health department acquires grants in cervical cancer detection, cardiovascular disease prevention, medical x-ray program, and TB testing. The Summit County Comprehensive Health Planning Agency established to develop an overall health plan for the community, is offered space on the third floor of the new health building. Discussion on having a Citizen's Advisory Committee to the Nursing Division is conducted but is not begun until 1970.

A $542,495 grant for rat control was awarded in 1969, and an open house for the new health building is scheduled for November 2, 1969. Shortly after the opening of the building, a Centrex direct dial system is installed, to avoid calls going through the Municipal Hall switchboard, but no receptionist is hired.

A community-wide rubella inoculation program was initiated due to the expected epidemic; 1,000 employees received the influenza vaccine.

The 70's Changes

The first group of eighteen student nurses begin public health training in cooperation with the health department and the University of Akron, School of Nursing. The salary for a Health Educator position is approved and Dr. Morley's top priorities are health education and to re-establish the school health program. A cooperative program with the Akron Public Schools to use the new dental clinic at the health department is established and in use three days per week. There are eleven Well Child conferences held weekly in various areas of the city, venereal disease clinics, a TB clinic in cooperation with Edwin Shaw, and a central immunization clinic now in operation.

The rubella vaccination program is extended to include 20,00 additional kindergarten and second grade students. The possibility of a Health Museum in the new health center is being explored and has the support of the Akron Junior League who provided $35,000. The Akron-Barberton Air Pollution Control Agency expands to include Summit County in 1970. A Family Planning Service Clinic for welfare families and medically indigent begins in the health department with the cooperation of the local Planned Parenthood Association.

Dr. Morley is offered a clinical appointment to become a faculty member in the Ohio State University, College of Medicine. The Health Museum is formed as a non-profit corporation in September, 1970, and the Director of Health will operate the museum, while the Health Museum Board will set policy. The museum will be known as the Akron Health Education Center. The health department's first Public Health Educator, Joe Dick, is hired December 16, 1970 to oversee the new health museum. Family Living, Human Growth, Drugs and Ecology are programs being considered for the new Health Education Center.

In 1972, with the E.J. Thomas Performing Arts Center under construction, the Health Commission reviews the University Concourse Project concept that surfaced when the Morley Health Building was being constructed.

HUD turned down Akron's 4-year urban renewal opportunity for the concourse; in the same year, the Presidential Wage Freeze eliminates any annual salary increment for City employees; the budget for AHD is $1,421,040, with 21 less positions appropriated than the year before. However, there is expansion in the Alcohol division; the Regional Alcohol Council is established. The new Health Education Center is to open on April 4, and a formal open house scheduled for June 8. A $2,500 grant request for funds to replace borrowed equipment now being used in the new Health Education Center is funded.

Space is already becoming a problem and Dr. Morley recommends that the Akron Metropolitan Area Transportation Study, a division of the Akron Planning Department, move out of their third floor offices.

A nutritional program for mothers and children in low-income families, sponsored by the United Services For All and Ross Labs, is held in the Child Health Services Clinic on Wooster Ave. This later becomes known as the WIC program. A prenatal clinic is established in the health department.

In 1974, it was recommended that the Housing and Environmental divisions be combined; an Urban Rat Control grant is approved, and an application is made for a Lead Poisoning Detection program. Dr. Morley plans to retire at the end of the year.

By early 1975, the budget has grown to $2,460,478; the health department serves on/or works with the Health Commission, Housing Appeals Board, Air Pollution Control Advisory Committee, Trailer Park Board of Investigators, and Pest Control Board.

Dr. Morley resigns on January 31, 1975 and Noble Sherrard is appointed as "Interim" Director on February 1, 1975, and serves until January 1976. Dr. Morley goes to Brown University to interview Dr. Allen Rosenberg for the health director position. Meanwhile, a letter is received from the Provost of NEOUCOM expressing an interest in using the health department facilities for teaching public health to med students; Miss Lillie Steadman, Director of Public Nursing (since 1962), retires and is replaced by Miss Vernie McGavick.

Mr. Sherrard receives several requests for smoking bans in public places, and space issues continue to be a problem at the health department. The Civil Service Commission acts upon a request from the Health Commission to reallocate the class of Director of Public Health from a pay range of 45 to 48, and expresses their willingness to work toward a cooperative arrangement between NEOUCOM and the health department for mutual exchange of services, facilities and manpower. NEOUCOM expresses the desire that the new director have experience teaching medical students.

From March through September, interviews continue for the director's position. Other candidates include: Dr. Basil Delta, Dr. Leroy Dalheim, Dr. Paul Leadley, Dr. Thomas Halpin, Dr. Anthony Mustalish, Dr. Brett Lazer and Dr. C William Keck, who was first interviewed in June and returned in September for an additional interview. Dr. Keck is offered the job and accepts. He is to begin in January 1976.

Meanwhile, Noble Sherrard reports that the Planning Department is studying the cost of the City's purchase and remodeling of a warehouse at 149-154 South

Broadway. This would give the health department an additional 20,000 square feet, of which 10,000 square feet would be for the Health Education Center.

All City employees receive a 7.3% raise, retroactive to April 1975, and the health department has a fleet of 92 cars. An Ambulance Ordinance is passed by City Council, and Dr. Keck will serve as a member of the Mayor's Advisory Board in January. The budget for 1976 is $2,452,867, that is later cut by $52,000, eliminating 5 positions. This also leaves four fewer positions in nursing and nine fewer in Environmental that had not been previously filled.

Remodeling and upgrading of the health museum, now called the Health Education Center, is completed in time for public and parochial school students to attend classes.

In the fall, a limited Childhood Lead-Based Paint Poisoning Prevention program is a possibility in the Model Cities area, and an alcoholism detox center is being considered with the Regional Alcoholism Council. A press conference is scheduled for December 5, 1975, to introduce Dr. Keck.

Dr C. William Keck, became the 9th Director of Health on January 12, 1976. In addition to a full time position with the Akron Health Department, Dr. Keck is expected to spend one day a week working at the new Northeastern Ohio Universities College of Medicine. A $6,000 grant from the Akron Community Trust was awarded for expansion of the Human Growth and Development program, with plans for programs to be taken out into the community. A $4,000 ODH grant for four Venereal Disease Workshops for teachers is to be coordinated by Joe Dick, the department's Health Educator.

Dr. Keck initiates a new infectious disease reporting system to enhance coordination and response to outbreaks of communicable diseases.

A proposal for a Health Systems Agency is being submitted to Health Education & Welfare (HEW) without a representative from Akron, and Akron represents 40% of the area involved.

However, in September, Dr. Keck is appointed to a 2-year term as a Trustee with the Health Systems Agency of Summit-Portage County and serves on the Board of the Statewide Health Coordinating Council.

In June of 1976, Mayor Ballard develops and mandates a program called Management By Objectives (MBO) for all departments in the City. The first University of Akron med students are doing Summer Practicums in Communicable Disease at the health department. The posting of choke-saving techniques is a requirement in all restaurants; the health department learns that 56 of their fleet of 92 cars are to be permanently removed from service.

Miss McGavick resigns in October and Miss Lucille Maher becomes Director of Public Nursing on January 10, 1977. A Mission Statement for the health department and a Community Diagnosis are about to become a reality. The Swine influenza vaccine is given to 60% of the elderly and high risk individuals; to another 37% of the elderly in Summit County by the end of December.

The Division of Environmental Health is reorganized to include the Air Pollution Control Division; a Childhood Lead-Based Paint Poisoning Prevention program and a Hypertension Control program are funded through grants. The budget for 1977 is reduced to $2,163,030.

In mid 1977, an educational leave policy is established and a prenatal clinic at Summit Lake begins utilizing obstetrical residents from area hospitals. A sliding fee scale for reimbursement of health department services is adopted, and creation of a Workhouse Health Care program is initiated. Akron has a hepatitis outbreak that is eventually traced to a day care center, and CPR training is offered to City employees.

Dr. Peter Rogers becomes the new Director of Medical Services on July 3, 1978, replacing Dr. J. Paul Sauvageot, who passed away the previous October. An Executive Director is hired for the Health Education Center using a grant from the Beacon Journal Fund, and a School Immunization Program turns out to be quite a success.

By the end of the decade, a data processing system is developed in Vital Statistics; a nutrition pilot program, "Thin Habits," is initiated at the Summit Lake facility; and plans are underway for the expansion of the health department.

The 1980's Budget Cuts and Internal Growth

A $118,397 excavating contract for the Morley Health parking deck is awarded in March 1980, as part of the health department expansion program. Ten-thousand community hypertension screenings in Acme-Click stores are accomplished as a collaborative effort of the Akron, Barberton and Summit County health departments.

The City asked for changes in the qualifications of the Director of Health in May of 1980 and make it an election issue that is defeated.

The health department is awarded a Risk Reduction grant to provide smoking and alcohol abuse programs in the schools. The pilot schools include Goodyear Junior High and East High School. The first Health Education Specialists are hired in March and June of 1981.

The first issue of a health department newsletter called Akron Health is distributed to the Health Commission, published in the Summit County Medical Society bulletin; and provided to the media. Bessie Petroff resigns as Health Commission secretary after 32 years of service and Sue Gesquiere(Phillips) replaces her.

The health department suffers drastic budget cuts during this time and a fee collection for services is initiated to help offset the budget cuts. Layoffs occur in 1982 and the department becomes a participant in the Child & Family Health Services and Prevention Services block grants.

By the mid 1980's, Right To Know legislation is implemented and the Community Diagnosis becomes a reality. In April 1985, the Health Commission is asked to look at a smoking ban in public places, and the health department clinic becomes an HIV counseling and testing site. In late 1985, the Division of Air Pollution Control changes their name to the Akron Regional Air Quality Management District, the Division of Vital

Statistics changes to Health Data Management; and the Division of Alcohol changes to the Counseling Services and Alcoholism Division.

Joe Dick retires as Public Health Educator and Jon Jenney is hired to replace him. In 1986, the WIC staff is transferred to Civil Service.

The newly formed Tobacco Initiative begins meetings that culminate in a Community Diagnostic Conference in April 1987. Noble Sherrard retires in 1986 with 35 years service and is replaced by Gregory Ervin. The NorthEast Ohio Task Force on AIDS (NEOTFA) is formed by the health department.

Computerization of the department begins in mid- 1986. A smoking policy for AHD employees is initiated, followed by a smoke-free policy in 1988. An old 1960 condom law which prohibits the sale of condoms in the city is repealed.

A Clean Indoor Air Act is implemented and the Food & Sanitation Division changes its name to the Environmental Health Division.

Clinic remodeling begins in 1988 and the grand opening occurs in May 1989. A Health Education Committee is formed in February 1987, with representatives from each of the divisions within the health department, to provide educational information and address issues within the health department. A new Health Education Division is growing steadily by the end of the decade.

The 90's Decade of Accomplishments

The 1990 budget is $4.2 million in general funds and $3 million in grant dollars. Dr. Keck serves as President-Elect, President, and Past-President of the American Public Health Association, and receives the first Albert B. Sabin Distinguished Public Health Service Award on Public Health Day in January 1991, in Columbus, OH.

The APEX-PH assessment tool becomes thoroughly entrenched within the health department in 1991, and the Health Education Center addition becomes a reality when the Mall/Plaza Skywalk restoration occurs. A classroom in the new addition is named in honor of Dr. Keck.

The WIC clinic moves to a new North Hill site in April 1992 and the Health Education Division moves into the former WIC space. Tattoo Parlor regulations go into effect in April 1992. Both a Drug Prevention Specialist III and a Health Education Specialist III classification become realities by mid-year.

By the end of 1992, the Health Education Committee is reactivated and changes its name to the IntraDepartmental Advisory Committee (IDAC). The first edition of an employee newsletter, Health Connections is published in January 1993 and an annual employee Holiday Party begins in 1993. Monthly employee staff meetings become the responsibility of the committee, as well as safety and marketing suggestions. Additional signage is added to help health department clients find their way throughout the building.

An ordinance banning smoking in all city buildings, parking decks, and vehicles is passed in March 1993. Plans begin for a regional School of Public Health.

A Five-Year Plan is developed as part of Phase One of APEX and a Community Leadership Panel is formed in April 1994, as Phase Two. The Community Leadership Panel distributes its report, "Healthy Summit 2000," in July, 1996. This prioritized list of Summit County's major public health problems is converted to a community health improvement plan in 1998. The Health Education Division changes its name to the Division of Health Promotion.

A federally qualified community health center, Akron Community Health Resources Center (ACHR) is funded in 1994, and opens in 1995. The HEALTHWISE Center, a collaborative effort of the Akron, Barberton, and Summit County health departments, opens at Rolling Acres Mall the same year. Akron is awarded a Breast & Cervical Cancer Grant (Pink Ribbon Project) that services Summit, Stark, Portage, and Wayne counties.

The Teaching Health Department concept is in the developmental stages with Northeastern Ohio Universities College of Medicine (NEOUCOM), and a possible merger among the health departments is again being considered when Dr. Martha Nelson retires as Health Commissioner of the Summit County Health

Department. It is again decided not to merge; thus, the three health departments (Akron, Barberton and Summit County) continue to provide services that include collaborative efforts throughout Summit County. Medicaid managed care is initiated in Ohio.

The budget for 1995 is $10,387,000 and grows to $11,167,000 by 1997. There is a Cyclospora outbreak in June 1996. The NorthEast Ohio Task Force on AIDS (NEOTFA) combines with The AIDS Housing Network and becomes the Community AIDS Network (CAN) in 1997.

The federally qualified health center (ACHR) that opened in the Arlington Street area becomes a partnership between ACHR, the hospitals, and AHD. ACHR receives a $100,000 grant from the GAR Foundation, $200,000 grant from Kaiser, and federal funding of $350,000, per year, for three years. In early 1999, remodeling begins on a new and larger facility to house the growing ACHR Center.

A $2.5 million grant from the federal Housing and Urban Development (HUD) agency to reduce lead-based paint hazards (abatement) in Akron homes is awarded to the health department's Housing Division in 1998, as a collaborative effort between the Health Promotion and Nursing Divisions, and a score of community partners, such as East Akron Neighborhood Development Corporation , Akron Metropolitan Housing Authority, Greater Westside Council of Block Clubs, and NEOUCOM. Screening of young children with possible exposure to lead-based paint was extended in 1999 to include daycares; and cleaning of homes containing lead paint, and education and awareness campaigns were initiated earlier through The Healthy Homes Project, funded by a grant from the Centers for Disease Control (CDC).

Dr. Keck co-edits a new book entitled Principles of Public Health Practice, and serves as President of the Council on Education for Public Health, the national accrediting body for schools of public health and master of public health training programs. He also serves as a member and then Chair of the Council on Linkages. This council was established to improve linkages between public health practice sites and academia. An important focus of the council is the improvement of public health worker competencies and the stimulation of a CDC project to develop guidelines for community services similar to the Clinical Preventive Services Guidelines. The CDC project will issue its first report in the year 2000.

Dr. Keck is one of six people editing the contents of a public health encyclopedia that will take three to four years, or until 2002, to complete.

The budget for 1998 was $13,807,375, and rises to $14,591,730 in 1999 with about 192 employees that are housed either at the health department or at CitiCenter, Canal Square, Cascade Plaza or the health department satellite at North Hill. The Divisions and Departments include: Administration, Laboratory, Housing, Health Promotion, Environmental Health, Nursing & WIC, Health Data Management, Akron Regional Air Quality Management District, Counseling Services & Alcoholism (Drug Prevention); and a Public Health Nutritionist, Disease Control Medical Officer,

Accounts Analyst, and Director and Deputy Director of Health. There are five members who serve on the Health Commission that meet monthly at the health department.

The population of Akron, founded in 1825, went from 69,000 to 210,00 between 1910 to 1920. By the mid 20's the population was in the 300,000's, and in 1999, stands at 223,019 with a city size of 62 square miles. More interesting facts about Akron can be found on the new City of Akron website www.ci.akron.oh.

Implementation of the mandated SYNAR Amendment, a federal law requiring ongoing inspections of tobacco vendors to determine whether they are obeying the state and local youth access laws making it illegal to sell cigarettes or other tobacco products to persons under 18 years of age, began in 1994 with a 50% non-compliance rate. By 1999, the countywide non-compliance rate had improved to 15.9%. Other issues addressed in 1999 included rabies control, tattoo regulations, and service fee changes.

The MPH degree program, a collaborative effort between Northeastern Ohio Universities College of Medicine, Cleveland State University, Youngstown State University, Kent State University and the University of Akron has been successfully established and accepts its first 20 students in August of 1999.

ACHR moves into their new and larger building in the Arlington Plaza in August 1999, and WIC moves into the original ACHR site in December 1999.

This concludes the 118-year public history of the Akron Health Department, from its founding in 1881 through 1999.

HEALTH BOARD ADOPTS "BEHAVIOR CODE"
Saturday, April 2, 1955

CITY FILLS MEDIC SERVICES POSITION
June 9, 1962

DISCARD ARMORY SITE FOR HEALTH BUILDING
October 24, 1964

AGREE ON HEALTH CENTER AS CITY-COUNTY PROJECT
December 18, 1963

COUNTY REJECTS HEALTH BUILDING PLAN
July 8, 1964

HEALTH BUILDING LOOKS AT THE TRACKS
November 11, 1966

AKRON'S DOCTOR...C. WILLIAM KECK'S IMPACT FAR SURPASSES OFFICIAL DUTIES
August 3, 1999