Toledo’s growth as an industrial city in the years following the Civil War produced a population boom that crowded more people into a city that was, at times, unprepared.  With the acceptance of the germ theory came the realization that public health must be a concern of government.  All citizens deserved clean water, safe foods, protection against communicable disease, and basic medical care. 
           The most destitute ill citizens were sent to the Lucas County Poor Farm and Infirmary beginning in the 1850s, including those suffering from mental illness.  City and county boards of health eventually took over responsibilities for maintaining birth and death records, controlling and preventing diseases, protecting maternal and child health, overseeing sanitation, regulating the safe handling of food, and controlling rodents.  The city struggled to maintain a safe water supply, especially when citizens failed to empty privy vaults, which contaminated groundwater.  Safe milk was also an issue, and in 1903 one in 20 deaths of children in Toledo was traced to the product.  Toledo also had the highest maternal mortality rates in the midwest between 1919 and 1921.
            But it was three public health issues in particular that plagued the city in the first half of the 20th century:  tuberculosis, diphtheria, and syphilis. 
            Attempts to control tuberculosis began in 1901 with the Thalian Tuberculosis Society.  In 1924, a new organization called the Toledo Public Health Association was created, and focused most of its efforts on preventing the disease in children.  It operated a “Fresh Air Camp” in Michigan during the summer for poor children, and provided free milk through the schools.  The Depression increased the circumstances that led to tuberculosis transmission, but it also provided federal money to build a tuberculosis hospital, which opened in 1937.  Fortunately, new detection methods using X-ray machines and new drugs helped to bring down death rates, although there were still 1500 cases in Toledo in 1965.
            Diphtheria was also rampant in Toledo in the late 19th and early 20th centuries.  A vaccine developed in the 1920s dramatically cut the number of cases, although the Depression, and limited access to health care it created, led to another epidemic of the disease in 1929.  By 1935, there was only one death in the city of the disease. 
            Harder to control was syphilis, much of it spread through prostitution.  In 1918, on the eve of World War I, it was discovered that many Toledo men were ineligible to serve their country because of infection.  In 1934, Toledo’s mayor ordered a study of prostitution so that police could better control the vice and help to control the spread of syphilis.  A concerted effort by Toledo doctors to detect the disease in the 1940s and the use of penicillin to treat it in the 1950s led to a dramatic drop in the number of cases from 2000 in 1953 to just under 300 in 1959.