286/Maryland Manual

ORIGIN & FUNCTIONS

Although the Department of Health and Mental Hygiene was created in 1969, its antecedent agencies
originated in the nineteenth century Certain functions now overseen by the Department, however, were
performed even earlier: the first recorded autopsy (possibly the first in America) occurred in Maryland in
1637; regulation of chirurgeons' fees began in 1640; registration of births, deaths, and marriages was
required in 1650; and the first official quarantine was instituted in 1694.

The multiple functions of the Department of Health and Mental Hygiene began separately and
developed at different rates, according to the State's recognition of a need to safeguard public health, the
perceived urgency of that need, the potential for scientific solutions, and later, federal mandates for funding
Baltimore City usually led the way due to the caliber of the City's medical professionals and the acuteness
of urban health problems. Also, the growth of Baltimore City was parallelled by the accumulation of
immense fortunes, and philanthropists often intervened to meet the urgent needs of sick, poor and insane
citizens before the State assumed these responsibilities.

Health in colonial Maryland was precarious, but if a settler survived exposure to various malarial fevers,
the seeder was likely to be healthier than his European counterpart due to better diet, less crowding, and
a cleaner environment. Epidemic diseases flourished in the squalidness of European cities where they had
become endemic and, with the growth of Atlantic seaports, Americans began to suffer too. Citizens of
seaports, Philadelphia and Charleston especially, were ravaged by recurring epidemics of smallpox and
yellow fever in the eighteenth century, while diphtheria decimated the children of New England. Maryland
was not free from the dreaded diseases, as evidenced by the legislative record showing the General Assembly
either did not meet (1747) or convened in Baltimore (1757) due to the report of smallpox in Annapolis
As Baltimore grew in prominence as a port, so too did the threat of epidemics increase. Little was known
about the source or treatment of the diseases, but clearly smallpox and yellow fever arrived by ship.

The Role of Baltimore City. Epidemics played a role in the establishment of public health agencies in
Maryland. The first health office in the Stare was created in Baltimore to cope with yellow fever epidemics
beginning in 1792 (Chapter 56, Acts of 1793), and in 1797, after Baltimore was incorporated as a city,
the State's first local health department came into being. Baltimore physicians had ample opportunity to
study yellow fever, since more than a century would elapse before the mosquito was identified as the
carrying culprit. However, Baltimore doctors were among the first to vaccinate for smallpox, and by 1802
had set up their own Institute to vaccinate the poor free of charge, a duty later assumed by the City Health
Department. The General Assembly authorized a lottery in 1809 to support the Vaccine Institute, but did
not create the State Vaccine Agency, the first statewide health agency, until 1864 (Chapter 269, Acts of
1864).

The Baltimore City Health Department performed many tasks before 1850: inspecting and quaran-
tining ships, transporting paupers to the almshouse, burying paupers, cleaning streets, removing snow
and ice, vaccinating the public against smallpox, keeping mortality tables showing age and cause of death,
running a hospital for contagious diseases to which sufferers could be forcibly removed, abating nuisances
such as stagnant ponds, and maintaining public fountains and sewers. In 1875, it began registering births
and deaths, a function the State, despite repeated efforts, did not begin to do adequately until 1898.

Development of the Department of Health. The first impetus for State involvement in the health of
Maryland citizens came from a group of physicians, mostly from Baltimore, who were chartered in 1798
by the General Assembly as the Medical and Chirurgical Faculty of Maryland (Chapter 105, Acts of 1798).
Their initial concern was ro diffuse medical knowledge and protect Marylanders from ignorant medical
practitioners and quacks, who abounded in the absence of an adequate supply of trained doctors. The law
authorized the Faculty to license doctors. The Faculty was instrumental in founding the first medical school
in the State in 18U7 and, even alter the Faculty lost its licensing power, it often petitioned the legislature
for improvements in health care facilities and regulation.

Maryland created a State board of health in 1874, the sixth state to do so (Chapter 200, Acts of 1874).
Overcoming rumors of the purported unhealthiness of certain areas of the State was seen as a necessary
boon for immigration, and accurate data was required for that purpose. At first, the State Board of Health
was primarily an advisory body with no regulatory authority In 1876, the Board reported that it had:

surveyed physicians throughout the State regarding health concerns, investigated nuisances in mining
towns, analyzed public drinking water in Baltimore City, examined conditions in county jails and
alni!>hum>es, IcLtured tu utizens un public- hygiene, t-ullei-ted infoimation on the pievalencc ofmalaiial
diseases, investigated a smallpox epidemic in Cumberland, and evaluated the deleterious effects of Jones
Falls and the Basin on health in Baltimore City The Board lamented the lack of any local health structure,
which made it difficult to acquire information about public health. Also, although towns might call in the