books were failing dismally. The first had created the State Vaccine Agency, and required smallpox
vaccination prior to enrollment in school (Chapter 269, Acts of 1864). Doctors were supposed to vaccinate
infants and other patients in their practice, and the law provided for vaccination of those unable to pay,
but the smallpox epidemic in Cumberland made it clear that vaccination was not widespread in 1876. The
second was the long-advocated law for registration of births, deaths, and marriages, which were to be
reported to the Secretary of the Senate by the clerks of court (Chapter 130, Acts of 1865). Vital statistics
were a major concern of the new State Board of Health in 1876 since few statistics had been forthcoming
under the 1865 law.

In 1880, the State Board was reorganized, empowered to establish local boards and deal with emergencies.
The Secretary of the Board acquired the additional title of Superintendent of Vital Statistics. Beginning in 1894,
Baltimore City physicians from the Johns Hopkins Hospital led a public health movement calling for sanitary
conditions in food processing from "stable to table. "They worked for laws to pasteurize milk, assure pure food,
and prevent the ancient scourge of tuberculosis. The State Board of Health benefited from this public interest,
and in 1910 was reformed as the State Department of Health, overseeing five bureaus with clearly defined
duties: Bureau of Communicable Diseases; Bureau of Bacteriology; Bureau of Chemistry; Bureau of Sanitary
Engineering; and Bureau of Vital Statistics (Chapter 560, Acts of 1910).

In 1939, the Medical and Chirurgical Faculty urged the State Planning Commission to look into the
availability of health care for the poor. The specter of socialized medicine loomed, and physicians were
interested in developing an alternative plan. The General Assembly enacted a law in 1945 to provide health
services to the indigent and medically indigent of the counties and later extended the plan to Baltimore
City. The 1945 law also authorized the Department of Health to operate State-owned hospitals for persons
with chronic diseases (Chapter 91, Acts of 1945).

Department of Mental Health. Maryland had assumed some responsibility for the fate of its insane by
1797 when the Maryland Hospital in Baltimore City was established as "a hospital for the relief of indigent
sick persons, and for the reception and care of lunatics" (Chapter 102, Acts of 1797). Care and custody
of the mentally ill suffered from the prevailing belief that insanity was not curable. Families kept their insane
members at home; those who were violent could be locked up in the local jail or almshouse. The legislature
perpetually was besieged with petitions for relief, and many private acts authorized a county to levy a
minimal amount to support an insane or feeble-minded individual at home. Early in the nineteenth century,
the so-called "moral" method for the care of the insane came into vogue, and physicians claimed that early
treatment by that method made insanity more curable than most diseases. The Maryland Hospital seems
to have used the method. In 1817 the county levy courts were authorized to commit their insane to the
Maryland Hospital upon payment by the county of $100 per year (Chapter 78, Acts of 1817). Since it
was cheaper to keep the mentally ill chained in the county almshouse with no care at all, probably the
most difficult cases, those least susceptible to a cure, were sent to the Maryland Hospital. It became
primarily a hospital for the insane in 1838 though it lacked sufficient space.

Dorothea Dix, outspoken advocate for the mentally ill, pointed out in her 1852 address to the Maryland
legislature that the 1850 census showed 946 insane and idiot inhabitants of the State. Of these, 133 were
in the Maryland Hospital, 74 in Mount Hope Hospital, 123 in the Baltimore Almshouse, and 8 in the
Maryland Penitentiary, leaving 598 either in private homes, county jails, or almshouses. Only those in the
Maryland or Mount Hope Hospitals were undergoing curative treatment. The General Assembly did
appropriate funds that year for a new hospital for the insane with capacity for 200 to 250 patients (Chapter
302, Acts of 1852), but by 1872 it was still under construction. Even when patients from the old Maryland
Hospital were moved into the new hospital, the State needed additional accommodations and in 1894
began the Second Hospital for the Insane of the State of Maryland (Chapter 231, Acts of 1894).

For most of the nineteenth century, feeble-minded, idiotic and alcoholic citizens often shared the fate
of the insane, locked in local jails or almshouses. The Board of Directors for the Maryland Inebriate Asylum
reported in 1864 that they were still without a building but some inebriated persons were being treated
in a lunatic asylum (Maryland Documents A, 1865). In 1883, the Medical and Chirurgical Faculty
petitioned the legislature on behalf of the feeble-minded and, in 1888, the Asylum and Training School
for the Feeble-Minded was authorized (Chapter 183, Acts of 1888).

At the turn of the century, the private sector was ahead of the State in providing space for the mentally
ill, and county jails and almshouses served as a last resort. To safeguard legal rights and protect against
abuses, the legislature created the Lunacy Commission in 1886 (Chapter 487, Acts of 1886). The
Commission was mandated to visit and inspect all places, public or private, where insane persons were
kept. Duties of the Commission were transferred to a Board of Mental Hygiene in 1922, and the State's
five mental institutions were placed under the Department ofWelfare (Chapter 29, Acts of 1922). Wartime
austerity cut back spending on State institutions, and public concern after the war about treatment of the