Maryland Manual 1996-1997 Department of Health & Mental Hygiene / 311

Health in colonial Maryland was precarious, but if a settler survived exposure to various malarial fevers,
the settler 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 some 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 port grew in prominence, so too did the threat of epidemics increase
Little was known about the source or treatment of the diseases, but clearly they arrived by ship

The -Role of Baltimore City Epidemics played a role in the formation of public health agencies in Maryland
The first health office m the State 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 mto 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 culpnt Baltimore doctors,
however, 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 In 1809, the General Assembly
authorized a lottery 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 quarantining
ships, transporting paupers to the almshouse, burying paupers, cleaning streets, removing snow and ice, and
vaccinating the pubhc against smallpox The Department kept mortality tables showing age and cause of death,
ran a hospital for contagious diseases to which sufferers could be forcibly removed, abated nuisances, such as
stagnant ponds, and maintained public fountains and sewers In 1875, it began registering births and deaths,
functions the State, despite repeated efforts, did not perform adequately until 1898

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 to 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 1807 and, even after 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 unhealthmess 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, mvesugated nuisances m mining towns, analyzed pubhc drinking water in
Baltimore City, and examined conditions in county jails and almshouses The Board additionally had lectured to
citizens on public hygiene, collected information on the prevalence of malanal diseases, mvesugated a smallpox
epidemic in Cumberland, and evaluated the deletenous effects of Jones Falls and the Basin on health m Baltimore
City The Board lamented the lack of any local health structure, which made it difficult to acquire information about
pubhc health Also, although towns might call in the Board v, hen health problems arose, the Board had no authonty
to mitigate nuisances The Board's report showed that the only two significant pubhc health laws on the books were
failing dismally The first had created the State Vaccme Agency, and required smallpox vaccination pnor to enrollment
in school (Chapter 269, Acts of 1864) Doctors were supposed to vaccinate infants and other patients m their practice,
and the law provided for vaccination of those unable to pay The smallpox epidemic in Cumberland, howe\ cr, made
it clear that vaccmanon was not widespread in 1876 The second was the long-advocated law tor registration of
births, deaths, and mamages, 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 ode of Superintendent of Vital Statistics Beginning in
1894, Balnmore City physicians from the Johns Hopkins Hospital led a public health movement calling for
sanitary conditions m food processing from "stable to table " They worked for laws to pasteunze milk, assure
pure food, and prevent the ancient scourge of tuberculosis The State Board of Health benefited from this
pubhc interest, and in 1910 was reformed as the State Department of Health, overseeing five bureaus with