The first comprehensive view into
the conditions of Maryland almshouses came in a groundbreaking 1877 report
by Dr. C. William Chancellor, the Secretary of the State Board of Health.
Chancellor personally visited each Maryland almshouse and jail and wrote
up a scathing report condemning their condition and administration.
"It is painful to report the shocking condition in which many of the public
institutions were found, and it is difficult to conceive that anything
worse ever existed in a civilized country". He described numerous
examples of mentally ill patients being held in unnecessary restraints,
inadequately fed, and improperly housed. In regard to all such institutions,
Chancellor concluded: "For the insane there is written over the portal
of the almshouse as those over the infernal regions, 'Whoever enters here
leaves hope behind'".
The responsibility for the regular inspection
of almshouses eventually passed to the Maryland State Lunacy Commission.
Founded in 1886, the Lunacy Commission possessed nominal oversight over
all the mentally ill held in institutions throughout the state. As part
of its charge, the commission secretary made visits to state hospitals,
almshouses, asylums and jails every six months and reported his findings
to the governor. As first organized, this body had little power to
effect any change. Public shaming appeared to be the only tool
at hand, and the commission used it in the pages of its annual report.
But few people ever saw the contents of these publications. The early
reports featured no illustrations.
The Lunacy Commission reports, though,
often contained very graphic descriptions. They uniformly decried
the use of almshouses for the reception and housing of the insane.
Since most almshouses lacked any form of recreation, employment, or therapy,
the mentally impaired, even those not held in some form of physical restraint,
whiled away the hours seated on benches or aimlessly roamed the halls and
the grounds. Conditions varied in different county almshouse, but
generally speaking the daily administration of most almshouses could be
described as loose. Superintendents, often local farmers appointed
through political influence, sometimes changed yearly. Attendants
had no training in the care of the mentally ill, which meant that physical
restraints often were used on patients, even though some Maryland medical
professionals had disapproved of the practice since the 1870s. In
at least one case improperly applied restraints led to the death of a patient
from gangrenous hands. Sometimes attendants used their fists to subdue
the demented or unruly. It appears that senile elderly were merely
locked in cell-like rooms to keep them from wandering away. Reports
speak of the "almshouse diet," a subsistence diet consisting mostly of
hominy or oatmeal as the daily fare.
Another term, "almshouse odor," can easily be
imagined as being an oppressive presence in a building that lacked indoor
plumbing or bathing facilities, and regular, daily care for the incontinent
or chronically ill population. The deceased sometimes lay on their
beds for several days before the undertaker made his appearance.
Some almshouse structures dated from the eighteenth century; others, reserved
for African Americans, appeared to be nothing more than old, drafty slave
Worcester County Almshouse, 1908
Almost every Lunacy Commission annual report calls
for the building of a proper state facility for the African American insane.
A string of commission secretaries recognized that the almshouse housing
reserved for people of color almost always was of poorer condition than
that for whites, usually "a dilapidated cabin, more or less clean, and
always overcrowded." Speaking of a western Maryland county facility,
one secretary thought that "the beasts of the field are taken better care
of than the poor negroes." Race segregated facilities existed in
many counties, though for want of funding, certain counties breeched this
unwritten law, allowing the races to co-habitate.