In the early 1890s, a movement
initiated by the Lunacy Commisssion and carried forward by the Medical-Chirurgical
Faculty, the state medical professional society, promoted improved care
for the mentally ill poor. Inspired by New York State's recent passage
of a state care act for the insane, the first in the nation, a few Marylanders
recognized their state's responsibility for the proper housing and care
of the indigent insane. In what could be characterized as a quiet
campaign engineered by Dr. George J. Preston, Secretary of the Lunacy Commission,
and supported by the medical community, legislation was passed in 1904
whereby the state would take over the care of it indigent insane on January
1, 1909. The State Care Act of 1904 faced no open opposition in the
House or Senate with both houses unanimously supporting the passage of
the bill. The transfer of mentally impaired county almshouse and
asylum residents to state hospitals would be made as soon as practical.
The law was never enacted. Maryland simply
lacked the adequate number of spaces within its facilities to house all
of its insane poor, and formidable competition for new hospital construction
funding existed. The building of good state roads in the interest
of economic development was a higher priority for state politicians.
In his opening message to the General Assembly in January 1908, Governor
Edwin Warfield remarked that "I doubt the feasibility of the State assuming
the care and maintenance of all her dependent insane [in 1909], because
it will not have adequate buildings and facilities for doing so, and the
State Treasury will not be in a condition to bear the burden." The
State Care Act was repealed in that year and immediately reinstated, moving
the start date two years forward to January 1, 1911. According to
Governor Warfield himself opposed any action
on the state care issue during his tenure.
Despite the postponement of
state care, 1908 was to be a pivotal year for Maryland's indigent mentally
impaired. The inauguration of a new, sympathetic governor and the
reorganization of the Lunacy Commission heralded a reinvigorated campaign
that sought to bring state care before the public eye. Johns Hopkins
Hospital's Dr. William E. Welch worked behind that scenes to recruit new
members for the commission, replacing four of the five members by August.
Welch, as president of the State Board of Health and a health care activist,
had Governor Crothers tap Dr. Hugh Young for the position of president.
Young, a urologist by training, had assisted in the successful passage
of legislation authorizing Maryland's first tuberculosis hospital.
Though not trained in psychiatry, Young's humanitarian interest coupled
with his influential contacts proved invaluable to the Commission.
Commission Secretary, Dr. Arthur P. Herring, served as the key administrator
over the daily functions of the body. Herring, a West Virginian by
birth, earned his medical degree in 1896 from the Baltimore Medical College,
where he then served as a faculty member. Herring acted as the visiting
neurologist and psychiatrist at the Bay View Asylum, Baltimore City's almshouse.
Herring possessed the medical training and intimate knowledge of the almshouse
setting to speak with authority before both politicians and the public.
The other three appointed members of the commission included Dr. Henry
Hurd, the former superintendent of the Pontiac State Hospital in Michigan,
Dr. R. Markley Black, and Dr. John D. Blake. Governor Crothers and
Isaac Lobe Straus, Maryland's Attorney General, served as ex officio members.
The reconstituted commission pursued a new, more
strategy to appealed directly to the people of
Maryland. The members decided to expose the almshouse conditions
and launch a campaign to enlist the support of Maryland's medical community
and influential citizens throughout the counties. "Public sympathy,
both professional and lay, is necessary to force the Legislature to the
realization of the fact that they can no longer 'play politics' with such
an important matter, but that they must declare themselves one way or another,"
observed the Maryland Medical Journal. Thirty years of reports
describing, sometimes in excruciating detail, the horrific county almshouse
and asylum scenes had failed to generate any true political advocacy on
behalf of the pauper insane. As the Journal noted: "If the
Lunacy Commission and the medical profession are not fully prepared to
face this issue with determination to win and with the full assurance that
they are supported by the intelligent laity, then the probabilities are
that there will be another delay or possibly the bill will be repealed."
Rather than continuing to rely on the good graces of politicians, the commission
would use the camera in its fight for mental health care reform.
County Almshouse residents, 1908
During the early twentieth century,
a movement arose across America broadly designed to ameliorate long-standing
social problems. A product of a more scientific approach to philanthropy
engendered by post-Civil War reformers, the Progressive Movement, as it
came to be known, enlisted specialized studies and formalized surveys to
systematically understand the basis of community ills. Areas of particular
interest included the housing of the poor, conditions in factories, child
labor and mental health care reform. Progressives hoped to draw public
attention of their reports, but for the most part they sought to convince
state and national politicians to enact legislation as the means to bring
about societal change. In essence, they solicited the legal and financial
support of government in their crusade for better conditions.
Progressive reformers used documentary photographs
in their campaigns for both educational and dramatic effect. The
pioneering work of Jacob Riis, a Danish-born columnist for the New York
Tribune who sought to expose the poor housing conditions in New York
City, is often cited as the model. Riis took his camera into the
dank basements and cramped alleyways that characterized the homes of immigrants.
With his images made into lantern slides, the journalist revealed his findings
through illustrated lectures to church groups and organizations.
His work brought the needed public exposure and the eventual and necessary
political support that ultimately brought about changes in the laws.
Maryland reformers also employed photographs to
publicize their campaigns. The camera had been used extensively and
successfully in exposing substandard housing conditions in 1907 Baltimore.
The Charity Organization Society and the Association for the Improvement
of the Condition of the Poor published a ninety-six page report that uncovered
the unsanitary conditions present in the rented dwellings of the city's
immigrant and poor populations. Janet E. Kemp compiled surveys of
the residents in three Baltimore neighborhood that ringed the harbor. Twenty-nine
images of dark alleyways and cellar apartments, often incorporating children,
provided emotionally charged evidence that change was needed.
Photographs were also important role in the community
health education campaign designed to combat the spread of tuberculosis.
The Maryland Tuberculosis Commission, in cooperation with several private
groups, sought to heighten public awareness about a disease that was reaching
epidemic proportions within the state. At its January 25, 1904, public
health exhibition held in McCoy Hall on the Johns Hopkins University campus,
the Tuberculosis Commission used images from a northwest Baltimore neighborhood
known as the "Lung Block" to illustrate the conditions that led to the
transmission of tuberculosis. A series of interiors from local sweatshops
and shots of New York tenements were also featured. An allied group
in this campaign, the Maryland Association for the Prevention and Relief
of Tuberculosis, delivered illustrated lectures using lantern slides.