MARYLAND STATE DEPARTMENT OF HEALTH 
R. H. Riley, M.D. 
Director 
Data On 
BUREAU OF COMMUNICABLE DISEASES 
Presented To 
! 
MARYLAND LEGISIaTIVE COUNCIL 
For Hearing 
September 18, 1942 
At Baltimore, Maryland 
C. H. Halliday, M.D. 
Chief and Epidemiologist 
bureau of communicable dismses 
MARYLiiND STaTE DEPART TENT OF HEALTH 
2411 North Charles Street 
Baltimore, Maryland CONTENTS 
Pages 
I • Summary 
II. Bureau of Communicable Diseases 
Policies and Service 1-3 
Tuberculosis 3-6 
Typhoid Fever 6-8 
Diphtheria 8-9 
Smallpox 9 - 10 
Rabies 10 
v/Pneumonia Control Program 10-11 
Rare Communicable Diseases 11 
Poliomyelitis 11 - 12 
Venereal Diseases 12 - 13 
III. Services for Crippled Children 13 - 17 
IV. Rheumatic Fever and Heart Disease Program 17 - 19 
V. Tables, Morbidity and Mortality 
VI. Maps Showing Military Reservations and Defense Activities SUMMARY 
The Bureau of Communicable Diseases covers a broad field of work in 
which there are several activities, varying widely in character one from the 
other. 
A summary of the morbidity and mortality of a few of the communicable 
diseases shews that there has been a decided decline in these diseases. 
Tuberculosis: Reporting of tuberculosis has been generally considered good. 
During 1936, the ratio of reported cases to deaths for the counties was 2,1. 
In 1922, the morbidity rate per 100,000 population for the State as a whole 
was, for the white race 151.2, and for the colored race 312.2; in 1941 the 
rate for the whites decreased to 106,9, but for the colored increased to 
449.1. 
Tuberculosis, which until 1917, stood first on the list as a cause of deaths, 
has dropped to seventh place. The death rate per 100,000 population in 1906 
for the whites was 167.1 and for the colored 387.0, and in 1940 the rate for 
the whites had decreased to 71.3 and for the colored to 204.0. 
The per cent decrease for the period 1906-1940 was 65.7 for the total popula- 
tion; 75.1 for the whites, and 47.3 for the colored race. 
Typhoid Fever: Morbidity data is considered complete for the period 1916- 
1940. In the first mentioned year there were 2,668 cases reported, and in 
1940 only 127 cases were reported. 
The death rate per 100,000 population for the period 1916-1940 shows a 
decided decline. There were 265 deaths in 1916 and 11 deaths in 1940, giving 
a mortality rate of 19.0 in 1916 and in 1940 a rate of 0.6. Stated in 
another way, there were fewer cases in 1940 than there we re deaths in 1916. 
Diphtheria: A marked decrease in the number of cases of diphtheria has 
occurred in the period 1916-1940; in the former year thero wore 1,885 cases 
reported and in 1916 only 158 caares, a morbidity rate in 1916 of 135.2 and in 
1940 a rate of 8.6. 
The deaths from this disease have decreased from 170 in 1916 to seven in 1940. 
The per cent decrease in the number of deaths for the period was 97.9. The 
death rate per 100,000 population has decreased from 12.2 in 1916 to 0.4 in 
1940. 
There are three programs which are worthy of special mentions 
I, The Pneumonia Control Program. 
In 1939, there was appropriated $10,000 for the control of pneumonia and a 
program vms formulated for the free distribution of sulfapyridine and sulfa- 
thiazole to practicing physicians applying to County Health Officers, for the 
treatment of patients unable to purchase the same. The program also provides 
systematic laboratory tests as a means of checking any untoward effects of 
the drug, and for nursing services by the County Public Health Nurses. 
Before this program was put in operation, the State Board of Health appointed a Committee on Pneumonia to determine the method of distribution of the drugs. 
As a result of the recommendation of the Committee, the program was laid 
before the Council of the Medical and Chirurgical Faculty and was approved by 
them. 
The program met with general approval and certain States and Canada requested 
authority to use the program. 
A chock of the results of control measures for one year, showed a significant 
drop, not only in the death rate, but also in the fatality rate. The death 
rate per 100,000 population dropped from a five year average of 108.5 per cent 
to 80.7; the case fatality rate fell from a five year average of 30.7 to 17.9. 
II* Special Poliomyelitis Program. 
Early in Juno, 1941, when it was apparent that the incidence of this disease 
was increasing, a Special Project was presented to the U. S. Children's Bureau 
for approval. The plan had three major objectives: (1) Locating all cases of 
infantile paralysis, consultation service and instruction to members of the 
household in preventive measures; (2) hospitalization of cases; (3) adequate 
medical care and after treatment of those patients who could not be hospital- 
ized. 
This plan received the approval of the U. S, Children's Bureau and the State 
received a special grant in aid of about $16,000. The sum did not require 
matching by State funds. 
Of the total number of cases showing definite paralysis, 63 were hospitalized 
and 67 received medical attention and after care in their homes. Of 130 
patients on which complete data is available* 72 made a complete recovery; 55 
had only slight or moderate residual paralysis remaining; and three remained 
with complete paralysis of the part which was involved at the onset of the 
disease. Seven deaths occurred in the group. Respiratory treatment was pro- 
vided for eight of the cases; this type of the disease usually proving fatal, 
only one died in this group of seriously ill patients. 
In the general program. Services for Crippled Children, there wore 89 clinics 
held, 462 patients hospitalized providing 33,274 hospital days at a hospital 
cost of 73,559.27; and $5,733.22 was expended for shoes, braces and appliances. 
Ill• The Rheumatic Fever and Cardiac Program. 
This program was made possible by a special grant in aid of about $30,000 from 
the U. S. Children's Bureau, without requiring State funds. While the plan 
provided that the program in the beginning be limited to Anne Arundel County, 
other children suffering from rheumatic fever and heart disease have been 
hospitalized and received medical care on the same basis as those children from 
Anne Arundel County; the number of children from the counties has equaled the 
number from Anne Arundel County, This service was extended to the counties on 
the premises that a child in one county was equally entitled to the same care 
as a child in any other county. 
Preventive Medicine: Today health departments are thinking more and more in 
terms of preventive medicine. Preventive medicine is the application of the 
principles wo have derived from scientists. The work of the immunologist has provided the moans for our prosont day programs of immunization which have 
resulted in a marked reduction in tho morbidity and mortality of smallpox, 
diphtheria and typhoid fovor. However, wo can not roly on immunization alone, 
but must remember that in preventive medicine the elementary and basic 
principles must include sanitation, safe water supplies, proper waste dis- 
posal, pasteurized milk, protected food supplies, and campaigns against 
insect vectors, proper food supply and adequate housing facilities. 
Laws: Some of our health laws should be revised to meet present day public 
health administration. Health and preventive medicine are the major 
consideration. Any health officer who knows the principles of preventive 
medicine so well that he can explain the steps necessary to maintain health 
to the genera} public in simple every-day language entirely free from 
technical terminology, will seldom have difficulty in securing the adoption 
of any reasonable measure to conserve the health of the people. 
The Present Emergenc 
"An emergency is a reality appearing suddenly and calling for immediate 
action." 
The emergencies with which tho health departments are faced today are 
both military and civil; the latter being especially those activities 
associated with the war production effort. 
Tho first emergency created was tho assembling within the health 
Jurisdiction area a largo number of men for tho army and civilian workers 
from a wide variety of homes and communities. With excessive population 
growth, such as has occurred in several sections of tho State, some hazards 
are bound to occur, which include unusual opportunities for exposure to 
bacterial and virus diseases of the upper respiratory tract, and likely to be 
accompanied by an increased occasion for venereal infection. 
Those increases in communicable diseases may express themselves as 
sudden increases in cases of mumps, measles, whooping cough, meningitis, the 
common cold, influenza and bacillary dysentery, first among the new arrivals 
and then in the contiguous normal population. 
Tuberculosis cases among defense workers have already occurred. These 
individuals may have had an inactive tubucular lesion, which under normal 
conditions of life may have never progressed, but the added physical strain 
and a changed environment were the necessary elements to push them across the 
state of well being to a state of ill health. Owing to limitation of bed 
space and their non-resident status, they are not elogiblo for admission to 
the State Tuberculosis Sanatoria. Tuberculosis in this connection may require 
some federal government assistance, either in providing transportation of 
this type of patient to his legal residence or hospitalization in a Federal 
Hospital. 
A second emergency, which has already occurred, is the insidious or 
obvious infiltration of prostitutes who will, or have, created a sanitary 
nuisance in zones surrounding military areas readily accessible to officers 
and men off duty as well as the defense workers. 
A third which occurred was the sudden establishment of a multitude of eating, drinking and amusement places accessible to troops, their visiting 
friends and the civilian population. These places have already been brought 
under control by the health officer, assisted in some instances by the 
military authorities. 
During the present military mobilization and industrial expansion, no 
serious hazard to health has occurred in any of the areas. This has depended 
upon the competence of the State and local health departments in two respects: 
first, the accurate, complete and up-to-date record of all potable and non- 
potable and potentially usable safe water sources in the areas, a record of 
all premises and persons permitted a license' to produce or sell milk, and of 
all public eating places, and the method and place of disposal of household, 
industrial and community waste. The second has been the knowledge of the 
incidence of notifiable diseases in the area and of insect and other vermin 
nuisances, and of the housing and industrial conditions which may become 
foci for the spread of disease. 
We must now make sure that there are available at all times complete 
records of all facts of sanitary importance in these areas, and keep these 
records up to date at all times. The civilian population must be kept in- 
formed of all clinics available to them, and from the military authorities 
we have the right to expect equally complete information as to tho sanitary 
status and communicable diseases among the troops. 
With the demobilization of thousands of soldiers and defense workers, 
health departments will bo faced with problems of great magnitude. 
There will bo thousands of individuals returning to civil life; many of 
whom will bo suffering from disabilities of body and mind as a result of war 
service. Those will rightfully be cared for by the Federal Government. 
Mon and women will bo returning from foreign lands whore there exist 
diseases unknown to tho general physicians and health officers; those will 
create medical and public health problems which wo must prepare to care for. 
Malaria fever which may have been held in abeyance by prophylactic treatment 
while in tho service may become potential foci for the spread of the disease. 
Many other infections existing largely in tropical and sub-tropical countries 
may bo brought into this country. 
State, City and County Health Departments during phase of war and in the 
post-war period will bo with problems of greater magnitude than before, and 
their activities will bo greatly expanded. BUREAU OF COld .UNICABLE DISEASES 
C. II, Halliday, li.D. 
The Bureau of Communicable Diseases was established by Acts 
of Legislature of 1890, 1096, 1904 and 1910, and authorized by 
law in the latter year. 
Policies 
and 
Service 
The Bureau covers a broad field of work in which there are 
several activities varying widely in character one from the other. 
The State Board of Health has kept work and activities in the 
Bureau of Communicable Diseases which are commonly conducted under 
separate divisions in other states. These are epidemiology, 
tuberculosis and venereal diseases for which separate divisions 
have not been created. 
The Bureau's responsibilities aro: 
1. To record, tabulate and study official reports of communicable 
diseases within the State; to check the completeness of 
official reports and to investigate unofficial and all other 
reports reaching the Bureau; and to make analysis of morbidity 
statistics, whether those be collected directly or through 
some other division. 
2, To check the mortality statistics obtained through the 
division of vital statistics with the morbidity data. 
3. To socure immediate information from the division of sanitary 
engineering or other divisions as to the prevalence of 
diseases• 
4. To use laboratory data as a source of primary information as to 
the existence of communicablo diseases. 
5. To make investigations of the existence, prevalence, sources 
and modes of spread of communicablo diseases within the State. 
6. To supervise the adequacy of local administrative measures in 
dealing with the control of communicable diseases. 
7. To make special investigations of problems, the solution of 
which may prove of value in conserving public health or in the 
advancement of knowledge on these subjects. 2 
8, To classify, analyze and interpret all available information 
with reference to disease for administrative guidance in 
formulating sound plans of procedure and acquainting health 
agencies, the medical profession and the public with facts. 
S. To assist local authorities in epidemiological activities, 
assist in the immunization programs and to render special 
service upon request. 
Records and Reports: 
1. Receive from the county health officers, private physicians 
and hospitals, reports of communicable diseases. Record, 
tabulate and study these reports and make available the data 
obtained. 
2. Report figures in weekly reports to health officers of con- 
tiguous states. Federal Officers at ports, certain Federal 
Hospitals and the Chief Surgeon, U.S. Army, relative to the 
prevalence of communicable diseases in the vicinity of 
military reservations and Rational Defense Projects. Special 
daily reports submitted to Baltimore City Health Department, 
District of Columbia Health Department and Washington 
Suburban Sanitary District. Special reports and tabulations 
of comuni cable diseases are sent weekly, monthly, quarterly, 
semi-annually and annually to the U.S. Public Health Service. 
In the event of an unusual outbreak of disease, a daily report 
is sent to the U.S. Public Health Service. 
3. Report migration of persons in an infectious condition and 
persons exposed to infection to the proper health officials 
within the State and state health officials of other states. 
4. Follow up official and unofficial reports of communicable 
diseases to complete records and to find unroported cases. 
5. Check death certificates of communicable diseases with 
communicable disease cases reported to ascertain whether the 
death had been reported as a communicable disease and, if not, 
to have it reported as such. Check laboratory reports 
against clinical diagnosis and physicians* reports. 
6. Investigate in the field and assist health officers and 
physicians in the prevention and control of communicable dis- 
eases by (a) tracing sources of infection and modes of spread 
(b) establishing diagnosis when requested in cases of doubt 
(c) giving detailed advice for the management of special 
situations and (d) enforcing the health laws and regulations. 
Field investigations are me.de upon request of health officers, 
physicians, school and other local officials and upon request 3 
or complaint of citizens and also when reports of cases 
indicate that an investigation should be made. In such in- 
vestigations a search is made for mild unrecognized and 
concealed cases of communicable diseases and well carriers. 
Tuberculosis Chapter 412, Acts of 1904, enacted by the General Assembly 
of Maryland and approved April 8, 1204, designated the State Board 
of Health to keep a register of all persons known to be affected 
with tuberculosis. 
The Act provided for the reporting of pulmonary and laryngeal 
tuberculosis by name, age, sex, color, occupation, social condi- 
tion and residence by superintendents of all State institutions 
and physicians. 
1. Statistics. 
(a) Receive case reports directly from physicians, county 
health officers, hospitals, institutions and clinics, 
except for Baltimore City from which reports are 
received from the Commissioner of Health. Record, 
tabulate, study and make available this accumulated 
data to county health officers and to other official 
and semi-official organizations. 
(b) Report data to the U.S. Public Health Service by 
regular and special reports. 
(c) Follow up official and unofficial reports to complete 
records and keep a complete file and a cross index 
file of all cases reported. 
2. Clinics: Regular clinics are held in each county health 
department. The clinic is the headquarters for field 
tuberculosis work and affords consultation service to the 
general practitioner for his private patients, serves as 
a distributing station for containers for specimens of 
sputum, acts in a supervisory capacity to industrial 
organizations, maintains close association with welfare 
agencies, assists physicians in the hospitalization of 
patients and provides facilities for X-ray, fluoroscopic 
examinations and tuberculin testing. 
3« Case Finding. 
Reports of casos by physicians from records of laboratory 
reports, tuberculin testing of all contacts and school 
groups. X-ray and physical examinations of contacts. 
4. Epidemiology, 
Investigation of every reported case of tuberculosis; 
check positive sputum laboratory reports; check death 
certificates against morbidity reports. Epidemiology 4 
includes a study of patients discharged from sanatoria 
with the purpose to learn what has happened to the 
patients after they are discharged from the institution. 
5. Control. 
Early diagnosis, prompt hospitalization, sputum disposal, 
registration, tuberculin testing of children, epidemi- 
ological investigations, operation of clinics, examination 
of contacts, special efforts to prevent infection in 
young children and the removal of the susceptible from 
contact with active cases. 
The real problem in control is to find the case, to trace 
it to its source, to maintain sanitary surveillance of the 
source, to remove susceptibility from contact with this 
source, and to raise the resistance of those who have 
already been exposed. 
6. Morbidity. 
Reporting of tuberculosis has been generally considered 
very good and with the development of county health 
departments and state-wide clinics, reporting has 
steadily improved. During 1936, the ratio of reported 
cases to deaths, corrected for residence, for the twenty- 
throe counties was 2.1, and for Baltimore City 1.9, giving 
the State a ratio of 1.9. For 1940, the ratio of reported 
cases to deaths for the State was 2.3. The morbidity rate 
per 100,000 population for the State as a whole for the 
white race in 1922 was 151.2 and for the colored, 312.2. 
In 1941, the morbidity rato for the white was 106.9 L,nd for 
the colored, 4.49.1, a marked decrease for the white and a 
decided increase for the negro. For the same year in 
Baltimore City the rato for tho whites declined to 166.6 
but for tho colored increased from 332.4 to 589.3. 
7. Mortality. 
Tuberculosis, which until 1917 stood first on the list of 
the principal causes of death in Maryland, has dropped to 
seventh place. This decrease is gratifying and testifies 
to the enormous amount of concentrated energy in the past 
of those working in the field. It does not, however, 
minimize the importance of the disease as a cause of sick- 
ness and death. For the period 1906-1940 the rate of 
cases for the total population was 50.1; for the whites 
59.9 and for the colored 31.6. The rate per 100,000 
population decrease was 65.7 for the total population; 
73,1 for the whites and 47.3 for the colored. The white 
decrease was approximately 68 per cent, while the rate for 
the colored showed only a 46 per cent decrease. 5 
There arc several possible reasons for this. It is 
usually argued that negro susceptibility to the disease 
is hereditary. This my be true, but it must also bo 
recognized that the conditions under which these people 
live probably tend to lower their resistance to infection. 
Poor or inadequate diet, occupational hazards, and un- 
sanitary and crowded living quarters, do not discourage 
the spread of any disease, especially tuberculosis, and 
these conditions cannot easily be improved because of the 
insecurity of the colored race. 
DEATH RATES PER 100,000 P0PULATI01I FOR TUBERCULOSIS (ALL FORI 13) 
STATE OF LARYLAIID, 1906-1940 
Ono of the major problems of the program at the present 
time is the epidemiological study of tuberculosis carried 
on by the health officers. This has already led to 
notable advances in our knowledge of the disease. This 
has been made possible by an intensive study of tubercu- 
lous families and the study of the childhood typo of 
tuberculosis. In carrying out these studios the x-ray has 
been an essential feature. 6 
Every ease of known tuberculosis forms a starting point 
for field investigation directed to discovering the source 
of infection. Those investigations frequently lead to the 
discovery of other eases of which the new case has itself 
been the source. By this procedure the chain of infection 
is traced exactly as in the epidemiological investigation 
of any other communicable disease. 
8. Sanatoria. 
The State and Baltimore City combine their problems in 
this field of the program, hence hospitalization must be 
considered on that basis. The combined bed capacity for 
1940 was 2,041; for the v/hitos 1,399 beds and for the 
colored, 642 beds. (There arc 66 additional beds for the 
colored race to bo opened at Kenryton). The ratio of beds 
per deaths was one for the colored and two bods for the 
white; for both races the ratio v/as 1.7, which brings the 
ratio of beds per death above the minimal requirements sot 
by the National Tuberculosis Association. 
Typhoid 
Fever 
1. Statistics. 
(a) Receive case reports directly from physicians, county 
health officers, hospitals and institutions except 
from Baltimore City, from which reports are received 
through the Commissioner of Health, Baltimore City. 
Record, tabulate and study and make available the 
accumulated data. Daily reports cf cases to Baltimore 
City and District of Columbia Health Departments and 
Washington Suburban Sanitary District, cases and 
carriers living on water or milk sheds. 
2. Morbidity. 
The reporting of typhoid fever is considered to approach 
nearly 100 per cent. The morbidity data is considered 
complete for the period 1916-1940. In the first year 
mentioned there were 2,668 cases reported, and since that 
year there has been a gradual decline in the number of 
cases; and for the year 1940 there were 127 cases reported. 
The morbidity rate per 100,000 population in 1916 was 
191,3 and in 1940, 7.0. 
3. mortality. 
The death rate per 100,000 population for the State of 
Maryland for the period 1916-1940 has shown a most remark- 
able decline. There were 265 deaths from this disease in 
1916 and eleven deaths in 1940, giving a mortality rate per 
100,000 population in 1916 of 19.0 and in 1940 a mortality 
rate of 0.6» In considering the decline of typhoid fever in 
the State of fairyland it is gratifying to note that in 1940 there occurred fewer cases of typhoid fever than there were 
deaths in 1916. 
4. Epidemiological Service, 
(a) Investigation of every reported case of typhoid fever; 
fix date of onset; inquire as to source, covering a 
period of at least one month prior to onset. Define 
a contact base from which laboratory specimens are to 
be submitted; history of previous typhoid in contacts 
or presence of typhoid agglutinins (not due to typhoid 
vaccine) in blood from contacts; include in investiga- 
tion food and milk handlers, water supply and sewage 
disposal. Any contacts with patients with whom he had 
rarely or never before had association and all elderly 
persons including visitors and visited persons who may 
have had some chance of handling food consumed by the 
patient; all persons in the homo or in visited home, 
regardless of age, who give a history of any recent or 
remote illness. 
5. Typhoid Carriers. 
(a) The term typhoid cai rier is used to mean a chronic 
typhoid carrier, defined as a person with or without 
a partial, present or atypical hidal reaction (also a 
VI antigen reactor) in whose stool, urine or bile 
typhoid bacilli arc found, provided that in persons who 
have had typhoid fover the infection is proved at the 
end of 12 months, or later, following onset. 
(b) Administrative effort is concentrated on carriers whoso 
occupations bring thorn in contact with milk or other 
roady-to-oat food, sold or served to the public. Under 
this may be included private nurses and domestic 
servants. 
Typhoid Carriers 
In the Counties of Maryland 
Eighteen typhoid carriers, who accounted for 13 cases of 
typhoid fever, were added in 1941 to the active list in 
the Counties of Maryland. There are now 235 on the 
active typhoid carrier list in the counties who have 
boon responsible, over a period of years, for 590 cases 
of tho disease. Carriers in Baltimore City are not 
included in this total. 
A register of typhoid fever carriers in Maryland was 
started in 1929 and is kept up-to-date as now carriers 
are discovered. The management of typhoid fever 
carriers has always presented a most difficult problem 
to health agencies. Tho regulations of the Maryland 8 
Stato Department of Health for the supervision of 
typhoid carriers forbid then to handle food or drink 
intended for the use of others. The movements of 
carriers are reported to the Department and rules are 
enforced regarding the personal hygiene and disposal 
of excreta from carriers. Known typhoid carriers are 
forbidden to engage in occupations such as food handl 
ing and dairy work. 
6, General Control. 
Improvement of public and private water supplies, rural 
sanitation, pasteurization of milk supplies; immunization 
among all intimate contacts with acute cases; immunization 
as a general program only in the presence of an epidemic; 
discovery and control of typhoid carriers. Patients are 
discharged on clinical recovery and negative stool and urine 
specimens. Feces and urine specimens should be submitted 
at stated intervals. At the end of one year if typhoid 
bacilli is found in urine or feces, intermittently or con- 
tinuously, such a person is added to the chronic carrier 
list. The number of carriers found by routine examination 
of specimens from large groups of persons, such as food 
handlers, is too small to warrant the expense. 
Diphtheria 1. Statistics. 
Receive case reports directly from physicians, county health 
officers, hospitals and institutions. Record, tabulate 
and study and make available accumulated data to county 
health officer. 
2. Epidemiology. 
Investigation of all reported cases and suspected cases; 
check laboratory reports and death certificates with 
morbidity reports; culture of contacts with cases; in- 
vestigate all possible sources of infection, including 
milk supplies; check cases with immunization records; 
tabulate statistical data for study and information of 
local health departments. 
3. Preventive Measures. 
Active immunization of all children without previous Schick 
testing at the age of six months with diphtheria toxoid. 
Same procedure applies to all children at or below six 
years of age if immunization has been neglected in infancy. 
Older children, adults, especially exposed, including 
teachers, nurses and physicians, found to be Schick- 
positive, should be actively immunized. Pasteurization of 
milk supplies. 9 
4. Morbidity. 
For the period 1916-1940, the number of cases of diphtheria 
reported to the Bureau of Communicable Diseases shows a 
decrease of 1,885 cases in 1916 to 158 cases in 1940. The 
morbidity rate per 100,000 population in 1916 was 135.2 
and in 1940, 8.6. 
5. Mortality. 
The deaths from diphtheria have decreased from 170 in 1916 
to 7 in 1940. The death rate per 100,000 population has 
decreased from 12.2 in 1916 to 0.4 in 1940. The per cent 
decrease in the number of deaths for the period 1906-1940 
was 97.9 for the total population; 97.8 for the white and 
98.1 for the colored. The per cent of decrease in the 
mortality rate per 100,000 population for 1906-1940 was 
98.5 for the total population, and approximately the same 
rate exists for the white and the colored. 
6. Control Measures. 
Recognition of cases; isolation until two negative cultures 
arc taken from nose and throat, not less than 24 hours 
apart, fail to show the presence of diphtheria bacilli. 
When culture is impracticable, case may be released 16 days 
after clinical recovery. Whore cultures are positive, 
virulency test is made three weeks after recovery. Patient 
may be released if cultures arc positive, if case is kept 
under observation of health department. 
Concurrent disinfection of all articles which have been in 
contact with the patient and all articles soiled by dis- 
charges of the patient. Terminal disinfection at end of 
illness; isolation or control over all intimate contacts 
found to be carriers; carriers of virulent bacilli not to 
handle milk or food supplies for public. 
Smallpox No case of smallpox has developed within the State in the past 
thirteen years. 
Provision for the distribution of vaccine virus by the State Board 
of Health was made effective by Acts of Legislature 1864, 1872, 
1888, 1904 and 1916, as follows: 
”The State Board of Health shall keep on hand, and procure 
as often as may be necessary, pure vaccine virus, and fur- 
nish such virus to the physicians of the State, 
gratuitously, when called for; . 
The law also states that it shall be the duty of every practicing 
physician to vaccinate all children in the circle of his practice 
whith may be presented to him one year after birth. The law im- 
poses a duty on the parent or guardian for the vaccination of the 
child and failure to comply imposes a fine of not less than five and no more than ten dollars for each offense. It is the duty 
of the teacher in the public school within ten days of the 
beginning of all terms to determine the number of children who 
have not been vaccinated and if the parents are not able to pay 
for vaccination refer them to the vaccine physician appointed 
by the county or to the county health officer for vaccination. 
Rabies. Antirabic treatment was first started in Maryland at tho Pasteur 
Institute of Baltimore, February 21, 1897, and vms under the 
direction of the late Dr. Nathaniel G. Kcirle. This institute 
was discontinued November 1, 1915, and control of rabies became 
a part of the Maryland State Department of Health, Bureau of 
Communicable Diseases. 
The following is an Act of the General Assembly, Section 248, 
Chapter 204, 1912, on rabies? 
"The State Board of Health is hereby authorized, 
empowered and directed to provide for the treat- 
ment of persons exposed to the contagion of 
hydrophobia who are unable to pay the usual charges 
for the treatment known as Pasteur treatment.” 
During 1940 1,077 persons reported to the Department on account 
of dog bites. Of this number 127 received the Pasteur treatment; 
950 were found not to require treatment by reason of the animal 
being detained and determined not to have suffered from rabies. 
The majority of the 127 persons who did receive the Pasteur 
treatment were treated because they were bitten by stray dogs. 
There was only one positive animal brain for rabies in the 
bacteriological laboratory during the year. At the College Park 
laboratory two positive brains were discovered. Dr. Mark Welsh, 
State Veterinarian, has stated that the number of stray dogs in 
Maryland has materially increased owing to animals being brought 
into the State by the influx of the population engaged in 
defense activities. There is undoubtedly a problem in the dog 
population for the State Veterinarian, and ho has met this 
situation as cases have developed. 
Pneumonia Control Program. 
In October, 1939, the State Board of Health appointed a Committee 
on Pneumonia to determine the method of distribution, by the 
State Department of Health, of sulfapyridine or other approved 
drugs and serums. The program as recommended by the Committee 
was approved by the Council of the Medical and Chirurgical 
Faculty of Maryland. 
The program included: 
(a) An adequate amount of the drug for the treatment of a 
patient, furnished to any physician who reports to the 
health officer a patient with pneumonia in his practice 
who cannot find funds to purchase the drug. (b) Through the central and regional laboratories and special 
trained public health nurses, systematic laboratory tests 
are provided at tv/o day intervals during the patient's 
illness as a check on toxic changes which may develop 
during the course of treatment. 
Other 
Communicable 
Diseases 
Measles, German measles. Mumps, Chickonpox and Whooping Cough. 
Regular communicable disease reports arc received on those 
diseases. 
Raro 
Communicable 
Diseases 
Rare communicable diseases, such as leprosy, amoebic dysentery, 
encephalitis, malaria, septic sore throat, trichinosis, undulant 
fever. Rocky Mountain spotted fever, typhus, psittacosis, are 
investigated and controlled in conformity with the control of 
those diseases as recommended by the Committee of the American 
Public Health Association. 
Poliomyelitis 1, Statistics. 
Receive case reports directly from physicians, county health 
hospitals, institutions and clinics, except for Balti- 
more City from which reports are received through the Commis- 
sioner of Health. Record tabulate, study and make available this 
accumulated data to the county health officers and to other 
official and semi-official organizations. 
2. Case Finding. 
Report of cases by physicians and institutions and by investiga- 
tion of cases or suspected cases reported from any source. 
3. Epidemiology. 
Investigation of all cases and suspected cases; diagnosis 
service to physicians on request to assist at the diagnosis of 
mild or cases of undetermined illness. Locate unrecognized and 
unreported cases of the disease; determine the extent of un- 
recognized illnesses, especially among children in community 
whore the disease occurs. Make special tabulations of the 
accumulated data for distribution to local health departments. 
4. Control. 
Isolation of patient for two weeks from date of onset; concurrent 
disinfection of nose and throat discharges from the patient. 
Exposed children of the household of school age to be kept from 
school, and adults in household whose vocation brings them into 
contact with children or with food to be eaten uncooked to bo 
kept from vocation for 14 days from last exposure to recognized 
case. 
During epidemics or unusual outbreaks, physicians and laity kept 
informed as to prevalence or increase of incidence of the disease. 
All children with fever isolated pending diagnosis. There have been several outbreaks of poliomyelitis in the State. 
The first to occur was in 1916 when there were 147 cases reported 
from the counties; one in 1921 with 73 cases; in 1928 with 162 
cases and the one of 1941 with 136 cases. Of the 1941 cases, seven 
patients died. 
In May, 1941, when it was apparent that we would have an increase 
in poliomyelitis, a plan was formulated for the intensive care of 
these cases. This program was made possible by a special grant 
from the United States Children’s Bureau. This is more fully 
discussed in the section on Services for Crippled Children. 
Venereal 
Diseases 
1. Statistics. 
Receive case reports directly from physicians, county health 
officers, hospitals and institution, except for Baltimore City 
from which reports are received through the Commissioner of Health; 
record, tabulate, study and make available the accumulated data. 
2. Distribution of drugs for the treatment of syphilis and gonorrhea. 
3. Consultation service in the diagnosis and treatment of syphilis 
(including central nervous syphilis) and gonorrhea. 
4. Venereal Disease Epidemiological Service. 
(a) Follow up persons reported by patients as source or 
probable sources of their infection; also infected persons 
reported by physicians as delinquent in taking treatment 
and arrange for necessary examination and treatment. 
(b) Arrange for examination of children of syphilitics and 
parents of syphilitics, and when necessary arrange for 
their treatment. 
(c) Through the Bureau of Child Hygiene Prenatal Clinics 
secure seriological examinations of all women attending 
clinics• 
(d) Through the local county health officers chock all draftees 
reported as having positive Wassermann tests as to whether 
they have been investigated by case workers and placed 
under treatment as a result of an epidemiological in- 
vestigation and whether those found were already under 
treatment. 
(c) Advise and assist or personally initiate legal steps in 
dealing with irresponsible venereal disease patients. 
(f) Advise and assist official and unofficial agencies in 
solving venereal disease problems in relation to welfare 
work. There are clinics for syphilis and gonorrhea held in all of the 
counties of the state. Approximately 3,300 clinic sessions were 
held during the year. For the counties of Maryland during 1940 
there were 3,456 cases of syphilis reported and in 1941, 3,365. 
There were 1,193 cases of gonorrhea reported in 1940 and 2,253 in 
1941. 
The U. S. Public Health Service has published ’‘Results of 
Serological Blood Tests for Syphilis in Selective Service 
Registrants”, based on the first million reports received. For 
the State of Maryland there were 13,461 tests made and 1,356 
syphilis cases detected. 
SERVICES FOR CRIPPLED CHILDREN 
Services for Crippled Children had their beginning in Maryland, 
about 1900, under the Baltimore Council of Jewish Women. That 
organization found a lack of educational facilities, both academic 
and vocational, inadequate medical care and lack of public support. 
Their work was continued until April, 1927, when they proposed 
their own withdrawal to give way to the new State-wide organiza- 
tion, the Maryland League for Crippled Children. 
When additional funds were offered by the Federal Government under 
the Social Security Act, the Board of State Aid and Charities was 
first designated as the official State agency in charge of the 
Services. The staff was enlarged to include seven physiotherapists 
located at strategic points through the State, and three ortho- 
pedic nurses. In 1937, by an Act of Legislature, the Services for 
Crippled Children were transferred to the Maryland State Depart- 
ment of Health. 
Definition For purposes of administration, a crippled child will be con- 
sidered as ”A person under twenty-one years of age who by reason 
of a physical defect or informity, whether congenital or acquired 
by accident, injury, or disease, is or may bo expected to bo 
totally or partially incapacitated for education or for remunera- 
tive occupation, but shall not include the deaf and the blind*” 
All children under the age of twenty-one years will be admitted 
to the services for examination, hospitalization and follow up 
care. Actual need for free consultations in the clinic and 
hospitalization will be determined by information secured by the 
executive secretary of the county welfare board, but those who are 
able to pay for part of the service will also be admitted. 
Methods 
of 
Administration 
The administration of the plan is under the Director, Services for 
Crippled Children, who is responsible for all administrative 
details and cooperates with the orthopedic surgeons conducting the 
clinics and the full time county health officers and their staff 
in providing clinic service, nursing and physiotherapy care for 
all those admitted to the register. Activities carried out consist of the followings 
a* State-wide planning and coordination. 
b. Locating, having examined, hospitalizing and 
follow-up services for crippled children. 
c. Preparing and submitting to the Children’s 
Bureau such reports as are required. 
d. Auditing bills for transportation; care of 
braces, appliances and shoes; expense accounts 
of personnel; hospitalization and surgeons’ 
fees • 
e. Preparation of rules and regulations, informa- 
tion and bulletins necessary for the effective 
operation of the program. 
Activities (A) Locating crippled children (other than through diagnostic 
clinics)* 
The law requires that the Board of Education make a biennial 
school census which includes a record of physically handi- 
capped children, and it is through the biennial school 
census that the majority of crippled children are located. 
The clinics for crippled children also afford a means of 
locating crippled children not previously on the State 
register. This class of patients come largely through 
private physicians referring known cases to the clinics. 
The county public health nursos on their visits to postnatal 
cases ascertain the physical condition of the baby, and any 
congenital defects, malformations, or crippling accidents 
at birth are added to the list. Private physicians refer 
or report the names of crippled children to the county health 
department; local social agencies and clubs assist in bring- 
ing to the attention of the local health departments all 
children suffering from crippling conditions with whom they 
come in contact and who need care or have lapsed in their 
treatment. Epidemiological reports are utilized, especially 
those of poliomyelitis, meningitis, undulant fever, 
encephalitis, bone and joint tuberculosis or other conditions 
which involve the central nervous system resulting in 
paralysis or crippling conditions. 
All children discovered in the census of the physically 
handicapped are reported to the county health officer who is 
required by law to have each child examined for the purpose 
of determining his physical and educational needs. The 
official birth certificate does not provide for reporting of 
congenital malformations and birth injuries. 
(B) Development of State Register of Crippled Children. 
Every child discovered in the school census or case-finding activities will have its name entered on register and re- 
ferred to one of the diagnostic clinics where it will receive 
a thorough examination by a competent orthopedist. After a 
diagnosis is established and treatment instituted, the case 
remains on the register until the orthopedist determines 
that complete cure has resulted, or until the child passes 
beyond tho age limit of 21 years. Then the case is carried 
on by an unofficial organization until tho case terminates 
by moving out of the State or by death. 
The State register for crippled children is prepared in 
accordance with tho Children’s Bureau memorandum of April 5, 
1938, "Outline of Principal Points to be Observed in 
establishing a State Register of Crippled Children”. All new 
cases admitted to the register since the publication of this 
memorandum have been recorded in compliance with the 
principals contained in the instructions. On December 31, 
1941, there were 3,410 patients on the state register. 
(C) Clinic Services. 
Approximately 55 clinics are held in the counties each year. 
Clinics are conducted by an orthopedic surgeon who is 
assisted by an orthopedic nurse, public health nurses, 
physiotherapist and secretary. During the calendar year 1941, 
2,651 patients were examined in the county clinics. 
(D) Hospitalization. 
All hospitals in Baltimore City and in the Counties of Mary- 
land which meet the "Standards of Requirements" as outlined 
by tho Children’s Bureau are used by the Services for 
Crippled Children. Hospitalization is authorized upon recom- 
mendation of tho attending orthopedic surgeon. In 1941, 
462 patients wero hospitalized at a cost of $73,559.27. 
All institutions in which the official State agency hospital- 
izes crippled children have provisions for tho admission of 
negro patients. Negroes are admitted on the same basis as 
whito patients. 
(E) Care in Children's Ovm Homos and in Convaloscont and Foster 
Homes • 
The Director, Services for Crippled Children, authorizes 
convalescent and foster home care when the resources of the 
child's own home cannot be utilized to provide suitable care, 
as recommended by the orthopedic surgeon. 
Follow-up care in the child's own home is supervised by the 
orthopedic nurse and the local public health nurse. 
(F) Appliances. 
The official State agency does not operate a brace shop. Appliances are purchased from private companies and/or firms. 
Charges are made for repair of appliances, varying according 
to the amount of work to be done and need of using new 
material for parts. No charge is made for fitting. Author- 
ization for purchase is by the Director, Services for 
Crippled Children. 
(G) Transportation of Crippled Children. 
Transportation of crippled children is provided to and from 
clinics, hospitals, convalescent and foster homes, and to and 
from storos of appliance shops for proper fittings. Trans- 
portation by State owned or privately owned cars operated by 
the personnel of the official State agency is not authorized 
except in very exceptional instances. Transportation is 
provided by parents, members of women’s clubs, American 
Legion, civic clubs and occasionally by an official of tho 
local political subdivision in which the clinic is operated 
or in which tho patient resides. 
Owing to shortage of automobiles, tires, etc., the train and 
bus will be used where possible. 
(li) Special Projects, Studies, and Demonstrations. 
A special project for the care of acute poliomyelitis cases 
is contemplated in the event of an outbreak similar to the 
program in effect during the summer of 1941. 
Objectives: 
1. Reporting by private physicians all cases or suspected 
cases among their clientele to the local health officers; 
investigations by the health officer of all cases brought 
to his attention; isolation of patients and proper in- 
structions to members of the household as to precaution- 
ary measures to be taken; and consultation service to the 
private physician or health officer. 
2. Hospitalization of selected cases living in the vicinity 
of hospitals in the early days of the illness, or proper 
care in the home of patients who for one reason or another 
could not be hospitalized. 
3. Hospitalization of patients in one of the orthopedic 
hospitals as soon as the acute stage subsides or when 
beds are available; thorough after care of patients on 
return home by a physiotherapist working under the 
direction of the orthopedic surgeon in charge of the case. 
The 1941 outbreak of poliomyelitis afforded the first 
opportunity for the Services for Crippled Children to put 
into effect its plan for the care of this type of patient 
during the acute stage. Of the total number of cases which SERVICES FOR CRIPPLED CHILDREN 
Calendar Year 1941 
County 
Ho. of 
Clinics 
Clinic 
Attendance 
Children 
Hospitalized 
Hospital 
Days 
Hospital 
Cost 
Cost of 
Appliances 
Allegany 
6 
658 
52 
3,643 
$ 7,756.50 
$ 262.79 
Anne Arundel 
27 
251 
41 
3,486 
5,686.95 
438.80 
Baltimore* 
0 
44 
57 
3,456 
8,246.59 
556.65 
Calvert 
2 
36 
4 
762 
1,635.00 
174.35 
Caroline 
2 
30 
5 
578 
720.00 
53.70 
Carroll 
2 
57 
20 
730 
2,172.47 
178.75 
Cecil 
4 
103 
12 
1,161 
2,988.50 
219.35 
Charles 
2 
58 
12 
911 
2,192.30 
42.60 
Dorchester 
0 
0 
9 
805 
2,087.50 
155.70 
Frederick 
3 
147 
25 
1,992 
4,896.50 
239.75 
Garrett 
4 
251 
24 
1,801 
3,907.50 
751.20 
Harford 
4 
107 
24 
1,363 
2,996.57 
337.85 
Howard 
2 
46 
9 
963 
2,252.50 
203.05 
Kent 
2 
48 
11 
974 
2,089.50 
138.75 
Montgomery 
3 
114 
21 
1,072 
2,199.00 
304.40 
Pr. George's 
3 
110 
40 
3,007 
6,427.50 
320.80 
Queen Anne's 
2 
65 
11 
444 
1,097.85 
212,55 
St. Mary's 
2 
47 
5 
269 
582.50 
170.10 
Somerset 
3 
52 
9 
258 
1,002.15 
97.70 
Talbot 
6 
122 
11 
538 
662.50 
118.00 
Washington 
4 
137 
21 
1,312 
2,623.39 
477.33 
Wicomico 
3 
123 
16 
1,128 
2,655.00 
141.30 
Worcester 
ry 
O 
45 
11 
1,554 
3,420.00 
143.75 
Balto. City 
3 
1,087 
3,261.00 
TOTAL 
89 
2,651 
462 
33,274 
$73,559.27 
$ 5,739.22 
* Patients 
examined in Baltimore City Hospital Dispensaries showed definite paralysis, 63 were hospitalized and 67 were 
seen by either orthopedic surgeons or pediatricians for con- 
firmation of diagnosis, and all received some treatment and 
instructions in their homes. Of the total number of 130 
definitely paralyzed patients for which we have complete 
records, 72 made a complete recovery or had little if any 
paralysis remaining. Of the total number, there wore only 
throe who, at the end of six months, showed complete paralysis 
of the part which was involved at the beginning of the 
disease. Seven deaths occurred among this group. It was 
necessary to provide respiratory treatment for eight patients. 
Those cases which wore placed in the respirator wore cases 
which ordinarily terminate fatally. Of the number receiving 
this typo of treatment only one died, and this child was in 
extremes when taken to the hospital. 
RHEUMATIC FEVER PROGRAM 
WITH SPECIAL REFERENCE TO HEART DISEASE 
Through a special grant from the Children’s Bureau, it was possible 
for the Services for Crippled Children to inaugurate a rheumatic 
fever program in Anne Arundel County, limited to this county for 
the purpose of determining the value of such a program in the State. 
The money obtained from the Children’s Bureau did not require any 
matching funds from the State of Maryland. 
For the quarter ending June 30, 1942, there were twenty-four new 
patients admitted to clinic service during the three months, and 
59 visits were made by patients to the clinics. There were five 
patients hospitalized, providing 37 hospital days; 136 days of 
care were provided in convalescent homos; and 160 days in foster 
homes. While this program, as an experimental activity, is limited 
to Anne Arundel County, children from other counties suffering from 
rheumatic fever have also boon given the benefit of hospitalization, 
and the number of children thus cared for in other sections of the 
State has equaled, or exceeded the number cared for in Anne Arundel 
County. This limited service was extended to other sections of 
tho State on the promises that a child in one county was equally 
entitled to the same care as a child in any other county. 
Definition. Any person under 21 years of ago suffering from heart disease or 
from conditions loading to heart disease that offers a reasonable 
expectation of improvement through medical treatment, hospitaliza- 
tion, convalescent care and after care, will receive service under 
the program. Primary consideration will be given to children 
suffering from the first attack of rheumatic fever. 
Adminis- 
tration 
The rheumatic-fever program is part of Services for Crippled 
Children, Maryland State Department of Health. Tho program has 
been limited to Anno Arundel County, but owing to constant requests 
from Washington County, it seems advisable to give favorable con- 
sideration to establishing tho rheumatic fever program in that 
c ounty. Geographic Scope of Program. 
In addition to the rheumatic fever program which has been in 
existence in Anne Arundel County for approximately two years, a 
similar program should be started in Washington County, and in 
cases where there is great need for cardiac consultation, such 
service should be available to patients living in other portions 
of the State. 
Plans for Case Finding. 
By cooperation of private physicians in reporting cardiac condi- 
tions in children among their clientele and furnishing information 
relative to families in which rheumatic fever does or has existed; 
through the regular medical examination of school children; at the 
tuberculosis, crippled children, venereal disease and child health 
clinics. All discovered cases will be referred to the rheumatic 
fever clinic and those acutely ill will bo hospitalized or will 
have some homo consultation service. 
Clinic Service. 
The rheumatic fever clinic will bo permanent and will bo conducted 
by a pediatrician or cardiologist assisted by a public health 
nurse and medical social worker (if one is available). Facilities 
will be furnished for laboratory, fluoroscopy, roentgenology and 
electrocardiography. The clinics will be located in the health 
department and will be conducted in cooperation with the Cardiac 
Clinic, Harriet Lane Home, Johns Hopkins Hospital. Four clinics 
will be conducted each month at the Annapolis Health Department 
and two each month at Hagerstown. 
Hospital Service. 
Patients suffering from rheumatic fever, heart disease or condi- 
tions leading to heart disease who are examined at the cardiac 
clinic or referred to the official State agency will be admitted 
to hospital services in cases where additional observation and 
laboratory procedures arc necessary for diagnosis; also in 
instances where the child's residence makes it impracticable for 
him to return to the clinic center for observation; and in cases 
whore the diagnostic problem is difficult and requires the opinion 
of one or more consultants. Patients suffering with acute 
rheumatic fever will in all instances be hospitalized whore the 
parent and attending physician's permission can bo obtained. 
Hospital rates will range from $2,50 to $5.00 per day. 
Home consultation Service. 
Children reported by a physician or county health officer to bo 
suffering from acute rheumatic infection or heart disease will bo 
eligible for diagnostic service at home by the pediatrician or 
cardiologist responsible for the clinic and assisted by the public 
health nurse and social service worker. This service is to be given only to patients who aro too ill to report to clinic for 
consultation service. 
Follow-Up Caro. 
The foilow— up caro will be carried on by the County Public Health 
Nurse assisted by the Medical Social Worker in Anne Arundel County 
and the Medical Social Worker in Washington County, when the 
services of one is available. The after care will also include 
proper instructions as to diet and proper rest periods. In 
cooperation with the Department of Education, home teaching will 
bo provided where such services are needed, and the services of 
a mental hygienist is available in those cases which show 
emotional disturbances. In the older children, vocational 
guidance will be provided. 
The results in the reduction of communicable dis- 
eases in the State have not been accomplished by 
efforts of any one individual or any one special 
bureau. The Bureau has enjoyed the cooperation 
between all of the departments of the State Health 
Department, the county health officers and their 
staffs, the physicians of the counties, and the 
interested citizens in the several communities. 
The results accomplished in the field of the Ser- 
vices for Crippled Children have been made possible 
by the unlimited services given by the orthopedic 
surgeons of the staffs of tho Children’s Hospital 
School and the Kernan Hospital, and by tho ortho- 
pedic nurses and physiotherapists of the Services 
for Crippled Children, and the aid and assistance 
given by the personnel of the local health depart- 
ments, civic groups and an interested community. MARYLAND STATE HEALTH DEPARTMENT 
MORBIDITY AND MORTALITY STATISTICS 
Death From all Causes; Baltimore City and Counties - 
Death and Death Rates; All Causes, State of Maryland, By Color - 1906-1940 
Deaths, Tuberculosis, by Color; Baltimore City and Counties - 1906-1940 
Deaths and Death Rates, by Color; State of Maryland - 1906-1940 
Death Rates, Tuberculosis, by Color and Sex; Baltimore City and Counties - 1931-1940 
Tuberculosis Cases and Rates, by Color; Baltimore City and Counties - 1922-1941 
Typhoid Fever Cases and Deaths; Rates for State of Maryland - 1916-1940 
Graph Typhoid Fever, Death Rates - 1907-1940 
Typhoid Fever Death Rates, by Color; Baltimore City and Counties - 1931-1940 
Diphtheria Cases and Deaths and Rates; State of Maryland - 1916-1940 
Diphtheria Death Rates, by Color and Sex; Baltimore City and Counties - 1931-1940 Deaths from all causes, by color: Baltimore City and Counties o1 Maryland: 
1906 - 1940 
BALTIMORE CITY 
COUNTI 
SS OF MARYLAND 
1'otal 
White 
Colored 
Total 
White 
Colored 
1906 
10,758 
8,041 
2,717 
9,296 
6,710 
2,586 
1907 
11,182 
8,384 
2,798 
9,620 
6,932 
2,688 
1908 
10,416 
7,861 
2,555 
9,761 
7,059 
2,702 
1909 
10,387 
7,804 
2,583 
9,544 
6,871 
2,673 
1910 
10,753 
8,152 
2,601 
10,052 
7,306 
2,746 
1911 
10,407 
7,757 
2,650 
10,287 
7,390 
2,897 
1912 
10,389 
7,851 
2,538 
10,088 
7,305 
2,783 
1913 
10,624 
7,912 
2,712 
10,869 
7,846 
3,023 
1914 
10,486 
7,879 
2,607 
10,828 
7,880 
2,948 
1915 
10,008 
7,536 
2,472 
11,345 
8,237 
3,108 
1916 
10,668 
7,956 
2,712 
11,844 
8,634 
3,210 
1917 
11,355 
8,362 
2,993 
12,089 
8,830 
3,259 
1918 
15,810 
12,143 
3,667 
16,324 
12,186 
4,138 
1919 
11,432 
8,896 
2,536 
10,582 
7,661 
2,921 
1920 
11,356 
8,782 
2,574 
10,006 
7,370 
2,636 
1921 
10,380 
8,106 
2,274 
9,600 
7,029 
2,571 
1922 
10,824 
8,423 
2,401 
9,442 
7,030 
2,412 
1923 
11,589 
8,908 
2,681 
10,522 
7,858 
2,664 
1924 
11,310 
8,672 
2,638 
9,664 
7,243 
2,421 
1925 
11,648 
8,718 
2,930 
9,980 
7,425 
2,555 
1926 
12,210 
9,220 
2,990 
10,439 
7,950 
2,489 
1927 
11,578 
8,613 
2,965 
9,524 
7,214 
2,310 
1920 
11,929 
8,970 
2,959 
9,785 
7,447 
2,338 
1929 
11,629 
8,746 
2,883 
10,244 
7,935 
2,309 
1930 
11,239 
8,424 
2,815 
10,328 
7,879 
2,449 
1931 
11,522 
8,600 
2,922 
10,246 
7,764 
2,482 
1932 
10,775 
8,060 
2,715 
10,272 
7,895 
2,377 
1933 
10,797 
8,243 
2,554 
9,827 
7,612 
2,215 
1934 
10,764 
8,049 
2,715 
10,183 
7,123 
2,260 
1935 
10,707 
7,917 
2,790 
10,431 
8,166 
2,265 
1936 
11,058 
8,134 
2,924 
10,849 
8,479 
2,370 
1937 
11,244 
8,415 
2,829 
10,740 
8,516 
2,224 
1938 
10,618 
8,034 
2,584 
9,986 
7,916 
2,070 
1939 
10,386 
7,907 
2,479 
10,241 
8,146 
2,095 
1940 
11,096 
8,243 
2,853 
10,707 
8,700 
2,087 
Total 
339,334 
293,718 
95,616 
365,625 
274,344 
91,281 
Maryland State Dept, of Health - 1942 DEATHS AND DEATH RATE FOR ALL CAUSES (STILL BIRTHS EXCLUDED) 
STATE OF MARYLAND 
1906 - 1940 
TOTAL DEATHS 
DEATH RATE 
PER 1,000 
POPULATION 
Total 
White 
Colored 
Total 
White 
Colored 
1906 
20,054 
14,751 
5,303 
16.0 
14.5 
22.7 
1907 
20,802 
15,316 
5,486 
16.4 
14,8 
23.5 
1908 
20,177 
14,920 
5,257 
15.8 
14.3 
22.5 
1909 
19,931 
14,675 
5,256 
15.5 
13.9 
22.6 
1910 
20,805 
15,458 
5,347 
16.0 
14.5 
22.9 
1911 
20,694 
15,147 
5,547 
15.7 
14.0 
23.7 
1912 
20,477 
15,156 
5,321 
15.4 
13.8 
22.6 
1913 
21,493 
15,758 
5,735 
16.0 
14.2 
24.2 
1914 
21,314 
15,759 
5,555 
15.6 
14.0 
23.3 
1915 
21,353 
15,773 
5,580 
15.5 
13.8 
23.3 
1916 
22,512 
16,590 
5,922 
16.1 
14,4 
24.6 
1917 
23,444 
17,192 
6,252 
16.6 
14,7 
25.9 
1918 
32,134 
24,329 
7,805 
22.5 
20.6 
32.1 
1919 
22,014 
16,557 
5,457 
15.3 
13.8 
22,3 
1920 
21,362 
16,152 
5,210 
14.6 
13.3 
21.1 
1921 
19,980 
15,135 
4,845 
13.5 
12.3 
19.4 
1922 
20,266 
15,453 
4,813 
13.6 
12,5 
19.0 
1923 
22,111 
16,766 
5,345 
14.6 
13.3 
20.9 
1924 
20,974 
15,915 
5,059 
13.7 
12.5 
19.5 
1925 
21,628 
16,143 
5,485 
14.0 
12.6 
20.9 
1926 
22,649 
17,170 
5,479 
14.5 
13.2 
20.6 
1927 
21,102 
15,827 
5,275 
13.3 
12.0 
19.6 
1928 
21,714 
16,417 
5,297 
13.6 
12.3 
19.5 
1929 
21,873 
16,681 
5,192 
13.6 
12.4 
18.9 
1930 
21,567 
16,303 
5,264 
13,2 
12.0 
18.9 
1931 
21,768 
16,364 
5,404 
13.1 
11.9 
19.3 
1932 
21,047 
15,955 
5,092 
12.6 
11.5 
18.0 
1933 
20,624 
15,855 
4,769 
12.2 
11.3 
16.7 
1934 
20,947 
15,972 
4,975 
12.2 
11.2 
17,3 
1935 
21,138 
16,083 
5,055 
12.2 
11,2 
17.4 
1936 
21,907 
16,613 
5,294 
12.5 
11.4 
18.1 
1937 
21,984 
16,931 
5,053 
12.4 
11.8 
17.1 
1938 
20,604 
15,950 
4,654 
11.5 
10.7 
15,6 
1939 
20,627 
16,053 
4,574 
11.4 
10.7< 
15.2 
1940 
21,883 
16,943 
4,940 
12.0 
11.1 
16.3 
PER CENT INCREASE OR DECREASE 1906-1940 
Number 
of Deaths 
Total 
White 
Colored 
+9*1 
+14.9 
-6,8 
Rate per 
1,000 Population 
Total 
White 
Colored 
-25.0 
-23,4 
—28 • 2 
Maryland State Department of Health, 1942 DEATHS FROM ALL FORMS OF TUBERCULOSIS BY COLOR 
Baltimore City and Counties of Maryland 
1906 - 1940 
BALTIMORE 
CITY 
COUNTIES OF MARYLAND 
Total 
White 
Colored 
Total 
White 
Colored 
1906 
1,500 
1,019 
481 
1,110 
686 
424 
1907 
1,477 
981 
496 
1,105 
681 
424 
1908 
1,421 
953 
468 
1,152 
680 
472 
1909 
1,447 
937 
510 
1,168 
708 
460 
1910 
1,404 
907 
497 
1,158 
734 
424 
1911 
1,394 
879 
515 
1,266 
755 
511 
1912 
1,394 
910 
484 
1,147 
723 
424 
1913 
1,348 
849 
499 
1,239 
772 
467 
1914 
1,320 
852 
468 
1,389 
880 
509 
1915 
1,287 
798 
489 
1,299 
826 
473 
1916 
1,321 
812 
509 
1,405 
902 
503 
1917 
1,395 
855 
540 
1,366 
907 
459 
1918 
1,478 
935 
543 
1,449 
980 
469 
1919 
1,238 
798 
440 
1,152 
751 
401 
1920 
1,105 
714 
391 
1,034 
623 
411 
1921 
1,047 
616 
431 
950 
636 
314 
1922 
1,000 
626 
374 
939 
629 
310 
1923 
985 
579 
406 
897 
573 
324 
1924 
939 
601 
338 
908 
655 
353 
1925 
959 
561 
398 
926 
574 
352 
1926 
888 
554 
334 
912 
589 
323 
1927 
821 
450 
371 
803 
512 
291 
1928 
828 
459 
369 
875 
545 
330 
1929 
855 
492 
363 
828 
527 
301 
1930 
813 
434 
379 
808 
478 
330 
1931 
789 
393 
396 
798 
500 
298 
1932 
707 
342 
365 
804 
492 
312 
1933 
647 
342 
305 
729 
450 
279 
1934 
813 
411 
402 
542 
340 
202 
1935 
808 
416 
392 
555 
333 
222 
1936 
836 
433 
403 
582 
350 
232 
1937 
861 
452 
409 
523 
312 
211 
1S38 
711 
379 
332 
503 
300 
203 
1939 
673 
336 
337 
476 
283 
193 
1940 
816 
393 
423 
486 
290 
196 
Maryland State Department of Health, 1942 DEATHS AND DEATH RATES FOR TUBERCULOSIS (ALL FORMS) 
STATE OF MARYLAND 
1906 - 1940 
DEATHS 
RATE PER 
100.000 
POPULATION 
Total 
White 
Colored 
Total 
White 
Colored 
1906 
2610 
1705 
905 
208.1 
167.1 
387.0 
1907 
2582 
1662 
920 
204.1 
161.1 
393.9 
1908 
2573 
1633 
940 
201.7 
156.6 
403.0 
1909 
2615 
1645 
970 
203.2 
156.1 
416.4 
1910 
2562 
1641 
921 
197.3 
154.0 
395.3 
1911 
2660 
1634 
1026 
202.3 
151.3 
438.0 
1912 
2541 
1633 
908 
191.0 
149.1 
385.6 
1913 
2587 
1621 
966 
192,1 
146.1 
408.0 
1914 
2709 
1732 
977 
193.9 
154.1 
410.5 
1915 
2586 
1624 
962 
187.6 
142.6 
402.1 
1916 
2726 
1714 
1012 
195.6 
148.6 
420.7 
1917 
2761 
1762 
999 
195.8 
150.8 
413.2 
1918 
2927 
1915 
1012 
205.3 
161.9 
416.4 
1919 
2390 
1549 
841 
165.8 
129.4 
344.3 
1920 
2139 
1337 
802 
146.7 
110.3 
325.3 
1921 
1997 
1252 
745 
135.3 
102.1 
298.4 
1922 
1939 
1255 
684 
129.8 
101.1 
270.5 
1923 
1882 
1152 
730 
124.5 
91.7 
285.1 
1924 
1847 
1156 
691 
120.7 
91.0 
266.6 
1925 
1885 
1135 
750 
121.8 
88.3 
285.9 
1926 
1800 
1143 
657 
115.0 
87.9 
247.5 
1927 
1624 
962 
662 
102.6 
73.2 
246.4 
1928 
1703 
1004 
699 
106.4 
75.6 
257.1 
1929 
1663 
1019 
664 
104.0 
75.9 
241.5 
1930 
1621 
912 
709 
99.1 
67.1 
255.0 
1931 
1587 
893 
694 
95.9 
64.9 
247.4 
1932 
1511 
834 
677 
90,3 
59.9 
239.2 
1933 
1376 
792 
584 
81.3 
56.3 
204.5 
1934 
1355 
751 
604 
79.1 
52.7 
209.6 
1935 
1363 
749 
614 
78.7 
52.0 
211,2 
1936 
1418 
783 
635 
81.0 
53.7 
216.5 
1937 
1384 
764 
620 
78.2 
51.9 
209.6 
1938 
1214 
679 
535 
67.9 
45.6 
179.3 
1939 
1149 
619 
530 
63.6 
41.1 
176,2 
1940 
1302 
683 
619 
71.3 
44.9 
204.0 
PER CENT DECREASE,1903-1940 
Number of 
Deaths 
Total 
White 
Colored 
50.1 
59.9 
31.6 
Rate per 
100,000 Population 
Total 
White 
Colored 
65.7 
73.1 
47.3 
Maryland State Department of Health, 1942  
! 
BALTIMORE CITY 
COUNTIES OF MARYLAND 
Both 
Colors 
’Shite 
Colored 
Both Colors 
White 
Colored 
Male 
Female 
r 
Mole 
Female 
Male 
Female 
Mai e 
Female 
Mai e 
Female 
Male 
Female 
1931 
105.2 
6*4,5 
r '111 
68.1 
35.7 
27*4.2 
196. u 
1 
89.3 
86.6 
69.7 
61.8 
189-3 
220.2 
1932 
93-8 
60.5 
59.6 
30.3 
2*48.2 
197.0 
: 81.3 
93-5 
58.5 
68.6 
200.5 
230.7 
1933 
91. u 
50.5 
62.9 
31.3 
219.0 
136.1 
7*1.1 
S6.*4 
58.8 
59.3 
155.2 
237.9 
193*1 
87,6 
52.8 
57.5 
2*1.8 
221.3 
176.2 
7**.5 
i 
7*4.1 
59.8 
53.5 
153.7 
190.9 
1935* 
95.6 
53.1 
58.*4 
31.9 
258.9 
1U5.5 
58.*1 
56.5 
*45.2 
37.3 
131.I 
167.2 
1936 
119. *4 
69.7 
8*4.3 
3 8.8 
272.2 
202.8 
60.6 
58.5 
*15.5 
39.0 
1*45.1 
173.1 
1937 
123.2 
69.5 
85.*4 
*40.1 
2S6.*4 
19*1-7 
50.7 
55.0 
36.3 
39.1 
132.3 
1*19.5 
193S 
99-0 
58.9 
7*4.1 
31.0 
205.7 
175.9 
*48.3 
51.5 
3*1-7 
3*1-9 
126.7 
152.3 
1939 
89.s 
58.3 
61.7 
30.3 
209.2 
17*4.*4 
*19.9 
*12.8 
39.7 
26.5 
109.7 
1*42.8 
19*40 
120. *4 
59.3 
80.9 
28.7 
286.3 
isu.5 
*49.0 
*41.8 
35.0 
27.5 
132.1 
130.2 
* Resident figures beginning 
with 1935* 
Death rates per 100,000 population for TUBERCULOSIS OF THE RESPIRATORY SYSTEM by color and sex: 
Baltimore City and Counties of Maryland: 1931 - 19**0* 
Maryland State Health Dept. ~ 19*+2  
STATE 
OF MARYLAND 
BALTIMORE 
CITY 
COUNTIES 
OF MARYLAND 
WHITE 
COLORED 
WHITE 
COLORED 
• 
WHITE 
COLORED 
YEARS 
Cases 
Rate 
Cases 
Rate 
Cases 
Rate 
Cases 
Rate 
Cases 
Rate 
Cases 
Rate 
1922 
1881 
151.5 
792 
313.2 
1057 
166.6 
329 
332.“+ 
82*4 
126.9 
U03 
296.7 
1923 
1832 
1^5.9 
856 
33“+. 3 
1081 
169.5 
U55 
396.8 
751 
121.5 
*401 
295.5 
192U 
219*4 
172.7 
926 
357.3 
1015 
15s. 2 
*462 
373-6 
1179 
187.“+ 
*46*4 
3*42.*4 
1925 
236O 
183.6 
1067 
*406.7 
10*40 
161.2 
510 
*401.6 
1320 
206.2 
557 
*411.5 
1926 
2lU3 
16*4.9 
872 
328. *4 
1005 
15M 
“+77 
366.1 
1132 
17“+.S 
395 
292.1 
1927 
2066 
157.2 
928 
3*45. *4 
953 
1*46.1 
508 
380.2 
1113 
168.1 
*420 
311.0 
192S 
208*4 
156.s 
9*46 
3*48.0 
927 
1U1.3 
*4*46 
325.6 
1157 
171.9 
500 
370.7 
1929 
2168 
161.*4 
957 
3*48.0 
969 
1*46.9 
*481 
3*42.9 
1199 
175.3 
*476 
353.3 
1930 
187*4 
138.0 
923 
331.2 
1001 
150.9 
531 
369.8 
273 
125.6 
392 
290.9 
1931 
188*4 
137-2 
872 
309.9 
912 
136.8 
516 
351.2 
972 
137.7 
356 
26*4.8 
1932 
1600 
115.3 
279 
302.9 
721 
107.5 
*481 
320.1 
279 
122.6 
392 
296.1+ 
1933 
1719 
122.6 
896 
311.5 
885 
131.3 
509 
331.5 
87*4 
11*4.6 
327 
288.6 
193*+ 
16*46 
115.5 
9*4*4 
327.6 
819 
121.3 
532 
380.8 
827 
110. *4 
362 
267.*4 
1935 
1293 
131. *4 
1170 
*402. *4 
1002 
1^7.7 
777 
500.0 
891 
116.9 
393 
289.9 
1936 
1672 
11*4.7 
109*4 
373.0 
277 
128.9 
688 
“*36.7 
795 
102.5 
*K)6 
299-1 
1937 
19S2 
13“+. 5 
1225 
*41*4.1 
1037 
151.5 
79“+ 
1+96.5 
9“+5 
119.6 
1+31 
317.1 
1932 
1812 
121.6 
1192 
399.5 
898 
130.6 
772 
*47*4.8 
91*4 
113.9 
*420 
308.5 
1939 
1510 
100.2 
1211 
*402.5 
703 
101.8 
812 
“+93.2 
807 
83.9 
399 
292.8 
19*40 
1*468 
96.1 
1099 
362.2 
777 
112.0 
766 
“+5S.7 
691 
23.3 
333 
2*4*4.1 
19*41 
16*46 
106.9 
1371+ 
*4*49.1 
905 
129.9 
992 
529.3 
7*41 
87.9 
376 
275.2 
Total 
37.“*3“+ 
20.223 
18,52*4 
11.95“+ 
18.850 
8.269 
Maryland State Dept, of Health - 19^-2 
TUBERCULOSIS CaSES AND RATES PER 100,000 POPULaTKN - (All Forms) 
BALTIMORE CITY, COUNTIES OF MARYLAND AND STATE OF MARYLAND  
— 
BALTIMORE CITY 
COUNTIES OF 
MARYLAND 
Both Colors 
White 
Colored 
Both Colors 
White 
Colored 
Year 
Mai e 
Female 
Mai e 
Female 
Male 
Female 
Male 
Female 
Male 
Female 
Mai e 
Female 
1931 
3.5 
2.7 
3.1 
1.5 
5.6 
g.l 
9.0 
6.1 
6.1 
U.3 
2U.0 
15.6 
1932 
1.5 
- 
1.2 
- 
2.7 
- 
5-9 
U.8 
5.1 
3.7 
9.9 
10.9 
1933 
0.5 
0.5 
0.6 
0.6 
- 
- 
3.S 
3.2 
1.9 
2,8 
lU.l 
9.3 
193^ 
1.7 
0.9 
0.9 
0.6 
5.3 
2.6 
3.3 
2.8 
2.1 
l.U 
9.9 
10.9 
1935* 
2.9 
0.5 
3.3 
0.6 
1.3 
- 
U.6 
2.7 
3.3 
1.6 
11.3 
9.3 
1936 
1.0 
0.9 
0.6 
- 
2.6 
5.0 
2.6 
2.0 
2.3 
1.1 
U.2 
7-7 
1937 
0.2 
1.6 
0.3 
0.9 
- 
u.o 
1.3 
k.o 
0.5 
U.2 
6.2 
1932 
1.2 
0.7 
1.2 
0.3 
1.3 
2.1+ 
2.5 
2.U 
0.7 
1.3 
12.7 
9.2 
1939 
0.2 
- 
0.3 
- 
- 
2.1 
0.9 
1.2 
0.5 
7.0 
3.1 
19^0 
0.2 
- 
- 
- 
1.2 
0.8 
1.3 
0.7 
1.0 
l.U 
3.1 
* Resident figures "beginning with 1935 
Maryland State Dept. of Health - 19*+2 
Death rates per 100,000 population for TYPHOID FEVER by color and sex: 
Baltimore City and Counties of Maryland: - 19*40* 
Per cent decrease in number of deaths;in rates per 100,000 Population 
for Typhoid Fever for State of Maryland, 1906 - 19*40 
Rate 
Total 
White 
Colored 
-92.5 
-98.6 
-92.0 
TYPHOID FEVER 
Number 
Total 
White 
Colored 
-97*9 
-98.1 
'-97-^ TYPHOID FEVER CASES A1ID DEATHS WITH RATES PER 100,000 POPULATION 
STATE OF MARYLAND 
Year 
Cases 
Rates per 
100,000 pop. 
Deaths 
Rates per 
100,000 pop. 
1916 
2,668 
191.3 
265 
19.0 
1917 
2,344 
166.2 
256 
18.1 
1918 
1,687 
118.3 
238 
16.7 
1919 
1,614 
113.2 
170 
11.8 
1920 
1,028 
71.3 
100 
6.9 
1921 
1,594 
109.2 
152 
10.3 
1922 
1,207 
80.7 
106 
7.1 
1923 
1,212 
80.1 
100 
6«6 
1924 
971 
63.4 
97 
6.3 
1925 
1,271 
82,1 
116 
7.5 
1926 
1,061 
67.7 
120 
7.7 
1927 
874 
65.2 
94 
5.9 
1928 
789 
49.3 
87 
5.4 
1929 
550 
34*0 
68 
4.2 
1930 
986 
60.2 
102 
6.2 
1931 
787 
47.6 
90 
5.4 
1932 
695 
41.5 
52 
3.1 
1933 
554 
32,7 
37 
2.2 
1934 
416 
24.3 
38 
2,2 
1935 
483 
28.0 
44 
2,5 
1936 
273 
15.6 
29 
1.7 
1937 
327 
18.5 
33 
1.9 
1938 
281 
15.8 
31 
1.7 
1939 
182 
10.1 
15 
0.8 
1940 
127 
7.0 
11 
0.6 
Maryland State Health Dept. - 1942 TYPHOID FEVER DEATH RATES PER 100,000 POPULATION 
5TATE OF MARYLAND, 1907-1940 diphtheria cases and deaths with rates per 100,000 population 
STATE OF MARYLAND 
Year 
Cases 
Rates per 
100,000 pop. 
Deaths 
Rates per 
100,000 pop. 
1916 
1,885 
135.2 
170 
12.2 
1917 
1,596 
113.1 
137 
9.7 
1918 
1,259 
88.3 
135 
9.5 
1919 
2,743 
190.3 
225 
15.6 
1920 
2,562 
174.9 
192 
13.2 
1921 
2,596 
175.8 
182 
12.3 
1922 
2,643 
176.9 
163 
10.9 
1923 
2,355 
155.7 
156 
10.3 
1924 
1,845 
120.6 
118 
7.7 
1925 
1,511 
97.6 
88 
5.7 
1926 
1,356 
99,4 
98 
6.3 
1927 
2,159 
136.4 
118 
7.5 
1928 
1,539 
96.1 
106 
6.6 
1929 
1,058 
65.3 
72 
4.4 
1930 
1,139 
69,6 
60 
3.7 
1931 
1,503 
90.8 
65 
3.9 
1932 
914 
54,5 
52 
3,1 
1933 
626 
36.9 
29 
1.7 
1934 
505 
29.4 
25 
1.5 
1935 
426 
24.7 
22 
1.3 
1936 
434 
24.9 
33 
1.9 
1937 
513 
29.1 
23 
1.3 
1938 
356 
20.0 
21 
1.2 
1939 
245 
13.6 
23 
1.3 
1940 
158 
8.6 
7 
0.4 
Maryland State Health Dept, - 1942  
Baltimore 
CITY 
COUN 
TIES OF MARYLAND 
Both Colors 
White 
Colored 
Both 
Colors 
Whit 
e 
Colored 
Year 
Male 
Female 
Male 1 
Female 
Male 
Female 
Male 
Female 
Male 
Female 
Male 
Female 
1931 
3,7 
1.9 
2.4 
1.5 
9.7 
4.1 
4.6 
5.4 
3.6 
4.3 
9.9 
10.9 
1932 
2.2 
1.4 
1.5 
0.9 
5.5 
4.0 
3.9 
4.8 
3.0 
4.5 
8.5 
6.2 
1933 
1.2 
0.2 
0.9 
0.3 
2.7 
2.5 
2.8 
2.7 
3.1 
1.4 
1.5 
1934 
1.2 
0.5 
1.2 
0.6 
1.3 
- 
1.8 
1.9 
2.1 
1.9 
- 
1.5 
1935 
- 
1.4 
- 
1.7 
- 
1.7 
2.7 
1.8 
2.4 
1.4 
4.6 
1936 
0.5 
1.4 
- 
0.9 
2.6 
3.7 
3.0 
2.5 
3.3 
1.6 
1.4 
7.7 
1937 
0.5 
1.2 
0.3 
1.1 
1.3 
1.2 
1.3 
2.2 
1.5 
2.1 
- 
3.1 
1938 
0.2 
0.5 
0.3 
0.6 
- 
- 
1.5 
2.4 
1.5 
2.3 
1.4 
3.1 
1939 
0.2 
0.5 
0.3 
0.6 
- 
- 
2.3 
1.9 
2.4 
2.0 
1.4 
1.5 
1940 
0.2 
- 
0.3 
- 
- 
0.4 
0.8 
0*5 
0.7 
- 
1.5 
♦Resident figures beginning with 
1935 
Rate 
Total 
lihite 
Colored 
-90.5 
-98.5 
-90,7 
Per cent decrease in number deaths and rates p-jr 100,000 Population 
for Diphtheria for State of Maryland, 1906-1940 
Maryland State Dent, of Health - 1942 
Death rates per 100,000 population for DIPHTHERIA by color and sax; 
Baltimore City and Counties of Maryland; 1931 - 1940* 
Number 
Total 
■White 
Colored 
-97.9 
-97.8 
-98.1 MARYLAND STATE DEPARTMENT OF HEALTH 
MAPS 
1* Table of Organization 
2. State of Maryland - Counties in Which are Located Military Reservations 
or Industrial Projects 
3. Allegany County 
4. Anne Arundel County 
5. Baltimore County 
6. Calvert County 
7. Cecil County 
8. Charles County 
9. Frederick County 
10. Harford County 
Since these maps were compiled, all the Eastern Shore Counties have some 
defense project or military reservation established or proposed. Director of Health and Chairman of the Board 
•OrJohnS-Fulton Jan.1,1923to May26.1928 
♦ Appointed Director Emeritus, May 26,1928- 
Dr. Robert H. Riley. Director oP Health 
ond Chairman of the Board, Mcy 26.1926. 
Secretaries ond State HealthOPPtcere 
Maryland State Board of Health 
• EXECUTIVE SECRETARIES - 
Or. E Lloyd Howard 1874. 1876 
Dr. Ch os. W. Chan cell or—1876 1699 
Or. Jomei Steuart 1893 1896 
*Dr. JohnS. Fulton 1896 1907 
* Sept 17 1896 to Moy 1.1907, - 
Secrrtory-GancroUntcmelional Congress 
on Tuberculosis, 1907 to 1909. 
Secretary-Generol.Internatiooal Congress 
on hygiene and Demography. 1909-1913. 
Or.Marshall L Price 1907-1913 
Dr John S Fulton 1913-1923 
i Secretary to the Board and State 
! Health Officer from 1914 to 1923. 
BUREAU OF 
CHILD HYGIENE 
Authorized by Law 
and organized in 1922. 
Consultation Service 
Pediatricj 
Obstetrical. 
Clinics: 
Prenatal, Postnatal. 
Infant ond Preschool. 
Public Health 
Nursing Service, 
Maternity and 
Child Hygiene. 
Nutrition Service.| 
Organization op 
Volunteer Service 
for Mothers 
and Children. 
Instruction in 
Maternity and Child 
Care.~ Lectures, 
Demonstrations, 
Conferences 
and Literature. 
Maintains Health 
Trai I er Travel ling 
Clinics for Children. 
Supervision over 
training of Mid wives 
State Department of Health of Maryland, 
BUREAU OF 
SANITARY 
ENGINEERING 
Bureau authorized 
by Law of 1910 and 
organized in 1912. 
So pervlsionand Control 
over Water o» 4 IceSoppIies 
Sewage and TradeWostes,. 
Defuse Disposal, 
Stream Pollution, 
Shellfish Investigations 
Supervision and Control 
over Installation, 
Extension, Alteration, 
Maintenance and 
Operation of 
Water and Sewerage 
Systems and Works. 
Approval of Plans, 
Design of Sanitary 
Works for State 
Institutions. 
Investigation of 
operation and 
maintenance of 
Sanitary Works. 
Research on Water, 
Sewage and Trade 
Waste Treatment. 
Promoting 
installation of 
Sanitary Works 
throughout the State. 
EDUCATIONAL 
County and Community 
Organization for School 
Dental Clinics. 
Undergraduate Instruction 
in Preventive Dentietry. 
Teacher training Course 
in Oral Hygiene. 
State Boards of Health-.- 
Massochusetts 1869 
California 1870 
Minnesota -.1872 
Virginia 1872 
Michigan 1073 
Maryland 187+ 
BUREAU OF 
FOOD Ss DRUBS 
Legislative Acts 
of 1890-1910 
Bureau authorized 
by Low in 1910- 
STATE FOOD AND DRUG 
COMMISSIONER ,1910 
DEPUTY DRUG 
COMMISSIONER, 1922 
Sanitary Inspections 
of Food and Drug 
Handling Establishments 
Educational and 
constructive measures 
Cold storage supervision 
Inspection of Dairies 
and Pasteurization 
Plants. 
Enforcement of 
Food, Drug and 
Pharmacy Laws. 
Food and Drug 
Inspection. 
Inspection of 
Canneries, 
Crabmeat and 
Oyster packing 
Establishments. 
NUTRITIONIST 
DIVISION OF 
ORAL HYGIENE 
* Chronology of inauguration of full time County health service-.'Allegany 1922Montgomery 1923; Frederick, Baltimore, 
Calvert and Carroll !924;Prince George's and Talbot 1927, Harford 1928, Cecil and Wicomico 1929, Kent, Washington and 
Anne Arundel 1530, Garrett, Dorchester,QueenAnnesend Worcester l931-,StMoryb,Charles, Howard ond Somerset 1932, Caroline 1954, 
DIVISION OF 
PERSONNEL 
AND ACCOUNTS 
Organized by the 
Board in 1910. 
Money 
Accounting 
Property 
Accounting 
Purchase and 
Distribution of 
all Supplies and 
Equipment. 
STATE BOARD OF HEALTH 
ORGANIZED, MAY6,1Q74 
ACT PASSED, JANUARY SESSION OF GENERAL ASSEMBLY 
Priniing 
DIRECTOR OF PUBLIC HEALTH 
• cJ arm ary 1,1923 • 
COUNTY . 
HEALTH UNITS 
Full Time Health Units 
in all the Counties. 
Legislative Acts of 
1914,1922 and 1931. 
County Health Officers arealso 
Deputy State Health Officers. 
They represent the 
Director of Public Health. 
In cooperation vith the 
State Health Department, 
they formulate ond administer 
the County Health Program. 
Epidemiological 
Investigations. 
Preventive Inoculations. 
Supervision of Clinics. 
Supervision of 
Nursing Service. 
Sanitary Surveys and 
Investigation of Nuisances 
Examination of 
School Children. 
BUREAU OF 
CHEMISTRY 
Legislative Acts of 
1887+1908 and 1910. 
Bureau authorized 
by Law in 1910. 
Examination of 
Foods, Drugs,Water 
and Sewage; 
also Trade Wastes. 
Development of 
new analytical 
Methods for Foods, 
Drugs, Water and 
Sanitation Products 
tAnalyst provided 
by the State Board 
of Health in 1687. 
STATE ADVISORY NURSE 
EDITORIAL 
ASSISTANT 
Public health Education 
Maryland State Board of Health 
is SIXTH in Point of Age. 
Admitted to Area of Death 
Registration in 1906. 
Admitted to Area oP Birth 
Registration in 1916. 
BUREAU OF 
BACTERIOLOGY 
Legislative Acts of 
1898,1910 and 1939. 
Bureau organized 
in 1912. 
Examination of 
Specimens for 
Physicians and 
Health Officials 
in connection with 
the Diagnosis 
and Control 
of Diseases 
Examination of 
Samples of Water, 
Milk. Shellfish 
and other Foods 
to determine 
freedom from 
Infectious Agents. 
Establishment of 
Minimum Standards 
and Qualifications for 
Laboratory Workers 
in the Counties of 
Maryland. (Ad-of1939) 
Central Laboratory; 
Baltimore. 
Branch Laboratories 
at Cumberland, 
Hagerstown, Hurlock, 
Frederick, Rockville, 
Salisbury, Elkton, 
Annapolis and LoPlata. 
DIVISION OF LEGAL 
ADMINISTRATION 
Investigates violations 
and enforces 
Health Laws. 
Administers Bedding 
and Upholstery Laws. 
BUREAU OF 
COMMUNICABLE 
DISEASES 
Acts of Legislature, 
1890,1896,1904,1910. 
Authorized by Law,19IO 
Registration of 
Morbidity of all 
Reportable Diseases 
Administrative 
control of 
Communicable 
Diseases. 
Tabulating,Computing 
and Analysis of 
Morbidity Data. 
EPIDEMIOLOGIST 
January 1,1930. 
Epidemiological ond 
Diaqnosti c Servi ces. 
PASTEUR 
TREATMENT 
V.D.CONTROL 
TUBERCULOSIS 
CONTROL 
SERVICES FOR 
CRIPPLED CHILDREN 
Former Presidents of the Maryland 
State Board of Health. ~~ ~ 
Dr. Nathan R.Smith 1874-1875 
Dr. E.Lloyd Howard 1876-1081 
Dr. Jos Robert Word 1881-1884 
Or. Richard McSherry 1884 "1885 
Dr. Jackson Piper. 1886-1893 
Dr.John Morris 1893-1895 
Dr. J.M.H. Bateman 1895-1897 
Dr. SChas.de Kraft. 1897-1899 
Dr. Wm. H.Welch.. Jan I900-Jonl923 
- Chairmen of the- Board ~ 
Dr. John & Fulton, Jan.1,1923-May 26,1928. 
Dr. Robert HRiley, May 26,1928— 
The Board consists of 9 Members,as-fbllows, 
4 Physicians, 1 Civil Engineer, I Pharmacist, 
1 Doctor of Dental Surgery, the Attorney General 
of the State and the Commissioner of Health 
of Baltimore City (ex-officio). 
The County Health Officers are appointed 
with the advice and consent of the State 
Board of Health. (Act of Legislature,1931). 
BUREAU OF 
VITAL STATISTICS 
Legis lative Act of 1865 
Amended, 1898,1900,1920. 
Registration began in 1898. 
Separate Bureau 
authorized in 1910. 
Registration of Births 
and Deaths through 
Local Registrars. 
Advice and Assistance 
to unregistered Persons 
Query.correction and 
indexing of Certificates 
1 ssoance of registration 
Statements ond 
Certified Copies. 
Filing Duplicates of 
Marriage and Divorce 
Certificates. 
Tabulation and 
Publication of 
Statistics. 
Conduct of 
Statistical Studies 
and Analyses. 
Licensing of Midwives] CoonD'eS /-n ch rcct/y n ect, eJ 
v/tA Defense A ct /&$ 
Coi/'n't 'C?S /*» there 
/*)'» I t~tsrry /?ese r yat / o s o*- 
Defense / 7* dr esD'r'f es 
St A'&eL Oftpt. of A/tk J / 9 iL* Outline Map of 
Maryland State Department of Health, 19^2 
ALLEGANY COUNTY 
Area Surrounding 
Kelly-Springfield Tire Co,, which is being converted into a war industry 
Population 86,973 
Square miles U25 Outline Map of 
ANNE ARUNDEL COUNTY 
Area Surrounding 
1. Fort?MeAde 
and vicinity 
2, Annapolis and 
Naval Academy 
Population 68,375 
Square miles 630 
Maryland State Department of Health, 1942 Outline Map of 
BALT DO HE COUNTY 
Area surrounding 
1. Black and Decker 
2. Bendix Radio 
3, Julien P. Friez & Sons 
4, Glenn Martin Aircraft and Bethlehem Steel Company 
5, Westinghouse Instrument Company, Lansdovme 
Population 155,825 
Square miles 702 
Maryland State Department of Health, 1942 Outline Maps Of 
CALVERT and ST. MARY’S COUNTIES 
Population Calvert County; 
Pop. 10,484 Sq.miles 369 
Population of St. Mary*s: 
Pop. 14,626 Sq. miles 799 
Indicates areas 
surrounding; 
1. Amphibious Base, U.S. Navy 
2. Airport, U.S, Navy 
Maryland State Department of Health, 1942 Outline Map of 
CECIL COUNTY 
Area surrounding 
1. Triumph Explosives and National Fireworks at Elkton 
2, U.S, Naval Training Station at Port Deposit 
Population 26,407 
Square miles 424 
Maryland State Department of Health, 1942 Outline Map of 
CHARLES COUNTY 
Area surrounding 
U.S. Naval Reservation 
at Indianhead 
Population 17,175 
Square miles 641 
Maryland State Department of Health, 1942 Outline Map of 
FREDERICK COUNTY 
Indicates area v 
surrounding Airport, U.S. Army 
Population - 57,312 
Area- 669 Square miles 
Maryland State Department of Health, 1942 Outline Map of 
HARFORD COUNTY 
Areas surrounding 
Bel Air 
Edgewood Arsenal 
de Grace and Aberdeen 
Population - 35,060 
Square Miles - 539 
Maryland State Department of Health, 1942 Outline Map of 
WASHINGTON COUNTY 
Area surrounding 
1. Fairchild Airplane Company 
2. Camp Ritchie- U.S. Army Reservation 
Population 68,838 
Square miles 468 
Maryland State Department of Health, 1942