Work on the Hospital for Negro Insane, later renamed Crownsville State Hospital, commenced in late April of 1910.  Thirty-one African American male patients from Montevue Asylum were put to work with clearing the land and building a railroad spur to the hospital site.  Arriving first in handcuffs and guarded by a dozen deputy sheriffs, the men "were told that they would be treated entirely differently, and that they would not be confined to cells or wear handcuffs or straight jackets."  Each man was then issued an axe.  With three orderlies to assist him, Dr. Robert J. Winterode, the appointed Superintendent of Crownsville, "worked with these 'dangerous insane' Negroes all summer, cutting hundreds of crossties, and many tall poles for the electric wires, and had not a single accident.  Best of all, this active life in the open greatly improved the mental condition of the patients and some of them were actually cured."  By 1913 all the mentally ill patients had been taken away from Montevue and the insane department closed. 

It is hard to assess to what degree the conditions actually improved for those left behind in the almshouses and asylums.  Though most of the indigent insane had been transferred elsewhere within a few years, other populations continued to languish in these settings.  The 1912 Maryland Department of Charities and Corrections Annual Report estimated that "one hundred percent of the feeble-minded individuals and sixty percent of the epileptics cases" still continued to be housed in these institutions. 

Dr. Herring's photographs and the Lunacy Commission's campaign to publicize them played a prominent role in bringing mental health care reform to Maryland.  What had been hidden in the text of reports for decades suddenly appeared as images before politicians and the public.  This time no one could look away.  The photographs challenged all Marylanders and, for a brief moment, caused them to pause and reflect on the progress of their society and its priorities.