During the twentieth century, Maryland
politicians, reflecting the citizens they represented, struggled with questions of reform.  Governor Crothers, considered a Progressive, gave his support both to the state care campaign and the movement to disfranchise black voters.  Crothers and most of the legislature believed that reform included the exclusion of African Americans from the political process.  They more often equated progress with building projects.   Baltimore, the last major city without a modern sewerage system, embarked upon a comprehensive construction program during this period.  A good macadam road was a wise use of state monies, bringing accolades upon the county representative or senator who championed the local interests.  Better roads brought the means to develop the state's natural resources and inaugurate better economic times for most citizens.  The roads themselves, used on a daily basis, provided a constant reminder of their necessity to everyday life.  Though road-building proved costly--$5,300 per mile in 1905 dollars--it was a shared expense from which everyone derived benefits.  The advent of the automobile and its subsequent enthusiastic embrace by the populace ensured roads  would recieve additional monies.  By 1908 the sum of one million dollars per year was budgeted in that direction with very little political opposition. 

Not all reforms, and not all forms of progress, moved so swiftly.
For reasons not yet fully understood, the core of upper- and upper-midle class Maryland women who championed causes such as playgrounds for children, pure milk, and smoke abatement during the Progressive Era, did not embrace the cause of the mentally impaired.  Hidden away in almshouses, often in the most inaccessible areas in the counties, the pauper insane remained invisible and faceless to the general public for decades until the Lunacy Commission photographed their mistreatment.  The commission understood that the needs of a marginalized population were no match for the general public's desire for good roads, yet in the absence of a broad-based citizens' campaign the commission had to plead its case before that very public. 

In the final analysis money remained an issue.  Hard-hearted economics--state road construction and the public's aversion to paying additional taxes--worked against the proper care of all of the state's mentally-impaired.  A contemporary appraisal of the State Care Act noted that it did not in fact provide for true state care. The counties' providing $100 of the $150 to maintain patients in state hospitals, "leaves the matter in a rather confused and unsatisfactory condition," commented one observer.   Maryland's population grew dramatically every decade, and so did its number of insane.  In 1916, state hospitals were still being enlarged to accommodate all the patients from the almshouses, but an adequate number of spaces never materialized.  By the 1930s state hospitals were themselves overcrowded. 

The Lunacy Commission photographs of the almshouses constitute a radically different use of images in state reports.
Dr. Herring's photographic expose, uncovering as it did the unsatisfactory conditions at county almshouses and asylums, constituted a well-engineered attempt to mold public opinion in favor of reform legislation through the use of selected images. 
Publicizing the images to a wide audience, thus garnering the support of an interested public, ultimately forced state legislators to pass the necessary legislation and an appropriations bill that allowed for the transfer of patients from county institutions into modern state mental hospitals.  In theory, with the passage of the revised State Care Act of 1910, the scenes that Dr. Chancellor had witnessed in 1877 would occur no more.