Introduction

To respond to a recent demand of the ACLU of Maryland, and to augment theories from Disability Incarcerated (2014) about the convergence of race, disability, and due process (or lack thereof), this essay analyzes the extent to which racism informed the creation of Maryland's Hospital for the 'Negro' Insane [Crownsville Hospital]. In light of our inequitable and sometimes reprehensible past, I locate this history within the rhetoric of making amends that is led by local activists who wish to hold the government accountable for institutionalized racism in the Jim Crow era. My work here is also allied with the Baltimore Uprising of 2015 and the Black Lives Matter movement. Crownsville Hospital opened in 1911, 22 miles due South of Baltimore, as the Maryland Hospital for the 'Negro' Insane. The institution closed in 2004. Today, we can—and do—remember Crownsville as a frightening extension of the tale of the "night doctors" who allegedly kidnapped Black people off the streets of Baltimore for research (Skloot 166). Without a doubt, Crownsville embodied a Jim Crow racism, aided and abetted by eugenics, that would serve up inequitable consequences for African Americans. And in another vein, we remember Crownsville as a place of survival, even healing, that attempted to offer aid to people when services in the community were scant and nearly impossible to access.

In order to understand the extent of racism in Crownsville's earlier years, I will take into account 14 categories within conditions of confinement from 1921-1928 and compare them to the nearby, white asylum. Ultimately, the hospital joins the ranks of separate and unequal (Plessy vs. Ferguson) institutions founded alongside a rhetoric of fear that the Baltimore Sun daily paper deemed "a Black invasion" of the city of Baltimore. That eugenic ideologies functioned as infrastructure for Jim Crow is no accident; the rhetoric of "racial hygiene" added medicalized reinforcement for the removal of people with more melanin from society. My analysis in this essay supports Tim Wise's view that "the way out is back through…there [is] no running from truth, no finessing it, no working around it as though it were not there. The injury has been real. It is still real today…and we do this not out of guilt…but out of responsibility" (194). Even more, I add to public memory of this racialized space invoking the rhetorical frame, as Kendall Phillips advises, of responsibility and apology (versus absolution) within the context of present-day racial justice movements.

Baltimore's Legacy

What follows in this section is an abridged account of Baltimore's racial history that gave rise to the opening of Crownsville Hospital. Much of this history of segregation and institutionalized racism is only a part of the public memory; thus, in order to understand Crownsville's place within public memory, we must begin with the urban realities of Baltimore. Not only was the City of Baltimore the last major city without a modern sewage system (Schoberlein 468), but it also was—and still is—"demographically singular" (Roberts 9). Baltimore's increasing number of Free Blacks led to the establishment by the legislature of Maryland of a State Colonization Society ("back to Africa" movement) in the 1830s. State funds were appropriated towards the removal of Black people out of the State. Throughout the 1850s and early 1860s, the General Assembly of Maryland passed resolutions "barring slaves and 'free negroes' from assembling for religious purposes, owning dogs or guns, from being educated, restricting their physical movement and job prospects" (Dilts 55-6). Legislators and public officials correlated Blackness with undesirability, even incongruity with civic and public life.

Even though the State of Maryland did not officially join the Confederacy, racial segregation was (it could be argued still is) the law of the land here. Maryland had abolished slavery in 1864, a year after the Emancipation Proclamation (since it wasn't part of the Confederacy, there was no mandate for emancipation in 1863), but "rebels, criminals, and lunatics" were excluded from this state-mandated freedom (Dilts). Between 1880 and 1900, Baltimore's Black population grew from 54,700 to 79,000 (Power 290). In 1910, Baltimore's Black census reached 84,000. In the U.S., only Washington, D.C. and New York City were home to more African Americans than Baltimore (Roberts 9). The Colonization Society, active in the first part of the 1800s, had failed but gave way to an oppressive Jim Crow culture. In 1911, Baltimore's white population reached 477,899, while "colored" people numbered 85,801 (Annual Report, State Board of Health 1911, 4). Today, the city's population totals 622,793 (as a result of white flight, 31% are white or 193,650 people; 63.3% are Black or 392,359 people) (Census). The death rate of African Americans has always been considerably higher than that of white people, as have the rates of incarceration and poverty.

Baltimore had a flourishing African American cultural scene leading up to 1911 when Crownsville Hospital opened. In the city, there were 31 Black newspapers between 1856 and 1900 (Roberts 10), and Pennsylvania Avenue was alive with performers such as Billie Holliday, Cab Calloway, and more. In response to the growth of Black culture, "fear of a Black invasion" prompted three proposed voting amendments from the legislature (disenfranchisement of Black voters) between 1903-11 (ibid) and a trend-setting Residential Segregation Ordinance in 1910, which prompted many similar ordinances in Southern states. The Ordinance deemed it illegal for a white person to move onto a block that was more than 50% Black and similarly illegal for a Black person to move onto a block that was more than 50% white (Power). The NAACP emerged to fight this wave of discrimination.

Due to the need for care amidst a society with foreseeable "separate but equal" mandates, Provident Hospital opened in Baltimore in 1894, two years prior to the Plessy decision, as a free hospital and dispensary to provide care for Black people by Black physicians (Elias 23). Encouraged by the moderate Booker T. Washington, Provident Hospital was created by and for Black people with the financial and ideological backing of African American churches, women's groups, and fraternal organizations. Black physicians during this period found themselves unable to practice medicine after graduation unless they could find a position in a Black institution, and thus Provident served two important functions. Johns Hopkins Hospital's Phipps Psychiatric Clinic in Baltimore provided advanced and benevolent care, but Black patients were rarely admitted if at all (Lamb 259).

Such widespread, legally sanctioned segregation would be the impetus by white politicians and white medical practitioners to open an all Black asylum (Crownsville) in the Baltimore region in 1911. Unlike Provident Hospital, Crownsville was not founded as a result of advocacy within Black communities; rather, it can be argued that Crownsville operated as the receiving station for a forced exodus and a "ghetto-clearing." The opening of Crownsville Hospital was fueled by Baltimore's preeminent brand of Jim Crow segregation as well as by progressive and often misguided reform aimed to assist the "insane." The same year that Crownsville officially opened, the Baltimore Ethical Society held its First (and last) Universal Races Congress of 1911. Dr. W.E.B. DuBois presented a paper titled "The Negro Race in the United States of America" as a report on racial oppression. Many anthropologists at the Congress argued that there existed inherent differences between races and that Blacks were of a different species entirely (Volcheck). This, paired with eugenic ideologies that professed against miscegenation ("interbreeding") and conflated blackness with criminality, lack of intelligence (even idiocy), contamination, and depravity, helped to crystallize the notion of racial hygiene as justification for brutally unequal treatment. This was the climate in Baltimore in 1911 which meant that black people—specifically those who were very broadly construed as "insane" or "unhygienic"—would pay a great deal for the legal doctrine of separate but equal.

Maryland Hospital for the "Negro" Insane

In addition to rendering visible a condensed version of Baltimore's racial history, it is also important to ferret out some of the details of Crownsville Hospital. Built on ideologies of eugenics and racial hygiene, at Crownsville Black people were further disadvantaged and services underfunded via racial segregation. Crownsville Hospital operated a workcamp for incoming "patients" upon its opening in 1911. No such workcamp is evidenced to have existed for the building of the nearby white asylum, though other asylums did have them. A photograph from the first Annual Report at Crownsville captures men clearing brush and unearthing soil to clear space for a new road from the hospital site to the temporary building. The State purchased farmland for $19,000 so that "12 able-bodied men [who] were obtained" from Spring Grove Asylum in Catonsville, MD (which was transferring out all Black people) could begin construction on the site and farm neighboring land (1^st AR; 25, 30-1). After the first twelve men arrived from Spring Grove in its move to transfer Black patients out, sixteen more followed from Montevue Asylum in Frederick, MD. Montevue had been the object of a photographic exposé in 1908-9 which contrasted the Victorian-style five story building for white patients alongside the crowded and ramshackle farmhouse in the back for Black patients. Black patients at Spring Grove had also experienced threadbare conditions, and often used tents as housing. Another 32 men arrived at the Crownsville worksite from other county asylums, Bayview Asylum (Lunacy Commission Report, Dec. 1910, 70), and almshouses and jails across the State. They cut trees and make crossties for the railroad tracks that would connect to the hospital.

Hugh Young, preeminent urologist from Johns Hopkins and a member of the Board of Managers of Crownsville, paints an unsettling picture:

The only men available were incarcerated at Montevue…which was devoted almost entirely to the violent and dangerous insane. Some of them were murderers. These were considered so dangerous that a number were kept in isolated cells or in strait jackets. Regardless of the bad character of these men, Winterrode [Crownsville's first Superintendent] said he could handle them, and begged us to send them down…handcuffed and guarded by a dozen deputy sheriffs (A Surgeon's Autobiography, 411; 1468).

Within the context of the hard labor performed, this commentary is confusing. No escape attempts or incidents are mentioned in the first Annual Report (Oct., 1911), though the following Report indicated "necessity of legislation to provide add'l guards to prevent escapes" (1911-13, 8). Despite Young's fears, nearly all of the work the first year was done with patient labor, which is quantified in the report according to its savings to the State A total of $2,509.75 in patient labor was recorded for the first year (which equals $62,618.27 today) (31).

Additionally, three individuals recorded as one epileptic "imbecile" 10 years of age and two adult males washed and ironed 40,000 pieces (Dec. 1912, Lunacy Commission). Other labor included turning broom corn into brooms, shoe repair, turning rags into rugs, reseating chairs with corn husks and hickory strips, and weaving baskets and hampers (Biennial 1911-13, 45-7). Female patients labored in the fields. Per the 1915-1917 report they labored "picking up potatoes, hoeing, weeding, picking beans, tomatoes, peas, and strawberries, stripping willows and raking leaves." In addition they did indoor work such as preparing vegetables, housekeeping, and sewing (Biennial 1915-17, 47).

The white men who led Crownsville have been valorized and remembered. Alongside Hugh Young—who is memorialized by having a Urological Award named after him— is the Johns Hopkins physician William L. Marbury. Marbury, who was the U.S. Attorney General for Maryland (1894-1898), held the position of President of the Board of Managers at Crownsville from 1910 until 1935. Garrett Power describes Marbury as having "credentials as a segregationist [that] were well established" (304); he was also a virulent anti-suffragist. He authored the second Segregation Ordinance and lived in a white neighborhood actively trying to "prevent negro invasion of white neighborhoods" (Wilson). Later, in 1927, a building on the grounds of the hospital would be built and named for Marbury "to honor the president of the Board of Managers…for his twenty-five years of devoted service." The building housed the industrial workshops, a carpentry shop, and a cannery; additionally, "the concrete blocks [of the building's walls] were manufactured by the patients in industrial classes" (MD Historical Trust, AA-970). Public memory of Young and Marbury is supported in the naming of buildings and awards.

Yet, no one seems to remember that inmates would wash their dishes separately from the white officers, employees, and guards (ibid, 24). Those inmates initially lived in the Reception Building which was the first building was occupied in 1913. It was made up of four stories, two wings with three stories. The first floor had hydrotherapy wards (ibid, 28) (prolonged tubs) where inmates might be victim to what likely felt like punishment. Some hydrotherapy "treatments" of the period included a determination as to whether the person required warm water to calm or tire them or cold water (sometimes ice or high pressured jets were used) to stimulate them. The second building erected was the Administration Building which housed the mortuary, post-mortem room (where autopsies were performed), a museum, and a storeroom.

As was common in the day, a belief in innate differences between races often extended to include mental and psychological diagnoses. When we confront stereotypes today, rarely do we remember the diagnostic category of dysaethesia aethiopica which "diagnosed" laziness in black people; we don't know that negritude was constructed as a mild form of leprosy. Blacks and whites received disparate psychiatric diagnoses that, likewise, were racially fraught in that they often advantaged white people. Henry M. Hurd, first director of Johns Hopkins Hospital (1889-1911) and member on the Lunacy Commission of Maryland, the governing body that started Crownsville wrote that,

The negro, as a race, after the war was not prepared to care for himself or to combat the new problems in his life. He became prey to his own weaknesses and passions and to whatever constitutional deficiencies he had. He suffered from ignorance and disregard of hygienic laws, promiscuous over-crowding in living quarters, and laxness in the bond of the family circle. Habits of indolence, intemperance, immorality; often insufficient and unwholesome, chat and adulturated food and whiskey, have all operated against the physical and mental welfare of the negro (Hurd, 373).

White doctors considered Black people more susceptible to mania than to depression or melancholia because whites supposedly had a higher developed intellect which made them more pensive and internally reflective; Black people were supposedly prone to outbursts, anger, and physical defiance, all embedded in an immoral lack of ability to care for the self (Hurd, 376; Summers, 75; Hughes 448). In 1911, Diagnoses (out of 194 inmates) looked like this: alcoholic intoxication (acute hallucinosis, paranoic state) 9; organic brain disease (focal lesion, senile dementia, general paresis/late-stage syphillis) 44; dementia praecox (schizophrenia) 10; manic depressive excited 7; manic depressive mixed 11; depressed 7; paranoic 13; melancholic 5; epileptic 16; neurasthenia (psychopathological mechanical weakness of nerves) 1; imbecility 71. Whereas there are still remnants of threads of Drapetomania (pseudo mental illness that causes a slave to want to escape), Hurd blamed the urban crowding and idleness as the causes of mental disease in Black people (374). It is apparent from the yearly reports that people were sent to Crownsville for alcohol problems, and the high rate of "imbecility" is likely indicative of biased assessments of intellect and fear of "how feeble-minded children had spread social diseases in white families in which they worked" ("Delegation"). It was suggested that a "school" be located on the grounds at Crownsville Hospital (ibid).

Martin Summers calls this medical practice "colonial psychiatry," a racial hierarchy that located Black people at the bottom and determined diagnosis and treatment. Eugenics, and in this case, racial hygiene, mistranslated social and economic neglect of communities as generational biological and racial inferiority. As Nancy Ordover writes, eugenics "is hydralike in strategy and ideology, one tentacle entwined with nationalism, another extending toward reform-oriented liberalism, others to blatant homophobia, racism, misogyny, and white supremacy" (124). At the confluence of Jim Crow segregation, biological determinism, scientific racism, and new modes of psychiatry, Crownsville Hospital emerged to offer "care" in the most dubious of contexts. Although I could find no evidence of sterilizations, racial health injustices and disparities are ever apparent. By remembering and accounting for disparities within communities affected by eugenics, we move closer towards a full picture of our past.

Conditions of Confinement

In the following section, to delve deeper into disparities, I will discuss the main features of confinement Crownsville from 1921-1928 and amass them alongside conditions at the nearby white asylum. I also look to conditions before and after these dates in order to offer context. These years of 1921-1928 were chosen to emphasize because of the accessibility of the corresponding records from both asylums and because of the larger number of patients by this period; admittedly, I also became engrossed in the story of the murder of William H. Murray that took place at the asylum in 1923 and wanted to include that in my study. In this section, I will also offer a brief explanation of my method.

Even though conditions at Crownsville were meant to be better than those at almshouses and county asylums, conditions were not good. It also can not be argued that conditions at the asylum were better than conditions in the city of Baltimore (as some used as arguments for the creation of it). Facilities were primitive and water quality was a recurring issue prior to the construction of buildings. Patients bathed over a cement pit and used outhouses, though this is not that unusual for the general public during this period (Dec. 1911, Lunacy Commission). It was observed that "Temporary [housing] quarters suggested itself" so the farm building was converted into temporary quarters; steam heat was repaired in it (Dec., 1911 Lunacy Commission, 46). Epidemics typical of the time were experienced by patients. In 1911, a Smallpox epidemic broke out– "The torch which started the contagion was a man sent from one of the county jails"; within six hours of diagnosis, 260 people (all staff and patients) were vaccinated (1911-13 48). After that everyone was vaccinated immediately upon arrival.

The report of 1911 requested a typhoid vaccine, indicating a problem with its spread. Although the typhoid vaccine was not licensed in the U.S. until 1914, Crownsville and other asylums began to vaccinate for typhoid as early as 1911 due to contaminated water supplies (Biennial, 51; see Hachtel article, 1911). Medical personnel, asylum and hospital patients, and prisoners (Crownsville, Springfield State Hospital, Spring Grove, Maryland House of Correction) received the vaccine prior to its licensing possibly due to desperation, though some might argue due to the ease with the vaccine could be dispensed to captive populations (State Board of Health, 1914, 168). Harriet Washington concurs that "These subjects [black, poor inner-city folks] were given experimental vaccines known to have high lethality" (6). Facilities that treated white folks, such as Spring Grove State Hospital for the Insane, Mercy Hospital, Springfield State Hospital and more, received the test vaccines as early as 1910 (Hachtel, 15). In 1909, Frederick F. Russell, a U.S. Army physician, developed an American typhoid vaccine and two years later his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military. Even though the Typhoid vaccine was requested at Crownsville in 1911, patients didn't receive it until all were vaccinated during the summer of 1913 (51). It is noted that there is "absence of typhoid" by 1915 with the routine inoculations and vaccinations (Biennial 1915-17, 22).

Typhoid fever, smallpox, diptheria, and influenza were less of a problem than tuberculosis in these early years: "With daily admissions from the most unhygenic environments placing us in constant danger of infecting our household with tuberculosis, isolation was an immediate necessity," claimed one Crownsville staff member (1911-13, 53). A temporary shack surrounded by a stockade of wire with separate yards was provided for these inmates, but a problem with heating developed when winter came so the administration asked for a permanent quarantine building. Again in 1917, the administration asked for construction of quarters for patients suffering from tuberculosis (Biennial 1915-17; 1140). Statistics on TB are more available a few years later. From October 1, 1921 to September 30, 1923, 264 new patients were admitted to Crownsville, 52 dismissed, and 166 died (16 of Tuberculosis). The death rate per 1000 in the city of Baltimore during 1922 was 12.91% for white people and 21.12% for Black people (Dublin, Louis I. Vital Statistics, American Journal of Public Health). For 1922, Crownsville's death rate was 21% (see charts). In October of 1924, with a total of 800 patients, the administration is begging for appropriations for TB accommodations. They estimate that 10% of the 800 will have tuberculosis (1923, 1394, 23). Influenza appeared to be less of a threat than TB. The epidemic of influenza in the U.S. made its first appearance in January of 1919 and continued for three weeks: "Inception and spread was traced to a patient, who, while on parole had been exposed to the dis. without our knowl, and brought back to the Hospital (Fourth AR, 1917-19). It is stated that "prompt isolation and timely administration of antitoxin prevented any further development" (1195; 19) (Fourth AR, 1917-19). A diptheria epidemic that broke out Jan. 29, 1923 was also brought under control (20). As these statistics show, the asylum offered no reprieve for patients coming from the city or from other asylums in terms of chronic physical disease.

In addition to a comparison of conditions to the nearby city of Baltimore, below I have situated those conditions in relation to the nearby white asylum, Spring Grove. The most prominent differences in the conditions of confinement I have collected from 1921-1928 include death rates, discharge rates, recovery rates, income from paying patients (versus state supported patients), money spent on entertainment and amusement, and circumcisions performed. I created the charts through a grounded method of noticing the categories as they arose, then combing back through text to compile data. I acknowledge that there are many subjective possibilities in analyzing this data and that each item has its own context that might sway meaning. By and large, an extrapolation of the data reveals conditions less favorable at Crownsville. Following the charts, I provide explanation of the data in the charts as well as reference other information on other dates as references.

Oct. 1, 1921-Sept. 30, 1923 (Biennial)

	Crownsville (p. 20)	Spring Grove (p. 17)
Daily average # of patients	540 (6.7 for every 10 at SG)	809
Approx. total number of patients	790 (6.9 for every 10 at SG)	1,148
Discharged	77 (9.7%)	192 (16.7%)
Recovered	52 (6.6%)	78 (6.8%)
Died	166 (21%)	112 (9.8%)
Medical and Surgical Supplies or drugs and surg. supplies	$2809	$3193
Salaries and Wages	$79,223	$153,705
Total expenses	$230,205 ($291 per person)	$304,342 ($265 per person)
Total farming income	$75,870 ($96 per person)	$103,249 ($90 per person)
State of MD Appropriations	232,210 ($294 per person)	266,345 ($232 per person)
Income from patients (pay, city and county)	183,271	doesn't list this
Income from pay patients	286	30,298
Entertainment/Amusements	none listed	2,162
Circumcisions	none listed	none listed

Oct. 1, 1923-Sept 30, 1926 (Triennial)

	Crownsville (31)	Spring Grove (14)
Approx. daily average # of patients	626 (7.1 for every 10 at SG)	879
Approx. total number of patients	1085 (7.1 for every 10)	1,527
Discharged	131 (12%)	374 (24.5%)
Recovered	25 (2.3%)	170 (11%)
Died	232 (44 from TB) (21.4%)	191 (12.5%)
Medical and Surgical Supplies or drugs and surgical supplies	$3341	7,671
Salaries and Wages	$140,955 (3 yrs)	287,349
Total expenses	$441,188 ($407 per person)	972,306 ($637 per person)
Total farming income	$58,197 ($54 per person)	173,677 ($114 per person)
State of MD Appropriations	456,863 ($421 per person)	648,265 ($425 per person)
Income from patients (pay, city, and counties)	70,462 (only listed for first year)	97,705 (only listed for first year)
Income from Pay patients	1,550	60,103
Entertainment	165 (15 cents per patient)	2,650 ($1.70 per patient)
Circumcisions	9	none listed

Oct. 1, 1926-Sept. 30, 1928 (Biennial)

	Crownsville	Spring Grove
Daily average # of patients	723 (7 for every 10 at SG)	1,038
Approx. total number of patients	956 (5.7 for every 10 at SG)	1686
Discharged	86 (9%)	472 (28%)
Recovered (also discharged as improved, unimproved)	10 (1%)	203 (12%)
Died	133 (21 to TB) (14%)	138 (8.2%)
$ Spent on Medical and Surgical Supplies or medicine/drugs and surgical supplies	2922	6342
Salaries and Wages	118,024	235,888
Total expenses/disbursements	328,112 ($343 per person)	528,393 ($313 per person)
Total farming income	not listed	143,286
State of MD Appropriations	353,741 ($370 per person)	593,054 ($352 per person)
Income from patients (pay, city and county)	not listed	not listed
Income from pay patients	not listed	45,964
Entertainment/Amusements	633 (66 cents per person)	2375 ($141 per person)
Parole or otherwise absent	20 patients	not listed
Circumcisions	4	not listed

Much can be gleaned from the data above; by the same token, in order to avoid inference, much is undiscoverable at this time. First, is most apparent there was a disparity of death rates 1921 to 1928 between Crownsville and Spring Grove. To offer context for 10 years prior to the charts, while the death rate in 1912 at Crownsville was 8% (143 under care; 11 died), Spring Grove in the same year had a death rate of 6% (704 under care; 38 died) (Lunacy, 1912). Not that divergent. By 1919 tuberculosis had become a significant problem, especially at Crownsville, and death rates reflect that (1919-21, 5-6). From 1921-1923, 21% of the people at Crownsville died versus 9.8% at Spring Grove. From 1919-21 57 of 177 deaths at Crownsville, nearly one-third, were attributed to tuberculosis (Roberts 191). From 1923-1926 the death rate at Crownsville was again nearly double that of Spring Grove. Henryton Sanitarium (1922-1985) for "colored" tuberculosis patients opened in 1922 to try to ease the TB rate at Crownsville; the death rate at Crownsville did drop from 1923-1926 to 14% as did the death rate at Spring Grove to 8.2%. It is clear from this data that the death rates are higher than those at the white asylum which is, to the say least, embodied inequity.

Another condition of confinement that speaks to inequity is that of who is able to "recover" and who is considered a "permanent patient." Of those admitted in John Hughes' study of the Alabama Insane Hospital at Tuscaloosa in 1890 (and throughout the South, generally), twice the number of Black people became permanent patients compared to whites (Hughes 455). Similarly, as apparent in the charts at Crownsville from 1921-28 discharge numbers were lower which indicates that more people there became permanent patients than those at the white asylum. In fact, the number of deaths at Crownsville often surpassed discharges. The rate of black people versus white people who had "recovered" is consistently lower between 1923-1928 (2.3% to 11%; 1% to 12%). I can interpret this lack of recovery as embedded in the web of "colonial psychiatry" and eugenics that deems blackness incurable.

Another condition of confinement that is embedded in the categories, but less overt is transportation and entertainment. The transportation system for patients at Crownsville differed from that at Spring Grove. A white patient who was to be evaluated by Adolf Meyer, the first psychiatrist-in-chief at Johns Hopkins Phipps Clinic, "was transported the short distance from Bay View to the Phipps in a horse-drawn ambulance (accompanied by its coachman and a fellow nurse) and admitted" (Lamb, 258). In contrast, on Oct. 29, 1915, 200 African American patients were transferred from Bay View to Crownsville in five special rail cars. There were "Twenty detailed officers, four physic., and fifteen nurses assisted in the movement. The change was made in one hour and a half without any mishap" (Biennial 1915-17, 1156; 23). When inmates arrived from Montevue asylum in 1911 (64 which were epileptics and imbeciles of low grade), they had to walk from Camden Station up to Lombard Street to board segregated train car. Men sit in leisure in suits and ties in a photo on the sun porch at Spring Grove (Biennial 1926-28; 16; 1350), while most if not all of the photos in reports of Crownsville show inmates laboring. At Spring Grove, an Amusement Hall is discussed as well as a luxurious patient parlor which was photographed in 1903 (1899; 1903 Annual Report). At Crownsville in the period from 1921-1928, less money is listed as being spent on entertainment and recreation (see charts). In order to obtain the first and only "motion picture machine" for Crownsville, sale of goods made by patients was held in the city (1915-17, 25). The conditions described here discernably disfavor patients at Crownsville.

Other numbers within the categories of staff salaries, expenses, state appropriations, farming income, and circumcisions do not allow for conclusive analysis until further research on contexts is completed. However, I can assert that it is apparent from the charts that income from private paying patients is significantly lower at Crownsville which explains why State support is higher at Crownsville versus Spring Grove. Additionally, just as John Hughes' study of Southern asylums demonstrates food deprivation in the Black inmate population moreso than in the white (453), Crownsville patients also suffered from poor food quality ("Inmate Complaints," 1925). Though the mid-century likely saw even worse conditions, that was not my focus here. The conditions of confinement that I do discuss here indeed lay bare institutional disparities that advantaged white people and white institutions. High rates of death alongside low rates of recover and discharge (all in relation to the white asylum) indicate that Jim Crow injustices were embodied; black bodies—black people lived in conditions that were in a general sense worse than whites. Of course, this is not to say that people in white asylums lived a life of leisure. On the contrary, my argument is locate the inequities of "separate but equal" in the study of asylums. In our communal move towards accounting for past wrongs, all of this is worth remembering.

Post-Mortem Management of Black Bodies

In addition to conditions of confinement, of central concern is what happens after death. A highly publicized death in the local news in the 1920s—that we fail to collectively memorialize today—was the murder of Crownsville inmate William H. Murray by Polish American guard Walter Swiskowski. Murray's murder is relevant because it attests to conditions of confinement and also suggests a pattern of post-mortem management of black bodies in Baltimore. Swiskowski, prior to his employment at Crownsville, had a criminal record of assault. On June 18, 1923, Swiskowski beat and killed Murray. The cause of death is listed as a "fractured skull from blow maliciously delivered." Murray was the father of Pauli Murray, the civil rights activist who wrote Song in a Weary Throat: An American Pilgrimage. William Murray graduated from Howard University, taught in Baltimore City and was also a principal in the city schools. The Baltimore Afro-American writes that "Excessive work caused him to become mentally unbalanced…at the hospital, Mr. Murray had a good reputation for conduct, and was employed in the rug shop. Often he turned out three or four small rugs a day which are sold by the institution for $3 a piece" ("Killing").

While there is no mention of the murder in the Biennial of 1921-23 or in the following report, Bertell Edelen, an inmate, did speak on conditions related to Murray's death, "As a perfect sane patient, I am going to inform you of certain facts which I hope you will enlist the aid of all the colored organizations to help stop brutality and illegal deeds committed by officials and subordinates at this hospital. This should be done at once before there is another murder….this place is worse than slavery and we are treated like beasts at times and fed on food that is not fit to eat" ("Inmate Complaints," 1925). With some manner of justice served, Swiskowski was convicted of manslaughter and given the maximum sentence of 10 years ("Crazy Guards"). Interestingly, Milton Dashiell, attorney for the defense of the man on trial for the murder of Murray was a leader in the segregationist movement. Murray was interred at Laurel Cemetery on June 22, 1923, which is only shocking in that today the Black cemetery lies beneath a shopping mall that still operates ("How a Prominent Black Cemetery Died"). The fact that Murray and so many others could still be interred under a shopping mall is evidence of collective negligence.

In the following discussion of autopsies and consent that reveals more negligence, I rely much on Harriet Washington's work as a guidepost for Crownsville. A relevant point to consider is the issue of authority and consent regarding autopsies—and this is true for Crownsville as well as other asylums. Consent regarding what happens to the body after death is a social justice issue. Today, "Bodies are held for 14 days before being sent to the Anatomy Board of Maryland. About 200 unclaimed bodies annually are shipped to medical or dental schools for use in education, said Ronald S. Wade, director of the Maryland board" (O'Reilly). I could find no data on the race of unclaimed bodies in Baltimore. Harriet Washington demonstrates how Black bodies were used for dissection, teaching, and experimentation at a higher rate than white bodies. She writes, "After the mid-nineteenth century, a supply of Black bodies was key to the primacy of the hospital at the new center for American Medical instruction and treatment" (103). Washington calls this demand for Black cadavers "an ugly historical tradition" (118), and it is my assertion that Crownsville played some part in the supply. Washington begins her chapter on this issue by quoting a white travel writer: "In Baltimore, the bodies of colored people exclusively are taken for dissection, because the whites do not like it and the colored people can not resist" (Harriet Martineau, Retrospect of Western Travel). The clinical use of cadavers became more "tacit" rather than advertised in nineteenth and early twentieth century (Washington, 109). No consent was given.

In late 1800s, Maryland State Legislator ordered it legal to use unclaimed bodies for medical research or teaching. The University of Maryland was the first school in the country require dissection for its students (Kinzie). Logic thus proceeds that unclaimed bodies from Crownsville must have been used for teaching purposes, research, or dissection. In 1893, 49 cadavers were legally obtained by seven Baltimore medical schools. Johns Hopkins was the exception: the school procured 1200 cadavers over the next six years—two-thirds of those were Black (Washington, 138). A 1913 survey of 55 medical schools concluded that cadavers were mostly obtained from almshouses, hospitals, and sanitariums (ibid). These days, medical schools often hold memorial services for unclaimed bodies and in many places in the U.S, but Washington also points out that today there exists no ethnic data on unclaimed bodies (117; 141-2).

As Washington concedes, these practices of lack of consent and a questionable ethics of care were not necessarily "deliberately engineered" (140). In her seminal work on health and racial injustice, she explains how "Blacks [were] the chief denizens of teaching wards" (104). And Crownsville was no different—a training school for nurses was established in July, 1917. Washington writes "We find this open desire for Black bodies to fill wards, surgical suites, operating theaters, autopsy tables, and pathology jars chilling today…" (107). It is clear that people functioned at least partially as raw, "clinical material."

At Crownsville, Dr. Nolan D.C. Lewis performed 67 autopsies from 1915-1917 (29-36). Specializing in pathology and neuropathology, Dr. Lewis graduated from University of Maryland, Baltimore in 1914. His postgraduate work was in psychology and biology at Johns Hopkins (1914-18), he was director of laboratories at Maryland General Hospital, JHU, Phipps Psychiatric Clinic, and St. Elizabeth's Hospital, and was known as the first practicing psychoanalyst in the United States. In most of his biographical information available, there is no mention of his work at Crownsville. Dr. Lewis' name appears as pathologist at Crownsville from 1915-19 in the institution's annual reports (From 1921-on, no Pathologist is listed). In Lewis's Report of the Pathological Laboratory (1915-17), he writes, "We have been fortunate in obtaining for autopsy 51.5% of the individuals dying at the institution, and as our main interests are in this field, the tissues have received special attention in histo-pathological preparations, each organ having been studied individually and accurate accounts of all finding have been filing among the hospital records" (30). Significant numbers of autopsies happened at Crownsville without consent.

In cross-referencing some of the autopsies performed at Crownsville in the early years, I found reports recording up to the 50^th autopsy in July 1916 performed on an 18 year old male named H.B. who died of tuberculosis (Autopsy Reports, MD State Archives, T1052). It appears autopsies began in 1915 with Dr. Lewis but there is no indication that any were performed after he left his official post as pathologist in 1919. However, autopsy reports from Crownsville patients in 1936 and throughout the 1950s exist in the Maryland State Archives, though no autopsy reports are available for review from 1917-1935. One point of relevance here lies in the fact of the line on autopsy reports after 1935 which leaves room to indicate who the "Authority" was—in other words, who authorized or gave consent for it. The earlier reports do not have designated space to list the "Authority." Without indication of authority, it must be assumed that the hospital staff took authority. Many autopsy reports or protocols list "unspecified" next to "Authority." Some list "unrecorded" or are simply left blank. Often the death certificates do not show burial at Crownsville patient cemetery, though some have "Anatomy Board" removal listed.

In a 1955 report, G.R., male age 31, died from respiratory failure due to electric shock therapy (MD State Archives, Autopsy Reports). The report notes he "had been serving a four year sentence for sodomy at Jessup…served six months before being transferred to Crownsville." He was diagnosed as mentally deficient with psychosis due to late stage syphilis. Dr. Klinger, medical examiner of Anne Arundel County, is listed at the "Authority" to consent to an autopsy. An inmate or patient without a familial authority could likely have been deemed "unclaimed." This is yet another example of how criminality, blackness, and mental illness are flattened into sister "maladies" all warranting incarceration.

Data from the Maryland Autopsy Board tells us that at Crownsville "the death certificates show that significantly fewer bodies were buried at the cemetery and many more were taken to the University of Maryland medical school. Janet Hayes-Williams says members of the Autopsy Board confirmed that cadavers were sent to the school for practice, and later unceremoniously incinerated" (Marquardt). In the final analysis, it appears that ethical violations occurred even after death. In keeping with the work of Janice Hayes Williams, a local advocate for the memorialization of Crownsville Hospital and the people who lived and died there, post-mortem dignity matters.

Resistance

Given the oppressiveness of Jim Crow institutionalization as told throughout this essay, it is logical that resistance to it always existed. In the forward of Disability Incarcerated, Angela Davis points to how political resistance is and was often deemed a psychological disorder (vii). In 1926 Charles Farmer of Camden, New Jersey was sentenced to Crownsville Hospital after trying to marry a white woman in Maryland. Farmer came to Elkton, Maryland with Marie Fisher, white, to apply for a marriage certificate. After the marriage license clerk interrogated the couple regarding their difference in race, Farmer tried to convince him that Fisher was partly "colored." When the clerk wasn't convinced, he refused to issue the license and asked the couple to leave ("Man Who Tried to Wed," Jan. 16, 1926). Farmer returned the next day with a Black woman and tried to obtain a license with her under the name of Marie Fisher (his actual fiance who was white). The same clerk from the day before, recognized them, and Farmer was arrested on a charge of conspiracy. The court sentence was suspended because he had not yet secured the license, and he was deemed of unsound mind and sent to Crownsville. This is one instance of how resistance to Jim Crow not only is criminalized but also said to be a sign of mental illness.

It was also the case that being black itself was both criminalized and categorized as mental illness. Another case of bias whereby Crownsville becomes the so-called curative: In May of 1932, G.L. was arrested for yelling in the Northwestern District of Baltimore, charged with disorderly conduct, and committed to Crownsville ("Yelling Man Slightly Off"). Willie Jones was sent to Crownsville and put in seclusion for following a couple of white women in Annapolis. The real reason, it is said, is because "He was Black" (Capital Gazette, Oct. 10, 1975).

By 1949, 1800 patients lived on a campus designed for 1100, which meant one doctor for every 225 patients. A 1948-9 a series of articles in The Baltimore Sun entitled "Maryland's Shame" indicted the institution. In 1953, tear gas and fire hoses were used against patients who rioted for better conditions ("Forty Insane Patients Riot"). But conditions failed to improve—and could be argued actually worsened—even with the appointment of the first Black superintendent, Dr. Phillips, in 1964 and the earlier 1948 integration of the staff. A 1956 annual report of the Department of Mental Health noted that pneumoencephalograph studies (where cerebral fluid was replaced by oxygen; this was performed on Elsie Lacks – see conclusion) happened at Crownsville. The numbers of experiments on patients performed soared from 521 in 1920 to 2719 in 1955 though I was unable to follow-up on the particularity of those experiments (Marquardt, June 5, 2013). Given the U.S.'s long history of medical experimentation on institutionalized people, this line of inquiry should be pursued.

In 1961 civil rights activists were sent to Crownsville after engaging in civil disobedience. The Elkton Three (Wallace Nelson, Juanita Nelson and Rose Robinson) were arrested when trying to sit down and eat at Bar H Chuck House near Elkton, Maryland. Edison C. Henderson, owner, later testified that he had told his employees not to "serve colored people sitting down." Denied services because they were Black and charged with trespassing, the protest was part of CORE's massive Freedom Ride along the New York to D.C. highway corridor. Refusing council, they began a hunger strike in jail, and then on the twelfth day of the strike were sent to Crownsville ("Mental Illness Not Found in Fasters"; Jackson, 24). When asked if they had mental problems, Sheriff Edgar U. Startt commented, "Anybody that will not eat and won't stand up in court and plead acts like a mental case to me-and also to the State's Attorney ("Mental Illness Not Found in Fasters"; Wells). Crownsville's Dr. Charles Ward determined that they were not insane and thus could stand trial. All were soon found guilty. In 1975, an extensive expose by a Nellie Bly-type journalist who infiltrated the asylum would stain Crownsville's unfavorable reputation for good (Struck). After years of complaints and resistance, the institution finally closed in 2004 when patients and staff were transferred to nearby institutions (Spring Grove and Springfield) or relocated along a so-called continuum of care. Numerous bills in the Maryland Legislature have been proposed to try to demolish the buildings, but this complicated history of criminalization of blackness, neurodiversity, and difference—and resistance to it—will not go away.

Making Amends

Given the disparities and injustices chronicled here about Crownsville, one would think that an apology and collective memorialization would readily follow. Still, full disclosure or redress has yet to come from the State of Maryland. Take the plight of the hospital cemetery as case in point. Next to a grassy slope, the remains of over 1,500 former inmates of Crownsville lie in unmarked graves on land managed by a Trust and maintained by local government. Yet were it not for local historians and advocates Janice Hayes-Williams and Paul Lurz's efforts, and that of family members of former inmates, community leaders, and other advocates, the hallowed ground might just vanish from memory. In 2004, activists held a re-dedication of the cemetery. In 2014 House Bill 404 committed the State to "provide perpetual care of the cemetery." Today, a fence and gate cuts off access to the cemetery which shares acreage with a sewage treatment plant and toxic sediment ponds. A "clean-up" is possible and wishful, and if that happens, the cherry trees should be allowed to remain.

But achieving a "right to the cemetery" means more than scanning for remains or caring for stones. The cemetery exists not just to memorialize people who suffered and died under the Jim Crow medical-industrial complex, but also to force consideration of how the past is always a reflection on the present. A "right to the cemetery" is not only judiciously democratic; it is the precondition for reciprocity and justice. Our Jim Crow history and resistance to it is inscribed in this cemetery and others like it. Our past is still buried there. But just how much responsibility should the State take and what does that look like? How do health disparities today reflect this legacy? Can trust in medicine be regained? The current mayor of Baltimore recently commented on the need to heal the city's racial divisions, after the Department of Justice released a condemnation of the police. Racial injustice of the past is very particular form of cultural grief. The city, like so many others, includes too much "generational amnesia" (Roberts 6).

In this sense, the story of Crownsville Hospital can not be disentangled from the story of Baltimore. The "Baltimore Uprising" (April, 2015) rallied folks in protest of the killing of Freddie Gray by police. It represents an enduring, historically-based strain between those in power and those living in extreme poverty who feel systematically denied resources, capital, due process, and a platform to speak out. 152 years after the end of slavery, Baltimore is enveloped in a racialized world where justice and resources still are not meted out fairly. In 2007, the Maryland Senate officially apologized for the State's role in slavery (Wan), but many have come to believe that state residents have yet to experience substantial and meaningful healing. The memorialization of Crownsville Hospital offers another such opportunity—of trying to demonstrate transparency, take responsibility, and even perhaps offer restitution. The story of Baltimore and the history of racial injustice has to be told in order to memorialize Crownsville Hospital and understand its early years.

Healing can only happen through responsibility, not absolution. In 2012 Springfield Hospital, a historically white asylum in Maryland, dedicated a large memorial stone in its cemetery etched with the names of patients buried there. If white patients at Springfield are memorialized, then allow Black patients the same respect. If the State has apologized for slavery, it must now apologize for the carceral racism practiced at Crownsville. If clean-up of the wastewater or other improvements in the Crownsville Cemetery and public lands are slated, then proceed with transparency and public explanation. The buildings have asbestos and lead. High radium is a problem in the whole area. The hospital buried toxic chemicals near the old barns. Clean up is desperately needed (Lurz).

Elsie Lacks, the daughter of Henrietta Lacks, must be paid homage in any discussion of Crownsville. Though she died at Crownsville (1955) at a later period relative to the focus on my study, it's important to note that David Lacks, her father, is listed as the "authority" on her autopsy report. As Rebecca Skloot has pointed out, however, Elsie's father has said he did not issue consent for an autopsy though one was performed. After analyzing the autopsy report I felt morally obligated (though conflicted by the need for the family's privacy) to reiterate that the cause of Elsie's death is dubious in the very least—an opinion that her living sister shares (Skloot 269-75). Elsie Lacks was said to have died of "respiratory failure due to epilepsy due to cerebral palsy" with a psychiatric diagnosis of "idiot with epilepsy – cerebral palsy." Lacks, however, "had no notes concerning any convulsive seizures while at Crownsville and records show no anti-convulsive medications" (MD State Archives, Autopsy Reports, 1949-1955). According to her sister, when Elsie died at 15 years old she had seizures and was deaf from syphilis in utero. Her death was preventable and could have been caused by x-ray studies (studies now be deemed inhumane) conducted on her brain (Skloot 275). And in the case of Elsie's mother, Henrietta Lacks, who unwillingly was the progenitor of the HeLa cells so essential to cancer research, some have said that moral justice has been meted out but not reparations (see The Immortal Life of Henrietta Lacks). The Lacks family now serves on the board at the National Institutes of Health to determine uses of the HeLa cells, they receive acknowledgements for the cells' worth, and they were given a Johns Hopkins Memorial Lecture named after Henrietta. But is that enough? Kendall Phillips, in Framing Public Memory, distinguishes between memories and appearances of memories. He explains that "as memories appear in public, they are already escaping the hegemonic cultural forces that produced them" (10). Is appearance of memory and acknowledgement of wrongdoing sufficient? The physicality of the cemetery, the land where the hospital sat, and its buildings are all part of our healing. What we need even more, however, is an official State apology and a solid community-supported plan for the future of the land. And even then, I still don't think that is enough.