The study found that deaths in custody were very rare in Maryland over the study period. Of the 145,425 cases examined, only 1 of every 720 met the inclusion criteria for death while in custody. Results also show significant qualitative changes in the manners and causes of death in custody, as well as in the characteristics of individuals who died over the 65-year period. Cardiovascular disease was the most frequent cause of death from the 1930s to the 1970s, except for the 1940s, when syphilis and tuberculosis were the most frequent causes of death. Asphyxia, the predominant cause of death in the 1980s, reflected the increase in suicidal hangings. In the 1990s and 2000s, drug-related deaths were prevalent. Sudden unexplained deaths that involved violent behavior, the use of multiple restraints, and drug intoxication were not identified until the 1980s, coinciding with a period of increased cocaine abuse in Baltimore and nationally. The increased use of restraints may be attributable to an increase in agitated, paranoid, and/or combative individuals being taken into police custody. Since the 1980s, subjects of custody deaths have been approximately 10 years younger than they were in the previous decades. Additional data in the cases of death in custody would assist in improving theoretical/conceptual uniformity and better methodological and analytical precision. Future research should include living populations, allowing for the systematic comparison of groups and the statistical calculation of mortality probabilities. 3 tables, 2 figures, and 17 references