To her neighbors, Grace Sommerhof seemed like a smart, capable and friendly woman who came for tea, bought gifts for neighborhood kids and stayed active in civic organizations.

But she was also curiously private behind her front door. Neighbors checked on her by phone, but she would not answer the doorbell. She never let them inside her faded, two-story brick Colonial in the comfortable Wiltondale neighborhood of Towson.

On Nov. 10, she became the first of 14 Maryland residents whose deaths this season have been attributed - in part at least - to cold weather.

Alerted by a concerned friend who had neither seen nor heard from Sommerhof in two days, Baltimore County police and paramedics entered her home through a partially open window.

They found the place heaped 2 and 3 feet high with newspapers, clothing and trash. There was no heat. The power was on, but many of the lights and appliances did not work.

Sommerhof, 79, was dead at the bottom of her basement stairs.

Laure Welebob, a forensic investigator from the chief medical examiner's office, ruled out a fall. Instead, she concluded that Sommerhof's death was the result of "arteriosclerotic cardiovascular disease" - which typically includes thickening of the arteries and high blood pressure - "complicated by hypothermia."

She described the house as "frigid."

Sommerhof's son confirmed that the house, in a neighborhood of $450,000 homes, was not heated.

Temperatures in the three days before she was found ranged from the upper 20s to the mid-40s.

Like Sommerhof's, many of the deaths attributed to cold weather in Maryland involved other factors, as varied as dementia, heart disease, alcohol intoxication, trauma and falling into frigid water.

But one element all the cases seemed to share was that the victims were alone at their most vulnerable moments.

'You didn't know'

"You feel terrible this was going on and you didn't know," said Judy Kondner, 60, who lives across the street from Sommerhof's home. "We miss Grace so much."

A tally by the state Department of Health and Mental Hygiene found that victims of the cold so far this winter have ranged from 40 to 88, with an average age of 63. Four of the 14 were women, and they tended to be older, averaging 81 years of age.

The dead were found in eight counties and Baltimore City - from Garrett County, where a 77-year-old man was found Dec. 19 in woods near his home in 25-degree weather; to Worcester County, where a 55-year-old man was found Jan. 21 on a hotel balcony. Temperatures in Salisbury had dropped to 6 degrees that morning.

But it doesn't require extreme cold to push vulnerable people into hypothermia.

Of the 14 deaths, only four occurred on days when temperatures were in the low 20s or below. Seven were found on days that never fell below 32 degrees.

"When it's really cold, people bundle up and actually take appropriate precautions," said Dr. David R. Fowler, Maryland's chief medical examiner. "But when it's not so cold, people may underestimate their potential risk. ... Your body temperature can decrease without you actually realizing it."

Of the 14 reported deaths, two were described as homeless. One was found on a Baltimore street corner Nov. 18; the other in the basement of a Frederick restaurant Nov. 14. Alcohol and brain inflammation contributed to those deaths.

Three deaths were attributed to hypothermia and drowning. Two were suburban boat owners found near their slips. The third was found in water near a pier but was not reported as a boat owner.

More common factors

Cardiovascular disease, alcohol and dementia were more common contributing factors.

Two of the dead men, neither of them homeless, were acutely intoxicated, including one of the drowned boat owners. The other, 65, was found Jan. 3 on a street in Baltimore and taken to a hospital, where his internal body temperature registered 75 degrees, more than 23 degrees below normal body temperature.

"Alcohol causes vasodilation [an increased flow of blood to the skin] and therefore greater heat loss," said Dr. Jeffrey Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center.

Intoxication also impairs awareness of the cold, judgment and the ability to get to a warm place.

Among alcoholics, Fowler said, poor nutrition and liver disease might also slow metabolism, reducing the body's ability to produce heat.

Two of the dead suffered from dementia, which probably clouded their judgment and their ability to shield themselves from the cold.

One was an 88-year-old Prince George's County woman who wandered outside her home in her nightclothes Dec. 7. The other was an 83-year-old Baltimore woman who apparently wandered into the cemetery where she was found Dec. 19.

The largest group of cold victims suffered from complicating illnesses or injuries. These included four people - Sommerhof among them - who had heart disease.

Fatal arrhythmia

As the cold begins to drive down internal body temperature, Fowler said, the heart will eventually slip into a fatal arrhythmia. In a healthy young heart, that is typically at 75 degrees.

"If there is heart disease, it will potentially go into arrhythmia at a much higher temperature - between that [75] and normal [98.6]," he said.

The elderly are particularly vulnerable to cold, Sternlicht said. They're less active and less able to compensate for heat loss, he said.

"Their recognition that they're cold is decreased, too. That's the result of nerve functioning as we get older," he said.

frank.roylance@baltsun.com

Cold-related deaths in Md.

Total:

14*

Location:

Baltimore (4); Baltimore County (2); Anne Arundel (2); Carroll, Frederick, Prince George's, Montgomery, Garrett and Worcester counties (1 each).

Age range:

40-88

Average age:

63

Age 65 or older:

7

Gender:

10 men, 4 women

Homeless:

2

Contributing factors:

drowning (2); alcohol (3); both alcohol and drowning (1); dementia (2); heart disease (4); trauma (1).

* through Jan. 29

[ Source: Department of Health and Mental Hygiene]