The fate of the perennial Dragons-Mouth-Orchid in Maryland exemplifies almost every cause for species decline. It is a beautiful orchid which flowers in June; its populations were decimated by over-collection. Although it primarily reproduces by seed, studies indicate that pollination in the wild does not occur very often.

Its preferred habitat is acidic minerotrophic bogs, or bogs which are fed by surface or ground water, although the plant may also be found in wet meadows. Because Dragons-Mouth-Orchid needs an open bog, it is vulnerable to any kind of canopy closure. These bogs are early successional in nature, meaning they disappear naturally as larger shrubs and trees increase. This wetland type is also easily destroyed by a change to its hydrology, usually caused by development. A third habitat threat is the encroachment by non-native species.

Dragons-Mouth-Orchid​, also called arethusa, has been extirpated from Maryland. It has not been seen in this state since 1919. It historical range spans from Newfoundland west to Minnesota and Saskatchewan and south to Maryland and Indiana and along the Appalachians down to North and South Carolina. Its dispersion throughout its range is patchy but it is apparently secure in the Great Lakes Region.