Ever since the English settled in America, extreme poverty and the inability of individuals to support themselves and their families have been persistent problems. In the early nineteenth century, many communities established almshouses, or "poorhouses," in a valiant but ultimately failed attempt to assist the destitute, including the sick, elderly, unemployed, mentally ill and orphaned, as well as unwed mothers, petty criminals and alcoholics. This work details the rise and decline of poorhouses in Massachusetts, painting a portrait of life inside these institutions and revealing a history of constant political and social turmoil over issues that dominate the conversation about welfare recipients even today. The first study to address the role of architecture in shaping as well as reflecting the treatment of paupers, it also provides photographs and histories of dozens of former poorhouses across the state, many of which still stand.