By the nineteenth century, alms-houses were the principle means of support available to those without any other means of subsistence. Though America had had a small number of such institutions from the seventeenth century, they began to mushroom exponentially following on from the report Josiah Quincy made in 1821 on poverty relief in Massachusetts. Criticizing compulsory provision to the poor as encouraging indolence and dissipation, he recommended alms-houses make their inhabitants work for some proportion of their maintenance. Though much of the rhetoric was philanthropic (working towards one’s upkeep was supposed to facilitate self-respect and dignity), the reality was more punitive, with extremely poorly-rewarded labor providing a punishment for the moral laxness that was supposedly the root cause of poverty. Lack of funding and capable staff further contributed to the dire circumstances the ‘able poor’ – a category peopled by destitute families, single mothers, widows, men who had lost their jobs and, increasingly, the mentally ill – experienced in these institutions.