My dissertation, Incurable Defects: Welfare, Medicine, and the Disabled Body in Philadelphia, 1790-1840, reviews the contested nature of physical disability in early America. I argue that negotiations surrounding health care, tax reform, and the nature of physical impairment created a foundational basis for a disabled identity. Disabled people petitioned the government for financial support, demanding that they take the role of proxy patriarch when kin structures failed. Collusion between government officials and doctors fed into a system of medicine that prioritized high turnover rates, a phenomenon reflected in today’s system. My dissertation combines a quantitative study of over five thousand pension and medical records with qualitative evidence from doctors and citizens to provide a nuanced history of institutionalization. I explore the characters involved in health care reform across the early nineteenth century, reviewing the actions of medical professionals, government bodies, and disabled individuals. Disabled people sought to legitimize their physical capabilities, pursued therapeutic treatment, resisted institutionalization, and maintained lives as fully participatory citizens, family members, and workers. Their involvement in welfare reforms throughout the nineteenth century shaped the history of medicine and welfare in America.