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This article examines negotiations between poor women and charity providers in Brattleboro, Vermont, during the Progressive Era, when the expansion and specialization of medicine shifted the focus of providers to improving the health of the poor as a means to alleviate poverty. Using a rich collection of charity case records and clients' petitions, this study analyzes the dialogue that determined aid allocation. Furthermore, it shows how ideas about gender shaped the delivery of health services and, in turn, how clients used the medical diagnosis of their problems to redefine deserving status around female invalidism. Similar to the maternalism underlying mothers' aid programs of the period, the focus on poor women's ill health not only provided clients with another bargaining tool and a potential basis for entitlement, but also reinforced female dependency and undermined women's efforts at self-sufficiency.