Contrary to the traditional account, there was a turnaround after the 1867 Metropolitan Poor Act and a popular reaction against expensive refonns. Moreover, poor law medical officers (PLMOs) were regularly charged with negligence from then. This thesis explains why those events were connected, how charges were brought against PLMOs and builds a framework for understanding negligence in the New Poor Law. First, the power of judiciary is located: lay inspectors. Second, a concept of standard(s) of care is articulated by reconstituting contemporary expectations of 'care' and 'duty'. Third, a textual analysis of the rules of PLMO employment demonstrates that the Local Government Board (LGB) framed them so that medical officers were legally culpable for system faults and a handy 'fall-guy'. In short, the LOB practiced a 'culture of blame' and, for the first time, this study explains why and how this impacted on New Poor Law medical welfare. An original methodology was created to research a wide-range of records. Quantitative, qualitative and comparative analyses, together, reconstitute poor law practice, avoiding the misleading aspects of policy documents. Database analyses maps the spatial and temporal incidence of negligence and, from this, provides evidence of a regionally-nuanced New Poor Law. The highest density of negligence occurred in North-West England, Wales and the Welsh-English border counties. Most of those 'charges' stemmed from salary or attendance issues. Part-time contracts and low salaries resulted in PLMOs prioritising private over public duties: they were compelled to ignore some medical orders. That clash of prerogatives caused a fault-line in the poor law medical welfare system and was the root cause of most negligent practice. F~om 1870, those tensions were strained by a shift in policy, known as the crusade against out-relief The 'crusade' lowered the standard of care by increasing PLMOs' workload, withdrawing vital expenditure and not investing in medically trained staff. A decline of care in the community during the 'crusade' caused higher numbers of incarcerated mental-health patients and systemic negligence: incurables, such as the disabled, were ignored by PLMOs. The thesis, thus, culminates with a case study, examining the negligent treatment of a disabled workhouse patient; restoring the 'lost' perspective ofpauper patients.