As she does so often, Marjorie McIntosh's work helpfully crosses the medieval–early modern divide, allowing her to consider the developments of the late medieval and early Reformation period as a single entity. Having said that, the bulk of the book focuses on the sixteenth century. It sees the late sixteenth-century creation of the 1598 and 1601 poor laws as a product of earlier experience. The book is the culmination of three decades of work in over seventy archives as well as printed sources, and both time span and archives are reflected in this study, which largely eschews the “cultural turn” approach that has come to dominate historical writing in the last twenty years, in favor of a quantitative one. However, much of the quantitative material is confined to appendices, and in an interesting hybrid engagement with the online world, additional material is to be found on the publisher's website at multimediafluids.uam.elogim.com/mcintosh/appendices. The main text is stuffed with evidence drawn from the full range of archives and printed sources. McIntosh draws heavily on churchwardens’ and other accounts, and other administrative documents to show us what late medieval and Tudor people were doing rather than what they were thinking. This allows her to dismiss in short order the old debate about the growth of a distinction between “deserving” and “undeserving” poor, and to argue that this simply represented changing priorities among donors. It also shows a significant shift from institutional support for the poor and sick in the pre–Black Death period to provision for the elderly in the late medieval period. What is less clear is why the change happened. Does it represent a greater valuing of the old or a demographic shift in which improved living standards reduced the numbers of poor and sick but allowed more people to survive into old age, or a cultural problem as the development of a northwest European marriage regime left more older people without younger residents in their household to care for them?

One thing that is made clear is the means by which the parish became a suitable vehicle for communal support for the poor. The increasing involvement of churchwardens in the collection and distribution of alms, particularly testamentary alms, meant that by the early sixteenth century many parishes were capable of managing poor relief, even if only a quarter of them yet did so. It was the changes of the period ca. 1530–53, and especially of Edward VI's reign, she argues, which started to turn that into a formal system of poor relief. The combination of the increasing amount and depth of poverty, combined with the disappearance of many institutions and traditional sources of charity in the early Reformation, led to a variety of authorities, ecclesiastical and secular, from the parish to the Crown, addressing the problem. This culminated in the 1552 legislation for parochial collection and distribution of alms, which McIntosh sees as the foundation of the latter sixteenth-century system of poor relief. She sees Edward's reign as marking a distinct turning point, with more than half of all parishes having some kind of collective provision for the poor, and thus argues that the legislation of the Elizabethan period is less significant than has sometimes been argued, for the most part building on the 1552 legislation.

Overall, McIntosh argues that the legislation and treatises hostile to the able-bodied but “idle” poor were less influential on behavior than has often been suggested. She confirms earlier work that there is little evidence for enforcement of the more draconian legislation but also says that there is evidence that casual almsgiving continued, with assistance by both householders and parish officials much more related to evidence of need, regardless of whether the recipient was known or unknown or had the right documentation. She also concedes a (sometimes justified) concern about fraudulent claims of alms. However, she argues that there was the development of a reliable source of poor relief in the parish that was the product of cooperation between church and state, local and national, private and public.

If this book does not pay a great deal of attention to what people thought, or said they thought, it is thoroughly focused on what they did, and that, McIntosh argues, reveals “personal sympathy for suffering people and concern about order and authority” (295).