This study investigates the emergence of the medical profession, the authority of medical practitioners, and the development of the healthcare system during the High Roman Empire. Ido Israelowich's work is part of an important debate about the nature of patient experience and medical culture in the ancient world, which now includes Chiara Thumiger and Georgia Petridou (eds), Homo Patiens: Approaches to the Patient in the Ancient World (2015), and William Harris (ed.), Popular Medicine in Graeco-Roman Antiquity (2016). I. makes some important contributions to this discussion, but he could also go further in a number of important ways.

The introduction sets up an intriguing intellectual framework, which stresses I.’s debt to the culture-historical approach to medicine developed by Arthur Kleinman, Patients and Healers in the Context of Culture (1980). I. elaborates on this with concepts drawn from Thomas Kuhn and Tamsyn Barton. I.’s introduction is workmanlike: it gestures towards some fascinating and provocative ideas, shows how his questions are largely ‘anthropological’, and sets up his intellectual context, but leaves these ideas under-developed. Ch. 1 — perhaps the strongest in the work — maps the ‘establishment of medicine as a profession at Rome’ (12). This argument moves from the appearance of Greek doctors in Rome in the third century b.c. through to Galen and beyond. I. shows that the policy of granting privileges, such as immunity from administrative duties, to physicians and allowing local communities to choose individuals who might receive such benefits helped authorize certain doctors and Greek medical ideas throughout the Empire. In legal terms, physicians were seen alongside other practitioners of liberal arts and craftsmen, such as teachers. This is a convincing argument which incorporates a remarkable body of evidence.

This discussion is enhanced by I.’s examination of patients’ views about healthcare in ch. 2. Here, epigraphic, votive and literary material (Aelius Aristides’ Sacred Tales) reveals patients’ views about ‘scientific’ medical practice in relation to religious forms of healthcare. I.’s primary objective is to show that there was often little or no distinction between these two areas of activity. While there is much to take from this argument, one feels that there could have been greater nuance in the treatment of some of the evidence, especially that of Aristides, where explicit and conscious distinctions are drawn between mortal and divine forms of healthcare.

Chs 3 through 5 examine three areas where healthcare was provided: childcare and birth in the domus (ch. 3), care in the Roman army (ch. 4), and medical practice at healing sanctuaries, spas and in urban centres (ch. 5). Ch. 3 aims to show how the domus acted as a ‘microcosm of the medical marketplace’ (71). It does much to elaborate how Roman culture defined the work, sphere of interest, and identity of midwives in relation to religious forms of healthcare and that provided by physicians. There is, however, little discussion of evidence for the choices that patients made or analysis of their understandings and expectations of care. Ch. 4 argues that the Roman army provided the conditions which promoted the position of Greek medical theory and practitioners across the Empire: the exclusive position given to particular trained medics ensured that Greek medicine held a ‘privileged position within the medical market place of the High Roman Empire’ (109). Ch. 5 explains the connections between different urban and non-urban locations in which individuals received healthcare by emphasizing their connection with Greek models or explanations of illness and health.

There are a number of strengths to this book. I.’s discussion of medicine's emergence as a profession at Rome is particularly enlightening, as is the discussion of the way medicine was linked with, or differentiated from, other professions and cultural practices. The monograph also does much to give more critical flesh to the inheritance of Greek medical ideas, practices and institutions within the Roman Empire. There are areas, however, where the work would have benefited from further nuance and discussion. The first concerns the consistent theme of the ‘medical market place’ which is a guiding principle throughout. For I., the patient is revealed as an actor from understanding their choices when seeking cures, and how they understood medical authority (3). It would have benefited the work to have a greater elaboration of this now quite (perhaps too?) familiar concept: how did patients in the Roman army, for instance, engage in an active choice about their healthcare provider while on campaign or in the camp? Did slaves (or women) treated by Galen or others make the same deliberative choices when receiving healthcare? How did patients choose between different styles of medical treatment?

Second, I.’s stated aim is to examine the views of both sides of the clinical encounter, to examine the experiences of both patients and practitioners, since healthcare involves the ‘interaction of two parties who often have altogether different expectations’ (1). The point is reiterated at various points throughout (for example, 85–6). While there is a wide body of evidence that does relate the views of some patients across the Empire (especially in ch. 2), there is not enough of this type of discussion in the work throughout. There is little treatment of medical case-histories from the Imperial period which — at least — represent patient-doctor interaction, and when extensive patient-centred narratives do exist, such as the Sacred Tales, they are, perhaps, not discussed in as much detail as one might expect. Perhaps owing to the paucity of evidence, the later chapters extrapolate patient views and experiences from medical or historical texts or historical situations, rather than analysing them.

These questions aside, this is a good piece of work which will continue to raise important questions and deserves a wide readership.