The Glass Ceiling in Health and Medicine
In recent years, we have become far more aware of professional inequalities across cultures, ethnicities, and gender identities. Scholars and cultural critics have drawn attention to the gender disparity within the medical and health fields. In 2017, the number of female physicians in the United States hovers around 34%. (The numbers are nearly identical when it comes to surgery.) While women are slowly inching closer and closer to breaking the glass ceiling in many male-dominated fields, historians of medicine might wonder, was there always this disproportion between the genders in the medical profession? To understand this question better, we can look back in Western history to some of the first female doctors, how and why they thrived, and how they shaped the medical field—while also acknowledging the important absence of women in the history of academic medicine. How has that silence influenced how gender is considered today in the world of health and medicine? By drawing insight from the past, we can better understand the trends of the present—and work to change them in the future. The focus of this piece will be on early female doctors and surgeons, whose careers differ from those of female healers and practitioners who did not receive a recognized medical education.
Perhaps surprisingly, women were not excluded entirely from medicine during the medieval and early modern periods. In the contexts of remedial medicine and midwifery, women were the dominant healers. And yet, despite the practicality of these specialties, academic physicians considered them lowly and unprofessional subjects of study, and did not teach them in a university setting. Midwifery in particular was thought to be a base field, even to the point that educated physicians in early modern Europe hardly considered it real “medicine” or worth the trouble of creating a true professional specialty around it. A female practitioner in midwifery or remedial medicine, then, did not attend university for her medical education. Instead, she could learn through an apprenticeship in the village, or at home from her mother or grandmother. When literacy skyrocketed between 1500 and 1800, cookbooks intended exclusively for female readers included basic techniques for healing burns, bruises, boils, or mild cases of the flux. But since women were not considered culturally equal to men in society, they were unable to become licensed professionals, even in fields of medicine they had dominated in practice for thousands of years.
Two Women, Centuries Apart
When we look at the manuscript evidence for female doctors in Europe before women’s medical education became commonplace, two women rise to the forefront as exceptional instances of professional female doctors: Trota of Salerno and Dr. James Barry. Trota was both an educated doctor of medicine and a teacher of the female body at the first medical institution in the western world, Schola Medica Salernitana (the Medical School at Salerno). For centuries after her death in the 1100s, her most popular text, Practica secundum Trotam (Practical Medicine According to Trota), was commonly used as a reference text in the medical universities throughout Europe. Besides her publications, we know very little about Trota, which has led some historians to question her existence. For example, many historians over the centuries have attributed her works to a man who used the pseudonym Trotula.
Nearly seven centuries later, Dr. James Barry (born Margaret Bulkley) became one of the top army surgeons of the British Empire during the mid-19th century. It was not until Barry’s death in 1865 that her true sex was revealed to the world, something she hid when she began her medical studies at the University of Edinburgh in 1809.  Barry’s impressive reputation and use of sanitary precautions helped to establish routine hygienic practices around the world. She also performed one of the first successful modern cesareans. Though separated by time, these women improved the wealth of knowledge and practice of medicine during and after their lifetimes.
Centuries after their deaths, both Trota and Dr. Barry have maintained their reputations as professional physicians. Yet how can it be that these two women, one from the 12th century and the other from the 19th, are the only significant representatives of female physicians in the early Western medical world? What was happening in the centuries between, and where were all the women? There are direct and indirect answers to this question. Few to no women were allowed to be educated to become professional physicians or surgeons in Europe (Barry was a unique exception because she hid the truth of her sex from the world). As to how Trota was educated, how she became a medical teacher at the only medical school in the world, and how her work was taken seriously enough to be used as vital reading for years to come, is still a mystery. Could other women have been educated at medical universities, or dressed like men to obtain a medical degree? Of course: although research has not unearthed documentary evidence of such cases, there may have been more women educated in and practicing academic medicine than our current discoveries would suggest.
Addressing Gaps in History
While the historian’s work normally relies on considering existing evidence, illuminating the gaps in historical voices can create a history of its own. These two extraordinary examples of women thriving as doctors call into question the silence that envelops the centuries between Trota and Barry. Was Barry’s concealment of her sex to be able to attend university an exceptional circumstance, or was it, in fact, a more common practice among women seeking a medical education? Were more “male” doctors really females hiding their identities? Or was Trota, a woman who did not have to hide her sex to become a noted physician, one of a dozen or a hundred women who were influential medieval doctors—but the only voice to survive the coeval influences of a lost historical record and patriarchal dominance over the academic medical marketplace? (History notes the presence of a larger group of women physicians and students at Salerno, known as “the women of Salerno,” who may have assisted Trota in writing De passionibus mulierum ante in et post partum—but other than names, there is no solid evidence to the rumor that such a group of female doctors existed in Salerno.)  It is time to try to answer these questions and provide agency to lost voices, instead of accepting their absences.
Unfortunately for the historian, it will be difficult to resurrect the narrative of the female physician in the centuries where female influence in health has been silent (or, more perniciously, silenced). Nonetheless, we should not abandon the search for such stories. Women have had an important underlying influence throughout the history of medicine, even if the players were few and far between. Trota wrote the first major works on the study of the female body (granted, male doctors were the ones interpreting and using her work in the period that followed). Dr. Barry was one of the most eminent surgeons in the British army of the 19th century, and, in her postings in South Africa, the Caribbean, and Canada, helped to popularize hygienic safety measures throughout the world.
As women today continue to fight for equality, we can learn from those whose voices endure from earlier periods, revealing the hidden prehistory of women’s struggle for advancement in academic medicine. Certain medical fields are still predominantly populated by men, but the origins of these trends are made much clearer as we look back in history at the few surviving records of women practitioners, alongside the implicit silence of many more. If there were more female health professionals in early modern Europe, then the disparity between the genders in various niches of the medical world might never have occurred. Perhaps women would have outpaced men as health specialists if society had accepted women into medical schools earlier than they did. With such ingrained notions of segregating sexes so early in the professional history of medicine, it is unsurprising that the trend prevails today.
Molly Nebiolo is a PhD student in World History at Northeastern University studying the history of medicine in the early modern period. She is also pursuing a graduate certificate in Digital Humanities.
 “Distributions of Physicians by Gender.” The Henry J Kaiser Family Foundation. April 2017. Web. https://www.kff.org/other/state-indicator/physicians-by-gender/?dataView=1¤tTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D#
 An example of such book: Stere Htt Well: A book of medieval refinements, recipes, and remedies from a manuscript in Samual Pepys’ library. Cornmarket Reprints and Magdalene College, 1972. Pp. 12.
 Belluci, Enrica. “Trotula of Salerno.” Kings College, Women’s History Department. Last revised 25 March 2015. Web. http://departments.kings.edu/womens_history/trotula.html
 Dronefield, Jeremy and Du Preeze, Michael. Dr. James Barry: A Woman Ahead of Her Time. Oneworld Publications: London, UK, 2016.
 Ferrais, Zoe and Ferrais, Victor. “The Women of Salerno: Contribution to the Origins of Surgery From Medieval Italy.” The Annals of Thoracic Surgery. Volume 64, Issue 6, December 1997, Pp. 1855-1857.