Historical studies in medical education are fitting and relevant because the identity of medical education will then further expand as it writes its own history. Literature about history of medical education is plentiful, for example, the seminal book written by Puschmann1 in 1889 or the compilation edited by O’Malley.2 Nevertheless, though history of medical education is extensive, some lacunae are inevitable. Indeed, some topics must be faced with the problem of their consideration into a determined context or bounded to a historical period; see for example the subject of medical travels3 for educational purposes in 18th century. So then, we are considering here another topic scarcely studied: Hispanic pioneer women doctors as a relevant archetype in medical education.

Certainly women's access to education and more specifically to medical studies has been a long and painful conquest for equality. In the case of Hispanic countries, such an achievement is even more commendable, given the countries’ often unique context of institutionalized misogyny, a common and accepted social pattern (“that's how it was” to put it colloquially) that with patience and, above all, sound arguments and best practices has, over time, slowly dissipated.

The most flagrant and glaring case of institutionalized misogyny was, perhaps, that of Trinidad Arroyo Villaverde, who was denied the possibility of enrolling in undergraduate studies in medicine by the rector of the University of Valladolid. It was only later, after a petition from the student's father, that the General Director for Public Education lifted the prohibition with a legal provision.4

Legal provisions to allow women access to higher education were continual and contradictory. Abundant regulatory documentation can be found in the Ministry of Education and Science; see Women and Science Unit's research monographs, especially Women academics in number5 and Women scientists in number.6 In 1882, a Spanish Royal Decree dated March 16th suspended “here in after the admission of ladies to Higher Education”, which, however, did not prevent two women from defending their dissertations that very same year. In 1888, another Royal Decree dated June 11th resolved “that women shall be admitted to studies under the Directorate General of Public Education as students of teaching, but will need the authorization of the Council of Ministers in order to register as regular students”. Women would have to wait until 1910 in order for Spanish King Alfonso XIII to ratify the Ministry of Public Education and Fine Arts’ Royal Decree, which gave them the right to free access to all educational institutions and official admittance to universities.

If at the time the number of women who actually went to Hispanic universities was small, smaller still was the number who managed to defend a doctoral dissertation; in fact it could be said that they could be counted on the fingers of two hands. At face value, it would seem that Hispanic countries were far removed from the small but clever Swiss nation,7 a true pioneer in women's access to doctoral studies, or from the French and British models and formats with their medical schools and hospitals exclusively for women8 or the powerful American historiographical movement on Women and Medicine that even published its own magazine, the Journal of the American Medical Women's Association. However, this study aims to provide evidence to demonstrate that the belief that there was a total lack of Hispanic women in the doctoral field especially in Medicine is unsustainable.

In the Ancient Régime, the subject of women's education in Spain is documented in a particularly significant primary source manuscript published in 1790, Discurso sobre la educacion fisica y moral de las mujeres (Discourse on the physical and moral education of women) by Josepha Amar y Borbón, whose life and work has been thoroughly inquired by López-Cordón.9 A similar case is that of María Isidra Quintina Guzmán y de la Cerda (1768–1803), also known as Dr. Alcalá, the first Spanish woman Doctor of Philosophy and Humanities, who defended her dissertation on a selection of verses from Greek poet, Menander in 1785 at the University of Alcalá. Her presentation was attended by King Carlos III himself. Her thesis was written in Latin, which was obligatory in every Spanish university up until the first third of the nineteenth century with the advent of Liberal-Napoleonic reforms. In fact, the Napoleonic university model served as inspiration for successive university reforms in Hispanic countries that imposed a centralized and bureaucratized system, particularly intensive in the case of doctoral degrees, and which lasted in Spain until 1954.10

A powerful movement emerged in nineteenth-century Spain concerned with the education of women, and gave rise to a practically unique pedagogical worldview. In light of this, universities and above all medical schools did not stand on the sidelines, but intervened in the movement with particular interest, especially on the study and dissemination of body and healthcare; a framework in which physical, intellectual, and hygienic education for women, topics that were virtually nonexistent then, became increasingly important.

Flecha11,12 performed a study of Spanish women's university education using the models proposed by the first two women Doctors in Medicine to graduate from a Spanish university: Dolors Aleu and Martina Castells. These two hardworking Catalan doctors who, after passing their undergraduate degrees at the Faculty of Medicine, University of Barcelona, went on to successfully defend their doctoral dissertations at the Central University of Madrid, the only center in Spain authorized to impart such qualification up until 1954. The two doctoral dissertations have an undeniable historical value, especially pedagogical significance, given that they are rooted in the hygienist tradition, a first-rate discipline that has been wittingly relegated in present Spanish school curricula.

Our study focuses primarily on the last third of the nineteenth century, a historical period where the enlightened urban bourgeoisie proposed new models of womanhood that were far removed from women's traditional and exclusive role as wife and mother. We understand that this type of study should be undertaken without animosity or acrimony, and that we should try to avoid falling into the frequent bias of historical studies that, often blinded by overinterpretation, incur in the partiality of presentism, a process which characterizes and interprets the past using the keys of the present by projecting our current despondency towards the tireless, persistent, and deep-seated sexism in Spain and Hispanic countries, onto past events. Yet neither should we relinquish nor undervalue prohistorical studies, the need for such studies in medical education is more than justified, even now with nineteenth-century medical dissertations.

Having said that, this should not prevent us from recognizing the fact that despite the impressive progress made in the women-to-doctoral dissertation ratio, there is still a long way to go before women achieve, at least on an equal footing, scientific eminence. The list of studies supporting this still asymmetric relationship is extensive.13,14 The abundant literature produced over the last thirty years highlights, above all, the creation of a hot research topic, namely: Women in History of Medical Education. This is a subject that has emerged strongly in the field of medicine and, more specifically, the budding “woman-to-doctoral dissertation” ratio in various disciplines and medical specialties.15

We explore exposing doctoral dissertations that were defended by women. This is, in essence, the objective of our study; we aim to confirm that Hispanic women performed the role of Doctors in the 19th century.

In order to perform our historical documentary study, we had access to two important data sources, the Catálogo Completo [Complete Catalogue] and Tesis UCM [UCM Theses], both created and managed by the Complutense University of Madrid (Spanish acronym: UCM). The presentation document, which was either handwritten and/or edited by a printing house, was annexed to the doctoral dissertation and submitted to a legal deposit, usually a library. And this is what we have access to today, a landmark document that testifies to the existence of a dissertation in order to study this valid and unique primary source. The Complutense University of Madrid's Catálogo Completo and Tesis UCM are secondary sources that bear witness to said documents, on which we performed year-by-year bespoke research of nineteenth century documents with the aim of identifying the names of women authors on doctoral dissertations.

The recovery of dissertations written by women was performed via a thorough examination of all nineteenth-century medical doctorates in order to identify names of women authors and also what were considered, at that time, as unisex names (i.e. Cruz, Patrocinio, Deogracias, Práxedes, or Trinidad), as in the case of Trinidad Arroyo.

The findings revealed in this study are essentially descriptive and provide basic evidence without going into more complex and sophisticated questions. Below is a list of medical dissertations written by women in 19th century and considered as case studies.

Having reached this point, a series of ad hoc considerations about the research subject should be raised. On the one hand, nineteenth-century medical dissertations written by women are considered rara avis. We established that there are only six Hispanic medical doctoral dissertations written by women (Galvis, Aleu, Castells, Grierson, Pimentel, and Villaverde). As such, this subject remains of singular importance as a multidisciplinary concern comprising the following topics: history, medical education, and women, but it is essentially still an almost unexplored and rather omitted historic graphical field of medical education.

A very long time has passed and many events have taken place since pioneer medical women wrote their dissertations. However, perhaps the most relevant event, in this respect, is the more than evident feminization of the study of medical doctorate majorly in Spain,6 and minorly in Latin-America.28

The fight for scientific eminence should remain a legitimate and natural aspiration for women doctors, who should not be cornered exclusively into the everyday rigors of professional practice even more when women with a high degree of social vocation place significantly less importance on material factors than their male counterparts.29

It would be intolerable to think that there could be a subtle but impregnable “glass ceiling” hindering the scientific careers of women doctors, preventing them from reaching the top of eminence. Apparently, there is nothing to prevent these professionals from accessing the “cupola” of knowledge, as the evidence provided by the bibliometric studies referenced here.13,15

This study could also have continuity down other avenues. The research on the production of dissertations on medicine defended by Hispanic women would need to be expanded to include the period 1900 to the present day, conducting systematic reviews that include longer periods or at least include dissertation catalogs as a culture for medical education. In short, the topic of doctoral medical education for women still has room for important growth in research and must, at all costs, continue.

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