When Half of Humanity Is Invisible

“Women are the world’s greatest untapped reservoir of talent.” — Hillary Clinton

The history of surgery is often told through the achievements of great men, while the contributions of women surgeons remain largely unknown. This historical erasure is not merely an oversight—it has real and lasting consequences for modern surgical practice. When the struggles and successes of pioneering women surgeons are forgotten, gender biases persist, limiting opportunities for aspiring female surgeons and reinforcing outdated stereotypes about who belongs in the operating room. The absence of female role models in surgical history weakens mentorship pathways, slows progress toward gender equity, and perpetuates institutional barriers that continue to disadvantage women in the field.

A major challenge lies in the way that history has traditionally been written. For centuries, surgical history has largely been recorded by those in positions of power—predominantly male physicians, historians, and medical institutions. This has led to a selective retelling of events, where women’s contributions have been either omitted or deemed less noteworthy than those of men. For example, Alison Shepherd, in her 2018 article “Those who also served: Medics in the First World War,” described women from the Scottish Women’s Hospital at Royaumont in France as nurses, even though some of them were doctors or surgeons¹. This systemic bias means that even when the achievements of women were noteworthy, they often were not given the same level of recognition as their male counterparts. Even today, efforts to document the role of women in surgery face resistance, with some dismissing it as a niche subject rather than an essential part of medical history. Recognizing the contributions of women in surgery can reshape the profession; this is important because when the history of women surgeons is not recognized, it inadvertently reinforces gender stereotypes that can affect the patient-provider dynamic, potentially diminishing the patient’s confidence in the surgical process, especially when being treated by a female surgeon. Reclaiming the stories of women surgeons is essential for creating a more inclusive and equitable future in surgery. This article explores the possible reasons behind women’s historical erasure in surgery and how the lack of historical awareness about women in surgery impacts modern surgical practice and patient perception.

Possible Reasons Behind the Historical Erasure of Women in Surgery

A Problem of Sources?

The history of women, as a whole, faces a simple mathematical problem—a lack of sources. The history of female surgeons is no exception. Michelle Perrot, historian and professor emerita of contemporary history at Paris-Diderot University, highlighted that invisibility is a general phenomenon that is particularly pronounced for women, as though memory itself had a gender². She considered that history, as currently written and taught, is an inadvertent instrument of male domination—a perspective shared by Simone de Beauvoir: “The present enshrines the past, and in the past, all history was made by men.”³

The knowledge sources that are available today regarding women physicians are fragmented. The scarcity of evidence hastened the exclusion of women from the practice of medicine and surgery. Yet, the most important feature emerging from these fragments is simply that such practitioners existed. This lack of sources can be explained in various ways, beyond the loss or destruction (accidental or otherwise) of documents.

It seems easier to remember someone when they move from the private to the public sphere. An official text, such as a notarial deed or a guild register, is more likely to be archived and preserved than a personal notebook. Among the sources still available to us today, Geneviève Dumas has studied, in detail, the “Register of Pleadings of the Parlement of Paris,” Series X (kept at the National Archives), particularly between 1364 and 1427⁴. She identified 34 legal cases related to health care, 8 of which involved women. The most striking finding is that, over 40 years, only 2 cases involved a woman surgeon or barber. Her work made it possible to transcribe the trial of Perette la Pétone, who was accused in 1410 of illegal surgical practice by the Parisian surgeons’ guild, and that of Jeanne Pouquelin (fourteenth to fifteenth century, exact dates unknown), who was brought to court over continuing her late husband’s barber practice.

For “nonofficial” documents, such as scientific publications, one might wonder whether the author worked alone or in a team (and in the latter case, only the primary author’s name would have been remembered). The Matilda effect, a theory developed by Margaret Rossiter, professor and historian of science, highlights the minimization—or outright denial—of the contributions of women scientists to research⁵. Rossiter based her theory on the Matthew effect, a concept developed in the 1960s by Robert King Merton to describe the inequitable recognition of discoveries. The Matthew effect takes its name from a verse in the Gospel of Matthew 13:12:

“For to the one who has, more will be given, and he will have an abundance. But from the one who has not, even what he has will be taken away.”

Rossiter observed that in cases of collaborative work, women’s contributions were often reduced to an acknowledgment or a footnote, and in cases of simultaneous discoveries, only the male name was typically retained. A recent example is Marthe Gautier (1925 to 2022), a French pediatrician specializing in cardiac pediatrics, whose role in discovering trisomy 21 was overshadowed by that of Jérôme Lejeune, a researcher at the Centre National de la Recherche Scientifique (CNRS). Another example is Rosalind Franklin (1920 to 1958), a British biologist whose contribution to discovering the helical structure of DNA was overlooked. Her former collaborator, Maurice Wilkins, shared the 1962 Nobel Prize in Medicine with Francis Crick and James Watson for their DNA work, which was based on her findings⁶.

A Problem of Methodology?

Monica Green, an American historian specializing in women’s health care in medieval Europe, proposed a pragmatic argument regarding the underrepresentation of women in history in an essay titled, “Documenting Medieval Women’s Medical Practice.”⁷ According to her, it might be a methodological issue: if women are absent from the sources traditionally used to compile biographical data on physicians or surgeons, it means that the sources—and thus the methodology—are unsuitable.

Green also explained that in many professions, a woman’s marital status determined her professional status. For instance, a young unmarried woman might apprentice under her father or work in a female trade, but her profession could change after marriage as she became a collaborator in her husband’s trade. Dumas suggested that holding multiple roles could hinder married women’s integration into guilds under their husband’s profession, thus explaining their noteworthy absence from corporate records⁴.

Epistemological obstacles may also have contributed to the underrepresentation of women in the field of health care. Nadia van Brock, a French linguist, highlighted that the feminine forms of certain terms have been translated differently from their masculine counterparts, without justification⁸. She gave the example of the Greek term “ἰατρός,” which is translated as “doctor,” but whose feminine form, “ἰατρίνη,” has been translated as “midwife.” Similarly, she noted that the Latin term “medicus” was easily translated as “doctor,” whereas its feminine form, “medica,” was translated as “nurse” or “caregiver.” A possible explanation for this phenomenon was proposed by Véronique Dasen, who suggested that the translation of a text is directly influenced by the culture of the translator⁹. This means that, consciously or not, translators are shaped by their own perception of the medical field and its current division of roles and responsibilities.

The field of health care is a constantly evolving domain, which complicates historical research, especially when rational and magical therapeutic practices coexist. A mid-fourth century BCE attic funerary stele depicting a woman named Phanostratê (Φανοστράτη) was found (Fig. 1). This stele included an inscription specifying her profession using 2 distinct terms, “μαῖα” and “ἰατρός,” which seems to differentiate between 2 types of activity. Evelyne Samama, professor of ancient history at the Versailles Saint-Quentin-en-Yvelines University, emphasized that this represents the earliest known usage of the term “ἰατρός” (doctor) to designate the profession of a woman¹⁰. The feminized form “ἰατρίνη” would have appeared later, with the increasing number of women practicing in the field of health care. Its earliest known appearance to date was found on a funerary stele from the second century BCE, discovered in the region of Byzantium, depicting a woman named Moussa.

Fig. 1.

Funerary stele of Phanostratê, mid-fourth century BCE, National Archaeological Museum of Athens. Reproduced, with permission, from the Hellenic National Archaeological Museum, Athens, + photographer: Irini Miari. © Hellenic Ministry of Culture/ Hellenic Organization of Cultural Resources Development (H.O.C.RE.D.)

A Problem of Interpretation?

Across millennia, we know little to nothing about our ancestors. At best, archeological evidence can be interpreted only through current technological advancements and cultural biases. The role of women in prehistory is still influenced by interpretations formed by nineteenth-century Western historians, in which prehistoric men mastered fire, hunted, and invented tools, while women were confined to motherhood and gathering. According to Marylène Patou-Mathis, prehistorian and research director at the CNRS, “The prehistoric man is also a woman, but the sexism of the scientific world minimized her for many years.”¹¹

Cranial trepanation has been recognized as the earliest known form of surgery. Its discovery was attributed to Dr. Paul Broca in 1874¹², following the discovery of “cranial discs” and “cranial amulets” by Dr. Prunières of Marvejols during excavations at a dolmen on the Causse de Chanac in Lozère in the summer of 1867.

While trepanation seems to have been a common surgical practice during the Neolithic Period, no evidence has yet been found regarding the gender of those performing it, as explained by Patou-Mathis¹¹. Similarly, the reasons for practicing trepanation more than 6,000 years ago remain unclear. It is plausible to suppose that women may have performed such surgeries, despite the perspectives of the male-dominated nineteenth-century anthropological societies, which perpetuate today’s stereotypes.

Misogyny

In antiquity, philosophers and physicians established the idea of the natural inequality between men and women. For example, Plato (428 to 348 BCE), in “The Republic,” categorized humanity into males and females, akin to even and odd numbers; however, these genders were not considered equal. In “Timaeus,” he proposed a definition of women as intermediaries between men and animals, essentially “failed men.”

Aristotle (384 to 322 BCE) regarded women as mere receptacles for the male’s fertilizing substance. According to his theories from the fourth century BCE, which were presented in the “History of Animals, Generation of Animals, & History of Animals I, Parts of Animals I,” women were intermediaries between men and monsters, and thus inferior to men.

Hippocrates (460 to 377 BCE), in his treatise “On the Diseases of Women,” defined women as inferior due to their cold and moist nature. Galen popularized this notion in his treatise “On the Usefulness of the Parts of the Body.” While aimed at rationalizing medicine away from magical or divine belief systems, these theories primarily reflected a lack of physiological understanding. Nevertheless, they served as dogma for the Christian Church until the seventeenth century. For more than 20 centuries, this rationale promoted the inferiority of women through a blend of ancient magical thinking and Christian faith.

With the spread of Christianity, the desire to explore the human body began to outweigh concerns about transgressing religious limits, such as preserving the body for resurrection. Dissection gained acceptance, as illustrated by relic practices and the papal decree “Detestande feritatis” by Pope Boniface VIII in 1299, which opposed body mutilation but allowed anatomical dissections.

During the Renaissance, the curiosity to examine and describe the body revived anatomical science. Human dissections initially had illustrated Galenic descriptions of animal dissections before having a direct medical impact. In 1472, Pope Sixtus IV authorized dissections in a decree that recognized their utility in medical practice. André Vesalius (1514 to 1564), in his groundbreaking works “De Humani Corporis Fabrica Libri Septem” (1543 and 1555), corrected numerous errors in ancient descriptions, challenging the notion of the infallibility of the ancients. By then, the grounds for the perception of female inferiority had shifted from their cold, moist nature to their reproductive organs, particularly the uterus, which was believed to be mobile and regarded as a site of periodic discharge.

The myth of the “weaker sex” persisted through the Enlightenment, and was exemplified in the article “Femme” from Voltaire’s “Philosophical Dictionary”:

“Weaker, women are gentler. Women being weaker in body than men, with more dexterity in their fingers, and much more supple than us; unable to work on arduous tasks such as masonry, carpentry, metallurgy, or plowing; necessarily assigned to lighter household duties, especially child care; leading a more sedentary life; they must have gentler characters than the male race.”

In the nineteenth century, French physician Paul Broca (1824 to 1880) conducted extensive studies on the relationships between brain size, sex, and intelligence¹³. Using methods such as filling cranial cavities with lead shot to estimate brain volume or directly weighing brains, Broca concluded that men’s brains were, on average, 181 g heavier than women’s brains, which he interpreted as proof that women were intellectually inferior.

However, it was well known, even by Broca, that brain volume varies depending on factors like body size, age, cause of death, and measurement methods. Notable autopsies of intellectual men, such as Anatole France (1-kg brain) and Ivan Turgenev (2-kg brain), revealed no correlation between brain size and intelligence. Nonetheless, for Broca and many contemporaries, ideological beliefs outweighed scientific evidence:

“On average, brain mass is greater in men than women, in eminent men compared to mediocre ones, and in superior races compared to inferior ones [...]. All things being equal, there is a remarkable correlation between intelligence and brain volume.”

Today, women generally outlive men in nearly all modern populations. Research now focuses on debunking the myth of the “weaker sex.” Studies, such as that by American demographer James W. Vaupel and colleagues in 2017, have shown that women have a survival advantage when compared with men, even in extreme conditions like famines, epidemics, and slavery¹⁴.

How the Lack of Historical Awareness About Women in Surgery Impacts Modern Surgical Practice and Patient Perception

Not knowing the history of women surgeons has important consequences for modern surgical practice, affecting everything from gender representation to professional culture and patient care. The historical erasure of female surgeons contributes to ongoing disparities and reinforces systemic biases that limit opportunities for women in the field.

First, the absence of women from surgical history perpetuates the myth that surgery has always been, and should remain, a male-dominated profession, reinforcing gender stereotypes in surgery. For example, in France, the French Academy did not officially approve the feminization of job titles, functions, and ranks until February 2019. The resurgence of the term “chirurgienne” (female surgeon) marked the reappearance of what seemed like new vocabulary, although it was not a neologism. In a recent study, Madanay et al. showed that patients’ perceptions of physicians’ interpersonal skills and technical competence were influenced differently by the physician’s gender¹⁵. Their results indicated that patients exhibited negative gender biases toward the interpersonal skills of female physicians, and they also applied disproportionate penalties to the technical competence of both female primary care providers and female surgeons. This could discourage young women from pursuing a career in surgery, as they may perceive it as a field where they do not belong. Without visible historical role models, aspiring female surgeons lack the sense of representation and legitimacy that is crucial for career motivation and confidence.

Surgery has long been associated with traits such as decisiveness, aggression, and physical endurance—qualities traditionally coded as masculine. When the contributions of female surgeons are ignored, these outdated perceptions persist, creating a culture that is often unwelcoming to women. This bias manifests in various ways, from gendered expectations in training (e.g., women being steered toward certain subspecialties) to workplace discrimination and harassment. It can also impact the patient’s expectations of the physician’s behavior. Hall et al., in a 2014 study, concluded that male physicians were generally perceived as more patient-centered than their female counterparts, although patient satisfaction reflected the differing behavioral styles of male and female physicians in both inpatient and emergency room settings¹⁶. The authors hypothesized that if female physicians consistently fail to receive recognition for their patient-centered care, this may discourage them from continuing to exhibit such behaviors. Additionally, some studies have focused on the online reviews of physicians^17,18. They have shown that highly rated male providers were more frequently characterized by agentic traits, with descriptors such as “informative,” “forthright,” “superior,” and “utmost.” In contrast, highly rated female providers were more often described in terms of communal qualities, with adjectives such as “empathetic,” “sweet,” “warm,” “attentive,” and “approachable.” But women surgeons should feel legitimate. A 2017 Canadian study conducted by Raj Satkunasivam and his team examined the effect of a surgeon’s gender on the postoperative outcomes of patients undergoing common surgical procedures¹⁹. The study concluded that patients treated by female surgeons had a slight but significant reduction in 30-day mortality compared with those treated by male surgeons.

Historically, women surgeons have played critical roles in advancing surgical techniques, patient care, and medical research. However, when their contributions are overlooked, medical knowledge itself becomes skewed. Suzanne Noël (1878 to 1954) is a famous example. She was a pioneering French plastic surgeon and feminist, known for advancing reconstructive and aesthetic surgery, particularly for soldiers who were disfigured in World War I, and for advocating for women’s rights in medicine. In France, Noël is not cited in any history lectures that are given in medical schools, or in history textbooks that are used in high school. Conversely, Ambroise Paré (1510 to 1590) is very famous, even in nonmedical fields, as a French male surgeon and pioneer of modern surgery. Both Noël and Paré were pioneers in surgery, but Paré is more recognized and famous.

Conclusions

Uncovering the history of women in surgery is essential for creating a more accurate and inclusive understanding of medical progress. Cultural and societal attitudes have influenced how women’s roles in medicine have been perceived. In many historical periods, surgery was considered too physically demanding, intellectually rigorous, or emotionally taxing for women. These prejudices reinforced the exclusion of women from surgical training programs and professional organizations, further contributing to their historical invisibility. By ignoring the history of women surgeons, the medical field risks repeating past mistakes, leading to slower progress toward equity and inclusion. Understanding the struggles and triumphs of pioneering women surgeons provides valuable lessons for addressing contemporary challenges, such as pay gaps, work-life balance issues, and gender-based discrimination in surgery. Reclaiming this history is not just an act of historical correction—it is an essential step toward a more equitable and innovative future in surgery, where diverse voices will be heard, respected, and celebrated for their contributions to medicine.