For my current work-in-progress, I’ve been looking at women physicians in history. My heroine is a doctor, informally trained as an apprentice to other doctors and through private tutorials. Most of this learning took place in her parents own kingdom in the Central Asian mountains of Kopet Dag, or in nearby Iran. This was certainly the path to knowledge for most female practitioners of medicine in Western history. Was it feasible for my Ruth?

In short words, yes. Looked at from the point of view of gender politics, the history of medicine in most cultures has been depressingly similar. Women have done most of the work and got the blame for things going wrong, while men have got the education, the pay and the glory. That might seem quite a large claim, but think about it. Women were responsible for the management of a household, which included care of the sick and treatment of minor injuries. Even today, who usually puts band aids on the cuts and kisses the bruises better? On a community level, someone usually had a greater interest in and better knowledge of herbs and their effects than others, and that person would pass on her knowledge. When home care failed, those who couldn’t afford a university educated doctor or even a surgeon-barber would see the local herb-wife.

A particularly successful healer might find herself something of a threat both to those doctors and to the local religious authorities, who, in many cultures, ran the universities and licensed the doctors. So women’s knowledge was downplayed or discredited. The only part of medicine that women were encouraged to practice was midwifery, until men began to take that over, too.  Until recently, the contribution of women has been largely ignored in medicine, as in other fields.

“How amazing is this [that patients are cured at all], considering that they hand over their lives to senile old women! For most people, at the onset of illness, use as their physicians either their wives, mothers or aunts, or some [other] member of their family or one of their neighbours. He [the patient] acquiesces to whatever extravagant measure she might order, consumes whatever she prepares for him, and listens to what she says and obeys her commands more than he obeys the physician.” Sā’id ibn al-Hasan (died 1072)

Nonetheless, the tradition of female physicians and healers goes back to ancient times. There’s a story of a woman in Greece around 2400 years ago who went to Alexandria to train, since the Egyptians had female doctors, and was so successful when she got back to Athens that she was arrested for breaking the law. Her female patients mobbed the court and they had to let her go. (In another version of the story, she trained privately with a sympathetic doctor, and practiced disguised as a man. Other doctors, jealous of her popularity with female patients, accused her of sleeping with them. In court, she stripped off to show she was female.) Be that as it may, we know that Greece had women practicing medicine, as did the Romans.

Most cultures have left traces of elite women who practice medicine–women who are born into a physician family and grow up as apprentices in the trade, or who have access to the wealth and education to defy the norms.

In Britain, we know of at least one woman who attended university as a man and practiced medicine for more than 50 years. She was identified as a man after she died in 1865. Other women were accepted (reluctantly) into the profession because they had qualified in universities overseas. One woman was harassed and abused right through her medical course at Edinburgh university and was awarded a Certificate of Proficiency when she completed the course, rather than the degree given to her male counterparts. She went to Berne, and then to Dublin, and returned with a qualification that allowed her to be registered as a doctor.

In the Ottoman empire, men had several recognised roles in medicine: physician, surgeon, ophthamologist. Women did not have access to formal training or formal recognition, and female medical practitioners were all called midwifes, whatever form of medical care they offered. But nonetheless, women practiced medicine, learning from family or other mentors and private tutors. Indeed, given the strict segregation at the highest level of Ottoman society, female physicians must have been essential on the women’s side of any great house.

My interest, though, is in Iran and its sphere of influence, the Turkmen tribes to the north and east. Did the same apply there? It certainly did in medieval times. I’m still trying to track specific sources for the late eighteenth and early nineteenth century, but meanwhile I’m following the usual cultural pattern in my Ruth’s training.

Ashbury pursed his lips and she waited for him to lecture her on her presumption, but he surprised her with a question. “Minnich tells me you are a physician. Where did you train, Lady Ruth? In the same place as you acquired your warlike attendants? Somewhere in the East, I assume?”

She inclined her head in agreement. “I apprenticed with several healers, including a physician who trained at a teaching hospital in Baghdad. I have also studied with Western physicians, though not since my family arrived in England.” She sighed. “I am well qualified to attend your niece, my lord, even though I am a woman.” And you have no one else, she wanted to tell him.

His eyebrows jerked upwards in response. “That’s not — I am not questioning your abilities, my lady.” His short laugh held no amusement. “I cannot afford to, after all. I have no alternative to offer.”