• 1 The article has been elaborated within the framework of two research projects: TRANSCAP: The trans (...)
• 2 Women were exceptionally granted university degrees in medicine throughout the centuries, though a (...)

1Spanish physicians of the nineteenth century constantly complained about their lack of public acknowledgement and authority, as well as about their precarious social and economic standing1. Instead of taking these complaints as a proof of the dire reality of the medical profession in Spain, we interpret them as a sign of a tortuous and contested transformation that the “art of healing” was undergoing in that period, including the redefinition of its gendered aspects. Firstly, there was the transnational trend of professionalisation of medicine that involved expelling men who did not possess a diploma from a medical faculty (or, at least, a “title” granted by public authorities or an expert body). Physicians also aimed at subordinating women to roles such as nurses or midwives whose skills were to be examined and certified by male obstetricians. Nonetheless, women skilfully used the discursive tensions in the self-representation of the profession to force their access to higher education and to the profession of physician by the early twentieth century. In Spain, as in many other countries, the profession of physician was among the first liberal professions women entered in noteworthy numbers.2

• 3 Josep Maria Fradera, The Imperial Nation: Citizens and Subjects in the British, French, Spanish, a (...)
• 4 Darina Martykánová and Víctor M. Núñez-García, “Ciencia, patria y honor: los médicos e ingenieros (...)

2Secondly, the new logic of a market that was both free and regulated by law forced the physicians to renegotiate their claims to be men of honour, rooted in a centuries-long tradition. They had to reconcile the need to make their profession a source of their financial autonomy with presenting themselves as self-sacrificing philanthropists. Last, but not least, the complex construction and implementation of constitutional parliamentarism (or Liberal Regime, as it is known in the Spanish historiography) and the reconstruction of an imperial identity after the loss of the greater part of Spain’s American domains in the 1810s and 1820s were two high-impact processes that characterised nineteenth-century Spain. As Josep M. Fradera and others have put forward, the period between the loss of most of the American colonies in the 1810s–1820s and the loss of overseas colonies after the Spanish-American war of 1898, known as “The Disaster”, was a period of neo-imperial reconstruction of Spanish national identity, during which the peninsula was redefined as an imperial nation in which the remnants of its colonial domains, the overseas territories, played an essential role, not only in economic terms, but also in showcasing the Spanish capacity of domination and “civilisation”.3 These two processes, constitutionalism and new-style colonialism, not only shaped the Spanish nationalist discourse, but also intervened in the redefinition of masculinities.4 Physicians had to negotiate their professional identity and their public image as patriots and as representatives of the civilising mission of an empire that was constantly questioned as decadent and obsolete not only by colonial subjects in Cuba, Puerto Rico, and the Philippines, but also by rival colonial powers. For this purpose, they mobilised the notion of medicine as science as well as an emphasis on the self-sacrificing aspects of medical practice, oscillating between the metaphor of a military hero and that of a missionary priest.

• 5 See, for instance, Javier M. Dos Santos, “Lost (and Found) in Translation: The Reception of Pinel’ (...)

3In our article, we analyse the image physicians presented of themselves in their professional discourse, to map this complex negotiation of their professional identity as simultaneously elite, masculine, and essentially Spanish. We contrast this with the representations of physicians in the contemporary urban visual culture, in Spain and in Europe, as a space of transimperial circulation of discourses and images. Though physicians strove to control these representations, they met with limited success. We introduce comparisons with the patterns of redefinition of the medical profession in France since this neighbouring country—and another global empire—was a constant point of comparison and reference for Spanish physicians, but also because French and Spanish physicians shared the same space of circulation of knowledge, practices, and institutional models for centuries.5

• 6 Nicola Mößner, Visual Representations in Science. Concept and Epistemology, London, Routledge, 20 (...)
• 7 Juan Pimentel, “¿Qué es la historia cultural de la ciencia?”, Arbor. Ciencia, Pensamiento y Cultur (...)
• 8 Roger Chartier, El mundo como representación. Estudios sobre historia cultural, Barcelona, Gedisa, (...)
• 9 Roger Chartier and Eduard J. Verger, “De la historia social de la cultura a la historia cultural d (...)

5The analysis of iconographic sources has been a popular approach in the history of medicine at least since the 1990s. Basically, there are two main lines of research: firstly, works focusing on scientific illustrations (expeditions, medical images, astronomical drawings, etc.); and, secondly, research on the representations of sciences in art throughout the history.6 Recently, these two lines of research have converged due to the new interest in the so-called cultural history of science, technology, and medicine that pays attention to the means of production, the media of communication, and the ways in which sciences and the arts (or technology) have been represented.7 In this approach, developed by cultural historians such as Roger Chartier or Peter Burke, the concept of representation includes a social dimension and is used as a tool to understand the articulation and transformations of collective identities of social, political, professional, and other groups.8 Thus, this article endorses three of the main premises of representation studies: collective representations have an impact on individuals and their perception of reality, these representations are disseminated by means of symbolic—iconographic—codes that are accessible in public, and these collective representations become consolidated through the institutionalisation of their codes.9

• 10 Noel Parry and José Parry, The Rise of the Medical Profession. A Study of Collective Social Mobili (...)
• 11 Josep Danon (ed.), La enseñanza de la medicina en la universidad española, Fundación Uriach, 1998– (...)

6In the nineteenth century physicians strove first and foremost to monopolise the supreme authority in the medical field.10 In this effort, they had pillars to build on inherited from the eighteenth century. The eighteenth century was the century of surgery, in Spain and in Europe more broadly. The authorities appreciated its progress and usefulness and funded surgery colleges, while the education of physicians continued to be anchored in theory. This began to change starting in the mid-eighteenth century, and there was a growing emphasis on clinical practice. In Barcelona and Valencia, clinical practice was introduced to the education of physicians in the framework of general hospitals.11 These developments prepared the ground for the future unification of medicine and surgery in the same university degree and in the same profession that would take place in Spain in the mid-nineteenth century, giving an important boost to the efforts of university graduates to monopolise the supreme authority in the medical field.

• 12 José María López Piñero, “Las ciencias médicas en la España del siglo XIX”, Ayer, no. 7, 1992, p.  (...)
• 13 On the official acknowledgement of physicians without university studies, see, for instance: “Esta (...)
• 14 On charlatanry, see Alexander Kohn, False Prophets. Fraud and Error in Science and Medicine, Oxfor (...)

9Another important change fuelled by constitutional regimes was the configuration of a coherent and combative professional discourse and identity, made possible by the freedom of speech and press. Medical journals emerged that did not shy away from discussing, criticising, and trying to shape government policies and parliamentary debates. This trend was marred by absolutist restorations (1814–1820 and 1823–1833).12 The consolidation of constitutional parliamentarism in the 1830s facilitated not only the revival of these critical debates that fostered professional cohesion, but also the transformation of medicine into a modern profession. This included unifying medicine with surgery and linking it inexorably to university education, though authorities continued to sanction the medical practice of men without university education through official titles until the end of the century.13 The issue of authority and exclusivity in the medical field remained open throughout the century, as it did in France, the Austrian and the Ottoman Empire, and elsewhere, despite the physicians pressuring public authorities to act and legislate on their behalf against “charlatans”, “intruders” and “ignorant healers”, the former two generally represented as men and the latter often represented as old women.14

• 15 Ute Frevert, Krankheit als politisches Problem 1770-1880. Soziale Unterschichten in Preußen zwisch (...)
• 16 Ainhoa Gilarranz, “Disease, deformity and health terrors in 19th-century cartoons: a cultural hist (...)
• 17 Violeta Ruiz, “Estanco terapéutico: Los límites de la autoridad del Cuerpo de médicos directores d (...)

10The quest to monopolise authority in medical field had two dimensions. The physicians explored the governing elite’s growing interest in public health and exploited it in their favour by presenting themselves as the ideal—or the only legitimate—candidates for the newly created public posts concerning health and healing.15 The cholera pandemics (that hit Spain heavily in the 1830s) were key in this process of institutionalisation of the physicians’ expert authority. However, their lack of capacity to act efficiently vis à vis the disease, combined with their new power to shape people’s lives according to what were often class prejudices rather than scientific criteria, led to a wave of social resistance to their authority and to the proliferation of negative images of physicians as arbitrary authority figures, as cowards and charlatans profiteering from people’s disgrace (illustration 3), similar to images in France and Great Britain (illustrations 1 and 2).16 One way or another, they managed to occupy (even monopolise) many newly created posts, such as those of medical directors of spas17, public employees appointed and paid by the state.

• 18 For a longterm exploration of these dynamics, see Monserrat Cabré i Pairet and Teresa Ortiz-Gómez (...)
• 19 Dolores Ruiz-Berdún, “La primera enseñanza reglada de las matronas en España: el Real Colegio de C (...)
• 20 Margarita Vilar-Rodríguez and Jerònia Pons-Pons (eds.), Un siglo de hospitales entre lo público y (...)
• 21 Barbora Rambousková, “The Doctor and his Patients…”, art. cit.
• 22 Víctor M. Núñez-García and Darina Martykánová, “Charlatanes versus médicos honorables…”, art. cit.

11Women were excluded from these new fields of action.18 In certain areas where women had held a strong position, such as obstetrics, they were pushed under the authority of physicians.19 Thus, a gender hierarchy in the birth assistance market was established that was more pronounced than during the Ancien Régime. In Spain, this process was remarkably slow, as public investment in hospitals and clinics was limited and physicians who attended home births of wealthy clients seem to have accepted the midwives catering to poorer women giving birth.20 Rather than focusing on “ignorant (old) women”—a rhetoric figure strongly present, for instance, in the discourse of Czech and German rural physicians21—Spanish physicians seemed to consider “other” men as their main rivals. These intruders were defined mainly in terms that mobilised class imagery. Charlatans and intruders were painted in two ways. Firstly, as lower-class men without university studies, some of whom pretended to be physicians and gentlemen, while others simply exploited the patients’ ignorance and offered them therapies while having no notions of medical science and its progress. Secondly, as desclasados, men of middle- and upper-class origins with or without a diploma in medicine, who, driven by their avarice, forgot the commandments such as love of humankind and love of the scientific truth, and compromised the medical profession by pandering to patients for profit and even tricking them out of their money.22 Spanish doctors occasionally mobilised xenophobic stereotypes to stigmatise the second “type” in particular, considering this kind of charlatanry as particularly common among foreigners (often implicitly or explicitly Frenchmen), while it was rare among the austere and honourable Spaniards.

• 24 Víctor M. Núñez-García and Darina Martykánová, “Charlatanes versus médicos honorables…”, art. cit. (...)

14In contrast, the class equals of the physicians were depicted as the embodiments of a “wrong modernity”, capitalism run amok, but also as problematic in terms of their masculinity due to their avarice. Their unwillingness to defend scientific criteria and their desire to submit to the patient’s desire and give them what they wanted implied a lack of manhood. Their seductive attitudes vis-à-vis their patients, particularly women, who were then left damaged with the charlatans’ lousy and dangerous therapies, also mobilised the image of the seducer: an undesirable, delinquent masculinity that needed to be vanquished by righteous men, the good physicians, who were called to defend their professional honour and that of the patients.24

• 25 José Francisco Pedralbes, “Exposición de mérito y premio de la medicina comparado con el de las de (...)
• 26 El Siglo médico, 30 July 1854.
• 27 “Marfugas del cólera”, La Esquella de la Torratxa, 23 Aug. 1884.

15The physicians were aware of their public image being beyond their control and including many unflattering notions. Avarice was a common accusation that was levelled against them, and they strove to displace it towards uncertified healers, or in the worst case, present it as a misbehaviour of dishonourable colleagues. It was, however, not the only criticism often repeated and represented in the press. Cowardice was, too. In an era marked by revolutionary upheaval and epidemics, Spanish physicians explored the prestige of a fighting hero to assimilate themselves to such a figure. In the 1820s they often argued that they deserved the same public honours and salaries as high-ranking officers, being at least as heroic as military men: “The bravest and fiercest military man trembles at an outbreak of a disease and shivers at a mere mention of contagion. In this natural battlefield shines only the heroic serenity of a physician, accompanied only by his enlightenment and philanthropy.”25 In the 1850s when revolutionary movements were perceived by many as a perturbation of order, the most influential Spanish medical journal El Siglo Médico even argued that the physicians’ kind of courage was superior to that of military men, more useful to the society and to humankind than revolutions and wars.26 They could not be surprised, then, if they were held to higher standards than average men when an epidemic struck, being expected to stay in the affected area and attend the sick. If they left running, they were mercilessly mocked for such a dereliction of duty, as we can see in a caricature from 1884 in the Catalan newspaper La Esquella de la Torratxa, concerning a cholera outbreak in Barcelona.27

• 28 Miguel Martorell, “Camelot en 1900: el código del honor y el ideal de perfecto caballero”, in Dari (...)

16The figure of a good physician was construed through comparison with these undeserving, undesirable, or subordinated Others. Nonetheless, the physicians’ professional discourse had to interact with the key concepts of constitutional liberalism, the patriotic discourse, and the class and gender dynamics of that time. This led to a self-representation that was complex and often tried to combine contradictory elements. In the mid-nineteenth century, a physician’s respectable manhood could be embodied in the heroic figure of a slim, austere, self-sacrificing man, either a rural physician or a man of science, mobilising references to priesthood (both Catholic and “pagan”, as in “Aesculapius’s priests”). A good physician could, however, also be represented as a sturdy, reliable, and discreet caballero (gentleman, a redefined category that came to include the middle classes28), with his black suit and top hat, counsel, and support to his patients (illustration 5). Such representations co-existed both in the physicians’ professional discourse and in the social imaginary, in Spain and elsewhere, for instance in France (illustration 6). The public image of physicians, however, often dwelled particularly on those features, practices, and skills that were problematic for their professional self-representation, the same ones that were often used by the physicians to criticise the charlatans, such as dandyism and popularity with the ladies:

• 30 Nerea Aresti, “El ángel del hogar y sus demonios: ciencia, religión y género en la España del sigl (...)
• 31 For instance, Spanish medical journal Décadas médico-quirúrgicas praised the contribution to medic (...)
• 32 Dr. Pedro Recio, “La Comadre”, Los españoles pintados por sí mismos, Madrid, Gaspar y Roig, 1851, (...)

17While scientific knowledge was a characteristic that united both figures, we do not consider that, at least in the Spanish context, it was the axis of the construction of the medical profession as an essentially masculine one. Women were not denied rationality: even if the notion of opposite and complementary sexes became widespread in mid-nineteenth-century Spain, it coexisted and interacted with the older, hierarchic notion of sexes, where women were, in a way, lesser men.30 This misogynistic hierarchy made it possible, however, to accept and praise exceptionally “virile women” (mujeres viriles) for their outstanding achievements in battle and in scientific pursuits.31 This tension was soon to be explored to legitimise the women’s entry into respectable professions: we can observe this dignified image in one of the first representations in Spain of female medical students in the late nineteenth century. Therefore, we argue that, rather than a straightforward denial of rationality to women, the masculine monopoly on authority in the medical field was construed through legal subordination and institutional exclusion of women, as well as through more subtle mechanisms that discouraged women from certain areas and activities by mobilising notions of class and desirability. Elite men, be they physicians, painters, or writers, often construed women in lower-status health professions as robust, sturdy, and often vulgar: “[the midwife] tends to claim for herself the respectable title of matron that indicates a serious and robust woman.”32 Their construction as both undesirable and lower class stands out in contrast with the representations of patients: mostly female, slim, pale, weak, with a lost gaze, the Romantic ideal of woman, that could be—and was—applied across the class divide.

• 33 On medical secret and charlatanry, see, for instance: El Siglo Médico, 31 May 1857, p. 231, p. 262 (...)
• 34 Robert A. Nye, “Honor Codes and Medical Ethics in Modern France”, Bulletin of the History of Medic (...)
• 35 Darina Martykánová and Víctor M. Núñez-García, “Sacerdotes en el mercado, héroes del progreso: los (...)

18In the case of the priest-like representation of rural physicians, the emphasis on mobility—horse-riding, night visits to remote places, attending patients in their homes—was hard to reconcile with an image of respectable Spanish lady. It might seem that the well-off urban physician could indeed be embodied by a bourgeois woman. But could it? First and foremost, home visits still prevailed over patients flocking to a physician’s surgery, so a female physician’s honour would be in jeopardy in urban areas, too. Second, the emphasis on discretion33, frequent in the descriptions of the essential features every physician should possess, mobilised gender and class imaginary. Concerning physicians in France, Robert Nye has pointed to the class aspects of discretion, in its links with Catholic priesthood and with the physician’s standing as a man of honour.34 As Martykánová and Núñez have argued, in Spain, too, discretion was a notion linked to priesthood and to masculinity, specifically to men of honour, that is, upper- and middle-class men who acknowledged each other as caballeros (gentlemen). Lower class men, men of other races and women of all classes were considered as chatty (women and blacks) and/or perfidious (women and “the moors”), and as prone to indiscretions and revelation of secrets. Just like in the case of mobility, the emphasis on discretion as essential for a good physician was one of the most important ways of constructing the profession as essentially masculine in nineteenth-century Spain.35

• 37 These dynamics were transnational: see Edward Shorter, Bedside Manners. The Troubled History of Do (...)

20This is a quote from an article called “A Physician’s Carriage”, part of a satirical series published in 1880 in a Spanish medical journal called El Genio Médico-Quirúrgico. In a light tone, the article argued that a physician needed a horse carriage to visit his patients, in the countryside or in the city, to appear “rich, ostentatious, elegant”. This quote proves that, until the end of the nineteenth century, expert knowledge and credentials did not guaranty physicians respect and social standing. The physicians explicitly acknowledged their need to mobilise the criteria of bourgeois respectability not only to be accepted as gentlemen, but also to be taken seriously as physicians. Respect and respectability were required for one to earn a good livelihood in a context where well-paid posts, public or private, were scarce and paying clients were a fundamental source of the physicians’ income.37 The physicians had to look wealthy in order to be wealthy, a conundrum that was particularly challenging for those who worked in the countryside. This went beyond an individual concern for material wellbeing and social standing. If the physicians wanted to construe their profession as worthy of a gentleman, they had to efficiently embody this figure. This caused urban physicians, including privileged court physicians and university lecturers to get involved in the fight for the improvement of the salaries and working condition of rural physicians (médicos rurales), who depended on meagre salaries provided by the municipalities they worked for. The image of a self-sacrificing priestlike doctor could not be effective if the physicians’ penuries were forced by dire financial circumstances, rather than being sign of their altruistic character.

• 38 Xavier Andreu Miralles, “Hacia una España viril. Las masculinidades patrióticas del liberalismo re (...)

21The tension between the desire to construe the profession as a selfless service to a suffering humankind and the need to mobilise bourgeois codes to reproduce the status of medicine as a liberal profession worthy of a gentleman characterised the central decades of the nineteenth century. We argue that in Spain this dynamic had its particularities, with many similarities to France. In both countries, the construction of medicine as modern profession had a political dimension. Unlike Central Europe, for instance, Spain and France were early comers to constitutional parliamentarism. In both countries, revolutionary patriotism created, in the early decades of the nineteenth century, specific settings for a redefinition of the Ancien Régime notions of honor and virility that stressed glory, heroism, fearlessness, and self-sacrifice.38 The physicians adopted and adapted these values in their professional discourse and self-representation.

• 39 On male suffrage in nineteenth-century Spain: María Sierra, María Antonia Peña and Rafael Zurita, (...)

22However, liberal values such as the emphasis on property soon became extremely important in the new political system and in society, particularly as the wars were over or became localised. For many decades, male suffrage was not universal, neither in Spain nor in France. Not only was it limited to men, but it was limited to property owners capable of paying high taxes. In both countries, an exception was made for the so-called “capacities” (capacidades), men of certain education and liberal professionals, for whom the tax barrier still existed, but was lowered.39 Physicians were only gradually included in this category in both Spain and France. They profited from medicine’s longstanding status, dating from medieval times, as a liberal art taught at the university (like theology and law), as opposed to servile (mechanical or vulgar) arts that were considered socially degrading and inappropriate for a gentleman.

• 40 Darina Martykánová and Víctor M. Núñez-García, “Ciencia, patria y honor…”, art. cit., p. 45–75.
• 41 The priest figure became heavily questioned, but the loss of respectability was neither complete n (...)
• 42 Jesús de Felipe, Trabajadores, lenguaje y experiencia en la formación del movimiento obrero españo (...)
• 43 Gonzalo Álvarez Chillida, El antisemitismo en España. La imagen del judío (1812-2002), Madrid, Mar (...)
• 44 Víctor M. Núñez-García, “A Physician and a Gentleman…”, art. cit.
• 45 Darina Martykánová and Víctor M. Núñez-García, “Sacerdotes en el mercado…”, art. cit. For similar (...)
• 46 José Francisco Pedralbes, “Exposición de mérito y premio de la medicina comparado con el de las de (...)

23As we have argued in previous research, work was a problematic concept in gender and social terms in mid-nineteenth-century Spain.40 Public activity and social usefulness had become important in Spanish elite masculinity since the Enlightenment, but remunerated work was not the least problematic way of being considered active and useful. In fact, the “need to earn a living” could be and was construed as undesirable dependence, and wealthy male rentiers and landowners who inherited their properties were more easily acknowledged as active citizens by Spanish (and French) law than professionals such as physicians, pharmacists, and engineers, who often failed to reach the tax requirements. In this context, professionals, including physicians, mobilised several notions, such as disinterest, service to the nation and to humankind, and science (or truth) as a moral compass. The emphasis on selfless vocation fuelled by their “love for humankind” was supposed to shield them from the accusations—levelled against the physicians jokingly and seriously, in press and in popular culture (illustration 7)—of avarice and profiting from people’s disgrace. It was also supposed to protect them from being presented as weak and dependent vis-à-vis their paying patients. All three of these aspects were problematic in gender terms. The sacerdotal figure was masculine, because it was independent and untouchable due to him being a man of principles, capable of protecting people’s secrets and prioritising his mission over material desires.41 The issue of profit was extremely ambiguous in mid-nineteenth-century Spain. On the one hand, usefulness and productivity were values that were associated with masculinity since the Enlightenment, and a capitalist logic of competition through commerce and industrial production rather than war was praised by many in Spain as a sign of the progress of civilization.42 On the other hand, the search for profit and the pursuit of individual interest were often construed as less manly and less patriotic than the defence of the common good in political cultures ranging from legitimism and conservative Catholicism to republicanism. In Spain (as in many other countries), antisemitic metaphors were often evoked to construe the capitalist as a lesser man whose morals and patriotism were questionable and whose values and traits were incompatible with the ideal of the Spanish hidalgo.43 This ambiguousness perpetuated the debate among medical professionals about how exactly to reconcile the desire for prestige linked to usefulness, public service, and exclusive knowledge with the need to earn a good living. As we have seen from the quote above, they mobilised the signifiers of bourgeois respectability, such as dress, transportation vehicles, and patterns of sociability. They also strove to present a united front as a professional group and demanded honours, help, and legal protection from the state, arguing that they made an important contribution to society and to the glory of the nation. To cement their respectability and social standing—and demand substantial salaries and fees (honorarios)—the physicians appealed to the values associated to the elite masculinities of the Ancien Régime (honours, glory, commitment to the Truth, service to the King), values that were redefined, however, through an interaction with the discourse of constitutionalism, national sovereignty, and the liberal logic of “removing obstacles to freedom”.44 While they endorsed or accepted the removal of corporative/gremial privileges, they called for legal protection that would grant them an exclusive position in the medical field.45 They supported their demands with arguments that combined Enlightenment and liberal values. Firstly, certified expert knowledge (sometimes called “science”) achieved through a costly and demanding education was an argument that fit in well with both Enlightenment and liberal emphasis on knowledge as a source of legitimacy, but it also mobilised the notion of a “good birth”. The notion of good birth, or good family, was redefined from a strictly aristocratic interpretation to a broader notion of one being born to a wealthy and decent family, capable of and willing to provide one with an education that promoted the right values and character traits (sensitiveness, discretion, tactfulness, self-discipline)46, while permitting one to acquire the kind of knowledge and skills required for a specific profession. Secondly, the emphasis on meritocratic mechanisms (exams) and the idea that physicians served the common good both by holding public posts and attending to private clients further strengthened their demands for state protection of their supreme authority in the medical field.

• 47 Patricio Rodríguez y Sulss, “Puerto Rico. Un paseo por esta isla”, El Siglo Médico, 26 Jun. 1859, (...)
• 48 This discourse is analysed, for instance, in Guillermo Lusa, “Contra los titanes de la rutina. La (...)

26In syntony with the ideas shared in the colonial metropolises all over Europe, colonial settings were construed as corrupting, a threat to the integrity of metropolitan man (the sources make no explicit reference to whiteness). When defending the use of quinin in cases of yellow fever, the physician Patricio Rodríguez Sulss argued he was following his reason, while some of his colleagues in Puerto Rico succumbed and imitated the practices of local healers, male and female: “These ideas are easily accepted by my reason, which could never settle for the empirical and barbarian treatment used by the curiosos [healers] and is adopted by certain gentlemen physicians to the detriment of their reputation and of science.”47 He understood this as a threat to their reputation as physicians, which, after all, was their problem as individuals. However, he also considered their therapies as a threat to medical science, a point we would like to stress. This shows that, by the mid-nineteenth century, Spanish physicians strove to present a united front as professionals, imposing their scientific criteria—negotiated, established, and shared within the medical community—on the patients, instead of adapting to the patients’ expectations. Moreover, we should underline the words empirical and barbarian. The accusations of empiricism—in the sense of a routine practice, accepted and perpetuated with no desire to understand its workings, learned through experience and repeated therapeutical methods with no effort to improve them—were very typical among professions who aspired to represent themselves as scientific in mid-nineteenth-century Spain, including those who claimed expertise in medicine, mathematics, and engineering.48 The physicians presented themselves as men of science in contrast to practitioners who had no access to formal education and learned to heal in the field, through practice, repeating well-established therapeutical methods. By the mid-nineteenth century, this was not considered enough to be a good physician, at least in France and Spain.

• 49 For a similar dynamic concerning yellow fever, including the rivalry with metropolitan physicians (...)

27The other slur, “barbarian”, however, brings us right into the symbolic world of colonial domination. Uncertified healers in the Iberian Peninsula were demeaned as empirical but were rarely called barbarians. This word evoked racial difference, or at least degradation through proximity and interaction with people considered as racially and morally inferior, as barbarians. While the threat of charlatanry and fraudulent practice loomed everywhere, it was as if the physicians in colonies were aware of the need to take special care to negotiate their position as respectable men of science. This caution, however, did not mean a straightforward refusal of subaltern knowledge. Some physicians were willing to learn from “the blacks and other indigenous” healers. While they argued that the influence of these healers even “among the highest society” was understandable because of the lack of qualified physicians in Cuba, they were willing to admit that the plants and remedies these male and female healers used needed to be taken seriously and examined by reasonable men of science, for they may actually be useful in healing. We could even speculate that this argument, developed in an article sent by a physician who practiced in Cuba to the most influential peninsular medical journal, might have been a way of asserting the position of colonial physicians vis-à-vis their peninsular colleagues, who, while teaching and practicing in prestigious institutions, had little access to all kinds of indigenous knowledge presented as helpful in curing the ailments typical of the colonial settings.49

• 51 Barbora Rambousková,“The Doctor and his Patients…”, art. cit.
• 52 “[…] when the next day I went to visit him for the second time, one of the family received me to i (...)

28In her work on physicians in nineteenth-century Bohemia, Rambousková has described how the younger generation of physicians, who were convinced of the harmfulness of bloodletting and excessive drug prescription, felt the need to negotiate with their patients who insisted on these practices. They accepted it on certain occasions in order to slowly gain the patients’ trust and convince them to cease demanding it in most cases.51 We have found the same willingness to adapt to the paying patients’ expectations on drug prescription in the social representation of the physicians in the Spanish colonies, too.52 Nonetheless, we can appreciate that some of the titled Cuban physicians were willing to learn from the healers and acknowledged the possibility that their remedies were indeed efficient, though they construed themselves as superior to the healers in their capacity for discerning the useful from the useless or harmful. By representing themselves as men of “practical science”, however, they also claimed advantage over the “men who cultivate science in opulent universities”. Prudent, thoughtful, and practical, a good listener and observer: all these were the characteristics a good physician needed to prosper in a colonial context.

• 53 On the attitudes towards the Chinese: Edgar Wickberg, The Chinese in Phillipine life (1850–1898), (...)

29The complexity and ambiguousness went even further. While the reader might suppose that the category of barbarian was applied to all rivals that were acknowledged as racially different, this is in fact far from true. It seems it was supposed to evoke the image of a black, mixed race or, in the case of Philippines, indigenous healers. The discourse of Spanish-speaking physicians concerning Chinese medical practitioners was radically different.53 First and foremost, they were referred to as physicians, and, in this sense, acknowledged as peers, however threatening and hated. They were considered as serious rivals, enjoying a good reputation for their skills and wisdom, and capable of attracting and satisfying prominent patients.

• 55 In fact, El Siglo Médico informed its readers about the state of the medical profession in China i (...)
• 56 Colonial physicians, Spanish and American, also strove to counterbalance the higher prestige of Eu (...)

30This quote shows few signs of “Western” superiority. While undoubtedly mobilising the stereotypes attached to the Chinese in mid-nineteenth-century Europe and America (luxury, opium, and servility), the criticism was not that different from the one levelled against French physicians operating in the Spanish colonies and in the Iberian Peninsula. First and foremost, there seems to be no notion of a “traditional Chinese medicine” as radically different from—and inferior to—a “modern Western medicine”. This may be because many physicians of the mid-nineteenth century still understood the art of healing as a broad set of knowledge, skills, and practices, verified by use and experience, rather than as a strictly defined scientific discipline of which they would be the unquestioned gatekeepers. Secondly, they did not deny their Chinese colleagues the category of physician, but focused their criticism on verifiable credentials, as they did in the case of their colleagues from France and the United States. They did not argue that a Chinese man with a diploma from China could not be a true physician;55 rather, they insinuated that men with fraudulent credentials or with lesser titles pretended to pass as their professional equals, benefitting from a positive image of their country as a land of good physicians—as they did in the case of men from France or the United States. They demanded protection as sons of the country, Spaniards and Americans, not necessarily as better physicians. It seems that this joint category included free men of colour, though we need to prove this with further research. What we can affirm, though, is that the logic of credentials was very powerful, and while it could be used to shed doubt on foreigners, it also facilitated mutual acknowledgement, however grudging, across racial and national differences.56 Last but not least, the terms on which the Chinese professionals were caricatured, while culturally specific, pointed to the very paradoxes of the Spanish and Spanish-American physicians’ own professional discourse. On the one hand, they construed themselves as humble men of science, beyond any ostentatiousness and pretension. On the other, as in the article regarding the physician’s need for a carriage, the physicians in the colonies fully acknowledged, jokingly or not, that they needed to mobilise social skills and status symbols to get respect and to attract paying patients:

• 58 For Cuba, “carriage, a robust horse and a well-nourished driver”. In J. Agustín Millán, “El Médico (...)

31While criticising their Chinese colleagues for impressing patients with luxurious clothes, exotic scents, and obedient servants, and portraying the French as prone to charlatanry and seductive behaviour, elsewhere they insisted on the utmost importance of dress, elegant writing, a carriage,58 and listening skills in making one a good physician who was able to make a living working as such, both in the colonies and in the Iberian Peninsula. Being a good physician was a complex negotiation of diverse elements: a self-representation that was rewarding in class terms could be problematic in gender or scientific ones and a tactic that worked to strengthen the cohesion of a professional community could have negative repercussions on the profession’s image in the eyes of the public.