The Improbable Dr. James Barry, the Physician who Pioneered the C-Section Surgery

By Godfrey Onime

James Barry
Portrait of James Barry early as a medical student

He appeared the most unlikely person to be the champion of women. Short for a man and quick tempered, Dr. James Miranda Barry was known to berate his staff and throw surgical instruments across the room. However, when it comes to his patients, he was gentle and caring. He sympathized with the less fortunate, including slaves and lepers, and was an advocate for pregnant women. In fact, he would make his mark in the history of medicine by advancing the surgical procedure that can today mean difference between life and death for many women, their baby, or both: the c-section. But the iconoclastic Dr. Barry had a yet other “secrete” legacy her perpetuated for all of his adult life, one, as would become clear, that many believe helps to understand his sympathy for the plight of women in his time.

For much of the pre-antibiotics and anesthesia era, c-section was reserved for the dead or women who were not expected to survive labor. After all, early surgery was fraught with high fatality. The equipment were also crude and unsterilized, so that the ensuing pain, bleeding and infection made it highly unlikely that a mother would survive early c-sections. And while some believed that the term caesarian section was derived from Julius Caesar, who was allegedly removed from his mother’s womb and abdomen through a cut, many historians believe otherwise. They reason that it was unlikely she would have survived a c-section surgery during that period.  

In time women too began to survive surgery along with their babies. This is thanks to the efforts of some dedicated, fastidious and careful surgeons, such as the oddball Dr. Barry.  Stationed in South Africa at the time, Dr. Barry is credited with performing the first known successful c-sections in which both mother and baby survived. However, the other reason for the interest in Dr. Barry by historians would only become apparent after his death, and certainly illuminate why she was so devoted to the care for women and the marginalized. Those preparing his body for the undertakers made the startling discovery that Dr. Barry was “a most complete and perfect woman.” Indeed Dr. Barry had been a “she” all along, and not a “he.” But why? What motivated her to go through all that trouble for nearly 50 years? 

Born Margaret Ann Bulkley around 1789 in Ireland, her father was…  Her elder brother, John Bulkley, was the hope of the family. The family spent a fortune to have him apprentice with a attorney. John also married a socialite, his wedding alone costing £1500. Unable to repay his debts and without help from the ungrateful son, Margaret’s father ended up in prison. Margaret and her sister on tow, her mother set our to London in search for work.

Margaret’s mother had a brother in London, an artist named James Barry. He died in 1806 and his assets were liquidated. The money split between Mrs. Bulkley, the remaining living brother, and some set aside for Margaret. By this time Margaret had not attained much schooling, but that was about to change.  It turned out that her uncle James ran with a liberal, forward-thinking crowd. They began to tutor Margret and were impressed with her intellect and ambitions.  One of the men was a doctor, and the other the General … who was exiled in Britain and planed to return and liberate his native Venezuela. And then there was a fellow named William Godwin, the widower of the author of Vindication of the Rights of Women, Mary Wollstonecraft.

It is believed that this radical bunch helped Margaret to concoct the plot to disguise as a man so she can attend medical school, which was not open to women at that period.  Margaret would adopt the name of his recently disease uncle James Barry, attend university and pass the examinations. Afterwards, she would reveal her true identity and accompany the General to Venezuela to help his cause.

Margaret enrolled in medical school in Edinburgh in November 1809. Only a few people were privy to the secret of her disguised appearance, including her mother and the liberal-mix. At least one other person knew of rues: her solicitor, Daniel Reardon.  In a letter to Reardon after she enrolled in medical school, “Barry” reported on “his” progress in school:

… indeed everything has far exceeded my most sanguine expectations and Mr. Barry’s Nephew is well received by the Professors &ca.

Like the students of her days, her studies in medical school included Anatomy, among others, as she further revealed in the letter

 ….I have been introduced to my Lord Buchan & have taken out my tickets for Anatomy, Chemistry and Natural Philosophy. I have been metriculated [sic] and attend the second Greek class at the University in fact I have my hands full of delightfull business & work from seven oClock in the morning till two the next …

She signed the letter “James Barry,” but on the outside of the letter Reardon wrote “Miss Bulkley.” Historians comparing the handwriting in the letter and a previous one signed by Miss Bulkley further indicate that Margaret Bulkley and the future doctor James Barry were in fact the same person.

Barry also studied surgery, medical theory, Latin, and pharmacy, among others. She tackled the exams in May 1812, which comprised a written test, two oral exams, and a public defense of a written thesis. Succeeding and graduating with 57 others in her class, Dr. Barry became Britain’s first qualified female physician.

The plans seemed all well and good so far, but a big hitch arose after Dr. Barry graduated. The Venezuelan General Miranda had been taken prisoner, fell ill, and died–and with that the newly minted doctor’s plans to go to Venezuela.

But Dr. Barry had worked so hard and loved medicine and hence decided to continue with the disguise in order to practice as a doctor. But why the military, which clearly added a layer of complication to the doctor’s masquerade as a man? The more appropriate answer, perhaps, is… why not? While still a girl and upset at her wasteful brother, the young Margaret once wrote, “Had I been a man, I would have become a soldier.” Well, then, here was her chance. She had already fooled everyone and earned a medical degree. So, a soldier Dr. Barry became.

Dr. Barry joined the British Army and participated in the Napoleonic Wars. Although he had a good reputation and her credentials superb, there was of course the problem of the physical examination. Historians conjecture that Dr. Barry obtained a certificate of a clean bill of health from a private physician.

Once commissioned, the military sent Dr. Barry around the world, including Canada, India, Jamaica, South Africa, among others. It was while stationed in South Africa in 1826 that the performed a Caesarean section that is believed to be the first truly successful in which both the woman and baby survived. 

Of course the surgery had not been planned, as were all c-sections at that time. It was a Tuesday, June 25th, 1826, and Dr. Barry had been summoned in the middle of the night — these things always seem to happen in the middle of the night. The woman, Wilhelmina Munnik, had been in protracted labor, unable to deliver naturally.  She had become dangerously exhausted, so that the only alternative was to at least try to save the living fetus through a caesarean surgery.

Dr. Barry obtained Wilhelmina’s consent, both woman and doctor knowing that the woman was unlikely to survive and too commonly, the baby as well. That night Dr. Barry worked as fast and dexterously as she could, paying attention to hygiene and bleeding. Her expertise and attention to detailed paid off, and fate smiled down at Wilhelmina and her son, both surviving.  The by boy was christened James Barry Munnik. That name would be passed down through generations of the Munnik family, in in honor of the surgeon who had worked miracles.

Reportedly a great doctor and possessing an excellent bedside manner, Dr. Barry appeared to love working and only reluctantly retiring at about age of 65. After retirement, she traveled some more, including to Jamaica. She died of dysentery in London in 1865.

It is believed that Dr. Barry had stated that no post-mortem examination was to be conducted after she died, but to be buried with the clothes she had on and wrapped up in the sheet on which she lay. Either the handlers for the undertaker were unaware of this or they had ignored this request.

The sex on Dr. Barry’s death certificate was indicated as male, but the nurse who tended to the doctor reported otherwise. When Barry’s doctor was challenged, he responded with this letter:

I had been intimately acquainted with the doctor for good many years, both in London and the West Indies and I never had any suspicion that Dr Barry was a woman. I attended him during his last illness, (previously for bronchitis, and the affection for diarrhoea). On one occasion after Dr Barry’s death at the office of Sir Charles McGregor, there was the woman who performed the last offices for Dr Barry was waiting to speak to me. She wished to obtain some prerequisites of his employment, which the Lady who kept the lodging house in which Dr Barry died had refused to give him. Amongst other things she said that Dr Barry was a female and that I was a pretty doctor not to know this and she would not like to be attended by me.

I informed him that it was none of my business whether Dr Barry was a male or a female, and that I thought that he might be neither, viz. an imperfectly developed man. She then said that she had examined the body, and was a perfect female and farther that there were marks of him having had a child when very young. I then enquired how have you formed that conclusion. The woman, pointing to the lower part of his stomach, said ‘from marks here. I am a maried [sic] woman and the mother of nine children and I ought to know.’

The woman seems to think that she had become acquainted with a great secret and wished to be paid for keeping it. I informed his that all Dr Barry’s relatives were dead, and that it was no secret of mine, and that my own impression was that Dr Barry was a Hermaphrodite. But whether Dr Barry was a male, female, or hermaphrodite I do not know, nor had I any purpose in making the discovery as I could positively swear to the identity of the body as being that of a person whom I had been acquainted with as Inspector-General of Hospitals for a period of years.

That seemed to be that and the military kept its records from the public for 100 years.

And then there were the stretch marks on Dr. Barry. It is believed that she had a baby while still Margaret, apparently after she was rapped at around age 13 and her mother raised the child.

Cesarians have come a long way since Dr. Barry  performed the first truly successful case that saved mother and baby. The procedure is now generally more safely performed on millions of women every year around the world. In fact, the World Health Organization (WHO) recommends a c-section rate of 5% as ideal to reduced maternal and fetal morbidity and mortality. Unfortunately, the procedure has raised its own set of issues, including over and under-utilization, access, ethical concerns, among others.  But whatever the complexities today surrounding the procedure that Dr. Barry helped advanced, one thing remains clear: Where indicated, c-sections save lives–millions of life.

Dr. Barry would feel that her efforts at masquerading as a man for 56 odd years to be a part of that progress was well worth it.

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