28 April 2021

King’s Health Partners Academic Surgery celebrating women in surgery, honours the pioneer Margaret Bulkley, known as Dr James Barry, through our Professorships.

As King’s Health Partners Academic Surgery Bulkley-Barry-Cooper Professorship was named after Dr James Barry/Margaret Bulkley, we asked the esteemed author and authoritative biographer Jeremy Dronfield to share with us the story behind one of the most pioneering surgeons in history.

On a November morning in 1812, a newly qualified physician left his lodgings on the Borough High Street in Southwark, crossed the road and walked in through the gates of the old St Thomas’s Hospital. Dr James Barry [pictured right] – so slight and fresh-faced that he appeared to be a teenager – hadn’t come to St Thomas’s to take up a professional post; he was here to learn. His training at Edinburgh hadn’t equipped him sufficiently in practical surgery, and he was keen to remedy that.

What nobody at either Edinburgh or St Thomas’s knew was that this young man had once been female. Margaret Ann Bulkley was born in Ireland in 1789. Initially expecting a life as a governess, Margaret had been encouraged by radical friends to alter her gender identity and pursue a career in medicine. Thus, in 1809, Mr James Barry came into existence. (See note below on James Barry’s gender.)

While at St Thomas’s, James would study materia medica (pharmacy) more closely than at Edinburgh, serving as a pupil to the hospital apothecary, spending hours in patient consultations and preparing medications in the Herb Garret (which still survives). The rest of the time, he attended classes in surgery given by Henry Cline and the celebrated (and already fabulously wealthy) Mr Astley Cooper. The classes ranged from ulceration and gangrene to urinary calculi and lithotomy, spinal injury, hernias and amputation. James had written his MD dissertation on femoral hernia, citing Cooper’s pioneering work, so studying under him was a special privilege. Along with a flock of up to 100 surgical apprentices, every Friday afternoon James walked the wards of Guy’s Hospital under Cooper’s tutelage.

In July 1813, Dr James Barry took the oral examination at the Royal College of Surgeons and received his diploma. Despite having several influential patrons, he eschewed the lucrative prospect of society practice and joined the British Army, initially as a hospital assistant, quickly rising to become a staff surgeon. “Was I not a girl,” Margaret had once written, “I would be a soldier!” Now, with extraordinary daring, that ambition was made real.

James Barry’s military career lasted almost fifty years, taking him to postings in the Cape Colony, Mauritius, the Caribbean and the Mediterranean, rising ultimately to Inspector General of Hospitals for Canada before his retirement in 1859.

Dr Barry was renowned for his skill as a physician and surgeon. In 1826 he performed the British Empire’s first successful caesarean delivery. Among other achievements he helped develop a radical method of treating aneurysms by distal ligation, handled a rare case of bilateral, synchronous testicular tumours in a young soldier, and researched botanically sourced medications for venereal disease. Barry pioneered hospital sanitation and public health long before the discovery of bacterial infection, which must have contributed to his unusual clinical successes. In the Crimean War he ran an exemplary convalescent hospital and clashed bitterly with Florence Nightingale. As a young surgeon in the Cape Barry was the first Colonial Medical Inspector, single-handedly performing a role which was later found overly taxing for a committee of five men.

But it was James Barry’s character that attracted most attention. Noted for his tiny size, high-pitched voice and effeminate mannerisms (which he always struggled to overcome), he was notoriously bad-tempered. He fought at least one duel, was prone to violent outbursts of rage if his medical advice was ignored or challenged, and was slated for court martial at least once. The truth about James’s sex – which had the potential to ruin him utterly – was discovered three times by acquaintances, but was never exposed publicly. It’s nearly impossible to imagine the stress of living with such a secret in such a world, and this must have contributed to James’s notorious temper.

James, who had a deep dread of shame and exclusion, hoped to die and be buried without his biological sex ever being known. But after his death from cholera in 1865, his regular manservant mysteriously disappeared and the layer-out who prepared his corpse later revealed to the press what she discovered – that Dr James Barry had the body of “a perfect female”, and had evidently once borne a child.

The scandal was published in newspapers all over the Empire. It was such a sensation that Charles Dickens himself wrote a short biography of “Dr James”. Unable to imagine that a woman could have ambitions to be a surgeon or a soldier, many believed that the (then nameless) young woman had joined the army to pursue a lover. Some doctors speculated that Barry must have been intersex, because a woman surely couldn’t have achieved such clinical success or stomached the work of a surgeon. It would be more than a century before the truth about this remarkable pioneer would be known. Even now there are question marks, not least about his gender.

Note on James Barry’s gender. James Barry identified as a man and was indisputably transgender. But evidence suggests that he was not a trans man in the full modern sense of that term. Although he enjoyed living as a man, he was never fully comfortable in his masculine identity and struggled to sustain it. Moreover, he kept a secret collection of fashion plates cut from women’s magazines, implying that he would have liked to be able to live as a woman again (which would have cost him his career). Had Margaret Bulkley been born in 1989 instead of 1789, free to practise medicine and serve in the armed forces, it’s likely she wouldn’t have transitioned, but it’s possible that she would have lived as nonbinary.

Dr James Barry by Michael Du Preez and Jeremy Dronfield is published by Oneworld.