Margaret Ann Bulkley (James Barry) (1789−1865)

Margaret Ann Bulkley, under the male pseudonym James Barry, was one of the first female obstetricians in early nineteenth century British Empire. She was the first person to perform a cesarean section in South Africa. Cesarean section is a procedure in which a doctor cuts into the uterus of a pregnant woman to retrieve the fetus during complicated births. Bulkley hid her gender and lived life as the male Barry to practice medicine, an opportunity not allowed to women at the time. Barry's position as a Medical Inspector with the British Army enabled her to travel the world as a physician and to practice surgical techniques including the removal of fetuses during complicated births.

Bulkley was born in Cork, Ireland, in 1789 to Mary Ann Barry and Jeremiah Bulkley. Bulkley had a brother, John, and a sister whose name is unknown. Bulkley's father was a grocer and held a government position in the Weigh Houses of Cork but, after he losta lot of money from the arranged marriage of his son, he abandoned his family and moved to Dublin, Ireland.

Bulkley and her mother reached out to the maternal side of the family for help and petitioned Bulkley's uncle, James Barry, an artist living in London, England. Bulkley wrote a letter to her uncle narrating her family's unfortunate circumstances and after much correspondence she and her mother moved to London, where they lived for many years. In London, Bulkley's uncle introduced her to some of his colleagues, including physician Edward Fryer and Francisco Miranda, a general from Venezuela. Fryer and Miranda became her mentors and they helped her get admitted into medical school.

Soon after introducing Bulkley to Fryer and Miranda, her uncle died from unrecorded causes. Over the next two years Fryer and Miranda continued to help Bulkley in providing her general education. Due to her success with her studies, Miranda proposed that she attend medical school, although only men had access to medical education at that time. Bulkley agreed to pose as a man to attend medical school in Scotland and to go to Venezuela with Miranda upon earning her degree. In 1809, Bulkley (hereafter referred to by her pseudonym) assumed the name of her deceased uncle, James Barry, and started school at the University of Edinburgh in Edinburgh, Scotland. In 1812, when Barry completed her final medical school exams, the Spanish captured Miranda and he died from typhus in captivity. After Miranda died, the opportunity to practice medicine in Venezuela as a woman disappeared, and Barry retained her male pseudonym to practice medicine in England.

After graduating from medical school with her MD, Barry joined the British army to serve as an hospital assistant, and later as a surgeon assistant. She held that position through the Battle of Waterloo in 1815, after which she moved to Cape Town, South Africa. During her time in Cape Town, Barry performed one of the first recorded cesarean sections in South Africa, although the indigenous population had been practicing a variation of the technique prior to her arrival. Additionally, she studied local plants to find a treatment for the symptoms of syphilis, and reviewed the South African water system to prevent corrosion to the water pipes.

While practicing medicine in Cape Town, Barry performed a cesarean section on 26 July 1826, successfully delivering a healthy male infant, who was later named James after her. Barry had learned how to perform cesarean sections in medical school, but she had only seen two cesarean sections performed and both had proven fatal for the mother and fetus. At that time, antisepsis and anesthesia were not available and intense pain as well as high risk of infection occurred with a cesarean section. While Barry surgically removed the infant, she did not suture the uterus closed. Surgeons thought that if the uterus was sutured closed, then the stitches left behind during the procedure created infection and possibly uterine rupture. Although without suturing the womb, there was a high chance of maternal mortality, both the mother and the child survived the cesarean birth. Suturing the uterine lining did not come until almost three decades later, when James Marion Sims in the US developed techniques for suturing the uterus closed with silver wires in 1852.

After leaving Cape Town in 1828, Barry transferred to Malta where she helped contain a cholera outbreak. As a result of her efforts, The Duke of Wellington personally thanked her. Shortly after, Barry was promoted to the more prestigious position of medical inspector for the British Army, which required moving often. In 1857, she moved to Canada where she worked to improve the diets and living quarters of soldiers. In 1859, due to Canada's cold temperatures, Barry fell subject to influenza, which eventually developed into bronchitis.

Barry returned to London in 1859 and was discharged from the army due to her respiratory illness. On 25 July 1865 Barry contracted dysentery and died in England. After her death, Sophia Bishop, who took care of her body, discovered that Barry was a female. Newspapers in Britain reported the news, noting that a woman had received an MD, had become a renowned surgeon, and had served in the military four forty years as an officer, all under the guise of being a man. The British Army denied the fact and sealed all records relating to Barry for over 100 years, until historian Isobel Rae obtained permission to examine the records in 1950.