Wonders, Curiosities and Found Facts: The British Empire's first successful caesarean delivery

Wonders, Curiosities and Found Facts. An occasional series exposing the dimly lit recesses of history. In the course of writing books set in various historical periods, I continually come across remarkable details known only to a few people.

Today: Pioneering surgery by a woman in disguise!

THE NIGHT OF 25 JULY 1826 was cold and wet. In the small settlement of Wynberg, nine miles from Cape Town, Mrs Wilhelmina Munnik’s pregnancy was coming to a traumatic conclusion. The baby – for which Wilhemina and her husband Thomas had waited for ten years – refused to be born. The midwife had done all she could, and was forced to concede defeat. A doctor was needed.

Thomas Munnik ordered a servant to ride to Cape Town to fetch the very best surgeon available, a man known for his obstetric skill. Dr James Barry was a Staff Surgeon with the British Army garrison, as well as medical attendant to many of the Cape’s rich families and personal physician to the former Governor, Lord Charles Somerset. A fine medical practitioner, James Barry was known not only for his skill but also his eccentricity – particularly his appearance and manner. What was not well known about Dr Barry was that beneath his male attire he was a woman.

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James Barry's real name was Margaret Bulkley. Born in Cork in 1789, Margaret had decided at the age of 19 that she wanted to study medicine (under the influence of her tutor and a maverick Venezuelan revolutionary who was living in exile in London). In 1809 such a course was firmly closed to women, and so Margaret made a courageous, audacious decision. She disguised herself as a man and adopted the name of her late uncle, the eccentric painter James Barry. After successfully gaining the MD degree at Edinburgh in 1812, “Dr James Barry” became a member of the Royal College of Surgeons of England (the first woman to do so) and joined the British Army as a military surgeon. In 1816 Assistant Surgeon Dr Barry was posted to the Cape Colony, where he would make a great name for himself.

When Dr Barry arrived at the Munniks’ house on that rainy July night in 1826, he found Wilhelmina Munnik in a terrible state. An examination showed that the baby could not possibly be delivered in the normal way. This left only one option – an option dreaded by all doctors in that era. A caesarean operation would have to be performed.


19th century obstetric instruments. (Science Museum)

In the early 19th century, when surgical science was still horribly crude, the caesarean procedure was invariably a death sentence for the mother; it was only performed as a last restort, to save the life of the baby. James explained the situation to Wilhelmina and her husband. Wilhelmina, in an extremity of pain, consented, and Dr Barry put away his forceps and prepared his surgical instruments.


19th century surgeon’s kit.

Although the caesarean procedure was normally expected to be fatal, one or two isolated examples were known in which a mother was reported to have survived. Such a miracle was said to have happened once in America, and on another occasion in Switzerland; the latter case, performed by a Dr Locher in Zurich, had occurred in 1818 and was published in detail in a medical journal. James Barry would have known the paper well, and probably followed Locher’s procedure. (There is said to have been an earlier instance as far back as 1500, when Jakob Lufer, a Swiss pig-gelder, performed such an operation on his wife. Her survival probably had more to do with luck – or perhaps apocryphal myth-making – than surgical skill.)

Anaesthetics did not exist in 1826, and Wilhelmina, lying on her marriage bed, had to be held down as Dr Barry made the incision.

James Barry never described the procedure in detail, but Dr Locher did:

The sphere of the uterus, now appearing, extended the edges of the incision, so that there appeared a considerable vaulted surface of the womb. There protruded also a portion of small intestine, which, however, was easily kept back by means of linen anointed with fat. In order not to cut through the uterus exactly in a place where the placenta might accidentally be situated, and thus excite a violent bleeding, I chose a somewhat uneven part of its surface, and there made a little incision, so that I could introduce the index of the left-hand, to serve as a guide for the progress of the knife … Immediately the child presented itself … The nearest part of the child was an arm … Already before the head was freed from the womb, the infant moved its limbs, and on the development of the head, to the greatest joy of the mother and all the attendants, it proved its life by loud cries.

The Munnik baby was a perfect, healthy boy. Dr Barry stitched up the wound, saw that mother and baby were comfortable, and departed, promising to return the next day.

Now began the crucial period; this was the time when infection would set in, the mother falling into an illness from which she would never recover. Death would occur within a matter of days. Infection was not understood in the early 19th century – the very concept was unknown, and would remain so for several more decades. All a doctor could do was treat the symptoms. By the standards of the day, James Barry was a very good doctor.

Miraculously, Wilhelmina Munnik did not die. For the first time anywhere in the vast British Empire, a surgeon had brought a mother successfully through the trauma of a caesarean delivery. How fitting that the surgeon was a woman (a woman who had herself once given birth to a child, and was therefore the only surgeon then living who knew first-hand what childbirth was like). The baby was named in honour of his deliverer – James Barry Munnik – and Dr Barry stood godfather. Flattered and delighted, he gave the family the miniature portrait of himself that had been made in England on his being commissioned in the Army.

Margaret Bulkley, aka James Barry, achieved many remarkable firsts in her lifetime – first woman to qualify MD, first woman to join the Royal College of Surgeons, and later the first woman to reach the rank of general in the British Army – but from a medical point of view, performing the British Empire’s first successful caesarean delivery was perhaps her most important.

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You can read the the whole story of James Barry’s incredible life and career in Dr James Barry: A Woman Ahead of Her Time by Michael du Preez and Jeremy Dronfield, coming August 2016 from Oneworld Publications.

Dr James Barry: A Woman Ahead of Her Time has been selected for BBC Radio 2’s Fact Not Fiction Book Club – find out more and download a free extract.

© Jeremy Dronfield 2017