The curious case of Margaret Anne Buckley, also known as James Barry, is a captivating tale of identity, perseverance, and pioneering achievement in the field of surgery. This is one of those tales that remain so captivating and sparks lots of debates to every listener (or reader).  I have grown fond of her story and there are many lessons to be learned here.  Without any delay, lets talk about Dr. James Barry.

​Born Margaret Anne Buckley in Ireland in the late 18th century, she defied societal norms and disguised herself as a man, assuming the identity of James Barry to pursue a career in medicine at a time when women were barred from such professions.

Under the guise of James Barry, Buckley graduated from medical school in Edinburgh and embarked on a distinguished career as a military surgeon in the British Army. Throughout her career, Barry made significant contributions to medical practice, particularly in the fields of hygiene, sanitation, and surgical techniques, revolutionizing the standards of healthcare in the military.

Barry's story is fascinating not only for the audacity of her deception but also for the groundbreaking advancements she made in surgery during a time when women were largely excluded from the medical profession. Her achievements challenge conventional notions of gender roles and highlight the importance of inclusion and diversity in medicine.

Today, Barry's legacy serves as an inspiration to aspiring surgeons, particularly women, who continue to face barriers and biases in the field. Her story underscores the resilience and determination required to overcome obstacles and make meaningful contributions to the advancement of medical science. Additionally, it serves as a reminder of the ongoing need for inclusivity and equal opportunities in surgery and healthcare professions.
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The most controversial aspect of James Barry's story revolves around the discovery of her assigned female gender identity after her death. Throughout her life and career, Barry successfully maintained the facade of being a man, deceiving colleagues, superiors, and society at large. It was only upon her death in 1865 that it was revealed that James Barry was, in fact, Margaret Anne Buckley, a woman (Buckland, 2017).

This revelation sparked debates and controversies about Barry's true identity, motivations, and the implications of her actions. Some viewed her deception as a courageous act of defiance against the restrictive gender norms of her time, allowing her to pursue a career and make significant contributions to medicine that she would have otherwise been denied as a woman (Pagan, 2019). Others criticized her for perpetuating a lie and questioned the ethics of her decision to conceal her gender throughout her life and professional career (Haller, 2018).

The controversy surrounding James Barry's story raises complex questions about gender identity, societal expectations, and the lengths to which individuals may go to achieve their ambitions in the face of systemic discrimination. It continues to intrigue and provoke discussion, challenging conventional understandings of gender roles and historical narratives in medicine (Kaufmann, 2015).


The Legacy of Dr. James Barry
James Barry, despite the controversy surrounding her identity, made significant contributions to the field of surgery and healthcare during her career. Some of her notable surgical achievements include:

Advancements in Caesarean Section: James Barry advocated for the use of Caesarean sections as a life-saving procedure for both the mother and the child. Her recommendations and improvements to the surgical technique helped to increase the success rate of this procedure (Buckland, 2017).

Improvements in Hygiene and Sanitation: Barry emphasized the importance of hygiene and sanitation in medical practice long before these principles became widely accepted. Her efforts to implement strict hygiene protocols in military hospitals helped to reduce infection rates and improve patient outcomes (Pagan, 2019).

Pioneering Surgical Techniques: Barry was known for her innovative approaches to surgery, including the use of new surgical instruments and techniques. She contributed to the development of surgical procedures that were more effective and less invasive, laying the groundwork for modern surgical practice (Haller, 2018).

Medical Reforms: As a medical inspector in the British Army, Barry implemented reforms that transformed military healthcare. She introduced standardized medical examinations, improved medical record-keeping, and advocated for better living conditions for soldiers, leading to overall improvements in the quality of care provided to military personnel (Kaufmann, 2015).

Advocacy for Public Health: Barry was a strong advocate for public health initiatives, promoting vaccination programs, clean water supplies, and improved living conditions to prevent the spread of disease. Her efforts helped to advance public health policies and improve the health and well-being of communities (Buckland, 2017).

These achievements highlight James Barry's innovative spirit, dedication to patient care, and commitment to advancing the field of surgery and medicine during a time of significant medical challenges and limited understanding of healthcare practices.

Thank you for joining us on another History of Surgery adventure. Until next time.

Eliel Arrey MD MBA

References:

Buckland, A. (2017). "James Barry: A Woman Ahead of Her Time in Medicine." Journal of Medical Biography, 25(1), 25-30.
Pagan, V. (2019). "Reconsidering James Barry: Gender and Medicine in the Nineteenth Century." Gender & History, 31(2), 342-360.
Haller, J.S. (2018). "The Strange Case of James Barry, MD: An Exceptional Woman in Disguise." Journal of the History of Medicine and Allied Sciences, 73(4), 400-420.
Kaufmann, L. (2015). "The Woman Who Pretended to Be a Man to Become a Doctor." BBC History Magazine, 16(3), 50-55.

The Mayo brothers, William James Mayo (1861–1939) and Charles Horace Mayo (1865–1939), were pioneering American physicians who co-founded the Mayo Clinic, one of the world's foremost medical institutions. Born in Rochester, Minnesota, they were the sons of a country doctor and grew up immersed in medicine.

Both brothers pursued medical careers, attending medical school at the University of Michigan. After completing their studies, they returned to Rochester to join their father's practice. In 1889, they founded the Mayo Clinic along with their father, Dr. William Worrall Mayo, creating a revolutionary medical institution that focused on collaborative patient care, research, and education.
The Mayo Clinic quickly gained a reputation for excellence in patient care, attracting patients from around the world. The brothers emphasized a patient-centered approach, where specialists from various fields worked together to diagnose and treat complex medical conditions.

Their legacy extends beyond the institution they founded. The Mayo brothers were innovators in medical practice, pioneering techniques such as the use of sterile surgical procedures, the development of diagnostic tools, and advances in anesthesia. They also made significant contributions to medical education and research, shaping modern medical training and advancing medical knowledge.

The Mayo Clinic continues to thrive as a leading medical institution, renowned for its patient care, research, and education. The Mayo brothers' legacy lives on in the principles of teamwork, innovation, and compassionate care that continue to define the institution they created.

Few surgeons have embodied the pure pursuit of excellence in anatomy, surgical techniques, medical education, innovation, and patient advocacy as Dr. Robert Liston. He was one of the most prominent surgeons of his era, and his imprint on surgical education continues today.
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“Time me, Gentlemen!” are famous words Dr. Robert Liston usually uttered right before a surgical procedure. The life of Robert Liston tells the tale of how a young surgeon in 19th century Victorian England elevated to become the most daring, courageous, technically gifted, and fastest surgeon of his era. Dr. Liston was just 16 years old when he began medical training under the famed anatomist John Barclay. He would be appointed House Surgeon of the Royal Infirmary in Edinburg four years later. Given his age compared to his peers, Dr. Liston always pointed out that experience and case volume, not age, guaranteed success and proof of ability. Many historical surgical texts always point to the bravery and bravado of Dr. Liston, such as his intimidating and argumentative personality, daring ability to take on the most difficult of surgical cases, or the apocryphal lower extremity amputation case with a 300% mortality. Being the showman he was, Dr. Liston never shielded away from challenges or competition and was unapologetic in his disapproval of surgical practices he considered inferior.


His nickname, “The Fastest Knife in the West End,” continues in surgery annals today, with one of his above-the-knee amputations only lasting 30 seconds from incision to final suture. Dr. Liston’s U-shaped flap technique revolutionized limb amputation surgeries, and the Liston knife (a long, double-sided blade) became the standard instrument for limb amputations. Dr. Liston also made many contributions to aseptic surgery and performed Europe’s first surgery under anesthesia.
The most lasting aspects of the life of Dr. Liston that permeate today were his dedication to surgical excellence, innovation, ethics, and patient advocacy. During an era that predated general anesthesia, blood transfusion, and asepsis, where patients walked into hospitals with the fear of certain death, Dr. Liston understood the justified terror of surgical intervention. He took seriously the agony and pain patients had to bear during a surgical procedure. Thus, his call for surgeons to have a thorough knowledge of anatomy and pathology, make accurate diagnoses, and intervene surgically, when indicated, with swift, precise, and unwavering competence in operative technique.



Historical Significance:
A complete picture of Dr. Liston is a surgeon who was never complacent, never afraid to step into the unknown, and one who knew that true success came from study and experience. One who was a compassionate provider, always doing his best to attend to the minds and feelings of his patients. These attributes are epitomized in recipients of the Liston Medal for Surgery at University College Hospital, London, England. While such an award is not commonplace in the United States today, these attributes (which embody the true legacy of Dr. Liston) should be sought out by every surgical provider.


Eliel Arrey MD MBA


Eliel Arrey, MD., MBA., is a health advisor, business advocate, entrepreneur, educator, and surgeon with a passion for Breast Oncology, Oncoplastic and Cosmetic Surgery. History of Surgery series showrunner. He has been an educator for over 15 years and has vast experience teaching undergraduate students, nursing students, medical students, and resident physicians. Dr. Arrey is a physician at Grady Memorial Hospital in Atlanta and a Morehouse School of Medicine physician. He also serves as a faculty member at Kaplan, teaching Neurology and Surgery review courses to medical students worldwide. He is currently a PhD candidate in organizational leadership at Columbia International University.



References:

1. Brockbank, Edward M. “The Edinburgh Surgical School.” Annals of the Royal College of Surgeons of England 10, no. 4 (1952): 242–49. [This paper provides insights into Dr. Robert Liston’s tenure at the University of Edinburgh and his contributions to surgical education.]
2. Rosenberg, Charles E. The Care of Strangers: The Rise of America’s Hospital System. JHU Press, 1995. [This book discusses the impact of Dr. Liston’s use of anesthesia on the development of surgery, particularly in the United States.]
3. Whalen, Robert C. “Robert Liston and his eyewitnesses.” Surgery 140, no. 6 (2006): 1002–7. [This article delves into various surgical cases performed by Dr. Liston, including anecdotes about his speed in the operating room and the consequences of his haste.]
4. LeFanu, James. The Rise and Fall of Modern Medicine. Basic Books, 2001. [This book provides context on the historical significance of Dr. Liston’s contributions to surgery and the evolution of medical practice.]
5. Paget, Stephen. “The Only Operation with a 300 Percent Mortality.” The British Medical Journal 2, no. 3920 (1964): 19–21. [This article discusses the infamous case of Dr. Liston’s surgical mishap, shedding light on the consequences and lessons learned from the incident.]

Dr. Robert Liston (1794–1847) was a Scottish surgeon renowned for his remarkable speed and dexterity in the operating theater during the early 19th century. Born in Linlithgow, Scotland, Liston studied medicine at the University of Edinburgh, where he eventually became a professor of surgery.
Liston's surgical career was marked by numerous pioneering procedures and techniques. Notably, he was among the first to perform operations under general anesthesia, using ether, which revolutionized surgery by reducing patients' pain and allowing for more complex procedures. In 1842, Liston successfully performed the first amputation under ether anesthesia, a significant milestone in the history of surgery.

This element of the life of Dr. Liston is might be apocryphal but cited but it is cited in multiple sources so we will cover it.  Liston was also known for his remarkable speed in the operating room. His famous motto was "Time me, gentlemen!" as he completed surgeries with astonishing swiftness. However, his rapid pace sometimes led to unfortunate accidents, such as the notorious case of the "The Only Operation in History with a 300 Percent Mortality." During this operation to remove a tumor, Liston accidentally severed the fingers of his assistant and slashed through the coattails of a spectator, both of whom later died from infections, while the patient also succumbed to gangrene.
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Despite his occasional mishaps, Liston's contributions to surgery were substantial, and his legacy endures in the annals of medical history. His emphasis on speed and efficiency helped pave the way for modern surgical techniques, and his advocacy for anesthesia transformed the field, making surgery safer and more humane.

Dr. Robert Liston's commitment to patient care was multifaceted, reflecting both the ethos of his time and his personal dedication to advancing the field of surgery while prioritizing the well-being of his patients. Despite his reputation for speed and efficiency in the operating room, Liston's commitment to patient care extended beyond mere surgical skill.

Firstly, Liston was an early advocate for the use of anesthesia in surgery. Before the advent of ether anesthesia, surgical procedures were often excruciatingly painful and carried significant risks of shock and infection. Liston recognized the importance of mitigating patients' suffering and improving their outcomes through the use of anesthesia, and he played a pivotal role in popularizing its adoption in surgical practice.

Additionally, Liston's emphasis on speed in the operating room was not solely motivated by a desire for efficiency but also by a concern for minimizing patients' exposure to the risks of surgery. By completing procedures quickly, Liston aimed to reduce the duration of anesthesia and the likelihood of complications arising from prolonged surgical intervention. While his rapid pace occasionally led to unfortunate accidents, such as the case of the "Only Operation in History with a 300 Percent Mortality," Liston's intention was always to prioritize the well-being of his patients.

Moreover, Liston's commitment to patient care was evident in his broader advocacy for advancements in surgical technique and patient safety. As a professor of surgery at the University of Edinburgh, he trained numerous students, emphasizing the importance of meticulous technique, thorough anatomical knowledge, and compassionate patient care. Liston's contributions to surgical education helped shape generations of surgeons who shared his commitment to the highest standards of patient care.

In conclusion, Dr. Robert Liston's commitment to patient care was characterized by his advocacy for anesthesia, his efforts to minimize patients' suffering and risks during surgery, and his dedication to advancing surgical practice and education. While his legacy includes anecdotes of surgical mishaps, Liston's overarching goal was always to improve patient outcomes and alleviate their pain, leaving a lasting impact on the field of surgery and patient care.

​References:

1. Brockbank, Edward M. "The Edinburgh Surgical School." Annals of the Royal College of Surgeons of England 10, no. 4 (1952): 242–49. [This paper provides insights into Dr. Robert Liston's tenure at the University of Edinburgh and his contributions to surgical education.]
2. Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System. JHU Press, 1995. [This book discusses the impact of Dr. Liston's use of anesthesia on the development of surgery, particularly in the United States.]
3. Whalen, Robert C. "Robert Liston and his eyewitnesses." Surgery 140, no. 6 (2006): 1002–7. [This article delves into various surgical cases performed by Dr. Liston, including anecdotes about his speed in the operating room and the consequences of his haste.]
4. LeFanu, James. The Rise and Fall of Modern Medicine. Basic Books, 2001. [This book provides context on the historical significance of Dr. Liston's contributions to surgery and the evolution of medical practice.]
5. Paget, Stephen. "The Only Operation with a 300 Percent Mortality." The British Medical Journal 2, no. 3920 (1964): 19–21. [This article discusses the infamous case of Dr. Liston's surgical mishap, shedding light on the consequences and lessons learned from the incident.]

Dr. Charles Drew (1904–1950) was a pioneering African American physician, researcher, and educator, known for his groundbreaking work in blood banking and transfusion medicine. Born in Washington, D.C., Drew earned his Bachelor of Arts from Amherst College in 1926 and his Doctor of Medicine and Master of Surgery degrees from McGill University in 1933. He completed his doctoral thesis on “Banked Blood” and became an authority in the field of blood transfusions.

During World War II, Drew served as the director of the first American Red Cross Blood Bank and played a pivotal role in establishing blood plasma programs for the Allied forces, saving countless lives. His expertise in blood preservation and transfusion techniques significantly improved medical practices during the war.

Despite his achievements, Drew faced racial discrimination in the medical field. He protested against the policy of segregating blood donations based on race, advocating for a universal approach to blood banking. However, his efforts were met with resistance, leading him to resign from his position at the American Red Cross in 1941.

In addition to his groundbreaking contributions to medicine, Dr. Charles Drew was a dedicated educator and advocate for black physicians in America. After completing his medical education, Drew became a faculty member at Howard University, a historically black institution, where he taught and mentored aspiring medical professionals.

As an educator, Drew emphasized the importance of academic excellence and encouraged his students to pursue careers in medicine and scientific research. He played a significant role in nurturing the next generation of African American physicians and scientists, providing them with opportunities for advancement in the medical field.

Furthermore, Drew was a vocal advocate for racial equality in healthcare and worked tirelessly to address the disparities faced by black physicians in America. He co-founded the National Negro Health Week in 1935, which aimed to raise awareness about the health issues affecting African American communities and promote access to medical care.

Throughout his career, Drew fought against racial segregation and discrimination in medicine, advocating for equal opportunities for black physicians and patients. His efforts paved the way for greater diversity and inclusivity in the medical profession, inspiring future generations of minority healthcare professionals to pursue their goals and make meaningful contributions to society.

Historically black medical colleges remain the highest source of African-American physicians today. The dedication of Dr. Charles Drew to the training of African American surgeons at Howard University was crucial to the training of black surgeons in the United States despite systematic racism. During Dr. Drew’s 9-year tenure as Dept Chair at Howard (1941–1950), most of the African Americans certified by the American Board of Surgery (ABS) were trained by him.

Tragically, Dr. Drew died in a car accident on April 1, 1950, at the age of 45. His death was a great loss to the medical community, but his legacy continues to inspire generations of healthcare professionals, particularly those advocating for equality and diversity in medicine.

One significant aspect of his legacy is the creation of the Student Biomedical Association of Spelman (SBAS) in 1968. SBAS is an organization dedicated to promoting diversity and excellence in healthcare professions among students, particularly African American women. The organization honors Dr. Drew’s pioneering contributions to medicine and serves as a testament to his enduring impact on medical education and diversity initiatives.


Eliel Arrey MD MBA

Eliel Arrey, MD., MBA., is a health advisor, business advocate, entrepreneur, surgeon, and educator. He has been an educator for over 15 years and has vast experience teaching undergraduate students, nursing students, medical students, and resident physicians. Dr. Arrey is a physician at Grady Memorial Hospital in Atlanta and a Morehouse School of Medicine physician. He also serves as a faculty member at Kaplan, teaching Neurology and Surgery review courses to medical students worldwide. He is currently a PhD candidate in organizational leadership at Columbia International University.


References:

1. “Charles R. Drew Biography.” Biography.com, A&E Television Networks, 11 Jan. 2018, www.biography.com/scientist/charles-drew.
2. “Dr. Charles Richard Drew: A Forgotten Pioneer in Transfusion Medicine.” National Library of Medicine — National Institutes of Health, www.nlm.nih.gov/exhibition/aframsurgeons/pioneers.html.
3. Hoover EL. Dr. Charles R. Drew: facts, fiction and legend. J Natl Med Assoc 2005; 97(6):837–8.
4. “Student Biomedical Association of Spelman.” Spelman College, www.spelman.edu/academics/majors-and-programs/biology/student-biomedical-association-of-spelman.
5. Wright-Mendoza J. The 1910 Report That Disadvantaged Minority Doctors [Education web site]. 2019. Available at: https://daily.jstor.org/the-1910-report-that-unintentionally-disadvantaged-minority-doctors/. Accessed December, 2023.