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SunLit Excerpt: An account of improbable cesarean success by “The Cape Doctor” introduces this historical novel

In EJ Levy's Colorado Book Award winner, the doctor based on a real-life figure encounters a woman dying in childbirth in 19th-century South Africa

Author’s Note: “The Cape Doctor” was inspired by the life of a brilliant, irascible, 19th-century Irish army surgeon, Dr. James Miranda Barry, who practiced medicine in the British colonies in the first half of the 19th century. Dr. Barry performed the first successful caesarian recorded in Africa, improved medicine for the socially marginalized, was caught in a sodomy scandal with the governor of the Cape Colony in 1824, but nonetheless rose to the rank of inspector general, only to be discovered after death in 1865 to have been “a perfect female” who had carried a child. 

We now know that “perfect female” was Margaret Ann Bulkley born in Cork, Ireland, around 1790, who took the identity of James Barry in order to enter medical school at Edinburgh University in 1809, 40 years before first known woman would be granted a medical degree in the U.S. in 1849, and more than 50 years before a woman would be licensed to practice medicine in Great Britain. 

For fictional purposes, Dr. James Barry’s name has been changed to Dr. Jonathan Perry. The novel focuses on 20 years of the doctor’s life, from Margaret’s arrival as a girl in London to her transformation into Jonathan in order to enter medical school in 1809, to their posting to the Cape Colony in South Africa in 1816, where they would remain for a dozen years. 

The following excerpt is from the book’s penultimate chapter, Chapter Nine: Cape of Storms, and recounts one of the doctor’s many miraculous medical feats.


Strange what we remember, what we forget. What’s worth recalling?
What will be recalled of me? If I am remembered in
the future it will be, I imagine, for saving a single life. When I arrived
that night, it seemed I’d been called to certify a death.
There are so many ways to leave this life. Few ways to enter
it. There is little to say of those final years in Cape Town, but
there is this. Not long after Lord Somerton’s departure from
the Cape, I was summoned in the middle of a July night to
attend the labor of a wealthy tobacco merchant’s wife, who
was dying in childbirth.

I rode through the winter rain till I reached the stucco house,
illuminated as if for a party by candlelight and oil lamps. I did
not bother to knock; I followed the sound of screams to a bedroom
where Mrs. Wilhemena Munnick lay moaning, pale,
near to death on the bloodied bedding. The room was crowded
and close, reeking of mud and cigars, shit, wet wool and fear,
as packed as a country dance with female family, friends, and
household staff. I cleared the room of all but the midwife
and Munnick himself, who—despite propriety and custom—
admirably insisted on remaining by his wife’s side.

I rinsed my hands at the water stand on the bureau using
the bleach that I always carried then, impatient as the midwife
recounted the progress of the labor that had begun well
at dawn, gone awry by sundown. I asked questions about the
position of the foetus, her treatment; I could guess what had
happened, had seen it before. I told her to hold the lamp
close as I lifted the sheet that tented Mrs. Munnick’s legs. I
gently prised apart her knees, which were clenched together
in evident pain, her condition worse than I’d imagined. When
I slipped my hand into the vaginal canal to see if the child
might be extracted with my help, I felt a tiny foot, a leg, only
one, the other tucked up in the womb. It was instantly clear:
breach, half born. Her water long ago broken, her energy spent
on hours of fruitless labor, worsened by the tonics applied to
ease her pain. I pressed the leg back inside the uterus, then
retracted my arm.

I ordered the strongest liquor in the house, which proved
to be good Jamaican rum, and boiling water. Told the maidservant
to scrub down the kitchen table with the water and
bleach and to give Mr. Munnick a shot of rum.

“Get her to the kitchen,” I said.

“Should she be moved, Doctor?” Munnick asked.

UNDERWRITTEN BY

Each week, The Colorado Sun and Colorado Humanities & Center For The Book feature an excerpt from a Colorado book and an interview with the author. Explore the SunLit archives at coloradosun.com/sunlit.

“No,” I said. “But she will surely die if she is not.”

He nodded, not understanding what risks he took or I did.

“She may die in any case, Munnick,” I said. “You must
understand that. She likely will. And the child. There is a
chance of saving one of them, by surgery. A slim chance, but
a chance.”

Later I would be asked if I hadn’t worried that I put my reputation
at risk by attempting the lethal operation; it didn’t occur
to me. I could not let a woman die to protect my name.

As a dresser at St. Thomas’ Hospital, I had observed
the caesarean operation performed with success, the belly
slit down the midline, along the linea alba, then opened
to reveal the protuberant uterine wall, which—once split—
allowed for removal of the amnion sac and child. But at St.
Thomas’ there had been no risk, as mother and child were
already dead.

The caesarean was rare for good reason: it almost always
failed, or rather it almost always succeeded in killing both
mother and child. I could count on a single hand the successful
performance of the procedure in the last thousand years. A
Swiss sow gelder had reportedly saved his wife by such means
in 1500. Two surgeons—one in France and one in Holland—
had claimed success in the last century, as had a single midwife
in 1738 in England. But there was no proof, and such
tales were held to be little better than fantasy. This much I
knew: no one had successfully performed it in Africa.

More common was to kill the child to save the mother,
extracting the foetus by forceps, piecemeal, so the mother
might live; if she were too far gone, one waited for her to die,
then cut her open to save the child. But I could not let either
die while I stood by.

TODAY’S UNDERWRITER

Mrs. Munnick was delirious with pain and beyond comprehending
as we lay her on the kitchen table, which the midwife
had scrubbed with hot water and bleach; her pelvis raised on
cushions, her legs held wide by maids, her husband—abashed
but compliant—grasped her arms and chest in his strong
farmer’s embrace to prevent her from wrenching away as I
cut. I had nothing to give her save for a vial of laudanum—
hardly enough to quell a toothache. But it stilled her some and
proved tonic for her husband, who could believe she did not
feel great pain. I told him to hold her firm as I put the blade
to her belly to begin the long midline incision. At the first cut,
as the knife split her skin, Mrs. Munnick screamed and tried
to rise, but her husband held her down. She collapsed onto
the table.

“Is she dead?” he asked.

“Not yet,” I said. “Keep her still and she might not be.”

He turned away, but the midwife held a lantern close to
where I worked. I moved quickly, with an assurance I did
not feel. My cutting kit set on a chair beside the table. I
proceeded through the geologic layers of the body: each layer
like a page in the textbooks I had studied a dozen years before
now reappeared before my eyes. It was like moving through a
country I had lived in long ago.

I worked quickly, drawing down the knife, cutting from
xiphoid to pubis, avoiding the rectus muscles, then down
through fasciae and muscle, grateful the gravid uterus had
displaced the abdominal viscera, so I could see clearly the
rose-pink glossy sack of the uterine wall and make a small incision
there, through which I slipped a finger to guide the knife
as I cut along the surface, making another vertical incision,
until the uterus split open and the fetus was revealed. Sacrum
posterior, as I’d feared—head up toward the mother’s heart,
face forward. I slipped a hand inside until my fingers found the
infant’s legs, then working my way by feel, I located its feet to
ensure they were free of the vaginal canal, then took both legs
into my hand; I attempted to lift the infant’s body from the flesh
cavern, but it was stuck, held firm. I tried to turn its body but to
no avail; it was too large, too closely fitted to the space. I feared
cutting further, feared the damage I might do—that she might
bleed out and die before the child had been birthed. There
on the table, my hands inside her, the child there too, delivering
her unto death. The infant was stuck fast. Blood seeped
around the cuts I’d made; my pulse pounded in my ears.

“You may feel some pressure,” I said to the unconscious
woman on the table. “Hold her firm!” I shouted to her
husband. I stepped up onto a chair and braced the heel of
my hand against her sternum, and with my other hand I
grasped again the infant’s legs and lifted them up and pulled
for all I had.

Mrs. Munnick groaned and her body rose from the table
before I relented.

I braced my bootheel against the table’s edge, and placed a
palm once more against her sternum, the infant’s legs clasped
firm in my other hand, and with all my strength hauled back.

I felt the mother’s body rise again, felt a shift inside her bowels
as if I were disemboweling her, which I feared I might just
do. A line from the Iliad came into my mind: planted a heel /
against his chest, wrenched the spear from his wound / and the
midriff came with it—

Her face was grey-blue in the candlelight; she was dying;
what choice was there but to continue? My palm against her
sternum, I pulled again and felt the child shift. I reached inside
the fundus, my free hand seeking the cranium now, the
infant’s feet cupped firm in my right. Then I lifted the baby’s
legs, somersaulting them toward the mother’s chest, and felt
the cradled head at last slip free as I raised the infant into the
air, bloody and purple-blue, slicked with amniotic fluid, the
umbilicus hanging like glistening rope or ribbon.

We stood amazed.

I slapped the child and it screamed, then I cut the umbilicus
and knotted it before I held the infant out to Munnick—
his face pale with strain, glassy-eyed, sweat-glazed—and said,
“You have a son.”

I stitched up Mrs. Munnick and saw her settled into her now clean
room, before I left strict instructions for the care of the
patient and the wound, ensuring the most sanitary conditions
for her convalescence. Then I accepted a glass of brandy in
the parlor. I sank into a chair by the fire.

“How can I thank you, Doctor?” Munnick said. His face
glistened with tears and sweat.

“Take care of your wife and son,” I said.

“Please,” he said. “Accept our thanks.” He pushed into my
hand a wad of notes—a fat packet of rix-dollars—money I
badly needed since my demotion the prior year.

But I declined. “You’ll need it for your family, more than I,
who have none.”

“Is there nothing we can offer you?”

“Invite me to the christening.”

“Surely there is something you desire?”

There was so much that I wanted, hoped for, wished: to
have my friend back, my good name restored, above all a wish
too dear even to name or think.

“There is one thing,” I said, “that would mean a very great
deal to me.”

“Name it, and it’s done,” Munnick said incautiously.

“I would be honored if the boy might take my middle name
as his own. As I have no children.”

I could not know if the child I bore still lived, or if he
did what name he bore; I could be sure only that it was not
my own. I had had no right to name him or even to know
what name was his, or even if he lived; I had given up that
right when I had given him up. I had been so habituated to
loss that it came more easily than love, than fighting to keep
those I loved.

“I’ll do better than that,” Munnick said. “We’ll name him
after you.”

On 20 August 1826, Jonathan Perry Munnick—my godson,
my namesake, my almost consolation—was baptized at the
Evangelical Lutheran Church.

I did not know, would not know for years, what I’d helped
to birth that day.


EJ Levy’s novel, “The Cape Doctor,” was named a New York Times Book Review Editors’ Choice and one of Barnes & Noble’s Best Books of Summer 2021. Her story collection, “Love, In Theory,” won a Flannery O’Connor Award and GLCA New Writers Award for Fiction. Levy’s anthology, “Tasting Life Twice: Literary Lesbian Fiction by New American Writers,” won a Lambda Award. She is an associate professor in the MFA program at Colorado State University.


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