From 1817 to 1827 he was with the army in the Cape Colony, introducing several needed reforms, mainly in the areas of diet and hygiene, that seem obvious to present day readers, and was promoted to Colonial Medical Inspector. However not being the most political of men he also incurred the enmity of several of his colleagues. This pattern was to recur in his later appointments. He also performed the very noteworthy event of the first caesarian section in the colony that was survived by both mother and child. He served in Mauritius and Jamaica. In St Helena he cleaned up an epidemic of dysentery by attention to diet. He also caused a disturbance by insisting on female attendants for female patients. In Malta he dealt with an epidemic of cholera, with personal thanks from the Duke of Wellington. In Corfu he handled the hospitalization of men wounded in the Crimean war. From Corfu, on official leave he went to the Crimea where he encountered Florence Nightingale who was later to describe him as the 'most hardened creature I ever met'. After the war he was appointed to Canada as Inspector General of Hospitals, where he caught bronchitis and had to retire. This was in 1859 when he was 64. He died in 1865.
Upon his death a new drama started. A charwoman, Sophia Bishop, who was present at his death and who was employed to lay out his body made the claim that he was a woman, and that furthermore there were marks on his stomach to indicate that he had once given birth. She spoke from her experience as a mother of nine. On the other hand, Staff Surgeon major D.R. McKinnon, who had served with Barry in the West Indies, who had been treating him for some months for bronchitis, and who signed the death certificate, stated in a letter to the Registrar General that Barry was probably intersex, although he does not do say this with great certainty. Mrs Bishop's tale soon did the rounds of the London clubs. It was published within a fortnight of his death in Saunder's News Letter of Dublin, and shortly after that by the Manchester Guardian. However no London newspaper published the story. The Medical Times and Gazette of the same month published 'A Female Medical Combatant', the same account as had appeared in Saunder's, except that it merely specified 'A certain Doctor'. The very next issue carried a rebuttal from Dr Edward Bradford, Deputy Inspector General of Hospitals, who had known Barry since working with him in Jamaica in 1832. He considered that Barry was a male with arrested sexual development. He described Barry as 'quite destitute of all the characteristics of manhood' and described his voice as that of 'an aged woman'. However the opinion of Barry as a woman was launched. People remembered the scandal from 1824 in Cape Town when it had been suggested that Barry was sexually involved with the Governor, Lord Charles Somerset, and a placard had been posted on a popular bridge that referred to 'Dr Barry's little wife'. The assistant surgeon who had treated Barry for yellow fever in Trinidad now remembered that he had discovered that Barry looked like a woman. As late as 1935, the nephew of Dr Andrew Smith, who had been a colleague of Barry's in the Cape Colony, would claim that Barry as a young woman had fallen madly in love with Smith and when rebuffed had donned male attire and studied medicine.
Isobel Rae, in her much cited 1958 biography of Barry refers to him throughout as 'she' as do such recent writers as Carlotta Hacker and Julie Wheelwright. While it is true that to attend medical school, or any other university, in 1809 it was necessary to pass as male, it is also true that Barry maintained his chosen gender, if it was chosen, for the rest of his life even after retirement. His decision was to be male, and like other female-bodied persons who lived as men, he would be entitled to the male pronouns. On the other hand, if he were intersex, we should be able to pin it down more closely and specify what kind of hermaphroditism he had. The key text for this approach is a paper written in 1970 for the South African Medical Journal by Dr Percival Kirby, a medical historian. He considers two options. Firstly that Barry had Klinefelter's Syndrome which would give him breasts and small genitals, and maybe a lack of beard and a female voice. Secondly and more likely in his opinion is the possibility that Barry had Testicular-Feminization Syndrome, also known as Androgen-Insensitivity Syndrome, which is more consistent with being taken as a woman, and is more likely to result in no facial hair. Kirby considers that although his sex may have been ambiguous at birth, he would have been raised as a boy. This choice of diagnosis raises problems of its own. Most Androgen-Insensitive babies have a very definitely feminine vagina and are raised as girls, only realizing a problem when they fail to menstruate. They are females in all but chromosomes, and if Barry were Androgen-insensitive and raised as a girl, it would be extreme pedantry to say that she was not female. Hacker, citing Kirby as a reference, rejects this whole approach. The only reason, in her opinion, for considering the possibility of hermaphroditism is a male assumption that a mere women could not have achieved as much as Barry did.
- 'A Female Medical Combatant' - Medical Times and Gazette: a Journal of Medical Science, Literature, Criticism and News - July-December 1865. Early statement that Barry was a woman.
- A Strange Story. The Manchester Guardian. 21 August 1865.
- E Rogers. 'A Female Member of the Army Medical Staff' - Lancet - July -December 1895. Early argument for Barry as intersex
- Olga Racster and Jessica Grove. Dr. James Barry: her secret story. London: G. Howe, ltd, 1932. Reprinted as Journal of Dr James Barry. London: J. Lane. 1949. A fictionalization, in the first person.
- Isobel Rae. The Strange Story of Dr James Barry, Army Surgeon, Inspector General of Hospitals, Discovered on Death to be a Woman. Longman, Green. 1958. Refers to Barry throughout as 'she'. The seminal argument for Barry as female.
- P.R Kirby. 'Dr James Barry, Controversial South African Medical Figure: A Recent Evaluation of his Life and Sex' - South African Medical Journal - 25 April 1970, vol 44. The seminal argument that Barry was intersex.
- Carlotta Hacker. The Indomitable Lady Doctors. Clarke, Irwin & Company Limited. 1974: chp 1. Presents Barry as the first woman doctor in Canada, and rejects the intersex theory as male prejudice that a woman could not have achieved so much.
- June Rose. The Perfect Gentleman: The Remarkable Life of Dr. James Miranda Barry, the Woman Who Served as an Officer in the British Army from 1813 to 1859. Hutchinson 160pp,1977
- Don Akenson. At Face Value: the Life and Times of Eliza McCormack/John White. McGill-Queen's University Press. 1990: 238-9. Summarizes the literature and opts for the intersex theory.
- Anne & Ivan Kronenfeld. The Secret Life Of Dr. James Miranda Barry. Write Words, Inc. 274pp, 2000. Another fictionalization.
- Patricia Duncker. James Miranda Barry. London Serpent’s Tail, New York: Ecco Press. 375 pp. 1999. London Picador (pb) 2000. A novelization that assumes that he was a woman.
- Rachel Holmes. Scanty Particulars: The Scandalous Life and Astonishing Secret of James Barry, Queen Victoria's Most Eminent Military Doctor. Random House 384 pp, 2003. Asserts that Barry was intersex, based on a study of his writings and medical interests.
- Savona-Ventura. Dr. James Barry: an enigmatic Army Medical Doctor. www.geocities.com/hotsprings/2615/medhist/barry.html
- “James Barry (surgeon)”. Wikipedia, the free encyclopedia en.wikipedia.org/wiki/James_Barry_(surgeon)