Bunyoro – Kitara Kingdom invented Caesarean sections – Dr R. W. Felkin

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Caesarean Section in Bunyoro 1879. Credit: The African Exponent

Bunyoro-Kitara Kingdom was the first place in the world to perform Caesarean Section commonly known as C-Section, according to a Scottish Catholic medical missionary and philanthropist, Dr Robert William Felkin.

C-Section refers to a surgery used to deliver babies through incisions in the mother’s abdomen and uterus other than through vaginal birth.

Although it is hard to know when these surgeries began in Bunyoro –Kitara kingdom, a testimony documented in his book The Development of Scientific Medicine in the African Kingdom of Bunyoro –Kitara, Dr Felkin said in 1879, Kabalega’s Bunyoro was the only place in the world where caesarean section was performed to save both mother and baby.

He said Caesarean sections were invented in Bunyoro-Kitara Kingdom long before Europe and the rest of the world fully mastered how to perform them.

When a baby could not be vaginally delivered, midwives and surgeons would turn to C-Section by first sedating the woman in labour with a lot of banana wine to make the experience less painful for the mother and heat-sterilised sharp knives could be used. The operation used to be quick to avoid excessive loss of blood.

Felkin’s account was received with shock and cynicism in Europe and especially England where Caesarean section was considered a final emergency measure to childbirth, unlike in Bunyoro – Kitara kingdom where it had been mastered and not regarded as the greatest gravity measure to save the mother and child.

The doctor added that although mortality rates for C-section in the US and European countries like Britain drew up to 85 percent in the 19th century, C-section was being performed regularly and successfully in Bunyoro-Kitara kingdom.

“Nearly half of European and US women died in childbirth, and nearly 100% of European women died if a C section was performed,” he said.

Felkin disclosed that he witnessed one such an operation at a place called Kahura (Kahoora? – in Hoima District) where a woman delivered her first baby with the help of traditional healers including a midwife, an anaesthetist, a surgeon and his assistants.

 The Scottish doctor reported that the 20-year-old woman carrying her first pregnancy lay naked on an inclined bed before being semi-intoxicated with banana wine for an operation to begin.

Surgeons performing a C-Section on an expectant mother. (Photo: American Pregnancy Association)

Excerpt:

“So far as I know, Uganda is the only country in Central Africa (he thought that Uganda was positioned in the central part of Africa) where abdominal section is practised with the hope of saving both mother and child.

The operation is performed by men, and is sometimes successful; at any rate, one case came under my observation in which both survived. It was performed in 1879 at Kahura (Kahoora? in Hoima District).

The patient was a fine healthy-looking young woman of about twenty years of age. This was her first pregnancy … The woman lay upon an inclined bed, the head of which was placed against the side of the hut. She was liberally supplied with banana wine, and was in a state of semi-intoxication. She was perfectly naked.

A band of mbugo or bark cloth fastened her thorax to the bed, another band of cloth fastened down her thighs, and a man held her ankles. Another man, standing on her right side, steadied her abdomen.

The operator stood, as I entered the hut, on her left side, holding his knife aloft with his right hand, and muttering an incantation. This being done, he washed his hands and the patient’s abdomen, first with banana wine and then with water.

Having a C-Section. Photo by lamez.org

Then, having uttered a shrill cry, which was taken up by a small crowd assembled outside the hut, he proceeded to make a rapid cut in the middle line, commencing a little above the pubes, and ending just below the umbilicus.

The whole abdominal wall and part of the uterine wall were severed by this incision, and the amnion fluid escaped; a few bleeding-points in the abdominal wall were touched with a red-hot iron by an assistant.

The operator next rapidly finished the incision in the uterine wall; his assistant held the abdominal walls apart with both hands, and as soon as the uterine wall was divided he hooked it up also with two fingers.

The child was next rapidly removed, and given to another assistant after the cord had been cut, and then the operator, dropping his knife, seized the contracting uterus with both hands and gave it a squeeze or two.

He next put his right hand into the uterine cavity through the incision, and with two or three fingers dilated the cervix uteri from within outwards.

He then cleared the uterus of clots and the placenta, which had by this time become detached, removing it through the abdominal wound.

A baby removed from the mother’s womb after C-Section.

His assistant endeavoured, but not very successfully, to prevent the escape of the intestines through the wound.

The red-hot iron was next used to check some further haemorrhage from the abdominal wound, but I noticed that it was very sparingly applied.

All this time the chief “surgeon” was keeping up firm pressure on the uterus, which he continued to do till it was firmly contracted.

Dr Robert William Felkin

No sutures were put into the uterine wall. The assistant who had held the abdominal walls now slipped his hands to each extremity of the wound, and a porous grass mat was placed over the wound and secured there.

The bands which fastened the woman down were cut, and she was gently turned to the edge of the bed, and then over into the arms of assistants, so that the fluid in the abdominal cavity could drain away on to the floor.

She was then replaced in her former position, and the mat having been removed, the edges of the wound, i.e. the peritoneum, were brought into close apposition, seven thin iron spikes, well-polished, like acupressure needles, being used for the purpose, and fastened by string made from bark cloth.

Expectant mothers in a maternity ward at Jinja Hospital (Photo credit: Daily Monitor)

A paste prepared by chewing two different roots and spitting the pulp into a bowl was then thickly plastered over the wound, a banana leaf warmed over the fire being placed on the top of that, and, finally, a firm bandage of mbugo cloth completed the operation.

Until the pins were placed in position the patient had uttered no cry, and an hour after the operation she appeared to be quite comfortable. Her temperature, as far as I know, never rose above 99.6°F, except on the second night after the operation, when it was 101°F, her pulse being 108.

The child was placed to the breast two hours after the operation, but for ten days the woman had a very scanty supply of milk, and the child was mostly suckled by a friend.

The wound was dressed on the third morning, and one pin was then removed. Three more were removed on the fifth day, and the rest on the sixth. At each dressing fresh pulp was applied, and a little pus which had formed was removed by a sponge formed of pulp.

A firm bandage was applied after each dressing. Eleven days after the operation the wound was entirely healed, and the woman seemed quite comfortable. The uterine discharge was healthy.

This was all I saw of the case, as I left on the eleventh day. The child had a slight wound on the right shoulder; this was dressed with pulp, and healed in four days.”

In a theatre. Credit: youbabyandi.com

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