Caesarean section in Buganda in 1879

By Muniini K. Mulera

Uganda

June 21, 2016

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FROM THE TINGASIGA ARCHIVES: February 1, 1999

Dear Tingasiga:

The last palace of Kabaka Mutesa I at Kasubi-Nabulagala, is perhaps the most visible evidence of the grandeur and sophistication of late nineteenth century Buganda.

The visitor who beholds the architectural marvels of Muzibu-azaala-mpanga, Mutesa's main residence at Kasubi-Nabulagala which is now a mausoleum for the last four Kabakas, gets a tiny glimpse into Mutesa's Buganda, one of the most advanced nations in Africa at the time.

However, the story that Kasubi's grandeur does not tell, and which has not been well documented in the history books either, is how medically advanced Mutesa I's Buganda was.

Pristine Buganda in 1879?

Long before the arrival of the European missionary doctors, Baganda surgeons were already performing a highly developed surgical procedure, complete with anaesthesia (a drug-induced loss of sensation, especially to pain.)

One Robert W. Felkin, a Scottish medical anthropologist who witnessed Baganda surgeons performing a Caesarian Section (delivering a baby through the abdomen) in 1879, documented his observations in a dissertation (titled 'Ueber die Lage und Stellen ber der Geburt') which he submitted to Maburg University in Germany in 1885.

An English translation of Felkin's report was reproduced by Dr. B.G. Chipfakacha in the February 1989 edition of the Central African Journal of Medicine, and it is from there that I have reproduced it in a language understandable to the non-medical reader.

Visiting Buganda, Felkin reported: "A 20-year old woman, carrying her first pregnancy, lay on an inclined bed. She was supplied with banana wine and was in a semi-intoxicated state. She was perfectly naked.

A band of mbugu (bark-cloth) fastened her chest to the bed, while another mbugu band fastened down her thighs and a man held her ankles. A man standing on her right side steadied her stomach, while the operator stood on the left side holding his knife aloft and muttering an incantation.

The operator washed his hands and the patient's abdomen, first with wine and then with water. Then having uttered a shrill cry that was taken by the crowd assembled outside the hut, he proceeded to make a rapid cut in the middle line. The whole abdominal wall and part of the wall of the uterus (womb) was severed by this incision, and the amniotic fluids (water which surrounds the baby) shot out.

The bleeding points in the abdominal wall were touched with red hot iron by an assistant. The operator then swiftly increased the size of the incision in the womb; meantime another assistant held separated abdominal walls with his hand, and proceeded to hold the separated wall of the womb with two of his fingers but at the same time holding the abdominal wall apart.

The child was rapidly removed and given to an assistant and the umbilical cord was then cut. The operator put his knife away and seized the contracting womb with both hands giving it a squeeze or two.

He next put his right hand into the cavity of the womb and using two or three fingers dilated the part of the womb which connects to the vagina from within outwards. He then cleaned the uterus and uterine cavity of clots and lastly removed the placenta (afterbirth) which had separated by now.

His assistant was endeavoring but to no avail to prevent the intestine from escaping the incision. The red hot iron was used once more to stop the bleeding from the abdominal wound, carefully avoiding the healthy tissue. The operator then let loose the womb which he had been pressing the whole time . No sutures were applied into the wall of the womb.

The assistant holding the abdominal walls now let go and a porous grass mat was placed over the wound and secured. The mbugu bands were untied and the woman was brought to the end of the bed where two assistants took her in their arms and held her upside down so as to let the fluid in the abdominal cavity drain out onto the floor.



She was then returned to the original position. The edges of the wound were brought together into close opposition, using seven well polished iron pins which were fastened by a string made from mbugu.

A paste prepared by chewing two different roots and spitting the pulp into a bowl was then quickly plastered over the wound and a warmed banana leaf was placed on top of the paste. A firm bandage was applied to the wound and dressing using mbugu cloth.

During the whole operation the patient never uttered a moan or cry. She was comfortable after the operation. Two hours later she was breast-feeding her newborn.

On the third day after the operation, the dressing was changed and one pin was pulled out. This procedure was repeated on the fifth day after the operation but this time three pins were removed. The rest of the pins were removed six days after the operation. At every dressing new pulp was applied and pus was removed using foam from the same pulp.

Eleven days after the operation the wound was entirely healed; the patient had no fever and was very comfortable. The secretions from the birth canal were normal."

The year was 1879, yet modern medical doctors and nurses have no trouble following the above report. What Felkin witnessed was not different, in principle at least, from what modern doctors do.

Doctor extracts baby at Caesarean delivery, 2016

The use of banana wine for both anaesthesia and to cleanse the woman's abdomen prior to operating demonstrate an understanding, however rudimentary, of the principles of anaesthesia and microbiology (role of germs in causing infection.)   The red hot iron, the polished irons for closing the wound, and the mats for dressing have very close equivalents in modern surgery.

Of course we do not know how many women died during or soon after such operations. However, given that the woman whom Felkin witnessed survived long enough to start breast feeding her child, we can, with confidence, affirm that Buganda medicine and surgery had reached a fairly advanced level before the arrival of the first European doctors. There is a lot to celebrate in our rich heritage.

 

Ref:

Felkin RW: Notes on labour in Central Africa. Edin Med J 1884;29:922-30

Anonymous. Robert William Felkin   BMJ 1927;i:309

Post-script: There is controversy regarding the location of this event. Some believe that Kahura, where Felkin observed the operation, was in Bunyoro. Others believe that it was in Buganda. We continue to seek historical records that may resolve the question.

 

Safer and cleaner birth in 2016 Uganda, but same basic principles as in 1879 Buganda.