The first birth by caesarean in uganda on record

Public holidays are good times for reading. I was halfway through Richard Branson’s Like a Virgin (Secrets they won’t teach you at Business School) when a friend brought me an extract from a medical journal titled: “Perinatal Lessons from the Past”. Among other things, the article carries a drawing of a caesarean child delivery in Uganda in 1879, in which, obviously for hygienic purposes, the woman in labour, the chief surgeon and his all male assistants are naked.

The author
The article was among correspondence from Robert Felkin MD (1853 – 1926) to Professor Peter Dunn of the Department of Child Health at Bristol University Southmead Hospital in England.
Felkin first met explorer David Livingstone who inspired him with his tales of Africa, before meeting medical missionary A.M. Mackay in London in 1877. Although he was only 24 years old then and had two years earlier enrolled as a medical student at Edinburgh University, he became determined to visit Africa.

In 1878, he was sent to Uganda by the Church Missionary Society. He travelled through the Sudan, meeting General Gordon and later Emin Pasha, the Governor of Equatorial Province.
In Uganda, he was presented to Kabaka Mutesa, whose personal physician he became in 1879. He studied the “local diseases and also undertook anthropological measurements of the pygmies.”
Of special interest, though, were his studies on childbirth. In 1880, he returned to England in the company of envoys of Mutesa to Queen Victoria. He also spent time in Zanzibar where he actively campaigned against slave trade, before finally returning to England in 1881 to complete his medical studies.

As a final year student, he gave a lecture to the Edinburgh Obstetrical Society on January 9, 1884 entitled: “Notes on Labour in Central Africa”. It is from that lecture that a fascinating account of a caesarean delivery in Uganda emerges.

The birth
As far as he knew, he said, Uganda was the only country in Central Africa where “abdominal section” was practised with the hope of saving both mother and child. He personally observed one operation in which both the mother and the child survived. Although the venue of the operation is not clear, the appearance of the medical personnel, the description of the surroundings and the tools and herbal medicines used indicate it was in present day Buganda.
Felkin describes the proceedings in detail, but for limitations of space I will quote him only briefly: “The patient was a fine healthy-looking young woman of about 20 years old. 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.”

The procedure
Felkin then talks about a band of “mbugo or bark cloth” which fastened the woman’s thorax and thighs to the bed, and two men who held her ankles and 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 (praying)”.

“This being done, he washed his hands and the patient’s abdomen, first with banana wine and then water. 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,” Felkin explained. After the baby had successfully been removed from the abdomen, the process of repairing the mother’s incised organs started.

Felkin talks about a hot iron being “sparingly” applied to the abdominal wound to stop haemorrhage, about a porous grass mat that was placed over the wound and later removed, the seven thin iron spikes that were used as needles, and the strings made from bark cloth with which the wound was stitched.

Treating the new mother
“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 bark cloth completed the operation”, Felkin noted. The wound entirely healed in eleven days, and the child survived.

The purpose of publishing this article is firstly to show that, given adequate assistance and facilities in the fields of modern medical training and research, Ugandans have always had the potential of becoming great physicians and surgeons and, secondly, that our people have always been very resourceful and innovative.

The blame for shortages of medicine, medical personnel and equipment in our hospitals should hence be placed squarely on the shoulders of our political leaders and not on the population as such.

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How Did caesarean Sections Get Their Name?

The story that the C-section originates—either in practice or in name, depending on who’s telling the story—with the birth of everyone’s favourite Roman Consul has been around for a while and gets repeated often.

The 10th century Byzantine-Greek historical encyclopedia The Suda reads, “For when his mother died in the ninth month, they cut her open, took him out…” Even the Oxford English Dictionary gives that story as the term’s origin. Almost every other historical and etymological source, though, is stacked behind the answer “probably not.”To start, Gaius Julius Caesar (we’ll call him GJC from here on out) certainly wasn’t the first person born via C-section.

The procedure, or something close to it, is mentioned in the history and legend of various civilisations—from Europe to the Far East—well before his birth. He wasn’t even the first Roman born that way.

By the time GJC entered the world, Romans were already performing C-sections and Roman law reserved the operation for women who died in childbirth (so that the woman and her baby could be buried separately) and as a last resort for living mothers in order to save the baby’s life during deliveries with complications.

Among the still-living mothers, no Roman or other classical source records one surviving the procedure. The first known mother to make it through the ordeal was from 16th century Switzerland (her husband, a professional pig castrater, performed the delivery), and before that the mortality rate is presumed to be 100 percent. This is an issue because GJC’s mother, Aurelia Cotta, is known to have lived long enough to see her son reach adulthood and serve him as a political advisor, despite what The Suda says. Some sources even suggest she outlived him. If little GJC really was born via C-section, Aurelia was exceptionally lucky to not only survive the delivery but also not have anyone make a fuss about it and record her accomplishment for posterity.

Does the C-section at least take its name from GJC? Again, probably not. While The Suda mistakenly has Aurelia Cotta die in childbirth, it does hint at a strong candidate for the origin of “Caesarean section.” The rest of the passage quoted above goes, “…and named him thus; for in the Roman tongue dissection is called ‘Caesar.’” Not quite right, but going in the right direction. In Latin, caedo is “to cut,” so Caesar, both as the name for the man and for the procedure, might derive from some form of the word (like caesus, its part participle). The Roman author Pliny the Elder notes that origin for both Caesar and Caesones, the name of a branch of the Fabian family.

But if “Caesarean section” comes from a word for cut, and GJC wasn’t born that way, how’d the two get connected? That might come from some confusion about Pliny’s writings. Pliny refers to a Caesar being born by C-Section, but not GJC. Pliny was actually talking about one of GJC’s remote ancestors, specifying that he was the first person to bear the name Caesar (who exactly that was is unclear) that “was so named from his having been removed by an incision in his mother’s womb.”

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