The case of a caesarean delivery in pre-colonial Central Africa

Written by Muniini K. Mulera, June 24th, 2016
The case of a caesarean delivery in pre-colonial Central Africa that was described by Robert William Felkin has caused some unanticipated controversy. Where did Felkin make his observations? Was it in Buganda or Bunyoro?
It appears that those who believe that the event took place in Bunyoro base that view on a paper by Dr. JPN Davies, the famous pathologist in whose honour the main lecture theatre at Makerere Medical School is named.
In his paper, published in 1959, Davies wrote: “In 1879, (Felkin) was detained for a few days at a place called Katura, now a part of Buganda but then part of Bunyoro. There he witnessed a Caesarean section performed by an African surgeon, he subsequently watched the patient’s progress, wrote copious notes, and drew sketches, and finally was presented with, and brought away, the surgeon’s knife.”
In fact Davies’ source is R.W. Felkin’s own “Notes on Labour in Central Africa”, which he read before the Edinburgh Obstetrical Society on January 9, 1884.
After describing the delivery process in Lango, Felkin stated: “In this part of the country, as also in Unyoro and Uganda, I had great difficulty in seeing women in labour; their friends much objected to it, and often presents of cloth would not prevail on them to permit my being present.” Then he added: “In Unyoro most women are delivered in a squatting position.”
A few paragraphs later, he turns his attention to Uganda (Buganda). He states: “In Uganda, the natives possess beds (called kitanda), a rough framework of wood laced with cowhide. The women are, as a rule, delivered on their backs.”
Very clearly, Felkin knew the difference between Unyoro (Bunyoro) and Uganda (Buganda). His descriptions were quite specific to the two countries and there is no doubt which one he was referring to when he stated: “ So far as I know, Uganda is the only country in Central Africa where abdominal section is practiced with the hope of saving both mother and child. The operation is performed by men, and is sometimes successful. In any case one case came under my observation in which both mother and child survived. ……….. It was performed in 1879 at Kahura.”
Dr. Davies, who calls the venue of the caesarean delivery Katura, transplants the operation to Bunyoro-Kitara, which was the subject matter of his book.
We should note that at the time of his presentation of his notes to the Edinburgh Obstetrical Society, Felkin was a youthful 31 year-old whose memory would have been very sharp. He was talking about an event that he had observed only 5 years earlier. It is highly likely that he wrote his notes soon after the operation was completed. He knew the difference between “Unyoro and Uganda.”
The two documented original witness accounts were both by Robert W. Felkin. It is all we have to go by. I therefore have no reason to doubt that the famous caesarean delivery took place in Buganda.
Felkin RW: Notes on labour in Central Africa. Edin Med J 1884;29:922-30
Felkin R W. Ueber die Lage und Stellen bei der 
Geburt. (Med. Diss.) Marburg, 1885.
BG Chipfakacha: Abdominal Deliveries in Africa: Food for thought to scholars of the History of Medicine. 
Central African Journal of Medicine. Vol. 35, No.2 February 1989
Davies, JNP: The development of `scientific’ medicine in the African kingdom of Bunyoro-Kitara Med Hist. 1959 Jan; 3(1): 47–57.

Robert William Felkin 1853-1926

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