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.

Forest and Savanna in Africa in the Ishasha Region of Queen Elizabeth National Park
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.

Caesarean delivery Buganda 1879-2

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 reaching into the womb for a Cesarean section baby
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.



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.


Operation for cesarean section with new born infant in operating
Safer and cleaner birth in 2016 Uganda, but same basic principles as in 1879 Buganda.

38 Responses to “Caesarean section in Buganda in 1879”

  1. Avatar

    I am fascinated and impressed but traumatised. Cant get the photo out of my mind.

    • Avatar
      Muniini K. Mulera

      Oops! Sorry about that Hope. We take this normal daily sight for granted.

  2. Avatar
    Robinah Rwabirima

    This is amazing!I never read it when you first published it Dr Muniini and appreciate your documentation and archiving skills

    I have always known our ancestors had a lot of knowledge of herbal medicine but surgery !

  3. Avatar
    Lillian Kimumwe

    I am thinking of many deaths due to infection . Also this was such a long and painful procedure for the woman however much intoxicated she was. All said, “Bravo!” to the Baganda surgeons of that era.

    • Avatar
      Muniini K. Mulera

      With the alternative being death for both mother and child, a painful C/section was an easy choice. BTW, that was the experience of women in Europe before the discovering of anaesthesia.

    • Avatar
      Josiah nyakwara

      Indeed Africa had great knowledge in medicine and surgery only that it was not publicized. In Kisii Kenya we know of a skilled group that used to do brain surgery in those old days. Most of those surgeries were successful. Even there is a clip on you tube attesting to that.

  4. Avatar
    Lillian Kimumwe

    Was this procedure available for all the Baganda women or only the Abambejja?

    • Avatar
      Muniini K. Mulera

      There is nothing in the reports that addresses your question.

      • Avatar
        Monday wilfred

        Its just unfortunated that in africa we do not write about what we have studied thats why the whites come and copy our ideas then they develope them and practice it then the take the credit

  5. Avatar

    I don’t know where we went wrong! It looks like our traditional herbalists have a very faint and thin knowledge of our ancestors medical science.
    Can you please publish that finding for us to appreciate Dr. Muniini Mulera? I have enjoyed reading that science.

  6. Avatar
    Edmond Kalungi

    There is something about Baganda and the Buganda kingdom that amazes me. Baganda have what is called “Okulanya” which is in the Bible as well and we call it “okutambula nga Omuganda.” The government of the Buganda kingdom was so advanced that the first colonial masters were amazed. And now this, oh my God surgery. Am proud to be a Muganda. Other tribes in Uganda you are equally good. For God and my country Uganda

    • Avatar
      Ayebale David

      That is what I also told him. That article talks about Kahura which was mispronounced and misspelled instead of Kahoora which is the central part of Hoima town, the capitaal of Bunyoro, two miles from Kabalega’s former palace at Mparo. The Whites used to mispronounce and misspell Africa’s words. Like another instance being the name of Bunyoro-Kitara’s king “Ruhaga” was instead mispronounced ans misspelled as “Duhaga.” So, C-section was in the current Bunyoro not Buganda!

  7. Avatar
    Jadwong Olweny

    The famous African-American activist Malcom X once remarked, “Of all our studies, history is best qualified to reward our research.” This holds true for the history of Buganda, Uganda and Africa. Sadly, many would prefer to forget the past! A thoroughly enjoyable and well researched piece. Look forward to more such pieces Dr. Munini. Thanks

  8. Avatar
    Asa Ahimbisibwe

    Dear Dr. Muniini,

    Thank you for this reminder again. It is a subject which has been dear to my heart and somehow a cause of so much distraught to my existence, as a Ugandan physician, who first of all, witnessed my relatives die in labor awaiting a caeserian delivery, and later decided to become an Obstetrician to help prevent such tragedies.

    It was 137 years ago, when our traditional men and women performed this life saving procedures on pregnant women to save life, before there was modern medicine. but today, when you visit our National Referral Hospital in Mulago, women die waiting to have this life saving procedure. As Ugandans, we need to ask ourselves, what went wrong, hold our leaders to accountability, and search ourselves as individuals- what have we done about this.
    As a reminder, 20 women in Uganda, die each day due to pregnancy related complications and 99% of these complications can be treated.
    With the peace, unity, and modernization, we should be doing better for our mothers and children.

    Let us all ask the question ” why are our women still dying of causes that are preventable”?

  9. Avatar
    Fred Musoke

    It was crude but had all the hallmarks of modern surgery. We we’re deprived of developing at our own pace in so many aspects besides medical practices. Besides the crudeness and possible high mortality and morbidity it’s worthwhile knowing that bit of of our history.
    Thanks Dokotera Mulera for your article.

  10. Avatar
    Dennis Babaasa

    This Buganda/Bunyoro surgical operation may not be much different from what was being done in Europe 100 years ago. There is a figure in the biology textbook we used to read at A-level – Roberts MBV 1986. Biology: A Functional Approach. 4th Ed. ELBS, London – on page 251, they show in a picture the crude conditions in which surgical operations were carried out and contrast it with another showing the aseptic atmosphere of today’s modern operating theatre. The picture was got from the Wellcome Historical Medical Museum and Library. Thxs Dr for this historical revelation.

  11. Avatar
    Edmund Lubega

    Kalungi, Buganda is not a tribe but a state society. We do have tribes (bika) within Buganda eg Basese, Bakooki, Baruuli etc

    • Avatar
      Ayebale David

      Bunyoro is also a State since it has many ethnic groups like Bagahya, Bagungu, Bakobya, Bagangaizi, etc with each having their clans either similar in names or different but with same totems.

  12. Avatar
    Maria Nakabiito

    Amazing and informative! Edmund Lubega ; Basese, Bakooki etc are not clans. Not sure what those are but clans are like Babito, Baliga, abe Mmamba etc . One can be omuliga and a mu Koki and a Muganda. Or owe Mmamba owe Ssese and Muganda.

  13. Avatar
    Mona Muguma-Ssebuliba

    Dear Dr. Mulera,

    My husband Jordan, and I, were just this morning talking about medicine and he told me about this c-section story that you write of, happening in Buganda in the 19th century. I was skeptical about his claims and to that end, as you know, arguments like these are settled via google and I added that I would only believe a credible source. Only for the result to bring up your article as the second link on the story! Sources don’t get any more credible than this! And you have done this great historical piece of information justice with your usual writing prowess….but more importantly, you have handed Jordan a rather decisive victory!!! And for that, I owe him a sumptuous breakfast in bed….

  14. Avatar

    This is fascinating. Unfortunately the rift between modern and traditional practice is still big and these traditional experts are leaving us. Thank you for this archival information Dr Muniini. Please keep sharing.

  15. Avatar
    Apollo Lumu

    It is such history that will evoke the spirit of independent mind thinkers and innovators in Uganda.
    A history of human achievement that transcends our fragile ethnic divide.
    It is so painful to hear ( not to listen to) our current politicians manipulating our history , often conveniently reffering to it as a turbulent , primitive violent past without anything to celebrate.
    A times one could be forgiven for thinking that Buganda was formed in the late eighties during the LUWERO conflict.
    I salute you doctor for sharing this amazing story . As a proud Muganda, I couldn’t care less if the operation was performed in Lango at the time, the fact is it was in Uganda and by Africans, period.

  16. Avatar
    Douglas Kiggundu

    This great to hear that a muganda had already knowledge on how to save life and perform such a scientific operation on a fellow human being

  17. Avatar
    Alice Burnham nee Musoke

    Thank you for this wonderful and informative article. What a pity a lot of our history has been lost. The destruction of the BUGANDA MUSEUM at Kitante Rd and his Palaces in 1966 after Kabaka Edward Muteesa II was ousted, contributes a lot to the loss of many more historical information that would have been of beneficial contribution to World History. May the search continue for many more of our history, most likely in some old archives in some British Museums. The early explorers were forever sending reports back or pilfering and sending back whatever they found interested them.

  18. Avatar
    Phinehas Tukamuhabwa

    Thank you Dr Muniini for this wonderful piece that demonstrate that Africans are not dead to high level innovation. This article is an eye opener that we have the capacity to remarkable innovations as long as we think for ourselves. Truth is that all innovations start in a rudemenatry form.
    Bravo to these Baganda/Banyoro surgeons of the time. But we can still do it if we become stop being overdependent

  19. Avatar
    Dr Vincent N.kaliisa

    It’s very interesting history as for as our medical history ins concerned.
    From that far to this this time “ Ebenezer”

  20. Avatar
    Tendo Kaluma

    This is interesting article and it collaborated with a story in my family of my great maternal grandfather Mwerango / who lived around the same time frame -although he died of a hernia himself – he used to operate on folks who suffered from hernias and the story goes that he used to make sutures out of lamb entestines! Now I wonder how they kept it sterlile! That said he was no ordinary man he could also levitate and foretell what was to come!

  21. Avatar
    Kyetume Kasanga

    This is Buganda chauvinism! Buganda is fond of unduly claiming a sense of entitlement where it’s not due. They have unduly and unfairly peddled propaganda that they were so advanced in the practise of medicine that they did the first C-section in 1879, yet it was Bunyoro which was so advanced then and performed the procedure. Interestingly, the Baganda claim quotes Dr Robert Felkin’s account of the events as he witnessed them in Bunyoro, by merely twisting it away from the reality. Look at his original writing:

    • Avatar

      Stop being jealous,no one knows exact Kingdom and it’s possible both kingdoms could perform the procedure. And it’s not written anywhere that it was the first of its kind, may be by the time she witnessed they had practiced it over and over to perfection..even ideas are shared, I think you’re aware of which kingdom used to produce Mbugo for clothes and salt exchange..And history tells us that Buganda and Bunyoro are very close in social set up though great traditional enemies .

    • Avatar
      Ayebale David

      Thank you comrade Kasanga. That is what I also told them. As a journalist I have researched extensively about that and concluded that C-Section was first performed in Bunyoro having read Africa Exponent and both talking about Bunyoro. Thank you.

  22. Avatar

    I know. Kyetume Kassanga. You are so right. I wondered how Felkinwould write auch a detailed account and not know the region it was being performed in. I have read the book and this article with all honesty needs to be put down. Or at least corrected in the sense of the location of the procedurs. Untruths will mot get us anywhere they serve only to divide us and breed bitterness. Surely many other procedures must have been practiced even in Buganda

  23. Avatar
    Ayebale David

    Come on Raymond. Stop cheapness. Read the article as given by Mr Kasanga. Follow the link and read instead of shouting. That is the very article I also read. Wake up, please!


Leave a Reply

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>