Modification by Hermann Johannes Pfannenstiel in 1900, see Pfannenstiel incision Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912) Adherence to principles of asepsis Anesthesia advances Blood transfusion Antibiotics Indigenous people in the Great Lakes region of Africa, including Rwanda and Uganda, performed caesarean sections on a regular basis with a low mortality rate during the 19th century. The Africans normally used alcohol to anesthetize expectant mothers and sterilize their hands for the procedure. They also used herbal mixtures to encourage healing and prevent infections. From the well-developed nature of the medical procedures employed, European observers concluded that the Africans had employed these procedures for a long time. Robert William Felkin provided a detailed description. James Barry was the first European doctor to carry out a successful caesarean in Africa, while posted to Cape Town between 1817 and 1828. The first successful caesarean section to be performed in the United States took place in Mason County, Virginia (now Mason County, West Virginia), in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth. Caesarius of Terracina The patron saint of caesarean section is Caesarius, a young deacon martyred at Terracina, who has replaced and Christianized the pagan figure of Caesar. The martyr (Saint Cesareo in Italian) is invoked for the success of this surgical procedure, because it was considered the new "Christian Caesar" – as opposed to the "pagan Caesar" – in the Middle Ages it began to be invoked by pregnant women to wish a physiological birth, for the success of the expulsion of the baby from the uterus and, therefore, for their salvation and that of the unborn. The practice continues, in fact the martyr Caesarius is invoked by the future mothers who, due to health problems or that of the baby, must give birth to their child by caesarean section. Etymology The Roman Lex Regia (royal law), later the Lex Caesarea (imperial law), of Numa Pompilius (715–673 BC), required the child of a mother who had died during childbirth to be cut from her womb. There was a cultural taboo that mothers should not be buried pregnant, that may have reflected a way of saving some fetuses. Roman practice required a living mother to be in her tenth month of pregnancy before resorting to the procedure, reflecting the knowledge that she could not survive the delivery. Speculations that the Roman dictator Julius