Why ‘Caesar’?
If there ever was a word we have heard repeated frequently in recent months, it must be the word ‘Caesar’. But the majority using this word are blissfully unaware why this surgical procedure was named after the honorific title of a Roman Emperor. Perusing the old records, the first thing that strikes us is the fact that this procedure was attempted for an entirely different cause compared to what it means today.
Although the above surgical procedure performed on a pregnant mother is called a ‘Caesar’ in common parlance, the correct term is caesarean section (CS). The procedure involves the opening of the abdomen of a pregnant woman followed by opening the womb to extricate the foetus. Although the procedure had been practised by many cultures, both European and non-European, the origin of the word is tangled in mythology.
The earliest records are found in Roman and Greek mythology and popular legends in relation to beings with supernatural powers, the idea being that such powerful personalities did not pass through the vaginal canal of a woman at the time of birthing.
The use of the term ‘Caesarean Section’ in Obstetrics came to be established only in the 17th century. The operation was carried out exclusively on dead and dying mothers and the emphasis was only on the baby and not the mother. But, let us find out how an honorific of a Roman emperor came to be established for this surgical procedure
Historians agree that the operation is ‘misnamed’ and apparently Julius Caesar (100 – 44 BC) who is believed to have had a non-vaginal birth had nothing to do with it. The misnaming was perpetuated after the famous sage Pliny the Elder who proclaimed that Julius Caesar was born by ‘Caesarean Section’. The honorific ‘Caesar’ for Roman Consuls originated with the family of ‘Julii’ following the defeat of Hannibal by Generals Scipio Africanus and Mamillius in Carthage in 200 BC while the second Punic war was in progress.
The customs and traditions of the period and the indication for a surgical procedure in the birthing process clearly show that Julius Caesar could not have been born by surgery. Historical records show that the second ruler of Rome, Noma Pompilius (715 – 673 BC) issued a Royal Order – Lex Regia that no dead pregnant woman should be buried before removing the foetus from the woman’s womb. This procedure appears to be the original description of the ‘caesarean section’.
In fact, many religions laid down their own ‘laws’ and ‘decrees’ in relation to the rights of such born babies. The Christian church required a dead ‘baby’ so removed, (or alive even if only at the time of birth), be baptized. For the above reason alone Julius Caesar loses the credit for naming the procedure. His mother Aurelia Cotta brought forth six more children after the first born Julius Caesar indicating that she was alive and well after the supposedly CS. A mother living after such an ordeal was unheard of during the Roman Empire. History records that Aurelia Cotta died only in 54 BC.
In Greek mythology powerful gods are described as being birthed non-vaginally. Thus, Zeus who seduced Semele later delivered the baby by CS. The baby was apparently taken out before term and Zeus then implanted it in his loin until the baby was born at term. Apollo delivered his son Asklepios, the God of Medicine, by CS. The story goes that Apollo found out that his favourite nymph Coronis had been unfaithful and got her murdered by Artemis and at the funeral pyre the baby was removed by a CS.
In the Middle Ages, Christians in Europe were decreed to have a priest performing a CS on a dead or dying pregnant woman or at least to be present when it was being performed so that the baby could be baptized. Jewish religious laws laid down that twins born this way could not become priests and had no rights to succession.
Implication of a CS are seen in Shakespeare’s ‘Macbeth’ ‘… for none of women born shall harm Macbeth’. In the last scene Macduff says he was ‘ripp’d’ off his mother’s abdomen (CS) and then he kills Macbeth.
The operation performed on a living or dying woman invariably ended up fatally due to uncontrolled bleeding as the cut in the womb was left open. There were many indeed who abhorred the procedure calling it ‘sacrificial midwifery’. The first successful CS where both baby and mother survived was allegedly performed by Jacob Nufer, a Swiss and animal castrator in 1500. The woman subsequently had seven children and died at the age of 77. The first successful CS operations where both mother and baby survived were carried out in Netherlands (1782), South Africa ( 1826), UK (1834), USA ( 1835), Germany (1841) and in Uganda ( 1879, performed by traditional doctors).
New developments in midwifery and in medicine in general shifted the 100% maternal mortality following CSs to a few surviving mothers. The credit for the miracle goes to those pioneers who thought of securing the cut womb by suturing, first with silver wire. Frank Polin in USA (1852) and Max Sänger (1882) in Leipzig were the pioneers in this procedure that minimized the post operative bleeding.
Several new developments in midwifery and in general in Medicine paved the way for a much safer outcome both with respect to mother and the baby. Anaesthesia with ether by Jackson and Morton in Boston (1846), the introduction of aseptic techniques by Ignace Semmelweis in Vienna (1847) and antisepsis by Lister in Edinburgh (1887) were the main new developments that made the surgery a little safer. The introduction of prophylactic and therapeutic antibiotics after the Second World War further promoted the procedure much safer for mothers and babies. By now the emphasis has shifted from saving the baby to saving the mother (or both).