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Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0
Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0

Just How Old Is C-Section Birth?

Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0
Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0

An 18th-century Hungarian woman made history this week—her mummified remains preserve the earliest direct evidence of C-section. Sadly, neither she nor her full-term son survived. Which raises the question: Just how old is C-section birth, and when did women and babies start surviving it?

CHILDBIRTH AS EVOLUTIONARY COMPROMISE

Basically since humans started walking upright, childbirth has been difficult for women. The brains of our hominin ancestors got larger and larger, with the result that today’s average newborn has a head 102 percent the size of its mother’s bony pelvis. Yes, you read that right—our babies’ heads are actually larger than our skeletal anatomy.

Obviously, an evolutionary compromise was worked out, so that humans could have large-brained babies and still walk upright. Babies’ skulls bones can slide around and overlap to help them get out. The fetus also goes through a sort of dance when it’s born, wiggling and turning with the help of contractions to make its way through the bony pelvis. And, perhaps most importantly, towards the end of pregnancy, a hormone is released that weakens the cartilage of the joints of the pelvis, letting it widen just enough for the baby to come out.

But we humans also rely on culture for our existence, and the same is often true for birth. The caesarean section—which includes the Latin root word for cut—involves extraction of a baby through a cut into the mother’s uterus. Although the practice dates back thousands of years, women didn’t survive it until comparatively recently.

HISTORICAL RECORDS OF C-SECTIONS

Ancient Roman relief carving of a midwife attending a woman giving birth. Wikimedia Commons // CC BY 4.0

There is some argument among scholars that C-sections were performed in Egypt around 3000 BCE, but the earliest clear documentation in ancient texts comes from early Rome. The second king, Numa Pompilius (c. 700 BCE) passed a law called the Lex Regia, later renamed the Lex Caesarea and reported in Justinian’s Digest (11.8.2). This law forbade burying a pregnant woman until her offspring had been excised from her body. The reason stated for the law was that there was a small chance the baby would survive, but it is unclear if the law was religious in nature or whether it simply aimed to increase the population of tax-paying citizens. A similar reference to post-mortem delivery comes from Sage Sustra, a practitioner of Hindu medicine around 600 BCE. But in neither case is it clear how often—if ever—this was carried out.

This means that the first person who was born by C-section is also hotly debated. Julius Caesar is often held up as the most famous example, with the assumption that his cognomen—third name or nickname—resulted from his style of birth. Sadly, it seems that the Roman author Pliny either made this up or was referring to a very distant ancestor of the Julii clan. Since women didn’t survive C-sections in ancient Rome, Caesar’s mother Aurelia, who lived well into her 60s, did not deliver him in that way.

Historical records of famous people born by C-section actually go back further than Caesar, though. Some scholars claim [PDF] that the earliest documented C-section produced the orator Gorgias in the 5th century BCE, but the historical evidence is murky. Although Pliny was wrong about Caesar, in his Historia Naturalis (VII.ix) he wrote that the celebrated Roman general Scipio Africanus was born in this manner in 236 BCE. If either of these cases is correct, there is evidence of viable offspring from C-sections nearly 2500 years ago. But these procedures were certainly only done when the mother died or was about to die in childbirth.

It wasn’t until the 1500s that doctors began to expect women to survive the procedure. French physician François Rousset broke with medical tradition at the time and advocated performing C-sections on living women. In practice, though, it was still only performed as a last-ditch effort to save the newborn. Certainly some women survived C-sections from the 16th to 19th centuries, but it was still a very risky procedure that could easily lead to complications like endometritis or other infection. C-sections didn’t become common until the 1940s, following advances in antibiotics that made them survivable.

ARCHAEOLOGY OF CHILDBIRTH AND C-SECTIONS

Medieval caesarian on a deceased woman. Wikimedia Commons // CC BY 4.0

The infant mortality rate was very high in antiquity, as were rates of mothers dying in childbirth. Consequently, you might expect that archaeologists have found loads of mother-fetus burials. But very few exist. In fact, the number of pregnant female burials in the published archaeological literature from around the world is only about two dozen.

There are several potential reasons for this lack of evidence. First, archaeological methods got significantly more scientific in the 1970s, so more recent excavations are better at finding tiny fetal bones. Second, the mother could outlive the fetus, and the newborn could outlive the mother. Death at different times will not be obvious archaeologically as evidence of childbirth-related complications. Even when the mother and baby both die before birth, though, this may not be evident because of a phenomenon called “coffin birth”—when the gases that build up within a corpse cause post-mortem “birth” of the fetus. And finally, cultural practices could be to blame for our lack of evidence—application of the Roman Lex Caesarea, for example, could result in a woman buried by herself and a viable newborn who grows up and dies much later.

Unfortunately for archaeologists, C-sections usually involve soft tissue only, so it is unlikely that we will ever find direct ancient evidence of it in a skeleton. There are two possible ways to see physical evidence of ancient C-sections. One is cut marks on the pelvis made around the time of the mother’s death by a surgeon. (Normally, C-sections don’t involve cut bones, but symphysiotomies—cutting through the front of the pelvis—can be done with or without accompanying C-sections to aid in delivering a baby.) The second is a mummy with an incision into the uterus and other physical changes associated with pregnancy and labor. At the International Conference on Comparative Mummy Studies earlier in April, the first ever direct evidence of an early C-section was presented. The case study, presented by anthropologist Ildikó Szikossy of the Hungarian Natural History Museum, involves a woman named Terézia Borsodi, who died in December 1794 during the birth of her sixth child. While historical records suggest that the baby boy was delivered alive, Terézia’s mummy shows she was likely already dead when the C-section was performed. The baby also did not survive, and they were buried together.

CHILDBIRTH IS BIOLOGICAL AND CULTURAL

Successful Caesarean section performed by indigenous healers in Kahura, Uganda (1879). Wikimedia Commons // Public Domain

Childbirth is both a biological and a cultural process, today and in the past. But while biological variation is consistent across all human populations, the cultural processes that can facilitate childbirth are quite varied. A quick glance at the rates of elective C-section around the world demonstrates this easily. So archaeologically, we should also expect to see variation in the lives, deaths, and burials of women and infants.

Archaeologists use skeletons, historical records, medical artifacts, and other clues from burials to reconstruct childbirth practices and interventions in the past. New advances in microscopic analysis of the bones of ancient fetuses are also revealing whether or not the baby was alive or stillborn. As the archaeological record gets better, and as excavation, recording, and analysis techniques advance, we should soon have better methods for understanding this key time in the lives of mothers and infants, and for figuring out when the earliest C-sections occurred.

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History
A Very Brief History of Chamber Pots

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Photo illustration by Lucy Quintanilla, Mental Floss. Saint Nicholas: HULTON ARCHIVE, GETTY IMAGES. Skulls, backgrounds: iStock
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Tomb Raider: The Story of Saint Nicholas's Stolen Bones
Photo illustration by Lucy Quintanilla, Mental Floss. Saint Nicholas: HULTON ARCHIVE, GETTY IMAGES. Skulls, backgrounds: iStock
Photo illustration by Lucy Quintanilla, Mental Floss. Saint Nicholas: HULTON ARCHIVE, GETTY IMAGES. Skulls, backgrounds: iStock

Throughout history, corpses have been bought and sold, studied, collected, stolen, and dissected. In Rest in Pieces: The Curious Fates of Famous Corpses, Mental Floss editor Bess Lovejoy looked into the afterlife of numerous famous corpses, including Saint Nicholas, one of the many canonized bodies whose parts were highly prized by churches, thieves, and the faithful.

Don't tell the kids, but Santa Claus has been dead for more than sixteen hundred years. No, his body is not at the North Pole, and he's not buried with Mrs. Claus. In fact, his remains are thousands of miles away, on Italy's sunny Adriatic coast. And while Santa might be enjoying his Mediterranean vacation, he's probably not too happy about what happened to his remains. They were stolen in the eleventh century, and people have been fighting over them ever since.

Of course, the Santa Claus of folklore doesn't have a skeleton. But his inspiration, Saint Nicholas, does. That's about all we can say for sure about Nicholas: he was a bishop who lived and died in what is now Turkey in the first half of the fourth century. Legend tells us that he was born into a rich family and delighted in giving gifts. Once, he threw three bags of gold into the window of a poor family's house, saving the three daughters who lived there from a life of prostitution. Another time, he raised three children from the dead after a butcher carved them up and stored them in a vat of brine. He also protected sailors, who were said to cry out his name in rough seas, then watch the waves mysteriously smooth.

The sailors spread Nicholas's cult around the world. Within a century of his death, the bishop was worshipped as a saint, lending his name to hundreds of ports, islands, and inlets, and thousands of baby boys. He became one of the best-loved saints in all of Christendom, adopted by both the Eastern and Western traditions. Christmas probably owes something to his December 6 feast day, while Santa Claus’s red outfit may come from his red bishop’s robes. "Santa Claus" is derived from "Sinterklaas," which was how Dutch immigrants to New Amsterdam pronounced his name.

As one of the most popular saints in the Christian world, Nicholas had a particularly powerful corpse. The bodies of saints and martyrs had been important to Christianity since its beginning: the earliest churches were built on the tombs of saints. It was thought that the bodily bits of saints functioned like spiritual walkie-talkies: you could communicate with higher powers through them, and they, in turn, could manifest holy forces on Earth. They could heal you, protect you, and even perform miracles.

Sometimes, the miracles concerned the saints' own bodies. Their corpses would refuse to decay, exude an inexplicable ooze, or start to drip blood that mysteriously solidified and then reliquefied. So it was with Nicholas: at some point after his death, his bones began to secrete a liquid called manna or myrrh, which was said to smell like roses and possess potent healing powers.

The appearance of the manna was taken as a sign that Nicholas’s corpse was especially holy, and pilgrims began flocking by the thousands to his tomb in the port city of Myra (now called Demre). By the eleventh century, other cities started getting jealous. At the time, cities and churches often competed for relics, which brought power and prestige to their hometowns the way a successful sports team might today. Originally, the relics trade had been nourished by the catacombs in Rome, but when demand outstripped supply, merchants—and even monks—weren't above sneaking down into the crypts of churches to steal some holy bones. Such thefts weren't seen as a sin; the sanctity of the remains trumped any ethical concerns. The relics were also thought to have their own personalities—if they didn't want to be stolen, they wouldn't allow it. Like King Arthur's sword in the stone, they could only be removed by the right person.

That was how Myra lost Saint Nicholas. The culprits were a group of merchants and sailors from the town of Bari, located on the heel of Italy's boot. Like other relic thefts, this one came at a time of crisis for the town where the thieves lived, which in this case had recently been invaded by a horde of rapacious Normans. The conquerors wanted to compete with the Venetians, their trading rivals to the north, who were known for stealing the bones of Saint Mark (disguised in a basket of pork) from Alexandria in 827. And when the Normans heard that Myra had recently fallen to the Turks, leaving Nicholas’s tomb vulnerable, they decided to try stealing a saint for themselves.

According to an account written shortly after the theft by a Barian clerk, three ships sailed from Bari into Myra's harbor in the spring of 1087. Forty-seven well armed Barians disembarked and strode into the church of Saint Nicholas, where they asked to see the saint’s tomb. The monks, who weren't idiots, got suspicious and asked why they wanted to know. The Barians then dropped any pretense of politeness, tied the monks up, and smashed their way into Nicholas's sarcophagus. They found his skeleton submerged in its manna and smelled a heavenly perfume wafting up from the bones, which "licked at the venerable priests as if in insatiable embrace."

And so Nicholas of Myra became Nicholas of Bari. The relics made the town, and the men who stole them. The thieves became famous in the area, and for centuries their descendants received a percentage of the offerings given on the saint’s feast day. The townspeople built a new basilica to hold the remains, which drew thousands of pilgrims throughout the Middle Ages. Even today, Bari remains a major pilgrimage site in southern Italy, visited by both Roman Catholics and Orthodox Christians. Every May an elaborate festival, the Feast of the Translation, celebrates the arrival of Nicholas’s relics. As one of the highlights, the rector of the basilica bends over Nicholas’s sarcophagus and draws off some of the manna in a crystal vial. The fluid is mixed with holy water and poured into decorated bottles sold in Bari's shops; it is thought to be a curative drink.

But Bari is not the only place that boasts of the bones of Saint Nicholas. If you ask the Venetians, they will say their own sailors visited Myra during the First Crusade and stole Nicholas’s remains, which have been in Venice ever since. For centuries, both Bari and Venice have claimed the saint's skeleton.

In the twentieth century, scientists waded into the dispute. During renovations to the basilica of Bari in 1953, church officials allowed University of Bari anatomy professor Luigi Martino to examine the remains— the first time the tomb had been opened in more than eight hundred years. Martino found the bones wet, fragile, and fragmented, with many of them missing. He concluded that they had belonged to a man who died in his seventies, although because Martino was given only a short time with the bones, he could say little more.

Four decades later, Martino and other scientists also studied the Venetian bones. They concluded that those relics and the ones in Bari had come from the same skeleton, and theorized that the Venetian sailors had stolen what was left in Myra after the Barians had done all their smashing.

As for Demre, all they have is an empty tomb. And they want their bones back. In 2009, the Turkish government said it was considering a formal request to Rome for the return of Nicholas's remains. Though the bones have little religious significance in a nation that’s 99 percent Muslim, there’s still a sense in Turkey that the centuries-old theft was a cultural violation. Its restitution would certainly be an economic benefit: according to local officials, tourists in Demre frequently complain about the barren tomb, and they weren't satisfied by the giant plastic sculpture of Santa Claus that once stood outside Nicholas’s church. Even though Santa has become an international cultural icon, his myth is still rooted in a set of bones far from home.

From REST IN PIECES: The Curious Fates of Famous Corpses by Bess Lovejoy. Copyright © 2013 by Bess Lovejoy. Reprinted by permission of Simon & Schuster, Inc.

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