Ancient origins of caesarean section and contextual rendition of Krishna’s birth

INTRODUCTION

Retrieving the foetus from the womb of a dead or dying pregnant full-term woman was a known practice in ancient cultures, dating back to the era before the birth of Christ. There is mention of the practice in ancient Greece, Rome, Babylon and India.¹ The origins of the name “caesarian” are thought to be from the Latin “ Ab utero caeso” meaning “to cut open the uterus” ; this procedure is thought to have been conducted to deliver one ancestor of Julius Caesar – Plinus the Elder, surname Caesar, hence the name caesarian.² Julius Caesar himself is also thought to have been born in similar fashion, with his mother also surviving the process, and living on till the death of the former. In fact, the Roman law “Lex Caesarea” decreed it mandatory to carry out the procedure in dead women to save the infant.³ In Indian lore, Bindusara (son of Chandragupt Maurya and father of Ashoka) is supposed to have been born by ceasarian section. The legend goes that Bindusara’s mother accidently ingested poison, and Chanakya conducted the operation in order to save the life of the heir to the throne of Magadh.⁴ The ancient surviving surgical Ayurvedic text, Sushrut Samhita, very succinctly describes the indications and procedure to be adopted to extract the foetus from the womb.⁵ This makes it amply clear that the method was known and practiced in Puranic era.

The following rendition of the birth of Lord Krishna is an attempt to elucidate the delivery of the infant Krishna in the context of the situation where inimical forces were hell-bent upon disallowing the new arrival from seeing the light of day.

The atmosphere was charged. There was suppressed excitement among the Yadava chiefs of Mathura and Brij-bhumi- the moment for the fulfillment of the prophecy of Maharishi Ved-Vyas was fast approaching. Devaki, wife of Vasudeva, the chief of the Shoora clan of the Yadavas, was about to deliver her eighth child. For many long years, the resolute couple had withstood the fury of Devaki’s cruel brother King Kansa, with firm faith in the prophecy – Devaki’s eighth child would be the ‘Deliverer’ from Kansa’s atrocities and would re-establish Dharma in Bharat-varsha.

The previous seven children of Devaki had all been seized by Kansa at birth, only to be slaughtered mercilessly, since Kansa was afraid that any one of the children might turn out to be his nemesis. The eighth child was about to be born and Kansa was determined to get his hands onto this baby the moment it was delivered, so that he could extinguish the new life in order to save his own.

On the other hand, the wise and elderly men of the Yadava clan were determined to see the prophecy come to fruition. For all these long years they had waited with hopeful expectancy for the birth of the ‘Deliverer’. They had made frantic efforts to break through the security cordon surrounding the villa in which Vasudeva and Devaki were under house-arrest. Their sustained efforts over many years finally bore some fruit after the loss of six of Devaki’s children, when they had succeeded in salvaging the seventh pregnancy of Devaki (see footnote), thus kindling hope that they could succeed at the next instance (eighth pregnancy) also. Their hopes were shattered when they heard of increased security measures being put into place. Kansa began to take great precautions. He withdrew all the servants from the palace in which Devaki and Vasudeva were held captive. This time no mid-wife was going to be in attendance as before. Instead, Putana, his trusted cousin and the wife of Pradyota, his equally trusted captain of the guards, had moved in with the couple. Orders were issued that no one could see them except Gargacharya, the family priest, who attended to the daily rituals which could not be denied to Vasudeva. Putana, who lived in-house sent Kansa regular messages about Devaki’s progressing pregnancy. Kansa also posted Magadhan soldiers in key positions around the town.

The wise men of Mathura witnessed and scrutinised all these measures taken by Kansa. On the face of it the situation appeared hopeless, but they had deep faith in the Prophecy and kept up their efforts. The D-day was approaching fast and they just had to work out something to save the ‘Deliverer’. Ultimately, a plan was put into place – Devaki’s eighth child would be substituted by that of Yashoda, the wife of Nanda, chief of Gokul. Yashoda was also nearing the end of her confinement and could deliver anytime soon. Nanda was an ardent follower of Vasudeva and was willing to sacrifice his own child for the sake of Vasudeva’s child, even though he had been child less so far. But how to switch the babies was the problem confronting the elders.

Gargacharya had been working towards this end.⁶ He had hesitatingly tried to strike conversation with the guards during his visits and had achieved some measure of success. He had even been able to sometimes offer sweets and snacks to the guards whose tiresome job it was to spend long hours just doing nothing. The rains had started a few weeks back since the monsoons had reached Mathura the previous month of Sawan .The flooding of the roads and the general disruption of services had made things more difficult for the guards. They were only too happy to take a bite from the delicacies quietly offered to them by the venerable Gargacharya. Hence Garhacharya had managed to befriend the guards posted by Kansa to some extent. It was now the eight day of the dark fortnight of the month of Bhadon. Throughout the day there was thunder and lightning, the rains came down in cascades and the winds lashed the streets. About noon time, in spite of the foul, stormy weather, Gargacharya came to perform the daily rituals at the villa. After these were over, the old priest embraced Vasudeva and whispered a message in his ear – Yashoda was about to deliver. Since the rain was coming down heavily, the guards allowed Garga to stay-put and rest in the palatial villa.

The rains continued to pour down heavily and, even before sunset, darkness fell over the town. Putana, who had gone to her house in the morning, could not return to her post as the roads had been flooded. The palace guards, shivering to the bones, had closeted themselves in their guard-room to cosy up, leaving the gates open for her to come in whenever she managed to reach there. A little before midnight, a boat docked on the Yamuna ghats near the palace. In it was a Brahmin with a bundle in his hands. Garga was at the ghat to receive him and he silenty gestured at the bundle, quizzically. “Yes, it is a girl. Yashoda delivered a little while back and has been medicated into a long slumber”, said the Brahmin. Silenty and carefully Garhacharya lead the Brahmin into the palace from a back door and went to inform Vasudeva about his arrival.

The young Brahmin Sushruta was a disciple of Rishi Bhardwaj and had been especially trained for the job under the instructions of Ved Vyas and Gargacharya. He had previously spent many years in deep study under Vamdeva, the Rishi who was master of the Atharva-veda. The Atharvans were adept at the science and craft of Ayurvedic medicine and surgery and had deep knowledge of the working of the human body. It was due to this reason that Rishi Bhardwaj had sent his best pupil to Vamdeva to master the surgical craft. Bhardwaj who was himself a past master of Ayurveda, then discussed thread bare with Sushruta all possible ways of delivering a baby. This expertise was then put to test during Balaram’s birth who was thus also called “Sankarshana” (one who has been pulled out by force) – this concept is similar to forceps delivery in modern obstetrics. Gargacharya soon returned and lead Sushruta into Devaki’s chambers. After examining the lady, Sushruta came out and was asked by Gargacharya, “What do you think? Within how much time can you deliver the baby ?” Sushruta thought a moment before replying “If we proceed to deliver the baby through normal course, it may take all night. Devaki is not in labour and the pains will have to be induced.” But we can’t wait till tomorrow! exclaimed Gargacharya; “The weather is helping us and you have already brought Yashoda’s baby as substitute. We may not get such an opportunity again”. “In that case, we will have to take the baby out by Shalya-prayoga (operation)”, replied Sushruta.

Gargacharya was able to immediately grasp the significance of what Sushruta was saying. ”Just wait a while”, he told Sushruta and went to confer with Vasudeva. Vasudeva had total faith in his preceptor – “Do what you think is best, Wisest of Acharyas”, he said to Gargacharya. “Then get the sweets ready. I shall make the arrangements for the operation”, said Gargacharya, handing Vasudeva a small carefully packed packet. Vasudeva headed towards the kitchens and carefully opened the packet handed to him by Gargacharya. He then proceeded to lace the freshly prepared sweets with the tranquillizing herbal powder brought by Sushruta and went out to serve these to the guards. It was pitch dark and raining heavily. The weather had become quite cold and the guards were all huddled up around a fire in the guardroom, playing cards to pass time. They welcomed Vasudeva into the room and happily partook of the delicious sweets that he offered them. After making sure that each one of the guards had eaten the sweet-meats, Vasudeva swiftly left and reached the side of Devaki.

By this time Sushruta had arranged all the boiled and sterilized instruments, and the materials required for the operation in Devaki’s chambers which he had converted into a make-shift theatre.He had also fumigated the make-shift theatre with anti-septic dhoom smoke, thus completing the aseptic process.⁷ He instructed Vasudeva on how to assist him during the procedure. Soon Gargacharya came with the news that all the guards has fallen asleep. “Now is the right time. Lets proceed”, the Acharya said.

Sushruta requested Gargachgarya to stay near Devaki’s head-end and administer the inhalant sedative which was required in order to make her numb to the pain of the operation. While Sushruta and Vasudeva carefully washed their hands, Garga gave Devaki a few inhalations of the narcotic. Soon Devaki was snoring and the surgically adept anchorite started the procedure after cleaning the mother’s abdomen and spreading sterilized sheets of cotton over it. Within a short while, the silence of the night was shattered by the lusty cries of a new born baby who was immediately handed over to Gargacharya. Gargacharya had one look at the baby and gasped in surprise. The boy was perfectly formed and coloured like a sky blue Lotus. He had stopped crying and had a beatific smile on his tiny lips. Garga was filled with awe –the “Deliverer” had arrived. Soon Sushruta was finished with the procedure and came out of the theatre to examine the baby.

DISCUSSION

Sushruta is known as the father of plastic surgery, primarily because of the principles of flap reconstruction which survived down the centuries. Besides reconstructive surgery, Sushruta has also described many other operations like laparotomy, cysto-lithotomy and fistulectomy. Dozens of instruments are explained in detail in the treatise Sushruta Samhita, many of which have been adopted into modern surgery. Suturing of war wounds was well known in ancient India. The ancient surgical practices have been kept alive in racial and tribal memory by customs and rituals practiced at times of fasting and festivals.

The tradition observed at Janam Ashtami by the people of Brij-Bhumi (comprising areas of Agra, Mathura & Aligarh districts) is interesting and illuminating. At the stroke of midnight, a large cucumber is slit & the little Krishna delivered from inside – quite akin to a caesarian section operation. This ritual carried out in innumerable homes in the Brij Kshetra at Ashtami is perhaps a ritual device to keep alive the racial memory of Krishna’s modality of birth. This seems even more plausible when one learns that the rishis had already been successful at another form of assisted delivery – The forceps. A year before Krishna’s birth, infant Balarama had been delivered by forcible extraction through the natural route, hence his birth name was Sankarshan– One who has been pulled out by force.⁷ In fact, another medical feat had been performed to save the seventh gestation of Devaki; her foetus had been extracted and re-implanted into the womb of the second wife of Vasudeva, Rohini. This foetus had survived and developed inside Rohini’s womb to be delivered later by forceps, and grow up to become the legendary Balarama. In scientific terminology the transfer of the foetus will be called embryo transfer.

CONCLUSION

Surgery has been practiced in different forms since ancient times. Treatment of homicidal wounds and war wounds were obviously necessary to keep alive the fighter class who were also the reigning class. Practices of sterilization and fumigation were practised in olden times and have survived till today. If we intercept the hints, we can reach to concrete conclusions regarding the levels of expertise present in ancient civilizations. A scientific interpretation of ancient myths and practices can yield highly beneficial results to modern mankind.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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