A Singular Operation
In October 1794 London’s “The Gentleman’s Magazine”, published a letter from the anonymous “B.L.” detailing a remarkable surgical procedure.
Accompanied by a now iconic engraving and annotated diagram, it told of a surgical procedure, unknown in Europe but practised “from time immemorial” in India (or the East Indies as they were then known). A bullock driver with a Parsi name Cowasjee, but from the Mahratta peoples of central and Western India, had been working for the British during the third Anglo-Mysore war of 1792. Subsequently taken prisoner by Tippu Sultan’s army, they deliberately amputated his nose and one hand, a then common local punishment for both judicial and social transgressions.
The letter reported that after 12 months without one, a new nose had been surgically fashioned by one of the “brickmaking caste" (or possibly potters), from Mahratta named “Kumar”, a family skilled in this procedure. B.L. names two Anglo-Indian Army Surgeons based in Pune, Thomas Cruso, and James Findlay (whom he misspells “Trindlay”) as having personally witnessed the procedure. He goes on to describe the process of using a wax template to plan a pedicled flap of skin, then raised from its forehead donor site and fixed into the freshened raw margins of the old nose.
However, it was James Wales, from Aberdeen, then artist in residence in modern Pune who had actually produced a drawing of Cowasjee, before publishing his own, original account of the procedure in a Bombay journal of March 20th 1794. “B.L” it seems, has simply taken from much of that account. Wales then authroed the single page article “A Singular Operation”, published in the January 1795 edition of “The Gentleman’s Magazine”. This time it showcased an engraving of his own painting by renowned engraver William Nutter. A second version of this article and now iconic image of the alleged 10 month-post-operative result, then appeared with the same date in London, but including legends alongside the smaller drawings.
Indian surgeons had been reconstructing noses in this manner using flaps of tissue taken from the forehead and inner cheek for many centuries. They may also have used free skin grafts from this latter donor site. Similar procedures are described in the Susrutha Samhita, dating to at least 500 BCE, probably much earlier.
This operation would be very familiar to modern plastic surgeons, a refined version still being in widespread use today and considered the best
way to deal with a substantial loss of nasal skin. However, without a skeletal support of bone or cartilage, and lining of the nasal passages, it is unlikely that Wales assertion that “This operation is always successful” is true. Harold Gillies later re-learned this lesson during the First World war and discovered that another Indian Army Surgeon- Keegan, had already devised a solution.
The Gentleman’s Magazine publications caused a stir in London and were eventually picked up by one Joseph Constantine Carpue (1764-1846), Staff Surgeon to the Duke of York Hospital in Chelsea. Carpue went on to perform the procedure himself, at least twice. He published his work in “An account of two successful operations for restoring a lost nose” (1816). In it he acknowledged an account passed to him by a Major Heitland of the Indian service, of a Mr Lucas, possibly Colly Lyon Lucas, an Anglo-Indian military surgeon from Madras (now Chennai). Lucas may have performed the procedure himself several times between 1794 and 1797. Lucas’s service record puts him in the same conflict, at the same time as Cowasjee. However, it is said that Cowasjee’s reconstruction was delayed by twelve months.
We are left with the probability that Lucas was “B.L.” of the original magazine letter. He may have seen an August 1794 Madras Gazette account of the March 1794 Bombay report by Wales, and written to “The Gentleman’s Magazine” to claim the procedure himself. Some authors have claimed that Lucas actually performed Cowasjee’s procedure. However, Lucas had likely returned to Madras by the time it was performed, and no-where is he, and not one of the “Kumar” dynasty mentioned as the surgeon responsible.
Images courtesy of the Wellcome Collection, under Creative Commons