A NOSE LOST AND HONOUR REGAINED: THE INDIAN METHOD OF RHINOPLASTY

REVISITED
Author(s): Nayana Sharma Mukherjee, Susmita Basu Majudar and Susmita Basu Majumdar
Source: Proceedings of the Indian History Congress , 2011, Vol. 72, PART-I (2011), pp.
968-977
Published by: Indian History Congress
Stable URL: http://www.jstor.com/stable/44146788

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 A NOSE LOST AND HONOUR REGAINED:
THE INDIAN METHOD OF RHINOPLASTY
REVISITED
Nayana Sharma Mukherjee & Susmita Basu Majudar

Our study begins with a news report that appeared in the 1790 's and
created much impact in the medical circles of India and Europe. During
the Anglo-Mysore war of 1 792, Cowasjee, a Parsi bullock (cart) driver
of the English Army was taken prisoner by Tipu Sultan, and suffered
amputation of his nose and one of his hands. Thereafter, Cowasjee
rejoined the army and became a pensioner of the East India Company.
For a year he remained without a nose until he was given a new one by
a Maratha potter. This remarkable operation was witnessed by two
English physicians, Thomas Cruso and James Findlay, of the Bombay
Presidency.
It is usually stated that the news of this unusual procedure was
first reported in the Hircarrah or The Madras Gazette of 4th August,
1794.1 On 20th March, 1794, there appeared in Bombay a copper-plate
of one folio sheet with the portrait of the patient. James Wales had
painted a portrait of Cowasjee in January of that year, ten months after
the surgery, and an engraving of that portrait by R. Mabon was published
in March. This was followed by the publication of a much celebrated
letter in London in The Gentleman 's Magazine for October, 1794 (See
Appendix B).2 Written by a certain 'B.L.', this letter was intended to
bring to the knowledge of the Europeans, of what the author believed
unknown in Europe, "very curious .... chirugical operation which has
long been practised in India with success: namely affixing a new nose
on a man's face".3 It was accompanied by a full-page plate with the
portrait of the patient after his recovery along with other figures
illustrating the procedure and describing it as 'A Singular Operation'.4
Mr. Colley Lyon Lucas was the chief surgeon and member of the
Medical Board of Madras, to whom some scholars have attributed the
B.L. letter in The Gentleman 's Magazine this view is no longer tenable
for it has now been established thąj B.L. are the initials of Barak
Longmate.5 The letter says that, "Mr. Urban, A friend has transmitted
to me from the East Indies, the following very curious, and in Europe
I believe unknown, cirurgical operation which has long been practiced
in India with success: namely affixing a new nose on a man's face. The
person presented in plate I is now in Bombay....". It is clear from this
letter that B.L. had not travelled to India and it was one of his

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 Modem India 969

acquaintances from India who had co

Keegan mentions that Cowasjee's portr
Magazine was engraved by Longmate
not known. Since this is the first pub
west, the question which arises here i
procure it?
It is interesting to note that a portrait of Cowasjee engraved by one
of the three assistants of Wales named Robert Mabon on 20 March,
1794 exists in the library of the Herzogliches Collegium Anatomico-
Chirurgicum at Brunswick. This copper plate portrait of Cowasjee has
a nearly, though not quite identical English account of the case.6
The B.L. letter no doubt aroused much interest in the subject for in
the following issue of the same magazine, we find a letter by a person
named T.J., who pointed out to the editor that correspondent B.L. was
mistaken in his understanding that such an operation was unknown in
Europe. Taliacotius, surgeon to the Grand Duke of Tuscany, had written
a treatise in 1687, entitled De Curtis Membris, the part IV of which
described the reconstruction of nose, ears and lips.7 The Bombay
Courier, in an article, entitled, 'Account of the method of Supplying
Artificial Noses; as practised by the Natives of the Malabar Coast', 4th
April, 1795, commented that the Indian method was far superior to
any other method in the world.8
Cowasjee's case is significant in more ways than one. It led to the
discovery by the West of a particular procedure of nasal reconstruction
that gave India her position in the annals of plastic surgery especially
in the field of rhinoplasty, and which is still known as 'The Indian
method'. In Cowasjee's case, however, the pedicle flap of skin was
taken from the forehead, twisted and brought down to reconstruct the
nose and the skin flap was inserted on both sides of the nostrils to give
it proper shape. The uniqueness of the operation made the surgeons in
Europe to name it the 'Indian Method'. Indian surgery had never
attracted the attention of European surgeons but this was the first case
which aroused their interest in acquiring more knowledge about this
method of plastic surgery.
Restoration of a disfigured nose was also known in Europe, of which
one method involved a flap of skin taken from the arm. This operation
of Italian origin is first noticed in an anatomical work by Alexander
Benedictus published in Vienna in 1497; but there is historical evidence
that an operation of this kind was performed more than fifty years before
that date by a Sicilian surgeon named Branca or Brancas. But the most
famous practitioner of the Italian method was Gasparo Tagliacozzi or
Tagliacotti of Bologna. Since the flap of skin is raised from the upper

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970 I HC: Proceedings , 72nd Session, 2011

arm, it is necessary to keep the arm in contact with the fact for about a
fortnight, and hence the palm of the hand is placed on the top of the
head.

A second procedure of rhinoplasty of French origin was also

known.9 Initially, however, an observer like Thomas Pennant, firm in
his belief that surgery is totally unknown among the Hindoos,
commented that the Poonah artist had revived the Taliacotian art.10 As
opposed to this comment is the view of the Bombay Courier : "It is to
be much lamented that the Europeans, whose talents have been devoted
to the literature of India, have applied themselves rather to the
speculative than to the practical parts of their knowledge; and that their
discoveries, however meritorious, have been more curious than useful."
In fact two kinds of surgical procedures are praised as being remarkable
- the depression of the chrystalline lens when it becomes opaque and
the second nasal reconstruction.11

A study of the details of Cowasjee's case which has more than one
version raises certain questions. Lt. Col. Ward was the commanding
officer of Cowasjee at the time when the latter was carrying provisions
for the British army during the Anglo-Mysore war of 1 792. On the way
to Seringapatam, Cowasjee was taken prisoner with four other native
soldiers by the Sultans' army, who cut off the hands and noses of all
the five and then had them sent back to the English, with leaves bound
over the stumps of their arms to stop the bleeding and with their
mutilated noses. They returned to Poona where they received initial
medical aid and were granted pensions later.
It is again worth mentioning that Cowasjee's name occurs in every
document mentioning the case of rhinoplastic operation but none of
them ever mentions the name of the surgeon who performed it. Not
much is known save that a potter ( kumhar ) or a person of the brickmaker
caste, and that the operation took place near Poona. Probably his name
is omitted because of his oriental origin and above that he was not a
professional medical practitioner, which completely overshadowed his
skill. Though Pennant describes him as 'the great restorer of Hindostán
noses', he also mentions that surgery is totally unknown among the
Hindoos.12

Dr. J.C. Carpue, the British surgeon who first carried out nasal
reconstruction by the Indian Method in London in 1816 had made
extensive inquiry about Cowasjee's case from Lt.-Col. Ward of the
India Service, who besides being the commanding officer of Cowasjee
was also a witness to his rhinoplastic operation.13 Ward mfprmed him
that after a couple of months from the incident of loss of nose by
Cowasjee and his associates, a native merchant selling oilcloth came

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 Modem India 97 1

to the house of Sir Charles Warre Male

at Poona in the court of Peshwa. The merchant's residence was some
four hundred miles from Poona. A cicatrix or scar was observed on the
centre of the merchatn's nose, and when he was asked about it, he
showed another scar on the forehead and explained the operation he
had undergone. He confessed that he had been deprived of his nose as
a punishment for adultery, and was operated upon by an artist who
lived where he resided and who frequently did the same for others.
After hearing this account, and immediately thinking of Cowasjee and
the four sufferers, Sir Charles Malet caused the operator to come to
Poona, where he gave new noses to all the five. It was understood at
Poona that this operator was the only one in India who could restore
noses and the art had been hereditary in his family.
Carpue in course of his inquires also learned from Sir Charles
Mallet that this had been a common operation in India, from time
immemorial; and, that it had always been performed by the caste of
brickmakers, and, that though not invariably, it was usually successful.
We have from Carpue names of other gentlemen who had resided in
India and had witnessed such procedure among which are Mr. James
Stuart Hall, and Dr. Barry, of the India Service. The latter informed
that it took an hour and a half, and was performed with an old razor,
the edge of which, being continually blunted in dissection, was every
moment re-set. Interestingly, according to Major Heitland, of the India
service, in the time of Hyder Ali, Mr. Lucas, an English surgeon in
India, was in several instances, successful in the operation, which he
copied from the Hindoo practitioners.14 The question which also arises
is that if Dr. Lucas performed the rhinoplastic operations successfully
before Dr. Carpue using the Indian method successfully, why were they
not brought to light or publicised in Europe?
Cowasjee was not the only person to get his nose restored there
were four more, but again curiously their names never were mentioned
in any of the reports. Cowasjee, therefore, must have been particularly
important to the Company, and was probably not just a bullock-driver
as given in the accounts he may have been the one in charge of supplying
provisions to the British army. Secondly, he is the only one whose
portrait was painted by James Wales the renowned British painter whom
Charles Warre Malet had appointed as official artist.
The text along with Cowasjee's portrait (See Appendix A) shows
that the intention of the officer was not to highlight the achievement of
the native surgeon, they were to some extent surprised to find a surgical
procedure not common in Europe and further it was to malign their
enemy Tipu. Arrangement for fixing of new noses for the five native

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972 IHC: Proceedings, 72nd Session , 2011

soldiers at official expense accompanied by documentation of the

process could probably imply two conclusions besides the obvious one
i.e. reporting a curious surgical case: one, to highlight the barbarity of
native rulers of which the natives themselves were victims and as also
the British soldiers, and second, the officials were keen to impress
upon the fact that native soldiers were well treated by the Company
and were not neglected if they happened to be grievously wounded in
war. It is reported that Hyder Ali and Tipu Sultan were in the habit of
cutting off the noses and ears of their English prisoners who were caught
attempting to escape. Before Mangalore, Tipu mutilated in this manner
an entire sepoy brigade who attempted to prevent an execution.15
As rightly pointed out by B.L.'s letter in The Gentlemen 's Magazine
and the engraved description in the copper plate print of Cowasjee
kept in the British Museum,16 formation of new noses is not an operation
uncommon in India, rather it has been practised from time immemorial.
The earliest reference to a rhinoplastic operation is that given in the
Susruta Samhita. The surgical procedure is similar to described in
Cowasjee's case though with an important difference: that being the
pedicle flap according to our classical ancient text was taken from the
cheek17 while the Maratha surgeon dissected it from the forehead.
According to Susruta, a leaf is taken and cut to fit the nose, and a skin
flap of the same shape and dimension is then raised from the cheek
and the nose is rebuilt maintaining the continuity of the skin. In
Cowasjee's procedure, the surgeon first made a thin plate of wax to fit
the stump of the nose, which was flattened and laid on the forehead. A
line was drawn around it, and the necessary amount of skin of the same
shape was taken there from.18 Niccolo Manucci describes a case of
Indian rhinoplasty in about 1686, in Bijapur where again the surgeons
cut the skin of the forehead above the eyebrows and brought it down
over the disfigured nose.19

II

Cutting off the nose was a common punishment for various kinds of
crime throughout India, indulgence in adultery and sexual offences.
Our ancient literature is replete with such instances of cutting off noses
as a punitive measure. Manu states the ten places of the body where
punishment should be inflicted in the case of non-brahmanas: the
reproductive organ, the belly, the tongue, the hands, the legs, the eye,
the nose, the ears, property or wealth and the whole body.20 Mutilation
of the nose was also given as punishment for other crimes. Nawab Mir
Kasim had an intriguer's nose severed, while among the Doonjas of
Gujarat, many women had to suffer this punishment for the practice of

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 Modem India 973

witchraft.21 Mutilation was often

practised by the Makrani outlaws of
Existence of such surgeons in Indi
When Akbar besieged this hill state, h
things: manufacture of new noses, t
basmati rice and a strong fort. Vigne r
who restored noses of those crimina
mutilation. He was given a jagir i
Alexander Cunningham visited Kangr
"... the repair of noses still goes on,
the close of Sikh rule, when ampu
practice. But people still come from
Noses lost by disease defy restoratio
have been cured".24 Here the patient
to make him senseless. The skin of t
arises from which a piece of skin is d
This art was handed down for generatio
families in Kangra who are skilled in
member, Hakim Dinnath performed it
to the caste of potters.26

Ill

The technique of reconstruction of nose using the forehead flap as

practiced in India had its impact on the west and surgeons performed
this surgery in Europe and recognised this method as the 'Indian
method'. It was the publication of Cowasjee's case that inspired J.C.
Carpue to study the detailed procedure and carry out two successful
operations in 1814€ Subsequently, through the publication of these
operations by Carpue in 1816, the Indian technique gained popularity
in Europe, and by 1897, 152 such procedures had been performed
there.27

The 'Indian Method' was transmitted from one generation to the

other as a family skill and kept as a secret but it is doubtful if these
practitioners of rhinoplasty were aware of the medico-surgical treatise
that described the methods in detail like the Susruta Samhita. Since
the mention of the forehead flap method does not occur in any treatise,
the development of rhinoplastic surgery from cheek flap to forehead
flap cannot be traced. A renowned practitioner of this surgical procedure
in the late 19th century was Tribhovandas Motichand Shah, Chief
Medical Officer of Junagadh. He published a book titled Rhinoplasty
in 1889, in which he is stated to have carried out 100 cases in four

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974 IHC : Proceedings , 72nd Session, 2011

years, many of his sufferers being victim of the depredations of a

notorious dacoit Kadu (Kalu). Interestingly, in the first 10-11 cases he
used cheek flaps (as mentioned in the Susruta Samhita), but the results
not being satisfactory, he decided to use forehead flaps.28 He acquired
such a reputation that according to a proverb prevalent in the local
dialect, it was said, "Kadu cuts off noses and Tribhovan remakes them",
implying a problem that can be resolved. Songs were composed to
celebrate his remarkable skill.29

Dr D. F. Keegan acquired an experience of rhinoplasty in India of

more than 20 years in which he conducted 50-60 surgeries in which he
used the 'Indian method' with some modification. Many of his patients
were women, almost invariably of the lower castes. In most cases owing
to some domestic quarrel, they were often punished by their jealous
husbands by such mutilations. He further mentions that among the purda
nashin women such cases were rare; however, very few of them
consulted male physicians.30 His experience convinced him that "....
the Indian operation ... always affords a good prospect of success, and
that a nose restored in this way is far superior to any artificial
substitute."31 Keegan also points out that in Indian cases patients were
young and robust who had lost healthy noses unlike in Europe, where
surgeons had to repair noses of patients which had become disfigured
owing to some ailment.

IV

The nose being the 'organ of reputation', the victims had to suffer much
ridicule and social contempt. As the proverb rightly says 'Necessity is
the mother of all inventions' the cut noses and the intense desire and
necessity to regain social prestige by repairing of their noses by victims
made them approach the then practitioners of surgery, who developed
this art of rhinoplasty. The interest of the European surgeons in the
Indian method was due to the fact that it was a time tested surgery with
best results that left a minimal scar on the patient's face and secondly,
though there were almost no such cases of mutilation in Europe in the
form of punishment, yet the need for restorative surgery often arose
for those patients who suffered nasal disfigurement due to diseases
like tertiary syphilis and lupus. Cowasjee's case was not the only one;
yet his name remains in the annals of plastic surgery because of his
portrait illustrating the procedure of surgery and an account of the case
became available in the west. The art of rhinoplasty was already known
in the European medical world but had fallen out of use and this
technique, as has been discussed above, was completely different from
the 'Indian Method'. The forehead flap reconstruction had thus brought

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 Modem India 975

a major change in the field of rhinop

the 'Indian Method'.

Appendix A
Reproduced here is account appearing in the Madras Gazette of 1793
COWASJEE: A Mahratta of the caste of Husbandman. He was a bullock
driver with the English Army in the War of 1792; and was made a
prisoner by Tippoo, who cut off his nose and one of his hands. In this
state he joined the Bombay Army near Seringapatam, and is now a
pensioner of the H.E.I. Company. For above twelve months he remained
without a nose, when he had a new one put on by a Mahratta Surgeon,
a Kumar near Poona. This operation is not uncommon in India and has
been practised for time immemorial. Two of the Medical Gentlemen,
Mr. Tho. Cruso and Mr. James Findlay, of the Bombay Presidency,
have seen it performed as follows. A thin plate is fitted to the stump of
the nose, so as to make a nose of good appearance; then it is flattened
and laid on the forehead. A line is drawn around the wax, which is then
of no further use. And the operator then dissects off as much skin as it
covered, leaving undivided a small slip between the eyes. This slip
preserves the circulation till an union has taken place between the new
and old parts. The Cicatrice of the stump of the nose is not pared off,
and immediately behind this raw parted through the skin which passes
round both land goes along the upper lip. The skin is now brought
down from the forehead, and, being twisted half round, its edge is
inserted into the incision. A little Terra Japónica is softened with water,
and being spread on slips of cloth, five or six of these are placed over
each other to secure the joining. No other dressing but this cement is
used for four days; it is then removed, and the cloths dipped in Ghee (a
kind of butter) are applied. The connecting slip of skin is divided about
the 25th days, when a little more dissection is necessary to improve the
appearance of the nose. For five or six days after the operation the
Patient is made to lie on his back; and on the 10th day bits of soft cloth
are put into the nostrils to keep them sufficiently open. This operation
is always successful. The artificial nose is secure, and looks nearly as
well as the natural one; nor is the scar visible on the forehead very
observable after a length of time.

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976 IHC: Proceedings , 72nd Session, 2011

Appendix B
Reproduction of B.L.'s letter which appeared in The Gentleman's
Magazine in October, 1794.
Mr Urban,
October 9

A friend has transmitted to me, from the East Indies, the following
very curious, and in Europe I believe unknown, chirurgical operation
which has long been practised in India with success: namely affixing a
new nose on a man's face. The person presented in Plate I is now in
Bombay.
Cowasjee, a Mahratta of the cast of husbandman, was a bullock
driver with the English Army in the War of 1792; and was made a
prisoner by Tippoo, who cut off his nose and one of his hands. In this
state he joined the Bombay Army near Seringapatam, and is now a
pensioner of the H.E.I. Company. For above twelve months he remained
without a nose, when he had a new one put on by a man of the
brickmaker cast, near Poona. This operation is not uncommon in India
and has been practised for time immemorial. Two of the medical
gentlemen, Mr. Thomas Cruso and Mr. James Findlay, of the Bombay
Presidency, have seen it performed as follows. A thin plate of wax is
fitted to the stump of the nose, so as to make a nose of good appearance;
then it is flatted and laid on the forehead. A line is drawn around the
wax, which is then of no further use. And the operator then dissects off
as much skin as it covered, leaving undivided a small slip between the
eyes. This slip preserves the circulation till an union has taken place
between the new and old parts. The Cicatrice of the stump of the nose
is not pared off, and immediately behind this raw parted through the
skin which passed round both land goes along the upper lip. The skin
is now brought down from the forehead, and, being twisted half round,
its edge is inserted into the incision. A little Terra Japónica is softened
with water, and being spread on slips of cloth, five or six of these are
placed over each other to secure the joining. No other dressing but this
cement is used for four days; it is then removed, and the cloths dipped
in Ghee (a kind of butter) are applied. The connecting slip of skin is
divided about the 25th day, when a little more dissection is necessary to
improve the appearance of the nose. For five or six days after the
operation the Patient is made to lie on his back; and on the 10th day bits
of soft cloth are put into the nostrils to keep them sufficiently open.
This operation is always successful. The artificial nose is secure, and
looks nearly as well as the natural one; nor is the scar visible on the
forehead very observable after a length of time.
B.L.

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 Modem India 977

NOTES AND REFERENCES

1. Thomas Pennant, ' View of Hindoostan', London, 1798, Vol.11, p. 237.

mentions that the news was reported in the Hircarrah or The Madras
here 'or' may have been used in the sense of 'and', as these were two d
newspapers and the report might have been published in both.
2. Paolo Santoni-Rugiu and Philip J. Sykes, "A History of Plastic Surgery'
Heidelberg, 2007, p. 199.
3. D.F. Keegan, 4 Rhinoplastic Operations with a description of Recent Improvements
in the Indian Method London, 1900, p. 15.
4. Ibid., p. 67.
5. John Symons, 'A Most Hideous Object: John Davies (1786-1862) and Plastic
Surgery', in Medical History , 2001, 45, pp. 395-402.
6. Ibid., p. 68.
7. The Gentleman's Magazine and Historical Chronicle , Vol.76, Part II, London,
p. 1093.
8. John R. Coxe, (ed.), Philadelphia Medical Museum, vol.11, Philadelphia, 1806,
p. 344.
9. Keegan, op. cit., pp. 11-14.
10. Pennant, op. cit., pp. 236-7.
1 1 . John R. Coxe, (ed.), op. cit., pp. 342-344.
12. Pennant, op. cit., p. 237.
13. Keegan, op. cit., p. 69.
14. Ibid.

15. Norman Chevers, Medical Jurisprudence in India , Calcutta, third edition, 1870
p. 488.
16. Keegan, op. cit., p. 67.
17. G.D. Singhal, S.N. Tripathi, G.N. Chaturvedi, (ed.), Ancient Indian Surgery , vol.1,
Delhi, reprint, 2007, 16:27-31.
18. Keegan, op. cit., p. 67.
19. S. Saraf, 'Sushruta: Rhinoplasty in 600 B.C.' The Internet Journal of Plastic
Surgery , 2007, Vol.3, no. 2 @ http://www.ispub.com/journal/the-internet-iournal-
of-plastic-surgerv/volume-3-number-2/sushruta-rhinoplastv-in-600b-c.html.
20. G. Buhler, The Laws of Manu, Delhi, 1988, VIII, 124-125.
21. Chevers, op cit., p. 488.
22. Keegan, op. cit., p. 18.
23. John Hutchison, and Jean Philippe Vogel, History of the Panjab Hill States , vol.1,
New Delhi, Reprint 1994, p. 148.
24. Ibid., p. 149.
25. Ibid.

26. Subodh Kapoor, (ed.), Indian Encyclopaedia , vol.1, New Delhi, 2002, p. 5697
27. S. Saraf , op. cit.
28. Keegan, op. cit., pp. 14-15.
29. Paolo Santoni-Rugiu, Philip J Sykes, op. cit., p. 209, fn.66.
30. Keegan, op. cit., pp.v-vi.
31. Ibid., p.10.

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