To mark South Asian Heritage month, we are exploring the story of Cowasjee – an 18th century Indian man and recipient of nasal reconstruction surgery – whose portrait features in our print collection. The print showcases an important South Asian surgical technique in the history and development of rhinoplasty.

Cowasjee was a bullock driver who worked for the British Army during the Third Anglo-Mysone War. He and four others were imprisoned in 1792 by Tipu Sultan, ruler of the Kingdom of Mysore (1782-1799), under whose order they were forced to undergo amputations as punishment for working for the British. Cowasjee had his nose and one of his hands amputated. Rather remarkably, however, after twelve months of living without a nose, Cowasjee and the four other men with whom he was imprisoned, had their noses restored through a surgical procedure that involved crafting a new nose out of a flap of skin from the patient’s forehead.

The details of Cowasjee’s nasal surgery were first published in 1794 in The Madras Gazette and later in the Gentleman’s Magazine, through the medium of a letter, which aimed to introduce readers to a surgery unlike anything seen in Europe up to that point. The process of restoring Cowasjee’s nose was detailed by the writer as follows:

A thin plate of wax is fitted to the stump of the nose, so as to make a nose of a good appearance; it is then flattened and laid on the forehead; A line is drawn round 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 next pared off, and immediately behind this raw part an incision is made thro’ the skin which passes around both alae and goes along the upper lip. The skin is now brought down from the forehead, and being twisted half round, its edge is inserted into this incision, so that a nose is formed with a double hold above and with its alae and Septum below fixed in the incision.

Claims that a surgery of this kind had never been performed in Europe were later contested, as a similar operation, known as the Italian method, was noted by Alexander Benedictus in a 1497 work published in Vienna. Evidence also suggests that such a surgery had been performed over 50 years prior to this publication by a Sicilian surgeon. Nevertheless, rather than using skin from the forehead, the so-called Italian method used skin from the arm, requiring the patient’s arm to be strapped to their head throughout the healing process.

The so-called ‘Indian Method’ of rhinoplasty, which was performed on Cowasjee, has a long history which spans back millennia, though its first known documentation can be found in the Susruta Saṃhita, an ancient Sanskrit medical treatise that details surgical training and procedures, and acts as one of the foundational texts for traditional Ayurvedic medicine. The Susruta Saṃhita details a version of nasal reconstruction surgery that sources the flap of skin from the cheek as opposed to the forehead but is most likely the source of the procedure performed on Cowasjee. Likewise, the document advocates for the use of dissection as a method of learning about human anatomy and contains a great deal of knowledge about anatomy, joints, bones, muscles, and blood vessels. As demonstrated in the following passage, which describes how a surgeon might aim to restore a torn earlobe, particular attention is paid to the importance of ‘living flesh’ and continued blood supply in the process of reconstructing parts of the body:

[…] Then the part, where the artificial ear lobe is to be made, should be slightly scarified [with a knife] and the living flesh, full of blood and sliced off as previously directed, should be adhered to it [so as to resemble a natural ear lobe in shape].

Unlike in Europe, where nasal reconstructions were most commonly required in cases of tertiary syphilis or leprosy, in India such surgeries were used and mastered due to the frequent use of nose amputation as a form of criminal punishment. Such means of punishment date back to at least the time when the Susruta Saṃhita was written, and it is likely that its proposed methods of restoring the nose were passed down through generations of families. Whilst the identity of the surgeon who operated on Cowasjee is unknown – the letter deriving its information from English witnesses of the surgery, rather than from the individual who performed the procedure – it is mentioned in the letter that they were a ‘Kumhar’ – a person from the caste or community historically associated with pottery – from Maratha.

Unfortunately, information about Cowasjee’s surgeon and how he was able to master the skill of nasal reconstruction are almost entirely missing from the historical record. Instead, further records of Cowasjee’s case prioritise telling the story from the perspective of Sir Charles Malet, who learnt of and sent for the surgeon to help Cowasjee and the four others who had undergone amputations. Though the publication of Cowasjee’s story is clearly interested in informing readers of the innovation and success of such operations in India, it is important to recognise that it also contains another agenda, aiming to convince readers that British East India Company took good care of their employees, covering the costs of the operation and providing a pension for Cowasjee, whilst simultaneously working to further damage and barbarise the image of Tipu Sultan.

The under appreciation of the role of Indian surgeons in the development of rhinoplasty continues to this day. When searching online for the history of rhinoplasty you are quickly presented with information about Joe Orlando Roe, American otolaryngologist, naming him the ‘Father of Aesthetic Rhinoplasty’. Likewise, Dr Harold Gillies, is recognised as the pioneer of the pedicle flap graft in reconstructive surgery, thanks to the reconstructive surgeries he performed on men injured during World War 1. Meanwhile, historic examples like those described in the Susruta Saṃhita, and later performed on Cowasjee are too often glossed over, condensed, and categorized as ‘early’ or ‘primitive’ versions of the surgery, Cowasjee’s surgeon remaining unnamed and thus uncelebrated. Though approaches to restoring and altering noses have changed considerably since Cowasjee’s operation, it is important to acknowledge the importance of this long held Indian surgical practice, not only because of its role and significance in the canon of reconstructive surgery, but also due to the immense impact it would have had on the lives of Cowasjee and thousands of others.

Lauren Medway, UCL Museum Studies MA student

Sources:

Loukas, M, et al. (2010) Anatomy in ancient India: a focus on the Susruta Samhita (Accessed 16 July 2024)

Mukherjee, Nayana Sharma, et al. (2011) A Nose Lost and Honour Regained: The Indian Method of Rhinoplasty Revisited  (Accessed 16 July 2024)

Raman C. Mahabir. Ancient Indian Civilisation: Ahead by a Nose (Accessed 16 July 2024)

Royal College of Physician Catalogue. PR15585a: ‘A singular operation: Cowasjee’ (Accessed 16 July 2024)

Royal College of Physicians Catalogue. PR5011, ‘Cowasjee, A Singular Operation’ (Accessed 16 July 2024)