A letter to the editor published in ‘The Gentleman’s Magazine’ in October 1794 proved to be a watershed moment in the history of plastic surgery and especially in the field of corrective rhinoplasty. The letter, appearing under the heading ‘Curious Chirurgical Operation’, gave a brief account of a nasal reconstruction surgery carried out in Pune (then spelt by the British as Poonah) by a native potter on an Indian bullock cart driver who had suffered nasal mutilation. The letter introduced the ‘Indian method’ of nasal reconstruction using a forehead flap to Europe which quickly caught on in the West.
The letter was accompanied by a full-page portrait of the patient, identified as Cowasjee, after his recovery from the operation. The appearance of the patient indicated a very successful result.
“Cowasjee, a Mahratta of the caste of the 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 Honorable East India Company. For about 12 months he has remained without a nose when he had a new one put on by a man of the brickmaker caste, near Poonah. This operation is not uncommon in India, and has been practised from time immemorial,” wrote the person who identified himself only as ‘BL’. “The artificial nose is secure and looks nearly as well as the natural one; nor is the scar on the forehead very observable after a length of time,” he wrote.
The details of the letter were subsequently published in other newspapers and journals in Europe and USA and led to considerable interest.
The first surgeon to make practical and successful use of this information in England was Dr Joseph Carpue, an anatomy expert and surgeon at a private medical school in London, who performed two successful surgeries in 1814 and published the results. Subsequently, the procedure gained popularity in Europe.
This method of rhinoplasty, which was introduced to the West through Cowasjee’s case, became known as the ‘Indian method’. There were two other known ways of performing nasal reconstructions at the time, namely the Italian and the French.
In the Italian method, the flap of skin was taken from the arm which necessitated that the arm was attached to the face for at least a fortnight. A Venice based surgeon Gasparo Tagliacozzi is said to have performed this operation many times, but after his death in 1599, it fell out of fashion, largely because of the requirement of keeping the hand attached to the face.
In the Italian Method the flap was taken from the arm which had to be attached to the face for at least a fortnight. (Illustration from ‘Rhinoplastic operations : with a description of recent improvements in the Indian method’ by D.F. Keegan, published in 1900)
The French method spared the discomfort of having one’s hand tied to the face by using lateral and facial flaps. But the results of the rhinoplasty weren’t found to be as good as in the Indian method.
Dr D F Keegan, who was a residency surgeon at Indore in the late 19th century and performed scores of nasal reconstructions, opined that the Indian method gave far superior results. “… an experience of rhinoplasty in India, extending over more than twenty years, has nevertheless convinced me 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.”
“A flap taken from the forehead is a much better covering for the nose than one taken either from the arm or the cheek,” wrote Keegan in his book ‘Rhinoplastic Operations: With A Description Of Recent Improvements In The Indian Method’ published in 1900.
Nose – an organ of honour
Nose being an ‘organ of honour’ in South Asia, cutting off a person’s nose was frequently resorted to during ancient and medieval periods as an act of vengeance or shaming. Majority of victims of retributive rhinectomy were women who incurred jealousy of the husbands owing to suspicion of an affair.
Before and after comparision of nasal reconstruction of Choonibai, a resident of village Pahlia near Indore, performed by Dr Keegan in 1892 using ‘Indian method’. Credit: Rhinoplastic Operations by Dr D F Keegan)
Mutilation of body parts was a punishment frequently awarded by the rulers for crimes ranging from theft, arson, adultery, murder, or those against the state. Dacoits were also known to resort to mutilations during ambushes.
Dr Norman Chevers, in his ‘Manual of Medical Jurisprudence in India’ (first published in 1856), links this prevalence of nose cutting – as punishment given by the state or as a result of individual retribution – for having led to local expertise in nasal reconstruction.
How Cowasjee met the potter-surgeon
Lieutenant Colonel Ward, who was the commanding officer of Cowasjee in the 1792 war, conveyed the following additional details to Dr Carpue, upon inquiries, about how the nasal surgery came about in Pune.
“Many months after Cowasjee and others returned to Poonah, one day a native merchant came to the house of Charles Malet offering to sell oilcloth. A cicatrix or scar being observed on the centre of the merchant’s nose, he was asked how he came by it, upon which he showed another scar on his forehead and explained the operation he had undergone. He confessed that he had been deprived of his nose by the executioner as a punishment for adultery, and added that his new one was the work of an artist who lived where he resided and who frequently did the same for others,” Dr Carpue wrote in 1816.
“Upon receiving this account, and immediately thinking of Cowasjee and his fellows, Sir Charles Malet caused the operator to come to Poonah, where he gave new noses to all the five,” he wrote.
Considering that the letter published in ‘The Gentleman’s Magazine’ proved to be a watershed moment for the rhinoplasty surgery in Europe, attempts were made, in the late 1900s, to determine the identities of those involved in the affair. As mentioned earlier, the writer of the letter had identified himself only with his initials: BL.
The ‘BL’ letter sent to The Gentleman’s Magazine and published in its October 1794 edition. Edward Cave edited the magazine under the pen name ‘Sylvanus Urban’ to which the contributors would address their correspondence.
In 1970, surgeons Thomas J S Patterson and Felix Freshwater concluded that the likely author of the letter was an army surgeon Colley Lyon Lucas who had probably performed nasal reconstruction surgeries while in India after observing the local practitioners. This finding was questionable as the initials did not match and that the author of the original letter had mentioned in the opening lines that “a friend had transmitted to me the information from East Indies” thus placing ‘BL’ out of India and thereby removing Lucas as a candidate as he was residing in India during the period.
The mystery continued to intrigue reconstruction surgeons, and in 2009, Phillip J Sykes, Iain Whitaker and others identified a well-known London engraver Barak Longmate as the ‘BL’ who read about Cowasjee’s nasal surgery in the English press from reports and drawings sent by James Wales, the Scottish artist who stayed in Pune for several years. The ‘BL’ letter was published seven months after Wales published the Cowasjee engraving and details of the surgery in newspapers ‘Hircarrah’ and ‘Madras Gazette’ among other publications.
The most important giveaway is the fact that the engraving published along with the letter is signed ‘Longmate’ in the fine print. “Wales’ publication appeared in Bombay seven months before the letter, in time to make the sea journey to London where Barak Longmate, spotting an opportunity, copies the text and, being a skilled engraver, did a new engraving of Cowasjee that is remarkably similar to the Wales version…,” conclude Sykes and his colleagues.
While Cowasjee’s name appears in every telling of the rhinoplastic operation, none of them mentions the name of the potter-surgeon who performed it, except that he stayed at a location about 400 miles from Pune and that he belonged to the potter or bricklayer caste.
A portion of the engraving sent by James Wales, the Scottish artist who stayed in Pune for several years, and was published in Indian english newspapers Hircarrah and Madras Gazette seven months prior to the 'BL' letter in The Gentleman's Magazine. 
In the Italian Method the flap was taken from the arm which had to be attached to the face for at least a fortnight. (Illustration from ‘Rhinoplastic operations : with a description of recent improvements in the Indian method’ by D.F. Keegan, published in 1900)
Before and after comparision of nasal reconstruction of Choonibai, a resident of village Pahlia near Indore, performed by Dr Keegan in 1892 using ‘Indian method’. Credit: Rhinoplastic Operations by Dr D F Keegan)
The ‘BL’ letter sent to The Gentleman’s Magazine and published in its October 1794 edition. Edward Cave edited the magazine under the pen name ‘Sylvanus Urban’ to which the contributors would address their correspondence.
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