Science Content Expert Philip Eagle explores the first plastic surgery operation in Britain.
On 22nd October 1814, Joseph Constantine Carpue (1764-1846) performed the first plastic surgery operation in Britain, reconstructing the nose of an army officer whose nose had collapsed due to long-term mercury treatments for a liver complaint. The operation lasted fifteen minutes, with no anaesthetic. Three days later, the patientâs dressing was removed, and on observing the successful results a friend of the patient exclaimed: âMy God, there is a nose!â
Carpue was inspired to perform the operation after reading reports of successful nasal reconstructions in India, using skin flaps from the cheek or forehead. The most famous of these was a 1794 report in the Gentlemanâs Magazine, describing the reconstruction of the nose of a man named Cowasjee. Cowasjee had been mutilated by the forces of Tipu Sultan during the Third Anglo-Mysore War for working for the British.
Nasal reconstructions had been practised as a relatively routine procedure in India for centuries. This was driven by the common use of nasal mutilation in India as a means of punishment or private vengeance for various forms of immorality. The procedures are described in two well-known early Indian medical works, the SuĹruta SaášhitÄ, thought to date to the middle of the first millennium BCE, and the AášŁášÄáš gahášdayasaášhitÄ, believed to date from the sixth century CE*. By the nineteenth century the technique had been handed down through separate families in three different parts of India.
Rhinoplasty by transfer of skin flaps from other body parts had also been practiced in Italy in the sixteenth century, most famously by the Bolognese surgeon Gaspare Tagliacozzi (1545-1599). However, it had declined following Tagliacozziâs death, due to a mixture of professional politics in Italy, misconceptions about the nature of the procedure, and moral disapproval of an operation that was often performed to repair damage done by syphilis. (Even in his own book, Carpue felt at pains to insist that the mercuric treatment that had damaged his first patientâs nose was not for syphilis.)
Carpue published a book in 1816 on the subject, discussing his predecessors and inspiration and then describing two cases of nasal reconstruction that he had performed. The second was on a named patient, a Captain Latham whose nose had been injured during the Battle of Almuera, in the Peninsular War. Carpueâs work inspired further practice by the German surgeon Carl Ferdinand von GrĂ¤fe, who is credited with coining the term âplastic surgeryâ.
With thanks to Pasquale Manzo (Curator, Sanskrit Collections) for information on British Library holdings of ancient Indian medical texts.
- *The British Library has several manuscript and printed copies of these works, notably including an 1808 manuscript copy of the AášŁášÄáš gahášdayasaášhitÄ presented by Anandrao Gaekwad, Maharaja of Baroda, at IO SAN 2455. Catalogues are available here and here
- Aesthetic Surgery Journal: Available online in British Library Reading Rooms
- âB. L.â. [Untitled letter], Gentlemanâs magazine, October 1794: 891-2. Rare Books and Music RAR 052
- Carpue, JC. An account of two successful operations for restoring a lost nose
- Cock, E. âLead[ing] 'em by the Nose into Publick Shame and Derisionâ: Gaspare Tagliacozzi, Alexander Read and the Lost History of Plastic Surgery, 1600â1800, Social History of Medicine, 2015, 28 (1), 1-21. Available online in British Library Reading Rooms.
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