A historical episode popular among Indian doctors in general and plastic surgeons in particular, is the story of one Cowasji of Maharashtra, a story which also finds mention in the recent book The Covenant of Water by Abraham Verghese. Cowasji was a peasant (“of the caste of husbandmen”) who worked in the employ of the East India Company. Some time in 1792 he was captured by the soldiers of the Company’s rival Tipu Sultan, and had his nose chopped off. Remarkably, about a year later, he got a surgical procedure done to his face that gave him a new nasal structure using skin from his forehead. A London magazine published a short letter in 1794 furnishing these details, and describing it as a “curious chirurgical operation which has long been practised in India with success”.Despite the existence of just one direct historical source, Cowasji’s story has generated an abundance of contemporary interpretations and claims. Perhaps the most significant claim which is now almost inseparably tethered to this episode is that Cowasji’s operation was derived from, and was part of the larger knowledge-system of, Ayurveda. More specifically, the nose surgery is claimed to be the same as nasal surgical procedures described in the classical Ayurvedic treatise Susruta-samhita. Cowasji thus finds mention in articles with titles like “Sushruta: father of plastic surgery”, “How India invented the nose job”, and “How Tipu Sultan’s 18th-century punishment quietly reshaped beauty standards across Bollywood and Hollywood”. The presumed smooth continuity of the stories of Sushruta and Cowasji – separated by two long millenia – is proclaimed in sentences like “Performed nearly 2500 years after Sushruta wrote his text, the method was essentially unchanged.”These are indeed grand claims, but are they historically grounded? Here, let us remember that while the name of the patient (Cowasji) has become immortalised, we do not know the name of the practitioner who performed the procedure. The 1794 report tells us that he was of the “brickmaker caste”, and later reports (like this 1795 one) use the term “Kooma caste”, which probably is an anglicised version of “kumhar” or “kumbhar” (i.e., potter). I was first alerted to the importance of this aspect of the Cowasji story during a conversation with historian Projit Mukharji, who argued that it was important to pay more attention to this brickmaker-practitioner. In fact, a serious oversight that affects the vast majority of commentaries on Cowasji, and by extension on the history of plastic surgery in India, is that people do not dwell even for a moment on the actual surgeon who successfully “reconstructed” his nose, but instead instantaneously jump to focus on a surgeon (i.e., the writer/s of the Sushruta-samhita) who lived two thousand years ago in a different part of the subcontinent in a completely different medical context.Unfortunately, historical sources are silent on our brickmaker-surgeon, though that silence itself is telling. The invisibilisation of the surgeon despite the hypervisibility of his work and skills is unsurprising given his caste background as a Bahujan (to employ a contemporary term). But if we assume that this surgeon’s knowledge came from the Sushruta-samhita, it is pertinent to ask: how does a brickmaker get access to classical, centuries-old, Sanskrit-language Ayurvedic texts, especially in the 1700s when they existed only in the form of generationally-handed-down manuscripts in mostly Brahman families (and not in the form of more accessible printed books)? To make any claim positing a direct relationship between the procedures described in the Sushruta-samhita and the 1794 nose reconstruction, this quandary about caste-based access needs resolution – but it is shocking that almost all the commentaries have completely ignored it.The plain answer to that question, of course, is no. A brickmaker, or for that matter any Bahujan-caste person, would have been unable – even uninterested – to access and read passages from the Sushruta-samhita in the then social and cultural context of India and of the Peshwai-dominated province where the surgery took place. The possibility of learning through apprenticeship with an Ayurvedic vaidya was equally nil, not just because of entrenched casteist ways of life, but also simply because surgical procedures have never been a part of everyday Ayurvedic practice in South Asia. The popular image of the Ayurvedic vaidya generally emphasised their learnedness, diagnostic acumen and skills like nadi-pariksha (pulse-reading), but not surgical expertise. Vaidyas are not known anywhere in the subcontinent for couching eye cataracts, or cutting for stone, or, well, reconstructing noses. The historical record is clear on this.Decades-long historical work has shown us that the treatises we know as Charaka-samhita and Sushruta-samhita were not the products of single authors, but were instead composed, commented on, and committed to writing (in the form of hand-written manuscripts) by multiple authors over a period of centuries. The earliest versions of Charaka-samhita date to between about 100 BCE and 200 CE, and the earliest surviving physical record of the text, discovered in modern-day China, is seen in the so-called Bower manuscript dated to between 400 and 600 CE. The Sushruta-samhita was composed in the early centuries of the first millennium CE, being complete by 500 CE, while its earliest surviving physical record is in the manuscript named “MS Kathmandu KL 699” in Nepal, dated to 878 CE. In other words, the Sanskrit-language foundational texts of Ayurveda are roughly around 2,000 years old.The knowledge contained in the samhitas, however, goes back a few additional centuries, originating in the late first millennium BCE in the healthcare practices of Adivasi communities, ascetics, mendicants, the new Buddhists and Jains, and of Vedic practitioners who had abandoned orthodox Vedic society. Much of this knowledge was committed to writing in the institutionalised spaces of Buddhist monasteries, and can be accessed in what is known as the Buddhist canon (“Tipitaka” in Pali). The wide range of similarities between medical ideas in the Buddhist canon and in the Sanskrit samhitas, along with evidence of a retrofitted “Hinduisation” of the samhita texts (e.g., through claims of the divine origin and transmission of Ayurvedic knowledge to mortal humans), point to a deep but erased connection between asceticism, early Buddhism, and Ayurveda.This non-Brahmanical origin of many aspects of what we now know as Ayurveda, is a key part of the explanation for why Cowasji’s 1790s nasal reconstruction was done by a Bahujan, non-Ayurvedic practitioner despite the description of a similar procedure in the Sushruta-samhita. While the earliest contributors to the contents of the samhita might have performed many of the surgeries themselves, such bodily procedures were looked down upon in orthodox Vedic society. They became still more marginal in elite imaginations of medicine and healing during and after the Gupta period (c. 320 to 550 CE) when two major developments occurred: caste-based hierarchies and values took on a new, destructive, foundational form for the rest of South Asian history, and the classical Ayurvedic treatises came close to their final compiled form, with Ayurveda simultaneously being appropriated as an orthodox Brahmanical tradition. Additionally, as Dominik Wujastyk’s research shows, the nose surgery passage in the text of Sushruta-samhita itself is “brief and laconic, and certainly not detailed enough to be followed without an oral commentary and practical demonstration”. It is unaccompanied by any anatomical illustration (“there is no tradition of anatomical manuscript illustration in India”).However, there is a lot more to “Indian medicine” than just Ayurveda. Even though mainstream Ayurvedic medical practice discouraged bodily contact and surgical procedures, the South Asian landscape has historically nurtured a number of other knowledge-systems and practices, with Ayurveda both learning from and contributing to these. Vaidyas were only one among the many groups of healers and practitioners in the subcontinent, with the majority of practitioners hailing from the vastly numerous but marginalised “low-caste” or subaltern communities. In fact, when we shift our gaze from the (more limited) history of Ayurveda to include the (more wide-ranging) histories of surgery in South Asia, we open up our minds to the much more expansive and diverse landscape of Indian medicine or South Asian medicine. The famous Cowasji’s unknown “plastic surgeon” was not an elite Ayurvedist, but was nevertheless a skilled practitioner, and belonged to the larger traditions and knowledge-systems of medicine in the subcontinent. Though the name of this brickmaker-surgeon is forever lost to history, he lives on through his knowledge and skills which have been immortalised in the engravings that accompanied the 1794 report.However, with respect to how the Cowasji episode has been memorialised in the mainstream discourse and been tethered to the 2000-year-old Sushruta-samhita, we must finally make our peace with historical realities: that Cowasji’s surgeon was not an Ayurvedic vaidya, and that after at least the Gupta period, the practitioners with expertise in bodily procedures like surgeries and childbirth were mostly from subaltern-caste backgrounds. In other words, we must finally acknowledge the fact that Sushruta, the “father of plastic surgery”, did not leave behind any direct chirurgical offspring.Kiran Kumbhar is a historian, teacher and former physician, currently affiliated with the University of Pennsylvania.In his column ‘Past Forward’, Kumbhar provides us with a rear-view mirror that ensures we drive straight ahead.