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Biographical entry Carpue, Joseph Constantine (1764 - 1846)

Member of the Corporation of Surgeons Feb 1st 1798; FRCS Dec 11th 1843; one of the original 300 Fellows; FRS Feb 13th 1817.

Born
4 May 1764
Brook Green, UK
Died
30 January 1846
Occupation
General surgeon

Details

Born on May 4th, 1764, at Brook Green, the son of a gentleman of small fortune descended from a Spanish family. As a Roman Catholic he was educated at the Jesuits' College, Douai, being at first intended for the Church. At the age of 18, before the Revolution, he travelled about France on foot, saw Louis XVI and Marie Antoinette at the dinner table with Philip Egalité, Duke of Orleans, waiting on them. Later, in Paris, he listened to the declamations of Danton, Marat, and Robespierre. This was the beginning of what he continued through life, journeying on foot through Wales and the Highlands of Scotland with Sharon Turner the historian, also through Holland, Italy, Germany, and even, in 1843, the Tyrol.

After the Church Carpue next thought about becoming a bookseller in succession to an uncle Lewis in Great Russell Street; then his admiration for Shakespeare turned his thoughts towards the stage, and up to the time of his death he continued to advocate the erection of a colossal iron statue of Shakespeare at the mouth of the Thames. Finally, fixing on surgery, he studied at St George's Hospital under Keate and George Pearson. On qualifying as a surgeon he was appointed Staff Surgeon to the Duke of York's Hospital, Chelsea, in 1799, and, through Pearson, became an ardent vaccinator. The former post he resigned Oct 1st, 1807, because he declined to go on foreign service, but he continued Surgeon to the National Vaccine Institution until his death. At the Duke of York's Hospital he held classes in anatomy with a fee of 20 guineas for the course, and had for years an overflowing attendance. He delivered three courses of daily lectures during the year without intermission except for a few days in summer. He also gave lectures on surgery twice a week in the evening.

A strange occurrence happened in 1800. West, President of the Royal Academy, Sir Joseph Banks, and Cosway, agreeing that the classical representation of the Crucifixion was unsatisfactory, called upon Carpue. A murderer was about to be executed. Keate, Master of the College of Surgeons, gave permission. A structure was erected, including a cross, near the place of execution. The executed murderer, whilst still warm, was nailed on the cross, the cross suspended, and after the body had fallen into position, a cast was taken under the direction of Banks. The cast was removed to Carpue's anatomy theatre, and in 1843 was still in existence in the studio of Behnes.

In connection with his anatomy teaching Carpue published a Description of the Muscles of the Human Body. He took up medical electricity, had a fine plate machine in his dining-room and made many experimental researches, including that on himself for the relief of lumbago, by passing the current through his loins. He published a book on the subject in 1803.

On the occasion of the illness of Princess Amelia, at Worthing, Carpue was introduced to the Prince Regent, who talked with him on medical subjects, as he did later when king. Hence, when Carpue published his Account of Two Successful Operations for Restoring a Lost Nose, in December, 1815, he dedicated it to the Prince Regent. Carpue began with an historical account of the Tagliacotian operation by tracing the first description of the operation to the Sicilian surgeon Branca in 1442. Tagliacozzi (1546-1599) first noted his operation in his Epistola ad Hieronymum Mercurialem de Naribus multo ante abscissis reficiendis, 1587. He described it more fully in De Curtorum Chirurgia per Insitionem, libri duo, 1597, which included the well-known engraving of an arm attached to the nose by a flap of skin. Outside Italy the only reported case subsequently had been that by Griffon, of Lausanne, in 1590, mentioned by Fabricius Hildanus. The operation had been popularly confused with transplantation of skin, particularly from the buttock of a donor. Butler, in the 1st canto of his Hudibras, had mixed up this transplantation of skin with the superstition about sympathy. The nose restored from the donor's buttock, Butler's 'parent breech', was said to disappear on the death of Nock, the donor, the portion of the donor's spirit, or numen, having to rejoin that of its parent breech, alias Nock-
"When the date of Nock was out,
Off dropped the sympathetic snout."

What had occurred in several instances was healing by first intention when a cut-off nose had been sutured into place at once. Carpue entered upon a long disquisition concerning healing by first intention, and mentioned more or less veracious instances. Yet owing to cold or other causes, a restored nose might shrivel up or slough off. Carpue's attention had been attracted to the description of the Indian method in the Gentleman's Magazine, 1794, given by two English surgeons, Thomas Cruso and James Findlay. It was also described in Pennant's View of Hindoostan, 1798, ii, 237, as a procedure practised from time immemorial by the caste of the Koomas - potters and brickmakers.

His first case was that of an officer the tip of whose nose had sloughed in 1809, not so much the result of syphilis as from the excessive administrations of mercury for hepatitis. There are four plates in illustration of the operation and result. The second case was that of an officer the tip of whose nose had been cut off at the Battle of Albuera, in 1810; Plate V illustrates the deformity and the result of the operation. In both instances an exceedingly good result was obtained considering the surgery of the time.

In 1819 Carpue published a History of Suprapubic Lithotomy, giving a history of other methods, without adding anything from his own experience, but the book is a useful compendium. Carpue saw the operation performed in Paris by Soubervielle. Franco had pushed up the calculus in a boy's bladder; John Douglas and Cheselden injected water to distend the bladder. In either procedure the fold of peritoneum was likely to be raised. But Frère Côme introduced his sonde-à-dard, by an incision in the perineum, to push forward the wall of the bladder after he had emptied it of urine. Consequently a perforation of the fold of peritoneum was likely. Either this accident, or the over-distension of the bladder causing rupture, was the reason why the operation failed. Suprapubic lithotomy was resuscitated by Carson, who showed that the fold of peritoneum was raised when the rectum was inflated; by Petersen, of Kiel, who carefully distended the bladder; and by the method of Sir Henry Thompson in pushing up the exposed fold bluntly with the fingers.

Carpue was also Surgeon to the St Pancras Infirmary, and after seeing at Greenwich Hospital multiple punctures made into inflamed areas, he adopted the practice. It was especially through Sir Joseph Banks that Carpue was elected Fellow of the Royal Society. At the College of Surgeons he was one of the original Fellows but was not elected to the Council. Although successful at first in attracting a large anatomical class, private medical schools died out as the staff of the great hospitals set themselves to give medical instruction systematically and ceased to take private pupils. J F South, although he allowed that Carpue was a very good anatomist, depreciated him for holding private classes.

Soon after the opening of the railways to Brighton, Carpue in travelling there put his two daughters in a first-class carriage, whilst he himself with two servants travelled in an open car. A collision occurred which threw him and his servants out upon the line. One of the servants was killed, and Carpue sustained severe contusions. After a tedious process at law he obtained a verdict for damages in the sum of £250, most of which had already been spent in costs. He did not recover, suffered from increasing bronchitis, and died on Jan 30th, 1846.

His portrait, as well as a marble bust, was presented to St George's Hospital by his daughter, Miss Emma Carpue, who left St George's Hospital £6,500 and £1000 to the Society for the Relief of the Widows and Orphans of Medical Men. Carpue is described as a tall, ungainly, good-tempered, grey-haired man who wore an ill-fitting suit of black relieved by an enormous white kerchief which encircled his neck like a roller towel. He was a facile draughtsman on the blackboard and thus earned the name of 'the chalk lecturer'. Each pupil was made to repeat after him and in identical words the description of the bone or organ which he had just given.

Tom Hood alludes to Carpue in his "Pathetic Ballad of Mary's Ghost":-
"I can't tell where my head is gone,
But Dr Carpue can.
As for my trunk, it's all packed up
To go by Pickford's van."

Publications:-
"Cast of Crucifixion," from an unpublished MS in Carpue's handwriting. - Lancet, 1846, I, 167.
Description of the Muscles of the Human Body, London, 1801.
An Introduction to Electricity and Galvanism, with Cases showing their Effects in the Cure of Disease, London, 1803.
An Account of Two Successful Operations for Restoring a Lost Nose from the Integuments of the Forehead in the Cases of Two Officers of His Majesty's Army, to which are prefixed historical and physiological remarks on the nasal operation, including descriptions of the Indian and Italian methods, with engravings by Charles Turner, London, 1818, translated into German, Berlin, 1817.
A History of the High Operation for the Stone by Incision above the Pubes (with observations on the advantage attending it, and an account of the various methods of Lithotomy from the earliest periods to the present time), London, 1819.

Sources used to compile this entry: [Lancet, 1846, i, 166. Dict. Nat. Biog. Feltoe's Memorials of J. F. South, 1884, 102. Med. Press and Circ., 1918. cv, 338. An account of Carpue's or the Dean Street Medical School appears in the Brit. Med. Jour., 1895 i, 1390. Carpue's evidence before the Royal Commission appointed to inquire into the Teaching of Anatomy is interesting. His answers are 6691-8742 in the Report. Johnston's R.A.M.C. Roll, No. 1837].

The Royal College of Surgeons of England