Paul Brand and the myth of rotting flesh
|Dr. Paul Brand|
Paul Wilson Brand (1914-2003) was born to missionary parents in India. He initially studied construction with a view to assisting in his parents’ work, but by the end of his studies he fell in love with medicine. He trained as a surgeon in London during World War II while the city suffered the onslaught of the German Blitzkrieg. At that time he became acquainted with the research effort taking place under enemy fire; this experience of struggle against all odds left an impression which proved valuable when working later in the underprivileged setting of rural India.
After his studies, he returned to India to work as a surgeon in Vellore. Through Robert Cochrane, a famous leprologist, he first came in contact with the thousand inmates of the Chingleput leprosy hospital. The sulphones had cured them, but they were still disfigured outcasts with bizarre musculoskeletal problems. Brand was amazed by the grip strength of a patient’s clawed hand, which proved that his muscles were anything but useless. Spurred by his desire to help those unfortunate people, and applying his varied skills, he developed surgical procedures using tendon transfers for the functional correction of claw hands. The results were impressive, and the patients regained the capacity to earn their living.
Brand did not stop at correction: he wanted to know the cause of the deformities. Until his time the prevailing view was that leprosy caused the flesh to rot and fall off. He observed patients in everyday life, and he was struck by the fact that they kept walking on feet bearing horrible wounds, and even stuck their hands in live coals without a flinch of pain. He began to suspect that their deformities might be due to the loss of pain perception caused by leprosy. This deficiency converted trivial daily injuries into sources of infection, gangrene, and eventual mutilation. Based on this hypothesis, he persuaded a group of young and eager patients to play a detective game: they had to inspect their senseless limbs regularly for new injuries, account for each one of them, and learn to protect themselves from trauma. They soon realized that wood splinters, tight fitting shoes, minor burns from hot stoves, and even rat bites during sleep were experiences that previously passed unnoticed. Once they detected and treated such wounds as soon as they occurred, new deformities disappeared almost miraculously.
It took Brand years of painstaking effort and meticulous documentation to convince the medical and social establishment that leprosy itself did not cause ‘rotting flesh’. Eventually this fact was accepted worldwide, and his methods for healing and prevention spread in all countries where leprosy was rife. However, he did not rest on his laurels. Finding the cause, correcting the deformities, and preventing further injuries were big steps forward, but the patients still bore the hallmarks of the dreaded disease on their faces. So he went on to develop plastic surgery techniques to eliminate the facial stigmata of leprosy, such as collapsed noses and lost eyebrows and lids, thus making patients once again presentable and acceptable to their own families and communities. He even designed special padded shoes to prevent foot injuries.
After almost twenty years of this pioneering work in India, Brand moved to Carville, Louisiana, as head of rehabilitation in the only leprosy hospital on United States soil. Once again he had to fight prejudice, which he even found enshrined in government regulations on patient isolation. Although the number of leprosy victims in the United States was quite low compared to India or Africa, the problems were the same. In a more favorable financial climate new solutions were developed. Brand soon applied similar methods in the management of neuropathic feet in diabetes, a much more common disease, with equally rewarding results.
Working with patients afflicted with painlessness, Brand developed a profound appreciation for pain, which he considered a friend and not an enemy. His fascinating book Pain: The Gift Nobody Wants narrates his journey of discovery and extols the many virtues of this ‘friend’ and its role in protecting our bodies from the risks of constant and repetitive stress.
We have come to associate scientific discovery and progress with famous academic institutes, shining high-tech facilities, and substantial financial grants. Beside the myth of rotting flesh, Paul Brand’s work effectively dispelled the notion that research is a sport for the rich and privileged: most of his ground-breaking work, including delicate restorative surgery, was done in mud huts, in hot and dusty climates, away from air-conditioned laboratories and even ordinary hospital wards from which leprosy patients were ostracized. His career is an example of how careful observation, an inquisitive mind, hard hands-on work, and a charitable spirit can transform the lives of millions of suffering people, far more than expensive drugs or devices.
- Brand P & Yancey P. Pain: The Gift Nobody Wants. Zondervan 1993 [subsequently re-printed under the title ‘The Gift of Pain’]. Autobiography plus Brand’s philosophy on pain and its significance.
- Dorothy Clarke Wilson. Ten Fingers for God: The Life and Work of Dr Paul Brand. Zondervan 1989. A biography.
There is at least one video in YouTube of Paul Brand addressing a medical conference, where he highlights some of his research experiences – worth viewing: http://www.youtube.com/watch?v=30piDE5iIVw
ANTHONY PAPAGIANNIS, MD, MRCP(UK), DipPallMed, is a practicing pulmonologist in Thessaloniki, Greece. He received his MD degree from the Aristotle University of Thessaloniki Medical School in 1981. He trained in internal medicine in Greece and subsequently in the United Kingdom, and specialized in pulmonary medicine. He also holds a postgraduate diploma in palliative medicine from the University of Cardiff, Wales, United Kingdom. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece. He is editor of Iatrika Themata, the journal of the Thessaloniki Medical Association.