FIGHTING A CRUSADE
Paul Wilson Brand is a missionary surgeon who worked in south western India. He was the first professor of orthopaedics and hand research at the Christian Medical College in Vellore, where he pioneered surgical work in treating those suffering with leprosy.
In India, back in the 1940s, leprosy was viewed as a curse from the Gods. Thus, as a result of false stereotypes and ignorance, leprosy became a disease marked with stigma. The discovery of sulfone drugs was a major development in the treatment of the disease. Even though sulfone helped to arrest the disease, lepromatous leprosy caused severe deformity.
After visiting a leprosarium, where he saw clawed hands of its inhabitants, Brand became interested in leprosy. It was, then, widely believed that those suffering from leprosy lost their fingers and feet because of rotting flesh, although it was recognized that the disease silenced pain signals. However, Brand was not satisfied with this explanation. He began comparing finger measurements of patients over a period of months and years. His study showed that some of the most severe loss of digits occurred in people who were tested negative for leprosy, which showed that tissue kept dying even after the bacilli became dormant. This made him more curious.
He became the first surgeon to use reconstructive surgery to correct deformities caused by the disease – in hands and feet. He also developed many other methods of prevention and healing from the disease. Dr.Brand began treating leprosy with a single desire to repair damaged hands. But along the way, he met with an even greater challenge: protecting the repaired hands and feet from (further) damage. For example, while following up with his patients after the tendon transfer surgery, he noted that the surgical wounds of the hands healed on schedule, while foot ulcers in the same patients did not. He observed, after dressing a grossly contaminated wound, the patient put his entire weight on the wound while walking! He explained that this was due to lack of appreciation of pain at the site of lesion.
Through his studies related to leprosy, he assumed that all damage to hands and feet of the patients was due to their insensitivity to pain. To prove this, he assembled a team of leprosy patients every day and tried to track the causes of their injury and came to a conclusion. His theory was that leprosy merely silenced the pain and further damage came about as a result of the patients‘ insensitivity to pain. Normally people prevent many injuries unconsciously through pain reflex. Preventing these avoidable injuries, when one is deprived, so of pain reflex, required that he consciously anticipate possible dangers. So, Brand along with his team made a set of rules for his patients and discovered new forms of prevention and healing. For example, he applied plaster casts to foot ulcers and observed that a sore sheltered in a cast healed much better than a sore wrapped up in a dressing. By his new methods the amputation rate of leprosy patients began to drop dramatically.
In 1951, Vellore became the first general hospital to build an entire ward for the treatment of leprosy patients. Paul Brand sensed that repairing hands and feet alone did not adequately equip the patients for their day today life. As result he began to perform reconstructive surgeries and found a New Life Center to rehabilitate the patients. He fought hard to change the social stigma associated with leprosy, by educating the public that the disease was caused by an organism, namely Mycobacterium Ieprae. He succeeded in telling the public that most people had built-in immunity against leprosy; the disease can be treated easily; and, as such, with proper care it need not lead to serious complications.
After working for 20 years in India, Dr. Brand extended his work into the treatment of diabetes mellitus. He earned several distinguishing awards; he was honored by Queen Elizabeth II as Commander of the Order of the British Empire.
This article by Thabitha J. Hoole (33rd Batch), was appeared in the First MSU Newsletter published in September 2013.