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http://www.leprosyhistory.org/cgi-bin/showdetails.pl?

ID=31&type=person
Dr Paul Wilson Brand
Surgeon
Notes
Dr Paul Brand (1914-2003) was a world-renowned orthopaedic specialist and leprosy surgeon.
The son of missionary parents, Dr Brand spent his early years in the mountains of southwest India. At age nine, he
went to London, England for his education and later completed medical school at London University, becoming a
Fellow of the Royal College of Surgeons.
Together with his wife Margaret, whom he met at medical school, Paul Brand returned to India in 1946 to teach
surgery at the Christian Medical College and Hospital in Vellore.
In India the Brands first came across deformities caused by leprosy. Very little was known about the true cause of
these. It was generally believed that the hands and feet of infected people simply disintegrated or rotted away as a
direct result of the disease. A senior colleague, Dr Robert Cochrane, challenged Paul Brand to use his skills as an
orthopaedic surgeon to find out why people with leprosy developed deformed hands, and to try to find an effective
treatment.
Dr Brand drew on experience he had gained during the Second World War with polio-paralyzed and war-injured
hands. He undertook extensive research on damaged hands to test muscle strength and sensation. There were many
obstacles to overcome not the least being prejudice and resistance to using surgical skills on people with leprosy,
and allowing them access to hospital care.
Paul Brand pioneered the idea that the loss of fingers and toes in leprosy was due entirely to infection and was thus
preventable. Because leprosy attacks chiefly the nervous system, resultant tissue abuse occurs because the patient
loses the warnings of pain not because of inherent decay brought on by the disease.
As a skilled and inventive hand surgeon, he pioneered tendon transfer techniques with leprosy patients, and opened
up a whole new world of disability prevention and rehabilitation for those affected by leprosy.
In the late 1940s, he became the first surgeon in the world to use reconstructive surgery to correct the deformities
of leprosy in the hands and feet. Dr Margaret Brand devoted herself to researching methods to prevent blindness in
persons with leprosy. Later, Dr Paul Brand was able to apply similar techniques to treat the limbs of persons with
diabetes, as both diseases destroy pain sensation.
In 1953 the Brands joined the staff of The Leprosy Mission, and continued to develop their research and training
work at Vellore and at the nearby Schieffelin Leprosy Research and Training Centre, Karigiri, newly founded and
funded jointly by The Leprosy Mission and American Leprosy Missions. In 1964 after over 17 years in India, Paul
Brand was appointed as The Leprosy Missions Director of Surgery and Rehabilitation.
Two years later they were seconded to the United States Public Health Service Hospital in Carville, Louisiana, which
is the only leprosy hospital in the US and a world-famous centre for leprosy research. Here Paul was Director of the
Rehabilitation Branch until his retirement in 1986 and continued to act as Medical Consultant to The Leprosy mission.
From 1993 to 1999, Dr Brand was President of The Leprosy Mission International.
In retirement Dr Brand continued to contribute to leprosy work through his advisory role to The Leprosy Mission and
to the World Health Organisation. He moved to Seattle and became Clinical Professor of Orthopoedics, Emeritus at
the University of Washington.

Dr Brand has received many honours and awards in recognition for his outstanding achievements: he was Hunterian
Professor of the Royal College of Surgeons in 1952; in 1960 he received the Albert Lasker Award for outstanding
leadership and service in the field of rehabilitation; in 1961 he was honoured by Queen Elizabeth II with a CBE
(Commander of the British Empire) for promotion of good relations between the Republic of India and Great Britain;
in 1977 the Damian-Dutton Award for outstanding contributions in prevention of disabilities due to leprosy; and the
US Surgeon Generals Medallion for his rehabilitation work in Carville, LA.
Dr Brand authored 100 scientific papers and seven books, including Clinical mechanics of the Hand, which is the
premier handbook for hand surgeons, physiotherapists and other hand specialists. Co-author with Philip Yancey of
three inspiring books, Fearfully and Wonderfully Made, In His Image, and Pain The Gift Nobody Wants, Paul Brand
is also the subject of Dorothy Clarke Wilsons biography, Ten Fingers for God.
Dr Paul Brand died at the age of 89 years, from complications related to a subdural hematoma, on 8 July 2003 at
Swedish Hospital, Seattle, Washington, USA.
Biographical details adapted from TLMI obituary for Dr Paul Brand, by Janet Walmsley, Director for Support and
Development, 11 July 2003 There are also obituaries by Dr CK Job and Dr NH Antia in the Int J Lepr, 71.4 (2003):361-3.
Entry made 21 July 2003. Additional information added 15 September 2006.
Treatment Used/Researched
Reconstructive Surgery
Leprosaria associated with
Carville, Louisiana, USA
Karigiri, Madras Presidency, India (currently
Tamil Nadu, India)

Paul Brand was surgeon at Vellore during 1961. (Information


supplied by LEPRA)

National Leprosarium of Shanghai, Shanghai,


Kiangsu, Jiangsu Province, China (currently
Shanghai, Shanghai Municipality, China)
Lady Willingdon Settlement, Tirumani /
Alapakkam, Madras Presidency, India (currently
Tirumani / Chingleput, Tamil Nadu, India)
Research Institute(s) associated with
Christian Medical College and Hospital, Vellore, Vellore, Madras, India (currently Vellore, Tamil Nadu, India)
Schieffelin Leprosy Research and Training Centre, (currently Tamil Nadu, India)
Publications
100 scientific papers and seven books, including Clinical mechanics of the Hand, which is the premier handbook for
hand surgeons, physiotherapists and other hand specialists.
Co-author with Philip Yancey of three inspiring books, Fearfully and Wonderfully Made, In His Image, and Pain The
Gift Nobody Wants.

http://www.hektoeninternational.org/paul-brand.html
Paul Brand and the myth of rotting flesh
ShareThis

Anthony Papagiannis, MD, MRCP(UK), DipPallMed


St Lukes Hospital, Thessaloniki, Greece
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 patients 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.
Dr Paul Brand
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 Brands 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.
Recommended Bibliography
1. Brand P & Yancey P. Pain: The Gift Nobody Wants. Zondervan 1993 [subsequently re-printed under the title
The Gift of Pain]. Autobiography plus Brands philosophy on pain and its significance.
2. Dorothy Clarke Wilson. Ten Fingers for God: The Life and Work of Dr Paul Brand. Zondervan 1989. A
biography.
Additional Resources
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.
Return to Physicians of Note
RETURN TO HOMEPAGE

Video: https://www.youtube.com/watch?v=yG21uTCByn0

http://www.jmm.org.au/articles/4786.htm BY ROWLAND CROUCHER AND OTHERS JULY 29, 2003


THE LEPROSY MISSION
A Legend has passed into history Dr Paul Wilson Brand 1914-2003 Obituary
An Extraordinary, Gifted Orthopaedic Surgeon who Straightened Crooked Hands and Unravelled the Riddle of
Leprosy
by Ms Janet Walmsley
This week countless thousands and millions around the world mourn the passing of Dr Paul Brand, world-renowned
orthopaedic specialist and leprosy surgeon who solved a riddle that has plagued the world for centuries; Do the
hands and feet of leprosy-affected people just fall off? What causes the terrible deformities of leprosy? Can anything
be done to prevent them or restore the damage?
Dr Brand, a modern-day Father Damian, died on Tuesday, 8th July 2003 at Swedish Hospital in Seattle Washington,
aged 89, surrounded by his wife, Dr Margaret Brand and family.
The son of missionary parents, Dr Brand spent his early years in the mountains of southwest India. At age nine, he
went to London, England for his education and later completed medical school at London University, becoming a
Fellow of the Royal College of Surgeons.
Together with his wife Margaret, whom he met at medical school, Paul Brand returned to India in 1946 to teach
surgery at the Christian Medical College and Hospital in Vellore.
Paul Brand did not set out to become a doctor. Initially he refused to follow in his fathers footsteps and study
medicine, and he trained as a carpenter and builder. This skill he later used in a remarkable way teaching leprosyaffected people with damaged, insensitive hands how to do carpentry and woodwork without further injuring their
fingers and hands.
It was in India that the Brands first came across leprosy beggars, deformed, blind and crippled by the disease.
Deeply affected by the acute anguish and isolation of people afflicted with leprosy, he and his wife dedicated
themselves to relieving their suffering.
Very little was known about the true cause of leprosy deformities. It was generally believed that the hands and feet
of infected people simply disintegrated or rotted away as a direct result of the disease. A senior colleague, Dr Robert
Cochrane, challenged Dr. Paul Brand to use his skills as an orthopaedic surgeon to find out why people with leprosy
developed deformed hands, and to try to find an effective treatment.
Dr Brand drew on experience he had gained during WWII with polio-paralyzed and war-injured hands. He undertook
extensive research on damaged hands to test muscle strength and sensation. There were many obstacles to
overcome not the least being prejudice and resistance to using surgical skills on people with leprosy, and allowing
them access to hospital care.
Through his research in South India, Dr Brand changed forever the worlds perceptions and treatments of leprosyaffected people:
First, he pioneered the startling idea that the loss of fingers and toes in leprosy was due entirely to infection and was
thus preventable. Because leprosy attacks chiefly the nervous system, resultant tissue abuse occurs because the
patient loses the warnings of pain not because of inherent decay brought on by the disease. Paul Brand discovered
the gift of pain, claiming that because leprosy destroyed the sensation of pain in affected parts of the body, paindeprived people inadvertently injured and destroyed themselves.

Second, as a skilled and inventive hand surgeon, he pioneered tendon transfer techniques with leprosy patients, and
opened up a whole new world of disability prevention and rehabilitation for the most vulnerable and helpless in
society.
In the late 1940s, he became the first surgeon in the world to use reconstructive surgery to correct the deformities
of leprosy in the hands and feet. Dr. Margaret Brand devoted herself to researching methods to prevent blindness in
persons with leprosy. Later, Dr. Paul Brand was able to apply similar techniques to treat the limbs of persons with
diabetes, as both diseases destroy pain sensation.
In 1953 the Brands joined the staff of The Leprosy Mission, and continued to develop their research and training
work at Vellore and at the nearby Schieffelin Leprosy Research and Training Centre, Karigiri, newly founded and
funded jointly by The Leprosy Mission and American Leprosy Missions. In 1964 after over 17 years in India, Paul
Brand was appointed as The Leprosy Missions Director of Surgery and Rehabilitation which offered worldwide
opportunities to share his life-changing skills.
Two years later they were seconded to the United States Public Health Service Hospital in Carville, Louisiana, which
is the only leprosy hospital in the US and a world-famous centre for leprosy research. Here Paul was Director of the
Rehabilitation Branch until his retirement in 1986 and continued to act as Medical Consultant to The Leprosy Mission.
From 1993 to 1999, Dr Brand was President of The Leprosy Mission International.
In retirement Dr Brand continued to contribute to leprosy work through his advisory role to The Leprosy Mission and
to the World Health Organisation. He moved to Seattle and became Clinical Professor of Orthopoedics, Emeritus at
the University of Washington.
A gifted speaker and writer, Dr Brand has received many honours and awards in recognition for his outstanding
achievements: he was Hunterian Professor of the Royal College of Surgeons in 1952; in 1960 he received the Albert
Lasker Award for outstanding leadership and service in the field of rehabilitation; in 1961 he was honoured by Queen
Elizabeth II with a CBE (Commander of the British Empire) for promotion of good relations between the Republic of
India and Great Britain; in 1977 the Damian-Dutton Award for outstanding contributions in prevention of disabilities
due to leprosy; and the US Surgeon Generals Medallion for his rehabilitation work in Carville, LA.
Dr Brand authored 100 scientific papers and seven books, including Clinical Mechanics of the Hand, which is the
premier handbook for hand surgeons, physiotherapists and other hand specialists. Co-author with Philip Yancey of
three inspiring books, Fearfully and Wonderfully Made In His Image, and Pain The Gift Nobody Wants, Paul
Brand is also the subject of Dorothy Clarke Wilsons biography, Ten Fingers for God.
Dr Paul Brand died from complications related to a subdural hematoma. He is survived by his wife Margaret, their six
children, Estelle, Chris, Jean, Mary, Patricia and Pauline, and twelve grandchildren.
A man of deep faith and passionate commitment ,Paul Brand brought great dignity, humour and humility to the role
of greatness that was laid on him. He was truly great, but with a natural humility that maintained to the end a hint of
surprise that others should think that he had done anything outstanding.
Eddie Askew, a friend and colleague of Paul Brands at The Leprosy Mission, said of him: From his work many
thousands of individual lives have been transformed and enriched. . it wasnt just the surgical techniques that Paul
worked on, it was the people. I have often watched him as he engaged with patients, assessing their disabilities and
deciding what would best meet their needs. I noticed that he never concentrated solely on the hand or foot he held
so gently and intimately. He looked at the patients face, looked into the eyes. Paul was concerned for the individuals,
their personalities, acknowledging and valuing our common humanity.
Dr Paul Brand spent a lifetime working with people affected by leprosy, doing his utmost to destroy the stigma of the
disease, and rebuild the lives of those destroyed by it. In doing so, he recognised the extraordinary gift of pain that

the rest of the world usually takes for granted. Within each person he treated, he saw a broken spirit full of pain, as
well as a broken body which felt no pain. And in each person Paul Brand saw the image of God.
11 July 2003

http://www.myhero.com/go/hero.asp?hero=P_Brand_whitworth_US_2009
"God designed the human body so that it is able to survive because of pain."

HEALTH HERO:
DR. PAUL BRAND
by Al Schmidt from Spokane

(http://www.request.org.uk/
main/history/brand/brand01.htm)
Dr. Paul Brand was an orthopedic surgeon who used reconstructive surgery to
correct deformities of leprosy in the hands and the feet. Among his many merits
was the fact he helped humankind to better understand and treat leprosy. His
most significant research brought a new understanding of the important role of
pain in peoples lives. His idea is that when we are suffering but cease to respond
to pain, the consequence of the pain is likely to cause more damage to us. The
absence of feeling pain weakens us, either because its so overwhelming that we
become numb, or because we alleviate the pain through a variety of artificial
means, or become used to the pain and insensitive to it.
Doctors Paul and Margaret Brand pioneered work with lepers in India. They developed new medical techniques that
allowed lepers to function in society in spite of their handicaps. Dr. Paul Brand, a British subject born in 1914 to
missionary parents, grew up in India until 1923, and studied in England from 1923 until 1946. He returned to India as
the first Professor of Orthopaedics and Hand Research at the Christian Medical College and Hospital in Vellore, India
(concisely referred to as CMC, Vellore). He left India in 1965 after performing thousands of reconstructive and
other surgical procedures. In 1967 he moved to the National Leprosarium in Carville, Louisiana, the only leprosy
hospital in the U.S., at the invitation of the U.S. Public Health Service. Dr. Brand was Director of the Rehabilitation
branch at this hospital until his retirement in 1986. He then moved to Seattle, WA, where he died on July 8, 2003 at
the age of 89.

(http://www.zondervan.com/
images/contributor/medium/brandp.jpg)
To help treat lepers, he developed surgical methods to straighten crooked bones, especially
in their hands and feet. He performed tests on muscle strength and sensation to determine
the proper surgical intervention for people suffering from hand and foot problems. He
proved that the loss of fingers and toes in leprosy patients was caused by infection and was
a preventable disease when properly treated.
Until Dr. Brand developed his reconstructive surgical procedures, most people believed that
lepers lost their fingers and toes because of decaying flesh. However, Dr. Brand's research proved that lepers
malformations were tied to their loss of ability to feel pain. He called his discovery "the gift of pain". He found that
the disease numbed the sensation of pain in parts of the body to the point where leprosy patients were actually
injuring themselves, through their insensitivity.

Leprosy affects the nervous system, and triggers tissue damage, which can escalate when its victims ignore early
warnings of pain. Dr. Brand not only answered questions about leprosy deformities and their causes, but was able to
recommend what could be done to heal patients and prevent their disease from spreading.

Dr. Brand at the groundbreaking ceremony at Christian Medical School in


Vellore, India
(http://pmrcmcv.tripod.com/ri/dig.jpg)
Dr. Brand was a medical consultant to the Leprosy Mission and Clinical Professor
Emeritus of Orthopaedics, at the University of Washington. He continued to
contribute to leprosy work through his role in the World Health Organization and Leprosy Mission International (for
which he served as president from 1993 to 1999).
In 1952, he was Hunterian Professor of the Royal College of Surgeons. In 1960 he received the Albert Lasker Award
for outstanding leadership and service in the field of rehabilitation. In 1961, Queen Elizabeth II honored Dr. Brand as
Commander of the British Empire for contributing to good relations between India and Great Britain. In 1977, he
received the Damian-Dutton Award for his contributions in the prevention of disabilities due to leprosy. Finally, he
received the U.S. Surgeon General's Medallion for his rehabilitation work in Carville,
Louisiana.
His thesis, "Clinical Mechanics of the Hand," is still regarded as an authoritative reference
on reconstructive surgery for hand surgeons, physiotherapists and other hand specialists.
Dr. Brand was the author of 100 scientific papers and six books. He co-authored three
inspirational books with Philip Yancey: Fearfully and Wonderfully Made, In His Image,
and Pain - The Gift Nobody Wants. Dorothy Clarke Wilson wrote a biography on him
called Ten Fingers for God.

(http://www.hrsa.gov/hansens/
images/HISTORY/HISTORY_PWB_PIC-A.jpg)
As a hand surgeon, his character qualities included compassion, commitment to
work, and humility. He was known for his passionate commitment and compassion
for people. Dr. Brand believed that pain was indispensable. He wrote: "God
designed the human body so that it is able to survive because of pain."

http://www.formations.org.in/OrgForCofl/index.php?tmpl=component&view=article&id=210

He was born to missionary parents (Jesse and Evelyn "Granny" Brand) and grew up in the Kolli Hills of Tamil Nadu,
India, until he was sent to the United Kingdom in 1923 for education. Dr. Paul Wilson Brand, CBE (July 17, 1914 July
8, 2003) was a pioneer in developing tendon transfer techniques for use in the hands of those with leprosy. He was
the first physician to appreciate that leprosy did not cause the rotting away of tissues, but that it was the loss of the
sensation of pain which made sufferers susceptible to injury.<br />In 1946, he was invited to join the staff of the
Christian Medical College &amp; Hospital in Vellore, India. After a visit to the Leprosy Sanatorium at Chingleput, a
government institution that was at the time under church management, Brand was motivated to explore the reasons
for the deformities developed in those with Hansen's disease. After careful observation and research, he came to
understand that most injuries in Hansen's disease patients were a result of the pain insensitivity they experienced,
and not directly caused by the Hansen's disease bacilli. In 1950, with a donation from a missionary woman, Brand
established the New Life Center, Vellore, as a model rehabilitation center for Hansen's disease patients. The center
was a village environment in the residential area of the Christian Medical College &amp; Hospital campus. During his
career, Brand received many awards and honors. He was awarded the Hunterian professorship of the Royal College
of Surgeons in 1952, and the Lasker Award in 1960. Queen Elizabeth honored him with a title of the Commander of
the Order of the British Empire in 1961.He served as President of The Leprosy Mission International based in London
and was on the Panel of Experts on leprosy of the World Health Organization. He was one of the main architects of
the All-Africa Leprosy Rehabilitation and Training Center in Addis Ababa, Ethiopia, and the Schieffelin Leprosy
Research and Training Center at Karigiri, India, in the Vellore district. He was an honorary member of the American
Society of Hand Therapists, in recognition of his many contributions to the field. In 1966, he accepted a post as chief
of rehabilitation at the public hospital in Carville, Louisiana, the only leprosy hospital in the United States. His
appreciation of the importance and value of pain is well described in his 1993 book with Philip Yancey, Pain: The Gift
Nobody Wants. He saw pain as vital for the preservation of healthy tissue in anyone leading a normal life and he
gives horrifying descriptions of the results of insensitivity in those with Hansen's disease or congenital absence of
pain. He goes on to question the pursuit of pleasure in Western society and offers practical ways to ameliorate the
effects of pain. The book contains a foreword by Surgeon General C. Everett Koop, who said that if he could have
chosen to be anyone else besides himself, he would have chosen to be Dr. Paul Brand.

http://www.leprosy-ila.org/leprosyjournal/gn1/detalhe_artigo.php?id=MTgy&secao=OBITUARY

Volume 71 , Number 4

Page: 3613

OBITUARY
Paul Wilson Brand 19142003

Dr. Paul W. Brand, one of the greatest physicians of all time, well known to all leprologists of his generation, passed
away on 8th of July, 2003, at the age of 89. He was a pioneering surgeon, an excellent teacher, a compassionate
leprologist, and a dedicated missionary.
He was born in South India in July, 1914 of British parents, studied medicine in the University College Hospital,
London, and later qualified for the FRCS diploma. His father Jessi Brand died of malaria while serving as a missionary
to the tribal people in Kolli Hills, situated in the mountain ranges of South India. His mother took over the work of
her husband and served the tribal folk until her death at the ripe old age of 96. Service to the suffering,
underprivileged, and the poor was his inheritance.
The call to serve as a medical missionary in India came to him in 1946 from Dr. Robert G. Cochrane, the then
principal of the Christian Medical College, Vellore, who was desperately searching for a surgeon to satisfy the
university requirements for recognition of the MBBS degree offered by the college. Dr. Brand was a born teacher. His
graphic descriptions of disease presentations were brilliant and were long remembered by many of his students; I
was fortunate to be one of them. His deep concern and care for patients touched and moved each one of his
students to whom he was a role model.

It seems to me that it was Gods plan that brought together the world famous leprologist, Dr. Robert Cochrane and
Dr. Brand, the young enthusiastic, ingenious and compassionate surgeon. In 1947 when, at the leprosy hospital at
Chinglepet, Dr. Cochrane showed him the useless, deformed and disabled hands of leprosy patients that no surgeon
had ever cared to touch and to repair, Dr. Brand saw the challenge before him. He started his careful research into
the pathology and pathogenesis of deformities in leprosy and into methods to reconstruct their paralyzed hands and
feet. His pioneering work in the correction of deformities caused by leprosy changed the lives of thousands of
grateful patients. He also trained many surgeons from different parts of the world using the facilities at Schieffelin
Leprosy Research Center, Karigiri, and at Christian Medical College, Vellore.
Another area of research he was engaged in was the pathogenesis of plantar ulcers. He established that the main
course of these ulcers was loss of sensation due to nerve damage and not just leprosy. This finding led to the
adoption of measures to heal, to protect, and to prevent the damage to insensitive hands and feet. Specialized
sandals, made out of microcellular rubber, were found suitable to prevent the formation of plantar ulcers and to
stop their recurrence. A rubber mill to manufacture microcellular rubber was established at Schieffelin Leprosy
Research and Training Center, Karigiri because it was not profitable for any commercial rubber company to
manufacture this product.
Dr. Brand was the first one to demonstrate that nerve damage was localized to subcutaneously placed nerves and to
suggest that M. leprae multiplied at the cooler regions of the body. This finding led to the path breaking
experimental studies by Charles Shepard who succeeded in growing M. leprae in the footpads of mice.
At various periods during his tenure in Christian Medical College, Vellore, Dr. Brand held the posts of Professor of
Orthopedic surgery, Associate Director and Principal. He was also consultant surgeon at Schieffelin Leprosy Research
Center at Karigiri. He established the New Life Center, Vellore, as a model rehabilitation center for leprosy patients.
This Center simulated a village environment and was located at the residential area of the Christian Medical College
campus, in an effort to dispel the stigma that was so prevalent even among medical professionals. Correcting
deformities to restore the self-respect of patients and to integrate them into society was his cherished goal.
In 1966, after 19 years of service in India he moved to the U.S.A. on invitation to take up the position of Chief of
Rehabilitation Branch at the National Hansens Disease Center at Carville. He worked there for 20 years and
established a well-equipped and well-staffed research unit to study the complications of insensitive hands and feet,
their prevention and management. His methods for prevention and management of plantar ulcers are now
extensively used for treatment of patients with diabetes mellitus who have similar problems. His contribution to the
understanding of pain is monumental. He emphasized the role of pain, which protects and preserves and is a
blessing. When he retired in 1986 from the U.S. Public Health Service, he moved to Seattle and continued his
teaching work as emeritus professor of Orthopedics in the University of Washington.
During his career, Dr. Brand received many awards and honors. He was awarded the Hunterian professorship of the
Royal College of Surgeons in 1952, and the Albert Laskar award in 1960. Queen Elizabeth honored him with a title of
the Commander of the Order of the British Empire in 1961. He served as President of the Leprosy Mission
International based in London and was on the Panel of Experts on leprosy of the World Health Organization. He was
one of the main architects of the All Africa Leprosy Rehabilitation and Training Center in Addis Ababa, Ethiopia, and
the Schieffelin Leprosy Research and Training Center at Karigiri, India. A biography was written on him entitled, Ten
fingers for God, by Dorothy Clarke Wilson. He authored several books that were best sellers among Christian
literature. They are Fearfully and Wonderfully made, 1981, In His Image, 1984, and Gift of Pain, 1993. He also
wrote a standard reference book for hand surgeons entitled Clinical Mechanics of the Hand.
Dr. Paul W. Brand, with all the honors he received and with all his greatness, remained a simple and humble
Christian leprosy worker. He was a man of integrity and witnessed for his convictions forcefully and effectively with
gentleness and respect. He exemplified in his life that excellence in medicine was not just knowledge and skills but
the application of them to serve and to give ones best to the cause of the poor, needy and the neglected. His many
contributions to the care of leprosy patients will be long remembered.

He leaves behind his loving wife, Dr./Mrs. Margaret Brand, six children and twelve grandchildren. Mrs. Brand is also
a leprologist who has received international acclaim in the study and management of eye complications in leprosy.
We, his students, friends, colleagues and patients, share with the family the sadness and the loss. Nonetheless, we
celebrate his great contributions and the privilege of having known him, having had him as a teacher, friend,
colleague, and caregiver. We thank and praise God for his wonderful and blessed life that has been a blessing to
many.

- Dr. C. K. Job

DR. PAUL WILSON BRAND 19142003


My first meeting with Paul Brand was at the Proctor House Mission in Bombay when I had gone to enquire of him
the danger of contracting leprosy during surgery. He assured me that this was a mere myth as he and his staff had
kept a record of needle pricks during surgery for over a decade with no untoward consequences.
We next met when I advertized for a physiotherapist for our hospital resulting in an interview visit by Furness,
Brands senior physiotherapist and the husband of Brands secretary (also an old leprosy patient). This resulted in
obtaining his brother-in-law, Walter Jennings, as our physiotherapist, who served our hospital for almost two
decades, a former leprosy patient who had both his hands operated on by Brand. The excellence of Brands surgery
not only permitted him to undertake excellent physiotherapy, but also to keep typed records of patients and their
surgeries. As a result of our discussions, he eventually performed many tail operations on paralyzed hands with
excellent results, for he could judge the tensions of the graft better than most surgeons.
Another outcome of Furness visit was the visit of Ernest Fritschi to Pune in order to observe our plastic surgery
approach to deformities of the face in this disease, undertaken under primitive conditions with patients as the only
assistants.
This led to several decades of interaction between Dr. Brand, myself, and his colleagues in Vellore and Karigiri. Paul
visited Kondhwa and observed Sir Harold Gillies undertaking surgery during his visit in 1958.
My first visit to Karigiri was in 1959, to attend the First International WHO conference on Rehabilitation on Leprosy
Deformities, where I was familiarized with the care of the ulcerated foot in leprosy. At this meeting, Ernest Price also
demonstrated his interesting observations on the footprints of leprosy patients. This meeting provided due
recognition to the pioneering work of Brand in this field. It also led to support from the U.S. Department of Health,
Education, and Welfare for several of our leprosy and burn activities including surgery, research, and rehabilitation.
This was followed by a series of exchanges between our institutions and my personal interaction, not only with Paul
and Margaret, but aslo with the Karats, Selvapandian and Anthony Samy at Katpadi - a fruitful exchange.
During a six week visit to our department at the J. J. Hospital in Bombay, Dr. Robert Cochrane provided interesting
information as to how he had inveigled a new orthopedic surgeon of Vellore into undertaking the correction of
deformities of patients sent to him from the Victoria Hospital in Chengleput. Thanks to Paul, Vellore became a mecca
of surgery for leprosy. Many of the surgeons from various countries of the world while visiting Vellore also visited us
in Bombay and Kondhwa.
The contributions of Cochrane and Brand will always remain as landmarks in leprosy with Vellore as their home.

It is heartening for me to see that leprosy is one of the few diseases of poverty that has shown a definite decrease.
This is also reflected in the decrease of its deformities, even though eradication will remain a distant dream till
necessary poverty is banished by concerted political action at all levels and in all countries.

- Dr. N. H. Antia

Imagens:
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