Pioneer of reconstructive surgery

Print edition : September 12, 2003

Dr. Paul Wilson Brand, 1914-2003.

THE legendary orthopaedic surgeon Dr. Paul Wilson Brand, who pioneered reconstructive surgery to straighten crooked bones in leprosy patients at the Christian Medical College and Hospital, Vellore, Tamil Nadu, for 18 years, died on July 8 after being in a coma for three weeks in Seattle, Washington, United States. Dr. Brand, aged 89, who devoted his lifetime to working with people affected by leprosy to remove the stigma of the disease, was also a world-renowned author and speaker.

He was the first surgeon in the world to use reconstructive surgery - in the late 1940s - to correct the deformities of leprosy in the hands and the feet. He later used the same techniques and procedures for patients with diabetes who, like leprosy patients, lost all sense of pain. His wife, Dr. Margaret Brand, meanwhile, focussed on research to prevent blindness in people with leprosy.

Until Dr. Brand began his path-breaking reconstructive surgical procedures, it was widely felt that leprosy patients lost their fingers and toes because of decaying flesh. Dr. Brand's research showed that these deformities were owing to the loss of the ability to feel pain.

Dr. Brand grew up in India, where he was born to missionary parents. He was sent to England at the age of nine for his education. Initially, he did not wish to be a doctor; he trained as a carpenter and builder before taking up medicine at London University and becoming a Fellow of the Royal College of Surgeons. He married his classmate, Margaret Barry, after graduation in 1943. In 1946, Dr. Brand returned to India as the first Professor of Orthopaedics and Hand Research at CMC, Vellore. Moved by the condition of leprosy-afflicted beggars - deformed, crippled and blind from the disease - the Brands made a lifetime commitment to help leprosy patients. Interestingly, Dr. Brand's skills as a carpenter came in useful to teach leprosy-affected people with damaged, insensitive hands how to do carpentry without further injuring their fingers or hands.

Responding to a challenge from a colleague, Dr. Robert Cochrane, to use his skills as a surgeon to find out why leprosy patients developed deformities and how they could be effectively treated, Dr. Brand used his experience during the Second World War in treating the hands and feet of the war-injured and those paralysed by polio. He undertook path-breaking research that would later alter the lives of thousands of leprosy patients and diabetics with hand and foot problems. His research was extensive and soon became a lifetime passion for him. He conducted tests on muscle strength and sensation, which would change the world's perception and provide surgical intervention for people with hand and foot problems.

His conclusions proved beyond doubt that the loss of fingers and toes in leprosy patients was primarily caused by infection and could be prevented through proper treatment. Leprosy basically affects the nervous system, and the ensuing damage to tissues came about because its victims ignored early warnings of pain and not because of any inherent decay caused by the disease. Dr. Brand not only answered the questions about the deformities and their causes, but what could be done to prevent or rectify the damage.

Dr. Brand felt that pain was not antithetical to life, but was indispensable to it. He later wrote: "God designed the human body so that it is able to survive because of pain." He called his discovery "the gift of pain". Because the disease eliminated the sensation of pain in the affected parts of the body, leprosy patients inadvertently injured themselves, he said.

The next most important thing he did was to use his skills as a surgeon to evolve innovative techniques and procedures to correct the deformities. He pioneered tendon transfer techniques, thus opening the floodgates for disability prevention and rehabilitation. At that time his work was sensational and brought relief to thousands of leprosy patients.

The Brands, who joined the staff of the London-based Leprosy Mission in 1953, continued to develop its research and training work at Vellore and at the new Schieffelin Leprosy Research and Training Centre at Karigiri, near Vellore. Dr. Brand left India in 1965 after performing more than 3,000 reconstructive surgical procedures and thousands of other surgical procedures, but he continued his association with CMC, Vellore for the rest of his life as an honorary director of its Board.

He left India when he was appointed the Leprosy Mission's director of surgery and rehabilitation. This opened up worldwide opportunities to share his life-changing skills. In 1967, the Brands were invited by the United States Public Health Service to work at the National Leprosarium in Carville, Louisiana, the only leprosy hospital in the U.S. and a world-famous centre for leprosy research. Dr. Brand, who was Director of the Rehabilitation branch at the hospital until his retirement in 1986, continued to act as medical consultant to the Leprosy Mission.

After retirement, he moved to Seattle and became Clinical Professor Emeritus of Orthopaedics, at the University of Washington. Dr. Brand continued to contribute to leprosy work through his advisory role in the Leprosy Mission International (serving as the president of the organisation from 1993 to 1999) and to the World Health Organisation.

Dr Brand has received many honours and awards in recognition of his outstanding achievements. In 1961, he was honoured by Queen Elizabeth II with a CBE (Commander of the British Empire) for promotion of good relations between India and Great Britain. 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 1977, he received the Damian-Dutton Award for outstanding contributions in the prevention of disabilities due to leprosy, and the U.S. Surgeon General's Medallion for his rehabilitation work in Carville.

THREE remarkable qualities stand out in this outstanding hand surgeon: his compassion, his notable commitment to work, and his humility. If he recognised the extraordinary gift of pain, which the rest of the world usually takes for granted, it was because of his compassion for people. He could see within each person he treated not just a broken body that felt no pain but also a broken spirit full of pain.

The greatest tribute about his passionate commitment and compassion for people has come from Eddie Askew, his long-time friend and colleague at the Leprosy Mission. Askew said: "From his work many thousands of individual lives have been transformed and enriched... it wasn't 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 patient's face, looked into the eyes. Paul was concerned for the individuals, their personalities, acknowledging and valuing our common humanity."

Those who knew him noted how he conducted himself with great dignity and humility, and had a great sense of humour. He would brush aside any comment that he had done something outstanding. His treatise, Clinical Mechanics of the Hand, is still regarded as the authoritative word on reconstructive surgery and hand problems - the premier handbook for hand surgeons, physiotherapists and other hand specialists. Dr. Brand authored 100 scientific papers and six other books. He co-authored three inspirational books with Philip Yancey, Fearfully and Wonderfully Made, In His Image, and Pain - The Gift Nobody Wants. Incidentally, Dorothy Clarke Wilson who authored his biography Ten Fingers for God died earlier this year.

Dr. Brand is survived by his wife, their six children, and 12 grandchildren.

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