|MEDICAL HISTORY PAGE
|Year : 2015 | Volume
| Issue : 1 | Page : 98-100
A tribute to Dr. Paul Wilson Brand 'A Gift of God'
Jagannath B Kamath, Nikil Jayasheelan
Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
|Date of Web Publication||8-Dec-2014|
Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore - 575 001, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kamath JB, Jayasheelan N. A tribute to Dr. Paul Wilson Brand 'A Gift of God'. Muller J Med Sci Res 2015;6:98-100
The world will remember and sadly celebrate the year 2014 as the hundredth anniversary of the First World War, but for the medical fraternity, it is also the year of the birth centenary of a legendary, iconic, and holistic surgeon, who fought a war against leprosy, which was no less important for mankind. The worst part of the misery related to leprosy may be behind us, but the men who laid the foundation of conquering leprosy will always remain immortal. It is time we revisit history and pay rich tributes to Dr. Paul Wilson Brand, who single handedly taught the entire world to look at the problem of leprosy through a prism of optimism.
Dr. Paul Wilson Brand was born in the hidden hill station, a small mountain range in South India - Kolli Hills Ϳ now situated in the Namakkal District of Tamil Nadu, to a missionary couple (Jesse and Evelyn 'Granny' Brand), who practised rural medicine.  At the tender age of nine, the senior Brands thought it appropriate to send him to the United Kingdom for higher studies. Paul who initially ventured into carpentry, (an art that he later put into practice when treating his patients with Hansen's disease) realized that his true calling was the medical profession. The University College Hospital, London, in addition to training him also gifted him with the first reward of his life, Margaret Berry, a classmate, who went on to become his life partner and a renowned ophthalmologist, with a special interest in deformities in the eye, in leprosy. During the end of the Second World War, Dr. Paul Brand, with an adequate qualification, served for a short while, treating not only the wounded soldiers of the war, but also the children afflicted with poliomyelitis, at the Great Ormond Street Childrens Hospital, where he was exposed to reconstructive tendon transfer surgeries. His hunger for knowledge helped him to complete his Fellow of the Royal College of Surgeons (FRCS) degree in the year 1945. Then came the turning point of his life, when he was invited to join the Christian Medical College (CMC), Vellore, by a senior physician and a leprologist, Dr. Robert Greenhill Cochrane (who went on to become the Principal of that prestigious institution), in the year 1946. He joined the CMC Vellore, initially as a general surgeon and later after a year as an orthopedic surgeon. His curiosity and the proximity to Dr. Robert Cochrane (popularly called Bob uncle) led him to the Leprosy Sanitarium in Chengelpet, run by the churches of Scotland, where he was exposed to leprosy and its devastation. His keen interest in the topic forced Dr. Cochrane to challenge him to dwell into the depth of the causation of deformities in leprosy. Unable to communicate in the local language, Dr. Paul gave a friendly pat to a patient, and the response from the patient was a tearful joy, for no one had touched him for years. Such was the pathetic distress of the patients suffering from leprosy. It was this anecdote and the challenge thrown to him by Dr. Robert Cochrane that sowed the seeds for an enormous research, culminating in erasing the myth of infection being the primary cause of deformity and mutilation in leprosy. Dr. Paul proved convincingly that it was the lack of a protective sensation that led to overuse and abuse of the hands and feet, ultimately leading to auto or surgical amputation. With the encouraging results of the then newly described drug Ϳ sulfone Ϳ and the better understanding of the lack of sensation as the primary cause of the deformity in leprosy, it was recognized that the problem of leprosy was not only curable, but also preventable. The patients were not only medically treated, but also socially addressed and integrated into the main stream. During his 19 years of stay (till 1966) and association with the CMC Vellore, Dr. Paul had not only corrected more than 3000 deformities involving the hands and feet due to leprosy, but had also established a department and a center for the holistic treatment of patients afflicted with leprosy, which was similar to a well-oiled machine. He had emphasized that pre- and postoperative therapy was an integral part of the surgical protocol in Hansen's disease.
As per the law of nature, if a challenge is very well accomplished and the accomplishment is near complete, one gets many more challenges, sometimes tougher. Dr. Paul followed this law, as he was offered the position of Chief of the Rehabilitation Branch of the National Hansen's Disease Center, at Carville, Louisiana, USA, to shoulder the responsibility there. This was the only center in the country dedicated to the study of Leprosy. It was a bigger call for a greater purpose. His role in the new place was more of a research on the problem of neuropathic lesions in the hands and feet, due not only to Hansen's, but also to other diseases, such as diabetes. What he did in Vellore for leprosy, he did in Carville for diabetes. The result was again magical, with the introduction of several offloading devices for the diabetic feet, in the form of a total contact cast, innovative customized footwear, insoles, and metatarsal bars. His passion for this topic was so great that he converted his wealth of knowledge into his last publication (a chapter on Thermal changes in feet in a monogram on Diabetic foot Ϳ a clinical atlas) just few months before his death, at the age of 88. In the year 1986, when he retired from the US Public Health Service, he moved to Seattle to take up a new assignment, as Clinical Professor Emeritus of Orthopedics in the University of Washington.
This well-deserving teacher, surgeon, researcher, and above all a wonderful human being, was bestowed with several honors during his path along his glorious journey. To name a few, he was selected as a Hunterian Professor of Royal College of Surgeons, in 1952, Lasker Award in 1960, Commander of the order of the British Empire in 1961, awarded by none other than Queen Elizabeth, President of Leprosy Mission International, London, Chief of the Panel of Experts on leprosy, World Health Organization (WHO), Founder member of the All Africa Leprosy Rehabilitation Center in Adis Ababa, Ethiopia, and the Schieffein Leprosy Research and Training Center at Karigiri, India. None of these honors diluted or changed his focus on the projects he was involved in.
He used his pen with the same ease as he used his scalpel. Being a good orator and a writer, he had more than a 100 scientific publications and was the author of seven books, the most popular one was 'The Clinical Mechanics of the Hand,'  considered as a bible for hand surgeons and hand therapists. He co-authored three inspiring books with a close associate of his, Mr. Philip Yancy, which were named, 'Fearfully and Wonderfully made', 'In His Image,' and 'The PainͿThe Gift No Body Wants'. Dr. Paul Brand himself was a subject of Dorothy Clarke Wilson's biography, 'Ten Fingers for God'.
He has shared the important lessons that he learnt with others in his book, 'The pain Ϳ The Gift No Body wants,' published in 1993, which had to be republished due to popularity, in the year 1997, as 'The Gift of Pain'. Dr. Paul Brand, in that book, as a lateral thinker, saw the good side of pain and highlighted the importance of pain and its protective role in normal healthy individuals. Absence of pain in Hansen's, Diabetes, and Congenital absence of pain, would result in a devastating effect on the extremities, which was better prevented than cured. It is quite astonishing that Dr. Paul Brand recalls his first tendon transfer surgery ever done on a patient with Hansen's Disease very clearly in his book when unfolding the surgical details Ϳ the nervousness he felt while opening the bandage following the surgery and the smile on the face of his first patient, by name Mr. Krishnamurthy, when he moved his thumb postoperatively Ϳ all after a period of some 45 years, when he first published the book, in the year 1993. A fine surgeon and a keen hand therapist himself, he did not forget to acknowledge the physiotherapist Mr. Ruth Thomas profusely. He also described the visit of Prof William White, a renowned plastic and reconstructive surgeon from Pennsylvania, who demonstrated a surgical procedure. He described how it was a learning experience for the entire team at Vellore.
For a man who understood so much about the importance of pain, the end came painlessly for him, as he developed a minor stroke on 29 May, 2003, and had a fall from the staircase on 19 June, 2003, which resulted in a subdural hematoma. A surgery for this did not help him regain his consciousness. He died at his home in Seattle on the 8 July, 2003, leaving behind his wife, six children, 12 grandchildren, and an ocean of well-wishers, friends, and patients transcending across the geographical boundaries.
If one goes through the life of Dr. Paul Wilson Brand, it is hard to miss that every event in his life had a specific purpose and his destination was in sync with his destiny. History will not pardon us if we remember him only for his technique of tendon transfers and reconstructive surgeries and miss his larger contribution in so many facets of prevention and treatment of deformities due to lack of sensation, whether it was due to leprosy or diabetes. As we are celebrating the birth centenary of Dr. Paul Wilson Brand during this year, it will not be out of context to also acknowledge the contribution of Dr. Robert Cochrane, who was instrumental in inviting, inspiring, challenging, and supporting Dr. Paul Brand for his monumental contribution and to bring about the 'The Brand Effect' in the field of Leprology.
I do not have words to sum up the story of Dr. Paul Brand, who believed that pain was a blessing or a Gift of God Ϳ a noble thought from a scientist, giving an insight into his spiritual and philosophical mindset. What made him different was probably that he observed and listened to his patients more than anybody else. That is a big enough lesson to follow for a life time.
| References|| |
Brand PW. Clinical Mechanics of the Hand. Maryland Heights, Missouri: Mosby; 1985.
Brand P, Yancey P. Pain: The Gift Nobody Wants. Grand Rapids, Michigan: Zondervan; 1993.