Wednesday, November 7, 2007

Paul Brand, MD (1914-2003)

There is a wonderful essay on pain, "Pain and Suffering", written by T over at her blog, Notes of an Anesthesioboist. Emilyoboe left a comment "have you read The Gift of Pain (alternately titled Pain: the Gift No One Wants) by Paul Brand and Philip Yancey? I think you might enjoy it, it relates a lot to what you're also saying about pain." These were my source of inspiration for this post. (photo credit)

I actually got to meet this wonderful man, Dr. Paul Brand. I was in such awe that I could hardly speak. I was doing a Flexible Internship at Earl K Long Hospital in Baton Rouge, Louisiana. They allowed me to do a hand surgery rotation with Dr. Ronnie Matthews. He was a friend (and student) of Dr. Brand's. He took me with him when he went to Carville to watch the two of them do some tendon transfer surgeries and see patients in the clinic there. Carville was the location of the US Public Service Hospital for Hansen's Disease patients. For over a century, from 1894 until 1999, Carville was the site of the only in-patient hospital in the continental United States for the treatment of Hansen's disease, the preferred designation for leprosy. It is now the site of the National Hansen's Disease Museum (photo credit and website link).

Dr. Paul Brand was born to missionary parents (Jesse and Evelyn "Granny" Brand) and lived in Southern India until he was sent home at age 9 yrs to the United Kingdom for education. His father died in 1928 of malaria after Paul's return to the UK in 1923. Dr. Brand trained in Medicine at University College Hospital during the Second World War, and later gained his surgical qualifications while working as a casualty surgeon in the London Blitz. He meet his wife Margaret while at medical school. She was an ophthalmologist.

In 1946, he was invited to join the staff of the Christian Medical College & Hospital in Vellore, India. 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.

After a visit to the Leprosy Sanatorium at Chingleput, Dr. Brand was motivated to explore the reasons for the deformities developed in those with Hansen's Disease. Through his research in South India, Dr Brand forever changed the world’s perceptions and treatments of leprosy-affected people:

  • First, he pioneered the then 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, pain-deprived 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. His wife 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 1950, with a donation from a missionary woman, Dr. Brand established the New Life Center, Vellore, as a model rehabilitation center for Hansen's Disease patients. The center was a village environment located at the residential area of the Christian Medical College campus. This helped 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, he moved to the United States on invitation to take up the position of Chief of Rehabilitation Branch at the National Hansen's 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. Dr. Brand also popularized the technique of serial casting for the finger deformities (flexion contractures) that often result from Hansen's Disease, a technique that is now widely used by hand therapists to treat contractures due to many different hand injuries and conditions. 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.

His appreciation of the importance and value of pain is well described in his book 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. I think I gained some of this appreciation for pain from him and his book. I don't (except in surgery) want my newly post-surgery patients to be completely pain-free while healing. I want them to use that pain to protect themselves from over-activity. I want to ease their post-surgery pain, not erase it.

References

THE LEPROSY MISSION, A Legend has passed into history Dr Paul Wilson Brand - 1914-2003 Obituary by Ms Janet Walmsley

Dr Paul Wilson Brand – 1914-2003; An Extraordinary, Gifted Orthopaedic Surgeon who Straightened Crooked Hands and Unravelled the Riddle of Leprosy

Dr. Frank Duerksen, a Leprosy Surgeon--an interview, influenced by Dr. Paul Brand

4 comments:

T. said...

What a terrific introduction to Dr. Brand and reminder of how medicine can truly be put to the service of the most despairing in our human community. Thank you for writing this piece! I gotta go find me that book!

Vijay said...

Wonderful post RLB. I've been to Karigiri, the place where he did most of his work, but I did not know about Dr. Brand before I read this.

FtSrgn88 said...

I had the opportunity to hear Paul speak at Montefiore Hospital and later to learn total contact casting from him. I just thought about him and went to the internet for an update on him. This came up as a patient of mine with sarcoidosis developed neuropathy from the Leprosy medication dapsone.

Doctor Brand was a wonderful physician and human being. He will surely be missed.

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