Paul Brand 1914-2003

Paul Brand was born in Ootacmund on the Nilgiri Hills in South India on 17 July 1914. He died on 8 July 2003. His parents were Jesse Brand of Guildford and Evelyn Harris of St John’s Wood, London. They had married and gone to work for the Strict Baptist Mission in the Kolli Hills, 150 miles from Madras, and there Jesse died from malignant malaria in 1929, but his mother believe that she had also had the call from God to India and so she lived and worked there for a further 47 years being buried next to her husband in December 1974 on the Kolli Hills. Her story has been told in the book, “Climb Every Mountain.”

There were two children, Paul and Connie, and they knew their father away for days at a time visiting mission stations where he had set up schools, clinics and agricultural projects. In the nights there might be a knock on the door and his Evelyn would be summoned away to care for a sick person. Paul would be left to look after Connie. Scorpions and snakes were a constant threat. Cheetahs would carry off their buffalo calves.

For their education the children were sent back to London where they were cared for by their mother’s family in London, many of whom worshipped God in the St John’s Wood Strict Baptist Chapel. For six years the children did not see their parents, during which time Paul attended the University College School in Hampstead. He was converted and joined the St John’s Wood congregation, and at 18 began to preach in different churches.

In 1930 Paul began a five-year building apprenticeship. He developed a cockney accent so that he would fit in better with his work mates. After his apprenticeship was over he felt the call to the mission field and in 1936 began missionary training in Norwood, but took the course for just one year. In 1937 he began his studies at University College Medical School in central London where he met his future wife Margaret Berry. They married in 1943.

During the bombing of London in the Second World War he dealt with the victims of the Blitz and it was during this time that he first developed an interest in the human hand. He was appointed surgical officer at the Great Ormond Street hospital for Sick Children in London and then assistant in the surgical unit at University College Hospital.

Once the war was over he was invited by the world’s leading authority on leprosy, Dr Robert Cochrane, to join him at the Christian Medical College Hospital at Vellore, Tamil Nadu, in southern India. Here most of their six children were born. It was also at Vellore that the Brands became aware of the anguish and isolation of people with leprosy.

“Never in my life had I seen so many stumps and claw hands,” he later recalled in his autobiography. “Shortened fingers pointed out at unnatural angles, while some lacked thumbs and digits altogether.” Paul was very perplexed, however, when he asked a patient to squeeze his hand: “Anticipating a weak twitch from paralysed muscles, I was astonished to feel a jolt of pain shoot through my hand. At the moment, I felt a sudden awakening. In this one man’s grasp I had proof that a useless hand contains live and powerful muscles.” Cochrane was a skin specialist, and no orthopaedic surgeon had ever studied leprosy, even though there were 15 million sufferers world-wide.

So if Paul could mobilise the still-functioning muscles and reattach them to the paralysed fingers, the leper’s hand could be made to work again. His suggestion was turned down. “They have bad flesh,” he was informed. “If you operate, the wound won’t heal.” But Paul typically persisted. He examined some 2,000 patients and discovered that paralysis was uniform and conformed to a precise pattern. There were always “good” muscles in the hands that had been unaffected by the disease. So his first operation, reattaching a tendon to a paralysed thumb, was gratifyingly successful for both doctor and patient. The wound healed well, and so it was a myth that those with leprosy had “bad flesh.” How, then, to account for the missing digits? Dr Brand next showed this to be a consequence of chronic infection of the bones from cuts and abrasions that went unnoticed because of the loss of sensation in the hand. Logically, them, meticulous attention to this slightest injury should prevent this process – as indeed it does.

In a few short years Paul Brand had overthrown the centuries-old belief in the hopelessness of trying to treat leprosy. He went on to created a full-scale hospital and research centre spread over 265 acres. He was the first surgeon in the world to use reconstructive surgical techniques to correct the deformities of leprosy in hands and feet. His original tendon transplantation, using a good muscle from the patient’s forearm, became known as the “Brand operation.”

Paul Brand’s work was not ended because his patients returned to say that their “healed” hands impaired their effectiveness as beggars. So he set up the New Life Centre where his patients were taught new skills before returning to the community.

In 1952 the Rockefeller Foundation in new York offered him a grant, enabling him to consolidate his work. He was also offered sponsorship by the British Mission to Lepers. As news of Brand’s success spread, leprosy patients began to arrive for all over southern India. By 1959 the first trainee surgeons were at Vellore and at the Schieffelin Leprosy Station at Karigiri where Paul attended clinics and carried out operations. By now some 5,000 reconstruction of hands and feet had been carried out at these two sites, of which Brand had personally performed about half.

In 1966, while his mother was still working in the Kolli hills and continued there for another eight years, Paul Brand was seconded to the US Public Health Service Hospital at Carville, Louisiana, a renowned centre for leprosy research. For more than 20 years, he taught surgery and orthopaedics at the Medical College at Louisiana State University. After retiring in the mid-1980s he moved to Seattle to become emeritus Clinical Professor of Orthopaedics at the University of Washington. He remained actively involved with international medical missions.

Dr Paul Brand’s main textbook is “Clinical Mechanics of the Hand,” the reference book for hand surgeons and specialists. In the introduction to one of this text books be describes going to hear Artur Rubinstein play Beethoven’s ‘Moonlight Sonata’ and realising that the co-ordinated movement of the muscles of the pianist’s fingers defied scientific explanation. “>From my own calculations, I know that the powerful arpeggios of the Third Movement are simply too fast for the hand to accomplish consciously,” he wrote. “The nerve impulses do not travel fast enough for the brain to sort out how the third finger has just lifted in time for the fourth to strike the next key.”

Dr Brand’s story has been told by Dorothy Clarke Wilson in the classic “Ten Fingers for God.” To hear Dr Brand speak you must read his own books, “Fearfully and Wonderfully Made”, but especially “The Forever Feast” which tells you a great deal about the man and his Lord. He co-wrote a number of books with Philip Yancey, and he recently said to him, “Because of where I practised medicine, I never made much money. But as I look back over a lifetime of surgery, the host of friends who were once patients bring me more joy than wealth could ever bring.”

Another fascinating book on the human hand has just appeared, written by Prof. Raymond Tallis of Manchester University, “The Hand, a Philosophical Inquiry Into Human Being” (Edinburgh University Press, £19.99, pbk.). He points out in the book that the hand does more than just grip and pinch: it “acts”, “knows” and “speaks”. It understands and explores the world through touch, and it has a vast repertoire of non-verbal forms of communication. “Through the ramifications of the hand,” he tells us, “we are led into the boundless oceans of the human world.” Without the hand there would have been no history, no buildings, music, painting or any of the artefacts of our civilisation. This is a book that tells us much about ourselves.

GEOFF THOMAS