Number of words: 509

Paul Brand’s main purpose in coming to the Christian Medical College and Hospital at Vellore was to see whether he might be able to apply his highly developed skills in reconstructive surgery to the special problems of lepers. Commonly, lepers’ fingers tend to “claw” or partially close up because of the paralysis of vital nerves controlling the muscles of the hand. Brand wanted to try to reactivate the fingers by connecting them to healthy nerve impulses in the leper’s forearm. This would require, of course, reeducating the patient so that his brain could transmit orders to the lower forearm instead of the hand for activating the fingers. He wasn’t at Vellore very long, however, before he realized he couldn’t confine himself to problems caused by the clawish hands of lepers. He would have to deal with the total problem of leprosy–what it was, how it took hold in the human body, how it might be combated. He immersed himself in research. The more he learned, the greater was his awareness that most of the attitudes toward leprosy he had carried with him to Vellore were outmoded to the point of being medieval. He became determined to pit the scientific method against the old mysteries of leprosy.

He was to discover that the prevailing ideas about “leprous tissue” were mistaken. Wrong, too, was the notion that missing toes or fingers or atrophy of the nose were direct products or manifestations of the disease. Most significant of all perhaps was his awareness that leprosy was a disease of painlessness.

As head of the research section, Paul Brand first needed to find out as much as he could about tissue from the affected parts of lepers. Medicine had long known that leprosy was produced by a bacillus somewhat similar to the organism that causes tuberculosis. This discovery had been made by Gerhard Henrik Hansen almost a century and a half ago; the term “Hansen’s disease” became synonymous with leprosy. As in the case of tuberculosis, the bacillus leprae produced tubercles. The leprosy tubercles varied in size from a small pea to a large olive. They appeared on the face, ears, and bodily extremities. It was commonly thought that the bacillus was responsible in some way for the sloughing-off of fingers and toes, and even of hands and feet. Yet very little had been done in actual tissue research. Was there anything in the flesh of finger stumps or toes that differentiated this tissue from healthy cells? Was the bacillus leprae an active agent in the atrophy? Dr. Brand put the pathologists to work. Through research, they came up with the startling finding that there was no difference between healthy tissue and the tissue of a leper’s fingers or toes.

One point, however, was scientifically certain: the bacillus leprae killed nerve endings. This meant that the delicate sense of touch was missing or seriously injured. But the flesh itself, Dr. Brand ascertained, was otherwise indistinguishable from normal tissue.

Excerpted from ‘Anatomy of an Illness’ by Norman Cousins, pg 106-109