Paul Wilson Brand
Authors: J. E Nash
Journal: BMJ (2003)

In 1946, when Paul Brand was only a few years out of medical school in London, he received an invitation that was to set him on the path to world renown as a hand surgeon and leprosy specialist. Robert Cochrane, who was then the world's foremost leprologist, asked Brand and his wife, Margaret, also a doctor, to join him at the Christian Medical College, in Vellore, Tamil Nadu, southern India. Cochrane challenged Brand to use his skills as an orthopaedic surgeon to explore why people with leprosy developed deformed hands—and to see if he could find an effective treatment.​treatment.




Figure 1




Brand spent years researching the cause and effect of the neuropathic limb and discovered that the ulceration and paralysis found in the later stages of leprosy were the result of anaesthesia and nerve damage. He pioneered a form of reconstructive surgery that transplanted tendons. This represented a leap forward in the rehabilitation of people with leprosy, showing that it was possible to overcome the paralysis of the intrinsics and restore the mobility of the so called “clawed hand.” It was largely because of Brand's work that the prevention of impairment and disability have become such an integral part of leprosy control programmes around the world.

Born in the mountains of south west India of missionary parents in 1914, Brand returned to the United Kingdom for his education at the age of nine. After qualifying in medicine during the second world war, Brand specialised in surgery, becoming a fellow of the Royal College of Surgeons and gaining experience as a war casualty surgeon at Great Ormond Street Hospital, treating victims of the Blitz. It was here that his interest in the human hand began.

In 1953 the Brands joined the staff of the Leprosy Mission International, and continued to develop their research and training work at Vellore and the newly founded Schieffelin Leprosy Research and Training Centre, Karigiri. In 1964 Brand was appointed as the International Leprosy Mission's director of surgery and rehabilitation, based in London.

In 1966 the Brands were invited by the United States Public Health Service to work at the National Leprosarium in Carville, Louisiana. Brand became chief of rehabilitation. For more than 20 years, he conducted research and taught surgery and orthopaedics at the Medical College at Louisiana State University. During this period he carried out extensive study on the biomechanics of the hand, the use of the total contact cast in the healing of plantar ulcers in the neuropathic foot, and the use of thermal mapping in the management of insensitive feet and stumps.

He also remained actively involved with international medical missions. He served on the World Health Organization's expert panel for leprosy and as medical consultant and then international president of the Leprosy Mission, from 1992 to 1999. He also cofounded the All-Africa Leprosy and Rehabilitation Training Centre (ALERT) in Addis Ababa, Ethiopia, and served on the board of the American Leprosy Missions.

In the mid-1980s, Brand retired and moved to Seattle, becoming clinical professor of orthopaedics emeritus at the University of Washington.

He wrote 100 scientific papers and seven books, including Clinical Mechanics of the Hand, a leading textbook for hand surgeons, physiotherapists, and other hand specialists.

He leaves Margaret, a leprosy ophthalmologist; five daughters; a son; and 12 grandchildren. Memorial services will be held in Seattle on 2 August and in London at the end of September.

Paul Wilson Brand, orthopaedic surgeon (b southern India 1914; q London 1943; CBE, FRCS), died on 8 July 2003 from complications related to a subdural haematoma.