And the leper in whom the plague is, his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean.
Of all the ancient plagues, perhaps none has instilled greater fear—and misunderstanding—than leprosy. Now called Hansen’s disease—or HD—leprosy is caused by an infectious microorganism which attacks the nerves and desensitizes the skin. “In India,” says Dr. Paul Wilson Brand, 63, a world-renowned expert on the disease, “leprosy is called ‘the creeping death’ because people see fingers and toes, hands and feet slowly vanishing. They see a man with big ulcers on his legs and bare bone sticking through. He pays no attention because he cannot feel the pain, and this horrifies people.”
Dr. Brand has spent the larger part of his career dispelling the stigma of leprosy. Drugs like DDS and rifampin have been effective in arresting the disease, and deformities can often be corrected by surgery. “After the medicine treatment is begun, as far as we can tell, the disease is no longer contagious,” Brand says. Still, he argues with the widely held notion that HD has been conquered. “It is shocking, but there was more leprosy worldwide in the 1960s than in the 1950s,” he reports. An estimated 15 million people have the disease, more than 3,000 of them in the U.S. Brand and other scientists are especially alarmed by what may be a new strain of drug-resistant leprosy-producing bacteria.
Many of the 150 or so new cases detected each year in this country are treated at a sprawling (100 buildings, 325 acres) Public Health Service hospital at Carville, La. (The only other U.S. leprosarium is in Hawaii.) Dr. Brand joined Carville’s staff in 1966 and is chief of its rehabilitation branch. Born in India of English missionary parents, he originally intended to be a house builder. But in his early 20s Brand took a short course in first aid which pointed him toward medicine (“I got excited at the potential for helping people”). As it turned out, his study of carpentry proved useful in his specialty: orthopedic surgery. “Bones and wood are very similar, and knowing how to design joints and fixtures has undoubtedly helped me.”
At London’s University College Hospital he met—and later married—Margaret Berry (“Most romantic,” she says drolly of their courtship in the chemistry lab). He returned to India in 1946 to teach surgery; she joined him and later specialized in ophthalmology. They also reared six children.
He remembers with painful clarity his first meeting with an HD victim. “I put my hand in his and asked him to squeeze. I expected a twitch, but he almost broke my fingers because he could not control his hand properly. He obviously did not realize he had hurt me and, all in a flash, I found the whole secret of leprosy—the grotesque deformities are not caused directly by the disease but by the absence of pain. Not feeling pain, a patient puts his hand on a hot stove and it burns away.”
Brand’s rehabilitation includes surgery to relieve the contraction of hand and foot muscles, which is a frequent symptom of HD. He also trains patients to avoid dangerous situations (“Wear new shoes only a few hours, cook only with pots with wooden handles”). From Carville both Drs. Brand travel widely in their medical specialties; his honors, affiliations and publications fill seven typewritten pages.
“The disabilities and deformities of leprosy are not inevitable,” Paul Brand says. “Patients can be returned to society as independent, wage-earning, taxpaying citizens. That’s really my angle on leprosy today.”