Paul Brand – Missionary and Pioneer

At this year's Desert Foot Multidisciplinary High Risk Foot Seminar (Nov 16- 18, AZ Grand Resort in Phoenix) we will be honoring a true legend with the inauguration of our Annual Paul Brand Memorial Lectureship. Some of you may have no idea who this remarkable man was (even though you all practice with the principles that he taught us). If you treat a neuropathic foot, you are approaching that high risk foot with the guidance that Dr Brand offered over his many years of practice and writings.

Paul Brand, MD 7/17/1914 - 7/8/2003

Paul Brand, MD (July 17, 1914 - July 8, 2003)was a Christian Missionary working in Vellore, India at a Leprosy Mission for many years (1946-1966). A trained Orthopaedic Surgeon, Dr. Brand, who grew up the son of English missionaries to South India, achieved world renown for his research on leprosy and related research on the dynamics of pain. He was a pioneer in developing tendon transfer techniques for use in the hands of those with leprosy (Hansen's Disease). He was the first physician to appreciate that leprosy did not cause the rotting away of tissues, but that it was the loss of the sensation of pain which made sufferers susceptible to injury. Brand contributed extensively to the fields of hand surgery and hand therapy through his publications and lectures, and wrote popular autobiographical books about his childhood, his parents' missionary work, and his philosophy about the valuable properties of pain.

His book, Pain: The Gift Nobody Wants, one of several of his reflections on physiology, combines autobiography, stories of research, and reflections on pain and pain management. Indeed, still today we hear renowned lecturers use that same term to describe the affliction of diabetic persons with neuropathy — and how that loss of protective sensation robs them of the "gift of pain" that can protect their limbs from injury.

In 1966, after 19 years of service in India, he moved to the U.S.A. to become the Chief of Rehabilitation Branch at the National Hansen’s Disease Center at Carville, Louisiana. 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. During his time in Carville, he trained a number of podiatrists, physicians, and physical therapists and became well known for his understanding of neuropathic injuries to the lower extremities in leprosy as well as diabetic patients. He also introduced the concept of moderate repetitive stress (through his experiments on the footpads of mice) as the underlying etiology for the majority of neuropathic foot lesions.

His methods for prevention and management of plantar ulcers have subsequently been widely adopted for treatment of patients with diabetes mellitus. Brand reintroduced and popularized the Indian technique of total contact casting for effective offloading of the ulcerated neuropathic foot.

I first met Dr. Brand in 1978 as a new practitioner when I visited him in Carville to learn of his theories and principles. When he retired in 1986 from the U.S. Public Health Service, he moved to Seattle and continued his teaching as  Emeritus Professor of Orthopaedics at the University of Washington. I again met him in Atlanta in 1996 at the American Diabetes Association Meeting, where he was awarded the prestigious Roger Pecoraro Award from the Foot Care Council, which I had the great honor to receive this year.  His lecture on the Biomechanics of the Insensitive Foot was a stirring account of his life and research on neuropathic deformities and injuries. The lecture certainly warranted the standing ovation that he received after its delivery!  My final encounter with Dr Brand was at the APMA National Meeting in Seattle in 2002, where he also was a guest speaker.  The photo attached was taken at that meeting where you can see Paul Brand flanked by a much younger me (right) and the world renowned diabetic foot expert, Professor Andrew Boulton of Manchester, U.K.

Professor Andrew Boulton, Paul Brand and yours truly, Robert Frykberg at the APMA National Meeting in Seattle in 2002

It is most fitting that Professor Boulton receives the inaugural lectureship award named after Paul Brand this November 17th at our Desert Foot Meeting (AZ Grand Resort, Phoenix, AZ)..  No one has taken up the mantle for the diabetic foot better than Andrew Boulton.  More than any other person today, he is truly the International Ambassador for the Diabetic Foot around the Globe.  Traveling to practically every Continent each year, Andrew tirelessly spreads “the Gospel” about the management of the neuropathic diabetic foot.  Also a student and colleague of Dr Brand, Professor Boulton frequently mentions the “Gift of Pain ” as espoused by Dr. Brand in his lectures on neuropathy and diabetic foot disorders.  The recipient of numerous accolades and awards for his work in this regard, Dr. Boulton has also been the recipient of the ADA’s Roger Pecoraro Award and the DFCON’s Edward Olmos Award.  

Please join us for this inaugural event as we honor both Paul Brand, MD and Andrew Boulton, MD during the proceedings of the 8th Annual Desert Foot Multidisciplinary High Risk Foot Symposium. I look forward to welcoming you there.Best regards,

Robert Frykberg, DPM, MPH
PRESENT Editor, 
Diabetic Limb Salvage

Comments:

Marni says:
December 18, 2011 at 12:12 am
Great hammer of Thor, that is powrfeully helpful!

Marni says:
December 18, 2011 at 12:12 am
Great hammer of Thor, that is powrfeully helpful!