The big pioneers
Most authors who write about leprosy cannot avoid mentioning the Bergen consultants Daniel Cornelius Danielssen and Gerhard Armauer Hansen, as well as the Norwegian leprosy registry (1, 12, 13). References to the pioneers in leprosy surgery are, however, scarcer.
For those of us who have worked in reconstructive surgery of the extremities, it is impossible to discuss the history of our field without mentioning the two great Bs: Sterling Bunnell and Paul Brand.
For those of us who have worked in reconstructive surgery of the extremities, it is impossible to discuss the history of our field without mentioning the two great Bs: Sterling Bunnell and Paul Brand
Sterling Bunnell (1882–1957) was considered the 'founder of hand surgery'. During World War II, he was tasked with establishing ten regional hand surgery units for the many tens of thousands of American soldiers with hand injuries. About one-third of the combat-related injuries involved the hands. Bunnell's voluminous textbook from 1944, Surgery of the Hand, laid the foundation for hand surgery as a surgical specialty.
Professor Paul Brand (1914–2003) is a towering figure in leprosy surgery. He was an exceptionally gifted individual, as a craftsman, surgeon and researcher, and above all, he had deep compassion for every patient. As a missionary child in India, he was sent back to England at the age of nine to attend school. He trained as a carpenter and engineer before pursuing medical studies and qualifying as a specialist in orthopaedic surgery. He later returned to India, where he dedicated most of his life to leprosy surgery and was a true pioneer in the field.
Brand was the first to attempt reconstructive surgery for leprosy. He first had to demonstrate that the patients had normal healing ability and that the surgical wounds healed properly, which some of those in authority doubted. This was an absolute prerequisite for any surgical intervention. Over time, he developed techniques such as tendon transfers to correct claw hand deformities and the lack of thumb opposition. His hand surgery textbook Clinical Mechanics of the Hand (1985) was groundbreaking work that was appreciated by hand surgeons worldwide. Brand also worked extensively on designing appropriate footwear and finding suitable materials for numb and deformed feet. He also developed tendon transfer techniques to correct patients' lack of ankle dorsiflexion. These techniques are now used worldwide for other neurological disorders and for injuries from foot drop (8). In 1966, Brand was headhunted to Louisiana, where he was appointed head of the United States' only leprosy hospital, The National Leprosarium, in Carville. He also took up a professorship at the University of Washington (14).
The Danish plastic surgeon Johannes Andersen (1922–2005) was one of Paul Brand's trainees, and he continued Brand's work with service in countries such as India, Nepal, Tanzania, Kenya and Ethiopia. He defended his thesis on leprosy in Denmark (15). At the ALERT Hospital (All Africa Leprosy Rehabilitation and Training Centre) in Addis Ababa, he was succeeded by one of the authors of this article (Paul Egil Gravem).