When Paul studied a thermograph and noticed hot spots on the readout, he could stop further damage or infected ulcers from rupturing the skin. The thermography machine became an effective tool in early detection and treatment of tissue.
Although thermography was a useful tool, it did not answer Paul’s burning question: Why could a normal person walk for an hour or more and suffer no damage to his or her feet, when a leprosy patient, even one who had undergone corrective foot surgery, doing the same would almost always end up with tissue damage and ulcers? That is where Paul came up with the idea of slipper socks to help him unlock the mystery.
Paul approached a chemical company to produce small microcapsules containing dye. The microcapsules had a skin of heavy wax that with constant pressure would ultimately break down and release the dye. These microcapsules were then impregnated into foam socks that a person slipped onto his or her feet, hence slipper socks. Once the chemical company perfected the microcapsules, Paul had a machine built at Carville to produce them, and then the leprosy patients got to work making slipper socks.
As a person walked in the socks, microcapsules would rupture at pressure points on the feet, and the dye would be released into the foam, turning blue as it did so. The more microcapsules that ruptured, the darker the blue dye. After testing the socks with his staff, Paul was satisfied that they worked as they were supposed to, and he went to work on his research. One of the physical therapists at the hospital volunteered to walk eight miles around the concrete-floored corridors of the institution. After every two miles he would change his slipper socks, and Paul would take a thermograph of his feet.
At the end of the experiment, Paul was fascinated by the results. After two miles, it was clear from the thermograph and the dye on the socks that the pressure points had been on the big toe and the inner edge of the physical therapist’s foot. However, after the next two miles, the pressure points had shifted to the outside of the foot. For each of the four thermographs and socks, there was a different pressure point on the foot. While he did not make any of his leprosy patients walk the eight miles to repeat the experiment, Paul had enough of his patients wear the slipper socks that over time he began to clearly see what was going on. It was clear from the physical therapist’s results that as he walked, he was changing his gait to relieve pressure points on the feet and avoid blisters and tissue damage. Paul realized that he himself did the same thing when he walked, not consciously but subconsciously. As the nerves sent pain signals to the brain, the brain would adjust his gait to alleviate the pain signals and shift the load to other pressure points. It was a simple and natural process to avoid injury to the feet.
As Paul examined the slipper socks of leprosy patients, he saw that the patients never altered their gait, no matter how far they walked. They walked on the same pressure points on their feet, and this led to tissue damage and the formation of ulcers. Because of nerve damage, no nervous system process allowed them to respond to pain signals and adjust their gait. And with no pain signals getting through their nerves to the brain, the brain was mistakenly led to believe that their feet were injury free.
This was a moment of clarity and understanding for Paul, much like when he came to understand why nerve swellings occurred at particular points in the body of leprosy sufferers. The leprosy bacilli preferred cooler temperatures to multiply, and they found such temperatures where the nerves ran close to the surface of the skin, such as above the elbow, at the ankles, knees, and wrists, and on the cheeks. To combat the growing population of leprosy bacilli at these locations, the body sent in armies of antibodies to attack and kill the bacilli. In the process, these antibodies caused swelling inside the sheath surrounding the nerve. The constricting effect of this swelling slowly cut off the supply of blood and killed the nerve. In the end, the leprosy bacilli did not cause the swelling. Rather, the swelling came as a result of the body’s immune system trying to fight them off and in the process, killing a perfectly good nerve.
While Paul was grateful for the financial support his research received from the U.S. Department of Health, Education, and Welfare, the country’s economy was worsening. More and more newspaper headlines were about some new government budget cut. With fewer than six thousand Hansen’s disease patients in the United States, the argument was made that the research being done at Carville was not benefiting many Americans and was, in fact, benefiting more foreign sufferers of the disease. As a result, the U.S. government could no longer justify paying for such research. Paul sensed that it would not be long before he had to shut down some of his research projects.
Something wonderfully unexpected happened, however. One night while Paul was flipping through a medical journal, two words jumped out at him—diabetic osteopathy. Since osteopathy had to do with bones, Paul wondered what diabetes, a disease affecting the metabolizing of glucose in the body could possibly have to do with bones? As he read the article, he was amazed to see pictures of X-rays of the feet of diabetics that looked just like the X-rays of the feet of leprosy patients. The two authors of the article were based in Houston, Texas. When Paul contacted them, they invited him to come to Texas to discuss the topic with them.
The two doctors were intrigued as Paul showed them X-rays of leprosy patients’ feet that were almost identical to the X-rays they had of diabetics’ feet. Paul realized that diabetes itself was not causing the foot problems. Like leprosy, though from a different cause, diabetes caused nerve damage. Without the sensation of pain in their feet, diabetic patients did not care for their feet properly. This was the same problem that leprosy patients experienced with their feet.
The doctors invited Paul to address the next meeting of the Southern Sugar Club, a group of diabetes experts from the southern states who met regularly to discuss the latest research on the disease. At the meeting Paul presented his ideas about the similarities in the causes of foot problems between leprosy patients and diabetic patients.
Although his address to the Southern Sugar Club was well received, Paul knew that many of those present did not believe him. Many doctors told Paul that he didn’t understand. Even if he was right about nerve damage causing the problem, diabetic flesh would not heal, because of the lack of blood in the extremities. Paul felt like he was back at Vellore. It was the same old “bad flesh” argument he had heard so often regarding leprosy and which he knew was wrong. Already several diabetics had visited the foot clinic at Carville. Paul knew from thermographs of their feet that they still had enough blood flow in their extremities to heal from the ulcers on the soles of their feet.
Several months later, Paul received a call from Dr. John Davidson in Atlanta. Dr. Davidson explained that he had been at the Sugar Club meeting and had been skeptical of what Paul had said. Nonetheless, because of Paul’s talk, he had employed a podiatrist at his diabetes clinic in Atlanta to examine the feet of patients when they came for a checkup. Much to his surprise he found that most of them had some kind of foot problem along the lines of what Paul had laid out in his talk. Also much to Dr. Davidson’s surprise, in the previous year, 150 of his patients had received foot amputations, most of which he had not known about. Dr. Davidson explained that his patients came to him to have their insulin checked and to give blood and urine samples, but because they did not think he was interested in their feet, they said nothing about any foot problems they were having. When a patient did have a foot problem, he or she went to a foot specialist. Once the specialist realized that the patient was a diabetic, he or she would give up hope of the patient’s foot healing and would order an amputation.
Armed with what Paul had told him at the Sugar Club and with a podiatrist now on staff at his clinic, Dr. Davidson was able to catch foot problems at an early stage before they had a chance to fester into much bigger problems. In fact, Dr. Davidson was so impressed with Paul’s insights into the problem of diabetic feet that he asked Paul to prepare a chapter on the subject for a textbook he was writing on diabetes. He even sent his entire staff to Carville for special training from Paul and his team.
It wasn’t long before word got out that the research being done by Paul at his foot clinic at Carville had more far-reaching applications than just to leprosy patients. Diabetes was a growing problem in the United States. Instead of slashing his research budget, the Department of Health, Education, and Welfare increased it.
Nothing could have pleased Paul more. Paul was profoundly grateful that his and Margaret’s work at Carville could continue. As the years rolled by, one by one the children finished school and embarked upon their own careers. Christopher became a zoologist; Jean, a church worker in India and England; Mary, a nurse; Estelle, a preschool teacher; Pauline, a journalist; and Patricia, a doctor. All of them except Jean married and set up homes in the United States. Estelle married a young Hawaiian man who had come to Carville as a patient and had been successfully treated by Paul. Soon, Paul and Margaret had assumed the role of grandparents to seven grandchildren.
The couple continued to travel the world, advising, teaching, and inspiring another generation of leprosy caregivers. In fact, their speaking calendar filled up at least two years in advance.
Each year in October, Paul returned to Vellore to see how things were progressing, share new research and insights with doctors there, and teach in medical college. In 1974 he made two visits to Vellore, one in March with his daughter Jean and his regular trip in October. On both occasions his mother made the trip down from her home in the hill country to see him. She was now ninety-five years old and thin and frail. As always, she was feisty and totally committed to serving the poor people of the hill country. Each time Paul had visited his mother, he wondered whether it would be for the last time. October 1974 was the time. After his departure from Vellore, Evelyn had returned to her home in the mountains, but a month later she had returned to Vellore sick and more frail than ever. She stayed with Dr. Ernest Fritschi and his wife, Mano, and died at their house on December 18, 1974.
Paul was sorry to hear of his mother’s death and wished he could have been there for the funeral. Now both his parents had died and been buried in India without his being there. Evelyn Brand’s body was taken to Vazhavanthi in the Kolli Hills. The funeral service was held in the chapel that Paul’s father had built years before, and her body was buried beside that of her husband. After forty-five years, Jesse and Evelyn Brand were once again side by side.
Although Paul had left the mission field to take up a secular position with the U.S. Public Health Service, his mission followed him. The Brands became active members in the Carville Protestant Chapel on the grounds of the leprosarium, where Paul often preached and held Bible studies. While Paul was content with that, his insights into Christianity from a medical viewpoint were about to be spread around the world. One day a young Christian writer named Philip Yancey came to hear Paul speak at the chapel and urged him to write a book. Paul confided that he had already written a manuscript but had never shown it to anyone. He went home to find it. He entrusted the manuscript to Philip, who took it and worked on it. Within months Dr. Paul Brand was on his way to becoming a best-selling author with the publication of his manuscript as the book Fearfully and Wonderfully Made.
