Free Anatomy of an Illness as Perceived by the Patient by Norman Cousins Page A

produced tubercles. The leprosy tubercles varied in size from a small pea to a large olive. They appeared on the face, ears, and bodily extremities. It was commonly thought that the bacillus was responsible in some way for the sloughing-off of fingers and toes, and even of hands and feet. Yet very little had been done in actual tissue research. Was there anything in the flesh of finger stumps or toes that differentiated this tissue from healthy cells? Was the bacillus leprae an active agent in the atrophy? Dr. Brand put the pathologists to work. Through research, they came up with the startling finding that there was no difference between healthy tissue and the tissue of a leper’s fingers or toes.
    One point, however, was scientifically certain: the bacillus leprae killed nerve endings. This meant that the delicate sense of touch was missing or seriously injured. But the flesh itself, Dr. Brand ascertained, was otherwise indistinguishable from normal tissue.
    As is often the case in medical research, some of Paul Brand’s most important discoveries about leprosy came about not as the result of systematic pursuit but through accident. Soon after arriving in Vellore he observed the prodigious strength in lepers’ hands. Even a casual handshake with a leper was like putting one’s fingers in a vise. Was this because something in the disease released manual strength not known to healthy people?
    The answer came one day when Paul Brand was unable to turn a key in a large rusty lock. A leprous boy of twelve observed Dr. Brand’s difficulty and asked to help. Dr. Brand was astonished at the ease with which the youngster turned the key. He examined the boy’s thumb and forefinger of the right hand. The key had cut the flesh to the bone. The boy had been completely unaware of what was happening to his fingers while turning the key.
    Dr. Brand had his answer at once. The desensitized nerve endings had made it possible for the child to keep turning the key long past the point where a healthy person would have found it painful to continue. Healthy people possess strength they never use precisely because resistant pressure causes pain. A leper’s hands are not more powerful, he reasoned; they just lack the mechanism of pain to tell them when to stop applying pressure. In this way serious damage could be done to flesh and bone.
    Was it possible, Dr. Brand asked himself, that the reason lepers lost fingers and toes was not because of leprosy itself but because they were insensitive to injury? In short, could a person be unaware that, in the ordinary course of a day’s activity, he might be subjecting his body to serious physical damage? Paul Brand analyzed all the things he himself did in the course of a day—turning faucets and doorknobs, operating levers, dislodging or pulling or pushing things, using utensils of all kinds. In most of these actions, pressure was required. And the amount of pressure was determined both by the resistance of the object and the ability of his fingers and hands to tolerate stress. Lacking the sensitivity, he knew, he would continue to exert pressure even though damage to his hands might be incurred in the process.
    He observed lepers as they went about their daily tasks and was convinced he was correct. He began to educate lepers in stress tolerance; he designed special gloves to protect their hands; and he set up daily examinations so that injuries would not lead to ulceration and to disfigurement, as had previously occurred. Almost miraculously, the incidence of new injuries was sharply reduced. Lepers became more productive. Paul Brand began to feel he was making basic progress.
    Some mysteries, however, persisted. How to account for the continuing disappearance of fingers, in part or whole? Why was it that parts of fingers would vanish from one day to the next? Were they knocked off? There was nothing to indicate that bones of lepers were any more brittle than the bones