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

of normal people. If a leper cut off a finger while using a saw, or if a finger were somehow broken off, it should be possible to produce the missing digit. But no one ever found a finger after it had been lost. Why?
    Paul Brand thought about the problem. Then, suddenly, the answer flashed through his mind. It had to be rats. And it would happen at night, while the lepers were asleep. Since the hands of lepers were desensitized, they wouldn’t know they were being attacked and so would put up no resistance.
    Paul Brand set up observation posts at night in the huts and wards. It was just as he had thought. The rats climbed the beds of lepers, sniffed carefully, and, when they encountered no resistance, went to work on fingers and toes. The fingers hadn’t been dropping off; they were being eaten. This didn’t mean that all “lost” fingers had disappeared in this way. They could be knocked off through accidents and then carried away by rats or other animals before the loss would be observed. But a major cause of the disappearance had now been identified.
    Paul Brand and his staff went to work, mounting a double-pronged attack against the invaders. The program for rodent control was stepped up many times. Barriers were built around the legs of beds. The beds themselves were raised. The results were immediately apparent. There was a sharp drop in the disappearance of fingers and toes.
    All this time, Paul Brand kept up his main work—reconstructing hands, rerouting muscles, straightening out fingers. Where fingers were shortened or absent, the remaining digits had to be made fully operative. Thousands of lepers were restored to manual productivity.
    One of the grim but familiar marks of many lepers is the apparent decay of their noses. What caused the shrinkage? It was highly unlikely that the nose suffered from the kind of persistent injury that frequently affected the desensitized hands and feet. What about rats? This, too, seemed unlikely. Enough sensitivity existed in a leper’s face, especially around the mouth, to argue strongly against the notion of rodent assault.
    As Paul Brand pursued the riddle, he became convinced that neither injuries nor rats were involved. Finally, he found his answer in his research on the effect of bacillus leprae on the delicate membranes inside the nose. These membranes would contract severely in lepers. This meant that the connecting cartilage would be yanked inward. What was happening, therefore, was not decay or loss of nasal structure through injury. The nose was being drawn into the head.
    It was a startling discovery, running counter to medical ideas that had lasted for centuries. Could Brand prove it? The best way of proceeding, he felt, was by surgery that would push the nose back into the face. He therefore reconstructed the nose from the inside. It was a revolutionary approach.
    He knew that the operation couldn’t work in all cases. Where the leprosy was so far advanced that membrane shrinkage left little to work with, it was doubtful that the operation would be successful. But there was a good chance that, in those cases where the disease could be arrested and where the shrinkage was not extreme, noses could be pushed back into place.
    The theory worked. As a result, the nose restorative operation developed at Vellore has been used for the benefit of large numbers of lepers at hospitals throughout the world.
    Next, blindness. Of all the afflictions of leprosy, perhaps none is more serious or characteristic than blindness. Here, too, it had been assumed for many centuries that loss of sight was a specific manifestation of advanced leprosy. At Vellore, this assumption was severely questioned. Intensive study of the disease convinced Paul Brand and his fellow researchers that blindness was not a direct product of leprosy but a by-product. A serious vitamin A deficiency, for example, could be a major contributing cause of cataracts and consequent