Few institutions have had as profound an influence on the development of leprosy rehabilitation in India as the Schieffelin Institute of Health – Research & Leprosy Centre (SIHRLC) at Karigiri, near Vellore in Tamil Nadu.
Established in 1955, Karigiri became far more than a hospital for people affected by leprosy. It developed into an internationally recognised centre for research, reconstructive surgery, physiotherapy, occupational therapy, disability prevention and the protection of insensitive hands and feet.
Its history is particularly important to the prosthetics and orthotics profession because many of the principles now associated with pressure redistribution, protective footwear, splinting and rehabilitation of the insensate foot were developed, refined or disseminated through work carried out in and around Vellore and Karigiri.
From an Isolated Site to an International Centre
The driving force behind the creation of the institution was Dr Robert Cochrane, one of the leading figures in twentieth-century leprosy medicine.
Finding a suitable site was not easy. Fear and stigma surrounding leprosy meant that communities were often reluctant to have treatment centres nearby.
Eventually, land was obtained close to the village of Karigiri, approximately 15 kilometres from Christian Medical College in Vellore. At the time it was isolated land several kilometres from a usable road. The Government provided part of the site, while additional land was acquired with the involvement of organisations working in leprosy care.
The project was developed through cooperation between Christian Medical College Vellore, The Leprosy Mission and American Leprosy Missions.
Dr Ida Scudder, the founder of Christian Medical College Vellore, formally turned the first soil for the project on 6 September 1952. The institution was named in honour of William J. Schieffelin, then President of American Leprosy Missions, whose organisation helped fund the development.
The Schieffelin Leprosy Research Sanatorium formally opened on 20 June 1955.
At its beginning, Karigiri was remarkably modest: a hospital containing just 17 beds, a research laboratory, several staff houses and cottages for patients. Its mission, however, was ambitious — to study leprosy, treat its medical and surgical complications, develop effective approaches to control and rehabilitation, and train healthcare professionals.
The Influence of Paul Brand
Karigiri’s rehabilitation history cannot be separated from the pioneering work of Dr Paul Brand.
Working initially at Christian Medical College Vellore, Brand transformed understanding of disability caused by leprosy. He recognised that many of the devastating injuries seen in patients were not simply a direct destruction of tissue by the disease.
Loss of protective sensation was critical.
When patients could no longer feel pain, repeated pressure, friction, burns and minor trauma could occur unnoticed. Continued loading could turn a small injury into an ulcer, infection or severe deformity.
That understanding fundamentally changed rehabilitation.
Rather than simply treating wounds after they appeared, Brand and his colleagues increasingly concentrated on preventing injury by managing pressure, movement and mechanical loading.
Brand was instrumental in establishing reconstructive surgical work at Karigiri. His methods were subsequently developed further by surgeons including Dr Ernest Fritschi, Karigiri’s first resident surgeon, and other clinicians associated with the institution.
Reconstructive Surgery Becomes a Karigiri Speciality
It was in reconstructive surgery that Karigiri first achieved particular international recognition.
Surgery was developed for deformities affecting the hands, feet, eyelids, nose and face. Procedures included tendon transfers to restore more useful movement, correction of muscle imbalance and reconstruction designed to preserve limbs and improve function.
But surgery alone was never considered sufficient.
Patients required extensive rehabilitation before and after surgery.
Physiotherapists worked on joint mobility, muscle re-education and functional recovery. Occupational therapists developed splints and adaptations and helped patients relearn tasks using altered muscle function.
By the 1970s, Karigiri had become one of the world’s most important training centres for leprosy reconstructive surgery. Historical accounts suggest that a large proportion of surgeons internationally involved in this specialised field during the period received training at Karigiri.
Its influence consequently spread far beyond Tamil Nadu.
Protecting the Insensitive Foot
For the orthotics and footwear profession, perhaps one of the most important legacies of the Vellore–Karigiri programme concerned the anaesthetic or insensitive foot.
A person who loses protective sensation can continue walking even when damaging levels of pressure are being applied to the plantar surface.
Without pain providing an early warning signal, repetitive loading may cause tissue breakdown and chronic plantar ulceration.
The solution therefore required more than dressing wounds. Clinicians needed to change how forces travelled through the foot.
This led to increasingly sophisticated approaches to:
- redistributing plantar pressure,
- cushioning vulnerable areas,
- accommodating deformity,
- reducing shear and friction,
- providing stable soles,
- modifying footwear,
- and educating patients to inspect and protect their feet.
These principles remain recognisable in modern diabetic-foot and neuropathic-foot management.
The Development of Protective Footwear
Paul Brand articulated important principles for footwear designed for insensitive feet.
Historical accounts describe four essential characteristics: a soft insole, firm undersole, secure heel strap and construction without nails that could injure an insensitive foot.
A particularly important development was the use of microcellular rubber, or MCR, as cushioning material.
In collaboration with Madras Rubber Factory, now known as MRF, work associated with Brand resulted in the production of MCR insoles for insensitive feet in the early 1960s. The material allowed footwear to be manufactured locally while providing cushioning and pressure redistribution.
MCR footwear subsequently became widely associated with leprosy rehabilitation in India.
Its importance eventually extended beyond leprosy. Similar principles and materials became widely used in protecting feet affected by diabetic neuropathy and other causes of sensory loss.
In this respect, solutions developed for one of India’s most stigmatised diseases helped influence a much broader field of therapeutic footwear.
An Early Orthotic Philosophy
Long before computerised plantar-pressure measurement, CAD/CAM insoles or sophisticated pressure-mapping systems became widely available, the clinicians and technicians at Karigiri were applying principles that would now be recognised as biomechanical orthotic management.
They understood that an intervention had to address the mechanical environment around vulnerable tissue.
Footwear was not simply a covering for the foot. It became a therapeutic device.
Splints were similarly developed to maintain corrected positions, protect tissues and improve function.
Occupational therapists and other rehabilitation specialists at Karigiri also developed locally appropriate protective devices and functional adaptations. Historical accounts particularly identify occupational therapist Premkumar with the development of indigenous protective devices, functional splints, safety training and vocational modifications.
This focus on practical, affordable solutions was crucial in an Indian healthcare environment where imported technologies were often inaccessible.
Research, Training and Knowledge Transfer
Karigiri was never intended simply to treat people who arrived at its hospital.
Education was embedded into its mission from the beginning.
Doctors, surgeons, physiotherapists, occupational therapists, nurses, laboratory personnel and other healthcare workers travelled to Karigiri for training.
Figures including Dr C.K. Job, Dr R.H. Thangaraj and Dr Ernest Fritschi played important roles in the development of research, clinical services and professional education.
The institution also became deeply involved in epidemiological research and community leprosy-control programmes.
Beginning in the 1960s, Karigiri operated a defined control programme around the institution. Its official history reports that, through collaboration with the Government of India, WHO and international leprosy organisations, prevalence in the area was reduced from approximately 250 per 10,000 people to below 1 per 10,000 by 2006.
Rehabilitation Beyond the Hospital
Another important part of Karigiri’s philosophy was the recognition that rehabilitation could not end when a surgical wound healed.
Leprosy historically carried enormous social consequences.
People could lose employment, family relationships, social status and financial independence because of deformity and stigma.
Physical rehabilitation therefore had to be combined with social and vocational rehabilitation.
This approach anticipated what would later become a much broader understanding of rehabilitation: successful treatment is not measured only by correction of impairment but by whether a person can participate meaningfully in family, work and society.
In 2000, Karigiri introduced a multidisciplinary programme known as Prevention and Management of Impairments and Consequences (PAMIC). It approached impairment from the patient’s perspective and incorporated physical, social, psychological and economic needs, with family participation forming part of the process.
Karigiri Evolves
The institution changed considerably as leprosy prevalence declined and local healthcare needs evolved.
In 1974, the original Schieffelin Leprosy Research Sanatorium became the Schieffelin Leprosy Research & Training Centre.
In 1977 it was formally registered as an independent organisation.
General health services were progressively integrated from 1997, reflecting both the declining prevalence of leprosy and the medical requirements of surrounding communities.
In 2006, the institution adopted its present name:
Schieffelin Institute of Health – Research & Leprosy Centre.
Today it operates as a broader secondary-level hospital while maintaining its historic expertise in leprosy, research, rehabilitation and specialist care. Recent institutional information describes a 150-bed hospital providing general medicine, surgery, plastic and hand surgery, paediatrics, orthopaedics, dermatology, ophthalmology, ENT, dentistry and other services.
Karigiri’s Legacy for Today’s CPO Profession
For today’s prosthetists and orthotists, the Karigiri story is much more than a chapter in the history of leprosy.
Many principles central to contemporary clinical practice are visible throughout its history:
protect tissue before it fails; understand the biomechanics creating the problem; redistribute pressure rather than simply cushioning symptoms; provide devices people can realistically use; combine technology with patient education; and consider function and participation alongside anatomy.
These ideas are now routinely applied to diabetic foot management, neuropathic ulcer prevention, orthotic design and rehabilitation.
Karigiri continues to contribute to this field. Researchers from the institute have published work examining therapeutic insole materials and appropriate footwear for people at risk of ulceration from leprosy and other neuropathic conditions.
The technology may have changed from hand-shaped rubber and workshop-made footwear to digital pressure analysis and advanced materials.
The underlying problem has not.
How do we protect a vulnerable foot while allowing its owner to continue walking and participating in everyday life?
More than seventy years after Karigiri opened its doors, that question continues to sit at the heart of orthotic practice.
- Schieffelin Institute of Health – Research & Leprosy Centre: Official SIHRLC website
- History of SIHRLC Karigiri: About the Institute
- Karigiri Surgical Services and Reconstructive Surgery History: SIHRLC Department of Surgery
- Karigiri Historical Archive: International Leprosy Association – History of Leprosy
- Physical Rehabilitation in Leprosy: International Textbook of Leprosy
- History and Development of Hand Surgery in India: Read via PubMed Central
- SIHRLC Research on Therapeutic Insoles: Leprosy Review