Medicine Ball

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The Healing of the Ten Lepers by James Tissot (1896).

We read in Luke 17: 11- 18 one of Jesus’ many medical missions. In this episode, ten lepers requested treatment via the effective (albeit always annoying) method of shouting. Perhaps the volume irritated him, who knows, but Jesus sent them away with the instruction, “Go, show yourselves to the priests”. And off they went.

They were all miraculously healed. With newfound health, they scampered away to enjoy the fresh prospects that lay ahead of them. But one felt the need to acknowledge Jesus for his divine doctoring, so he went to look for the healer. When he found Jesus, he threw himself down to his knees and thanked the Son of God. This surprised Jesus. Not the act. Nor the appreciation. But the number.

“Where are the other nine?” Jesus asked.

They were nowhere to be found. This made Jesus upset, leading him to comment, “Has no one returned to give praise to God except this foreigner?”

The one who came back was a Samaritan. If we remember another story in the book of Luke, Samaritans were considered disdainful, outsiders, and were generally hated by the Jews. But lo and behold, here was a Samaritan – this foreigner – the only one among the ten to have had the good sense of thanking the King of the Jews.

If it bothered Jesus that only one came back, imagine what would his reaction be if none did – worse, if some passing quack claimed credit for it! Jesus may have been spared from that humiliation, but the person who developed a technique to create an effective cure for leprosy suffered that fate.

Deprived of divinity but blessed with intellectual gifts the world over would appreciate, Alice Ball (1892-1916) was a double Samaritan who found the cure for leprosy.  A double Samaritan in the form of a black woman. Politically and socially frowned upon for their sex and the color of their skin.

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Alice Ball in 1915. ©University of Hawaii

Born from a well-to-do American family, Ball found herself at home in the sciences early on in her life, as evidenced by her high marks for the subject when she was in high school. Ball kept on rolling to the University of Washington where she studied chemistry and ended up receiving degrees in pharmaceutical chemistry (1912) and pharmacology (1914). Her next academic stop was Hawaii.

But why Hawaii?

After her stint in the University of Washington, she received two scholarship grants for graduate studies: one from the University of California, Berkeley and the other from the University of Hawaii (then known as College of Hawaii). Ball chose the latter. Presumably her choice might have had something to do with nostalgia, or familiarity, or simply both. The Ball family were residents of Hawaii from 1902 to 1905.

In many ways, especially in the interest of science, it was the right choice and the wrong choice.

Ball worked on her master’s thesis in haste and diligence. She was done within a year and received her diploma in 1915. Shortly after, the university hired her as lecturer. Alice Ball – the first woman of any race to graduate with a master’s in the University of Hawaii and enter its faculty ranks. Double whammy for the double Samaritan.

While handling teaching duties, Kahili hospital assistant surgeon Dr. Hally Hollmann approached Ball and persuaded her to help him out in one oily problem. Hollmann had been thinking about chaulmograa oil and its potential as curative for leprosy, but he could not quite put a finger on it.

Chaulmograa oil, an extract taken from the seeds of the Hydnocarpus wightiana tree native to India, has been used to treat leprosy for centuries. It had potential. It had hope. But give it to a patient, they will say nope. There were problems with it. When applied topically, that is, on the surface of the skin, it provided minor relief. Minor. It was a tad bit helpful when taken orally. But the taste was awful, and so was the nausea that followed. Some had the bright idea of injecting it to patients. This was not helpful at all.

In its raw form, chaulmograa oil is insoluble in water. Add to that dilemma is its high viscosity, defined as resistance to flow. Think of honey dripping off the end of a spoon. Slow, right? It is so because honey is unbeelievably viscous. Now imagine injecting a viscous fluid, say, honey, into your veins and watch as it slowly makes its way inside then altogether lose interest in the travel. It will eventually stay dormant (resisting flow) and end up as a lump underneath the skin. Patients say that it hurts a lot, the pain akin to burning. And since it is insoluble, the pain is nothing but indulgence in masochism, with no medicinal effect whatsoever. Solubility is one character sought for in many curatives – since the body is mostly made up of water, soluble compounds mix with the body’s chemistry faster and easier.

In those days, America dealt with the problem of leprosy by not actually dealing with it. Instead, they sent lepers packing away to leper communities, away from the healthy public. Often, in brute force, as some were forcibly removed by armed men from their families and homes (a model followed by one of its then colonies, the Philippines). Those exiled were never to return. They were considered legally dead. Invalids only counted as biological anomalies – threats to the well-being of society. Forced to live the rest of their lives in isolation in the harshest terms possible. Perhaps even death might have been better.

One of those communities was in the Hawaiian island of Molokai: its name was Kalaupapa.

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Molokai island c.1922

The task at hand was both historically and medically urgent. Hollmann chose the right ball to hit two birds in one throw. Ball knew the problem and the solution lay in the chemistry of chaulmoogra oil. But oil is slippery business, and many who dared step on it fell, leading to broken glassware and dreams. Ball simply bounced – she knew she was in the right ballpark.

Oil is a liquid that contains fatty acids, long molecules with a carboxyl head. Fatty acids are also called carboxylic acids. For reasons of wrecking, imagine a swinging large iron ball suspended in the air by a chain attached to a ceiling. The iron ball makes a “COOH” (the molecular formula of carboxyl) sound as it swings from side to side. The chain keeps it from falling to the floor, in the same way that the hydrocarbon chain – a long carbon skeleton clothed in hydrogen skin – attached to the carboxyl head prevents it from mixing with water because of its hydrophobic property. Chemically coaxing the fatty acids of chaulmoogra oil to minimize its fear of water would prove to be Ball’s wrecking ball against leprosy’s mayhem.

What Ball did was make ethyl esters from these fatty acids. Carboxylic acids and hydroxyls produce esters when put together in a process called esterification. Hydroxyls, whose molecular formula is -OH, are alcohols. Best remembered as the sound exclaimed when reminded of a forgotten alcoholic adventure: “Oh!” This should not be confused with the negatively charged hydroxide ion OH(the moral to recall is, alcohol is not always a negative thing). Ball used ethanol, the alcohol present in many beverages (adding strength to the maxim alcohol is the solution) to produce ethyl esters from the fatty acids in chaulmoogra oil. While not all esters are soluble in water – solubility depends on the length of their hydrocarbon tails – what Ball was able to produce were water soluble. After less than a year of researching, a new dose of hope was available for all despondent hearts.

For the residents of Kalaupapa, this meant a new lease on life. A chance to salvage what scraps life can still offer them. The Journal of the American Medical Association reported in 1918 that 78 patients were successfully treated and released by Kalihi hospital after administering the new chaulmoogra formula. For medicine, it opened a new research arena and unlocked opportunities for improvement. It became the drug of choice by physicians, until the development of new therapies that included multi-antibiotic regimens dealing with the causative bacterium (Mycobacterium leprae).

Just when she reached new heights in medical research, Ball’s bounce was abruptly cut short. Her teaching duties included chemistry demonstrations in ill-equipped classrooms. Setting the necessary variables for a disaster. An accident involving chlorine gas in a room without vents deflated the life out of her. At the age of 24, Alice Ball died in December 31, 1916.

Ball’s untimely demise inflated the opportunism in one of her colleagues. Then president of the university Arthur Dean produced vast quantities of the new drug, and published his own account of the research, naming the process “the Dean Method”. But Hollmann set the record straight in 1922 properly attributing the credit to Ball, who “solved the problem” with “the Ball Method”.

It is unfortunate that a light so bright had to be extinguished early on in its radiance. Infuriating, too, that someone even attempted to steal her shine. She was a ball of fire who could have burned more brightly had fortune stayed by her side. Alas, it was not so. But the shortness of her life should not be held tantamount to the lasting legacy she imprinted into the hearts of those society abandoned. The unnamed invalids whose names remain lost in history. They will remain so, for a long long time.

Perhaps like the anonymous nine Jesus inquired of.

Maybe they were nowhere to be found because they were actually busy thanking the priest that healed them. The nameless lepers might be nowhere in history because of the same reason – they are off to thank the actual person who went out to help them. Joining her incognito in history. Samaritans in a world that refused to see them as persons.

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Kalaupapa residents c.1905

References:

Parascandola, John. (2003). Chaulmoogra oil and the treatment of leprosy. Pharmacy in History. 45(2). 52-55

Brown, Jeanette.  African American woman chemists. Oxford: Oxford University Press. 2012.

Maggs, Sam & Foster-Domino, Sophia (illustrator). Wonder women: 25 innovators, inventors, and trailblazers who changed history. Philadelphia, USA: Quirk Books. 2016

3 comments

  1. Fascinating!

    Liked by 1 person

    1. Thank you! More fascinating content to come! 😀

      Like

  2. […] exactly the most advanced human beings in terms of social and political outlook. Over in Hawaii, Alice Ball developed a technique to make the world’s first inoculable treatment against leprosy – a technique that […]

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