For centuries, and up until about the 1920s, there was no remedy for leprosy’s debilitating symptoms or its social stigma, but these days it’s treatable – partly thanks to a curious tree and the work of a pioneering young black female scientist.
The young woman, Alice Ball, laid fundamental groundwork for the first effective global treatment of Hansen’s disease, also called leprosy.
But her legacy still prompts conversations about the marginalisation of women and people of colour in science, writes Mark Lambert in The Conversation.
He writes:
As a bioethicist and historian of medicine, I’ve studied Ball’s contributions to medicine, and am pleased to see her receive increasing recognition for her work, especially for a disease that remains stigmatised.
Alice Augusta Ball, born in Washington in 1892, became the first woman and first African American to earn a master’s degree in science from the College of Hawaii in 1915, after completing her studies in pharmaceutical chemistry the previous year.
After she had attained her master’s degree, the college hired her as a research chemist and instructor in the chemistry department.
Impressed by her master’s thesis on the chemistry of the kava plant, Dr Harry Hollmann with the Leprosy Investigation Station of the US Public Health Service in Hawaii, recruited Ball. At the time, leprosy was a major public health issue there
Doctors now understand that leprosy is minimally contagious. But in 1865, the fear and stigma associated with the disease led authorities in Hawaii to implement a mandatory segregation policy, which ultimately isolated those with the disease on a remote peninsula on the island of Molokai.
In 1910, there were more than 600 leprosy patients living there.
This policy overwhelmingly affected Native Hawaiians, who accounted for more than 90% of all those exiled to Molokai.
The significance of chaulmoogra oil
Doctors had attempted to use nearly every remedy imaginable to treat the disease, even experimenting with dangerous substances like arsenic and strychnine. But the lone consistently effective treatment was chaulmoogra oil.
Chaulmoogra oil is derived from the seeds of the chaulmoogra tree. Health practitioners in India and Burma had been using this oil for centuries as a treatment for various skin diseases. But there were limitations with the treatment, and it had only marginal effects on leprosy.
The oil is very thick and sticky, making it hard to rub into the skin. The drug is also notoriously bitter, and patients who ingested it would often start vomiting. Some physicians experimented with injections of the oil, but this produced painful pustules.
The Ball Method
If researchers could harness chaulmoogra’s curative potential without the nasty side effects, the tree’s seeds could revolutionise leprosy treatment. So Hollmann turned to Ball. In a 1922 article, Hollmann documents how the 23-year-old Ball discovered how to chemically adapt chaulmoogra into an injection that had none of the side effects.
The Ball Method, as Hollmann called her discovery, transformed chaulmoogra oil into the most effective treatment for leprosy until the introduction of sulfones in the late 1940s.
In 1920, the Ball Method successfully treated 78 patients in Honolulu. A year later, it treated 94 more, with the Public Health Service noting that the morale of all of the patients drastically improved. For the first time, there was hope for a cure.
Tragically, Ball did not have the opportunity to revel in this achievement, as she died within a year at only 24, probably from exposure to chlorine gas in the lab.
A legacy, lost and found
Ball’s death meant she didn’t have the opportunity to publish her research, and Arthur Dean, chair of the College of Hawaii’s chemistry department, took over the project.
Dean mass-produced the treatment and published a series of articles on chaulmoogra oil. He renamed Ball’s method the “Dean Method”, and never credited Ball for her work.
Ball’s other colleagues did attempt to protect Ball’s legacy. A 1920 article in the Journal of the American Medical Association praises the Ball Method, while Hollmann clearly credits Ball in his own 1922 article.
Ball is described at length in a 1922 article in volume 15, issue 5, of Current History, an academic publication on international affairs.
That feature is excerpted in a June 1941 issue of Carter G Woodson’s Negro History Bulletin, referring to Ball’s achievement and untimely death.
Joseph Dutton, a well-regarded religious volunteer at the leprosy settlements on Molokai, further referenced Ball’s work in a 1932 memoir broadly published for a popular audience.
Historians such as Paul Wermager later prompted a modern reckoning with Ball’s poor treatment by Dean and others, ensuring that Ball received proper credit for her work. After Wermager’s and others’ work, the University of Hawaii honoured Ball in 2000 with a bronze plaque affixed to the last remaining chaulmoogra tree on campus.
In 2019, the London School of Hygiene and Tropical Medicine added her name to the outside of its building. Her story was even featured in a 2020 short film, The Ball Method.
The Ball Method represents both a scientific achievement and a history of marginalisation.
In 2022, then-Governor David Ige declared 28 February as Alice Augusta Ball Day in Hawaii. It was only fitting that the ceremony took place on the Mānoa campus in the shade of the chaulmoogra tree.
Mark Lambert – assistant professor of Behavioral Medicine, Medical Humanities, and Bioethics, Des Moines University, Iowa, USA.
See more from MedicalBrief archives:
Leprosy bacteria able to regenerate organs – Scottish study
Immune suppressant is ineffective in treating leprosy inflammation
Investment in ‘neglected’ tropical diseases