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The Pursuit of Health: Colonialism and Hookworm Eradication in Puerto Rico

Public Health Crossings Top, Colonel Bailey K. Ashford, ca. 1893. Courtesy of Wikimedia Commons. Image is in public domain. Bottom, William H. Hunt, Governor of Puerto Rico, 1901–1904. Courtesy of...

References
1.	The broad term "peasant" includes the diverse farmers and laborers of Puerto Rico's mountainous coffee region. This operational definition is not meant to override social and property distinctions within the region. See Sidney Mintz, "A Note on the Definition of Peasantries," Journal of Peasant Studies 1 (1973): 91–106. See also Frederick Cooper, Allen F. Isaacman, Florencia E. Mallon, William Roseberry, and Steve J. Stern, Confronting Historical Paradigms: Peasants, Labor, and the Capitalist World System in Africa and Latin America (Madison: University of Wisconsin Press, 1993).
2.	Bailey K. Ashford, A Soldier in Science: The Autobiography of Bailey K. Ashford (San Juan: Editorial de la Universidad de Puerto Rico, 1998 [1934]), 3.
3.	Ibid., 5.
4.	William H. Hunt, Message of the Honorable William H. Hunt to the Second Legislative Assembly (San Juan: Bureau of Printing and Supplies, 1904), 20–21.
5.	One notable exception is Nicole Trujillo-Pagán, Modern Colonization by Medical Intervention: US Medicine in Puerto Rico (Boston, MA: Brill, 2013). For hookworm disease in Puerto Rico, see Francisco A. Scarano, "Desear el jíbaro: Metáforas de la identidad puertorriqueña en la transición imperial," Illes i imperis 2 (1999): 65–74; José Quiroga, "Narrating the Tropical Pharmacy," in Puerto Rican Jam: Essays on Culture and Politics, edited by Frances Negrón-Muntaner and Ramón Grosfoguel (Minneapolis: University of Minnesota Press, 1997), 116–26; and Fernando Feliú, "Rendering the Invisible Visible and the Visible Invisible: The Colonizing Function of Bailey K. Ashford's Antianemia Campaigns," in Foucault and Latin America: Appropriations and Deployment of Discursive Analysis, edited by Benigno Trigo (New York: Routledge, 2002), 153–68. Despite its contribution, this literature focuses mostly on imperial discourses and practices, not on the popular responses to the hookworm campaign or its transnational implications.
6.	On hookworm eradication in the US South, see John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge, MA: Harvard University Press, 1981); and Matt Wray, Not Quite White: White Trash and the Boundaries of Whiteness (Durham, NC: Duke University Press, 2006), 96–132. On Costa Rica, see Steven Palmer, From Popular Medicine to Medical Populism: Doctors, Healers, and Public Power in Costa Rica, 1800–1940 (Durham, NC: Duke University Press, 2003), 155–82. On Brazil, see Gilberto Hochman, A era do saneamento: As bases da política de saúde pública no Brasil (São Paulo: Editora Hucitec, 1998). On Mexico, see Anne-Emanuelle Birn, Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico (Rochester, NY: University of Rochester Press, 2006), 61–116. On the Philippines, see Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, NC: Duke University Press, 2006), 104–29.
7.	For the nomenclature dispute between Ashford and Stiles, see Ettling, Germ of Laziness, 29–33.
8.	José Rigau, "Bailey K. Ashford, más allá de sus memorias," Puerto Rico Health Sciences Journal 19, no. 1 (2000): 51–55.
9.	Paul A. Kramer, "Race, Empire, and Transnational History," in Colonial Crucible: Empire in the Making of the Modern American State, edited by Alfred W. McCoy and Francisco A. Scarano (Madison: University of Wisconsin Press, 2009), 199–209.
10.	For the interplay of elite and popular responses to the United States, see Eileen J. Suárez Findlay, Imposing Decency: The Politics of Sexuality and Race in Puerto Rico, 1870–1920 (Durham, NC: Duke University Press, 1999), 110–34.
11.	For the coffee boom in nineteenth-century Puerto Rico, see Laird W. Bergad, Coffee and the Growth of Agrarian Capitalism in Nineteenth-Century Puerto Rico (Princeton, NJ: Princeton University Press, 1983), especially chapter 4.
12.	Irene Fernández Aponte, El cambio de soberanía en Puerto Rico: El otro '98 (Madrid: Editorial Mapfre, 1992).
13.	James J. Plorde, "Hookworms," in Sherris Medical Microbiology: An Introduction to Infectious Diseases, edited by Kenneth J. Ryan and C. George Ray (Norwalk, CT: Appleton and Lange, 2010), 844–46.
14.	Bailey K. Ashford and Pedro Gutiérrez Igaravídez, Uncinariasis in Porto Rico: A Medical and Economic Problem (Washington, DC: Government Printing Office, 1911), 11.
15.	On nineteenth-century charity work, see Teresita Martínez Verge, Shaping the Discourse on Space: Charity and Its Wards in Nineteenth-Century San Juan, Puerto Rico (Austin: University of Texas Press, 1999).
16.	Francisco del Valle Atiles, El campesino puertorriqueño: Sus condiciones físicas, intelectuales y morales, causas que determinan y medios para mejoralas (San Juan: Tipografía de González Font, 1887), 8.
17.	See Astrid Cubano-Iguina, "Political Culture and Male Mass-Party Formation in Late-Nineteenth-Century Puerto Rico," Hispanic American Historical Review 78, no. 4 (1998): 631–62.
18.	João Biehl, "The Activist State: Global Pharmaceuticals, AIDS, and Citizenship in Brazil," Social Text 22, no. 3 (2004): 105–32.
19.	On the impact of San Ciriaco, see Stuart Schwartz, "The Hurricane of San Ciriaco: Disaster, Politics, and Society in Puerto Rico, 1899–1901," Hispanic American Historical Review 72, no. 3 (1992): 303–45.
20.	Anonymous, "La invasión Yanqui," in La poesía popular en Puerto Rico, edited by María Cadilla (San Juan: Sociedad Histórica de Puerto Rico, 1999), 322.
21.	On the importance of 1898 in Puerto Rico, see Francisco A. Scarano, "Liberal Pacts and Hierarchies of Rule: Approaching the Imperial Transition in Cuba and Puerto Rico," Hispanic American Historical Review 78, no. 4 (1998): 583–602; Silvia Álvarez Curbelo, Mary Frances Gallart, and Carmen Raffucci, eds., Los arcos de la memoria: El '98 de los pueblos puertorriqueños (San Juan: Postdata, 1998); Fernando Picó, 1898: La guerra después de la guerra (Río Piedras, PR: Ediciones Huracán, 1987); and Lillian Guerra, Popular Expression and National Identity in Puerto Rico: The Struggle for Self, Community, and Nation (Gainesville: University Press of Florida, 1998).
22.	Bailey K. Ashford, "Report to the Surgeon General," December 22, 1899, Otis Historical Archives, National Museum of Health and Medicine, RG 2.3, box 10.
23.	British physician Patrick Manson (1844–1922) published the first manual of tropical diseases in 1898. While he recognized that the term "tropical disease" defined ailments linked but not exclusively confined to the tropical latitudes, he inaugurated a new medical specialty that associated the tropics with specific diseases. See David Arnold, "'Illusory Riches': Representations of the Tropical World, 1840–1950," Singapore Journal of Tropical Geography 21, no. 1 (2000): 6–18.
24.	Fawcett Smith to Charles Allen, November 26, 1900, Fondo Fortaleza, Archivo General de Puerto Rico, box 74.
25.	Bailey K. Ashford and Pedro Gutiérrez Igaravídez, Summary of a Ten Years' Campaign against Hookworm Disease in Porto Rico (Chicago: American Medical Association, 1910), 3.
26.	Bailey K. Ashford and Walter W. King, "A Study of Uncinariasis in Porto Rico," American Medicine 6 (1903): 391–92.
27.	William H. Hunt to Bailey K. Ashford, October 9, 1903, Colección Ashford (hereafter CA), Universidad de Puerto Rico, Recinto de Ciencias Médicas, book 1.
28.	William C. Gorgas to Bailey K. Ashford, December 3, 1903, CA, box 6; Gorgas to Ashford, January 22, 1904, CA, box 6; Ashford to Gorgas, January 28, 1908, CA, box 6.
29.	Bailey K. Ashford, "First Announcement of the Causes of Anemia in Porto Rico to the Medical Profession of the Island," CA, box 1, document 5.
30.	Manuel Quevedo Baez to Bailey K. Ashford, December 16, 1903, CA, box 5.
31.	William P. Craighill to General O'Reilly, March 14, 1904, Papers of the Office of the Adjutant General, National Archives and Records Administration, RG 97, box 478, document 65329.
32.	On the pauperization of the Puerto Rican population, see Guerra, Popular Expression, 19–45.
33.	El heraldo español, June 15, 1904, 1, CA, box 6. Emphasis in the original. See also Bailey K. Ashford, Walter W. King, and Pedro Gutiérrez Igaravídez to Beekman Winthrop, September 23, 1904, CA, box 6.
34.	See "Puertorican Labor Conditions," CA, box 6, document 175a.
35.	"Samuel Gompers Aclamado en CA, box 6, documents223a–e.
36.	Hunt, Message, 20–21.
37.	Bailey K. Ashford, Walter W. King, and Pedro Gutiérrez Igaravídez to Beekman Winthrop, n.d., CA, box 1, document 132.
38.	On May 1, 1904, Agustín Stahl held a public ceremony at the Bayamón hospital to commemorate Ashford. See "Dr. Ashford Is Honored," San Juan News, May 3, 1904, 1.
39.	Ashford and Gutiérrez Igaravídez, Uncinariasis in Porto Rico, 106.
40.	Bailey K. Ashford, Walter W. King, and Pedro Gutiérrez Igaravídez, Report of the Commission for the Study and Treatment of "Anemia" in Porto Rico (San Juan: Bureau of Printing and Supplies, 1904), 14–15.

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