In 1899, Puerto Ricans faced a devastating hurricane, leaving thousands dead and without a home. Bailey K. Ashford was one of the US doctors who helped. He lived in Puerto Rico for years, collaborated with local medics, and married a local woman. During his work on the islands, Ashford discovered that the local peasants suffered from hookworm and thus were anemic, weak, and often died. They worked in hot, moist, crowded environments that contributed to the parasite’s spread. Anemia was the leading cause of death in the colony. The problem had a simple solution—a pill that dislodged the worm—but hygiene, shoes, and latrines were habits to be maintained to remain free of the parasite. A similar parasite problem existed in the American south. A campaign funded by philanthropist John D. Rockefeller targeted the delicate nature of this problem.

The hookworm treatment was part of a broader effort to fight yellow fever and smallpox in Puerto Rico. While the death rate was significantly reduced, reinfection remained a problem—a result of poverty and population density. The governor proposed darker solutions, such as lowering the birth rate “among the lower and more ignorant elements of the population” (143) through sterilization. President Franklin D. Roosevelt argued that “the only solution is to use the methods which Hitler used effectively” (143), seemingly in jest.