How to Hide an Empire: A History of the Greater United States

by Daniel Immerwahr

Meanwhile, in Puerto Rico, Ashford, Gutiérrez, and their colleagues treated hundreds of thousands and headed off the direst cases, of which there were many. Hookworm treatment, plus parallel campaigns that the military ran against yellow fever and smallpox, brought the Puerto Rican death rate down dramatically. Yet Ashford and Gutiérrez watched in frustration as their patients succumbed to reinfection again and again. Treatment could forestall death, but all the worm pills in all the dispensaries couldn’t change the larger facts: most Puerto Ricans were poor, they worked outdoors without shoes or privies, and their government lacked the resources, and possibly the will, to do much about that. Medicine reduced hookworm disease’s morbidity in Puerto Rico, but not its spread. In 1930 it stood pretty close to where it had been when Ashford first arrived more than thirty years earlier. It was now chronic rather than acute, but it still afflicted eight or nine in ten rural Puerto Ricans.

Wow. Difference in funding in autonomy on mainland vs colonial treatment of hookworms