Modern Colonization by Medical Intervention: U.S. Medicine in Puerto Rico by Nicole Trujillo-Pagán (review)

The advent of U.S. colonial rule in Puerto Rico in 1898 brought with it profound changes in the island’s government, society, and economy. Many Puerto Rican doctors had been prominent in political struggles with Spain, but how members of the medical profession responded to the arrival of U.S. colonialism and all that it entailed has been neglected by previous histories of the topic. In this book, Nicole Trujillo-Pagán provides a first survey of the medical profession at the time of the U.S. intervention, describing the island’s elite urban doctors and those of its small towns, their political and economic interests, and their varying levels of involvement in and resistance to the colonial administration. She recounts how elite doctors initially opposed U.S. medical reforms that supplanted their authority and undercut their own claims to leadership in modernizing the island. She shows that U.S. colonial administrators in turn were first able to curry the favor of small-town doctors by appointing them as municipal physicians. Gradually, the U.S. campaign against hookworm convinced many of the urban elite that joining its efforts, and giving up political advocacy, was a more secure route to regaining professional prestige. In short, Trujillo-Pagán effectively tells the story of how the Puerto Rican medical profession, at first a potentially strong collective challenger to U.S. colonialism, became “Americanized.” This is a valuable contribution to the growing literature on U.S. colonial medicine.

Trujillo-Pagán also puts forward numerous intriguing theses that, although unsupported in the book, warrant further inquiry. Consider the claim that U.S. colonialism itself created the “sickening and deadly conditions” of malnutrition-induced anemia that it then claimed credit for remedying with the campaign against hookworm (p. 208). This conclusion does correspond to well-documented findings of scholars of other episodes of colonial medicine, such as the Belgian campaign against sleeping sickness in the Congo (by Marynez Lyons, 1992). And the argument that the shift from ranching to sugar production coupled with stringent new food inspection regulations created scarcities of meat, and so malnutrition, is at least plausible. On the other hand, the widespread complaints under Spanish rule that high taxes had rendered meat prohibitively expensive for most Puerto Ricans; the lack of any presentation of evidence on trends in meat production, imports, or pricing; the fact that anemia had been widespread long before the arrival of U.S. troops; and the dramatic successes of the hookworm campaign all give a reader pause before accepting either that malnutrition had worsened under U.S. rule or that it was the primary cause of anemia on the island. That the campaign against smallpox was an effort to expand the military government’s surveillance of its political opponents (p. 2); that Bailey Ashford, the famed U.S. Army doctor, aimed in his early research on hookworm to depoliticize Puerto Rican doctors (p. 182); and many other provocative statements are in this work simply asserted. These are questions that could and should be investigated and decided on the record of primary sources.

The role of U.S. colonial medicine and public health—and its ramifications for doctors among the colonized—has drawn less scholarly attention in the case of Puerto Rico than in Cuba and the Philippines. Trujillo-Pagán has made an effort toward remedying the imbalance. There is much work left to be done.