9
DOCTORS WITHOUT BORDERS
The U.S. conquest of Puerto Rico was relatively painless—“a picnic,” as one journalist put it. But if Puerto Ricans had avoided the horrors of war, they met something similar the following year, when a category-4 hurricane slammed into the island. Whole coffee plantations washed down the mountains. Thousands of people were killed, more left homeless.
From the perspective of Assistant Surgeon Bailey K. Ashford, it was Dantesque. Ashford was stationed in Ponce, the hometown of Pedro Albizu Campos. He saw the hurricane wreck the city, demolishing houses, denuding trees, flinging metal roofs through the air. He watched as “hordes of pallid refugees” fled the mountains seeking food, shelter, and medical treatment.
They could have done much worse for a doctor than Ashford. He was a gifted physician whose talents had drawn him to Leonard Wood’s attention. Wood had befriended Ashford and encouraged him, which is how Ashford ended up in Puerto Rico in the first place. But unlike Wood, Ashford didn’t hold himself aloof from the colonized. He learned Spanish, fell in love with a Puerto Rican woman, María, and had three children with her: Mahlon, Margarita, and Gloria María. He collaborated closely with local physicians, particularly his colleague Dr. Pedro Gutiérrez Igaravídez. Indeed, as Ashford would live on the island for most of his life, he came to see himself as Puerto Rican, not as a mainlander.
But that would come later. Now Ashford had a more immediate concern: the refugees. He eyed their “flabby flesh and ghastly pallor” with alarm. His wife, María, explained that what he was seeing was not just the work of the hurricane, but the work of centuries. This was just what peasants looked like, she explained. They are weak and anemic. They die.
Thinking the problem was their poor diets, Ashford fed them meat, beans, and fish. Yet their complexions stayed pale, and they kept dying. He examined their blood and confirmed María’s diagnosis: they were severely anemic. But this made no sense. An epidemic of anemia afflicting an entire class? “It was unthinkable.”
He inspected one of his patients’ feces under a microscope. There he saw something interesting: an “oval thing with four fluffy gray balls inside.” An egg. Probably a worm egg. He checked his manual of tropical diseases. It looked like hookworm.
Hookworm—the force of the revelation struck him. It was, he felt, “like a veil had been lifted.” Peasants didn’t just look like that. They weren’t simply malnourished because they were oppressed. Nearly all—Ashford would later estimate nine in ten rural Puerto Ricans—were suffering badly from an intestinal parasite.
Like most parasites, hookworms are both fascinating and deeply gross. The larvae grow in shaded, moist, warm soil and seek human feet. They bore through the skin, usually the skin between the toes, and worm their way into the bloodstream, then to the lungs, and then, after a cough and a swallow, into the upper part of the small intestine. There, they take up residence and live out their six- or seven-year lives, subsisting on blood. People with enough worms in them—it can be more than two thousand—grow listless, become pale, and lose muscle. They also, through their feces, pass out hundreds of thousands of worm eggs, which, if deposited in the right environment, will hatch, find more human feet, and complete the revolting cycle.
Hookworms have stowed away in humanity’s small intestines for some twelve thousand years, a side effect of domesticating dogs. But since the parasites typically weaken rather than kill, and since the African populations most likely to carry them have some immunity, hookworms went unnoticed until the nineteenth century. Western doctors first realized how dangerous they could be in 1880, when a professor at the University of Turin found a lethal form of hookworm disease among workers digging a long tunnel under the Alps between Italy and Switzerland. The tunnel was hot, wet, crowded, and full of feces—hookworm heaven. Rather than carrying just a few worms, the men were overloaded, expelling eggs and reinfecting themselves daily.
It’s hard to imagine a habitat as congenial to hookworms as a trans-Alp tunnel, but Puerto Rico came surprisingly close. Not only was the island densely populated, but nearly two-thirds of Puerto Ricans lived in the highlands, where coffee was king. The coffee plantations lacked privies, the workers toiled barefoot, and the harvest was during the rainy season—providing a pretty good approximation of the hot, moist, shaded, and well-trafficked soil of the tunnel.
Hookworms flourished so abundantly on the island’s coffee estates that they didn’t only enfeeble workers, they killed them. By the turn of the century, anemia was the leading cause of death in the colony, accounting for some 20 to 30 percent of mortality.
But the worms in Puerto Rico were unusual, as Ashford discovered. Unlike the ones in his book, they had no teeth. He returned to Washington “carrying a bottle of my precious worms with me” and presented them to his former professor at Georgetown, Charles Wardell Stiles. Stiles concluded that this was a previously unknown species. He gave it a dramatic name: Necator americanus. American murderer.
Luckily for Ashford, Necator americanus was easily dealt with. A cheap (though nausea-inducing) pill was all it took to dislodge the worms, and visible recovery took just days. Ashford returned to Puerto Rico and, with his colleague Pedro Gutiérrez Igaravídez, established a clinic at Utuado. Patients came slowly at first, then quickly, until Ashford, Gutiérrez, and their colleagues were treating hundreds a day. The physicians supplied medicine and spoke to their patients about hygiene, explaining the importance of shoes and latrines.
In 1905 the Puerto Rican legislature funded a national program, again under the supervision of Ashford and Gutiérrez. By 1910, they estimated that nearly 30 percent of the population had been treated, for less than a dollar per patient.
As Bailey Ashford fought hookworm in Puerto Rico, his professor, Charles Wardell Stiles, continued to contemplate the disease. In 1908 Stiles took a train through North Carolina with Walter Hines Page, the great Southern journalist, and Henry C. Wallace, the Iowa agricultural expert (and father of the future vice president Henry A. Wallace). Wallace pointed to a pale and hunched man by the station. “What on earth is that?” he asked—he hadn’t seen anyone like that in Iowa. Page explained that this was a poor white, an all-too-familiar type in the South. Such men were called “dirt eaters.”
Stiles piped up. No, that man was suffering from a severe hookworm infestation. His pallor and posture were the result of anemia. Severely anemic people eat dirt or clay; they are hungry for iron. And the man could be cured “at a cost of about fifty cents.”
“Good God! Stiles, are you in earnest?” Page exclaimed.
Again, the veil lifted. Is that where the “lazy white Southerner” stereotype came from? Is that why Southern whites looked funny—lanky, pale, and slack? Page introduced Stiles to John D. Rockefeller’s aide, who arranged for the oil baron to give a million dollars to deworm the South. This was an early venture by Rockefeller into philanthropy, which would culminate in the establishment of the Rockefeller Foundation.
The head of the Rockefeller campaign traveled to Puerto Rico to consult with Ashford. The idea was to start something similar in the South, with Stiles as part of it. Thus, while Ashford battled hookworms on the island, his former teacher would fight them on the mainland.
Even with cheap deworming pills, though, a hookworm campaign was not an easy sell. Stiles, born in New York, found white Southerners prickly to the point of violence when he brought up the delicate subject of their toilet habits. After one address to a school, the local sheriff insisted on guarding Stiles until he made it safely out of town. The editor of a Tampa newspaper threatened to lynch him. The Civil War was over, but it wasn’t so far past that Southerners would stand for a Northern doctor diagnosing their entire region as pathologically lazy and unhygienic.
Mark Twain, watching from the sidelines, hooted with delight at the indignity of it all. He wrote a lilting satire in which he imagined biblical figures suffering from the timeless scourge (“Six thousand years ago Shem was full of hookworms”).
Few, however, shared Twain’s sense of humor. And it seems that elite Puerto Ricans were as prideful about this matter as Southern whites were. Some mocked the doctors, questioned the diagnosis, and put up active opposition. Yet the manner in which the two campaigns were carried out was a study in contrast, one that says much about how things worked in the colonies.
In the Southern campaign, the Rockefeller men took great care to avoid offending public sensibilities. Instead of sending their own doctors, they worked with state boards of health and employed local doctors—all white. They courted newspaper editors. And they adopted a familiar cultural form for their campaign: the Southern tent revival. Like itinerant preachers, hookworm fighters quietly approached local power holders, secured their blessing, and then brought the show to town with great fanfare. There were picnic lunches, gospel songs, and dramatic conversion testimonies (once I was blind, now I can see; once I was wormy…). The dispensaries doled out the medicine—to more than 440,000 patients in five years—and downplayed the stern lectures.
Ashford and Gutiérrez would have loved to run a campaign that way. They envisioned a network of clinics and an army of local Puerto Ricans, men who enjoyed the confidence of the peasants, to “preach the gospel.”
But that required funding, which meant squeezing resources from the colonial government. Whereas the Southern campaign began with a million-dollar grant from John D. Rockefeller, the Puerto Rican one started with $5,000 from the colonial treasury. After Ashford and Gutiérrez demonstrated that deworming worked, they begged for funds to permanently eradicate hookworm disease. But the money that arrived was, in their judgment, “utterly inadequate”: half what was needed in the best year, then down to a third. In 1908 the government didn’t appropriate any funds, so all dispensaries were officially closed (though some persisted, using stockpiles and volunteered labor) for more than three months.
Unable to afford persuasion, Ashford and Gutiérrez tried compulsion. They implored plantation owners to force workers to wear shoes. They advocated a “sanitary ordinance” to be “energetically enforced” throughout the colony. In order to work, peasants should have to carry papers certifying that they were hookworm-free. Such measures would infringe on the “liberty of the citizen,” Gutiérrez admitted, but the cause was worth it.
Yet these laws never passed, and it’s unclear how well the colonial government would have enforced them. In the end, it didn’t matter. Oversight was taken from Gutiérrez (Ashford had already resigned) and placed under a single authority, the Washington-appointed commissioner of health. The campaign fizzled.
The result? Hookworm disease in the South was reduced substantially, with enduring economic effects, mainly due to children staying in school longer. So encouraging were the results that the Rockefeller Foundation took on a more ambitious project: combating hookworm throughout the tropics—history’s first global health campaign.
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.
By 1930, hookworm was just one of Puerto Rico’s many problems. Two years before, another hurricane—the worst the region had seen in modern times—had sliced across the island. It killed hundreds, inflicted tens of millions of dollars of damage, and nearly destroyed the coffee industry. The next year, 1929, brought the Great Depression, which sent sugar prices and wages tumbling. Incomes in Puerto Rico fell by nearly 30 percent between 1930 and 1933. Meanwhile, prices rose, trade plummeted, unemployment engulfed more than half the workforce, and strikes lit up the ports, needlework factories, tobacco fields, and cane fields.
The causes of Puerto Rico’s woes were multiple and complex. Many involved arcane aspects of sugar tariffs and the lax enforcement of landholding laws. Mainlanders, however, tended to focus on a different explanation: overpopulation. It was the very thing that had troubled them about Puerto Rico back in 1898, when they worried that Spain’s colonies had too many nonwhites to be safely annexed.
Puerto Rico was densely populated—that’s one reason why hookworm spread so easily. But it wasn’t any more so in 1930 than New Jersey was. Still, the fingers pointed and heads shook. The governor believed that restricting births “among the lower and more ignorant elements of the population” was “the only salvation for the Island.” President Franklin Delano Roosevelt joked grimly to an adviser—at least, I think and fervently hope he was joking—that “the only solution is to use the methods which Hitler used effectively.”
“It is all very simple and painless,” he continued. “You have people pass through a narrow passage and then there is a brrrrr of an electrical apparatus. They stay there for twenty seconds and from then on they are sterile.”
Depression, disease, accusations of overpopulation—this was the state of affairs when another mainland doctor arrived: Cornelius Packard Rhoads, “Dusty” to his friends. Rhoads had trained at Harvard (he overlapped briefly with Albizu) and then went to work for the Rockefeller Institute in San Juan as part of its global fight against hookworm. It was a bitter irony that Puerto Rico, a pioneer of deworming, was now a target in that hookworm campaign. But the island still suffered badly from anemia, and the Rockefeller Foundation’s International Health Division hoped that experimental treatments might be tried.
Cornelius P. Rhoads was a far cry from Bailey K. Ashford. Whereas Ashford collaborated easily, including with Puerto Ricans, Rhoads was testier. He was an “outspoken, frequently blunt” man, wrote The New York Times, with “hawk-like eyes that burn bright blue through round steel-framed spectacles.” “A man of brusque manners and few words” is how one Puerto Rican colleague described him.
His methods differed from Ashford’s, too. Ashford had always been cautious about medical experiments. The first time he administered a deworming pill, he stayed up all night making “nervous half-hour visits” until he saw that his patient was unharmed. Rhoads, by contrast, appeared to regard Puerto Rico as an island-size laboratory. He saw the empire much as Daniel Burnham had: a place to try out ideas while facing few consequences.
Rhoads made the most of his carte blanche. He refused treatment to some of his anemia patients so he could compare their progress with treated patients. He tried to induce anemia in others (he referred to them as “experimental ‘animals’”) by restricting their diets. “If they don’t develop something they certainly have the constitutions of oxen,” he remarked.
Even with this extraordinary freedom, Rhoads wearied of Puerto Rico. Five months into his stay, he took his car to a party and, when he came out to get it, found it had been stripped. Days later, he wrote a letter to a colleague in Boston. It started off chattily enough, though with an air of petulance:
Dear Ferdie:
The more I think about the Larry Smith appointment the more disgusted I get. Have you heard any reason advanced for it? It certainly is odd that a man out with the entire Boston group, fired by Wallach and as far as I know, absolutely devoid of any scientific reputation, should be given the place.
Then it took a turn:
I can get a damn fine job here and am tempted to take it. It would be ideal except for the Porto Ricans—they are beyond doubt the dirtiest, laziest, most degenerate and thievish race of men ever inhabiting this sphere. It makes you sick to inhabit the same island with them. They are even lower than Italians. What the island needs is not public health work, but a tidal wave or something to totally exterminate the population. It might then be livable. I have done my best to further the process of extermination by killing off 8 and transplanting cancer into several more. The latter has not resulted in any fatalities so far. The matter of consideration for the patients’ welfare plays no role here—in fact, all physicians take delight in the abuse and torture of the unfortunate subjects.
Do let me know if you hear any more news.
Sincerely, Dusty
Clandestine villainy, an incriminating letter—it was straight out of a nineteenth-century novel. In another novelistic twist, Rhoads composed his letter at the desk of a hospital stenographer and then accidentally left it there. It circulated swiftly among the Puerto Rican staff. A lab assistant, Luis Baldoni, sent the purloined letter to his home in Utuado, a four-hour drive away.
Rhoads blanched. He drove out to Utuado in an unsuccessful attempt to intercept Baldoni. Back at the hospital, he apologized emotionally to the staff, claiming that the letter was written “in a moment of anger” and pointing out that he hadn’t actually sent it. “I have a high notion of Puerto Ricans,” he explained. He pressed a “loan” on Baldoni. And then he left for New York, never to return.
Rhoads surely hoped that his apology and hasty exit would mark the end of things—what happens in San Juan stays in San Juan. It very well might have ended there, too. Except that Baldoni still had the letter, and he gave it to a man who knew what to do with it.
He gave it to Pedro Albizu Campos.
Albizu had changed since the First World War. After failing to get to the Paris Peace Conference, he’d finished his law degree at Harvard. But his enthusiasm for the United States had flagged. The dream of Puerto Ricans in 1898 had been that the island could become a prosperous state, on an equal footing with those of the mainland. By 1930, that dream had revealed itself to be a fantasy. Wilsonianism had yielded no change in status, poverty hadn’t budged, and mainlanders seemed plainly hostile to their fellow citizens from Puerto Rico.
When Albizu returned to the island, he joined a small political party, the Nationalists. As he saw, for Puerto Rico to flourish, it must be free.
In poverty-racked Puerto Rico, that wasn’t a hard sell. The Liberal Party sought independence, too, and it did well at the polls. The only question was pace. The Liberals, of whom the newspaper editor and rising political star Luis Muñoz Marín was the most able spokesman, sought a managed transition. Albizu and the Nationalists, by contrast, demanded a clean and immediate break.
The disagreement turned, in part, on whether the United States could be trusted. Albizu didn’t think it could, and with Rhoads’s letter in hand, he had his proof. He sent copies everywhere: to all the papers, the League of Nations, the Vatican, the American Civil Liberties Union. A cover letter by one of his colleagues explained that the United States was seeking to exterminate Puerto Ricans just as it had the North American Indians.
Did Cornelius Rhoads actually kill eight of his patients? The question lives on to this day. Rhoads and his defenders offered multiple and contradictory excuses: he was angry, he was joking, he was drunk. The colonial governor took the matter more seriously. He deemed the letter a “confession of murder” and ordered an investigation.
That investigation uncovered another letter, which the governor viewed as “even worse than the first.” But the government suppressed it, and it has never been found. Thirteen patients did die in the Rockefeller Commission’s study group (it was a hospital, after all), but they weren’t exclusively Rhoads’s patients and a review of their records showed nothing amiss. The most damning evidence presented in the investigation was a claim by Baldoni that Rhoads failed to sterilize his needles, though that was contested. In the end, the prosecutor concluded that Rhoads was “a mental case or unscrupulous person,” but not a murderer.
A 2003 investigation by an esteemed bioethicist at Yale, Jay Katz, reached a similar conclusion: Rhoads’s behavior was reprehensible, but there was no evidence that he’d killed anyone.
Still, an investigation by a government that destroys incriminating evidence and doesn’t even require the accused to participate can hardly be called fair or thorough. The 2003 inquiry was based, by necessity, on what documents remained. To this day, many Puerto Ricans are convinced that Rhoads was guilty and that the government covered up his crimes.
Many in the 1930s thought so, too. Puerto Ricans had felt the condescension and scorn of mainlanders. They’d heard the talk about “overpopulation.” And now there was this letter—a killer’s clear confession—and yet no trial. The whole thing seemed to confirm the worst fears about U.S. imperialism. That a doctor would murder his patients out of racial hatred—to many, it seemed plausible.
The Rhoads affair was a turning point in Puerto Rican politics. Before the letter, the Nationalists were an obscure group. After it, they were a force. For centuries Puerto Rico had endured colonial rule with little direct resistance. But now, with disease and poverty ravaging the island, and with what looked like proof of an official desire to exterminate Puerto Ricans, things were different. Albizu’s insistence that independence must be seized, immediately and forcibly, was not so easily dismissed.
Waving the Rhoads letter, Albizu led the Nationalist Party in the 1932 elections. He fared poorly, although the pro-independence Liberals did very well. It was Albizu’s first and only attempt at electoral politics. Later that year, he drafted a constitution for the Republic of Puerto Rico and created a Liberation Army. The “army” didn’t appear to have any weapons—its cadets drilled with wooden replica guns. But they drilled nonetheless.
“Where tyranny is law, revolution is order,” Albizu declared.
A bomb went off at the governor’s country estate, though nobody was hurt. Then the chief of insular police, Francis Riggs, found four sticks of dynamite in the garden of the governor’s mansion—only a defective fuse had prevented them from exploding.
This was just the start. A 1934 sugar workers’ strike nearly paralyzed what remained of the economy. Tellingly, the strikers chose Pedro Albizu Campos as their spokesman. With the strikes, the bombs, the poverty, and Albizu’s men marching in the streets, mainlanders felt the colony slipping from their grasp. “The sit. is getting worse daily,” Riggs wrote to Senator Millard Tydings. “Can’t go on much longer!” “Help me!!!!!!” he added at the bottom of the letter. (Five days later: “The situation is getting worse … Chaos and anarchy!!!!”).
“Public order,” warned Luis Muñoz Marín, “hangs by a thread.”
Nineteen thirty-five was the year of the bomb: at National City Bank (today known as Citigroup), at post offices, at police stations. They exploded on holidays—New Year’s Day, the Fourth of July—or directly after Albizu’s speeches. Nobody was killed and nobody was convicted, but it wasn’t hard to guess who was responsible.
“Some night, here, we will rise,” Albizu promised in a radio speech. “There must be placed into the hand of each Puerto Rican a dagger, an arm in order that he may make valid the rights of his country.”
In the same speech, Albizu berated students at the University of Puerto Rico for adopting mainland ways. He called the men effeminate and the women prostitutes. When a group of students organized a protest against Albizu, five nationalists drove to the university. What they intended to do is unclear—the police who intercepted them said they were planning to bomb the campus. Someone started shooting, and the police killed four of them, plus a bystander.
Francis Riggs, the chief of police, hinted at more to come. He promised “non-stop war” against “criminals.”
“There will be war,” Albizu agreed. But it would be “war against the Yankees.”
As Riggs made his way home from Mass one Sunday morning, two nationalists shot and killed him. The police captured the assassins, took them back to the station, and killed them there. The official story is that they were “trying to escape.”
The insurgency continued, with police and nationalists trading fire in the streets. More bombs went off. Luis Baldoni, the lab technician, got into a shoot-out with the police. A U.S. congressman requested a contingent of marines to accompany him to Puerto Rico; he promised to “clean up” the “Puerto Rican situation” in a week. No troops were forthcoming, but J. Edgar Hoover sent FBI agents to the island to follow Albizu—the start of three decades of continuous surveillance.
To no one’s surprise, Albizu was arrested. He was charged with conspiring to overthrow the government—a charge that guaranteed a federal trial. The U.S. attorney in Puerto Rico, A. Cecil Snyder, described it to Roosevelt as “the most important criminal case ever tried in Puerto Rico.” When the jury, which included seven Puerto Ricans, failed to convict, Snyder arranged a second trial the next week, this one with a hand-picked jury containing only two Puerto Ricans. It worked. The judge chided Albizu for wasting his Harvard education and sentenced him to ten years in the federal penitentiary at Atlanta.
On Palm Sunday 1937, while Albizu languished in prison, the Liberation Army marched in the streets of Ponce. The marchers carried no weapons, but their opponents did: Ponce’s small police force swelled to five times its usual size as more than a hundred officers arrived carrying rifles, gas bombs, revolvers, clubs, and Thompson submachine guns (“tommy guns”). They surrounded the nationalists on all sides. As the marchers began to move, gunfire erupted, and the police let loose a minutes-long fusillade from all directions. Eighteen demonstrators and onlookers died, and two policemen were killed in the cross fire. Probably more than 150 people were wounded.
The governor insisted that the Nationalists had fired first. But an FBI agent reported privately to J. Edgar Hoover that it was a “common fact” that the police were “almost 100 percent to blame.” Indeed, an independent investigation, headed by the general counsel of the American Civil Liberties Union, pointed out glaring holes in the government’s story. It concluded that the affair was not an unfortunate mishap, but rather a “massacre.”
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Corpses of bystanders lie in the street after the shooting in Ponce.
Albizu’s birthplace, once known for being “delirious” with enthusiasm for the United States, was now etched in memory as the site of the Ponce Massacre. To this day, it remains the bloodiest shooting by police in U.S. history.
Puerto Rico in the 1930s continued to simmer: an attempt to assassinate the judge who sentenced Albizu, an attempt on the governor’s life, more bombs, strikes. But it happened without Albizu, who was sent to Atlanta and would spend most of the rest of his life behind bars.
Things turned out differently for Cornelius Rhoads. News of the scandal had followed him back to the mainland, though in a muted way. The Washington Post reported that Rhoads had written a “jocular letter,” which Puerto Rican nationalists had blown out of proportion. Time printed the letter but, at the urging of the Rockefellers’ public relations firm, omitted the more disturbing sentences and described the letter as a parody. Touting Rhoads’s research, the magazine predicted that the doctor’s six months on the island would come to be seen as “one of the best things that ever happened to the populace there.”
The coverage surely embarrassed Rhoads, but it didn’t impede him. Not only was he never tried, he wasn’t even fired: he continued to work for the Rockefeller Institute. In 1940 he was made director of Memorial Hospital in New York. In 1942 he was elected vice president of the New York Academy of Medicine. Then, with the United States at war, Rhoads was commissioned as a colonel in the army.
The military was an interesting place for a man of his expertise. Ever since Fritz Haber released chlorine gas at Ypres in 1915, the threat of chemical warfare had hung in the air. Roosevelt pledged that the United States wouldn’t be the first to use gas in the Second World War, but the military prepared for a chemical war nonetheless. That meant not only manufacturing poison gas but testing it, too. And the chief of the Chemical Warfare Service’s medical division was Cornelius P. Rhoads.
It was an important post. Though the Chemical Warfare Service ran tests on animals—goats were a favorite—it insisted that all gases and equipment be ultimately tested on humans. Those humans were soldiers, recruited with modest inducements such as extra leave time or appeals to patriotism.
They participated in three types of tests. In the drop test, liquid was applied to their skin. In the field test, planes sprayed them from overhead. In the chamber test, sometimes called the “man-break test,” participants were locked in gas chambers and gassed until they faltered. Those inhaling gas usually had protective gear, but the tests often pushed past the point where that gear functioned. In some cases, that meant days in gas chambers or in the jungle with gas bombs dropping overhead. Participants seeking to leave midway through were threatened with court-martial.
During the war, the military tested its gases and gear on more than sixty thousand of its own men.
These tests were secret. They rarely appeared on service records, and participants were firmly instructed never to speak of them. By and large, the men complied. Although many suffered debilitating aftereffects—cancer, lung disease, eye problems, skin abnormalities, psychological damage, scarred genitals—the extent of the program remained unknown until the 1990s. Some participants told their families only on their deathbeds.
After the revelation of the tests themselves came another revelation: some of the experiments were race based. African Americans, Japanese Americans, and Puerto Ricans were tested to see if they would fare differently than whites against mustard agents.
Beyond the experimental use of Puerto Ricans in racial tests, the Chemical Warfare Service relied on them for field tests at its “jungle” testing site: San José Island off Panama, an entire island for testing chemical weapons. The Puerto Ricans weren’t brought there because of their race per se. They were brought because they were easy to get. The Military Personnel Division refused to send enough men “from the Continental Limits” for the tests but was happy to send Puerto Ricans. One GI who participated in the tests on San José Island (and later developed stomach and throat cancer) observed that more than two-thirds of his fellow soldiers had Spanish surnames and couldn’t understand the instructions in English.
Jay Katz, the Yale bioethicist who made the 2003 study of the Rhoads affair, also took part in a review of the chemical warfare tests. Those experiments, he concluded, ran on the principle of the “cheap availability of human beings,” with little thought given to how to minimize harm. The soldiers were “manipulated, exploited, and betrayed.” What happened, in his judgment, was “unconscionable.”
Where was Cornelius Rhoads in all this? Right in the middle. As chief of the medical division, he was the highest-ranking doctor involved, charged with approving tests on human subjects. Decisions about safety and, ultimately, ethics were his to make. Yet in my review of the records of the Chemical Warfare Service, I found no evidence of his hesitation regarding any test. Rather, it seems that he participated enthusiastically. He established medical testing stations, including on San José Island. He arranged to transport men to be gassed. He recommended which gases to use and how to use them. He offered comments on the tests, including one of how people of different skin colors responded to chemical burns.
At the war’s end, Rhoads won a Legion of Merit award for “combating poison gas and other advances in chemical warfare.”
For Rhoads, this was just the beginning. Scientists had known from the start of the war that mustard agents—the main chemicals with which Rhoads was working—targeted lymphoid tissue and bone marrow. Perhaps they could be used to treat lymphoma? Wartime findings were suggestive, but other research had priority.
Scientists planned to return to the issue once the fighting was done, using what they had learned during the war. The military had leftover chemical agents available for research, and Rhoads chaired the committee that decided what to do with them. He divided the stock among three hospitals, one of them his own.
Rhoads also recruited nearly the whole program staff of the Chemical Warfare Service to work for him researching those mustard agents, this time for drug development. He did this at a new center that was started with a $4 million grant from Alfred P. Sloan, the president of General Motors. As the director of both Manhattan’s Memorial Hospital and the Sloan Kettering Institute (as it was called) next door, Rhoads was perfectly positioned. He had a massive lab. He had money. And he had a hospital full of terminally ill patients who would eagerly consent to experimental treatments.
Rhoads launched what he called a “frontal attack with all our forces” on cancer, trying chemical after chemical. Given Rhoads’s great force of will, his considerable resources, and his intolerance for alternative approaches, his research agenda dominated the scene. The journal Science heralded him as “one of the most prominent American medical researchers” of his day. He made the cover of Time in 1949.
Today, Cornelius Rhoads lives in Puerto Rican memory as a villain. On the mainland, however, he’s been remembered differently: as a pioneer of chemotherapy.
Indeed, more than remembered, he has been honored. Starting in 1980, with money from an anonymous donor, the American Association for Cancer Research (AACR) gave the prestigious Cornelius P. Rhoads Memorial Award annually to the young investigator who showed the most promise in cancer research. Rhoads recipients have gone on to be field leaders; one was a Nobel laureate. But so complete was the informational segregation between Puerto Rico and the mainland that the prize was given for twenty-three years before anyone objected. When a biologist from the University of Puerto Rico lodged a complaint, the AACR was taken aback. “It was just totally shocking to us to receive this barrage of communications from people in Puerto Rico out of the blue,” said the CEO. Even the donor who’d funded the award hadn’t known of Rhoads’s Puerto Rican legacy.
And that’s how you hide an empire.