December 10, 1899 treaty of Paris ended the SAW. Ashford was assigned as the Commanding Officer for the city of Ponce Military Hospital in the new U.S. territory of Puerto Rico. It was the hurricane of 1899 that was the catalyst for his next contribution. Many displaced persons from the center and south of the island walked for miles to receive careinPonceatAshford’s hospital. He noted the pale, emaciated appearance of the refugees and sets out to examine and diagnose the cause of what was then known as the “Portorrican Anemia.4”
He noted that the refugees failed to thrive in spite of adequate nutrition. He systematically studied and documented their pallor, weight loss, and anemia. Their blood smears showed a pronounced eosinophilia.4 Suspecting a parasitic infection, he analyzed their stool and identified the presence of both parasites and eggs. Ancylostoma duodenale was a parasite previously known in much cooler European climates. Dr. Ashfordnoted that the local population was infected with a remarkably similar looking parasite and shared his samples with his teacher mentor fromGeorgetown Medical School, Dr. Charles Stiles who described it. The parasite was called Necator americanus, (since also known as “new world hookworm”). Beyond identification, he found a successful treatment as well. He used thymol, a naturally occurring phenol known at the time for its antimicrobial properties. He demonstrated that the “Portorrican Anemia” was a treatable and preventable illness.
REFERENCES
- Chaves-Carballo E: Carlos Finlay and yellow fever: triumph over adversity. Mil Med 2005; 170(10): 881-5.
- Ashford BK: A Soldier in Science. New York, William Morrow and Company, 1934.
- Hill SW: U.S. Army Hospital Ship “Relief.” Mil Med 2015; 180(1): 118.
- Ashford BK 1st Lt Assistant Surgeon: Ankylostomiasis in Porto Rico. Report of the Surgeon-General of the Army to the Secretary of War, pp 274 – 5, 1899.
- Ashford BK: The etiology of sprue. Am J Med Sci 1917; 157(8): 154. Available at http://jama.jamanetwork.com/article.aspx?articleid=440189; accessed December 1, 2014.
- Military Times Hall of Valor: War Department, General Orders No. 3, 1925. Available at http://valor.militarytimes.com/recipient.php?recipientid= 17203; accessed August 18, 2014.
- de Arellano AB Ramirez: From document to monument: the School of Tropical Medicine of the University of Puerto Rico. P R Health Sci J 2009; 28(2): 140-2.
- U.S. Department of Veterans Affairs, Puerto Rico National Cemetery. Available at http://www.cem.va.gov/cems/nchp/puertorico.asp; accessedAugust 18, 2014.
- Jose E. Nieves, MD; Kathleen M. Stack, MD McDonald Army Health Center, 576 Jefferson Avenue, Fort Eustis, VA23604.