CARAVAN OF SPECTERS
by Carlos García Saúl
García Saúl’s historical novel dramatizes real-life figure Lt. Bailey Ashford’s discovery of a successful treatment for anemia caused by hookworm infestation, the leading cause of death in Puerto Rico at the turn of the 19th century.
In 1898, Southerner Ashford, 25, is a bit disappointed to be sent to Puerto Rico instead of Cuba as his first assignment as a U.S. Army Medical Corps doctor during the Spanish-American War. His deployment in Puerto Rico, however, turns out to have important consequences. Ashford provides critical medical support as the U.S. gains Puerto Rico from the Spanish at the wind-down of the war. Further, he meets his soon-to-be wife, and, most significantly, observes and then seeks to address the deadly anemia plaguing rural coffee-plantation workers and their families. A hurricane, temporarily halting plantation operations, brings sufferers, notable for their pallor, as a “caravan of specters” into Ashford’s base city. The influx allows Ashford to ramp up his studies, aided by his interpreter, an aspiring microbiologist and son of a rich American based in Puerto Rico; the now city-based son of a rural family devastated by this disease; and an American nun working in a city clinic. Through analysis via microscope of patients’ blood and examination of their feces, Ashford establishes that hookworms are entering through the skin of tropical climate inhabitants who walk barefoot and don’t have access to proper latrines. He identifies and tests a low-cost drug treatment to expel these parasites, eventually getting support to bring the treatment to clinics in rural areas. Resistance is rampant, however, but then the “legendary White Eagle” bandit breaks the impasse, with a commission launched to stamp out this disease in Puerto Rico and elsewhere.
In this highly engaging diagnosis-hunting/clinical trial–focused fictional account, Florida-based medical doctor García Saúl, a Puerto Rico native educated at Harvard and Yale who practiced medicine for 28 years in Massachusetts and Kansas, effectively makes his case that the achievements of Ashford, “not the subject of common discussions or island holidays,” deserve more attention and recognition. As with most such narratives, one sometimes wonders just how much artistic license is being exercised, such as in García Saúl’s rather melodramatic portrayal of the White Eagle bandit, also a historical figure. Occasionally, medical terms (specifying the white blood cell type of eosinophils, for example) may baffle lay readers, although García Saúl is quick to explain these terms in the context of his plot. Readers will be transfixed by Ashford’s journey—and the magnitude of what he accomplished. García Saúl skillfully showcases the critical human factors involved in advancing science, detailing not only Ashford’s dogged persistence, but also the heroic decision by a rural family to take the drug treatment (even though one of their own died during Ashford’s early testing of it) and local hospital nuns’ bravery in administering the drug despite their superiors’ ban regarding it. “Imagine an often-fatal disease that affects 60 percent of our current population...imagine a rookie medical graduate stating that by simply taking a few pills, thousands upon thousands (millions, if we extrapolate to today) of people can be restored fully to health in a matter of days,” marvels García Saúl in his author’s note. Readers of this book are greatly aided in this imagining thanks to this consummate, lively fleshing out of Ashford’s landmark work.
A gripping, multilayered depiction of a transformative medical investigation.