THE CITY’S DANGEROUS decade seemed to be ending. After trapping the plague rat inside the California warehouse, inspectors tore the place apart, looking for stragglers. It turned out to be the last of its infected breed.
The San Francisco Call hailed Rupert Blue as a hero and a “modern Pied Piper who can charm rats out of their holes with a whistle.”1
In the Robert Browning verse “The Pied Piper of Hamelin,” the town failed to pay the piper his fee for getting rid of rats, and instead paid with the loss of its children. San Francisco, another heedless town, also paid a fearful price for its negligence: 281 sick and 190 dead of plague.2
Blue must have felt satisfied as he and Rucker surveyed the statistics of their public health campaign. More than 11,000 houses had been disinfected. Over 250,000 square feet of Victorian boardwalks had been replaced with concrete sidewalks. Over 6 million square feet of homes, shops, and stables were now girded with rat-proof cement floors.3
More stupefying were the rat statistics. Blue’s brigades had set out over 10 million pieces of bait. More than 350,000 rats had been trapped, killed, and collected from bounty hunters. Over 154,000 animals had undergone bacteriologic tests at the Fillmore Street rattery. Most of the vermin, however, were trapped far below the city streets. All told, the total kill was estimated at more than 2 million rats—five times the human population of the city.
For months, San Franciscans saw great gray rafts of rat cadavers wash out of the sewers and into the bay, floating on the waves and bobbing against the rocks, until at last the tide swept them out to sea.
Gradually, the currents and the brisk salt winds swept away the stench of chemicals and rat kill. The city’s natural perfume of brine and sun, eucalyptus and woodsmoke, sourdough and coffee, returned. The campaign continued to deliver other dividends, too. Not just plague, but all infectious diseases started to subside. Clean homes and shops, remodeled sewers, pure food and water—together, these improvements curbed a host of diseases from typhoid to diphtheria.
Amid the city’s return to health, its rebuilt downtown area sparkled in the fall and winter of 1908. In two years since the earthquake, twenty-five new skyscrapers thrust up from the flattened city center. Nine reconstructed landmarks, including the Palace Hotel and the Chronicle Building, reclaimed their spots on the skyline.
A new Chinatown arose from the ruins like an electrified phoenix. Old wooden shops were replaced by illuminated pagodas that bathed the district in peacock hues. Old-timers along Do bahn gai, Dupont Street, shook their heads in dismay over this transformation. But the tourists returned in droves to stroll, sip tea, and buy curios. The city’s sense of fun, which years of suffering had all but eclipsed, came roaring back.
Buffalo Bill’s Wild West Show brought its gaudy spectacle to Market Street in the fall of 1908. Nearing his eightieth birthday, the old showman Colonal William F. Cody shook his grizzled locks in wonder at the city’s rebirth. “San Francisco,” he said, “why she’s all right. The earthquake and the fire were blessings in disguise. They have made your city the most modern in the world. If it were not for the fatalities incurred, a shake-down would be a good thing for all big cities.”4
Nobody, not even Blue, would have claimed that plague was good for San Francisco, but the eradication program doubtless left it a healthier city.
Headlines on Thanksgiving 1908 proclaimed the long-awaited recovery:
Blue couldn’t celebrate right away. Just as plague left, the winter of 1909 blew a ferocious influenza into town. The past year, he’d escaped. This year, Blue caught the virus he called “my old and unterrified enemy.” Sicker than he’d been in years, Blue was confined to bed at the St. Francis and nursed for three days by hotel housekeepers and waiters. He was so weak that he apologized in his next letter to his sister Kate because his filigreed penmanship wasn’t up to par. “My hand,” he explained, “is somewhat shaky.”6 But he rebounded in time to receive the thanks of the city.
On the late winter night of March 31, 1909, San Francisco spread a feast on Nob Hill to honor the Pied Piper of Marion and his men. Nine years since the death of the first victim, Wong Chut King, and one year since the last plague case, the ordeal was over.
That evening, Blue and his officers shed their khakis for evening dress, straightened one another’s bow ties, and piled into cars and buggies, bound for the Fairmont Hotel. Once past the white stone-pillared portico, they traversed the gilt-and-marble lobby, en route to a balconied banquet hall. There four hundred of the city’s elite paid $7.50 to dine with the health officers whose mission they had scorned in 1900.
A vast expanse of black tails and broad white shirtfronts met their eyes. Photographers took flash pictures that burst like sheet lightning over the hall, blanching faces and making the celebrants blink. The white-napped tables boasted hothouse flowers and menu cards engraved with the evening’s bill of fare. Each course was a corny conceit on the theme of plague. Oysters came first, but not Blue Points, the menu said, because “he’s been giving them to us for years.” Next came a course of striped bass, released from quarantine. Vegetables were prepared from the city’s pristine produce district. For dessert, ice cream was molded in the shape of a mousetrap. Punch was poured into tin tankards that looked like garbage cans, with the slogan “Keep the lid on.” Lurking inside each drink was a toy rat favor.
Governor Gillett, Mayor Taylor, and merchant-activists applauded the release of new health figures showing that the federal cleanup had not only quelled bubonic plague, but slashed the rate of other communicable diseases like diphtheria and scarlet fever by 75 percent.
Blue looked across the crowd. There were the city’s prosperous and powerful, recent converts to the cause of public health. Then there were his men: his loyal aide, Colby Rucker; and thin, bespectacled George McCoy and black-bearded Carroll Fox, the flea wranglers. There were old faces from a decade ago, such as H. A. L. Ryfkogel, the crippled pathologist who had helped Blue and who was spied on, fired, and denied back pay for his trouble.
In keeping with early 1900s social customs, dinner was a masculine affair. Not invited to dine, the women of the plague campaign were cloistered in a gallery high above to hear the speeches.
When Blue was called to the dais, an ovation roared for five minutes. His old shyness flooded back, and he flushed scarlet. “It’s difficult to say much when the heart is full,” he began. “I feel as if I were one of California’s adopted sons.” He saluted the local men—the inspectors and rat catchers—whom he called “the brawn and sinew” of his campaign.
“San Francisco has set an example,” he said. “It behooves all seaport cities to look to their sanitary defenses, for there is where the disease enters. San Francisco has fought her battle, and as one of you, I am proud of the victory she has gained.”7
Mayor Taylor presented Blue with a gold pocket watch. The heavy gold disk sprang open to reveal an inscription engraved within: “To Rupert Blue, Passed Assistant Surgeon U.S.P.H. & M.H.S., from the citizens of San Francisco in grateful recognition for his services to the city while in command of the sanitary campaign of 1908.” The mayor then pinned medals on fourteen public health service officers.
A bass chorus of hurrahs erupted again, joined by cheers from the women in the gallery. As Colby Rucker had often reminded them, the city’s cure was their triumph, too.
With Hearst’s usual flair, the Examiner’s editorial page declared the next morning, April 1, that the dinner presaged a golden age of health in the twentieth century. “Man’s conquest of disease,” it said, “is certain.”
But it wasn’t really over. The plague that had menaced the city still thrived in the hills and grasslands just east of the bay. As soon as the winter rains subsided, and the mud-softened country roads were firm enough for buggy wheels, Blue sent his forces rolling into Contra Costa County with camping equipment and War Department tents. By striking early, he hoped to prevent a crop of human cases during the summer. He wanted Colby Rucker to lead the charge on the squirrel plague again. Surgeon General Wyman had other ideas. He planned on transferring Rucker up north to Seattle. But Blue begged the surgeon general to reconsider. Rucker was the most seasoned plague warrior he had. And there was the matter of Annette.
By now, her diagnosis was unavoidable.
“Mrs. Rucker, I regret to state, has pulmonary tuberculosis,” said Blue in a handwritten postscript to Wyman. She was feverish now and bedridden. “The doctor does not desire that any special provision be made for him on this account but does not wish to have to take her to Seattle as the climate is not good there. R.B.”8
Surgeon General Wyman relented and let Colby Rucker stay with the campaign. When the spring sun dried the roads, Rucker returned to the East Bay hills leading a handful of men armed with sacks of poisoned wheat.
But during the years of delay, the infected squirrels had dispersed widely, migrating over a vast swath of north central California. By mid-1909, plague had invaded 1,500 square miles of suburban and rural terrain—more than thirty times the space it had occupied in the forty-nine-square-mile city of San Francisco.
Surveying this new infected zone, Rucker underwent “the most terrifying and grizzly experience of [his] life.” One Sunday morning, he and two colleagues struck out to explore some infected burrows with a load of guinea pigs. To test for infected fleas, the scientists tied a string to a guinea pig’s leg and lowered it into a suspect burrow as a flea magnet. Then they would fish out the guinea pig, comb it for insects, and analyze them for plague. That day, however, they needed no guinea pig. From several paces away, they beheld a graveyard of squirrel skulls around an abandoned burrow, out of which swarmed a strangely pale cloud—fleas.
Three feet above its opening, the famished fleas attacked the men. “Is your life insurance paid up?” one colleague joked nervously. Rucker fought the urge to run away. Now the fleas jumped and wriggled under his clothes, biting furiously. When the work was done, Rucker returned to his hotel and stripped off his fatigues to find his skin as mottled with bites as if he’d had a full-blown case of measles.
An entomologist on the team assured him the fleas were hatchlings, too young to have sucked the blood of plague squirrels. Rucker thought grimly of all the corpses he had seen, bulbous and stained with the blue-black tokens of plague. “I knew just what they would find on my body at post-mortem,” he said. But the entomologist was right: The beige hatchlings were baby fleas. All three men escaped unscathed.9
The squirrel plague worsened inexorably, as did Annette’s health.
“It is impossible for me to be in so many places at one time,” Rucker confessed, and asked for an assistant. “Mrs. Rucker’s condition is very critical,” he said. “It is only a matter of time until I shall be obliged to ask for a leave on her account, and I would very much regret seeing my work pass into untrained hands.”10
Rucker stayed with the campaign. To carry him on his rural surveys, he got a noisy Buick roadster, which lurched over country roads. He left the ailing Annette in camp with a trained nurse. But fearing his son might contract tuberculosis if left by his mother’s side, Rucker took the boy on his road trips, tying him into the car with an improvised seat belt to keep him from bouncing out over the country roads.11
Rucker found that about 1.2 percent of the animals were infected already. Burrow to burrow, the infected squirrels were crossing the coastal hills, migrating eastward toward the Sierra Nevada. Surgeon General Walter Wyman asked his officers to map the territory, so Rucker sketched the state of California and shaded the plague zone with black ink.
Studying the plague map, Surgeon General Wyman finally beheld the results of years of red tape and delay: The lands now inhabited by wildlife infected by the plague spread out to cover a vast area that resembled a giant letter P.12 P for “plague.”
Digging in for a protracted battle against the squirrel plague in 1909 and 1910, Blue closed up the old Victorian headquarters on Fillmore and moved his office to San Francisco’s rebuilt downtown area. On New Montgomery Street, he outfitted his office with unusually posh appointments: a swivel chair, a rolltop desk, and a $35 rug from W. & J. Sloane. He now divided his time between the city and travels abroad as the government’s epidemic expert-at-large. When Chile suffered a plague outbreak in 1910, he sailed down to the coastal town of Iquique, where one hundred patients languished in a rat-infested lazaretto. When Panama and Hawaii were menaced by yellow fever mosquitoes, Blue advised the canal zone and the islands on epidemic control.
While Blue was on assignment overseas, Rucker remained in Berkeley, where his wife, Annette, died of tuberculosis in May 1910. Rucker and his son, Colby, transported her body to Milwaukee for burial. He remained in the Midwest for a year.13
In November 1911, Surgeon General Walter Wyman was shaving around his trademark walrus mustache when his razor slipped. The sixty-three-year-old Wyman was a diabetic, so a simple shaving nick posed a special threat. His diabetes-damaged vascular system couldn’t fight off the infection that grew in the flesh wound. Gangrene set in. With no antibiotics to fend off the infection, toxicity streamed from the wound into his bloodstream. Helpless against the overwhelming sepsis, Wyman fell into a coma from which he never recovered. He died, leaving the nation’s public health service without a leader.
As President William Howard Taft launched a search for Wyman’s successor, candidates sprang up from the ranks of senior officers to jockey for the job. The front-runner was Joseph White, Blue’s onetime commander and critic in the plague war. It was White who in 1901 initially disparaged the younger man as genial but inert, devoid of the energy and tact required of a plague commander. In the end, the two fought both plague and yellow fever side by side. Now they found themselves rivals for the public health service’s top post.
Joe White had seniority, and conventional wisdom gave him the inside track to become the next surgeon general. Rupert Blue was clearly his junior, but his success in San Francisco had raised his public profile and cachet as a man of action.
Colby Rucker, after a rough year in Milwaukee, returned to the public health service and began to lobby for Blue for surgeon general. Realizing he hadn’t actually consulted Blue about this, he sent a telegram in Hawaii: “Wyman dead. Have entered you in race. Too late [to] back out now.”
Blue wired back: “Go to it.”14
The campaign intensified and press speculation mounted. President Taft teased reporters a bit by saying they could pick their favorite color. One way or another, he hinted, the new surgeon general would be Dr. White or Dr. Blue. But the president didn’t deny he was favoring Blue.15
Blue was summoned to Washington. He kept his family in the dark about his rising fortunes. “Let us hope that the best man wins, for we need a Moses to lead us out of the wilderness of political intrigue,” Blue wrote to Kate just before Christmas. He coyly added that he expected to get “orders at any moment to get me hence to the alfalfa patch faraway beyond the Rocky Mountains.”16
But another tour of duty in the West wasn’t his destiny. On January 5, 1912, President Taft flouted convention and sent to the Senate his nomination of Rupert Lee Blue for surgeon general. Blue was confirmed, amid a groundswell of support for his record as an epidemic fighter.
The forty-six-year-old South Carolinian “was promoted over the heads of many older men,” commented the Medical Times of New York. “President Taft, recognizing the fact that the important public health service must be directed by the wisest and sanest and most skillful man in the corps, forgot the bugbear of precedence and nominated the best man.”17
Blue was moved his fellow officers thought him worthy of holding the highest office in the corps. His joy was incomplete, however. His mother, Annie Maria Blue, died that autumn in Marion, months before her youngest son became the highest physician in the land.
Blue’s first task as surgeon general was anything but exalted. He had to inspect the health of government buildings—a job he’d handled for Wyman back in 1906. Little had changed: Unsanitary cuspidors steeped the State Department in the scent of tobacco juice. Rats overran the Department of Justice.18 Toilets and drinking water were petri dishes for germs. Blue focused on the common drinking cup, a foul feature of many public facilities, and began replacing it with fountains, a simple change that slashed the cases of contagious disease.
Blue sketched for his family the life of a presidential appointee: the long days and nights at his desk, marked by moments of ceremony, such as donning his best bib and tucker to wish Happy New Year to the outgoing President Taft on January 1, 1913. He rarely made it home to Marion to see his sisters. His brother Victor and sister-in-law Nellie sent him a gift of Christmas cake, its taste recalling “the days of long ago when I had no responsibilities and few troubles.” He worked through the holiday, confessing, “All seasons and days are alike to me….”19 Now that he was deskbound, his once athletic frame thickened.
As surgeon general, Blue broadened his agenda to embrace a revolutionary new concept: national health insurance. Although it was as radical a notion then as now, national health insurance drew support from the American Medical Association (AMA). Good health is a right, Blue insisted. Promoting it was, in his view, the surest way to enhance the moral stature and happiness of a people. Moreover, he argued, it was a good investment, and every dollar spent on public health would be returned a hundredfold.
“Public health is a public utility,” he said in a speech before a 1913 convention of life insurance executives. “It is the great glory of the period in which we live that we have recognized our responsibility as our brothers’ keeper.”20
At this moment, all Blue’s instincts as a physician and a southern populist merged and flowered. In the middle of his tenure as surgeon general, Blue was elected president of the American Medical Association, becoming the only doctor ever to hold the two posts simultaneously. He made national health insurance the centerpiece of his administration.
“There are unmistakable signs that health insurance will constitute the next great step in social legislation,” he said. “The next great step in social legislation” became a rallying cry of the national health movement. One of its key supporting groups, the American Association for Labor Legislation, emblazoned Blue’s phrase across its stationery. But national health insurance found more support among public health professionals than private physicians.21 It withered before it could take root. Nonetheless, in 1915, the AMA gave Blue its Gold Medal Award, as the member who had done the most to promote the health and well-being of humanity.
Renominated in 1916 by President Woodrow Wilson, Blue planned an attack on diseases of the poor like hookworm and trachoma, a major cause of blindness. But soon his domestic agenda yielded to a global imperative: preparing the country for World War I. The public health service was temporarily made a branch of the military it had emulated for so long, with its uniforms and martial style. Blue readied the country’s doctors and hospitals to receive flood tides of casualties. But neither his upbringing as a soldier’s son nor his years in the public health service prepared him for reports of the carnage in trenches across the Atlantic.
“I had never thought that I would live to see such a colossal war that is prevailing in Europe,” he wrote to his sister. “It is simply barbarous.”22
In 1918, in the wake of war came a lethal epidemic of influenza. Among the casualties was a veteran of the San Francisco plague campaign. Donald Currie, posted to Boston in 1918 just as the epidemic hit the eastern seaboard, contracted the flu virus and died.23
Influenza wasn’t the only wartime epidemic. Soldiers came home bearing another scar of their service abroad: venereal disease. In an era when polite society shunned the topic of social diseases, Blue launched a vigorous VD prevention program aimed at young men. He also attended and admired a play in Washington entitled The Aftermath, about the scars left by VD. Struck by the power of drama to enlighten people about public health, he urged President Wilson to see the play. Hoping for a presidential boost to his prevention campaign, Blue wrote to Wilson’s secretary, urging the theater outing. Coaxing reluctant politicians to embrace controversial health campaigns was an art Blue had refined in San Francisco. But this time, he failed. At the bottom of Blue’s invitation, the commander in chief jotted his regrets: “Sorry, but I cannot. W.W.”24
After two terms as surgeon general, Blue now began to lose favor in Washington. The massive World War I–era conversion of hospitals into veterans facilities—ordered by Congress, but without adequate funding—stressed local governments and strained political relations. VA hospitals were Blue’s responsibility, and he took the heat for their troubled conversion. Meanwhile, cabinet members seeking political favors decided to appoint as their next surgeon general a candidate from Virginia. They chose Hugh Cumming, a tall, aristocratic Virginian with suave political instincts and none of Blue’s World War I–era political baggage. At fifty-two Blue was out of office, his ambitious dreams of national health insurance dashed.25
At a career juncture where many prominent men play golf and pen their memoirs, Blue resumed active duty in the public health service and refused to step down until he reached retirement age. Accepting the lower rank of assistant surgeon general, Blue tackled domestic disease outbreaks and traveled to Europe as U.S. delegate to international health congresses, including the League of Nations. In Geneva, he addressed such challenges as worldwide opium addiction and the need to create a standard medical lexicon to aid in global disease tracking.
In 1923, Blue received a distinction beyond the dreams of a lad from Catfish Creek. France decorated him as a Chevalier de la Légion d’Honneur.
“You will recall that as a boy I admired the First Napoleon perhaps more than any figure in history, and that I never tired of reading his life and of his deeds as a soldier and statesman,” he wrote to his sister Kate. “I never thought then that I would ever receive, much less deserve, the decoration which he bestowed upon his officers and men, that of the Chevalier of the Legion of Honor…. I wear the ribbon in the lapels of all my coats.”26 Finally, he had a decoration that shone as brightly as the military hardware adorning the chest of his elder brother Victor.
But Blue’s fall from political favor left a wound that never healed. In 1924, during one long night of drinking and dredging up the past with his old friend Colby Rucker, the pain and bile welled up. He denounced his rivals as “snakes” and “damned skunks.” Even Rucker, whose career had flourished under Blue’s successor, received an undeserved share of rebuke. Blue called him “a God-damn apostate.”27
It was too much. Rucker left his mentor alone that night, and the two men remained estranged for half a dozen years.
Their long silence ended when Rucker—ever the peacemaker—sent Blue a New Year’s card in 1930. Blue responded gratefully. But only a few months after this tentative thaw in their relations, Colby Rucker died. Having survived encounters with rats, fleas, and mosquitoes, Rucker fell victim to a sting by a yellow jacket on a golf course near New Orleans. The sting became infected with streptococcus, and in the era before antibiotics, the complication proved fatal. He was fifty-four years old.28
Blue survived his protégé, living as an old bachelor at the Hotel Benedick at 1808 “Eye” Street off Farragut Square in Washington, D.C. He continued to send money faithfully to his unmarried sisters, Kate and Henriet. After his brother Victor died of heart disease, he remained an attentive uncle to Victor’s sons, John Stuart and Victor Jr. The boys fretted over their uncle’s solitary life.29
Blue wasn’t quite as solitary as they feared. Having long resisted the “fair heads” of San Francisco, he was at last won over by a dark-eyed Washington socialite. Lillian de Sanchez Latour, widow of the Guatemalan ambassador to Washington, had reigned over Embassy Row parties in the 1920s. Now she became Blue’s companion in his autumn years. So discreet was their friendship, it came to light only when the U.S. government took the unusual step of sending Mme. Latour a formal letter usually reserved for next of kin.30
It was a letter of condolence.
After a lifetime of vanquishing exotic epidemics like yellow fever and plague, Blue fell victim to the same fate as his father and brother: heart disease. Advancing arteriosclerosis sent him to seek treatment in Baltimore, then he headed home to South Carolina.
Just one month shy of his eightieth birthday, in a hospital in Charleston, Blue’s heart gave out. Borne home to the Presbyterian church in Marion, he was carried to the town graveyard hung with Spanish moss and lulled by the song of the cicadas. A church quartet sang the old hymn “Lead Kindly Light.”31 He was lowered into a grave surrounded by those of his family and by the multitudes of marble angels and stone garlands in the old southern cemetery.
His headstone, a monolith of gray granite, towers over those of his sisters Kate and Henriette. Austere in the South Carolina sun, it bears only one ornament: the public health service emblem he wore on his belt buckle as a green recruit—the caduceus of the messenger god Mercury, patron of commerce. But the design, like Blue’s career, bears more than a passing resemblance to the staff of Aesculapius, ancient healer, who raised the dead and riled the gods.
“His work for humanity took him to many lands,” reads the inscription, “but he came home to sleep his long last sleep.”