WHILE KINYOUN BROODED OVER his plague experiments on fogbound Angel Island, another doctor kept watch over the sunstruck Mediterranean from his post in Genoa, Italy. If Kinyoun was a prodigy, thirty-two-year-old Rupert Lee Blue was a late bloomer just coming into flower. He too had recently been dispatched by the Marine Hospital Service to a remote lookout for epidemics. On June 27, 1900, Blue picked up a local newspaper and read a report that made his pulse quicken: A dozen people had fallen sick and three were dead of bubonic plague in Greece and Turkey. He dashed off a dispatch to Washington.
“The bubonic pest is slowly marching Northward along the Levantine shore and invading Europe from the East,” he wrote to the surgeon general.1 His prediction of an epidemic storming the gates of Europe was grippingly phrased to catch the eye of his boss, Walter Wyman, but it turned out to be a false alarm. A dozen cases on the Aegean coast didn’t herald the return of the Black Death to Europe.
Still, Blue was right to be on the alert. Since biblical times, plague had sown death around the world in sweeping pandemics—super-epidemics—three times over two millennia. As a Sunday schooler, Blue had no doubt read the Book of Samuel’s passage about a plague among the Philistines, who suffered “emerods in their secret parts,” a poetic description of the signature symptom—buboes, or swollen glands, in the hollows of the groin and armpits that give the disease its name. In the sixth century, Justinian’s Plague took nearly one hundred million lives in Asia, Africa, and Europe. In the fourteenth century, the plague pandemic known as the Black Death killed fifty million victims, including a quarter of Europe’s population. Aftershocks were felt for centuries, in outbreaks like the great plague of London in 1665.
Now, the third plague pandemic, centered in Hong Kong in 1894, was spreading along the trade routes. While plague once traveled on the wind that drove sailing ships, it now migrated at twentieth-century speed aboard new coal-fired steamships.2
Its symptoms were violent: Rampant fever, crushing headache, overwhelming nausea, and profound weakness swept over a person who had been strong only hours before. Inflamed lymph glands struggled to contain the invading bacteria. Wherever they swelled, a painful red bubo erupted. Inky hemorrhages burst from small vessels, staining the skin with blue-black tattoos—the fearful “tokens” of Black Death. The pulse galloped at first, then later dwindled to a thread dancing beneath the doctor’s finger. Delirium and pain unhinged the mind and stirred the limbs in an agitated dance of death. Victims in their final agony plucked at the bedclothes, unable to bear the slightest touch on their swellings.
Plague’s only mercy was its speedy end. When buboes were the main symptom, plague killed in five days. If a victim was spitting blood, a symptom of plague in the lungs, death came in two or three days. So-called pneumonic plague was the rarest and deadliest form of the disease. It was also the only form now known to be contagious, spread from person to person by saliva as the coughing victims helplessly infected caretakers and family. Bubonic or pneumonic, it all started from the same germ, the bacteria known, variously, as Bacillus pestis and Yersinia pestis.
More terrible than the scourge itself was the effect it had on the psyche: It turned humans into beasts. Giovanni Boccaccio gives an eyewitness account of plague-stricken Florence in his preface to The Decameron, describing how the sick were abandoned in agony, corpses layered in mass graves, and princely palaces left empty:
…[T]hings had reached the point where the dying received no more consideration than the odd goat would today…. As there was not sufficient consecrated ground in which to bury the vast number of corpses that arrived at every church day after day and practically hour by hour… enormous pits were dug in graveyards, once saturation point had been reached, and the new arrivals were dropped into these by the hundred; here they were packed in layers, the way goods are stowed in a ship’s hold, and each layer would get a thin layer of earth until the pit was filled up.3
Daniel Defoe, writing of seventeenth-century London in his 1722 work, A Journal of the Plague Year, said that the terror of the epidemic prompted “knavery and collusion” in infected towns where officials falsified burial records and fearful people hid the sick and the dead.
…[A]ll that could conceal their distempers did it, to prevent their neighbors shunning and refusing to converse with them, and also to prevent authority shutting up their houses; which, though it was not yet practised, yet was threatened, and people were extremely terrified at the thoughts of it.4
Doctors were powerless to halt the Black Death, but that didn’t inhibit their invention of strange nostrums. To ward off infected vapors, they prescribed smelling apples, molded from sandalwood, pepper, camphor, and rose. People drank infusions of treacle, wine, and minced snake, while the rich took costlier compounds of crushed pearls and molten gold. One Italian apothecary named Gentile da Foligno crafted fanciful remedies from gemstones—including amethyst amulets and potions of powdered emerald. The latter remedy was said to be “so potent that, if a toad looked at it, its eyes would crack.”5 Unfortunately for the desperate rich, ingesting gems and gold didn’t cure plague and may even have hastened their death.
From fourteenth-century Italy, too, came ancient protocols for plague control: lazarettos, or isolation hospitals named after Lazarus, the leprous beggar in the biblical parable; and la quarantina, the quarantine of ships, originally set at forty days to commemorate Christ’s sojourn in the wilderness.6
Given the dearth of scientific knowledge, people wrapped plague in religious mystery and interpreted its hideous effects as God’s punishment. To explain its occurrence, some people wove myths about plague showering down from comets, spread house to house by she-demons or flowing from wells poisoned by Jews. The scapegoats were bricked up in their homes and burned alive by suspicious and vengeful villagers. Such myths made plague a metaphor for medical catastrophe, while the reality of its transmission—from the bite of a lowly rat flea—remained veiled in mystery.
By the late nineteenth century, those remedies were consigned to history. But the Victorian Age introduced some harrowing remedies of its own. British colonial physicians in India prescribed that plague patients drink diluted carbolic acid, or cool their fevers by taking a refreshing ice-water enema.7
Despite Blue’s premonition of doom in Genoa, the Black Death didn’t renew a major assault on Europe in June 1900. But the suspected Mediterranean cases kept him on alert for new waves of the third plague pandemic, then migrating from China across the sea to other ports around the world. Plague had inflicted violent mortality in Hong Kong, and Washington was monitoring reports by the British colonial authorities. From that day in Italy onward, plague would be a leitmotif in Blue’s career. Within the year, he would be ordered to return from Italy to the United States and assigned to San Francisco, where the infection was just beginning to insinuate itself into the city.
Like his predecessor Joseph Kinyoun, Rupert Blue was a son of the South. Born in Richmond County, North Carolina, he moved at the age of three to his mother’s hometown of Marion, South Carolina. His father, like Kinyoun’s, had served in the Civil War. Unlike Kinyoun, who entered public health work as a pioneer bacteriologist and founder of a prestigious national laboratory, Blue started as a simple foot soldier in the war on disease. He was a soldier’s son, drawn to a life in uniform, but when he enlisted in the U.S. Marine Hospital Service, it was not as a warrior, but as a healer.
Descended from a line of Carolina Scotsmen who stood over six feet tall, Blue had blue eyes, jet hair, and a barrel-chested Victorian frame well upholstered by a robust appetite and a love of boxing. He styled his hair with a center part and grew a curved handlebar mustache that he twirled when amused or twisted when preoccupied. He was the sixth of eight children—three boys and five girls—born to Colonel John Gilchrist Blue and his wife, Annie Maria Evans. His grandparents owned spacious Carolina plantations with many slaves.8 However, Rupert Blue, born on May 30, 1868, was a child of the Reconstruction and lived amid freed servants and field hands. Within their conservative southern milieu, the Blues were more progressive than many of their contemporaries. Mrs. Blue had been one of the few girls in the antebellum South to go to college. Colonel Blue, for his part, practiced law and served in the South Carolina State Legislature, where he championed the cause of women’s education. His lonely campaign drew jibes that he sought to see women admitted to South Carolina’s famous military academy, the Citadel.9 His bill failed, but a century later, the joke it inspired would come true.
The Blue boys and girls—Sallie, Effie, Ida, William, Victor, Rupert, Kate Lilly, and Henriette—toiled in Marion’s public and private schools, studying history and Latin. Of the younger Blues, Victor and Kate were extroverts who sparkled in company, while Rupert and Henriette (called Henriet or Hettie for short) were both shy, indwelling souls whom folks found it easy to underestimate. Rupert read avidly about classical Rome, studied the Bible, and devoured accounts of Napoleon.
The Blue children were baptized and confirmed in the white-pillared Presbyterian church on Main Street. They straddled logs on the reed-choked banks of Catfish Creek, less than a mile from their back door, to angle for pikes, jacks, and catfish. There were quail and partridge for the hunting. The boys’ menagerie included blooded calves and purebred dogs, Angora goats and merino sheep, while the girls kept pedigreed cats and prize poultry.
In spring, they held contests to identify the first notes of birdsong from the chuck-will’s-widows in the Carolina pines. The most succulent treat of a summer morning was savored in stealth. Creeping into the melon patch at dawn, with the dew still on the vines, the Blue children would “bust melons” open with their fists, devouring the ruby centers without ceremony or silverware.10
The family’s plantation, Bluefields, was a stout, unpretentious family farmhouse with a broad-railed porch and heart-of-pine floors that rang with the steps of the parents and their eight growing offspring. On three hundred acres around their plantation, the family raised tobacco and cotton, corn and lumber.
Marion County, South Carolina, is shaped like a pork chop, stuck in the fork of the Big and Little Pee Dee Rivers. In summer, it is steamed languidly by a swamp that local Indians called Withlacoochee, but which the children knew simply as Catfish Creek. The town of Marion is anchored by stately Greek revival mansions, fringed with purple wisteria and the fuchsia blooms of crape myrtle. Any passing Yankees who dared steal its gray-green swags of Spanish moss as souvenirs would be bitten by red bugs, a source of local mirth to this day.
Marion was named for Francis Marion, the “Swamp Fox” of the Revolutionary War, who eluded the British and survived on roots and water. A century later, the boy who staged naval battles in Catfish Creek identified as much with the heroes of the Revolutionary War as with those of the War Between the States. As the Civil War waned, Marion escaped Sherman’s torch by an accident of the weather: A rainstorm flooded the Pee Dee River, and its rising waters deflected the Union general’s attack. Thankful Marionites dubbed the river “Sherman’s freshet.”11 Rupert Blue was born a son of the Confederacy, but he aspired to be in the Sons of the Revolution.
It’s often said the hero displayed gifts of brilliance and leadership in childhood. But, plainly, Rupert Blue didn’t start out as Marion’s most illustrious son. That honor belonged to his brother Victor, two years older, who emulated his father’s military service by entering the Naval Academy at Annapolis. After graduation, Victor served with distinction in the Spanish-American War, where he performed dangerous surveillance, gathering intelligence on enemy ships in the port of Santiago, Cuba. For this, he was feted as a naval hero. Chiseled, gallant, graceful in society, Victor cast a long shadow over his little brother. Round, shy, halting in public, the younger brother nicknamed “Pert” got lost in the glare of Victor’s glamour.12
Victor was “the family paragon, and entirely worthy of the great love his parents, brothers and sisters bore him,” his sister Kate Lilly rhapsodized. About her other brother, she measured her words.13
“There was the greatest difference between Victor and Rupert,” Kate said. When Victor returned home a war hero, he “hob-nobed with everybody he had ever known,” she said. The younger boy was neither war hero nor socialite. “Rupert is very different,” Kate said. “He just cannot stand on the street corner and give the glad hand to to somebody he might have gone to school with….”14
After school days were over, Rupert got his first taste of medicine in 1888, when he spent a precollege year studying practical pharmacy in Latta, South Carolina, a tiny hamlet eleven miles north of his home. He lived in a boardinghouse and was desperately homesick for the plantation but put on a brave face. “Thanks to a nature that is cosmopolitan,” he wrote gamely, “I am content to live anywhere.”15 Truth was, he so craved contact that he sent stamps home to coax the family to write him letters.
Blue’s boyhood ended abruptly one winter night. Although he stood a robust six feet two, Rupert’s father wasn’t as strong as he looked. During the Civil War, while leading a regiment called the Scotch boys, he managed to dodge lead balls and cannonfire, only to carry home scars in his heart, possibly from rheumatic fever. Although he was a noted temperance leader who abstained from alcohol, he indulged freely in tobacco, which further strained his heart. Even getting about the farm became difficult, and his sons implored him to rest. That winter, his vigor failed utterly. He left the clinging damp of Marion for the brisk air of his old home in Richmond County, North Carolina. Victor, then on naval exercises in Europe, and Rupert, at his pharmacy in Latta, wrote anxious letters home, begging for news of “Pa’s” recovery. When Mrs. Blue and the girls opened Colonel Blue’s letters home, they saw a frail and spidery hand that crawled across the page, belying his words of stout cheer and sure recovery.16
On Christmas Day 1888, Colonel Blue suffered a heart attack. He lingered through the New Year. As his family gathered around his bed late on Sunday night, January 6, 1889, he died. They buried him in North Carolina.17
His widow was left to manage on her own with two teenage girls at home—Kate and Hettie. Her eldest son, Bill, would manage the farm. Her middle son would continue his naval career. Her youngest boy, a twenty-year-old pharmacy apprentice, had no degree and meager prospects. That would change fast.
Galvanized by his family’s loss, Rupert now entered the University of Virginia at Charlottesville—“Mr. Jefferson’s University.” He wanted to reassure the family that, despite the enticements of college life, his soul wasn’t in jeopardy.
“You must not fear for my morals because I can not be persuaded to do a thing, when that thing is distasteful to me. I will not assimilate the vices of others,” he wrote to Kate. “[I]f I am spared to good health I can accomplish something, for I have the will & ambition.”18
After two years of study in the serpentine-walled campus at Charlottesville, Rupert entered medical school at the University of Maryland, Baltimore. There, he wasn’t the most brilliant student, but rather an earnest toiler with a sharp new sense of duty.
“I am working like a Trojan,” he wrote to Kate, “and I trust that my labors will be rewarded.” Money was tight since his father’s death, and he had to choose between tuition and travel. “I may come home in the spring,” he wrote, but he added, “It depends entirely on the state of my exchequer. I want enough to take a short course in hospital diagnosis.” In his command of medicine, he feared he was falling behind another Virginia school chap and friendly rival, Joe Guthrie, who surpassed him by taking a hospital course in New York. “There is,” he despaired, “so much to learn….”19
There were distractions. While he toiled, “matrimonial fever” swept the country cotillions of Marion. Rupert had been courting a local belle named Miss Emily, but he was a diffident suitor and wrote of love as a recurrent affliction from which “I hope I will be cured….”20
Finally, Blue’s medical school travails paid off. He won a rank of second place in anatomy class, with an average of 90 percent in other subjects.
On April 15, 1892, Blue graduated from medical school. None of his family attended his graduation, so he wrote a letter sketching the pageantry for his absent kin.
“Our commencement exercises yesterday were pompous and ceremonious to an extreme,” he wrote.
“I begin my professional career today with perfect cognizance of the many responsibilities which rest upon my shoulders,” he said. “When I listened to the valedictory address, I mentally determined that I should ever be found on the side of right—let the consequences be as they may. That temptation no matter how alluring should not deter me from the path of rectitude,” he went on. But anticipating that Kate would mock his solemnity, he rushed to add, “This confession may seem strange to you, knowing my early training and fixed attributes of character; but I will reply by saying that a physician’s life is one beset with peculiar environments and open to many possible indictments.”
Then, trying out his new title, he signed the letter with a professional flourish:
“Love to all. Yours, R. L. Blue, M.D.”21
After an internship in Baltimore, where he treated sick oyster-men, R. L. Blue, M.D., applied to join the U.S. Marine Hospital Service, the guardian of ports and quarantines that during his tenure would grow into the U.S. Public Health Service. Admission to the service was granted by a competitive exam covering medical and general academic knowledge. Blue was nervous. Kate, now an aspiring librarian, sent a shipment of great books so he could stuff his head with learned allusions. They came too late. But Rupert made a good show, reading Latin fluently. Still, entrance into the Marine Hospital Service commissioned corps required a presidential appointment and confirmation by the Senate. There were twenty-five applicants and only four vacancies.
As he waited for word, he gnawed away his anxiety by indulging in his father’s vice—tobacco—and wrote letters to his family.
“This branch of the service has many advantages over the Navy or Army…. I am in exactly the same straits that Victor was in that summer he was home from the 2 years’ cruise, [i.e.] in awaiting orders,” he wrote Kate. “I do not know yet where I will be permanently located. It can be anywhere from Maine to California or from the Lakes to the Gulf. There is some excitement in this condition and I am making tobacco fly….
“Our uniforms are the same as the Naval. The rank of assistant surgeon in the [Marine Hospital Service] is that of a lieutenant, the pay is from 16 to 17 to 18 hundred per year. You see the pay is better than that of an Ensign or [Lieutenant] on shore duty. But of course there are some disadvantages, viz. being ordered to a yellow fever quarantine station at Key West, Fla., or the Dry Tortugas. Tell Ma and Sallie not to fret….”22
Joking years later about his choice of public health over private practice, he told his mother that private physicians were too dependent upon the money and the gratitude of rich patients. And gratitude, he said, is part of the disease: Once the patient’s cured, it goes away. But the truth was, he didn’t aspire to just cure disease. He wanted to prevent it entirely.23
To Blue’s relief, his appointment to the U.S. Marine Hospital Service was promptly confirmed. One of his first assignments sent him south to the humid seaport of Galveston, Texas. There, in the Gulf town, he gave his mother a new cause to fret—not yellow fever, but a fever common to young men. Across the footlights of a Galveston theater, he saw a vivacious young actress and was smitten. Her name was Juliette Downs, and she was the daughter of a southern railroad man. Her choice of a stage career would have upset many a good Victorian matriarch, especially one born of genteel southern stock like Annie Maria Blue. One might court an actress, even sow a few wild oats. But marriage? An actress was certainly a questionable candidate for daughter-in-law.
Victor, on the other hand, displayed the same impeccable taste in a mate as he had in a career. Eleanor Foote Stuart, called “Nellie,” was a cameo blond beauty with a halo of curls and the daughter of a military family of means. Victor and Nellie produced two handsome sons, traveled the world, and returned home often to bask in the adoration of Marion society. Today, no one in the town of Marion—where everyone knew the Blues—even recalls hearing of a visit by Rupert’s love, Juliette.
Bucking convention, Rupert and Juliette were wed in 1895 and, after a stop in New York, soon headed for his assignments on the West Coast. The newly wed assistant surgeon in the Marine Hospital Service was stationed at the Angel Island quarantine station in San Francisco Bay, boarding ships, peering into dark and pungent cargo holds, and checking passengers from stateroom to steerage. In his performance reviews, Blue’s supervising officers rated him highly for his “diligence, discretion, and tact” and for solid professionalism, but they also noted that he liked an occasional drink and was “somewhat disposed to be hurried.”24
At twenty-seven, with his country boyhood behind him, Blue had to think about supporting a stylish wife with a taste for the finer things. In the rainy season, Angel Island turned into a mudslide, so the Blues moved into a hotel in the city. But the lifestyle there proved to be expensive. Rupert still sent home a portion of his paycheck as a monthly allowance for his widowed mother and his two unmarried sisters, Kate and Henriet. It was difficult to manage on $1,800 a year.
When the hospital service posted him to Italy in 1900, Rupert and Juliette reveled in an Easter holiday in Rome—accompanied by Juliette’s mother, Mrs. Downs. Juliette and her mother explored modern Rome, where Giacomo Puccini was following up his opera La Bohème with a new work called Tosca. On his own, Rupert explored la città eterna, wandering wide-eyed through the Forum, studying the classical antiquities he knew from school and the early Christian relics he recalled from his Bible lessons. He wrote to his mother and Kate to implore them to make a return pilgrimage with him. Juliette’s father, who had once done a favor for a touring Italian cleric, arranged a papal audience. The aging Pope Leo XIII clasped the young couple in benediction. As a lifelong Presbyterian, Blue was skeptical, but something happened when the pontiff took his face in his hands and, speaking in French, blessed Blue’s mother in her faraway farmhouse. “I like this grand old prelate,” Blue admitted, completely won over.25 After Italy, the return to domestic assignments would seem dull to any couple in their twenties: Portland had no Puccini, and Milwaukee had no Michelangelo. Money was tight, and Rupert continued to send a portion of every paycheck home—which meant less for ball gowns, carriages, dining, and nights out. The life of a circuit-riding doctor strained the best of marriages. The romance kindled in the heat of Galveston and stoked by the dolce vita of Italy would be tested by the deep freeze of Milwaukee winters and the dreary rains of Portland.
Rupert lacked Victor’s knack for military honors, social graces, and making an advantageous marriage. All too aware of his deficiency, he would season his brotherly love for Victor with rivalry all his life. Years later, when applying for membership in the Sons of the Revolution, he explained to Kate, “Victor has so many medals I wish to own a few badges myself in order to make a fair showing in uniform beside him.”26 Although Rupert Blue was no soldier, he had subtler strengths that lay quiescent, waiting to be tested in a time of epidemic.
In his earliest surviving portrait as a working physician, Rupert appears every inch a warrior. He is dressed in the rich regalia of the Marine Hospital Service’s dress uniform. His double-breasted frock coat of midnight blue was lined with eighteen gilt buttons and topped by gold-braided shoulder boards. His belt was vellum, shot with gold wire and striped with navy and gold silk. From it hung a thirty-inch ceremonial sword, with a white sharkskin grip wrapped in gilt wire and adorned with a heavy golden tassel. The service supplied a twenty-five-page pamphlet to outline all of its magnificent tailoring details, down to every last anchor and eagle ornament.27
In his dress uniform, Rupert Blue looked almost as much a military man as his brother Victor. Only the gilded clasp on his belt buckle hinted at a different mission. Engraved on its face was the anchor of the Marine Hospital Service, signifying the seamen who were his first patients. It also bears a caduceus, a winged wand with twin serpents interlaced. The caduceus was a symbol of both maritime commerce and the art of medicine. The caduceus also resembles the staff of Aesculapius, the progenitor of public health guardians. In ancient mythology, Aesculapius was a physician who outraged the gods by daring to bring the dead back to life. For his presumption, the god Zeus struck him down with a lightning bolt. Blue would later learn that a doctor could rattle politicians almost as much as Aesculapius had riled the gods.28
Nearly every day for the next two decades, Blue would live in the plain khaki fatigues of the hospital service’s working uniform. But it was in full ceremonial regalia that he posed that day. Turning right in a heroic three-quarter profile, chin up and arms akimbo, he gazed with a look both dreamy and defiant toward a future he could not imagine.29