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