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.”
Epilogue
NO MONUMENT STANDS IN San Francisco to mark the city’s plague ordeal and the public health warriors who fought against it. The epidemic, once extinguished, was all but forgotten.
Joseph Kinyoun, the bacteriologist and quarantine officer who diagnosed San Francisco’s plague, was chased out of town as an archenemy of the people. As a scientist, he was undone by mercenary politicians, who bartered the city’s health for trade. He was a victim of official denial and protectionism. But his character, in turn, fed the city’s animus. He was proud, isolated, dismissive of the very plague patients who most needed his help. Clashing with the Chinese and pouring fuel on the city’s anger, he was, in his own view, at war with everyone. Kinyoun’s quarantines and travel restrictions against Asians, while supported by his superiors, were crude and discriminatory tools. Moreover, we now know that, even if the courts had not overturned them, such measures would not have stopped bubonic plague. Wounded and uncomprehending, Kinyoun quit San Francisco, and shortly afterward, the public health service. His career on the national stage was over, and its premature end was a reminder that science without compassion is a dry and punitive discipline.
After leaving San Francisco in 1901 at age forty, Kinyoun returned to the East and worked as director of a company making vaccines and antitoxins, as a professor of bacteriology and pathology at the George Washington University School of Medicine, and as the city bacteriologist of Washington, D.C. During World War I, he served the U.S. Army as an expert epidemiologist. Not long after the armistice, however, Kinyoun developed an aggressive lymphoma of his neck. In 1919 at age fifty-eight, he died.1
History has been kinder to Kinyoun than his contemporaries were. For his founding role in the National Hygienic Laboratory, forerunner of the National Institutes of Health (NIH), he is posthumously recognized as the first director of the NIH. It was the work of his youth—applying the powerful tools of bacteriology to the diagnosis of infectious disease—that survives him, untainted by the political and racial poison that infected so many people in 1900.
Rupert Blue, who leapt from San Francisco to the surgeon generalcy, fared far better. To some degree, history favored his endeavors. Just when he took command of the situation in San Francisco, medical science finally grasped the facts about the transmission of bubonic plague. And it was Blue who put those findings into practice in San Francisco. Once rat fleas were identified as the primary culprits, Blue could spare people the ruinous consequences of quarantine, and focus on killing rats.