The Barbary Plague

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 Boheme with a new work called Tosca. On his own, Rupert explored la citta 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

Hiding the Dead

JOSEPH KINYOUN GRASPED his proof defiantly. With stains and slides, with microscopes and the mute testimony of dead lab animals, he had identified the germ that killed Wong Chut King.

The killer, he now knew, was the same bacteria that had ravaged Asia and Europe since biblical times. Was this the beginning of an epidemic like the one described in The Decameron, one that would send rich and poor to common graves and leave Nob Hill mansions as vacant as Florentine palaces?

Although plague had ravaged Europe for thousands of years, its true nature and cause weren’t discovered until 1894, after a feverish scientific race. Even after the bacterium was identified, how it entered the human body remained a mystery.

In 1894, as bubonic plague inflicted suffering and death on China, two rival scientists, Alexandre Yersin of Paris and Shibasaburo Kitasato of Tokyo, went to Hong Kong to identify the cause of plague. Both were eminent scientists, disciples of the pioneering microbe hunters Robert Koch, who identified the tuberculosis bacterium, and Louis Pasteur, who created the rabies vaccine. Yersin and Kitasato both used a basic technique in their work called Gram’s stain.

The brainchild of a Danish scientist, Hans Christian Joachim Gram, the test cleverly exploits the tendency of different bugs to either soak up or shed certain colored dyes. Whereas growing colonies of bacteria in culture takes days to complete, testing the Gram’s stain takes just minutes and requires only a few vials of blue or pink dye. A scientist drenches a sample of bacteria with blue dye, then rinses it. If the blue dye sticks, the germs are classified as “Gram positive.” If the blue dye washes off and the germs instead absorb a second, pinktinted dye, they are considered “Gram negative.” Some well-known bacteria, such as staphylococcus and streptococcus, turn blue— Gram positive. But plague bacteria shed the blue dye and stain vivid pink—Gram negative. The staining pattern also highlights the distinctive features and shape of a bacterium: The rod-shaped plague bacteria turn deep rose at the rounded tips, so that they resemble closed safety pins.

In their haste to discover plague, however, the rival scientists Kitasato and Yersin announced different results of the Gram’s stain. Kitasato was first to declare his results and rushed to tell the world that the plague bacteria stained blue—Gram positive. Later he vacillated, saying he didn’t know.

Yersin arrived in Hong Kong four days after his rival. Lacking the authority to perform autopsies in the major hospital, he had to improvise. Working in a tent behind his straw hut, he paid British soldiers doing undertaker duty for access to bodies awaiting burial. After opening their coffins and dusting the lime off their bodies, Yersin biopsied