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
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 Legion 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 protege, 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
