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
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
…[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]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
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
