"The town of Hubli—a mercantile town of over 50,000 inhabitants—was attacked by plague in an epidemic form at the commencement of the monsoon rains. The average rainfall between April and October amounts to more than 28 inches. Under these circumstances, although a large and weather-proof health camp had been prepared for emergencies, complete evacuation of the infected townsite was impossible; and the attempt to effect it would have led to the severest hardships and to the immediate spread of the disease into surrounding villages and districts. It was for this reason that the determination was formed to make a bold and comprehensive experiment with the prophylactic, and not on any à priori grounds. If this experiment had failed, the results, judged by the actual mortality among the uninoculated, would have been appalling. All possible sanitary measures in the shape of disinfection, unroofing of houses, and segregation, were applied concurrently with inoculation, as Government are already aware; but the rate of mortality among those who held back from inoculation rose at one time to a height which, I believe, has never been approached elsewhere....
"However, the experiment, in the hands of Dr. Leumann, did not fail, and it has afforded a demonstration of success which is of Imperial importance. Many thousands of lives have undoubtedly been saved, and at the present moment the plague mortality is merely sporadic, and Hubli is steadily regaining its normal population and trade, though surrounded by infected villages."
The Hubli report must be put at full length, for the vivid picture it gives of plague in India, and of the difficulties besetting the magnificent work of the Indian Medical Service. It is a story that Mr. Kipling ought to write. And it is to be noted that Surgeon-Captain Leumann, who saved Hubli, recognised the extreme importance of other methods than inoculation—disinfection, isolation of cases, evacuation of infected districts. He says:—
"While paying the highest tribute to the value of Mr. Haffkine's inoculation method, which I claim, here in Hubli, to have put to perhaps the severest test to which it has yet been subjected, I am of the opinion that individual protection is, on however great a scale conducted, of less importance to that of general protection and hygiene (considering each method separately, that is to say), for it seems to me more radical, if not more rational, to eradicate a disease than to leave it to pursue its course and only protect people against its ravages."
Sanitation, therefore, was Dr. Leumann's faith. Now for his works:—
"I first started inoculation here on 11th May.... When I began my inoculations, I operated first of all on some European or native gentlemen in front of a crowd of poor and low-caste people, whom I had gathered together in the worst-affected area, and they were thus soon induced to ask for inoculation themselves.... They have presented themselves, by the hundred, at all times of the day, before myself and others, for the purpose of being inoculated.[34] ... I have never experienced the slightest difficulty in inoculating Mussulmanis or any other purdáh women in Hubli.... The very men who, in March last, created a disturbance in Hubli, were not only the first and the most willing to undergo inoculation, but also to bring their wives and families to my hospital, or to invite me to their homes to inoculate them.
"Inoculated persons holding certificates of double inoculation have, at my special wish and order, been left in their homes throughout this epidemic; only their clothes, house, and property being disinfected on the occurrence of a plague case or death in their house. As the vast majority of plague cases have never been notified before death in Hubli (nor, in my experience of nearly two years, elsewhere, if native supervision be largely resorted to), it will readily be understood that the majority of the inoculated have actually been living in the same house, or even room, with a plague case (often of the pneumonic type, whose terrible power of spreading the disease was first shown by Professor Childe, I.M.S., of Bombay) during the whole of the time that case was living, probably attending on the patient, breathing the same stuffy air, and, perhaps, sharing the same blanket; and I attach at the end of this report a long series of cases where such conditions have occurred, the non-inoculated dying of plague, and the inoculated escaping, almost to a man.
"Various critics on my work, not knowing what the actual facts were and are, have at different times asserted that the inoculated inhabitants of Hubli left the town in larger numbers than the non-inoculated. Exactly the reverse was the case. The British officers on plague duty here, and all the Divisional Superintendents, invariably replied (officially and in writing when so required) that the non-inoculated left Hubli in far greater numbers and proportion than the inoculated; and my own observations entirely bear out this statement.
"It has been urged that those who received inoculation were of a class or classes better protected than others against plague by reason of their habits, the food they eat, the houses they live in, etc. In reply, I unhesitatingly state that if there be but one town in India where that line of argument will not hold good, it certainly is Hubli; for not only were the poorer, dirtier, lower-caste people the first to be persuaded to receive inoculation, but I made it my personal and special duty to work amongst them. My first few thousand inoculations were almost entirely amongst the lowest and poorest of the people. The Brahmins are, perhaps, of all castes, supposed to be the most cleanly in their houses, habits, etc., yet the Brahmins of Hubli (who at first, imagining themselves immune, were the foremost and greatest perverters of the truth concerning its efficacy, and the last to apply for the protection inoculation affords), simply inundated the various inoculation centres, as soon as plague began to spread in their midst, clamouring for the very method of which they had only lately tried to prevent others from availing themselves.
"Unfortunately, the average native, educated or not, appears to have the very greatest aversion to notifying any case of sickness—plague or other—and hence, in my opinion, it becomes more necessary than ever to protect the people by inoculation, since they will not help to protect themselves by the foremost and simplest of sanitary and hygienic measures.[35] With so few police (and those none too good) to help one; an inadequate British Staff; with so much reliance placed in Native Superintendents and Supervisors, and a Municipality so bankrupt that it could not apparently afford to buy enough blankets out of its own funds for the patients in the Plague Hospitals—the work of segregation, house-to-house inspection, etc., became, from a medical point of view, absurdly insufficient.