Tuberculosis as an “Occupational Disease”

Some socialists were not content to criticize from within the mainstream model or simply to encourage philanthropy. Legislative officeholders in particular were at the forefront of a struggle during the first decade of the twentieth century to include tuberculosis in a category of “occupational diseases” (maladies professionnelles) that would be subject to social insurance benefits. The episode stands out as emblematic of the gradual drift toward reformism and electoralism in French socialism between 1880 and 1914. From the time the first socialist deputy was elected in 1881 and the first socialist group was formed within parliament in 1886, there was pressure on the movement to increase and prove its strength through elections and legislative initiatives. Even onetime revolutionaries such as Jules Guesde and Edouard Vaillant evolved into reformists and parliamentarians, and the trend accelerated when conciliatory politicians such as Jean Jaurès assumed positions of influence within the socialist movement.^[19] On the specific issue of tuberculosis, this gradualist orientation can be seen in the socialists’ tendency to accept the dominant etiology and to strive for piecemeal reforms in the area of public health.

The effort to classify tuberculosis as an occupational disease presents an interesting case study in the ideological appropriation of the disease by the Left as well as in socialist strategy. Because the project originated in a version of the alternative, syndicalist etiology and adopted the political tactics of the socialists, it provided an intermediate arena of potential overlap or intersection of the syndicalist and socialist currents. In the end, it proved to be fundamentally socialist and reformist—an illustration of the process by which radically oppositional ideas could be absorbed and diluted by the very system that they threatened. Representing tuberculosis as an occupational disease also paralleled the official War on Tuberculosis in directing attention to places of special concern. While mainstream physicians and public officials trained their sights on the cabaret and on the interior of working-class lodgings—dangerous or preoccupying spaces, in their view—the Left focused on the workplace, which it saw as the key locus of workers’ oppression.

Edouard Vaillant, a socialist deputy, medical doctor, and veteran of the Paris Commune, introduced social insurance legislation in 1900 which was modeled after the German laws implemented by Bismarck in the 1880s. The bill came two years after the passage of France’s landmark 1898 law on accidents du travail, which mandated employer compensation of workers injured on the job. Vaillant’s assurance sociale would have provided benefits in cases of illness, accidents, invalidity, old age, and unemployment, among other “social risks.” Moreover, tuberculosis was specifically targeted in the bill’s preamble and supporting arguments.

If one considers that tuberculosis kills 50 percent of all workers, by the fact of their work—that is, their overwork—by the insalubrity of their workshop, by their housing, by their too meager wages,…by their insufficient diet, one recognizes two consequences:

1. That tuberculosis is truly, for the working class, an occupational disease and that, like occupational diseases, it must,…because it is a result of the unhealthy and dangerous conditions of the occupation, be included in industrial accidents and confer rights to the same reparations.

Treating tuberculosis like industrial accidents was not only just, it was also the most effective means of curing the disease, by giving sick workers the opportunity (and the money) to escape temporarily the conditions that compromised their health in the first place.

2. [O]f all early-stage cases of tuberculosis, the worker’s is particularly curable[;] removed from the occupation, the milieu, [and] the overwork by which he is perishing, [he] is reborn to good health, in a healthful climate and situation, as long as he is hygienically housed, clothed, and nourished.^[20]

This excerpt from Vallant’s proposed legislation represents a form of oppositional core narrative. In this case, instead of explaining the spread of tuberculosis, the proto-story equates overwork with illness by telling of the worker’s recovery when removed from labor and poverty. Just as in the mainstream core narratives, the subject is “he,” the working- class male, and women fade from consideration as victims of tuberculosis. By no means did narrative belong exclusively to the strategists in the official War on Tuberculosis. To illustrate the causes of disease and the morality of their position, the oppositional readings of tuberculosis relied as much on core narratives as did the dominant etiology. It is significant that in this bill, Vaillant did not restrict the designation of “maladie professionnelle” to cases of tuberculosis that could have resulted from workplace exposure to certain specific particles or contaminants. For all workers, tuberculosis was an occupational disease.

Even more significant is the fact that in Vaillant’s proposal, the French parliament—and by extension, the nation’s political leadership as a whole—was confronted for the first time with the oppositional etiology of tuberculosis. While the syndicalists might have quibbled with a shade of meaning here or there and would certainly not have accepted recourse to legislation as a means of action, Vaillant’s bill (like syndicalist agitation) proclaimed without ambiguity that through overwork, low wages, and their attendant ills, wage labor caused tuberculosis. Nevertheless, despite Vaillant’s argument that to detect tuberculosis early and nip it in the bud would cost less (as he claimed the German experience had shown) than long-term care for terminally ill patients, the social insurance bill failed to attract significant support in parliament.^[21] Given the extreme reluctance of the legislature and the courts to enforce even the weak industrial accidents law, the failure of Vaillant’s comprehensive plan was no surprise.

Yet the former Communard, by then one of the elder statesmen of French socialism, did not give up. The following year, among many proposed amendments to the 1898 law on accidents du travail, there appeared one submitted by Vaillant. The amendment itself was simple and straightforward. “Occupational diseases are included under industrial accidents and considered as such by this law. [¶] Tuberculosis in workers and employees is held to be an occupational disease.” Vaillant made it clear that he did not expect the chamber to adopt his amendment as it stood, but he asked that his colleagues at least refer the question to the social welfare committee for examination. The extreme Left of the chamber resounded with cries of “Très bien! très bien!” but some deputies reacted with astonishment and consternation to the sweeping proposal.^[22]

Léon Mirman, the committee’s rapporteur on the 1898 law amendments, cautioned that “the question is extremely delicate.” Of course, Mirman added, some diseases were obviously of occupational origin and should be covered in the same fashion as accidents.

The first difficulty…is to know which diseases should be considered occupational. There are certainly some which come to mind and which we could list, but I must admit I was somewhat astonished to see that in the additional clause proposed by M. Vaillant, tuberculosis was indicated as an occupational disease.^[23]

“It is above all a general disease,” maintained Deputy Charles Ferry. “I have always considered tuberculosis a general disease whose origins are quite unclear,” echoed Mirman. As proof of this uncertainty, Mirman noted that he had seen posters in train stations, on boats, and on buses urging passengers to avoid contagion by not spitting on the floor. (The implication was that if tuberculosis was caused by spitting and contagion, it could not be caused by work and could not be considered an occupational disease.) Vaillant countered that his proposal neither asserted nor denied the relevance of contagion. “I [only] declared,” he said, “that in workers predisposed by their working conditions, by their insufficient wages, by the excessive length of the workday, by overwork, etc., a general weakening ensued, and then tuberculosis.” Because the disease developed as the “inevitable result” of their occupations, it was indisputably an occupational disease and an “accident du travail.”^[24]

Deputy Mirman remained unmoved, however. Pleading ignorance as to whether or not tuberculosis was an occupational disease, he nevertheless left little doubt which answer the law would ultimately give. “That its development is favored by certain hygienic conditions in working-class housing or in factories, of this there is no doubt; but [as for] whether it is an occupational disease or not, I did not believe so, [but] I do not know [je ne le croyais pas, et je n’en sais rien].” Other deputies pleaded with Vaillant to separate the two elements of his amendment: the expansion of the 1898 law to occupational diseases and the explicit recognition of tuberculosis as one of them. Separating them (that is, acknowledging that the second part was unrealistic and overly controversial) would facilitate the chances of eventually passing an occupational diseases bill and would avoid alienating potential supporters who might be frightened by extremist measures such as including tuberculosis. Vaillant resisted the pressure to dilute his amendment, but it was eventually tabled in committee.^[25]

Maladies professionnelles nevertheless continued to preoccupy socialist legislators intent on expanding the domain of the 1898 law. One deputy in particular made occupational diseases a personal project and pursued their legal recognition over two decades. Jules-Louis Breton, a close colleague of Vaillant in politics and journalism since their younger days together in the Cher, had become by 1903 a prominent spokesman for the moderate socialists in parliament. In that year, Breton introduced another maladies professionnelles bill that also targeted tuberculosis as a common and deadly occupational disease. But this time the universality of work-related tuberculosis was replaced by a much more limited view of possible occupational causes of the disease. Once again, the bill aimed at extending the protection of the industrial accidents law to “diseases of occupational origin.” However, tuberculosis enjoyed quite a different status in this bill than in Vaillant’s defiant proposal to recognize it as broadly occupational in origin among the working class.

Breton affirmed the centrality of “pneumoconiosis” in the determination of occupational diseases. The word denotes a category of lung disorders (at the time often indistinguishable from tuberculosis, now seen as including asbestosis and silicosis) caused by the inhalation of irritant particles. According to Breton’s legislation, workers in jobs involving dust emissions or dusty surroundings ran a great risk of pneumoconiosis, which in turn “predisposed them by the alteration of their lungs to contract tuberculosis.” At issue in the text of the bill was not whether occupational pneumoconiosis per se should be subject to compensation (Breton considered this a self-evident example of occupational disease) but whether the law should apply to tuberculosis of unknown origin in workers habitually exposed to dust or other harmful particles. “In other words,” the bill asked, “does the continual inhalation of these dusts predispose the worker to tuberculous infection to such an extent that the employer owes in all fairness…the indemnity” under the provisions of the 1898 law?^[26]

Breton maintained that it did. Quoting a report by the extraparliamentary Commission on Industrial Hygiene (appointed by the Ministry of the Interior), he listed those industries in which workers were massively exposed to “animal,” “vegetable,” and “mineral” dusts.^[27] The role of workplace exposure in determining not only pneumoconiosis but also tuberculosis was so well established in the view of the commission (and in Breton’s mind) that it justified making tuberculosis an occupational disease under the law for those industries.^[28]

While many deputies doubtless still considered this proposal too radical and a threat to business, it was certainly a major retreat from Vaillant’s global inclusion of tuberculosis as a maladie professionnelle. Breton recognized full well that many cases of occupational tuberculosis would not be covered under his bill. Unfortunately, he explained, tailoring the bill to fit such cases would torpedo its chances of passage in the Chamber. This central stumbling block loomed large in the entire debate on maladies professionnelles. The necessity of compromise for the sake of getting legislation passed divided not only the antiparliamentary syndicalists from the socialists but also radicals from moderates within the socialist camp. Whereas Vaillant apparently preferred to stick to his principles and act as a gadfly by introducing bills that had not the slightest chance of passage, Breton toiled persistently at fashioning an occupational diseases bill that could become law. (When one finally did, after World War I, it bore his name, and he would come to be remembered as the father of maladies professionnelles.)

The risk of this strategy, of course, was watering down the legislation beyond the point of responsiveness to one’s original constituency. Breton’s willingness to compromise and tireless effort seem to have created a certain momentum for occupational disease legislation. Eventually, however, the substantial opposition to coverage of tuberculosis in any form wore him down. In 1907, the most recent incarnation of his bill (which, like the 1903 version, included tuberculosis in the “dusty” industries) faced off in committee against a drastically narrowed government-sponsored bill, which covered only lead and mercury poisoning. A government official testified before the social welfare committee that determining with certainty the occupational origin of a disease was problematic. “However,” he said, “there are cases of diseases which we must resolutely exclude. We can say as much of tuberculosis, which has been admitted by M. Breton into the ranks of occupational diseases.” Breton’s response was a terse “There are special cases,” to which the official answered, “One can generalize too easily.” Shortly thereafter, the committee’s minutes reported that “M. Breton agrees to exclude tuberculosis [because it] might cause the bill to fail.”^[29]

In the space of six years, then—a period that coincided with the height of public attention to the social aspects of tuberculosis—while parliament failed to pass any occupational disease legislation, proposals proceeded from Vaillant’s universal coverage of tuberculosis to inclusion only of cases involving continual particle inhalation to no coverage of tuberculosis whatsoever. The center-Right composition of governmental coalitions and their extreme reluctance to challenge the prerogatives of private property and capital thwarted many efforts at social reform during the first half of the Third Republic. Faced with so many arguments against the feasibility of occupational disease legislation, it is perhaps unsurprising that socialists such as Vaillant and Breton could manage neither to keep tuberculosis in their proposals nor to pass any bill at all on the subject before World War I. Nevertheless, the story of their attempts—particularly the path traveled from Vaillant’s resolute inclusion of all cases of tuberculosis to Breton’s pragmatic abandonment of it altogether—illustrates a central feature of the socialist dilemma. Efforts to address the social causes of tuberculosis within the political arena were caught in the tension between the desire for radical change and a commitment to the system that made such change impossible.