The Syndicalists and the International Tuberculosis Congress of 1905

When the world’s most eminent doctors and an impressive number of France’s political and philanthropic dignitaries gathered in Paris for the International Tuberculosis Congress in October 1905, many syndicalists watched closely to see what the establishment would do about the deadly scourge that affected the working class so severely. At least one observer claimed beforehand in the pages of Les Temps nouveaux that he knew exactly what was going to happen at the congress. Michel Petit (the pseudonym of Dr. Edouard Duchemin), an occasional contributor to the anarchist newspaper on medical issues, wrote a satirical article in May 1905 predicting the nature of the upcoming proceedings. The piece, entitled “A Fable for Grown-up Children,” exuded sarcasm and contempt for the authorities.

“The fortunate ones of this world,” Petit began his fable, “realized one day that it could be dangerous for them to allow diseases which could one day strike them—and were already threatening the productive value of their employees—to propagate themselves among the poor.” Self-interest and “cowardice” made the bourgeoisie take notice of tuberculosis, Petit continued, but what would they do about it? In the past, blame had been laid squarely on the victims.

Official science has stuck to the axiom “tuberculosis is a function of alcoholism,” which they teach to schoolchildren, an easy formula to remember, and thanks to which it is natural to conclude that if a poor person falls ill it is his own fault, and one can only advise him to behave better!^[59]

Petit reasoned, however, that the congress would have to go beyond such pat formulas. It would bring together in the glittering Grand Palais France’s most prominent business and civic leaders, along with their wives and daughters (who would take advantage of the opportunity for a shopping spree at the Parisian department stores), and would treat them to lavish banquets and receptions—a festival of self-congratulation for their generous humanitarian efforts. They would doubtless hear a “harangue” from the president of the republic, reminding them of the urgent task at hand: “safeguarding human lives” and “battling against destructive forces.”

You know the slogans. That one is cliché number two. For example, it wouldn’t do for him to pick the wrong box and take out cliché number one, which covers the necessity of arming oneself against the invader of the fatherland [and] the selflessness with which each citizen must sacrifice his life and especially that of his fellow man.

Petit surmised that the president’s clichés would be followed by arcane lectures on such topics as “saprophytic forms of the Koch bacillus” and “tachycardia in pretuberculosis.” Socialist collaborators in the governing coalition such as Alexandre Millerand would plead for reforms “to better the lot of the needy,” and the assembled throng would unanimously agree to do so—by forming another government commission or even calling for a cabinet ministry of public health. “After that, they will break out the champagne,” Petit added caustically.^[60]

When the congress was over, Petit contributed a follow-up article to Les Temps nouveaux, claiming that the first story “wasn’t a fable” after all. Not surprisingly, he reviewed the actual proceedings just as cynically as he had previewed them five months before.

The ceremony took place, absurd, devoid of facts and useful ideas, full of demonstrations in which bluff competed with free advertising—in a word, a carnival of vanities and appetites, in just the way our present society transfigures every action whose pretext is the betterment of humanity.

What few worthwhile presentations there were at the congress had been “drowned in an uninterrupted series of pointless communications, poured forth in incomprehensible jargon and mumbled at full speed” (so as not to exceed the ten-minute time limit). Petit saw the congress as a perfect illustration of the suppressive power structure within the scientific community. The stranglehold of elite figures in universities, publishing houses, and hospitals over the production of medical knowledge effectively silenced innovative thought by preventing its dissemination. Even congresses, he wrote, “which are designed—we tell the naive ones—precisely to allow unknown and isolated [researchers] to deliver their results to the public,” fell prey to the stifling of new ideas, and the tuberculosis congress had been no exception.^[61]

Those who had attended the congress could have saved themselves a great deal of time and money, Petit concluded, by replacing the entire affair with a batch of posters proclaiming three propositions.

1. No longer will anybody have to work beyond the limits of his or her strength;
2. Everyone will be able to eat his or her fill;
3. Persons living in unsanitary housing (that is, poorly ventilated, unexposed to sunlight, or too small) will have the right to move into any unoccupied quarters.

With that, Petit announced, “tuberculosis will disappear from the human race.”^[62] While the congress gave him another chance to deride some of the leading socialists who had joined in the mainstream fight against tuberculosis, it also prompted Petit to present the syndicalist etiology in a new light. Granted, the powers that be would never be sympathetic to the social critique embodied in this oppositional medical knowledge; but, he seemed to argue, even scientific research, past or future, that might shed light on the true social causes of tuberculosis would never be allowed to surface by the controlling elite in the medical community.

Curiously, though, a hint of subversive knowledge did surface at the congress. Dr. Albert Calmette, already an eminent figure in French medicine, had founded a dispensary in Lille in 1901 and published a report on its operations in conjunction with the 1905 congress. Calmette hired as medical director of his “preventorium” Désiré Verhæghe, a young local physician, and apparently entrusted to him the section of the report dealing with the dispensary’s medical statistics. Whether Calmette knew it or not, Verhæghe was also deeply involved in the labor movement. The result was a set of figures, along with some explanatory text, that deviated remarkably from the orthodox interpretation of tuberculosis—and appeared under Calmette’s name.

For example, the report noted that 96 to 98 percent of the dispensary’s patients showed signs of “physical surmenage” (the proportion varying slightly from year to year) and 67 to 76 percent suffered from malnutrition (alimentation insuffisante). In contrast, direct contagion was found to be responsible for tuberculosis in only 7 to 9 percent of patients, alcoholism in only 15 to 18 percent. The statistics and accompanying text read like a manifesto of the oppositional etiology, based on empirical evidence.^[63] Surprisingly, although the report was discussed at the congress, it did not cause much of a stir. Some accounts of the proceedings mentioned the statistics (without comment), but the report as a whole served mainly to promote the cause of dispensaries in the War on Tuberculosis.

A week after the close of the congress, an article appeared in Lille’s socialist newspaper decrying the bourgeoisie’s impotence in the face of the tuberculosis problem. The article was signed simply “Max,” but clues in its style and content reveal it to have been almost certainly the work of Verhæghe. Given his enviable position at Calmette’s dispensary, it would have been unwise for him to write such a virulent piece under his real name. (It was not uncommon in some provincial cities for activists with syndicalist leanings to be published in local socialist newspapers, which were often more radical than their Parisian counterparts.)

After citing at length (his own) statistics from the Lille dispensary report, Verhæghe drew the conclusion that “the question of tuberculosis, as a disease of the urban working class, boils down to a question of wages and duration of work.” He dismissed the congress’s proclamations, philanthropic gestures, and the “half-measures” proposed by the authorities as a “safety valve against the potential explosions of anger from the exploited masses.” “For us, socialists, truly effective action against tuberculosis…can only be that which…forces capitalism to limit its exploitation, pending…the complete transformation of society, [which will] free the working class from all exploitation.” In a postscript to those “comrades” who had been asking him what to make of the flamboyant claims of some doctors at the congress that they had found a cure for tuberculosis, “Max” insisted that even if the Koch bacillus were to disappear from the earth, debilitated workers would still be vulnerable to other diseases that would take its place. “The surest remedy for tuberculosis, as for all human miseries,” he wrote, “is revolution.”^[64]

After the heady days leading up to and following May Day, 1906, when the furor had subsided and organized labor had lost momentum in the struggle for the eight-hour day and other reforms, tuberculosis became a less prominent fixture of syndicalist propaganda. By 1909, the most active period of labor unrest theretofore seen in French history was over, and new issues such as the threat of war dominated public debate. Even in mainstream circles, tuberculosis had faded from the headlines. Nevertheless, the appearance of occasional pamphlets, articles, and trade union congress reports proved that the oppositional etiology of tuberculosis remained part of the revolutionary syndicalist program in the years immediately preceding the outbreak of World War I.

In the long run, certainly, left-wing agitation over tuberculosis was a failure. It never managed to change official policy to any significant degree, and reforms such as the eight-hour day were realized only later—granted from above rather than imposed from below, as the syndicalists had urged. The broader historical importance of this episode, however, is more difficult to gauge than are its immediate effects.

Labor historians today wonder why the workers’ movement in nineteenth-century France never made working-class health a significant issue in its organizing activity and in its demands.^[65] The answer is that it did, in a sustained and extremely vocal manner, but the voices have been lost in accounts of the theory of the general strike or the question of collaboration in bourgeois governments. If a cartoon representing tuberculosis could arouse (or even be expected to arouse) workers to strike for shorter workdays, then clearly some subversive ideas about the nature of disease had gained a certain amount of acceptance.

Similarly, the story of the Left challenging the authority and impartiality of the medical profession does not fit into the conventional history of medicine. Histories of tuberculosis and public health in France have been dominated by a model contrasting artistic romanticism with the gradual progress of dedicated men of science—supported by public consensus—toward ultimate victory over disease. The development of a militant oppositional understanding of tuberculosis at the turn of the century in France indicates that, on the contrary, the field of production and implementation of medical knowledge was hotly contested terrain.

The significance of this episode may even go beyond the existence of struggle behind the facade of scientific progress and consensus. In France and elsewhere, medicine and public health were critical domains in the “marginalizing” and “normalizing” functions of the dominant culture in its transition to modernity.^[66] These sciences represented certain people and practices as pathological and others as normal, just as they diagnosed pathologies within the human body. Because the syndicalist movement challenged the basic tenets of mainstream medicine and public health through an alternative understanding of tuberculosis, it posed a qualitatively different threat to the institutional structures of modern capitalist society than did, for example, oppositional attacks limited to the domain of political economy. The syndicalist etiology of tuberculosis rejected both bacillophobia and the priority of surveillance and discipline in the fight against disease. Where mainstream medicine, philanthropy, and government proposed remoralizing the poor and monitoring dangerous public and private spaces, the extreme Left fought instead for the fortification of the individual worker’s body. Viewed from this perspective, a scientific disagreement over the relative importance of exposure versus resistance to the tubercle bacillus becomes much more—truly a debate over the entire social and political order of modernity. The fact that the syndicalist challenge never fully realized its goals should obscure neither the reality nor the seriousness of the threat.

Moreover, the ever-increasing scientific sophistication of debates on disease control since the mid-nineteenth century should not be seen as foreclosing the possibilities of “alternative” interpretation. Far from narrowing the range of available answers, the proliferation of detailed epidemiological studies of the past century—regardless of their authors’ or sponsors’ intentions—has not shut off the dissenting perspectives that, for whatever reasons, make mainstream medicine uncomfortable. After all, the rise of germ theory did not inevitably result in the bacillophobia of the War on Tuberculosis; the syndicalists’ focus on overwork and resistance to infection owed just as much to the science of germ theory as did the dominant etiology. That bacillophobia—and the oppositional etiology—did result says more about French society and politics than it does about bacteriology per se.