7. Dissenting Voices

Left-Wing Perspectives on Tuberculosis in the Belle Epoque

To find views of tuberculosis that directly conflicted with the dominant etiology, one must look for evidence outside the mainstream of medical literature. Popular genres such as political cartoons can provide some important clues in this regard. Two intriguing cartoons, side by side, suggest that in Belle Epoque France, the popular meaning of tuberculosis—especially its political meaning—at times eluded the control of the doctors and public officials leading the War on Tuberculosis. La Voix du peuple, the weekly news and propaganda organ of the Confédération générale du travail (CGT), came out with a special edition on May Day 1906. Two years earlier, at its Bourges congress, the CGT had decided to focus its energies on a single issue, the eight-hour workday, and to culminate its agitation with a wave of strikes on May 1, 1906. “As of May 1, we will stop work after eight hours,” their slogan claimed. The May Day issue included a conspicuous indication that the extreme Left in France had claimed tuberculosis as a prominent issue in its agitation. In fact, the period leading up to May Day 1906 marked an important step in the creation of an alternative—and defiantly oppositional—body of medical knowledge.

The special issue of La Voix du peuple mixed propaganda urging workers to support the campaign for the eight-hour day with reports of ongoing labor unrest and police repression around the country. Two eye-catching cartoons (fig. 13) occupied the bottom left- and right-hand corners of page three. On the left, a sullen, sickly figure of indeterminate age—seemingly equal parts old man and scrofulous young boy—stares wanly out from beneath the headline “10 hours,” his workman’s clothes hanging loosely from his body. The caption reads, “Long days breed the seed of tuberculosis.” Across the page, under the headline “8 hours,” a robust, smartly dressed youth, one hand clenched in a fist and eyes fixed on some distant target, exudes strength and determination. His caption: “Short days…seed of revolt!”^[1] In this journalistic context, the opposition of these two simple images clearly identified tuberculosis as two things: the result of long workdays, and a major obstacle in the realization of the workers’ true interests (through revolution). That a political cartoon could represent the disease in this manner testifies to the power of tuberculosis as a social signifier at the time.

La Voix du peuple was not just the newspaper of a major trade union federation. It was the official voice of revolutionary syndicalism, the internal threat most feared at the time by representatives of the established order in France. To be integrated into the CGT’s eight-hour-day propaganda in such a way, tuberculosis must have achieved by that time a certain degree of recognition—at least in the syndicalist milieu and among most observers of the workers’ movement—as a potent political issue, a key component of the “social question.”

The story of how tuberculosis came to be seen as a side effect of industrial capitalism in general, and of overwork in particular, involves both the maturation of revolutionary syndicalism in France and the development of deep ideological cleavages within the medical profession itself. It also highlights the place of medicine and other specialized forms of knowledge in oppositional ideologies. Rather than attacking bourgeois power only in the domain of political economy, syndicalists broadened their assault to include fields such as medicine and public health, which by means of expert knowledge allowed society to be organized, normalized, and disciplined. The historiography of medicine in general and of tuberculosis in particular has tended to ignore such issues. Especially for the period after the rise of germ theory, conflict and opposition within medical science regarding the etiology and prophylaxis of disease recede from the historiographical picture. In fact, this period was alive with controversy, debate, and political division within French medicine.

Although its roots can be traced back beyond the era of germ theory to the early-nineteenth-century hygienists’ work on inequality before death, the syndicalist view of tuberculosis reached maturity and gained currency during the two decades preceding World War I. Even within this period, its peak period of vitality as a weapon in syndicalist polemics lasted only from approximately 1900 to 1908. It is no coincidence that the heyday of revolutionary syndicalism in France converged chronologically with the peak years of both the mainstream War on Tuberculosis and the syndicalist, oppositional version. These were years of tremendous turmoil and strife, when the workers’ movement sought to consolidate its status as a threat to the existing power structure and when many bourgeois observers feared the disgruntled French worker as both a political and a biological danger, a threat to public order and public health alike. When both the official War on Tuberculosis and the syndicalist critique achieved their greatest public expression in the period 1904–1906, the specter of revolution was more haunting than ever to the propertied classes, and workers struggled with ever greater force and determination against what they saw as social inequality and injustice. The sparks generated when revolutionary syndicalism converged with increased public attention to tuberculosis portray both syndicalism and public health in a new light.

The Origins of the Oppositional Critique and the Contours of the Socialist Current

On a fundamental level, the turn-of-the-century oppositional critique of tuberculosis had its roots in the work of the early hygienists during the July Monarchy. The studies of Louis-René Villermé, most notably, showed a direct correlation between poverty and mortality—the basis of later left-wing agitation. Yet Villermé left open both the extent and the exact nature of the causal connection between the various conditions that constituted poverty and specific causes of death. Moreover, he shunned even the slightest implication in his work that socialism or any socialist remedies would be an appropriate response to the deplorable conditions he uncovered.^[2] Nevertheless, Villermé’s work stood as a pioneering exploration of poverty as a public health problem, and it laid a foundation for future work by others who did not share his aversion to socialism.

Left-wing denunciations of the disproportionate incidence of tuberculosis among the working classes surfaced long before the official view had coalesced—and even before Robert Koch’s identification of the tubercle bacillus. For the most part, the earliest expressions of discontent fall into two categories: quasi-romantic, paternalistic laments about the workingman’s lot;^[3] and analyses in the tradition of Marx, Engels, and scientific socialism, which tied overall mortality rates, for example, to the price of wheat and invoked tuberculosis only peripherally.^[4]

Throughout the 1880s and early 1890s, left-wing critiques of official medicine in general and tuberculosis in particular were all but absent from both medical and socialist literature. During this period, as Koch’s 1882 discovery penetrated through the profession and became medical dogma, the dominant etiology of tuberculosis began to take shape. Tuberculosis became firmly established as a “social disease,” whose three determinant social causes were exposure to the tubercle bacillus, unsanitary housing, and immoral behavior. It was only by the late 1890s that theories of bodily exploitation had evolved sufficiently—and that the French workers’ movement had regained enough strength—for the reformist and revolutionary strains to diverge. At the same time, the French trade union movement was gradually organizing workers and gaining strength; the formation of the CGT in 1895 marked a key step in this process. Socialist political parties were also growing during this time, although they did not achieve unity until 1905.

The consolidation of the dominant etiology and the strengthening of the workers’ movement set the stage for the development of an alternative understanding of tuberculosis. Eventually, this oppositional critique split into two more or less distinct currents. The far Left, revolutionary syndicalist perspective rejected the dominant etiology altogether and saw tuberculosis as inherent in the logic of capitalism. The syndicalists focused their antituberculosis efforts on the fight for shorter workdays and higher wages in the short run and for the complete overthrow of the capitalist system in the long run.

In contrast, the “socialist” or “reformist” opposition accepted the fundamental tenets of mainstream Pasteurian medicine and of the official antituberculosis campaign. In particular, this socialist current emphasized two of the three main components of the dominant etiology of tuberculosis, the pathogenic role of unsanitary housing and of any exposure whatsoever to the bacillus, while downplaying the third component, alcoholism and other immoral behavior. Within this dominant etiology, the socialist critics sought to represent the workers’ viewpoint by demanding that government attenuate those aspects of capitalism that they felt most directly threatened workers’ health.

Several peculiarities of the socialist current make it difficult on occasion to distinguish it from the mainstream or “official” view of tuberculosis. The socialists aimed at changing laws and policies from within the economic and political power structure. They generally accepted the terms of debate set by the medical establishment and adopted the rhetoric of government officials and prominent doctors. Conspicuously absent from their polemics was the language of class conflict. This socialist current fought to represent the worker’s voice within the official debate, to focus that debate on pathogenic factors imposed on workers by their economic condition, and to absolve workers of some of the blame directed at them in the dominant etiology of tuberculosis.

A debate in the pages of Le Mouvement socialiste in 1901 exposed the tensions inherent in the socialists’ stance. Two doctors, Jules Thiercelin and Octave Tabary, disputed what contributions could best be made by socialists to address the prevalence of tuberculosis in the working class. Thiercelin urged the working class not to fall into the trap of the official War on Tuberculosis, lest it be diverted from the real struggle.

I do not believe at all…that it is necessary, nor would it be effective, to undertake a specific war on tuberculosis; the working class, which is most afflicted with the Koch bacillus, could end up wasting a great deal of time in the war against various microbes: the latter are too numerous (even though unanimous public opinion is against them . . .).^[5]

Microbes were not the enemy, nor were they even the effective cause of tuberculosis. To devote tremendous amounts of time and money to destroying bacilli, without changing the fundamental causes of working-class disease, would be futile.

It is quite obvious, in effect, that the scourge is not the Koch bacillus, which has no doubt existed for a long time and will survive for a number of years hence, but the physiological poverty of the working class; thanks to machines and competition, the exploitation of one’s fellow man no longer knows any limits, except one: the limit of the human organism’s resistance, and today that limit is called tuberculosis.

Thiercelin used the example of England, where lower mortality from tuberculosis accompanied wage increases and reductions in work hours, to bolster his contention that only overall physical well-being and enhanced resistance to infection could vanquish the disease.^[6]

Just as he would not be taken in by official slogans, however, neither could Thiercelin accept the conclusion of some anarchosyndicalists that any governmental action at all was a sellout of the working class. “We must not…get too accustomed to that simplistic solution…of waiting for a new society to resolve all of our current problems.” Those who did so were nothing but “lazy and ignorant dreamers.”^[7] In fact, Thiercelin obliquely lumped together his opponents on the Left and Right with this curious characterization: “Against the governmental anarchy of today, we must oppose organization and regulation, to the benefit of all. It is we who are the party of order.” Normally, “the party of order” (traditionally used in France to refer to the forces opposing revolution) would not be an epithet coveted by a socialist; Thiercelin appears to have been using this rhetorical device to advocate a sensible middle ground—a policy including income taxes and strict labor laws—between illogical alternatives.^[8]

Dr. Tabary, in contrast, refused to sit back and criticize while there was urgent work to be done. To abstain from the War on Tuberculosis, he replied to Thiercelin, would be “a crime.” “The socialist party…does not have the right to let its members die without protesting against the negligence of the propertied classes.” Tabary lashed out at the “doctrinaires” who would wait for a maximum of suffering among the working class to bring about “the realization of their ideal of justice and solidarity.” Isolated in their “ivory tower,” they advocated an “all or nothing” approach to social reform, fearing that any improvement in the workers’ condition would delay the ultimate emancipation.^[9]

Fed up with the extremist revolutionaries, Tabary held in equal contempt the inaction that had characterized the official response to tuberculosis. The government had taken refuge behind grave pronouncements and encouraged the private sector to shoulder the economic burden of tuberculosis prevention and care. Tabary deemed the private sector’s response laughable, given the scale of the problem. “The remedies brought about by bourgeois philanthropy have so far been ridiculously impotent and stingy.” Instead of depending on the generosity of the rich, Tabary maintained, socialists should incorporate the necessary “radical measures” into their political program. Among those measures, he stressed national insurance against tuberculosis for all workers as a crucial one.^[10]

Underlying the vigor of Tabary’s protest against the authorities, though, was a basic acceptance of their terms of reference. While acknowledging the pathogenic role of overwork and meager wages, his article railed at length against the unsanitary overcrowding that typified workshops and working-class housing. In fact, much of the dominant sociomedical etiology of tuberculosis—targeting exposure to the bacillus and cramped, unclean surroundings—stood unchallenged in Tabary’s analysis. Only the blaming of workers for their own illness (through drink or other immoral behavior) was missing. Furthermore, of the three main weapons in Tabary’s proposed fight against the disease—dispensaries, sanatoriums, and health insurance—the first two were fundamental (if largely unrealized) aspects of the official effort. Neither aimed at altering the social conditions by which tuberculosis spread throughout the working class. Tabary was well aware of this.

Doubtless the creation of antituberculosis sanatoriums and dispensaries does not resolve the social question and does not change in the slightest the relations between capital and labor. It is just one reform among many others which directly interests the working classes.

Piecemeal, gradual reforms were essential, Tabary believed, to the long-term struggle for justice. “Even while having as our goal the transformation of society, our duty is to enact all possible democratic reforms.”^[11] His was a plea for step-by-step action, fighting the workers’ fight on the authorities’ battlefield.

Thiercelin shot back, still in the pages of the Mouvement socialiste, that such a fight was wrong-headed. “The working class need not enter into a specific fight against tuberculosis,” he repeated, and he found Tabary’s arguments wholly unconvincing.^[12] They proved only that “our doctor-legislators” were unwilling to face up to the failures of medicine and to its inability to solve social problems. All of the legislative proposals emanating from the medical community amounted to an elaborate attempt to hide the profession’s total impotence against tuberculosis. Unable to come up with effective medication or a vaccine, doctors took refuge behind the age-old cure hygiéno-diététique. That the sanatorial regime of fresh air, rest, and abundant meals would temporarily “cure” symptoms of tuberculosis was self-evident, argued Thiercelin. Yet even if the money could be found to send workers to sanatoriums, their illness would resurface as soon as they were returned to their “natural” environment of overwork, malnutrition, and overcrowding. The vaunted cure hygiéno-diététique was, and always had been, a cure for the wealthy.^[13]

Tabary and other observers often cited the example of Germany to support their call for the creation of sanatoriums, claiming that tuberculosis mortality there had declined markedly since the opening of numerous such institutions. Thiercelin rejected the example as irrelevant, because the sanatoriums were too new and had treated too few people—even the workers’ facilities, subsidized by national insurance—to have affected the nation’s mortality. More apropos, according to Thiercelin, was the experience of England: an industrial nation, with a poor climate and not a single sanatorium, it enjoyed the lowest death rates from tuberculosis of any major European country. The reason was simple and had nothing to do with medicine or medical care. “It is because the English worker, who benefits from the absence of military service, is especially privileged in that his workday is the shortest and his wages the highest.”^[14]

In dismantling the sanatorial myth and chiding Tabary’s faith in such a futile institution, Thiercelin did not stop at the familiar arguments over therapeutic efficacy. Impulses more sinister than mere misguided medicine were at work, he seemed to contend. By posing as the advocates of the sanatorium, not only were doctors trying to “mask their complete failure” to find an antituberculosis serum but they were paving the way for the economically efficient quarantine of the sick. (Sanatorium treatment of workers would cost less, it was argued, than giving them equivalent medical care at home.) Thiercelin’s ultimate judgment on sanatoriums in Germany is suggestive: “Forced-rest homes, which bourgeois philanthropy offered to and imposed on workers, in order to imprison them in the event of tuberculosis.”^[15] Here, Thiercelin left the door open for a comprehensive analysis of the surveillance and containment impulse in the public health policies of the period, but for the most part, such an analysis was forthcoming neither from the socialists nor from the syndicalists.

Despite Thiercelin’s polemical tone, his practical conclusions betrayed a remarkable degree of moderation. The first two of the four recommendations ending his article fit closely with the tenor of the entire piece: “that the working class not preoccupy itself with the war against various microbes” and that it keep in mind its “immediate goal,” reduced hours and better wages. The last two, however, would have fit as well in Tabary’s analysis (or in the medical establishment’s journals) as in his own. They urged workers to pursue health and labor legislation to enhance their immediate “security” and “comfort.”^[16]

Among other things, Thiercelin suggested measures requiring crachoirs in the workplace and mandatory declaration of all contagious diseases. Sanitary spittoons had been a hallmark of the government’s proposed defense measures since the first outlines of the War on Tuberculosis emerged. Many observers on the Left considered the matter an absurd displacement of concern from the vital issue of bodily resistance onto spitting a distraction at best.

An even more controversial issue, mandatory declaration had been the battle cry of hard-liners so fearful of contagion that they wished to force doctors to divulge publicly the names of all tuberculosis patients. The government could then disinfect the “contaminated” lodgings at regular intervals and after death. Even doctors fully committed to the dominant etiology of tuberculosis balked at mandatory declaration, which flagrantly violated doctor-patient confidentiality. It also raised the specter of unprecedented state surveillance of private citizens, which frightened libertarians as well as many socialists. Thiercelin grouped mandatory declaration with mandatory vaccination (for such diseases as smallpox) in his recommendations, apparently considering both to be medically necessary infringements on individual rights.^[17] On the whole, it is striking how much both Thiercelin’s and Tabary’s socialist manifestos accept the dominant etiology; just as noteworthy is the way both blended a deep suspicion of the powers that be with a reliance on reform legislated from above.

The same puzzling mixture of radicalism and gradualism appeared in most articulations of the socialist current in the tuberculosis debate. Quite often, such texts would pay lip service to exploitation and overwork when discussing disease among workers, yet ignore such factors completely when making practical recommendations for fighting tuberculosis. Tabary, for example, called the widespread distribution of spittoons “uncontestably the most urgent measure” and also recommended outlawing marriage for “young people suspected of [having] tuberculosis.”^[18] Except for an occasional rhetorical nuance, the socialist current endorsed both the theory and practice of the mainstream antituberculosis campaign.

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.

Revolutionary Syndicalism and the Development of an Alternative Etiology of Tuberculosis

During the mid- to late 1890s, at roughly the same time that socialists were developing a critique of tuberculosis, the new ideology of revolutionary syndicalism began to address the disease in its propaganda. As the CGT and the bourse du travail movement (a network of local trade union organizations) articulated an intense opposition to electoral politics and a reliance on the working class alone in the struggle to remake society, workers’ health assumed importance as an issue workers themselves needed to take charge of. Syndicalists rejected not only the socialists’ electoralism and reformism in parliament but also the idea that any facet of the official War on Tuberculosis could help the working class.

What most distinguished the syndicalist perspective on tuberculosis from the others was its complete rejection of the medical establishment’s strategy and terms of debate. In place of slum housing, exposure to the bacillus, and moral depravity, the syndicalists targeted overwork and low wages as the chief causes of the disease. They also rejected the casier sanitaire, legislation, sanatoriums, and private charity in favor of “direct action”: intense propaganda and trade union organizing to press for economic demands, backed up by strikes and by the threat of the revolutionary general strike.

Given the syndicalists’ attitude toward existing institutions and authorities, there were a limited number of avenues available to them through which to publicize their position on tuberculosis and other health issues. All organs of the medical establishment and the mainstream press were inaccessible to their subversive, revolutionary ideology. Their oppositional etiology of tuberculosis seems to have been spread largely in the following ways: word of mouth; occasional propaganda posters or pamphlets; union or bourse du travail activities and clinics; and two major publications, the CGT’s La Voix du peuple and the more theoretically oriented anarchist journal Les Temps nouveaux.^[30] The nature of these avenues of expression, combined with the elusive nature of the phenomenon itself, makes it impossible to measure either the diffusion or the reception of the syndicalist critique. However, the alternative etiology of tuberculosis can be assessed and understood contextually through an analysis of the key texts in its development. Although as a general rule, historians both of the French labor movement and of tuberculosis have ignored this aspect of syndicalist agitation, these texts reveal the development of a coherent, medically sophisticated, and relatively widespread understanding of the disease that aggressively took issue with mainstream medical knowledge.

One of the earliest signs that revolutionary syndicalism was developing its own explanation of working-class tuberculosis and consciously rejecting the dominant etiology appeared in a series of articles by Fernand Pelloutier published in various journals between 1894 and 1897.^[31] Pelloutier, whom many historians consider to be the father of revolutionary syndicalism through his leadership of the bourse du travail movement, took a strong, unequivocal stand on tuberculosis. He ridiculed the bourgeois hygienists who ascribed high tuberculosis mortality to excessive population density and to working-class housing lacking sunlight and ventilation.

As noted above in chapter 4, Pelloutier contrasted two Parisian neighborhoods to prove his contention that poverty, not overcrowding, caused high death rates.

The Temple quarter, one of the most unsanitary in central Paris, is occupied both by rich merchants who reside there and by a mass of workers who descend there every day from the quite healthful heights of Ménilmontant. So, where do more people die? In the Temple? No, in Ménilmontant. Isn’t this because in the former, rest and wholesome diets triumph over unsanitary conditions, whereas in the latter, the purity of the air is powerless to neutralize the effects of extraordinary hardships?^[32]

Rather than in overcrowding, Pelloutier saw the cause of tuberculosis (as well as of epidemic diseases) in “the weakening produced in the worker by a despicable diet and hard labor.” Such diseases “would be extinguished at their source if poverty did not prepare soil favorable for their propagation.”^[33]

When Pelloutier first began the series of articles, which were later collected in La Vie ouvrière en France, it is likely that his was a voice crying out in the wilderness. By 1897, however, there were indications that some kindred political spirits were beginning to see tuberculosis and other health problems in the same light. In that year, the Groupe des étudiants socialistes révolutionnaires internationalistes de Paris (ESRI), an anarchist student group formed in 1891, published Misère et mortalité, the group’s sixth in a series of educational pamphlets. The mere fact that disease and mortality warranted a spot in their periodical propaganda writings on contemporary political issues signified a new conception of the role of such questions in a revolutionary movement. Although it was unsigned, the pamphlet was probably written by Marc Pierrot, a doctor who had been active in the ESRI since medical school and who would later prove to be one of the leading syndicalist authorities on health matters in general and tuberculosis in particular.^[34]

The pamphlet took pains to place individual diseases within a broad social and physiological context. To illustrate how this context affected the worker’s body and health, the group used tuberculosis “as the archetype of these general diseases determined by social conditions.” According to this analysis, the disease was most common where certain specific circumstances prevailed, and these circumstances fit exactly into a broad social profile.

[Tuberculosis] strikes above all those who are surmenés, weakened by hardships and by overwork, living in a confined atmosphere, in unsanitary and overcrowded lodgings, in the middle of a dense population. It is therefore in the working class, where all of these conditions are realized, that it finds most of its victims.

Again, as in Pelloutier’s argument, proof of the determinant role of social conditions in tuberculosis could be found in the statistical distribution of the disease in the arrondissements and quartiers of Paris. In the working-class districts, tuberculosis mortality reached levels nearly five times that of the fashionable eighth arrondissement.^[35]

With the publication in 1897 of Misère et mortalité, an important step was taken in the elaboration of the new syndicalist etiology. For one thing, Pelloutier’s dissenting voice found an echo in this anarchist manifesto against physiological exploitation. Moreover, as it was almost certainly written by a medical doctor (Pierrot), it presented a more fully theorized medical argument—at greater length and in more detail—than had Pelloutier’s articles.

By 1904, both the ideology of revolutionary syndicalism and the issue of tuberculosis carried much more weight in France’s public sphere. The syndicalist alternative to the dominant etiology had progressed significantly in terms of exposure and sophistication. Tuberculosis even showed signs of becoming part of the standard, familiar ammunition of labor propaganda. In spring 1904, for example, the local bourse du travail in Paris (at the time officially known as the Union des syndicats de la Seine) decided to publish a pamphlet on the causes of tuberculosis and its relevance to the workers’ movement. Paul Delesalle, a veteran of ESRI and a leading figure in the CGT, initiated the proposal, and the executive committee of the Union des syndicats agreed that workers needed to know more about the disease they all too often experienced. The committee did not want a general work on tuberculosis but something that would shed light on “the determinant causes of this terrible illness among workers[:]…poverty, overwork, lack of substantial nourishment”; they wanted, “in a word,…a union propaganda brochure.” A militant from the barbers’ union, Raymond Dubéros, was chosen to write it.^[36]

By the end of August, Dubéros had produced the pamphlet, and unions in the Paris region were working hard at getting it the widest possible audience. Dubéros had given the Union des syndicats the propaganda it had asked for; in fact, he managed in sixteen pages to turn a medical question into a trade union recruiting appeal. He based the appeal on a simple syllogism: “Tuberculosis is the sickness of poverty”; “to eliminate poverty is to eliminate tuberculosis”; “only [unions] are capable of effectively fighting tuberculosis, because only their action strives to eliminate poverty.”^[37] Not only was Dubéros’s pamphlet the first of the syndicalist texts to be devoted exclusively to tuberculosis but it also crossed the indistinct line separating theoretical critique from pragmatic program. As a direct call to action, the union’s brochure added a new dimension to the syndicalist etiology of tuberculosis.

Nearly simultaneously with Dubéros’s pamphlet, there appeared in Les Temps nouveaux another document that marked a new stage in the syndicalist understanding of tuberculosis. Between July and December 1904, the newspaper published a series of nineteen articles by Dr. Marc Pierrot entitled “The War on Tuberculosis and the Sanatorium Question.” Taken together, the articles represent no less than a complete medical textbook on tuberculosis—from an anarchosyndicalist perspective. Pierrot, who was a regular contributor to Les Temps nouveaux as well as an ESRI alumnus, took pains to explain germ theory, physiology and other medical concepts in a manner comprehensible and relevant to laymen. In place of inflammatory rhetoric or theoretical generalizations, Pierrot gave his readers an exhaustive exposition of the causes, prevention, and treatment of tuberculosis. He also gave household advice for avoiding the disease and for dealing with it rationally when it appeared. In sum, Pierrot attempted to combine an accessible medical treatise refuting the dominant antituberculosis strategy with a practical handbook on tuberculosis for working-class families.^[38]

Pierrot’s series of articles in Les Temps nouveaux and Dubéros’s La Tuberculose, mal de misère, both of which appeared in 1904, presented the alternative etiology of tuberculosis in its mature form, fully articulated and taking its place within the political program of revolutionary syndicalism. It is significant that the oppositional view reached maturity at that time. The CGT’s biennial congress in Bourges, at which it decided to focus its agitation on a single issue, the eight-hour day, took place in September 1904. The International Tuberculosis Congress in Paris, during which the disease was front-page news in all national newspapers, took place in October 1905. Dubéros’s pamphlet was published and Pierrot’s series in Les Temps nouveaux was well under way by the end of August 1904.

This chronology is important. Had these texts appeared slightly later, it might be plausible to dismiss the syndicalist antituberculosis propaganda on either of two grounds: that the movement attempted to refashion as many “workers’ issues” as possible in terms of long workdays, having already put all of their eggs in that basket (at Bourges); or that syndicalists seized on tuberculosis as fodder for agitation once it became a familiar and highly visible issue in the public eye. In other words, syndicalist propaganda might have opportunistically seized on any issue, including tuberculosis, that was being discussed by mainstream newspapers or politicians or that suited its immediate strategic needs. Instead, it seems that ideological forces within revolutionary syndicalism itself led to the appropriation of tuberculosis as a major topic of propaganda. These forces were rooted in the movement’s split from socialism and in its “holistic” tendencies, that is, its insistence (inspired by Pelloutier) on the importance of health, education, and general welfare in the overall economic struggle. A closer examination of the principal elements of the syndicalist critique illustrates the ways in which tuberculosis became a lightning rod and focal point of agitation.

Exposure and Resistance to Infection

The most salient medical feature of the syndicalist etiology was its emphasis on diminished resistance, rather than exposure, as the primary cause of tuberculosis. According to the ESRI group, the pathogenic effects of social conditions—including poor ventilation, malnutrition, overwork, and exposure to extremes of heat and cold—all had one thing in common: they “put the subject in a state of diminished resistance” (la mise du sujet en état de moindre résistance). The students’ brochure also pointed out the various social factors that increased workers’ chances of exposure to disease, including some common to the diminished resistance category. In fact, the “defective conditions” in which the working class lived and worked “put this class in a position remarkably favorable to receiving and developing various diseases.” The various causes of exposure and susceptibility to illness “combine, add to each other, act parallel and concurrently.”^[39]

In the ESRI pamphlet, overwork, the greatest threat to workers’ health, was presented as an inherent feature of capitalism. “The excessive length of the workday is a generalized economic phenomenon in the system of capitalist exploitation.…Overwork results in surmenage, which is characterized by general exhaustion.” “General exhaustion” was not just a catchall category for that which could not be explained medically. Pierrot had begun to develop a medical explanation of exertion and fatigue.

Physical exhaustion and nervous exhaustion lead to a general weakening and render the individual incapable of reacting against the invasion of any given disease. This weakening results from an accumulation in the body of excessive deposits, that is, from an actual poisoning.^[40]

In other words, the by-products of muscular and nervous activity, which could no longer be absorbed by the body, built up in the bloodstream and slowly “poisoned” the worker by interfering with his defenses against infection. Pierrot would later refine this conception of surmenage and analyze it in depth as a biochemical process, but in Misère et mortalité, it made its appearance (however tentatively) in the early stages of a syndicalist reappraisal of disease.^[41]

Dubéros even pointed to considerable evidence in mainstream medical literature to debunk the standard emphasis on exposure to the tubercle bacillus. Several studies, he argued, had shown that most (if not all) adults in France had been exposed to the bacillus; some of these studies pointed to bacilli found in saliva or tissue samples, others to autopsies commonly showing “healed” lesions from tuberculous infection in the lungs or other organs. With exposure or “contagion” so widespread, the crucial factor determining which bacilli caused illness and which remained harmless had to be the strength of the body’s resistance. Tuberculosis preyed most often on workers, Dubéros explained, because their “organic losses” (through expenditure of energy) were not “compensated for” (by rest and proper nutrition). “Their organism is anemic; they do not have the means to recuperate the strength they use up every day in…their labor.”^[42]

Alcoholism and Other Incidental Causes

The syndicalist authors acknowledged that overwork and meager wages were not the only causes of tuberculosis. They insisted, however, that all of the other significant causes could be traced, directly or indirectly, to economic exploitation. As far as alcoholism was concerned, Dubéros simply turned the mainstream’s moral etiology on its head. Alcoholic excesses could indeed contribute to tuberculosis by depressing the constitutional ability to fight off infection. But the reasons for consumption of alcohol—and therefore one of the causes of tuberculosis—differed, Dubéros maintained, between the working class and the class of “exploiters” and “parasites.”

As much as anyone, we deplore the ravages caused by alcoholism in the working class. But if members of the bourgeoisie drink alcohol in excess by habit or vice, they force workers, by the long and hard labor they impose on them, to do the same in order to obtain the temporary strength which will enable them just to hold out and accomplish their work.^[43]

In the case of the overworked proletariat, drink was a desperate and understandable attempt at a fleeting illusion of strength regained; in the case of the idle bourgeoisie, there was no reason for it other than moral weakness. This theme was characteristic of syndicalist propaganda on working-class alcoholism; it ran through much of the movement’s literature on tuberculosis as well, a corollary to the main axiom linking overwork to disease.

Pierrot also recognized that workplace issues such as wages and hours were not the only factors contributing to the prevalence of tuberculosis among workers. He devoted two installments in his series to the role of working-class housing and one each to alcoholism and child-rearing conditions. Yet each of these factors could ultimately be traced back to poverty; work and wages, too much of one and not enough of the other, conditioned all aspects of working-class life. For example, Pierrot saw alcohol consumption as an important cause of diminished resistance. Excessive and habitual drinking resulted in the “rapid usury [of the organism] with weakening and degeneration.” If one investigated the origins and circumstances of alcoholism in France, he asserted, one would always find a social context that included either severe job-related fatigue, poor diets, or exposure to extremes of heat, cold, or humidity. In these contexts, alcohol reliably produced the necessary short-term “coup de fouet” needed to revive flagging spirits and energy. “In sum,” Pierrot concluded, “it is the excess of labor that renders alcohol indispensable, so to speak, to the worker.”^[44]

Closely related to the question of alcoholism, according to the syndicalists, was that of nutrition. In Misère et mortalité, the ESRI bemoaned the deficiency of working-class diets in both quantity and quality. Low wages forced families to skimp constantly just to put something on the table.

[The worker’s] wages are not enough, in a large city, for him to afford the luxury of consuming all the substances necessary for his survival. He is often forced to play tricks with hunger, to eat soups with little nutritional value, to drink large quantities of coffee.…, to eat bread scraped with a bit of butter, etc.

Moreover, many of the foods a poor family could afford contained harmful preservatives, fillers, and other adulterating substances. Cheap wines and spirits were made with highly toxic fortifying and coloring agents. Under such circumstances, malnutrition could even rival overwork as a determinant cause of tuberculosis.^[45]

The Sanatorium and Bourgeois Philanthropy

Long hours, low wages, poor diet—all came with the territory of poverty, and the syndicalists saw them as inherent in the capitalist social order. What made the existing efforts to fight tuberculosis ineffectual, they argued, was that all were directed at the superficial manifestations of the disease and none aimed at the root cause—the social order itself.

In the first eight installments of his series in Les Temps nouveaux, Pierrot focused on the sanatorium as a weapon in the campaign against tuberculosis. Around the turn of the century, a wave of favorable publicity about Germany’s experience with sanatoriums had generated a debate in France over the wisdom and feasibility of following the German example. According to many reports, the recent efforts of the German social insurance system to establish sanatoriums accessible to all sectors of society had already resulted in a significant decline in tuberculosis mortality. Although French republicans were loath to imitate the autocratic German regime, sanatoriums seemed an attractive option in an antituberculosis campaign that had been long on words and short on results.

Pierrot regarded the sanatorium as little more than a resort scam for the rich and a smokescreen for the working class. For one thing, there could never be enough sanatorium beds available for the vast number of Frenchmen afflicted with tuberculosis. Even if enough facilities could be built, there would never be enough money to support families whose breadwinners were idle in sanatoriums. Furthermore, even if a significant number of working-class people could be “treated” effectively in sanatoriums, they would be returned at the end of their treatment to the same overwork and poverty that caused their illness in the first place.^[46]

The only effective treatment for tuberculosis, Pierrot argued, was prolonged rest, nourishment, and avoidance of all sources of debilitation, including overwork, malnutrition, and alcoholism. This treatment was a realistic possibility only for the wealthy, and there was no need for a sanatorium to administer it in any case. German statistics showing declining mortality from tuberculosis had been altered, Pierrot claimed, by doctors seeking to spare their patients the notoriety of mandatory declaration of the disease under the law. Figures showing favorable treatment results in sanatoriums were equally misleading, he maintained; any patient would show signs of improvement after several months of rest and fresh air—whether in a sanatorium or alone in a farmhouse. Once the patient left the sanatorium, there was little doubt in Pierrot’s mind that the improvement would not last.^[47]

In effect, Pierrot saw the sanatorium as nothing more than charitable window dressing; its appeal was limited to a bourgeoisie (and, to some extent, a government) eager to prove its benevolence and to show that it was doing something to fight France’s number one killer. “Charity…offers the ‘compassionate elite’ the opportunity to make itself known, to perform its social function, which is to dodge dangerous [social] demands by giving some scant alms, with the advantage of being able to glorify one’s own good deeds.”^[48] Pierrot even tarred dispensaries (which could ostensibly reach more people and intervene at an earlier stage and at less cost than sanatoriums) with the same brush. Testing for the presence of bacilli or pulmonary lesions and dispensing advice along with occasional food vouchers and clean linen, they did nothing that practicing physicians and local bureaux de bienfaisance did not already do. As for early detection, dispensaries depended entirely on the patient’s initiative to come in for a consultation—by which time the illness was usually quite advanced. And what good did early detection do, Pierrot asked, if the dispensary could not reduce the patient’s work hours or support the patient’s family? Many dispensaries, he concluded, were little more than fronts for unscrupulous doctors to enrich or make a name for themselves.^[49]

Dubéros also ridiculed efforts to raise money for the construction of sanatoriums for the poor. What good would it do, he asked, for unions and other groups to help in these efforts, when even successful sanatorial treatment would be followed by a return to the same poverty that made the patient ill in the first place? To be effective, workers’ action should combat the capitalist system that caused their poverty. “But by framing the issue in these terms, we know that we cannot count on philanthropy, nor on bourgeois charity, which will not follow us on this road because it is contrary to capitalist interests.”^[50] Disdain for bourgeois philanthropy was a staple of the syndicalist critique of tuberculosis. It was also the pivot on which Dubéros turned a medical argument about etiology into a CGT membership pitch. Since previous debates on how to combat tuberculosis had essentially focused on what type of institutions private charity could most effectively fund, and such a strategy was incapable of effecting real change, it followed that the fight had to come from a new source. According to Dubéros, that source had to be the workers themselves, represented by their trade unions and the CGT, because these were the only groups that targeted the real enemy, industrial capitalism.^[51]

Practical Strategies

It was sometimes more difficult for syndicalists to propose their own specific antituberculosis strategies than it was for them to criticize the official approach. The conclusion of the ESRI in 1897 typified the revolutionary syndicalist approach: since mortality and physical suffering among the poor stemmed from the existing social system, “let us put aside half-measures and partial reforms, which are nothing but deceptive stopgaps.” The only real solution would be “international Communist revolution.”^[52]

However, the syndicalist credo of workers’ self-reliance at least provided a principle on which to base a day-to-day strategy. Dubéros insisted that self-reliance applied as much to tuberculosis as to shop floor struggles or bread-and-butter issues. “Workers must rely only on themselves to improve their lot, and the only means they have for fighting effectively against poverty, against all ills and consequently against tuberculosis, is to join their respective trade union.”^[53]

The union’s “mission” was, in fact, “to combat all the causes of tuberculosis”: unemployment, low wages, long workdays, and unsanitary workplaces. Dubéros and other syndicalists saw no contradiction between seeking incremental gains in wages and hours while working to overthrow the system as a whole. The unions’ “struggle against all the forces of oppression and exploitation” would necessarily enhance workers’ well-being pending the realization of “the work of capitalist expropriation and social reorganization.” Dubéros ended his pamphlet with an appeal to nonunionized workers and to unions not affiliated with the CGT. These workers and unions, he wrote, were unwitting accomplices in capital’s assault on the health and welfare of the working class.^[54]

Pierrot did not mention unions by name, but his message was similar. He ridiculed the superficial strategies of the mainstream doctors and functionaries.

It must be pointed out that low wages ordinarily go hand in hand with prolonged workdays and intensive labor.…These are marvelous conditions for the blossoming of tuberculosis. What are we supposed to do about it? Avoid spitting on the ground? Create dispensaries? Elect better deputies?^[55]

While such sarcasm was something of a departure from Pierrot’s normally measured tone, his message was the same one syndicalists had always proclaimed: electing better deputies and adhering to the bourgeois agenda would get the working class nowhere. “Since workers have not yet obtained—because they have not taken it—the right to existence, they have only to wring as much as possible, by consent or by force, out of the propertied class…while waiting for something better.”^[56] In the case of tuberculosis, what workers had to wring out of employers were better wages, shorter workdays, and more hygienic workshops. To achieve these goals, Pierrot advocated “direct action,” the syndicalist term denoting a rejection of electoral politics in favor of economic tactics such as the strike (sometimes supplemented by boycott and sabotage). “The tactic best adapted to the conditions” of industrial capitalism, direct action provided the opportunity for the proletariat to show its strength while building class consciousness in preparation for the “complete transformation of society.”^[57]

Pierrot concluded his nineteen-part series by comparing the bourgeoisie’s reliance on fear—fear of tuberculosis, fear of the bacillus, and fear of people with tuberculosis—with his own prescription for fighting the disease. The enemy was not contagion, he insisted, it was capitalism.

Tuberculosis is an illness of poverty.…It is the direct product of capitalist exploitation.…There is only one real way to combat tuberculosis, and that is to transform society, to abolish wage labor, to assure everyone of well-being through common ownership of the means of [production].

When capitalism disappeared, according to Pierrot, so would tuberculosis. When the principle of “from each according to his strength, to each according to his needs” became reality, the devastating disease would be “rarer than leprosy.”^[58]

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.

Notes