The Parable of Tuberculosis
The greatest single threat to life in late nineteenth-century France was tuberculosis. This one disease killed more persons than all other infectious maladies combined. Precise statistics are lacking, but at its height in the Belle Epoque tuberculosis probably caused over 100,000 French mortalities annually, of which perhaps as many as 15,000 occurred solely in the city of Paris. If so, one must imagine that thirty to fifty Parisian families every day faced the tragedy of a consumptive death in their midst. Meanwhile, all across the land, the Big Killer had its way.1
Tuberculosis epitomized the French response to questions of public health and welfare. The magnitude of its impact after 1870 threatened to burst the rigid carapace of liberalism. Many traditional assumptions were unavoidably thrown into doubt: among them, that the state should desist from all manner of coercion in the private sphere, that the individual's personal life and health are strictly sacrosanct, that physicians must exercise total discretion concerning the condition of a patient, that social insurance ought to be a purely voluntary matter, and that direct taxation of family income in order to finance public hygiene should by all means be avoided. The tuberculosis crisis could not fail to test these limits of liberal ideology at a time when laissez faire was likely to mean laissez mourir.
Here it is pertinent to stress another aspect of the tuberculosis challenge: it brought the contrast between the German Reich and the early Third Republic clearly into focus. The relatively sluggish character of the French state was revealed by comparison with the strenuous efforts of the German empire to treat tubercular disease and to