Emergence et devenir du systeme de prise en charge de la tuberculose en France entre 1900 et 1940

Résumé In industrialised countries the treatment of tuberculosis was one of the first public health services to appear at the beginning of the 20th century. This initiative represented a departure from the usual measures set up by public health specialists for improving living and environmental conditions, as new knowledge about the process of infection meant that action could be taken on the population directly. The processes which served to stratify and differentiate living standards characteristic of this period of industrialisation are reflected in the epidemiology of tuberculosis: the hierarchy of mortality rates runs parallel to that of the social groups. Many authors now question the role of the health service in the regression of infectious diseases, which they attribute more to changes in lifestyle. This text attempts to analyse the context and the objectives which surrounded the establishment of the service to combat tuberculosis in France, with reference to the various theories which seek to explain the emergence of social services in health or in education. Hence three theses are examined with reference to the actual history of the tuberculosis service. In this service an instrument of the ruling class, owners of the means of production, who thereby assure the reproduction of the workforce at a time when industrialisation demands an increase in the workforce, and when additional reserves of manual labour are being exhausted? Was the use of techniques arising out of new knowledge accompanied by an extension of the power of doctors into areas which had hitherto been outside their field of intervention? Did medical activity lead to new norms being introduced into everyday life in the name of scientific values? An interpretation in terms of social control is put forward to explain both the public health movement, compulsory education and urbanisation. Is this helpful in understanding how the organisation of the struggle against tuberculosis came about? This research is based on the systematic analysis of documents and journals on tuberculosis published in France during the period under study. Support is found for elements of all the theses examined without any one being able to account for all aspects of the establishment of this service. The service represents the meeting point of a number of different forces: economic forces; political forces, as witnessed in the debate between the social and technical approach before the first World War; and professional forces, given the transformation of medical practice with the introduction of public health services and national insurance.