Tuberculosis in France
In 1917, in the midst of World War I, an estimated 150,000 French soldiers were discharged because of active tuberculosis infections. The disease thrived in the dirty and cramped conditions of trench life, but health officials also feared the impending public health disaster of thousands of infected soldiers returning to their homes.
A Call for Help
During World War I, the Rockefeller Foundation (RF) provided no relief to soldiers. While the RF had provided war-time assistance since the establishment of the War Relief Commission (WRC) in 1914, its work remained confined to non-combatants.
RF interest in tubercular soldiers was initiated in 1916 following calls for help from overwhelmed organizations and individuals working in the field. In July 1916 Warwick Greene, Director of the WRC, wrote to RF Secretary Jerome Greene of the impending tuberculosis crisis in France, “Certain conditions of trench warfare as well as the insufficient nourishment and other hardships in the case of many civilian populations appear to have stimulated the growth and spread of the disease. One often hears it said that it will be one of the most serious of the after-war problems.” Warwick Greene added, “Much can be done to help the individuals who are already infected with the disease, but the great opportunity appears to lie in the sphere of preventative medicine – to try to arrest this scourge before the stimulation it has received from the war carries it beyond control.”
Based on the information provided by Warwick Greene and the other organizations, the RF asked Wallace Sabine, an American professor at the Sorbonne, to provide a more detailed report on the tuberculosis crisis during the summer of 1916. Sabine noted that while the French had a clear scientific understanding of the disease, few practical treatments existed.
Further surveys of the situation in France were conducted by Herman Biggs of the New York State Health Department on behalf of the International Health Division (IHD). As a result of these surveys, The Commission for the Prevention of Tuberculosis in France was established in 1917 and put under the directorship of Livingston Farrand, President of the University of Colorado and Executive Secretary of the National Association for the Study and Prevention of Tuberculosis.
A Larger Goal
The establishment of the Commission was more than an attempt to curb the spread of tuberculosis throughout France. Like the Rockefeller Sanitary Commission’s (RSC) campaign against hookworm in the American South, it was hoped that successful management of the disease would result in a more robust French public health system. The Commission also closely mirrored the strategy of the RSC, including:
- Conducting a statistical survey to determine rates of disease throughout the country, both in rural and urban areas of France;
- Establishing dispensaries where patients could be diagnosed and treated;
- Providing additional training to French nurses and physicians;
- Implementing a broad public education campaign.
The French proved to be particularly receptive to the public education campaign, which was led by Selskar Gunn. Large, colorful propaganda posters were used to create awareness of the disease, and Gunn’s team traveled throughout the country leading health exhibitions in trucks equipped with informative panels and films. The team also gave lectures and handed out pamphlets.
Gunn’s campaign placed a particular focus on children to effect early changes in hygiene habits as a means of preventative care. Children learned such lessons through various methods, including school assignments, puppet shows and organized class trips to health exhibits.
From the start the RF campaign in France was a co-operative effort with the American Red Cross, existing French organizations devoted to the care of tuberculosis patients and the French Government. In its early plans for tuberculosis work, the IHD noted that:
The work will be done under the sanction and general administration of the French government, with the co-operation and under the supervision of the Comite Central d’assistance aux Militaires Tuberculeux. The work will be done in the main by France and the French people; the literature and exhibit material will be cast in the mold of the French mind; America will lend stimulus and direction and a limited amount of financial aid.
The RF saw its main role as teaching local authorities methods of organization and administration or, as described in the 1918 RF Annual Report, “organized team-play.”
The Commission for the Prevention of Tuberculosis in France ended its activities in 1922 and its work was gradually handed over to French organizations. In 1924 the Vice-President of the Comité National de Défense contre la Tuberculose wrote to Gunn of the progress since the RF’s departure: “Your services were so well organized that we only had to persevere and follow the roads you had mapped out, and the results seem to us so remarkable that we have decided to keep in its entirety the whole organization which you bequeathed to us.”
During its tenure the Commission was highly effective in treating tuberculosis in France. As a result of RF contributions, the number of dispensaries in France grew from 22 to 600, while the number of hospital beds available to tuberculosis patients rose from 8,000 to 30,000. In 1919 the French Parliament enacted a law requiring every French department to build a tuberculosis sanatorium or to arrange to have its patients sent to another department for treatment. The RF was also influential in helping to develop a general awareness of public health and the importance of hygiene in France.