1.2.5: Valuable Institutions

The image of the sanatorium as it appears in this case study seems much more about the building of things, rather than the care of patients. Attention to the link between simplistic capital accumulation and the growth of the medical enterprise, provides a necessary expansion of a Foucauldian framework—a way of thinking that stresses the singular importance of the pathologizing practices in medicine (1.1.2; 2.2.2).¹ Instead, a focus on property expansion and the building of facilities as a product of an intermingling of various ideologies fixed on, and informed by, historical, cultural, and political ventures. The clinical gaze is particularly adept at critiquing the epistemic frameworks of difference inherent to a medical viewpoint, but it does less to navigate the ways medical institutions have become massive capital enterprises. Medical knowledge, clinical practices, and cultural attitudes toward health are entwined with broader cultural, economic, epistemic, and political practices. In this case study medicine is entwined in broader ideological movements in the United States. In this example, manifest destiny and the conquest and subjugation of Indigenous nations undergirded the establishment of many of these health enterprises, especially those in the American west.

This way of seeing, in the case of sanatorium photographs and architectural diagrams (1.2.3), slips beyond the remit of this project, partly because of the limit of a medically focused sample. However, just as Foucauldian vision limits clinical epistemics to a singular viewpoint, the practices that undergird health humanities, science and technology studies (STS), and the history of medicine are limited because of the very real ways these systems and practitioners operate in quasi-medical arenas. Medicine and vision are diffuse, contested, ever evolving entities, and any clean demarcation of their overlapping boundaries is both factually and epistemically wrong. While doctors saw through their patients as a manifestation of symptoms, they also saw their patients as classed, raced, sexed, and abled (1.3.5). All of these ideas were entwined with and pathologized under the logics of eugenics (1.3.5), but maintained outside of and in parallel to these exceedingly medicalized contexts. The logic circumvents the more obvious economic and structural issues which, as a viewer from the twenty-first century, seem so obvious.

I am thinking in this way to describe medicine in the same kind of diffuse way that I am framing visual culture: not in totalities but in intensities.² Interrogating the nested interdependencies of the then-contemporary medical systems—health writ large—which extend and exploit the operations of white supremacy—capitalism and eugenics in its many forms and valences—exposes medical practice as an operation to amass cultural and material value (0.1.4). Just as the bodies of poor subjects are the resource to be harvested (2.1.4; 2.2.4; 4.1.3), so too is land to be built upon, made valuable, and ingested into the biomedical project.³

Value, as I use it in this dissertation, refers to a network of potential benefits for the actors who extract it from their resources—in this case, from the land they claim, develop, and work upon. Value is leveraged in monetary gain, but also, importantly, cultural capital.⁴ Disciplinary prominence made from this resource benefits the people who extract the value, always at the expense of the people or things from which that value depends (0.1.4). To address the sprawling ways in which power is leveraged through violence and discipline to produce value for biomedical actors, a certain flexibility is needed to pin it down in parts. Total arguments, like hard metals, are unscratchable but easily shattered, and diffuse arguments are malleable, but prone to imperfections.

The sanatorium is many things, from idyllic resort, to charity organization, from space of cure to location of research; it is, in all of these contexts also a space that needed to be built, and that needed to have sufficient financial input by would be investors (public and private alike). In the century after the height of the sanatorium movement, these buildings have tended to be subsumed by American biomedicine’s ever growing property portfolio. Again, though, this is a small portion of the many discourses that swirled about tuberculosis at the turn of the twentieth century. An institutional space, the sanatorium only factored as an arm of the larger war against the disease (2.3.1), one which was centrally addressed through the teaching of hygiene (1.3.4). With this in mind, I will move away from the sanatorium to an examination of the discourses around hygiene and tuberculosis. These visual practices are distinct, being much more focused on a pathologizing and dehumanizing approach to difference, but share a similar affinity to the sanatorium, as there is still a strange insistence on a patient’s living space (1.3.3). These discourses also move from the country and its idyllic natural surroundings (1.2.2), to look at the urban, its environments and populations (1.2.2).