1.3.3: Hygienic Visions

[[This is from an older version of this chapter, but I think it fits well here]]

The architectural intervention into tuberculosis was argued for as a social intervention, responding specifically to a kind of squalor of urban spaces envisioned and reinforced by the medical class. The sanatorium served as both a space of treatment, and a space by which medical professionals could instruct patients on the benefits of clean living. In contrast to the almost sterile sanatorium image, there were photographs of the living conditions of the urban poor (figs. 1 & 2). While these images were not commonly placed against one another in the books included in the corpus, there is a striking difference between how the lives of those sick with tuberculosis outside the sanatorium are depicted versus that of the institutionalized cases (figs. 3 & 4).

Figure 1. CharityOrganiza_AHandbookonthePreventiono_1903 353

Figure 2. Brown_TheHousesofAmsterdamNewYo_1917 13

Figure 3. Bonney_PulmonaryTuberculosisandi_1910 849

Figure 4. BridgeLindley_TheIdyllwildSanatoriumSan_1901 17

Built into the discourses of health are socially-inflected moralisms around hygiene: there is a compounding prejudice that undergirds these structural interventions into the health and wellbeing of tuberculous patients. Koch’s microbial etiology formulates another way for educated and upper class persons to create hierarchies that support their social placement. It enables doctors to espouse a victim blaming rhetoric: tuberculous patients are sick because of their failure to stay clean, their failure to avoid sick friends and family, and their failure to earn enough to move out of poorly ventilated housing. These patients were unable to create an environment for themselves that was healthy, sterile, and well ventilated. Moreover, this failure is not the result of the social-historical context of their birth and lives (as a twenty-first century scholar might argue), but due to a character failure: they cannot clean for themselves because they do not understand basic hygienic principles—the value of cleaning, of living in a particular ‘healthy’ environment, and of having proper ventilation.

This contrast builds more into an interlinked aesthetic trajectory. First is a construction of who is sick. Susan Sontag has written about this in regard to refugee images published by the international news media.¹ Linking a meta-critique of this genre of photograph, Sontag stresses that it is not the deplorable, horrifying image of the refugee in crisis, so much as the overarching claims as to who in general is suffering. For the international refugee, the refugee photograph maintains a neoliberal view of the subaltern subject that reaffirms the viewer’s inset ideas about themselves and their nation and constructs a refugee subject as other.² These hygienic images purport a rhetoric where the sick patient is someone who wallows in the squalor of modern life.

Second, there is an aesthetic and moral dimension which is mapped onto hygiene: it is not just cleanliness for cleanliness sake, but a way of ordering the world in ways that benefit the health of subjects. The child playing in filth, this aesthetics affirms, will lead to their death. The clean home is a caring home, it seems to read. All the while, this regimented sense of orderliness overrides any other prospect of living.³

The hygienic lessons which sanatorium living and dispensary culture reinforces is a common conflict in the health space. Flick’s White Haven Sanatorium dealt with recurring issues managing patients who sought help from the doctors. In addition to the regimented practices required by the institution toward the health of the subject, there were certain disciplinary needs both in the ways the patients treated one another, but also the way they interacted once they left medical care. The infantilizing and stuffy sanatorium rules led many patients to leave prior to completing their treatment.⁴

This contrast is folded into hygiene’s visual rhetoric, creating moments for doctors to argue their ideological position. As the visuals reinforce a binary between clean and dirty, healthy and diseased, the images position themselves as support in these claims. The sterilized, pristine halls of the sanatorium both represent the institution and the benefits of this mode of practice: they both represent the systems, but also the rhetorics of a generation of medicine steeped in germ theory. They are promotional object (1.2.3), and specimen, representing a kind of real for medical argument. In this way, the photographs become multifaceted: they help reiterate differing modes that strengthen the epistemic and cultural viability of the sanatorium discourse.

There is a slipperiness here, because of the ways the object of the sanatorium is posed in different contexts and uses, and which further research will be required. Moving to more human-centered images will help me frame these under the larger idea of the ‘portrait’—or image that isolates a single subject or object through modes of framing, focus, and composition. In many ways, most of the photography and illustrations in the corpus use this mode of making singular to document a particular person, pathology, or anatomical feature.