1.3.5: Social Engineering

Overlapping much of the sanatarium and hygienic interventions discussed in this section and the previous one (1.2.0), is the participation of medical professionals in discourses of social engineering. Tuberculosis is not a singular object, but instead an object that reproduces, manifests in different hosts, and presents a threat to a broader social fabric (be it state, national, or international groups). Seeded in these arguments is a notion of the body politic, which views the health of a community in broad strokes and engineers solutions to address the subject in aggregate. These arguments articulate a pernicious notion of disease by way of pollutant, which could effect the bodies of the ruling class. The control of disease is displaced onto the subject themsleves, they are made to blame for it, and then made to blame for its passage.

This can be seen most obviously in a report published by the state of Virginia’s tuberculosis commission in 1915. They write,

The careful consumptive, who has been taught not to spread his germs, and who wishes to save other people from his fate, is not dangerous, but on the contrary, is a valuable aid in teaching the important facts relating to tuberculosis. On the other hand, the wilfully [sic] ignorant and criminally careless consumptives spread their disease widely and are more dangerous than mad dogs. In the interest of public welfare, we recommend legislation which will effectually restrain the criminally ignorant and criminally careless consumptives.¹

Personal blame becomes a way to dodge blame for the more pernicious, systemic issues at play: the way doctors seem unable to imagine the systemic issues at play regarding class, environment, and health.² It is the untrained, uneducated subject who is to blame for the spread of tuberculosis, and then the willful refusal of that subject to be made docile that leads to the spread of the disease.

The hygienic system produced subjects and trained them in the manners and aesthetics of cleanliness, but always with a judging vision. If the patient could not conform to the regiments of the charity sanatorium, they were either asked to leave or would leave themselves.³ If patients used provided charity in a way that was unexpected or seemed otherwise ungreatful, they were chastened.⁴ The hygienic gaze is a kind of projection, of an imagined pollutant in the form of an undocile body, which must be made to act in particular ways.

There is a slippage here regarding the docile subject and the modes of resistance that are beyond the scope of the current project, especially in light of the resistances to hygienic measures during the peak of the Covid-19 pandemic. This is beyond the scope of the dissertation, however, but I bring this up to point to a more pernicious thread which is implicit in the hygienic regimes employed by American doctors: they are implicitly (and at times quite literally) eugenicist.

Considering the subjects denied care in charity organizations for not behaving according to the rules of care, the denial of care in terms of a chronic disease like tuberculosis not only permits the subject to spread the disease (an issue of hygiene) it also denies that subject potential life-saving or life-extending care. The creation of a docile subject, a hygienic subject, a healthy subject, meant the construction of a counter-subject which could be vilified, and through that vilification allowed to die.⁵ Denial of care for the tuberculous is a covert eugenicist necropolitics (x.x.x): the subjects can be allowed to die because of they endanger the larger (white) society.

The slipperiness of this argument needs further analysis, which is again outside the scope of this project, but returning to Virginia’s 1915 report, the logic of the period can be more explicitly seen. The authors write,

Since the greatest number of deaths and the greatest number of living cases occur among the negro race, since the relations between the two races are so intimate that a communicable disease affecting the negro must in a grave measure affect the white, since there is not a bed maintained by the State at present for a negro consumptive except in the State Asylum and Penitentiary, we would respectfully urge, for both humanitarian and economic reasons, that a sum of not less than $40,000 be appropriated for the immediate construction of a State sanatorium for the negro consumptive.⁶

Hygiene and public health, as they are constructed in this report, are used to protect a specific race of subjects. In the example images shown in the preceding sections (1.3.1; 1.3.3), the hygienic gaze was one that expressed anxiety over the supposedly unwashed nonwhite, lower-class that endangered the lives of the hygienic upperclass by their very proximity. Establishing moral failure is a means to give an excuse to why the lower class may be allowed to die.⁷ Designating who is clean and unclean, healthy and unhealthy works into an imagined idealization of the subject⁸ but there is a secondary engineering at play: the moralization of how one is allowed to live or die. Necropower

”the new technologies of destruction are less concerned with inscribing bodies within disciplinary apparatuses than with inscribing them, when the time comes, within the order of the maximal economy now represented by the ‘massacre.’”⁹

[add in a quote from Mbembe about technologies of exclusion.] The aesthetics of hygiene, and the hygienic gaze articulated in this section, proliferates a deeply eugenicist idea: some patients should be left to die because they are, in the parlance of racist and classist rhetoric ‘uncivilized’ and thus a threat to the broader social order.