In lieu of an abstract, here is a brief excerpt of the content:

Reviewed by:
  • Building Resistance: Children, Tuberculosis, and the Toronto Sanatorium by Stacie Burke
  • Maureen Lux
Stacie Burke. Building Resistance: Children, Tuberculosis, and the Toronto Sanatorium. Montreal: McGill-Queen’s University Press, 2018. xviii + 554 pp. Ill. $39.95 (978–0–7735–5331–6).

Building Resistance is a study of children in the Toronto Sanatorium from its beginnings in 1904 to the 1950s, or the advent of chemotherapy for tuberculosis. This periodization, what the author terms the endemic era of tuberculosis, shapes the book’s analysis of sanatorium treatment from the palliative care of bedrest and nourishing food to the surgically induced “rest cures.” Based on more than eight hundred patient charts held by the sanatorium’s successor institution, Building Resistance provides an interesting and detailed examination of how children experienced the sanatorium, and how the sanatorium understood children’s tuberculosis.

Burke, a biological anthropologist, makes clear that hers is not an institutional history, but a “biosocial” perspective on childhood tuberculosis that highlights the connections among children, the bacteria, medicine, and the institution. A qualitative case study rather than a history, it is a thematic analysis of the medical world of the sanatorium at its height before antibiotics made it irrelevant. Burke rejects the negative characterizations of sanatorium treatment inspired by the work of Michel Foucault and Erving Goffman. Rather than a critical analysis of sanatorium treatment, Burke favors a more positive or “balanced” perspective that focuses on what physicians thought medical treatments such as artificial pneumothorax (lung collapse) would accomplish and how this translated into hope for survival for children and their parents.

The initial chapter sets the historical context for the emergence of sanatoria in Ontario, the early twentieth-century reform movements focused on the welfare of children, and the history of tuberculosis infection. Burke includes an analysis of resistance as a biological construct influenced by social conditions; resistance of the patient to disease (in the case of latent tuberculosis) and more recent, and more alarming, drug-resistant tuberculosis. The second chapter describes the founding of the Toronto Sanatorium and detailed portrayals of the long-serving medical superintendent and matron. The following chapter sets out how children came to be treated at the Toronto Sanatorium; families did not expect a cure, but they had great faith in the “modern doctor’s science, skills, and understanding of the body” (p. 190). Chapter 4 deals with the disease’s variability and how it manifested in children’s bodies: acute or chronic, active or latent, and how organs and tissues became infected.

Chapters 5 and 6 focus on the medical understandings that underpinned the therapeutic regimens of the rest cure and surgically induced rest cures. These chapters reveal most clearly how a qualitative case study differs from historical analysis as the perspective moves between contemporary and more recent medical research. The last two chapters return to the lived experience of institutionalized children, and then finally to the local elite and middle-class philanthropy that made treatment a possibility for most of the children in the Toronto sanatorium. [End Page 131]

Burke’s primary sources, 822 patient charts, also contained letters the children received, copies of outgoing letters, as well as incidents of rule-breaking and subsequent discipline. This should be the heart of the study, but the attention to detail at times overwhelms the narrative. While the focus on patient charts allows a close reading of the world of institutionalized children, or at least the medical staff’s perceptions, it also leaves the rather larger contexts unexamined, such as the impact on families, the institution, and medical practice of two world wars and the Great Depression.

As a qualitative case study, the approach “more or less hold[s] time fairly constant over the forty some years of this study, even as treatment regimens changed” (p. 60). The methodology creates space for an analysis of the ways that sanatorium care that built resistance was both medical and modern. The strict discipline and regimentation that characterized the rest cure, and the collapse therapies that surgically rested lungs, only seem mean-spirited and wrong-headed from the vantage point of the age of antibiotic cures. But, the author warns, the therapies that built resistance might...

pdf

Share