Building Resistance: Children, Tuberculosis, and the Toronto Sanatorium by Stacie Burke (review)

The history of tuberculosis has been a popular area of historical investigation since the 1980s. Given that national case studies have been the choice of most authors, Building Resistance proves to be unusual. Burke uses the exceptional archive of the Toronto Sanatorium for children, which opened in 1904, to ground her case study. The main focus is on those who write about children; the children themselves are usually silent in the sources. Overall, this book is a welcome addition to an existing body of literature about the history of tuberculosis in that it extends the well-known sanatorium narrative to pediatrics. The unprecedented richness of the material has much to say about the families of these children and their interactions and negotiations with medical personnel. The various chapters clearly link to the wider history of the disease, but through the lens of this particular institution.

Although the topic is a staple in the history of medicine, Burke wants the book to be read as an anthropological study. In a revealing paragraph, she forswears any intention to test hypotheses but instead to provide a thick description in a qualitative case study (8). This (short) declaration is complemented by a select reading of the available historiography of the sanatorium. Burke identifies some scholars as critical of the sanatorium and praises others for seeing the sanatorium in a more nuanced way. Yet the specific factors that determined the debate within the historiography remain surprisingly nebulous.

Burke professes to maintain a “balanced perspective” (8), which makes sense in light of her appeal to thick description rather than a clear analytical framework. The question is what exactly are the elements to be balanced? Positive and negative accounts of the sanatorium? Medical perspectives and patients’ views? A more detailed reading of the existing literature could have created clearer answers; the method of thick description might not have been the best approach. The book’s skeletal chronology is apt, if largely standard, starting with the Western sanatorium experience and ending with the arrival of streptomycin.

The title gives away the key analytical term for this book, resistance— the relationship between the body and the disease. All the chapters present vital information about the experiences of children, families, and physicians, demonstrating the methodology of thick description in a series of mini-case studies that confer considerable space to direct quotations from the sources. Throughout, Burke provides interesting commentary about the material, though she does not tend to analyze it deeply. Rather than engage with the secondary literature or with historical contextualization (although she does so to some extent in the introduction), Burke often reverts to the term of resistance as her lodestone. The problem is that what it means to her exactly is unclear. What was the contemporary view of it? How did it change, and to what extent is resistance a historical category at all? How does a modern reading of resistance contribute to historical understanding? In short, we want to know whether resistance served as a category of explication throughout the time of the Toronto Sanatorium. Burke’s use of resistance as an analytical category is not entirely convincing.

The source material for the book is nothing short of spectacular; no comparable collection exists elsewhere. The level of detail is impressive, painting a totally unambiguous picture of how children, parents, and professionals experienced life centered on the sanatorium. This book is a must-read for all those who are interested in the fundamental aspects of medical work in the realm of deadly diseases. Historians, however, may regret Burke’s reliance on case studies to order the narrative rather than on the historiography. Burke’s structure works well enough to organize the various treatment regimes in the source stories, but it cannot convey the ways in which the Toronto sanatorium was unique. How did its historical trajectory differ from that of other institutions? How much does Burke’s study contribute to the existing literature...