Between Decay and Maintenance: Tuberculosis Sanatoriums,Care Infrastructures and U.S. Health Policy Debates,1945–1972

Abstract

The development of streptomycin and isoniazid transformed the landscape of tuberculosis treatment in the United States in the mid-twentieth century. Sanatoriums continued to play a role in tuberculosis treatment in the early antibiotic era; yet, changing perceptions of tuberculosis as curable and a waning public health crisis sparked medical and legislative debates over their relevance and cost-effectiveness. By 1972, most specialized tuberculosis treatment facilities had closed. The sanatorium's legitimacy as an infrastructure supporting individual patient recovery and wider community health was negotiated in complex ways in 1950s and 1960s medical and public health literature. Examining changing imaginaries of sanatoriums as their relevance declined and their closure was debated enables a temporal analysis of how processes of maintenance and repair in infrastructure impact larger policy debates. The evolving role of sanatoriums figured prominently in national health policy debates because they were a multiscalar infrastructure that took shape through individual local sites and statewide (and nationwide) networks. By thinking infrastructurally about specific sites of care, this study contributes to a growing science and technology studies literature about opportunities for repair in care infrastructures as enabling more adaptable, equity-focused responses to enduring public health challenges, particularly as societies respond to limitations in biomedicine.