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Modern Architectures of North America

Anterior facade, administrative building

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Marianna Mapes, Disease and the Body Politic: The National Leprosarium at Carville, Louisiana

Negotiating the "Limitations" of Illness
In 1894, a facility to quarantine Americans with leprosy (now known as Hansen's Disease) was founded on the site of the former Indian Camp Plantation in Carville, Louisiana, halfway between Baton Rouge and New Orleans (Mizell-Nelson 2003, 306). Though leper colonies had been operational in the American South for more than one hundred years, the leprosarium at Carville was the first of its kind in the nation (ibid.). It was borne out of persistent, nationwide – indeed, global –stigma around individuals with leprosy, fueled by deep misunderstandings of its causes (Sermrittirong and Van Brakel 2014, 37) and the mythification of the disease through, e.g., wisdom literature (Gussow and Tracy 1971, 698). Given the common belief that leprosy was highly contagious, quarantine of all individuals with the disease was mandated once the leprosarium came under federal control in 1921 (Mizell-Nelson 2003, 308). Through the 1930’s, it was standard practice for patients to be assigned pseudonyms upon their arrival at Carville “in order to protect their families’ reputations” (Mizell-Nelson 2003, 309).

We now know that leprosy is a highly treatable, chronic infectious disease caused by Mycobacterium leprae (World Health Organization). Leprosy is a disease of both low pathogenicity and low virulence – it is spread only through droplets from the nose and mouth, and can remain latent for up to 20 years; though it can cause significant damage to the skin and nerves, it can be cured with multidrug therapy (WHO). But even at Carville – that is, in spaces designed for the deployment of clinical expertise in the treatment of leprosy – deep misconceptions about the causes and progression of the disease flourished. To date, discussion of the architecture at Carville has been quite limited; it is this lacuna in scholarship that I aim to address here, delving into a rich variety of sources covering aesthetic trends in the American South, the history of architecture as a form of social control, and even the ethical norms governing medical practice during Carville’s years of operation.

As indicated in the images below, during its years of operation, the leprosarium carved up physical space in ways that reinforced rigid norms regarding which bodies were deemed unworthy of civic engagement -- and therefore, of being seen in the public square. Though disability theory is not the sole conceptual lens that I consult for this project, it is especially valuable in understanding Carville – with all its vestiges and artifacts of oppressive thinking about wellness and disease – as a site of negotiation, transformation, and reclamation of citizenship. Carville offered limited opportunities for new ways of engaging with the bodily autonomy of which patients had long been deprived (for example, it was not until the early 1950’s that Carville patients successfully regained their right to vote, or were permitted to go on leave to visit family; “Crusade in Carville”). Stripped of their birth names, patients responded not by reclaiming those names, but by constructing even richer, more imaginative identities for themselves, if only for one fleeting evening.

"Tuberculosis was the leading cause of death in the United States during the late nineteenth and early twentieth centuries. Leprosy, on the other hand, was rare, but the disease was more greatly feared by the public. It is thus hardly surprising that the nation's only leprosarium was the nation's most gloomy and rigidly regulated sanatorium" (Mizell-Nelson 2003, 309).

The spatial arrangement of the leprosarium and the structure of the buildings themselves present an interesting reference point for evolving understanding of the nature of the disease and shifts thinking more generally about patient autonomy and the role of medicine. We find that the built environment is outgrown by deepening scientific understanding so that the structures reflect traditional medical lore’s conception of leprosy. The ways in which certain structural features are rendered obsolete by a firmer grasp of the disease and proper treatment stand as artifacts of a different conceptual framework for thinking about wellness and medicine.

Bibliography
"Crusade in Carville." Time 58.13 (September 24, 1951), 94.
Downs, Joseph. "The Greek Revival in the United States." The Metropolitan Museum of Art
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Elden, Stuart. "Plague, Panopticon, Police." Surveillance & Society 1.3 (2003): 240-53.
Gaudet, Marcia. "The World Downside Up: Mardi Gras at Carville." The Journal of American
     Folklore 111.439 (Winter 1998), 23-38.
Gussow, Zachary, and George S. Tracy. "The Use of Archival Materials in the Analysis and
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     health care: a place for sociology." Sociology of Health and Illness 37.7 (2015), 1007-1022.
Miller, Franklin G. "Clinical Research before Informed Consent." Kennedy Institute of Ethics
     Journal 24.2 (June 2014), 141-57.
Mizell-Nelson, Michael. "Treated as Lepers: The Patient-Led Reform Movement at the National
     Leprosarium, 1931-1946." Louisiana History: The Journal of the Louisiana Historical
     Association 44.3 (Summer 2003), 301-24.
Nations, Marilyn K., Geison Vasconcelos Lira, and Maria Fontenelle Catrib. 2009. “Stigma,
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Sermrittirong, Silatham, and Wim H. Van Brakel. "Stigma in leprosy: concepts, causes
     and determinants." Leprosy Review 85 (2014), 36-47.
Sternberg, Mary Ann. Along the River Road: Past and Present on Louisiana's Historic
     Byway. Baton Rouge: Louisiana State University Press, 1996.
World Health Organization. "Leprosy." May 2015. http://www.who.int/mediacentre/
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Patients, Prisoners, Politics
At both Carville and Tule Lake, value judgments regarding identity, autonomy, and community membership are made manifest in the built environment.

Introduction

In its design and day-to-day operations, the Tule Lake Segregation Center was a prison. It realized its aims of isolation, regulation, and ongoing surveillance of Japanese-Americans during World War II under the banner of national security. Meanwhile, more than 2,000 miles away from Tule Lake, the National Leprosarium in Carville, Louisiana, was fully functional as the only facility in the United States for housing and treating leprosy patients. Unlike Tule Lake, Carville was not a prison, but it was envisioned as a bulwark against a serious threat to public health. Importantly, key features of its built environment strongly reflect design elements of prison and asylum architecture. As a residential hospital, Carville centered its operations around (1) the isolation of patients from the community at large; and (2) the containment of the disease’s spread within the various spaces on the hospital grounds, e.g., from patients to medical staff. Its approach to isolation reflects the fear and stigma surrounding the disfigurement caused by leprosy, as well as the state of medical knowledge about the causes and progression of the disease; at both Carville and Tule Lake, value judgments regarding identity, autonomy, and community membership manifest in the built environment.

Importantly, narratives of negotiation and rebellion complicate the otherwise straightforward narratives of patient/prisoner oppression we might wish to construct. Patients and prisoners did find ways to manipulate the constraints of their physical spaces to forge interpersonal ties and explore facets of their identity beyond those emphasized by their respective institutions (i.e., Japanese heritage at Tule Lake, illness at Carville).

Because the Tule Lake Segregation Center was designed – and functioned as – a site of incarceration, its built landscape explicitly spells out its commitment to confinement and surveillance. In that connection, we will begin our image analysis with Tule Lake, and then turn to Carville’s more subtle, though nonetheless striking, instantiation of a penal architectural program. In other words, Tule Lake offers us a case study of prison architecture so that we may more fully grasp how this architecture is situated in a particular clinical context.
We highlight below several key areas of thematic and architectural common ground between the built environments at Tule Lake and Carville:

Surveillance & Structure

At Carville, a “high wooden fence…separated patients by gender” (Mizell-Nelson 2003, 310), a vestige of the view that leprosy was somehow the result of sexual impurity (Nations et al. 2009, 1220). In addition, the fence bespeaks the persistent view that physical containment was the best way to control the spread of the bacterium that causes leprosy, which we now know to be of low virulence (WHO). The fence was torn down in 1923; other mechanisms of control installed within the built environment endured long after. Though the leprosarium has no surveillance watchtower properly so called, the arrangement of patients’ dormitories around a central courtyard – with limited points of access from outside – conduces to maximal control over foot traffic into and out of buildings. In effect, freedom of movement is a privilege reserved for medical staff.

Heavy surveillance was paramount in the Tule Lake Segregation Center, as the camp specifically held those who took a mandatory loyalty test and answered ‘no-no’ to questions 27 and 28 (Tule Lake Committee Website). Consequently, they were considered enemies to the country and a danger to its citizens, making Tule Lake segregation center a maximum security facility complete with a “6-foot-high chain link fence topped with barbed wire,” guards, tanks, and watchtowers lining the perimeter (AJA WWII Memorial Alliance). Isolated in a desert with only a single point of access in the camp, detainees were barred from leaving. The structure of the camp reinforced ideas of surveillance and structure, as the living quarters were separated from the rest of the camp facilities, and buildings were set far apart in order to quell community organizing and heighten the level of surveillance over the detainees.

Fear, Isolation, & Othering

Set in a semi-arid desert isolated from civilization, thousands of Japanese Americans following the events following Pearl Harbor were deemed unsafe to live amongst other American citizens. Although a majority of the detainees were Nisei, or second generation Japanese-Americans who had no connection to their Japanese heritage, the detainees were forced to subscribe to an identity they didn’t feel they belonged to. This was achieved not only through forced detention based upon their Japanese heritage, but through participation in mandatory social events such as Ondo, Japanese folk dancing, and Sumo wrestling matches (Roxworthy, Japanese American Trauma: Racial Performativity). These events within the camps served to reinforce the idea that the detainees were not American, but Japanese, and had no place in American society.

When the hyper militarized camps began to develop a reputation as sites of violence, on Independence Day the detainees were allowed to participate in American activities and traditions. Events were held such as baseball games and talent shows where numbers had to be “Occidental” to show the public that camps like Tule Lake were effectively Americanizing the Japanese detainees (Ibid). But after Independence Day, efforts to suture Japanese and American culture disappeared, and the public’s hysteria and fear regarding the Japanese did not lessen. The detainees, regardless of their participation in quintessentially “American” activities, could not shed their status as others.

Carville, too, operated on the basis of a clear distinction between the ailing and the non-ailing. Hospital-issued rhetoric intensified the seriousness of the threat posed by individuals with leprosy by positioning them as “a menace to the general public health in those places where they [were] not properly isolated” (The Committee on Public Buildings and Grounds Hearings, 1922, 6). As we will see, rhetorical hysteria attended not only the seclusion of the hospital campus, but also the methods of confinement within Carville’s residential and clinical spaces.

Rebellion & Negotiation

The Japanese Americans detained in the Tule Lake Segregation Center actively protested their containment, though they did so peacefully. While they certainly protested their detainment as unconstitutional, their main aim in organized protests was to improve their living conditions (AJA WWII Memorial Alliance). Living in military style barracks with no heating, electricity, or running water, the detainees were treated as less than human. In an act of rebellion against their treatment, the Japanese Americans built gardens, added as many personal items as they could to their barracks, and battled the isolating design of the camp to find niches of community within their living quarters (Japanese Internees Use Environment As Resistance, Academic Spotlight). Similarly, as we will see, patients at Carville took advantage of the hospital's annual Mardi Gras celebration to play with rigid norms governing identity (Gaudet).

Post-Containment

For both the Tule Lake Segregation Center and the National Leprosarium at Carville, isolation cannot be disentangled from the broader project of institutionalization.
The central aim of the leprosarium was not the eventual reintegration of patients into society, but rather the isolation and control of a perceived threat; from the outset, leper patients’ institutionalization was indefinite (Mizell-Nelson 2003, 309, 315). Perhaps the most pernicious feature of leper patients’ segregation was the limited rationale required for their institutionalization (Gussow and Tracy 1971, 703). If we view medical care as a means to restoring physiological functioning, it becomes clear that Carville’s operations centered on an endeavor quite distinctive from, though not unrelated to, the practice of medicine: control.

By contrast, the Tule Lake Segregation Center claimed to rehabilitate Japanese-Americans for reintegration into the public sphere. But in reality, when the detained Japanese-Americans were allowed to leave, they felt they could no longer live within a country that had treated them so badly. As a result, “11,227 citizens then decided to give citizenship back and demanded that the U.S. government deport them to Japan,” though most had never even set foot in Japan (Roxworthy, Japanese American Trauma: Racial Performativity). While the unconstitutional detainment of thousands of Japanese Americans has ended, the message left by the camps still remains clear in the hearts and minds of Japanese Americans today. The existence of the camps within American history will always remind Japanese-American citizens that no matter their allegiance to America, or their rights, in a moment they can be controlled by an identity decided for them.

Continue onto the Suburbia page to see how ideas of confinement and identity connect to modern American domestic architecture!

Media Gallery Citations (from left to right)
Call Northside 777. Digital image. Ariel Ron. www.theappendix.net, n.d. Web.
Sketch of Bentham's Panopticon. Digital image. Dirk J. Vandenberg, Image & Narrative: Online Magazine of the Visual Narrative, n.d. Web.
Tule Lake Drawing. Digital image. National Park Service. Nps.org, n.d. Web. <https://www.nps.gov/common/uploads/photogallery/pwr/park/tule/1FD1A76B-155D-4519-3E6829C6884ECFB1/1FD1A76B-155D-4519-3E6829C6884ECFB1-large.jpg>.
Aerial view of United States Public Health Hospital at Carville. Digital image. The Daughters of Charity Provincial Archives, n.d. Web.