Was Modern Architecture Shaped by the 20th Century’s Obsession with Tuberculosis?

‘Hans Castorp peered through the lighted window, peered into Joachim Ziemssen’s empty skeleton.’ In the sanatorium of Thomas Mann’s 1924 novel The Magic Mountain, the protagonist gazes at his cousin’s bones through a screen; the column of his spine, the soft envelope of his flesh, the dark spots of his tuberculosis. Nothing will be the same for Castorp after this moment, when the lines between interior and exterior become blurred by the X-ray. 

The Magic Mountain is quoted several times throughout X-Ray Architecture (2019), a fascinating new book by the theorist Beatriz Colomina, issued by Lars Müller Publishers. It crops up with good reason. The bones of Colomina’s persuasive and wide-ranging argument are that modern architecture was shaped by the 20th century’s medical obsession with tuberculosis as well as with the tool for its diagnosis: the X-ray. Together, these clinical and technological paradigms brought about a new way of thinking about bodies and spaces, insides and outsides, health and architecture. 

Colomina begins by tracing a lineage from Vitruvius to Vasari, underlining the centuries-old tendency to view buildings as bodies and bodies as buildings. This lays the groundwork for what’s to come, as she leaps into the 20th century, to a time when health became a kind of religion for a number of key architects. Whether embodied in Le Corbusier’s rooftop gyms or Alfred Loos’s elimination of ornament, a new architecture emerged in the early decades of the last century that, in the author’s words, ‘presented itself as lean and fit, all the excess weight of neoclassical tradition stripped off to reveal a muscular and agile body in a white sports outfit’.  

At the core of this vision, she argues, is the sick and nervous body of the tuberculosis patient. In the book’s most convincing section, Colomina examines how the design of sanatoriums bled into other buildings. She takes an extensive look at the Paimio Sanatorium (1929–33) in Finland, designed by Alvar and Aino Aalto to be a medical instrument in its own right, where bedroom fittings were optimized to the smallest detail for hygiene and quiet, and wide terraces provided air and sunlight for patients to take the ‘lying cure’. 

Exactly how effective all this was is up for debate, given that the Paimio’s terraces had to be closed to stop patients from throwing themselves to their deaths, but sanatorium culture rippled outwards all the same. After effective antibiotic treatments for tuberculosis emerged in the mid-20th century, the philosophy of light, air and exercise persisted, mutating towards hotels and villas; spaces put to work as machines for health. Colomina makes a compelling case, nuanced in how it characterizes the figure of the fragile tuberculosis sufferer and that of the athletic rooftop sunbather as two sides of the same coin.

Yet, it wasn’t only the fear of disease that fuelled modern architecture; it was also the method of its diagnosis. In its second half, the book pivots to look at the impact of the X-ray. Much like Castorp peering into his cousin’s chest, society’s understanding of transparency, visibility and invisibility was altered by radiography; a sense of bodily inversion that Colomina says was absorbed by the built environment. Projects such as Ludwig Mies van der Rohe’s unrealized Glass Skyscraper (1921–22) for Berlin’s Friedrichstrasse or Bernard Bijvoet and Pierre Chareau’s Maison de Verre (1932) in Paris are presented as examples of structures that look a lot like X-ray images, with translucent facades half-masking ghostly interiors.

The book argues that these nascent experiments in glazed buildings were more than a novel aesthetic; rather, they were ‘a symptom of a deep-seated philosophy of design deriving from medical discourse’. By the 1930s, the idea of the glass house had become a symbol for a new form of health, as well as surveillance: the inhabitant a patient under observation from the outside world. But, like the overlapping bones and diaphanous tissue of an X-ray image, what is seen through the glass screen is not necessarily crystal-clear. When writing about the Eames House (1949), Colomina makes the point that the intention was not, in fact, transparency but a kind of blurring, with borders between interior and exterior confused.

So, too, does the book’s purpose become somewhat blurred as it progresses. A detailed look at an installation by the Japanese architecture studio SANAA for the Mies van der Rohe Pavilion in Barcelona (2008) is interesting in its vision of ‘porousness’ but it feels dislocated from the throughline of health and disease, particularly the 20th-century paradigms around tuberculosis that the majority of the study hinges on. Likewise, an afterword that gestures towards the ‘descendants of the X-ray machine’ is a thread that isn’t quite followed through to a satisfactory conclusion. In fact, Colomina’s book could easily have run to two volumes, with the latter developing the ideas of contemporary surveillance, transparency, data and privacy that are only touched on here.

There has lately been a renewed interest in the relationship between buildings and health. The recent ‘Living with Buildings’ exhibition at the Wellcome Collection in London, for example, also examined the lineage of the Paimio Sanitorium, and there are ongoing discussions about how architects should respond to rising cases of anxiety and rising air pollution levels in our cities. By homing in on the X-ray, Colomina goes further than charting the many echoes between hospitals and homes. She creates a picture of modern architecture as a legacy built up around the figure of the patient behind a screen: fragile, exposed, obscured as they are revealed.  

^{Main image: Ludwig Mies van der Rohe, Tugendhat House, c. 1945-1950, children exercising on the terrace with the physical education institute of Karla Hladká dancing school. Courtesy: Daniela Hammer-Tugendhat and Lars Müller Publishers} 

This article appeared in frieze issue 204 with the headline ‘Form Follows Flesh’