TY - JOUR
AU - Gorsky, Martin
AB - This new collection assembled by Hüntelmann and Falk aims to conjoin two traditions of scholarship. The first, deriving from the history of science, technology and medicine, considers how quantification has both informed and constrained ways of knowing about disease and therapies: by distinguishing the normal from the pathological, by validating evidence of efficacy and so on. The second, springing from the economic history of welfare institutions, seeks to analyse the financial inputs and outputs of physicians, hospitals and health insurers, thus to illuminate the social foundations of medical practice. The editors gather the two approaches under the organising theme of ‘accounting’, arguing that both were reliant on the same mathematical and material technologies. Satisfactory histories ought therefore to begin with the ‘calculation’ and ‘paperwork’ common to both the traditions, then let them complement and speak to each other. The result is an intellectually coherent volume with a broad range of themes and some real gems amongst the chapters. The initial contributions cover the book-keeping practices of early modern practitioners in Germany and Switzerland. Stolberg detects religious striving alongside the financial records, while Rieder shows how doctors’ accounting illuminates not just base economics, but also clinical relationships and issues of professional status. Leaping forward to the earlier twentieth century, Falk’s own chapter explores the dimensions of quantitative method in the work of an early diabetes specialist, who used measurement with individual patients to inculcate habits of self-management while at the same time developing a major resource for clinical epidemiology. The next section presents different case studies of the Western hospital, which taken together shed new light on its history. Hüntelmann’s survey of accounting at Berlin’s Charité through the long nineteenth century tracks the increasing sophistication with which the banalities of catering and staff costings transmuted into a ‘daily rate’ which could be charged to private or insured patients. Doyle observes the same process in the emergence of the French prix de journée, and fruitfully contrasts this with the less precise costing methods of English hospitals, attributable to their greater charitable tradition. Vandendriessche’s Belgian example similarly tracks the increasing professionalisation of hospital accounting, emphasizing how this met the needs of the emergent welfare state while also diminishing the power of medical elites. Finally, Porter examines the performative work of asylum accounts, whose tabulations of cured patients served both to elicit funds and legitimise the psychiatric speciality. This theme continues into a section covering research and the production of therapies. In an unexpectedly timely piece, Rusnock interrogates the quantitative representations of the Royal Jennerian Society, whose charitable accounting both reassured donors, legitimised vaccination and accumulated data for analysis; this did not prevent it from ending in voluntary failure and state takeover. Next an important essay by Gaudillière and Hess explores how the persuasory power of accounting has operated in more recent clinical trials for pharmaceuticals. They show how apparently neutral methods of scalar testing were sometimes closely geared to industry preferences and marketing concerns. Stark, by contrast, examines the filiations between accounting in state-sponsored research and in the Mennonite church, arguing that this provided common ground for the assertion of medical authority over churchgoers who participated in metabolic studies. The final section discusses accounting in different ‘polities’. Pranghofer’s study of quantification in early modern military medicine traces the prehistory of notions of human capital and deals another blow to the claim that the birth of the clinic occurred in nineteenth-century Paris. Turning to sickness insurance, a beautifully written piece by Mendelsohn unearths some very early box clubs created by German miners; he argues that their collective accounting practices were necessary precursors to the conceptualisation of industrial diseases. Next Castelbrandt adds a Swedish case of female health mutualism to the burgeoning comparative literature on friendly societies, deploying the concept of moral economy to demonstrate how accounting contributed to mutual endeavour. Finally, Sirrs documents the production of metrics by international organisations, showing how the comparative statistics created by UN bodies made possible today’s envisioning of global health. Occasionally, contributors include rather more fine detail of accounting’s ‘paperwork’ and material accoutrements than is strictly necessary for their expositions, while the admirable desire to illustrate the volume with photographs of the texts under discussion sometimes misfires: where hand-written sources are scaled down to fit half-page size they are rendered illegible, at least in the non-digital format. The book’s blend of dry business history and vivid social constructionism also produces a few delightful moments. I particularly liked Stark’s assertion that researchers conceiving of ‘age as a biological reality with physical thresholds’ (p. 265) were indulging in imagination. If only! As this summary suggests, the book provides a cornucopia of themes and argumentation across different periods and (mostly European) settings. It also helpfully demonstrates that the ‘economisation’ of health care is by no means a recent phenomenon. Overall, the collection succeeds wonderfully in its goal of knitting together economic and medical history around the concept of accounting. It should be noted that its developmental process brought the authors together over three successive symposia, in which their material was presented, critiqued and polished (full disclosure, I was a commentator at one of these). The editors, publisher and funders (ERC, Thyssen and Universität Bielefeld’s Zentrum für interdisziplinäre Forschung) should be congratulated for supporting this model of collective historical labour. © The Author(s) 2021. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Axel C. Hüntelmann and Oliver Falk (eds), Accounting for Health: Calculation, Paperwork and Medicine, 1500-2000
JO - Social History of Medicine
DO - 10.1093/shm/hkab074
DA - 2021-08-01
UR - https://www.deepdyve.com/lp/oxford-university-press/axel-c-h-ntelmann-and-oliver-falk-eds-accounting-for-health-Fa9bEoCTh4
SP - 578
EP - 579
VL - 36
IS - 3
DP - DeepDyve
ER -