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Axel C. Hüntelmann and Oliver Falk

Accounting is about ‘how much’ and is usually assumed to be about money, the administration of finances and the calculation of efficiency. This introduction suggests a broader understanding of accounting, especially in relation to health, medicine, and medical knowledge; and elaborates its characteristics by using the example of poor boxes in front of hospitals: money going in and out. But donations were made for a certain purpose and laden with moral or social intentions. Therefore, treasurers had to provide information about the donor’s gift to account for its efficient and legitimate use. Accounting for health involved information being collected, listed, and compiled in order to demonstrate good medical practice. Thus, monetary income is correlated with medical outcome. More generally, accounting for health is described as a set of calculative practices and administrative techniques in which money, goods, and other countable objects or patients, detached from their physical materiality, are transformed in specific codes and formats that appear in ledgers, account-books, or tables. Such an expanded meaning of accounting allows to trace the entwined monetary, moral, and epistemic dimensions of accounting (for health) and illuminates the linkage of accounting, health, and medical knowing and its deeply entangled history for over five centuries.

The introduction summarizes the various strains of sociological and historical research and literature on the history of (hospital) accounting and paper technologies. Discussing methodological issues, the introduction elaborates the longue durée perspective and the praxeological approach of the volume’s chapters and gives an overview about the structure of the book.

in Accounting for health
Accounting and the medical market in and around Geneva, 1760–18201
Philip Rieder

Accounts related to private medical practices and held by the practitioners themselves are both a part of medical activity and vehicle of information about healers’ practices and outlooks. This chapter is based on the ledgers written by three healers active in the last decades of the eighteenth century in the Geneva region: a country surgeon, a physician established in a small town, and a physician working in Geneva itself. Each practitioner imagined a structure and a code in order to elaborate and keep information about his practice and payments made. In proceeding thus, he surrenders information relevant to the meaning the accounts had for him and the organisation of his practice. The items listed inform both on the services offered, the value given to them, the expediency of clients to pay, and the different medical strategies adopted. Sometimes bills and accounts are clearly related, elsewhere emphasis is on certain types of clientele and, in one case, accounts aimed to estimate the progression of practice and, ultimately, the physician’s success. Comparing accounting practices carries information on the varying nature of medical services from one practitioner to another, on the value of medical counsel, and the social uses of medicine. Town and country practices are complementary, and practitioners from each environment bill different types of services. Contrasting these account systems enables us to understand how practitioners adapted to the demand and reveals something of the nature of the relationship the practitioner established with his patients and the type of medicine he offered.

in Accounting for health
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How performative accounting forged the ills of industry
J. Andrew Mendelsohn

J. Andrew Mendelsohn’s chapter focuses on economic, governmental, and medical policies in early modern mining societies in Saxony. Starting with the example of a penny box of German miners’ societies and the in and out of clinking pennies, the weekly payments of miners to the societies’ penny box, and the money’s use for injured or harmed miners suffering from miners diseases, J. Andrew Mendelsohn combines economic history (miners’ societies and sick funds as the earliest form of social insurance) and medical history (expertise on miners’ diseases as the earliest form of occupational health). Accounting, Mendelsohn argues, constituted each in relation to the other.

Mines and mining towns were both an important economic sector and a kind of experimental field for medical observation and knowledge production, amid the background of attempts to govern the laboring body of miners. This was because mining investors, with their public responsibility in miners, had a vested interest in miners living longer and healthier (and thus more productive) lives. In this sense Mendelsohn argues that all-pervasive values and practices of welfare, effective work, and good governance – in both a moral and technical sense – entailed accounting for anything significant happening to the bodies of miners. For this reason, the practice of the official mining physician involved substantial administrative organisation, managerial and medical oversight, and various forms of recordkeeping, especially simple forms of accounting, all within a framework of accountability that was both political and economic.

in Accounting for health
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Accounting practices in the Leuven Academic Hospitals, 1920–60
Joris Vandendriessche

This chapter scrutinises the role of accounting in the expansion of academic health care in the mid-twentieth century. Taking the hospitals run by the Catholic University of Leuven (Belgium) as a case study, it analyses the impact of a professionalising administration – accountants, economists, and managers included – on hospital governance. Its main argument is that accounting practices proved crucial for the establishment of the modern academic health centre as they enabled a centrally directed redistribution of means and responsibilities, in line with the health policies of the Belgian postwar welfare state and academic educational reforms. The chapter shows how the aggregate budgets, preprinted forms, and ‘strength reports’ designed by postwar bookkeepers effectively shaped new hospital realities. While new specialised medical services received more (financial) autonomy, the opportunities for expansion of other services were limited. The chapter further shows how such top-down and performative accounting differed from (and clashed with) professors’ prewar managerial roles. The autonomy of the latter as the directors of their own medical institutes was gradually limited. A heated debate over a centralised accounting department of the Leuven hospital for collecting the fees stemming from Belgian Social Security in 1944 illustrated the erosion of prewar hospital governance. Henceforth, centralised accounting became key to setting in motion the wheels of medical expansion.

in Accounting for health
Military health care and the management of manpower
Sebastian Pranghofer

Lists and tables that were used in war offices, regiments, and field hospitals to account for soldiers and their physical state had the long-term epistemic effect of establishing the notion of the military population as a dynamic factor. The relationship between military medicine and the management of military manpower is manifest in the military papers of the Electorate of Hanover and the Kingdom of Prussia from the 1680s to the 1760s. During this period, close proximity of civil and military medicine reshaped notions of military manpower as one of the key assets of the early modern state. Individual soldiers and their bodies were transformed into populations that could be measured and managed on a large scale. Such developments fit with broader processes during the period, when population emerged both as a theoretical concept and a field of political intervention. This culminated in the mid-eighteenth century in new evidence-based and statistical approaches to policy and politics. Military health care and the management of manpower played a key role in this process. Eighteenth-century military populations were considered to be assets for waging war. Within the context of cameralism, their utility can be interpreted in terms of a military economy of the body.

in Accounting for health

Using oral, archival and written sources, the book reconstructs the experiences of African women and men working in Zimbabwe’s hospitals in the twentieth century. It demonstrates how African nurses, i.e., nursing assistants, nursing orderlies, medics and State Registered Nurses were the spine of the hospital system and through their work ensured the smooth functioning of hospitals in Zimbabwe. The book argues that African nurses took the opportunity afforded to them by the profession to transform Zimbabwe’s clinical spaces into their own. They were interlocutors between white medical and nursing personnel and African patients and made Africans’ adjustments to hospital settings easier. At the same time, the book moves beyond hospital spaces, interrogating the significance of the nursing profession within African communities, in the process bridging the divide between public and private spaces. The book makes a significant contribution to global nursing historiography by highlighting how Zimbabwean nurses’ experiences within hospitals and beyond clinical spaces speak to the experiences of other nurses within the Southern African region and beyond. Through documenting the stories and histories of African nurses over a period of a century and the various ways in which they struggled and creatively adapted to their subordinate position in hospitals and how they transformed these healing spaces to make them their own, the book suggests that nurses were important historical actors whose encounters and experiences in Zimbabwe’s healing spaces – the hospitals – deserve to be documented.

Clement Masakure

The chapter centres on the historical enquiry of the Africanisation of nursing services in Southern Rhodesia in the wake of the opening up of SRN training to young African women. Besides training SRNs, the government began appointing African nursing tutors and sisters into more senior positions. The chapter argues that as much as this gesture began the gradual dismantling of the industrial colour-bar system that had denied Africans positions of power within the Civil Service, racism within hospitals continued. In fact the hospital remained quintessentially a colonial space – as the hierarchy of authority and the deployment of power within clinical spaces replicated colonial race and class relations. The chapter argues that in such a hostile environment, African nurses carved out a niche for themselves by making workspaces (hospitals) their own. At the same time, nurses’ testimonies suggest that nursing practice within colonial hospitals gave African women an opportunity to reshape cultural perceptions of nursing and the care economy in colonial Zimbabwe.

in African nurses and everyday work in twentieth-century Zimbabwe
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Clement Masakure

This chapter draws the main conclusions and reflects upon the significance of studying African nurses to nursing history within former settler colonies and international nursing history. The chapter also points to areas that need further research centred on the following themes: gender, race and the role of professional nursing organisations. In relation to gender, it calls for a need to explore the history of male nurses beyond mining and the war, which have traditionally been dominated by men thus can be considered as male spaces by exploring the experiences of male nurses in ordinary hospitals. An analysis of male nursing outside the ambit of mining and the military in Zimbabwe and Southern Africa will further complicate the discourse around nursing and masculinities within nursing historiography. Related to race, the chapter highlights the need for a further examination of white nurses, coloured nurses and nurses of Asian descent. An inclusion of these racial clusters in nursing history can be used as a point of entry into examining similarities and differences in experiences for nurses based on race across time and space. Lastly, nurses as other workers, organised to fight for their rights and influence policies that affected their daily work within hospitals. The chapter notes that an investigation of the areas mentioned above and other neglected themes in nursing history will add a further layer to the role of nurses in the history of Zimbabwe, the region and the world.

in African nurses and everyday work in twentieth-century Zimbabwe
Clement Masakure

The chapter examines the role played by nursing assistants, medical assistants, and nursing orderlies in the provision of medical services to Africans during the first half of the twentieth century. It notes that the history of medical auxiliaries allows us to appreciate the importance of a cohort of women and men who not only took up hospital work to improve themselves, but also played an important role in the provision of biomedical services to their fellow Africans. Initially, these medical and nursing auxiliaries were in-house trained and in most cases, the majority of these auxiliaries consisted of recovered patients or early converts. However, the late 1920s saw a significant shift in the training of nurses at mission stations in Southern Rhodesia. With the government’s support, missionaries began to move towards a more professional training of nurses and orderlies, targeting educated young women and men. At the same time, in the 1930s, the government began training their own medical nursing orderlies and the government expected male nursing orderlies to be the bastion of biomedicine in government clinics in African areas. For urban areas, the government began to think of the possibility of training African State Registered Nurses (SRNs). The 1940s saw debates on the training of SRNs and from these debates authorities reached a consensus on the need for the government to train African female SRNs in the process marginalising the possibility of having male SRNs. These discussions set the foundations for African female domination of the nursing services from 1950 onwards.

in African nurses and everyday work in twentieth-century Zimbabwe
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Clement Masakure

This chapter introduces the central thesis, supporting arguments, sources, methods and the significance of the work to nursing history in colonial and post-colonial societies in particular and global nursing history in general. The analysis around nurses’ daily experiences is framed around questions that focus on the centrality of African nurses in the provision of care during the period under study, and understanding as well as disentangling the complex relations between nurses themselves as well as between nurses and their superiors. It proffers the need to move beyond hospitals, exploring what the profession offered to those who practised it and societal expectations of nurses. The chapter highlights the need to appreciate that nurses’ struggles – within and outside clinical spaces – were part of the broader national struggles during the period under study. In the process, the chapter engages literature on colonial and post-colonial nursing history that has not only examined the various ways in which nursing and hospitals became sites of race, class and gender and ethnic struggles, but also focused on nurses who occupied the lower rungs of the profession, giving voice to those silenced in nursing historiography. Oral, archival and secondary material constitute the evidentiary base for the reconstruction of nursing history in Zimbabwe.

in African nurses and everyday work in twentieth-century Zimbabwe