Accounting practices in the Leuven Academic Hospitals, 1920–60
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.
This edited volume offers the first comprehensive historical overview of the Belgian medical field in the nineteenth and twentieth centuries. Its chapters develop narratives that go beyond traditional representations of medicine in national overviews, which have focused mostly on state–profession interactions. Instead, the chapters bring more complex histories of health, care and citizenship. These new histories explore the relation between medicine and a variety of sociopolitical and cultural views and realities, treating themes such as gender, religion, disability, media, colonialism, education and social activism. The novelty of the book lies in its thorough attention to the (too often little studied) second half of the twentieth century and to the multiplicity of actors, places and media involved in the medical field. In assembling a variety of new scholarship, the book also makes a contribution to ‘decentring’ the European historiography of medicine by adding the perspective of a particular country – Belgium – to the literature.
In an era of transnational and global historiography, reflecting on the national frames of writing medical history remains a necessary endeavour. On the one hand, it helps historians to interrogate the metanarratives they use in writing about the medical past, many of which still focus on interactions between physicians and the state and stem from an older social historiography of medicine. By widening their gaze to a history of (health) care, historians may bring a broader range of actors and influences into the limelight. On the other hand, questioning national frames of writing history also shows the complex stratification of local practices, international circulation of scientific knowledge and national structures. Medical histories of modern Belgium therefore consist above all of a variety of entanglements taking place both in Belgium and beyond.
This chapter offers a varied overview of the historical relation between medicine and religion in Belgium, which was until the 1960s a predominantly Catholic country. Moving beyond a too strong political reading of healthcare debates, in which both fields have been described as opposites (competing with one another or aiming for compromise), this chapter pays attention to intellectual encounters and to the role of religious practices and beliefs in medicine. First, the chapter sketches the evolution of Catholic organisations and institutions, most notably the changing role of religious orders, which in Belgium have held a firm grip on the medical field. It describes evolving Catholic views on ‘care’, along with political conflicts over an expanding welfare state and changing views on the growing role of lay medical personnel. Second, the chapter turns to religious practices, rituals and exceptional phenomena such as miracles, and the medical debates these inspired. From a medical perspective, religion could be a source of health (e.g. ‘moral therapy’ to treat mental illness) or disease (e.g. Christomanie). Third, the chapter goes on to discuss how Catholic doctors and caregivers gave their religious views a place in their professional work and identities. Here the chapter turns to medical ethics and professional codes of conduct, and the ways in which these have been inspired by Catholic thinking. The chapter pays particular attention to questions related to reproductive medicine and the end of life.