Accounting for health

Calculation, paperwork, and medicine, 1500–2000

Axel C. Hüntelmann, Oliver Falk, David Cantor

• Publisher: Manchester University Press
• Year: 2021
• Print ISBN:
  9781526135162
• eBook ISBN:
  9781526135186
• Topic: Medicina
• Subtopic: Historia social

Whether in the Swiss countryside or in a doctor's office in Boston, in German, English or French hospitals or within multinational organizations, with early vaccinations or with new pharmaceuticals from Big Pharma today, or in early modern Saxon mining towns or in Prussian military healthcare – for at least 500 years, accounting has been an essential part of medical practice with significant moral, social and epistemological implications. Covering the period between 1500–2000, the book examines in short case studies the importance of calculative practices for medicine in very different contexts. Thus, Accounting for Health offers a synopsis of the extent to which accounting not only influenced medical practices over centuries, but shaped modern medicine as a whole.
This book is relevant to United Nations Sustainable Development Goal 3, Good health and well-being.

Part I
Keeping the books

1
Accounting, religion, and the economics of medical care in sixteenth-century Germany: Hiob Finzel's Rationarium praxeos medicae, 1565–89

Michael Stolberg

In the sixteenth century, with growing numbers of doctores medicinae graduating from the universities, learned physicians became major representatives of a new group of urban professionals whose economic fortunes rested almost entirely on their academic training and the skills they had acquired. Their prosperity and indeed their livelihood depended on their success as practitioners – all the more so, since many of them set up their ‘business’ in places to which they had come as strangers, attracted by a salary as town physicians. Yet we know very little, at this point, about the economic aspects of learned medical practice in sixteenth-century Europe and even less about how physicians dealt with them. How did physicians fare financially? How high were their fees and how did they vary according to the patient's economic and social status? To what degree did their income depend on what they received from a small elite of upper-class patients? How important, compared to the payments they received from their patients, were their salaries as town physicians or personal physicians to individual families or institutions such as monasteries? Last but not least, what do we know about their accounting practices? How did they make sure that they received what was due to them?

A major reason for our ignorance in these matters is a lack of adequate sources. Physicians’ letters, contracts, and occasional autobiographical writings offer only fragmentary evidence on such matters.¹ In this chapter, I will approach the questions outlined above through a detailed analysis of the only extensive practice journal and account book that is known to have survived from the hands of a learned medical doctor in the sixteenth century and that medical historians (as well as the various biographers of its author) have ignored. From 1565 until shortly before his death in 1589, Hiob Finzel (c. 1526–89), a physician in Weimar, Eisenach, and finally in Zwickau, recorded more than 10,000 consultations in three heavy folio volumes.² They contain a wealth of information about not only the diagnostic and therapeutic practices of a learned physician, but also his patients and his interactions with them.³ As the title under which it has come down to us, Rationarium praxeos medicae, correctly indicates, bookkeeping was a major reason for Finzel maintaining this journal. At the time, Rationes was a familiar term for ‘accounts’ and ‘rationarium’ must be translated as ‘account book’ here.⁴

In what follows, I will provide a brief sketch of Finzel's biography, and describe my source and the way in which Finzel recorded the payments he received. In the following section, I will highlight the striking religious elements and connotations of his Rationarium and will place them into the context of his strong Protestant faith. My chapter will conclude with an analysis of the economics of Finzel's practice and of the relative importance of the payments he received from patients of different social and economic status.

Hiob Finzel

Hiob Finzel, or Iobus Fincelius as he latinised his name, was born around 1526 in Weimar, where his father Conrad acquired citizenship in 1525.⁵ Little is known about his family background. According to an epicedion for his sister Anna, she excelled in weaving fabrics and eventually lived at the court of Anna of Saxony. This might indicate that the family was in the cloth-making business, but more likely must be read to mean in general terms that she – and Hiob – came from a well-to-do family (that could also pay for Hiob's studies).⁶ He studied at the liberal arts faculty in Wittenberg⁷ and after his graduation, in 1549, we find him lecturing on natural history in the Gymnasium academicum in Jena, where he eventually served as a professor when the Gymnasium became a university in 1558.⁸ Finzel initially sought to establish himself as a humanist scholar and poet. He translated the elegies of the Greek poet Tyrtaios and published various poems of his own. From 1556 to 1562, the first edition of his famous Wunderzeichen was published,⁹ a collection of stories of miracles and portents, which Finzel, a devout Protestant, presented as divine warnings that humankind must change its ways.¹⁰ This is the work for which Hiob Finzel is well known among historians of German literature and popular culture; it includes stories like that of the pied piper of Hameln that have remained famous to this day.¹¹

But by the time the last volume of the Wunderzeichen appeared, Finzel had already turned to medicine. In December 1562, he received his medical doctorate in Jena. In the spring of 1564, he accepted the position of a town physician in Weimar for three years, with an annual salary of 100 gulden (fl) and a malter of grain.¹² In addition to that, he was appointed, in December 1566, as personal physician to the Saxon duke Johann Friedrich, ‘from home’, i.e. without the obligation to reside permanently at court, with an annual salary of 50 fl and another malter of grain.¹³ Finzel's professional future seemed secured. But Finzel became involved in the controversy between Duke Johann Friedrich and the Saxon Elector Johann Wilhelm. He was imprisoned for several weeks and his contract was not renewed. He was without a salaried position for two years, until May 1569, when he started working as a resident physician at the court in Eisenach.¹⁴ Finally, in 1571, he was appointed as town physician in Zwickau, with a salary of 60 fl and two piles of firewood per year (worth another 6 fl). In return, he promised to serve the town and its citizens in health matters, to perform an annual visitation of the local pharmacies, and to advise patients in the hospitals and sick-houses out of ‘Christian charity’, i.e. presumably for free.¹⁵ He was not allowed to leave the town over night without the mayor's permission.

Zwickau was a fairly prosperous town with a strong tradition in cloth production and some sizeable mining activities in the area. At least for much of the time there was a second town physician, but competition from other learned physicians seems to have been limited.¹⁶ Finzel was to remain in Zwickau until his death, in 1589.¹⁷ He had found his place, professionally, economically, and as a pater familias with a growing family.

Finzel's Rationarium praxeos medicae

Finzel's Rationarium praxeos medicae comprises some 1,500 pages in three heavy folio volumes. The entries start in April 1565 when he was still a town physician in Weimar, and they end in the spring of 1589, shortly before his death. Finzel's did not use an album, i.e. a book with empty pages, but wrote on little fascicles or individual sheets of paper instead. They were almost certainly ...

Table of contents

• Cover
• Half-title page
• Series page
• Title page
• Copyright page
• Contents
• List of figures
• List of contributors
• Introduction
• Part I: Keeping the books
• Part II: Household
• Part III: Production
• Part IV: Polity
• Index