PDF Standardizing Body Temperature
PDF Standardizing Body Temperature
Foreword iii
Body Counts
Medical Quantification in Historical and
Sociological Perspective /
La quantification medicale, perspectives
historiques et sociologiques
edited by
g é r a r d j o r l a n d , a n n i c k o pi n el,
a n d g e o r ge wei sz
by / par
Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-
consumer recycled), processed chlorine free.
VOLKER H E SS
s tandardizing t h e p r ac t ic e
of mea sur e me n t
lated reams of data in less than ten years, he proudly published the
“fundamental rules” in fever diseases based on the behaviour of inner
heat.9
However, neither Wunderlich nor his colleagues justified their defi-
nitions of physiological norms. Nor did nineteenth-century clinicians
pay much heed to statistics (in the narrow sense) and calculations of
the distribution or the standard deviation.10 As long as the data were
obtained using scientific measurement techniques they were taken to
offer an objective representation of the state of the human body.
But this historiographical perspective neglects the “normalization”
of fever measurement in hospitals. It appears as though measurement
merely brought hidden nature to light. That was why biological norms
– unlike other social or technical norms – expressed in the form of
normal values seemed particularly sacrosanct. In the case of body tem-
perature, however, this biological nature of the normal range was a
very artificial product. The reproduction of measurements indepen-
dent of place, time, and measurer was not as simple as we might think
in today’s world of digital and ear thermometers. The classic minute
maximum thermometer emerged only after establishment of the new
method.11 Without it, surveying body temperature was an extremely
laborious and time-consuming venture that often lasted more than
half an hour. Taking scientific – i.e., systematic – measurements
involved not fitting the instrument to the patient, but vice versa. The
Berlin clinician Ludwig Traube (1818–1876) first described this man-
agement of the patient’s body in 1851 and called it the “method of
measurement”:12
First of all the patient is placed as horizontally as possible on his back … The
arm is then brought toward the trunk so that it rests as tightly as possible along
the length of the trunk. As soon as it touches the trunk, it is bent to a right
angle at the elbow and the lower arm is passed by the thermometer and placed
on the stomach. The upper arm, which now rests tightly on the trunk is then
fixed in this position with a chaff-pillow, which is pressed against the arm hor-
izontally by means of a nearby heavy object, such as a chair. After ten minutes
the level of the mercury column is recorded and from then on every five min-
utes, until the column finally remains at a constant height for a period of five
minutes. Usually this will be the case only after a period of 25 to 35 minutes,
occasionally even longer. One of the main ways to ensure that a constant level
is reached quickly is doubtless the careful closure of the armpit.
th e body ’s ob je c t iv it y
For a long time, the German hospital was primarily a coercive institution
for poor relief. In recent years, however, empirical studies have uncovered
important nineteenth-century developments.14 By the first half of the
nineteenth century, the growing proportion of insured patients had
already transformed the traditional poor house into an institution of med-
ical treatment,15 while poor patients shifted to complementary forms of
ambulant care.16 The hospital clientele came increasingly from the lower
class, especially the ‘labouring poor.’ In the Charité Hospital in Berlin, the
proportion of so-called self-payers increased from 30 per cent in 1834 to
70 per cent in 1868.17 These people had to pay for health insurance
through workers’ unions or hospital subscriptions, and they came to con-
sider hospitalization not as an arbitrary act of mercy or bountiful philan-
thropy, but rather as a service purchased by their own contributions.
Academic physicians had little interest in hospitals before the early
nineteenth century because of their orientation towards traditional
bedside treatment.18 Although the social transformation of hospitals
gave them access to very interesting acute ‘patient material,’ it also
presented them with a new type of patient they considered unworthy
of their attention. And those patients had expectations and claims that
physicians were ill prepared to handle. The contrast between the new
clinical practice and traditional bedside treatment could hardly have
been greater.19 In traditional medicine, patients and physicians hailed
from the same socioeconomic class and shared the same conceptions
of the world and of themselves, as well as a common concern for the
human body and the civic ideals of a healthy life and regular behav-
iour. In hospitals, however, patients were not civic patrons who hon-
oured the physician, but instead workers, journeymen, or menial
labourers with room and board paid for by insurance companies.
CH06.QXD 3/9/2005 5:03 PM Page 113
c onc lusio n :
tec h nologies of q ua n t ific at io n
notes
1 On this and many of the arguments presented in the article, see Volker
Hess, Der wohltemperierte Mensch: Wissenschaft und Alltag des Fiebermessens
(1850–1900) (Frankfurt am Main: Campus, 2000).
2 Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: Cam-
bridge University Press, 1977), chap. 5.
3 Georges Canguilhem, Essai sur quelques problèmes concernant le normal et le
pathologique, 2nd ed. (Paris: Société d’Editions les Belles Lettres, 1950).
4 Michel Foucault, Surveiller et punir: La naissance de la prison (Paris: Galli-
mard, 1975), and especially his later work, Histoire de la sexualité, vol. 1:
La volonté de savoir (Paris: Editions Gallimard, 1976), on which the recent
discourses about “normalization” build. See, for example, Jürgen Link,
Versuch über den Normalismus: Wie Normalität produziert wird, 2nd ed.
(Opladen: Westdeutscher Verlag, 1997).
5 W.E. Knowles Middleton, A History of the Thermometer and Its Uses in Meteo-
rology (Baltimore, Md.: Johns Hopkins Press, 1966). In the 1660s the
first closed thermometers were produced, and after 1700 there were
many trials to determine fix points and scales of graduation. See also
Audrey B. Davis, Medicine and Its Technology: An Introduction to the History
CH06.QXD 3/9/2005 5:03 PM Page 123
18 The best example is the debate on the establishment of the Berlin Uni-
versity, in which physicians such as Hufeland argued for a small teaching
clinic separated from the Charité hospital. Along the lines of the the-
atrum nosologicum, they argued that the prospective physician learned not
from the quantity of observation but from the quality of exemplary study.
19 Claudia Huerkamp, “Das unterschiedliche Verhalten von Arzt und
Patient in der Krankenhauspraxis und der privaten ärztlichen Praxis im
19. Jahrhundert,” in Peter Schneck and Hans-Uwe Lammel, eds., Die
Medizin an der Berliner Universität und an der Charité zwischen 1810 und
1850 (Husum: Matthiesen, 1995), 254–68.
20 See Jens Lachmund and Gunnar Stollberg, “The Doctor, His Audience,
and the Meaning of Illness: The Drama of Medical Practice in the Late
18th and Early 19th Century,” in Jens Lachmund and Gunnar Stollberg,
eds., The Social Construction of Illness: Illness and Medical Knowledge in Past
and Present (Stuttgart: Steiner, 1992), 38–51.
21 Paul Uhle and Ernst Wagner, Handbuch der allgemeinen Pathologie, 5th ed.
(Leipzig: Wigand, 1872), 23ff.
22 Adolf Strümpell, Aus dem Leben eines deutschen Klinikers: Erinnerungen und
Beobachtungen (Basel: Vogel, 1925), 66–7.
23 Felix Niemeyer, Ueber das Verhalten der Eigenwärme beim gesunden und
kranken Menschen: Ein populärer Vortrag (Berlin: Hirschwald, 1869), 43
(emphasis added).
24 Wunderlich, “Remittierende Fieber mit Phlyetenideneruption,” 62ff.
25 For details, see Hess, Der wohltemperierte Mensch, 215–18.
26 Gustav Biedermann Guenther, “Ueber das Jacobshospital in Leipzig,”
Leipziger Tagblatt und Anzeiger 89 (1846), 829–31.
27 Barbara Elkeles, “Arbeiterautobiographien als Quelle der Krankenhaus-
geschichte,” Medizinhistorisches Journal 23 (1988), 353, and “Der Patient
und das Krankenhaus,” in Alfons Labisch and Reinhard Spree, eds.,
“Einem jedem Kranken in einem Hospitale sein eigenes Bett”: Zur Sozialgeschichte
des Allgemeinen Krankenhauses in Deutschland im 19. Jahrhundert (Frankfurt
a.m.: Campus, 1996), 361ff. See also Jens Lachmund and Gunnar Stoll-
berg, Patientenwelten: Krankheit und Medizin vom späten 18. bis zum frühen
20. Jahrhundert im Spiegel von Autobiographien (Opladen: Leske & Bud-
erich, 1995), especially 151–78.
28 V. Hess, “Die moralische Ökonomie der Normalisierung: Das Beispiel
Fiebermessen,” in Werner Sohn and Herbert Mehrtens, eds., Normalität
und Abweichung: Studien zur Theorie und Geschichte der Normalisierungsge-
sellschaft (Opladen: Westdeutscher Verlag, 1999), 222–43.
29 See Per Maseide, “Possibly Abusive, Often Benign, and Always Necessary:
On Power and Domination in Medical Practice,” Sociology of Health and
Illness 13 (1991), 545–61.
CH06.QXD 3/9/2005 5:03 PM Page 125
30 See V. Hess, “Messen und Zählen: Die Herstellung des normalen Men-
schen als Maß der Gesundheit,” Berlin Wissenschaft Geschichte 22 (1999),
266–80.
31 See Michael Stolberg, “‘Mein äskulapisches Orakel!’ Patientenbriefe als
Quelle einer Kulturgeschichte der Krankheitserfahrung im 18. Jahrhun-
dert,” Österreichische Zeitschrift für Geschichtswissenschaft 7 (1996), 385–404.
32 The political impact of science in general and of quantification and objec-
tification in particular was evident in the liberal-democratic movement of
1848 and in subsequent decades, See the detailed study by Constantin
Goschler, Rudolf Virchow. Mediziner – Anthropologe – Politiker (Cologne:
Böhlau, 2002), especially part 3: “Szientismus und liberale Utopie.”
33 C.R.A. Wunderlich, “Vorlegung einiger Elementarthatsachen aus der
praktischen Krankenthermometrie und Anleitung zur Anwendung der
Wärmemessung in der Privatpraxis,” Archiv für Heilkunde 1 (1860),
416.
34 Lily Braun, Memoiren einer Sozialistin, cited in Gunnar Stollberg, “Haben
messende Verfahren die Lebenswelt der Patienten kolonisiert? Über-
legungen auf der Basis von Autobiographien,” in Volker Hess, ed.,
Normierung von Gesundheit: Messende Verfahren der Medizin als kulturelle Prak-
tik der Medizin um 1900 (Husum: Matthiesen, 1997), 133.
35 Wunderlich, “Vorlegung einiger Elementarthatsachen aus der praktis-
chen Krankenthermometrie.”
36 See David Cahan, ed., An Institute for an Empire: The Physikalisch-Technische
Reichsanstalt 1871–1918 (Cambridge: Cambridge University Press, 1989).
37 See Geheimes Staatsarchiv Preußischer Kulturbesitz, Rep. 76 VIII B, Nr. 1731
(Berichte über Krankenanstalten und Prüfung der Thermometer).
38 Ibid., Report of the Medical Councilor, Aachen, 27 Nov. 1907.
39 Ibid., Report of the Medical Councilor, Stralsund, 18 Dec. 1907.
40 Ibid., district government Cologne, 30 Dec. 1907.
41 Johann Hermann Baas, Medizinische Diagnostik, 2nd ed. (Stuttgart: Enke,
1883), 66.
42 Fr. Dornblüth, “Aerzte und Publicum,” Gartenlaube (1884), 478–80,
527–8.
43 Carl Posner, “Fieber und Fiebermittel,” Gartenlaube (1909), 13.
44 Ute Frevert, Krankheit als politisches Problem 1770–1880: Soziale Unter-
schichten in Preußen zwischen medizinischer Polizei und staatlicher Sozialver-
sicherung, vol. 62: Kritische Studien zur Geschichtswissenschaft (Göttingen:
Vandenhoeck & Ruprecht, 1984), 215.
45 Ibid., 214.
46 Justus Thiersch, Der Kassenarzt: Eine Darstellung der Gesetze für Versicherung
der Arbeiter und ihre Bedeutung für den practischen Arzt (Leipzig: Barth,
1895), 62.
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