A-FRONT.

QXD 3/9/2005 5:00 PM Page iii

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

Published for / publié pour

Fondation merieux

by / par

McGill-Queen’s University Press

Montreal & Kingston • London • Ithaca
A-FRONT.QXD 3/9/2005 5:00 PM Page iv

© McGill-Queen’s University Press 2005

isbn 0-7735-2829-6 (cloth)
isbn 0-7735-2925-x (paper)

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Bibliothèque nationale du Québec

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McGill-Queen’s University Press acknowledges the support of the Canada Council

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of the Government of Canada through the Book Publishing Industry Development
Program (bpidp) for its publishing activities.

Library and Archives Canada Cataloguing in Publication

Body counts : medical quantification in historical and sociological perspective = la
quantification médicale, perspectives historiques et sociologiques / edited by Gérard
Jorland, Annick Opinel and George Weisz.
Text in English and French.
Proceedings of the symposium La quantification dans les sciences médicales et de
la santé: perspective historique, held at Musée Claude-Bernard, in Saint-Julien-en-
Beaujolais, France, Oct. 24–26, 2002.
Includes index.
isbn 0-7735-2829-6 (bound).—isbn 0-7735-2925-x (pbk.)
1. Medical statistics—History—Congresses. 2. Epidemiology—Statistical meth-
ods—History—Congresses. 3. Medical instruments and apparatus—History—Con-
gresses. I. Jorland, Gérard II. Opinel, Annick III. Weisz, George IV. Fonda-
tion Marcel-Mérieux V. Title: Quantification médicale, perspectives historiques et
sociologiques.
ra407.b62 2005 610’.9 c2004-906136-4E

Catalogage avant publication de Bibliothèque et Archives Canada

Body counts : medical quantification in historical and sociological perspective = la
quantification médicale, perspectives historiques et sociologiques / edited by Gérard
Jorland, Annick Opinel and George Weisz.
Textes en anglais et en français.
Compte-rendu du symposium La quantification dans les sciences médicales et de la
santé: perspective historique, présentée au Musée Claude-Bernard, in Saint-Julien-
en-Beaujolais, France, Oct. 24–26, 2002.
Comprend un index.
isbn 0-7735-2829-6 (relié).—isbn 0-7735-2925-x (br.)
1. Statistique médicale—Histoire—Congrès. 2. Épidémiologie—Méthodes
statistiques—Histoire—Congrès. 3. Médicine—Appareils et instruments—Histoire—
Congrès. I. Jorland, Gérard II. Opinel, Annick III. Weisz, George IV. Fonda-
tion Marcel-Mérieux V. Titre: Quantification médicale, perspectives historiques et
sociologiques.
ra407.b62 2005 610’.9 c2004-906136-4f

Typeset in 10/12 Baskerville by True to Type

CH06.QXD 3/9/2005 5:03 PM Page 109

Standardizing Body Temperature:

Quantification in Hospitals and Daily Life,
1850–1900

VOLKER H E SS

One of the first quantifying techniques in medicine, the thermome-

ter, entered hospitals only in the mid-nineteenth century and found
its way from there into everyday life at the end of the century.1 Fever
measurement was thus the first instrumental technique to incorpo-
rate the principles of modern medicine in three respects. First, the
measurement translated traditional modes of judgment based on
assessing the tactual heat or the patient’s feelings into an abstract
number. Second, by defining the normal ranges of a physiological
function, the data distinguished between the healthy and the sick in
a way that became characteristic of the quantifying approach of mod-
ern medicine.2 Third, by discretely demarcating borderlines, fever
measurement established a new way of dealing with illness inside and
outside of the hospital.3 In a sense, body temperature became stan-
dardized in triplicate – as a procedure for measurement, as biological
nature, and as a social value.
It is not my intention, however, to recount this story in the episte-
mological framework of Canguilhem or as part of a normalizing dis-
course à la Foucault.4 Instead, I concentrate on the practices through
which quantitative methods were established and deployed in the hos-
pital and in daily life. I wish to demonstrate that the instrumental
quantification of morbid states took on very different meanings that
we cannot understand simply in terms of Foucault’s concept of nor-
malization. Normalization is often too easily attributed to the intrinsic
effects of measurement and the quantitative appropriation of the indi-
vidual. By contrast, I intend to show for the German case that, in order
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110 Volker Hess

to account for the complexity of historical processes, one must distin-

guish between different stages in the standardization of instruments
and measurement practices on the one hand and Foucault’s normal-
ization on the other.
Hence, I first consider the standardization of measurement prac-
tices. Then I analyse the objectivity of the body subjected to those prac-
tices and their meanings for the patients. Finally, I look at technical
standardization in terms of the introduction of fever measurement in
day-to-day practice, emphasizing the social recognition and stabiliza-
tion implied in instrumental quantification.

s tandardizing t h e p r ac t ic e
of mea sur e me n t

Replacing qualitative thinking was the first step in standardization.

Although there were – even by modern standards – reliable ther-
mometers dating back to the late seventeenth century,5 physicians and
scientists remained sceptical well into the mid-nineteenth century as
to whether the thermometer recorded the natural heat of life or the
unnatural warmth of fever.6 At the turn of the seventeenth century, the
orderly measurements that Anton de Haen (1704–1776) had taken in
the Vienna Citizen Hospital seemed to contradict Hippocratic doc-
trine. As one contemporary remarked, “de Haen was certainly able to
observe sensitive heat – without inborn heat necessarily being likewise
constituted.”7 Today, we can barely imagine the qualitative diversity
once involved in distinguishing a caustic, dry, or burning heat – to say
nothing of a so called cold fever. This wealth of heat qualities disap-
peared through the introduction of instrumental measurement, which
translated the subjective experience of illness into the visible exten-
sion of a mercury column and thereby reduced the sensory qualities to
the discrete quantities that one could read from a scale.
Medical historiography has often portrayed objectifying quantifica-
tion as an inevitable consequence of scientific measurement.8 Indeed,
mid-nineteenth-century thermometry first gained a foothold in the
hospital as part of the scientific turn of medicine, when clinicians tried
hard to mimic the laboratory methods and disciplinary identity of con-
temporary physiology. The transformation of hospitals from social asy-
lums into institutions of medical care provided ample space for such
efforts. In large city hospitals, such as those in Berlin or Leipzig, clini-
cians managed within a few years to determine the ‘normal range’ of
human body temperature. One of them was Carl August Wunderlich
(1815–1877), the professor of the internal ward in Leipzig. In 1868,
having taken the temperatures of thousands of patients and accumu-
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Standardizing Body Temperature 111

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.

In effect, patients participated in producing an objective repre-

sentation of their biological ‘nature.’ The choreography of this new
body technique13 depended on patients who practised and learned
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112 Volker Hess

such sequences of controlled movement. The disciplined posture

thereby made possible the controlled and reducible measurements.
In turn, these measurements shaped the ‘normal’ ranges. One may
ask why hospital patients were willing to offer up their bodies to
these ends. Why did they willingly adapt themselves in such a man-
ner so as to guarantee the necessary fit between themselves and the
instrument? Why did they subject themselves to this procedure of
measurement? Why did they offer their body to the curiosity of the
physician? And what benefit did they derive from the objectification
of their bodies? In order to answer these questions, we must first look
at the historical background of the hospitals in which this body tech-
nique of temperature measurement arose.

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.
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Standardizing Body Temperature 113

While the structure of the traditional consultation aimed at helping

patients to cope meaningfully with their disease experience, the pri-
mary interest of hospitalized patients could well be the rapid restora-
tion of fitness to work. In the eighteenth century, examination of
patients was the essential element in the interaction that excavated
subtle perceptions and hidden feelings.20 In the nineteenth-century
hospital, however, the patient’s voice became useless to the physician.
As a widespread handbook of clinical medicine remarked, the
patient’s “descriptions usually concern only various feelings, com-
bined with speculations about the origin of the illness. If the patients
are able to relate the temporal course of their complaints, one can
learn something about the actual condition of their bodies from these
rather confused reports. One must learn to understand the vernacu-
lar and to translate these vague reports into the language of medical
reality.”21
The academic arrogance and social alienation associated with this
viewpoint are unmistakable. The educated doctor and the unedu-
cated, proletarian hospital patient hailed from different social worlds
no personally negotiated discourse about complaints and sickness
could bridge. For the doctor at the bedside and for clinical scientists
in general, hospital patients remained largely mute. Their speech
seemed vague, confused, and full of sensations – in a word, subjective.
But this judgment involved more than simply social exclusion. It
points to the central function of objectifying measurement in the doc-
tor–patient relationship. The rules of traditional bedside medicine
never governed hospital patients, because they were never able to par-
ticipate in the learned and enlightened discourse that characterized
examination in private practice. While measurement could not alter a
patient’s social standing, it did replace muted speech with a technol-
ogy that granted the body an ‘objective voice.’ This objective body,
brought into the hospital by the voiceless, lower-class patient, now
comprised the language of medical reality. The objective measure-
ments configured the body as the object of reference in the interac-
tion between doctor and patient.
One can suppose that patients were well aware of the problems of
communication. Because verbalization was insufficient to communi-
cate illness and its severity, measurement also offered patients a form
of communication based on the objective language of their bodies. If
Wunderlich, as I have suggested, spent more time on his rounds visit-
ing the fever curves rather than the patients themselves,22 then the bon
mot seems not as farfetched as its author may have intended; the well-
drawn curve was perhaps more communicative than any story told by
a case history.
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114 Volker Hess

The objective body, which spoke in an obvious, exact, and undeni-

able manner, superceded the eloquent patient. And the sense and
meaning of illness emerged not in enlightened conversation, but
through negotiation in a practice, which actively involved patients in
fitting themselves to the instrument. For the patient, the objective
body comprised not only the means and basis of the interaction, but
also the reference point from which to derive the illness’s meaning.
The sole verbal statements about this communicative function came
from physicians. For example, the clinician Felix Niemeyer confessed
publicly in 1869 that he would “often hide the body temperature from
hospital patients for reasons of humanity, because the patients had
learned first hand that high temperatures decreased their prospects of
recovery.”23 In this way, the bodies’ objectivity, articulated in measur-
able numbers, opened up new forms of perception and experience
that patients too shared.
However, the patients imposed their body’s objectivity not only in
the course of ward rounds. The body became the object of all medical
interest. Hospital staff pondered, cleansed, nursed, and fed it – and in
the 1860s, its recovery was a question no longer of subjective well-
being, but of quantifying practices such as daily weight control. In the
records of the Leipzig hospital, one can find the case of a young crafts-
man, whose “status was, much improved … after a treatment of six
weeks, the appetite and all functions [were] good, liveliness fully
returned and weight had increased at first slowly, then more quickly.”24
As the reports on weight control over the next ten weeks prior to dis-
charge indicate, the objectified body remained the reference point for
doctor–patient interaction.
As the complaints of the Leipzig city fathers demonstrate, the new
form of care was not simply the side effect of a new clinical treatment.
Concerned about rising costs, they noticed that disbursement for
patients’ food was increasing in comparison with other costs – despite
the falling price of bread. Analysing the details showed the reason for
the cost increase: physicians had ordered more and more special
rations instead of the regular meatless food.25 The hospital rightly
boasted about its food and catering, and it “did everything the physi-
cians deemed necessary without protest or delay.”26 And some patients
even mentioned in their autobiographies that they had spent the “best
time” of their lives in hospital.27
It would be wrong to explain patients’ conduct simply as a response
to the ‘reward system’ of institutionalized care. This would ignore the
expectations and claims brought about by the transformed hospital.
Patients usually received back the costs of the hospital stay, but sick pay
rarely compensated for lost wages. Each hospitalization meant a loss of
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Standardizing Body Temperature 115

income and required individuals to weigh the conflicting interests of

medical treatment and financial security. Thus the patient might feel
even better ‘understood’ by an interaction based on the moral econ-
omy of the objective body.
Clinical measurement did not simply translate physical distress and
need into medical language. It reduced them as well to ‘purely medical’
phenomena. Hospitals could hardly be expected to be able to treat the
‘proletarian disease’ and misery but they could deal with the abnormal
heat or excessively low weight of an objective body. Quantifications
might also operationalize needs and demands from the patients’ per-
spective in a way that fulfilled their expectations of good care and
treatment because they resulted in an immediate action. The scales
measured physical need as “underweight” and translated it into a ther-
apeutic diet. And the thermometer inscribed physical illness into read-
able fever curves and rewrote it in the form of therapeutic concepts.
The clinical quantifications not only endowed patients with bodies of
therapeutic relevance, but also freed them from all family needs,
doubts, and justifications by recognizing only ‘objective facts.’28

In the second half of the nineteenth century, the objective body

acquired a value of its own in three respects. First, medical practices
such as measuring temperature or weight became entirely adequate
body techniques from the patient’s point of view because they com-
bined into a meaningful relationship their own worries about the
sick body and physicians’ specialized knowledge and interests. Not
only did quantification meet the expectations placed in medical
expertise and competence, but it also assured that the situative and
adequate application of that expertise would depend on patients’
body techniques.29 Hence, body training in the regular procedure
of measurement ensured the controlled and regulated application
of the medical power that new forms of knowledge production had
generated.
Second, clinical quantification configured the objective body as a
social point of reference. One may today mourn the fact that the
patient’s subjective speech does not receive due consideration; but in
the historical context of the nineteenth century, minimizing doc-
tor–patient communication might have offered a chance to compen-
sate somewhat for pre-existing social inequalities in the treatment sit-
uation. Furthermore, the enlightenment discourse about “excavating”
subtle perceptions and hidden feelings turned out to be extremely
fuzzy and subjective and was ultimately disavowed and condemned as
unscientific. The practice of quantification made the bodies of lower-
class patients both scientifically objective and socially normal.30
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116 Volker Hess

Third, debates have arisen in the context of cultural history. Schol-

ars have emphasized that the often-obsessive self-observation so char-
acteristic of the enlightened discourse of bedside medicine served to
facilitate an understanding and an internalization of the values of sci-
entific objectivity and social normality. These values distinguished bod-
ies of the bourgeois from those of the nobility and the lower classes.
The fragile nature of bourgeois bodies – corresponding to their deli-
cate social status – required diligent observation, careful control of
internal motions, and constant concern about harmful influences.31 If
examination of patients had once centred on body care, on which the
aspiring middle class had based its hegemony, then what was the
meaning of measured and objectified hospital bodies? Quantification
also established a conscious and controlled interaction with the body.
The precision of the measurement was based on the precision of the
body. Only control could subject its physical nature to scientific objec-
tification and deem it ‘normal.’ Ultimately, over the course of the
nineteenth century, this body’s scientific qualities and meanings
became generally normative. Its objectivity also legitimated claims to
political and social equality at a time when the hierarchically divided
class society was changing into a complex and functionally arranged
industrial society. In this context, quantifying measurement estab-
lished a point of social reference beyond the economic and social class
divide.32

t ech nic al s tanda r d iz at io n

Real standardization of body temperature began when fever measur-

ing gained general acceptance. At the end of the nineteenth century,
‘normal ranges’ of temperature embedded themselves in the daily
life experience of illness as measuring instruments entered into the
private household. If we can believe contemporary physicians, faith
that temperature measurement could distinguish between morbidity
and health greatly facilitated this process. Furthermore, in private
practice the sick person had quickly learned to derive “reassurance
from the temperature measurement.” As Wunderlich proudly pro-
nounced, it had become “customary that patients, asked how they
felt, answered by stating their temperature.”33 Laypersons also soon
measured themselves.
And to the extent that patients began to verify their actual well-
being with instruments, the physiologically defined normal tempera-
ture acquired a normative meaning, which it had not previously had
in the laboratory or hospital. One remarkable episode appears in Jens
Lachmund and Gunnar Stollberg’s recent study of patients’ autobi-
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Standardizing Body Temperature 117

ographies. Lilly Braun (1865–1916), socialist and feminist, noted in

her diary about 1900: “I was so weak and scorching! I crept to the bed-
room with my last ounce of strength and place a fever thermometer
under the arm: 39½ [degrees Celsius] – I called for Berta and sent for
the doctor.”34 But aligning the subjective experience of illness with
measurable normality does not fully explain why a normative defini-
tion of health entered daily life. What led ill persons to view this align-
ment as self-evident? And why did they trust the measured quantities?
An initial clue surfaces in gauging and calibrating of thermometers –
practices that opened the way for the instrument to move into daily
life.
From the late eighteenth century on, the calibration of thermome-
ters had posed no serious problems. In contrast to measuring lengths
and volumes, temperature scales related to the physical properties of
water – and these were easy to reproduce everywhere as long as one
accounted for air pressure. Consequently, nineteenth-century clini-
cians could and had to gauge their own instruments. All the instru-
ments were employed, even if “the manufacturer’s calibration was
incorrect.” Only the “uniform calibration” of the scale, which could be
“carefully compared with a normal-thermometer,” was important.35
Usually each hospital had one or two so-called normal thermometers
with which people matched the clinical instruments. Such local stan-
dardization turned out to be sufficient for limited application within
hospitals. Outside, however, accuracy at a personal level required spec-
ifying the manufacturer of the instruments and the clinician conduct-
ing the readings. This seemed to be sufficient for the dissemination of
fever measurement as clinical practice.
Until the early twentieth century, states did not base efforts to cali-
brate thermometers on public health or hygiene policy; instead, they
responded to issues relating to industrial production and trade. The
official certificates granted by the Imperial Physical-Technical Insti-
tute (Physikalisch-Technische Reichsanstalt) attested to the quality of
manufacturers’ products as tested by an independent, scientific
agency and thereby promoted sales.36 The technical standardization
of the fever thermometer was part of the processes of industrial com-
petition, whereby strict standards could help ensure transparent con-
struction, function, and material quality. Official certification – on
paper or etched on the glass tube – vouched for the instrument’s
integrity.
Implementing technical standardization in the medical world of
hospitals also had important social components. This we can see in the
reports that the Prussian ministry of culture requested from the med-
ical administration districts in 1907.37 At first, the ministry wanted to
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118 Volker Hess

know the benefits that use of officially certified thermometers had

brought to public hospitals. Second, it was keen to find out what hospi-
tal directors and local medical officials thought about state-controlled
standardization. Throughout the empire – from Swabian Sigmaringen
to Upper Silesia – local officials did not necessarily support government
policy in this domain. Comparing the reliability and the precision of
standardized and unstandardized instruments, they saw no benefit from
official calibration. Nor did they perceive any technological advantages
to state-certified calibration as opposed to self-calibration: “[T]he com-
petition of the manufacturers among themselves resulted in more dili-
gent production of instruments,” as experience had shown. The results
of officially certified instruments were “not at all favourable.”38 Some
reports “recommended no general enforcement.”39
Agreement with or objection to the draft edict related not to tech-
nical concerns about precision or reliability. The decisive arguments
flowed from other considerations. Even opponents did not dispute
“the progress … that state certification will bring.”40 However, expert
opinions were usually rather hazy about what constituted progress.
They stressed again and again the “reliability” of official instruments
and their “desirable uniformity,” although these benefits had not
emerged in practice. So it was not any qualitative gain, but the so-
called guarantee of reliability, that was crucial. Thus, officially certified
measurement seemed to imply not instrumental accuracy, but rather
authoritative safety. It was not so much the metric correctness of the
measuring but rather some sort of general reliability that state sanc-
tion ensured and guaranteed.
The reports showed the significance of the state guarantee in three
respects. First, they articulated independent expertise in the form of
demands that state-employed physicians use state-certified standards.
The certification took on the function of a state guarantee for the
objectivity of medical opinion in the same way as trade associations
and insurance companies required certified thermometers for the
reports of medical examiners. Here objectivity meant official justifica-
tion and assessment free from any personal inclinations. Second, for
use of thermometers by unqualified staff and lay personnel, only state-
certified, technical quality control could guarantee competence and
reliability – at least in the eyes of the medical officials. While state reg-
ulation appeared superfluous or counter-productive in hospitals, it
was necessary for everyone involved with thermometers outside the
medical profession. Official certification seemed to guarantee the
safety and validity of the measurement that – from the physicians’ per-
spective – only the professional authority of their own guild could
legitimate.
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Standardizing Body Temperature 119

Third, official certification granted social status to the measure-

ments. It validated the measurement independent of the technical
quality of any single instrument. There was also no longer need for
medical confirmation if a certified instrument indicated a tempera-
ture that the enclosed instructions defined as “high fever.” State guar-
antees granted an official status to such terms and meanings. There-
fore state certification served a social function, transporting
professional authority from an originally medical practice to an imper-
sonal and independent standard.
At three levels state-ordered certification replaced locally autho-
rized standards in hospitals with statewide standardization. Within the
profession, it legitimated medical expertise; outside the profession, it
sanctioned the work of general practitioners vis-à-vis academic physi-
cians. And in the public sphere, it guaranteed that everyone could
measure fever without regard for professional expertise.
Despite medical officials’ objections, state certification began in
1910. As a consequence of technical, industrial standardization, the
normalized body temperature, created in hospitals, could now acquire
greater social influence. The most obvious example occurs in the
instructions of the Imperial Physical-Technical Institute enclosed with
the certified thermometer describing the meaning of high readings.
Those instructions allowed lay people to participate in the privileged
objectivity of measurement.
Physicians were not enthusiastic about this development, although
they were partly responsible for the increasing popularity of ther-
mometers. One of them presented horror scenarios in which “a kind
of meteorological station would be set up in the home of a feverish
person or a number of instruments would wander promiscuously into
all the accessible body openings of male and female clientele.”41 Such
apprehensions surfaced most outspokenly in the illustrated mass
press. There readers learned that “amicable doctor–patient relations”
were impossible if patients tried “to control or even to master” the
physician by acquiring medical knowledge.42
One author complained bitterly about the “unauthorized appro-
priation” of medical competence. After the introduction of anti-
fever drugs, some patients, with a certain satisfaction, told their doc-
tor that an hour earlier the thermometer still showed almost 38
degrees Fahrenheit but that now the temperature had dropped to
37. The measurement permitted the patients to form their own
judgment about their illness – something that physicians did not
always like. Some doctors tried in vain in the mass press to inform
the lay public that a “small deviation from the ordinary level was
often the cause of wholly unfounded concern.”43 This was, however,
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120 Volker Hess

no longer an esoteric one available only to physicians. If the mer-

cury column rose above the red mark, then the illness was officially
certified. At this level of social interaction, measurement registered
a standardized meaning.

Technical standardization supported an inner standardization, of the

definition and understanding of disease, most notably in the health
insurance industry. The organizational structures developed in this
sphere facilitated emergence of uniform standards of behaviour that
were just as important for the labour movement as for the state or
industrialists. Health insurance schemes (Kassen), to which factory
workers or former guild members contributed for their own benefit,
made it incumbent on all contributors to behave in a financially
responsible manner if they wished to enjoy the practical solidarity of
their colleagues. In spite of rigid rules set down in the statutes of
Kassen, there was no need for sanctions or pressure in smaller ones,
where everybody knew everyone else. Mutual control could form the
backbone of insurance schemes because everybody had an interest in
low payments and adequate reserves.44
Physicians received a major place in this care structure. Only they
could determine whether to grant or deny benefits.45 Their profes-
sional judgment could unlock sick pay. Yet their judgments were any-
thing but independent. Working for insurance plans put them in a
“most unfortunate” position.46 They always had to deal with the suspi-
cion of simulation of illness, which most company regulations threat-
ened to punish in draconian fashion and which was implicit in the pro-
cedures verifying sickness.47 None the less, at the turn of century the
handbooks for health-plan doctors constantly reminded them not to
treat the patient unjustly “as a simulator or hypochondriac.”48 They
even insisted “that any member seeking medical help first and fore-
most be viewed as an ill person.” In questionable cases, physicians
should, like judges, always rule “in favor of the patient.”49
Doctors often did not do this. Health-plan patients frequently com-
plained about unjust treatment.50 Some physicians in turn felt that
patients were being presumptuous whenever they did not behave as
indigents receiving medical care as an act of charity. Thus conflicts
arose time and again, ignited by self-confident patients who, because
they paid insurance premiums, made claims to services that, in the
eyes of physicians, should be only for private patients. Newspapers
accused health-insurance plans of awakening expectations by raising
the mere “possibility of treatment.” Whole “classes of the population”
had acquired a “consciousness and a feeling for all manner of suffer-
ing that they had previously never taken notice of.” 51
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Standardizing Body Temperature 121

Within this matrix, technical standardization and official certifica-

tion exercised a social impact. They served as an independent author-
ity that could resolve conflicts impartially and objectively, irrespective
of the individuals involved.52 State-certified objectivity could serve as a
corrective force for social control. If, according to the labour health
library, workers had a “certified standardized thermometer” at home,
then an abnormal temperature relieved the sick from the moral pres-
sure that the solidarity of the health-insurance community imposed. It
also granted the worker the right to go on sick leave. An abnormal
temperature justified physicians’ actions in the face of penny-pinching
insurance company boards. It likewise shielded them from workers’
expectations – regardless of whether they simulated their complaints
or, more probably, dissimulated them. Standardized measurement bal-
anced mutually conflicting interests, obligations, and values in this
way.53
Moral education and the internalization of Protestant virtues did
not minimize the conflict for the persons concerned. On the contrary,
things became rather more complicated for everyone caught up these
conflicting motivations – care for the needy body, the threat of the
family sinking into poverty, and behaviour that conformed with the
social world of the labour community.

c onc lusio n :
tec h nologies of q ua n t ific at io n

The quantification of body temperature was not a necessary result of

technological advance that simply progressed as an instrumental
objectifying practice from the laboratory to daily life via the hospital.
It was also not an inevitable result of the inherent forces of medical sci-
ence driven towards progress by curiosity and the urge to know. The
technology of quantification was no black box that could move from
one space of knowledge to another. Each shift related to a specific
labour of assimilation: to the hospital, where patients adapted to new
body techniques, and to daily life, where state decree standardized
instruments.
Consequently, despite long-existing technical and scientific precon-
ditions, fever measurement established itself only after the 1850s. It
did so in two steps: in the transformation of the hospital before 1900
and in the daily life of most people soon afterwards. Quantifying body
temperature grew out of a specific social space and was linked to spe-
cific social practice.
To say this is hardly new. Fever measurement, however, shows that
the usual model of normalization which sees quantification as an
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122 Volker Hess

essential element of modern biopolitics cannot fully explain the tech-

nology of quantification. Without a doubt, quantifying and objectify-
ing forged the biological, social, and cultural bodies we have today.
However, other social practices also imparted these technologies.
Embedded in a set of actions, they produced and related meanings
that historians overlook if they understand quantification as only a dis-
ciplinary and regulative technique. Thus the body technologies that
gave data their scientific value did not simply secure the coherent use
of medical power. Quantification provided the patient with a body,
whose objectivity lay outside the social restrictions and the social exclu-
sion of traditional forms of interaction. Even state certification was not
necessarily in the interests of medical experts. Rather, it contributed to
their regulation. It ensured that, within the social asymmetry of the sys-
tem of sickness insurance, patients could exert some social control
over medical authority.
No doubt the quantification of body temperature is only one exam-
ple of a new social technology. But the standardizations that prepared
the way for quantification in the hospital and in daily life did not sim-
ply serve to document, measure, control, and regulate the individual.
They also somehow allowed the individual to regulate and control this
social technology.

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
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Standardizing Body Temperature 123

of Medical Instrumentation (Westport, Conn.: Greenwood Press, 1981),

61–85.
6 It was “remarkable,” as Gershon-Cohen mentioned, “how the thermome-
ter comes in and out of prominence in physics and medicine without
achieving a permanent niche in medical practice in spite of being fos-
tered by some of the learned men in science and medicine.” See J. Ger-
shon-Cohen, “A Short History of Medical Thermometry,” Annals of the
New York Academy of Sciences 121 (1964), 4.
7 Kurt Sprengel, Die Apologie des Hippokrates und seiner Grundsätze (Leipzig:
Schwickert, 1789), 165.
8 See, for example, Reiser, Medicine and the Reign of Technology.
9 Carl Reinhold August Wunderlich, “Remittierende Fieber mit
Phlyetenideneruption,“ Archiv für Heilkunde 5 (1864), 57–77, and “Vor-
legung einiger Elementarthatsachen aus der praktischen Krankenther-
mometrie und Anleitung zur Anwendung der Wärmemessung in der Pri-
vatpraxis,” Archiv für Heilkunde 1 (1860), 385–416.
10 William Coleman, “Experimental Physiology and Statistical Inference:
The Therapeutic Trial in Nineteenth-Century Germany,” in Lorenz
Krüger, Gerd Gigerenzer, and Mary S. Morgan, eds., The Probabilistic Revo-
lution (Cambridge: Cambridge University Press, 1987), 201–26.
11 See Karl Ehrle, “Ueber den Quecksilberthermometer mit permanenter
feiner Luftblase, für die Körperwärmebeobachtung am Krankenbette,
für physiologische und pharmakologische Versuch,” Deutsches Archiv für
klinische Medizin 7 (1870), 345–55.
12 Ludwig Traube, “Ueber die Wirkungen der Digitalis, insbesondere über
den Einfluß derselben auf die Körpertemperatur in fieberhaften
Krankheiten,” Annalen des Charité-Krankenhauses zu Berlin 1–2 (1850–51),
622–91; 12–120, 119ff.
13 See Marcel Mauss, “Die Techniken des Körpers (Les techniques du corps,
1934),” in Wolf Lepenies and Henning Ritter, eds., Soziologie und Anthro-
pologie (München: Hanser, 1975), 199–220.
14 For an overview, see Alfons Labisch and Reinhard Spree, eds., “Einem
jeden Kranken in einem Krankenhause sein eigenes Bett,” in Zur
Sozialgeschichte des Allgemeinen Krankenhauses in Deutschland im 19. Jahrhun-
dert (Frankfurt am Main: Campus, 1996).
15 See Johanna Bleker, “To Benefit the Poor and Advance Medical Science:
Hospitals and Hospital Care in Germany, 1820–1870,” in Manfred Berg
and Geoffrey Cocks, eds., Medicine and Modernity: Public Health and Med-
ical Care in Nineteenth and Twentieth Century Germany (Washington, dc:
German Historical Institute, 1997), 17–33.
16 See Ragnhild Münch, Gesundheitswesen im 18. and 19. Jahrhundert: Das
Berliner Beispiel (Berlin: Akademie-Verlag, 1995).
17 See Hess, Der wohltemperierte Mensch.
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124 Volker Hess

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.
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Standardizing Body Temperature 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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126 Volker Hess

47 Ignaz Zadek, Die Arbeiterversicherung (Jena: Fischer, 1895), 33; Marlene

Ellerkamp, Industriearbeit, Krankheit und Geschlecht, Zu den sozialen Kosten
der Industrialisierung: Bremer Textilarbeiterinnen 1870–1914, Kritische Studien
zur Geschichtswissenschaft (Göttingen: Vandenhoeck und Ruprecht, 1991).
48 Jacob Wolff, Der praktische Arzt und sein Beruf, Vademecum für angehende
Praktiker (Stuttgart: Enke, 1896), 97.
49 Karl Jaffé, “Stellung und Aufgabe des Arztes auf dem Gebiete der
Krankenversicherung,” in Moritz Fürst, ed., Handbuch der Sozialen
Medizin, vol. II (Jena: Fischer 1903), 139.
50 Ibid., 139.
51 E. Düring, “Der Hausarzt,” Gartenlaube (1910), 35.
52 Theodore M. Porter, Trust in Numbers: The Pursuit of Objectivity in Science
and Public Life (Princeton, nj: Princeton University Press, 1995).
53 Hess, “Die moralische Ökonomie der Normalisierung.”