BEN GOFF HISTORY
23 APRIL 2021
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“Surgery as the servant of the nation in war,” Frontispiece to Memoires de L’Academie royale de Chirurgie (Paris, 1743)
About Me
I am a doctoral candidate at Florida State University. My research centers on France in the 18th century, with special focus on military history and medical history. Apart from my research, I have teaching experience in the Atlantic World; the Islamic World; and science, medicine, and the environment. I enjoy the abundance of things that the study of history has to offer. Digging in archives, traveling to new places, reaching interested students, creating new knowledge, diving into worlds that were, and illumninating the world that is.
About my dissertation
I study military hospitals and the tension that exists between individual health and state finances. An early instance of this tension appeared in early modern France where an expanding military hospital system increasingly ate into the war ministry’s budget. From about 1630 until the end of the Napoleonic Wars, the nation’s military-medical apparatus employed two administrative structures in the hopes of relieving the tension between health and finances. In the first structure, called la régie, the state controlled most aspects of hospital administration. Here, a state functionary called a régisseur oversaw the accounts of his designated hospital. He had the power to purchase necessary supplies on credit: everything from food, to medicines, to bandages. Observers held that this “public” option (for lack of a better term) cost more, but produced better-equipped hospitals, and thus saved more lives. The second structure, broadly referred to as l’entreprise, saw private individuals and companies bid to administer military hospitals. By employing these entrepreneurs, the state absolved itself of the administrative duties and financial burdens of overseeing military healthcare. Advocates claimed that this “private” arrangement saved the state money. But, opponents insisted that it exposed the health of soldiers to the vagaries of the market, and was less effective than its “public” counterpart. This public/private dichotomy might seem eerily familiar to present-day readers. In the current atmosphere of uncertainty regarding the U.S. federal government’s place in healthcare, an investigation of how prior generations understood and approached an analogous problem could help reframe our current healthcare crisis.
Taking inspiration from works like Jonathan Engel’s Unaffordable, my project focuses on the economics of an early healthcare system and particularly how market forces and the private sector influenced government healthcare policy. To do this I observe changes in hospital administration between 1630, when this system first arose, and 1815, when the Napoleonic Wars ended. I seek to better understand the merits and pitfalls of the aforementioned administrative structures, and to determine if contemporary assessments were accurate. I ask: how did medical practitioners, bureaucrats, and politicians view and work within both structures? In what situations did the state employ each and why? Were soldiers better cared for under a given administrative structure? I believe that the answers to these questions are more complicated than contemporaries would have us believe. For example, under “public” administration, the war ministry sometimes pressured régisseurs to be conservative with their spending.5 This cost-cutting measure prioritized the financial needs of the state over the medical needs of the soldiers. Consequently, some “publicly” administered hospitals wanted for supplies. In these situations, the “public” administration, which was supposed to be more expensive and provide better care, shared striking similarities with “private” companies, which were supposedly less expensive and provided poorer care. Circumstances like this suggest that neither “public” nor “private” solutions to healthcare are prefect and that governing a healthcare system has always been a tricky business.