Chemical Analysis of Urine for Life Insurance: The Construction of Reliability

Medical expertise plays a major role in large-scale welfare arrangements, for example, in private insurance companies. It symbolizes the objectivity and reliability of the procedures of risk selection and legitimates the acceptance and rejection of clients. To understand "reliability " in this context, this article discusses the introduction of chemical urine analysis for life insurance examination between 1880 and 1920. The article argues that reliability of urine analysis is not an intrinsic characteristic of the technology and thus cannot serve as the explanation for the relevance of this technology as a means of risk selection. The construction of a "reliable technology " went hand in hand with the development of a standardized, uniform, and predictable performance of the test and an emergence of specific network—namely, a large-scale, bureaucratic insurance practice in which examination rooms of physicians became connected to the head offices of insurance companies by administrative means. During this process, the balance of power between medical examiners and insurance companies was reversed. Insurance compa-nies depended on medicine for risk selection, but physicians increasingly had to act according to the rules set by life insurance companies. In 1864 the board of the Dutch Society for Life Insurance purchased a spirometer. If a doctor conducting a medical examination was not sure about an insurance candidate’s health, the latter would be requested to visit the head office for a respiration test to determine her or his lung capacity (Gedenkboek 1907, 117). Forty-one years later, in 1905, an X-ray machine was demon-strated during a meeting of the Dutch Insurance Association (Verzekering 1904/1905). As these examples illustrate, in the second half of the nineteenth century, Dutch life insurance companies followed developments in medical technology with great interest. AUTHOR’S NOTE: I would like to thank Marc Berg and Monica Casper for their comments on an early version of this article