The paper aims to analyse the role of accounting as a tool of government action, considering the function of the relationships established by the Santissima Annunziata Hospital in Chieti. Governmentality, intended by Michel Foucault as “governmental rationality”, attributes power and control to those who exercise it even though power is not to be understood as a steady property, but rather as a product of strategic conflicts between subjects. “Power”, however, had to enable the rulers to prepare actions oriented to social welfare and happiness (Rose and Miller, 1992: 174). The accounting of the Hospital of Chieti, which establishes power relations aimed at influencing internal governance, moves towards perspective. The Hospital, managed by different power groups, represented an example of alternation of powers. This charitable institution was run by religious brotherhoods, submitted to the ecclesiastical power and then to public leaders, who were, in their turn, subject to the power of the state. The paper analyses the accounting system used by these two kinds of power that administered the hospital as well as the ways to achieve social control over the people who were considered internal and supportive to each reference category. The study also uses primary sources, documents from the Chieti State Archives for the foundation and organization of the Santissima Annunziata Hospital in Chieti, and accounting books to verify the assistance activity, considering the application of two different accounting systems, from cameral system to the double-entry method.