American Jewish hospitals, once a powerful force in clinical care and academic medicine, are disappearing. In this article, I will trace the theological, cultural, and social origins of their rise and then describe the economic, social, demographic, and financial causes of their decline.
Origins of the Jewish Hospital
Judaism and healing
Religious traditions have long grappled with whether humans have the right to intervene in disease, which some view as divinely visited on the sick. Do physicians have the right to “interfere” with the deliberate designs of Providence?
Some religious traditions deal with the issue of a physician’s “interference” with disease by rejecting medical aid altogether. Others ask, Is there any less moral justification for curing illness than there is for applying human intelligence to build a home or water the soil? Some attempt to resolve the conflict by asserting that God granted humans the right to cure disease based on sanctions found in sacred scriptures.1
In Judaism, there is a strong tradition of support for human efforts to heal the sick, and physicians are held in high esteem. The obligation to heal is found in Leviticus 19:16, in which humans are enjoined not to “stand idly by the blood of your neighbor,” and in Exodus 21:18–19, wherein Jews are instructed that if a person is injured in a quarrel, then the individual causing the injury must cause the injured party “to be thoroughly healed.” The Talmud (Baba Kamma 85a) invokes the latter verse to teach that “from here [it is derived] that the physician is granted permission to cure.”
Judaism also teaches that the value of human life is supreme. The Talmud (Sanhedrin 37a) states that “if any human being saves a single soul of Israel, Scripture regards him as if he had saved an entire world.” The Prophet Ezekiel (34:4) chides Jews to include care for the ill as one of the attributes of God that they must emulate: “You have not strengthened the weak or healed the sick.” In addition, the Talmud includes multiple references to community health and responsibilities such as visiting the sick and repairing the world.2–4
In contrast to religious traditions that object to human intervention in disease, free will is deeply embedded in Judaism. The 12th-century rabbi and physician Maimonides wrote that “free will is bestowed on every human being” and “a man’s actions are in his own hands; no compulsion is exerted. He is constrained by nothing that is external to him.”4 The purpose of keeping the body healthy is to allow the individual to pursue knowledge of God and of God’s perfect morality. Maimonides wrote:
the study of medicine has a very great influence on the acquisition of the virtues and of the knowledge of God, as far as on the attainment of true spiritual happiness. Therefore, its study and acquisition are preeminently important religious activities.4
The development of European Jewish hospitals
During the Middle Ages, medicine was one of the few professions open to Jews in Europe. In addition, Medieval Jewish physician–translators helped preserve the medical teachings of the ancient Greeks and Romans and transmit them to the West.4
The English word hospital comes from the same Latin root as hospitality, hostel, and hotel. Early hospitals were religious establishments maintained by Christian, Muslim, and Jewish organizations as places of refuge for travelers, pilgrims, and the needy.5 As early as the 11th century, European synagogues set aside a hekdesh, or hostel for the poor, which was probably a room for the lodging of travelers that may also have been used as a place to care for sick itinerants. If medicine was not able to cure sick, indigent, traveling Jews, at least they could die with dignity in a hekdesh in the care of their coreligionists. In the 13th and 14th centuries in Spain and Germany, inns for the care of sick strangers were supported by the community, benevolent societies, and charity boxes.6,7
In the 18th and 19th centuries, Jewish communities erected more elaborate, modern houses for the sick (called Kranken haus) in Breslau, London, Berlin, Vienna, Paris, Amsterdam, and Hamburg. By the early 20th century, there were 48 Jewish hospitals in Poland, including 1,000 beds in Warsaw.6–12
The “Stuyvesant Pledge” and the Jewish community in the American colonies
In September 1654, the Sainte Catherine, a small French frigate, sailed into New Amsterdam (now New York City) carrying 23 Jewish refugees from Brazil. Peter Stuyvesant, director–general of New Netherlands, requested permission from his superiors at the Dutch West India Company in Amsterdam to refuse entry to these “deceitful,” “very repugnant,” and “hateful enemies and blasphemers of the name of Christ.”13 To Stuyvesant’s distress, his directors reminded him that some of the company’s shareholders were Dutch Jews and ordered him to admit the refugees provided they would pledge that “the poor among them shall not become a burden to the company or to the community, but be supported by their own nation.”9,10,12,13
The Growth of Jewish Hospitals in the United States
Some historians view the “Stuyvesant Pledge” as the foundation of American Jewish communal institutions. The formation of Jewish hospitals in the United States, beginning in the mid-19th century, was a logical continuation in the Jewish community’s creation of an extensive social network designed to assure the public that American Jews neither were nor ever would be a societal burden.13
There are at least three other major causes for the creation of American Jewish hospitals. First, the American Jewish community felt that by creating their own hospitals, they could spare their coreligionists the indignity of Christians’ attempts to convert them as they lay on their death beds.9,11 Second, Jewish hospitals were refuges that respected the faith of American Jews. They provided kosher food, an on-site synagogue, the comfort of a rabbi on the staff, and the placement of a mezuzah on the door post.14 Because traditional Jewish teaching takes a very circumscribed view of autopsy, Jewish hospitals were also created, in part, to reduce autopsies perceived as unnecessary.15–17
Third, Jewish hospitals were built in response to anti-Semitism in the medical profession. From the beginning of the 20th century through the 1960s, most U.S. medical schools and hospitals had restrictive quota systems designed to deny medical school admission to Jewish applicants, restrict the access of Jewish medical school graduates to internship and residency training in hospitals, and deny hospital staff privileges to Jewish physicians. Some institutions justified their quotas as favoring in-state applicants or promoting religious diversity in the physician workforce. Jewish hospitals provided workplaces for Jewish interns, residents, and physicians who were excluded from employment at other hospitals. Those few Jewish physicians who obtained positions in non-Jewish hospitals were subject to physical harassment as well as written and verbal abuse.16,18
In the United States prior to the mid-19th century, there were few Jewish physicians and no Jewish hospitals. Relatively secular German-Jewish immigrants fostered the first wave of hospital construction from 1854 to 1880, starting with the establishment of the Jewish Hospital Association of Cincinnati in 1854.7 By the time of the Civil War, the Jews’ Hospital in Manhattan had opened its doors to both Jews and non-Jews, and it explicitly offered its services for the care of the Civil War wounded. Soon after the war, the hospital changed its name to the more inclusive Mount Sinai Hospital.9 By 1868, there were also hospitals under Jewish auspices in Baltimore, Chicago, and Philadelphia.11,12,19 The second wave of construction, from 1880 to 1945, was fostered by more religiously observant East European Jewish immigrants.
In the last wave of construction, which was fueled by the Hill-Burton Act between 1945 and 1960, the number of beds in Jewish hospitals increased from 13,800 to 18,283. Philanthropic support to these institutions exceeded $18 million dollars per year, and social prestige within the Jewish community was associated with membership on a hospital board of trustees.11,12,20–22 In 1966, U.S. Jewish hospitals had an aggregate bed capacity of 25,000, admitted more than 560,000 patients, delivered about 75,800 babies, and recorded approximately 3.5 million outpatient visits.6
How Many Jewish Hospitals Were There? How Many Are There Now?
The American Jewish community founded many hospitals with clearly identifiable Jewish names. Eighteen hospital names contained the word Jewish, and five contained the word Hebrew. Fourteen were named Mount Sinai or Sinai, eight were named Beth Abraham, Beth David, Beth El, or Beth Israel, three were named Montefiore, and two were named Menorah.6,9–12,14,16,17,19,23,24
It is difficult to determine the total number of Jewish hospitals founded and operated in the United States because of openings, closings, name or location changes, gaps in the historical record, consolidation of two or more hospitals under a new name, and uncertainty about distinctions between hospitals, tuberculosis sanatoriums, chronic disease care institutions, and nursing homes. (In at least one case, I found that a hospital with a “Jewish-sounding name” was a Protestant institution.) After reviewing the published literature and consulting primary sources extensively, my best estimate is that, throughout U.S. history, there have been 113 Jewish hospitals.6,9–12,14,17,19,23,24 Of these 113 hospitals, 22 (19%) are still operating independently under a name and with other characteristics that at least minimally connote a Jewish heritage, and 24 (21%) have been purchased by or merged with 1 of the 22 still-extant Jewish hospitals. Another 35 (31%) have closed, whereas 24 (21%) have been purchased or merged with a non-Jewish hospital chain, and 9 (8%) are operating as old age/nursing home/rehabilitation facilities. These 113 hospitals were key components of undergraduate medical education and graduate medical education (GME) in Atlanta, Boston, Chicago, Cincinnati, Los Angeles, Miami, New Orleans, New York, Philadelphia, and San Francisco, and some maintain that role today.
But are the 22 hospitals that continue to operate independently still Jewish? Most have little or no input into their governance by the organized Jewish community as well as medical staffs and patient populations that are not predominantly Jewish. Several are in the process of merging with other, non-Jewish hospitals. This raises a broader issue: What does it mean to be an American Jewish hospital?
What Is a Jewish Hospital?
To define what it means to be a Roman Catholic hospital in the United States, you could turn to the Catholic Church’s ethical and religious directives regarding the operations of hospital and health systems and, by analyzing them, understand what a hospital would need to do to meet the standards.21,25 There are, in contrast, no equivalent documents that could help you determine what is and what is not a Jewish hospital.
It is not surprising that there is no consensus among American Jews concerning the definition or mission of a Jewish hospital. The Jewish community in the United States is characterized by a wide diversity of beliefs and ritual practices, a high rate of intermarriage, and low rates of synagogue membership and attendance. The largest American Jewish denomination, Reform, tried to craft an official prayer book in 1975 and ended up with 10 different Sabbath evening prayer services reflecting alternative, and sometimes contradictory, theological perspectives.26 (A subsequent Reform prayer book provided a more unified approach.)
For the purposes of this article, I will define a Jewish hospital as one which possesses most of the following characteristics10:
- a name designed to identify the hospital as being under Jewish auspices,
- governance derived primarily from the Jewish community,
- a predominantly Jewish administrative and medical staff,
- philanthropic support obtained primarily from the Jewish community,
- a history of founding principally by members of the Jewish community who, in the founding documents, indicated that they were building a hospital primarily to serve Jewish patients and physicians, and
- availability of Jewish religious practices (e.g., kosher food, ritual circumcision of newborns, respect for Jewish tradition regarding autopsy, placement of Jewish ritual symbols).
Using this definition, not more than five contemporary American hospitals with Jewish names meet most of the criteria. (In contrast to the decline of Jewish hospitals, an increasing proportion of U.S. hospital beds are in Catholic hospitals.21) For many secular American Jews, however, it may be sufficient to define the remaining Jewish hospitals as Jewish if they are “not Christian” (i.e., if they do not display Christmas trees or other outward signs of Christian observance).
The Fall of Jewish Hospitals
There are three major reasons for the disappearance of American Jewish hospitals: economics, decline in anti-Semitism, and demographic changes that affect philanthropy. I will consider each of these below.
Jewish hospitals are subject to the same marketplace pressures as their non-Jewish counterparts. Changes in Medicare regulations in the 1970s and 1980s, the rise of health maintenance organizations in the 1990s, and advances in medical technology prompted a wave of hospital acquisitions and mergers in the late 20th and early 21st centuries. While large, for-profit entities entered the industry, many small hospitals were impelled to close or consolidate. These changes particularly affected independent, community-based hospitals, including Jewish hospitals.10,20,22
Decline in anti-Semitism
Blatant anti-Semitic quotas designed to restrict Jews’ access to medical school, internship and residency, and hospital staff privileges declined in the 1960s. Such quotas and restrictions are now both socially unacceptable and illegal. The impetus for Jewish hospitals as a response to anti-Semitism in the medical profession has therefore largely disappeared. (For example, part of the motivation for New York’s Mount Sinai Hospital to establish its own medical school was to preserve a pipeline for recruiting Jewish physicians and scientists who were now able to secure positions elsewhere.24) Jewish applicants for GME positions may now seek jobs at any U.S. teaching hospital. Similarly, practicing Jewish physicians may apply for staff privileges anywhere without concern that their religion will stand in the way.
Demographics and philanthropy
Finally, the population of self-identifying Jews is shrinking as a proportion of the total U.S. population. In the 1940s, the Jewish population peaked at 3.7% of the U.S. population.13 In 2010, the Jewish population comprised 1.9% to 2.2% of the U.S. population.13,27–29
There has also been a general assimilation of the American Jewish community.30–32 The intermarriage rate is approximately 50%. Polling of American Jews shows that affirmative responses to the statement “I have a strong sense of belonging to the Jewish people” decline according to the age of respondents, from a high of 72% among individuals aged 65 years or older to a low of 47% for adults younger than 35.33 Further, the number of American Jews reporting that most of their close friends are Jewish fell by 10% from 1990 to 2000.29–31 The proportions of American Jews belonging to Jewish organizations other than synagogues and Jewish community centers, of those saying they have made donations to the Jewish Federation (the Jewish community-wide charitable body), and of those observing religious rituals have also decreased.30,31
Similarly, the proportion of Jews holding the traditional Jewish viewpoint that all Jews are responsible for one another is declining. A 1998 survey reported that only 52% of American Jews agreed with the statement “I look at the entire Jewish community as my extended family,” and 47% agreed that “I have a special responsibility to take care of Jews in need around the world.”13
It is not surprising, therefore, that philanthropic support for Jewish hospitals has also declined among American Jews. Organizations that were founded to provide services or employment mostly to Jews have quietly broadened their missions to accommodate and serve a diverse audience in order to survive.34 Jewish hospitals located in urban, historically Jewish neighborhoods have seen their constituencies move to the suburbs, where suburban Jews have sometimes created new hospitals. Often, the Jewish hospitals that were “left behind” have disappeared, although there are a few notable exceptions that either have carved out a market niche or have persisted because of a concentration of urban Orthodox Jews.
Traditionally, Jewish Americans concentrated their charitable donations on Jewish causes.11,30,31 However, the frequency of wealthy American Jews focusing on Jewish communal organizations as the major locus of their philanthropy has fallen from near 100% to 33%.20,22,30–33 Jewish Federation support to hospitals has also fallen: In 1959, approximately 25% of the total funds available to Jewish Federations for local purposes were spent on hospitals and other medical programs. After the creation of Medicare in 1966 and states’ widespread adoption of Medicaid in 1967, hospitals began to derive large proportions of their income from these two government-funded sources and from insurance payers. In light of these changes, by 1967, Jewish philanthropic bodies were reassessing the rationale for Jewish hospitals and hospitals’ continued need for Jewish Federation financing.6 By the end of the 20th century, Jewish hospitals received less than 2% of their revenue from Jewish umbrella funds or Federations.20,35,36
Concurrent with the decline in impetus for American Jews to provide philanthropic support to Jewish hospitals, there has been a rise in the acceptance of Jews into upper-class social circles in the United States.30–33,36 Not surprisingly, this rise has been associated with philanthropy from Jews being directed to secular universities, opera companies, symphonies, museums, social and civic causes, and non-Jewish hospitals and medical schools. For example, after World War II, Cornell University Medical College was threatened with lawsuits and governmental hearings regarding its admission quotas that discriminated against Jewish applicants.16,18 Now, the Weill Cornell Medical College is named after a Jewish philanthropist and his wife who donated several hundred million dollars to a medical school that probably would not have admitted Mr. Weill’s coreligionists in generations past.
Conclusion: Does It Matter?
Many Jewish hospitals have been sold, and the proceeds of those sales have been used to endow grant-making foundations. Recent sales have created assets that constitute almost 5% of the total assets of Jewish foundations.20,22 Some of these Jewish foundations have concentrated their grant making on health and human services, whereas others have focused on the needs of elderly Jews, recent immigrants from the former Soviet Union, people with disabilities, and Holocaust survivors.30–33,36
But does the disappearance of American Jewish hospitals matter? It seems to be to the detriment of traditional Jewish commitments to education and to provision of health care to the poor. Also, it is a loss to the extent that Jewish hospitals have served as a “public face” of the Jewish community in the United States. On the other hand, American Jewish hospitals may be the victims of the American Jewish community’s successes. In the late 20th century, the American Jewish community secured consistent support for Israel, participated in successful efforts to release a million Jews from the former Soviet Union, won widespread recognition of the Holocaust, and helped strike down residual, institutionalized anti-Semitism in housing, resorts, university admissions, and employment.
Further, the multiple achievements of the American Jewish community in the medical profession, the decline in anti-Semitism, open access to GME positions and hospital privileges, and the general acceptance of Jews in the American mainstream have, in many cases, made American Jewish hospitals into historical artifacts. In addition, although there are some areas in the United States with high concentrations of Orthodox Jews, the majority of American Jews do not insist that hospitals provide kosher food, Sabbath elevators, a synagogue, and a Jewish administrative and medical staff.
Many of the remaining “Jewish hospitals” are simply bricks and mortar with Jewish plaques and signs that no longer meet the criteria that would define them as Jewish. The evolving U.S. hospital marketplace and cultural changes have combined, in large measure, to make the distinctly Jewish hospital an endangered species that will likely survive in only a few places. These disappearing hospitals leave behind a proud legacy: They are institutions that succeeded so profoundly in abetting the success of the American Jewish community that they became unnecessary.
Acknowledgments: The author benefited from the thoughtful comments of Rabbis Avrohom Litvin and Joseph Rooks Rappaport.
Other disclosures: None.
Ethical approval: Not applicable.
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