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Asher Asher: Victorian physician, medical reformer and communal servant

Kenneth Collins

<plain_text><page sequence="1">Asher Asher: Victorian physician, medical reformer and communal servant* KENNETH COLLINS Asher Asher was born in Glasgow in 1837, the eldest son of immigrants. His father, Philip (or Pinchas), was of a rabbinical family from Lublin, Poland, and his mother, Hannah, from Holland.1 Philip Asher's grandfather had been Rabbi Zev Wolff, a Dayan in Lublin, where his father, Asher Wolff, ran a small dry-goods store. Orphaned at the age of sixteen, Philip lived at first with an uncle, but soon decided to seek his fortune in Britain. In London he adopted his father's first name as his surname and worked for a while in the docks before moving to Glasgow in the 1830s. There he set up as a furrier. Glasgow was then home to only a few dozen Jews. The first synagogue had been established in 1823, although Jews had lived and worked there for some time. Like Philip Asher, the first Jews had been attracted to the rapidly expanding city by the business prospects generated by the growth of a middle-class with a taste for luxury goods. From an early age Asher Asher had been an assiduous scholar in both Jewish and secular subjects. His initial Jewish studies were conducted at home and he had spent long evening and weekend hours studying with his father. He attended St Enoch's Parish School and then the High School of Glasgow, entering the University of Glasgow in 1853 to study medicine when only fifteen years old. Scottish universities were open to Jews at this time, when religious tests still applied in Oxford and Cambridge.2 Medicine offered Asher an alternative to working with his father in the fur trade. Yet entry into the medical profession in mid-nineteenth-century Bri? tain had its risks. The strong commercial atmosphere in cities like Glasgow set a low value on the medical profession.3 Emigration to the colonies, particu * Paper presented to the Society on 24 May 2001. 1 Details on Asher Asher can be found in Kenneth Collins, 'Asher Asher MD (1837-1889) Doctor of the Poor', Glasgow Medicine 2 (1984) 12-14; idem, Go and Learn: The International Story of Jews and Medicine in Scotland, 1739-1945 (Aberdeen 1988) 51-4; idem, Second City Jewry: The Jews of Glasgow in the Age of Expansion: 1790-1919 (Glasgow 1990) 44; David Kohn-Zedek, Bet Asher (Hebrew; bound with Asher Asher MD 1837-1889: Collected Writings [London 1916]; The Jewish Encyclopaedia (New York 1925) 2: 180-1. 2 Collins, Go and Learn (see n. 1) 11-13. 3 Margaret Lamb, 'The Medical Profession', in Olive Checkland and Margaret Lamb (eds) Health Care as Social History; The Glasgow Case (Aberdeen 1982) 17. 163</page><page sequence="2">Kenneth Collins larly the West Indies or Australia, drew away a significant number of early Jewish medical graduates in Scotland. Asher would have had little contact with established practitioners, and the local Jewish community was too small to provide him with a base for his career. Asher pursued his studies with enthusiasm and supported himself by working as a book-keeper in a local Jewish clothing firm. He had a successful undergraduate career, winning sev? eral class prizes notably in materia medica and the practice of medicine, and gained the first prize in forensic medicine. He graduated with an MD in 1856, the first Jew born in Glasgow to achieve this distinction and only the fourth Jew to have graduated at the University there. Asher was a contemporary of the great Scottish Victorian public-health specialist Dr James Burn Russell, and their careers show interesting parallels. Both were born in 1837 and they studied together at the High School of Glasgow. Russell entered medicine later than Asher, completing an arts degree before going on to become a visionary and innovative Medical Officer of Health in Glasgow between 1872 and 1898. During these years Russell promoted health policies based on improvements in housing and sanitation and the prevention of infection, just as Asher was to do in London.4 After graduating, Asher became a licentiate of the Royal College of Sur? geons of Edinburgh and began work as a parochial medical officer, covering Wester Cadder at Bishopbriggs, then a small mining town near Glasgow with a population of 5000. There was a tradition in the Glasgow area of providing free medical services for the poor, and this offered the new graduate an oppor? tunity to gain experience.5 The salary of ?15 a year was low and the work arduous, but as a young medical graduate aged nineteen, Asher could not have been choosy.6 The Parochial Board also ensured that the job was not a sinecure, closely scrutinizing the work of the Medical Officer and making sure he followed their policy of financial stringency.7 Asher was required to attend to the poor of the district and those resident within five miles of it without charge. Any fee for attending paupers living outside the district was earned only with the consent of the Parochial Board. West Cadder's annual health budget was minimal besides the meagre medical salary, the main expense being the ?5 paid to the Glasgow Royal Infirmary to cover the hospitalization of Cadder residents.8 To augment his income Asher undertook private medical work in Glasgow, although he was always 4 Edna Robertson, Glasgow's Doctor: Dr James Burn Russell: 1837-igio (East Linton 1998) 17. 5 Lamb (see n. 3) 5. 6 Collins, Go and Learn (see n. 1) 55. 7 Rona Gaffney, 'Poor Law Hospitals: 1845-1914', in Cheekland and Lamb (see n. 3) 17. 8 Minutes of the West Cadder Parochial Medical Board, 1858-1862, Greater Glasgow Health Board Archives, Mitchell Library, Glasgow. 164</page><page sequence="3">StfvLi, ,J6M Plate i Asher Asher, a portrait.</page><page sequence="4">Kenneth Collins ready to treat the needy without charge.9 Without such private work most doctors in mid-Victorian Glasgow would have been unable to survive finan? cially.10 Asher was also deeply involved in the affairs of the local Jewish community, which now had about 200 members. The 1850s had seen a steady growth in Glasgow's Jewry and the community's institutions were becoming stronger and better organized. From 1858 Asher attended the local Jewish poor and sick as Medical Officer of the Glasgow Hebrew Philanthropic Society, the first Jewish holder of this post. He was also Honorary Secretary of the Glas? gow Hebrew Congregation, yet he still found time to continue his Hebrew and Jewish studies.11 Asher displayed deep erudition in these, despite being almost completely self-taught. Asher resigned his post in Cadder in December 1861 after he and the Medical Officer for the neighbouring parish of Easter Cadder had applied unsuccessfully for an increase in salary. The four years in Bishopbriggs proved a valuable start to his career, however, for they taught him the medical and social requirements of the urban poor and the difficulties in providing medical care while under serious financial constraints. He left Glasgow for London in 1862 to join Dr Jacob Canstatt in practice at 4 Castle Street in Houndsditch. Canstatt had provided primary medical care for the Jewish poor of London at first under the auspices of the larger London synagogues, but in 1862 the system of delivering health services was altered. The London Jewish Board of Guardians for the Relief of the Jewish Poor (LJBG), originally formed in 1859, now assumed responsibility for the health care of the poor from the synagogues. Asher's specific kind of medical experience, as well as his Jewish scholarship and fluency in Hebrew and Yiddish, would have been consider? able assets in his new work. He was now working for a better-funded, locally based and religiously sensitive care body, even though such institutions often had a reputation for patronizing and parsimonious leadership. He was there at the start of its operations and showed that he possessed the ability to create and develop organizations, and the vision to drive forward the medical aspects of this particular one, recognized in the 1860s as among the most progressive philanthropic bodies in England.12 Asher's meticulous annual reports for the LJBG clearly demonstrate his care in tending to the medical needs of the London Jewish poor.13 He pro 9 Kohn-Zedek (see n. i) xv. 10 Lamb (see n. 3) 20. 11 Kohn-Zedek (see n. 1) xv-xvi. 12 Lara Marks, Model Mothers: Jewish Mothers and Maternity Provision in East London, 1870 1939 (Oxford 1994) 32. 13 Annual Reports of the London Board of Jewish Guardians [hereafter LJBG], 1862-1866, MS 173, Hartley Library, University of Southampton. 166</page><page sequence="5">Asher Asher: Victorian physician, medical reformer and communal servant vided careful guidelines for his work and ample statistics to permit evaluation of his activities. Canstatt and Asher received considerable financial support from the management, enabling them to carry out their work well provided with medical essentials. A subscription was taken out to a maternity society to provide for midwives. Bathhouse tickets were purchased and issued at the discretion of the medical officers. Medicines, such as quinine, cod-liver oil, wine and brandy, which were beyond the means of the poor, could be sup? plied directly on Asher's recommendation. The functioning of the new med? ical service was monitored monthly, the reports furnishing a guide to the miserable conditions of the time. Malnutrition, poor housing and a lack of sanitation characterized the lives of all the poor of London. In his first annual report Asher identified the key factors adversely affecting the health of the community.14 He made strenuous efforts to overcome the lack of adequate food and clothing and cleaning facilities, the poor light and ventilation and overcrowded housing. Convalescent care was organized, coal, blankets and cleaning material and a pride in hygiene encouraged. In his second report he was recorded a drop in fevers, including typhus, by about half, from 383 cases to 206, with the number of deaths falling from 10 to 5.15 (See Table 1.) Although the LJBG provided medical consultations and a dispensary, Asher arrived in London just after a review had considered the costs and benefits of providing such a system. This 'exhaustive report', produced in the name of a subcommittee on Medical Relief in May 1861, expressed con? cern about the vulnerability of the local Jewish population. Only a minority spoke English and there was considerable reluctance to attend dispensaries run by local hospitals and clinics.16 The subcommittee was also concerned that the dispensaries would not be sensitive to the needs of Jewish patients, and the report recommended that no changes be made in the delivery of the LJBG's medical care. It was twelve years before Asher was asked to revisit the report and make new recommendations in the light of changed circumstances. In 1865 Asher warned of the risks to the Jewish community in the East End of London from the cholera epidemic threatening the City, as well as from the health hazards related to dysentery and bronchitis. In 1866 London was significantly affected by cholera, related to the water supply and to unregulated shipping.17 As Superintendent of the (Jewish) Sanitary Society, Asher instituted urgent measures to deal with the outbreak. He visited all the 14 Annual Report, LJBG, 1862. 15 Annual Report, LJBG, 1863. 16 LJBG Subcommittee on Medical Relief, 28 June 1861, filed with Memorandum submitted to the Medical Committee of LJBG, 26 May 1873. 17 Anne Hardy, 'Cholera, quarantine and the English preventive system', Medical History 37 (i993) 255 167</page><page sequence="6">Kenneth Collins Table i. Diseases, Injuries, etc. During the Year 1862 (among outdoor patients) Diseases, Injuries etc. Total Deaths 9 10. 11 12 13 14 15 ZYMOTIC DISEASES a. Smallpox b. Measles c. Scarlatine d. Whooping cough, croup e. Diarrhoea, dysentery f. Influenza, catarrh g. Fevers: typhus, low, intermittent h. Various others DROPSIES, ABSCESS, ETC. TUBERCULAR DISEASE BRAIN, NERVES, ORGANS OF SPECIAL SENSES HEART AND BLOOD VESSELS LUNGS AND ORGANS OF RESPIRATION a. Bronchitis b. Other disease STOMACH AND DIGESTIVE ORGANS a. Teething b. Other diseases KIDNEYS ETC. ORGANS OF GENERATION JOINTS, BONES a. Rheumatism b. Other diseases SKIN, CELLULAR TISSUE, ETC. ABORTION DEBILITY OLD AGE VIOLENCE, SCALDS, BURNS, ETC. TOTAL 99 158 225 6 100 141 206 76 179 5i 54 15 78 27 318 118 9 28 68 8 43 13 121 10 13 2182 4 11 50 2 9 0 5 3 7 11 11 6 4 2 11 0 0 0 0 0 1 o 14 0 0 151 Source: Dr A. Asher (ed.) London Jewish Board of Guardians Year Book, 1863. seriously affected Jewish areas in the East End, using the hall of the Great Synagogue as a screening centre from where patients, depending on the sever? ity and stage of the illness, were directed home, to hospital or to convales? cence.18 The LJBG was mobilized to provide sanitary measures such as drain? age and lime wash, with new standpipes for fresh water replacing unhygienic cisterns.19 A number of unsanitary cellars used for housing were removed, 18 Kohn-Zedek (see n. i) xviii-xix. 19 Ibid. Annual Reports of LJBG, 1866 and 1867; obituaries of Asher in Asher Asher MD 1837 1889: Collected Writings (London 1916). 168</page><page sequence="7">Asher Asher: Victorian physician, medical reformer and communal servant the worst tenements boarded up and substandard homes cleaned and disin? fected. Street refuse was cleared and measures taken to prevent it accumulat? ing again. Fevers tended to spread rapidly in the Jewish community, where there was a reluctance, for religious reasons, to enter the hospitals. But with Asher's insistence on hospitalization for the most severe cases, the death rate was reduced. Asher campaigned for the establishment of a home at Norwood, since he believed in the value of convalescence in the rehabilitation of cholera victims. His role as Honorary Medical Officer later passed to his Dublin-born and Trinity-College-trained son-in-law, Abraham Cohen, husband of his daughter Hannah. Asher's early success with the LJBG, with its influential support and effective organizational structure, ensured that it was the leading agency in the fight against the contemporary health scourges. He proved able to work closely and effectively with the lay leadership of the key Jewish bodies in London, developing relationships with Samuel Montagu and members of the Rothschild family. His working partnership with Montagu's brother-in-law, Lionel Louis Cohen, Honorary Secretary of the LJBG and its President from 1869, later strengthened when Cohen became the first President of the United Synagogue and Asher its first Secretary. Policy could then be developed and implemented quickly and efficiently. By the time of Asher's death, improve? ments in housing and hygiene had reduced the prevalence of infection, and the LJBG was leading the fight against TB. Around Britain, Jewish Boards of Guardians, such as that in Asher's native Glasgow, gained credit for the contribution they made to the lower Jewish death rate from TB.20 Asher left his medical work in 1866 after winning a keenly contested elec? tion for the post of Secretary of the Great Synagogue. It was perhaps surpris? ing that Asher was prepared to relinquish his post with the LJBG for that of communal civil servant. But the lesson of the cholera outbreak was that con? trol of illness and improvements in the health of London's Jewish poor could be made only by effective Jewish organizations coordinating social and welfare improvements. Furthermore, the LJBG itself was set up to pool the welfare and medical services of London's Ashkenazi synagogues, and the importance of the Great Synagogue in the structure was quite clear. Asher won the elec? tion for the post of Secretary quite convincingly, even after a letter in the Jewish Chronicle, published just before the election, commented that 'it seemed a thousand pities to attract Dr Asher from a profession which he adorns and in which he has shown his value'.21 In 1870, with the formation of the United Synagogue (US) which linked the main Ashkenazi Orthodox synagogues in London, Asher became its first 20 Glasgow Jewish Board of Guardians, Annual Reports, 1912-1916, Scottish Jewish Archives Centre, Garnethill Synagogue, Glasgow. 21 Obituary, Jewish Chronicle, n January 1889. 169</page><page sequence="8">Kenneth Collins Secretary. In his role as communal official, and working closely with Lionel Louis Cohen, the first President, Asher continued to strive for improvements in the health of the Jewish poor in London. Though no longer a practising physician, Asher's daily routine remained a hectic mixture of meetings, both at and after work. Maintaining a lengthy correspondence in Hebrew, Yiddish and English, as well as his religious studies, often left him only four hours sleep a night. With Asher's enhanced communal influence, through his membership of a wide range of policy committees dealing with medical and social matters, he influenced improvements in a wide range of issues. The Jewish United Syn? agogue Act of 1870 gave the new body responsibility within the area of Jewish poor relief and, given the origins of the LJBG within the synagogues, it was some time before the welfare aspects were transferred from the US to the LJBG. As late as 1885 the United Synagogue Visitation Committee Relief Fund proposed improvements in Jewish health care by setting up an organ? ized system of public-health lectures and appointing health visitors. These were to instruct immigrants in health and hygiene and provide an introduc? tion to life in London, while enabling visitors to check hygiene in the home and its immediate surroundings.22 Asher continued to serve on the Medical and Sanitation Committees of the LJBG, working for change especially in the improvement of slum-housing conditions by voluntary and statutory bodies. He ensured the establishment of the principle of visitation, ensuring that Jewish inmates in poorhouses, hospitals and prisons were visited regularly to maintain their contact with the Jewish community. For this he required organizational support within the Jewish community and agreement, following discussion, from the Home Office, magistrates and prison inspectors, government bodies and hospital authorities. In an age when doctors required an economic sideline to survive financially, such as private practice, Asher's transformation into a communal civil servant provided both financial security and scope for professional devel? opment. His position with the United Synagogue was well paid: his final annual salary of ?700 was about three times that of a full-time medical officer of the LJBG only a decade earlier.23 Almost as soon as the US was formed, Asher and Cohen were involved in a reassessment of its role in charitable poor relief, and in particular its annual relief budget of about ?2000.24 This continuing transfer of welfare provision from the US to the LJBG naturally required close cooperation between the 22 Minutes of the Visitation Committee of the United Synagogue, 2712, 18 March 1885. In London Metropolitan Archives, 40 Northampton Road, London ECiR oHB. 23 Minutes of the Executive of the United Synagogue: 1870-1902, p.394. Minutes of the Exec? utive Committee of the London Board of Jewish Guardians, 1866, 1874. 24 Letter from Asher Asher and Lionel Louis Cohen to LJBG, 2712/6/1, 1 April 1871. 170</page><page sequence="9">Asher Asher: Victorian physician, medical reformer and communal servant two organizations, which Asher and Cohen were uniquely placed to provide. The main priority of the LJBG at this period was keeping Jews out of the workhouse, and there was a gradual move to transfer some of its direct med? ical-care provision to the local authorities. The Jewish poor were becoming more dispersed through London's East End and it was more difficult for the LJBG to provide convenient locally based medical services. Furthermore, dispensary provision and the availability of doctors in the statutory sector were perceived to be improving. The Medical Committee of the LJBG met on 26 May 1873 to consider a memorandum by Asher which revisited the questions on dispensary, also known as outdoor medical-relief, a provision originally considered in May 1861 while Asher was still in Glasgow.25 Questions had been asked about dispensary provision in the LJBG Annual Report of 1869, as 'hospitals and dispensaries are freely open [to the Jewish poor] and resorted to by them'.26 Accepting that local circumstances had changed considerably over the past twelve years, they cautiously proposed to 'cease tentatively' outdoor medical relief for a trial period of three months. It was no longer considered that immigrants saw English-language problems as insuperable, as a medical attendant could be provided to translate if required. Jewish patients now believed they could obtain as least as good a service, and possibly an even better one, by attending other dispensaries. Statistics in the memorandum showed that while the Medical Officers of the Board remained busy, and were even overworked given the five-fold increase in those attending since 1862, they could give only two minutes to each of the seventy or so patients attending every day. Asher's memorandum acknowledged that much of the Jewish medical relief provided was inappropriate, in that the medical officer was dealing with prob? lems of poverty rather than ill health. It recognized that there were no Jewish illnesses calling for particular Jewish provision, nor 'anything specifically Jewish in the medicine provided by the Board'. The Council of the LJBG accepted the underlying philosophy of the mem? orandum and welcomed the changes it proposed: 'Self respect is impossible without self support; and although poverty is a circumstance inseparable from this earth, pauperism can only flourish by what it feeds on, well meaning but indiscriminate alms giving; and indiscriminate medical relief is hardly worse than indiscriminate alms giving'.27 The 'tentative cessation' of outdoor medical relief began in October 1873, but in fact the Jewish dispensary remained in operation until 1879. In January 25 Memorandum to LJBG Medical Committee, 26 May 1873. 26 LJBG Annual Report, 1869. 27 Minutes of the LJBG Council, 1873. i7i</page><page sequence="10">Kenneth Collins 1879 the Medical Committee of the LJBG produced a further report on the subject, with Asher as one of the signatories. Even this did not mean the end of LJBG medical services, as it continued to subscribe to maternity services and to make available medical extras not provided by the parish.28 Asher tendered his resignation to the Medical Committee of the LJBG in September 1873, just weeks before the 'tentative cessation' was due to begin, but he was persuaded to remain in office 'because of his experience and value to the Committee'.29 Asher offered no reason for offering his resignation, but it was hardly likely that it was due to any opposition to Board policy, given that he had been its leading proponent. It is more likely that Asher considered that there was no role for the Medical Committee with the end of Jewish outdoor medical relief, and in particular that there was no continuing require? ment for his expertise. The Committee did not meet after 1880, but was not formally wound up until 1882. In January 1874, at tne en(i ?f tne trial period, it was agreed that the provision of Jewish outdoor medical relief by the LJBG could be ended, as there had been 'no complaint of hardship arising out of the new system . . . and this justifies [the Committee] in recommending that the outdoor medical relief be discontinued sine die\m The LJBG, both at the time in their Annual Report and later in a further Medical Committee meeting in 1879 which looked at residual outdoor relief activity, were keen to stress their unanimity. They confirmed that 'there is not the slightest divergence of opinion among them as to the necessity for a change or as to the direction in which that change should be made'.31 However, there were some complaints about the withdrawal of services, as Marks noted, in documents from 1888.32 The Committee's own emphasis on unanimity may indicate some uneasiness on the part of some of its members in acceding to the new developments. Rozin has gone further in criticizing the Board's assessment of its policy, suggesting that it indicated the power of the Jewish elite over the immigrant poor and its ability to control the middle classes.33 However, the principle that Jewish charities should provide only health and welfare facilities that were not available from statutory sources seemed the only practical one, if communal resources were to be employed efficiently. Interestingly, Jewish dispensaries flourished again in the first years 28 Marks (see n. 12) 109. 29 Minutes of the Medical Committee of the LJBG, 3 September 1873. 30 Minutes of the Medical Committee of the LJBG, 5 January 1874. 31 Annual Report, LJBG 1873; Minutes of the Medical Committee of the LJBG, 5 January ? l874 Marks (see n. 12) 109. 33 Mordechai Rozin, The Rich and the Poor: Jewish Philanthropy and Social Control in Nine? teenth-Century London (Brighton 1999) 179-80. 172</page><page sequence="11">Asher Asher: Victorian physician, medical reformer and communal servant of the twentieth century in most of the Jewish immigrant areas of Britain. This provided an alternative to Christian dispensaries working out of mission halls, often staffed by Yiddish-speaking converts to Christianity. Asher made use of his connections with the lay leaders in both the LJBG and the US to further his interests in wider communal philanthropy. He had particularly close ties with the Rothschilds involved in the lay leadership of the US. He also worked closely for many years with Samuel Montagu who had links with the LJBG. In 1887 Montagu helped set up the Federation of Synagogues to help regulate the increasing numbers of Chevras, prayer houses, in the East End, and this would provide a major communal role for himself without Rothschild involvement. Asher worked hard for peace between Montagu and Lord Rothschild, whose arguments on the role of the synagogue bodies were well known, and he was eventually successful in bringing the two men together. The Federation had careful links with the US during Asher's lifetime, but after his death the organizations perhaps inevitably increasingly diverged. Asher travelled to the Holy Land, Russia and America, giving advice on ameliorating the lot of the Jewish immigrants and making accurate assess? ments of their needs. After his visit to Jerusalem in 1875 with Samuel Mon? tagu, Asher wrote a report on conditions in Jerusalem for the Moses Montefiore Testimonial Fund, set up to mark the great philanthropist's ninetieth birthday. The report was widely credited with effecting significant improvements in the physical situation of Jews in Jerusalem, although it was bitterly criticized within the traditional religious community - the Old Yishuv - because it criticized reliance on halukah welfare funds and emphas? ized the need for secular education.34 In the 1880s Jewish refugees started flooding out of Russia, especially after the passage of the May Laws. These limited Jewish rights against an already existing background of economic hardship and anti-Semitism. Asher was appointed a trustee of the Mansion House Fund for Russian Jewish Relief, set up with contributions raised in London under the patronage of the Lord Mayor. It was quickly decided to send a fact-finding mission to Brody, an important rail junction on the Russian-Galician frontier, where many Jews were gathering. Asher is credited with bringing some order to the chaos and making plans for the resettlement needs of the refugees. His knowledge of Yiddish and medicine were again of value when he helped in the medical screening of thousands of transmigrants passing through London. Asher would sometimes work through the night, identifying those in need of imme 34 R. Shlomo Zalman Sonnenfeld, Guardian of Jerusalem: The Life and Times of Rabbi Yosef Chaim Sonnenfeld, adapted by Rabbi Hillel Danziger (New York 1983) 260-1. 173</page><page sequence="12">Kenneth Collins diate treatment and ensuring that those travelling onward were free of infec? tions that might prevent their entry into the United States. Asher was involved in two further missions abroad. In 1884 he visited areas of Jewish settlement in North America, gathering information about the final destinations of the refugees. He began in New York and travelled as far as Montreal and Chicago, finding time also to visit small communities in Utah and North Dakota. In 1886 he again accompanied Samuel Montagu, this time to Russia. Asher was able to visit his father's hometown of Lublin, where he was shocked by the conditions in which his relatives lived there. In Poland he unfortunately experienced an episode of pleurisy, a forerunner of the lung cancer which was prematurely to end his life. Asher took a special interest in the Chevrat Hakhnassat Brit, 'Society for Initiation into the Covenant', the organization responsible for the supervision of milah, religious circumcision. As a mohel, or circumciser himself, he believed strongly that doctors, rather than rabbis or laymen, should perform the rite of circumcision. He published a booklet on the subject dealing with the religious and historical aspects of circumcision, describing it as 'the foundation stone on which rests the whole Jewish polity'.35 Asher saw moral, religious and national factors in the practice of milah, for him the physical means for 'arriving at moral perfection and purity'.36 How? ever, by 1873 when Asher's The Jewish Rite of Circumcision was published, some of the religious aspects of the rite had come under attack. The early Jewish Reformers, who often displayed opposition to traditional practices, showed little enthusiasm for an end to circumcision. The principal opponents of circumcision were usually non-Jews who saw overt anti-Semitism as unac? ceptable and based their objections to Jewish religious practice on medical, hygienic or aesthetic grounds. Much of the opposition to circumcision centred on the performance of oral suction after milah, or removal of the foreskin, a procedure called metsitsah.37 Asher believed the reasons given in the Talmud and religious codes for oral suction were scientific rather than theological and concluded that a contem? porary consideration of the procedure should likewise be conducted on scient? ific rather than religious grounds. Asher supported his views by referring to the many other talmudic health prescriptions that later rabbinic authorities 35 Notes on Circumcision in Asher Asher (see n. 19) 99. 36 Notes on Circumcision in Asher Asher (see n. 19) 107. 37 For metsitsah see Bernard Homa, Metzitza (London 1966); Jacob Katz, Divine Law in Human Hands: Case Studies in Halachic Flexibility (Jerusalem 1998) 320-402; Louis Jacobs, Theology in the Responsa (London 1975) 212; Immanuel Jakobovits, Jewish Medical Ethics (New York 1967) 195-6. For views on how the issue has been understood in contemporary society see Sander Gilman, The Jew's Body (New York 1991) 93-6, 155-7; idem, Freud, Race and Gender (Princeton 1993) 45, 65, 69, 89; Ronald Hyam, Empire and Sexuality: The British Experience (Manchester 1990) 77-9. 174</page><page sequence="13">Asher Asher: Victorian physician, medical reformer and communal servant confirmed could not be applied to current-day diseases. There was both med? ical and religious support for Asher's view. Directives concerning the hygienic measures to be employed by mohalim were being issued by many governments and public health bodies in the last half of the nineteenth century, and in some German cities metsitsah was actually forbidden.38 Asher's critique of circumcision supported those who accepted the modi? fication of its practice while still operating within religious law. He assembled many arguments against oral metsitsah, noting that modern surgery considered it 'unquestionable that the sucking of a wound as a preventive or remedial measure is utterly useless'.39 Indeed, he pointed out that in Jewish communit? ies such as Paris, Vienna, Pressburg (Bratislava) and in W?rttemberg, where oral metsitsah had been abolished, 'if experience be worth aught as weight as against theory', there had been no evidence of any difference in the health of the child or any delay in healing'. In fact, there was more evidence that illnesses, especially infections like syphilis, could be passed from the mohel to the child, or indeed from child to mohel, during the procedure, the contem? porary literature being full of evidence of such spread.40 Given the medical and aesthetic opposition to oral metsitsah the use of a special pipette, designed by Rav Cahn in Fulda, gained widespread use. Lead? ing Orthodox Rabbis in Germany gave their approval to the device, but it gained little support from traditional Eastern European Rabbis. Their prime intent was to leave Jewish practice unchanged, and they permitted the use of the pipette only on an emergency basis, as they felt that metsitsah was not the health hazard its opponents claimed. After Asher consulted Dayan Jacob Reinowitz, a member of the London Beth Din, the Chief Rabbi's religious court, on matters related to circumcis? ion, Dayan Reinowitz wrote a treatise on the subject, noting that oral metsitsah was not being used in London. In ensuing correspondence with Reinowitz, the Chief Rabbi, Dr Nathan Adler, made clear his preference for the tradi? tional method.41 Although Asher's opposition to metsitsah set him against the Chief Rabbi, Asher was keen to have the approval of the Chief Rabbi for his book entitled The Jewish Rite of Circumcision. He therefore included a number of modifications and grammatical corrections at Dr Adler's suggestion, but still received approval only for his translation of the laws and specifically not for the introduction.42 Adler had been in communication with Rav Cahn in 38 Gilman, The Jew's Body (see n. 37) 93. 39 Rabbi Dr Eugene Newman, 'The Responsa of Dayan Jacob Reinowitz, 1818-1893', Trans JHSEzi (1971)22-3. 40 Asher Asher (see n. 19) 129. 41 Gilman, Freud, Race and Gender (see n. 37) 66. 42 Notes and correspondence of Asher Asher, MS 159: AS 166/9, Hartley Library, University of Southampton: letters from Chief Rabbi Nathan Adler, 21 March 1872, 30 October 1872, 9 December 1872. 175</page><page sequence="14">Kenneth Collins Fulda, supporting efforts to maintain the traditional practice, so it was not surprising that he wrote to Asher that while 'he admired the combination of a thoroughly God fearing spirit with scientific accuracy which pervades it. . . [I] cannot agree with your views on metsitsah*43 In 1888, ironically just months before Asher's death, Adler had to modify his policy on metsitsah.44 A number of deaths had taken place following cir? cumcision by an experienced London mohel and it was presumed that these were related to transmission of infection. To prevent a repetition of the tra? gedy one of the London mo he lim, Alexander Tertis, invented a rubber pump to be used for metsitsah, and when the Chief Rabbi called the London mohalim together it was agreed that the practice of oral metsitsah be suspended. In 1873, the same year as the publication of the circumcision monograph, Asher had a further clash with the Chief Rabbi, this time concerning early burials. Claims had been laid before the Council of the US 'that several persons at different periods had been buried alive', and Asher proposed that there be a delay of forty-eight hours between death and interment.45 The Council were informed that the Jewish poor were exerting pressure on doctors for the early issue of death certificates and it was claimed that doctors were being misled into believing that death had occurred many hours earlier. Doc? tors did not always confirm death personally and were often simply accepting evidence from watchers employed by the Burial Society. Jewish law requires burial as soon as possible after death, the formal week of mourning, shivah, beginning only after interment has occurred. Delay in burial could therefore result in financial hardship, requiring the bereaved to take extra time off work. Further, delay in removing bodies from cramped and impoverished homes, especially before the onset of the Sabbath, could cause families much discomfort. In explaining the dilemmas facing doctors in establishing the time of death, Asher wrote to the Chief Rabbi that 'modern science has established that there is no absolute test of death but decomposi? tion'.46 In his reply, Dr Adler stressed the religious duty of speedy burial and suggested a proper system of death certification and mortuary provision to permit the timely removal of bodies, thus effectively closing the discussion. While Asher had expressed his opinions on circumcision and early burial clearly and openly, his authority as Secretary was limited, for only the Chief Rabbi, as the supreme religious authority within the US, had the final word. 43 Asher Asher, The Jewish Rite of Circumcision with the Prayers and Laws Appertaining Thereto. Translated into English, With an Introductory Essary by Asher Asher, M.D. (London 1873); Notes and correspondence of Asher Asher. 44 Katz, Divine Law (see n. 37) 393-5. 45 Minute Book of the United Synagogue, 1870-1879, Vol.i, 25 April 1873, m London Metro? politan Archives (see n. 22). 46 Ibid. 176</page><page sequence="15">Asher Asher: Victorian physician, medical reformer and communal servant Asher's criticisms of certain practices associated with circumcision and early burial were consistent with his support for using current medical and scientific knowledge in defence of religious practice. His critique of metsitsah was intended to anchor the rite of milah at the core of Jewish religious life, while insisting that its performance met the medical criteria of the day. Asher saw no necessary contradiction between religion and society, and believed that the Jewish community should be integrated into society while remaining distinguished by its faith and practices. He did not see himself as a follower of that haskalah ideology which saw Jewish life divided into religious and secular areas.47 As Judaism saw preservation of life as a supreme religious obligation, physicians like Asher aimed to establish themselves as arbiters of certain aspects of religious practice. Asher combined strict adherence to certain areas of traditional practice with a considerable freedom of thought. His attitudes to a wide range of issues can be found in the numerous letters he wrote to the Jewish Chronicle, using a number of aliases such as 'Aliquis' and 'Delta'. We have already seen that he could be outspoken and controversial in public. Using his aliases he went much further, presenting views he probably could not have expressed as Secretary of the US. Asher was particular about Kashrut, unafraid to visit friends and colleagues, but to eat only if he felt their standards of observance matched his. In his personal life he was widely credited with almost legendary powers of tact, diplomacy and understanding for the views of others. Blessed with an encyclopaedic mind, his Jewish learning encompassed the full range of rabbinic literature. Asher was particularly upset when he found observant foreign-born Jews in conflict with the law of the land, observing that 'when physical observances are inculcated as moral precepts, the former will speedily supplant the latter'.48 Asher believed the synagogue should be a place for praying rather than merely 'saying prayers'. He disapproved of flamboyant hazanut and expressed outright opposition to the inclusion in the liturgy of medieval reli? gious poems, or piyutim. He quoted with approval the words of Ibn Ezra that their language was 'barbarous and impure', adding that 'no man was ever the wiser or the better for reading them: those who understand them best read them least'. Asher was vehemently opposed to what he considered to be superstitious aspects of Jewish law and custom. He criticized those minhagim, customs, which he considered to be non-Jewish practices legitimized by finding biblical 47 Thomas Schlich, 'Medicalisation and Secularisation: The Jewish Ritual Bath as a Problem of Hygeine: Germany, 1820S-1840S', Social History of Medicine 8 (1995) 423-42. 48 Asher Asher (see n. 19) 89. 177</page><page sequence="16">Kenneth Collins verses to give them support.49 It may have been out of opposition to the Ashkenazi practice of naming children only after the deceased that he called his daughter Hannah, even though his mother, who had the same name, was still alive. On the other hand, Asher's wife, Lucy Garcia, was from a Sephardi family, and her expectations might have been precisely the contrary and have led her to insist that her first daughter bear the name of her paternal grand? mother. The practice would have been unprecedented in the Asher family, however. Asher argued far more radically, in a letter of reply to Revd Simeon Singer in the Jewish Chronicle in November 1887 using the alias 'Delta', that phylac? teries were also a superstition.50 'Anyone who reads the Talmudic reasoning whereby it is sought to be proved that tephilin are ordained by God, must be struck by the puerility of the whole argument. Let Mr Singer get it translated into English and placed before the readers of the Jewish Chronicle, and I very much underrate their intelligence if they ever, from conviction (rather than an unwillingness to part with an old custom) use tephilin again.' Given Asher's recorded adherence to Jewish practices his personal attitude to tephilin may have been that of'unwillingness to part with an old custom'. It is not surpris? ing that a later Chief Rabbi, Dr Herman Adler, son of Dr Nathan Adler, should have said of Asher, in a sermon after his death, that he had 'given expression to some opinions and conjectures from which I would dissent'.51 Asher's death at the age of only fifty-one was widely mourned. His wife died a year or so later aged fifty. Both were survived by his elderly mother. Asher's name is deeply respected to this day in Glasgow and London. A marble memorial was erected in the Garnethill Synagogue in Glasgow and an annual undergraduate prize in his memory is still awarded in the Depart? ment of Diseases of the Ear, Nose and Throat at the University of Glasgow. Asher Asher, the son of immigrants, succeeded as a medical student at a time when Jewish students - especially those of humble origin - were rare in any university faculty. He set his stamp on mid-nineteenth-century British Jewry with his restless personality and ability to look beyond the status quo. Clear in thinking, possibly dogmatic, but able to understand opposing points of view, a skilled communicator in several languages, at ease both with immig? rants and communal leaders, he proved able to reconcile parties that had been at loggerheads for years. He had a vision of what could be achieved, whether in community health, politics or religion, and had the drive to carry it through. He established communal policy for health and welfare and for the cooperation of religious bodies, displaying loyalty to his faith and his com 49 Ibid. 56. 50 Ibid. 88. 51 Ibid. 191. i78</page><page sequence="17">Asher Asher: Victorian physician, medical reformer and communal servant munity. He died before the major influx of Eastern European Jews in the 1890s, but when they arrived, their complex religious and social needs could be assimilated into the communal framework that Asher had done much to nurture. His obituary in the Jewish Chronicle remarked that Asher had exem? plified the union of thought and practice in the noble tradition of that great Jewish medieval physician, Moses Maimonides.52 52 Jewish Chronicle, n January 1889. 179</page></plain_text>