Health and medical care of the Jewish poor in the East End of London, 1880-1914

<plain_text><page sequence="1">Health and medical care of the Jewish poor in the East End of London, 1880-1914* GERRY BLACK Some 35,000 Jews lived in the East End of London in 1880, most of them in Aldgate, Whitechapel and Stepney. Within thirty years, largely as a result of a mass exodus from Eastern Europe, their numbers had grown to 120,000, a high percentage of whom were recent immigrants and many of whom were poor on arrival.1 This massive increase set daunting challenges for the Anglo Jewish leadership, not least in the matter of health care. In the nineteenth century, primary responsibility for social welfare lay with voluntary agencies, particularly in health, education and housing. It was phil? anthropists who made themselves mainly responsible for new hospitals, schools, universities and university colleges; and it was they who financed medical and scientific research and who funded libraries, museums, art galler? ies, public parks and urban housing experiments. Facilities provided by the State were largely supplementary to their efforts. Parliament followed, but rarely initiated social reform. It was only gradually appreciated that voluntary organizations could not provide the complete answer and that the State would have to involve itself. There were three stages in the process. In their earliest days, social services were almost always provided by privately funded and administered organiza? tions. Later, when the State saw that the service met a social need, it assisted with grant-in-aid on a temporary basis while the management remained in private hands. In education, for example, the Jews' Free School largely depended on Rothschild charity throughout the nineteenth century, and gov? ernment financial aid came slowly and only after pressure was applied. In the third stage, the State took over the service and operated it as a public enter Presidential Address delivered to the Society on 18 October 1998. 1 This paper is based on the author's doctoral thesis (hereafter Thesis) of the same title (Leicester University 1987) and subsequent research. A copy of the thesis is in the Tower Hamlets Local History Library in Bancroft Road, Stepney. For further details of the Jewish population in nineteenth-century London see Jewish Chronicle (hereafter JC) 2 June 1876; V. Lipman, Social History of the Jews in England 1850-1Q50 (London 1954) 65, 99; J. Jacobs, Studies in Jewish Statistics (London 1891); L. Gartner, The Jewish Immigrant in England i8yo-igi4 (London i960; C. Russell and H. L. Lewis, The Jew in London (London 1900) App. A; J. Gerrard, The English and Immigration. A Comparative Study of Jewish Influx 1880 igio (London 1971) App. A. 93</page><page sequence="2">Gerry Black prise sometimes with and sometimes without voluntary assistance. Until the State intervened the work had to be done from within the general community, and in areas in which there were Jewish religious requirements, such as the need for kosher food and facilities to respect and celebrate the Sabbath and Festivals, Jews had to look after their own. To a Victorian philanthropist, the contemporary involvement of the State in social and welfare activities would have been inconceivable, and it is in that context that their efforts must be judged. Conversely, it is only with difficulty that an age that takes for granted large-scale public social services can fully comprehend the distinctive role assigned by the Victorians to char? ity. The crucial role in promoting health care for the Jewish poor was played by the wealthy members of the community. They not only provided the bulk of the required money, but undertook control of the institutions carrying out the work. The poor contributed too, sometimes giving more, pro rata, than the middle class. But with a few exceptions, notably that of the London Jewish Hospital and the Jewish workhouse, their payments were only a small proportion of the required total. By the mid-nineteenth century there were thirty-eight Jewish charitable organizations providing pensions, loans, grants, food and groceries, clothing, lying-in facilities, apprenticeships, care for the sick, homes for the aged and almshouses. Henry Mayhew wrote in his London Labour and the London Poor (1851) : 'The Jews ... are much to be praised, for they allow none of their people to live or die in a parish workhouse. It is true that among the Jews in London there are many individuals of great wealth, but there are also many rich Christians who care not one jot for the need of their brethren.' For many of the rich, one motive for helping the poor was certainly self-interest. As Haham Dr Moses Gaster said:2 'The boon of satisfactory health concerns the wealthy and the less wealthy members of the community alike. Assume for a moment that there were no hospitals at all: what would be the position of the well-to-do? They would be faced with a terrible cause of infection, and for their own sakes would have to take upon themselves the task of helping the poor sufferers.' Further, the wealthy sought to protect their standing in the general com? munity and sometimes associated themselves with the needs of the immigrant community only so long as it was virtually on their own terms. But self interest does not necessarily imply selfishness, and the wealthy Jews did a great deal for the sick poor out of compassion, benevolence and a sense of duty. Within a few years of the Resettlement in 1656, the Sephardi community employed a physician to treat its poor. The Ashkenazi synagogues too, the 2 JC 18 March 1912. 94</page><page sequence="3">Health and medical care in the East End of London Great, the New and the Hambro, employed a doctor who gave free treatment to those living within a one-mile radius of Duke's Place, an area that included the majority of London's Jewish poor. There were many spheres in which Jewish institutions were in the van? guard of progress - in care for the blind and the deaf, in providing home helps for pregnant and nursing mothers, health visiting and care for school? children, and in the fight against tuberculosis and poor sanitation. The Jewish Blind Society was established as early as 1819, and it was claimed by the Jewish Chronicle in 1842 that 'now, happily there does not remain in the metropolis a single blind Jew requiring aid without a stipend for life'.3 The Jews' Deaf and Dumb Home opened in Whitechapel in 1865 and was a pion? eer in this country of the oral- and lip-reading system.4 In 1861 the Jewish Board of Guardians took over from the synagogues the responsibility for providing doctors and medicines for the poor, but the Board soon discovered, as governments have found to their despair ever since, that it is extremely difficult to control the cost of medical care.5 The numbers calling on the Board's medical services quickly rose and the Board believed it was being taken advantage of by those who could afford to pay for their own medicines. As costs soared, the Board instigated an enquiry into the efficiency of the free services provided by doctors employed by the local authorities and found them to be adequate. The Board concluded that there was nothing of a specifically Jewish character in the dispensing of drugs and the giving of medical advice and decided in 1879 to end this service. So it was that immediately before the massive influx of the 1880s one of the strands of Jewish medical care was removed. The Board, however, continued to play an important role in safeguarding the health of the Jewish poor, as will be referred to later. The voluntary hospitals In 1880, although there was no National Health Service, a wide range of health services were available. London was generally better supplied with such services than the rest of Britain, and the East End of London better supplied than the rest of London. If you had to be Jewish, poor and ill, the East End was a good place to be. In the midst of the Jewish East End stood the great London Hospital (now the Royal London), at the time one of the 3 JC 12 August 1842. 4 I. Harris, Jubilee History of the Jew's Deaf and Dumb Home 1865-1915 (London 1915); The History of the Residential School for Jewish Deaf Children, written by ex-pupils and staff (Research by Joan Weinberg) (London 1992). 5 V. Lipman, A Century of Social Service 1859-1959. The History of the Jewish Board of Guard? ians (London 1959). 95</page><page sequence="4">Gerry Black foremost hospitals in the world. Instituted in 1741,6 it had from its earliest days provided Jewish patients with the opportunity to obtain kosher food by giving them an allowance of 2^d a day to purchase their own meat and broth. Over the next two centuries, and until after the Second World War, the London Hospital met requests from the Jewish community for kosher food, Jewish wards, facilities for celebrating the Sabbath and Jewish Festivals, spe? cial visiting hours, special arrangements for post-mortems and even separate ice chambers for Jewish bodies. They engaged Jewish almoners and on the death of a Jewish patient allowed wackers into the wards. At any given time there were several Jews on its Board of Governors and House Committee, although there does appear to have been a quota in operation; as one Jewish member died or retired he was replaced either the same year or the following year by another.7 Why was the London Hospital so generous to its Jewish patients? The answer lies in the generosity of the Jewish establishment towards the Hospital. The great voluntary hospitals such as Guy's, Bart's, St Thomas's and the London depended for their continued existence mainly on voluntary dona? tions from the public, and these came principally from the rich. Particularly strong ties existed between Nathaniel, the first Lord Rothschild, and Viscount Knutsford, the Chairman of the London from 1897 to 1931.8 Following the mass immigration of the 1880s Rothschild and Knutsford entered into an agreement9 according to which Knutsford would ensure that the London Hospital provided poor Jews with every facility they could reasonably require, while Rothschild agreed to ensure that wealthy Jews contributed handsomely to the Hospital. Both kept their word. The London provided the facilities, and wealthy Jews supported the London financially. Dr Eardley Holland, a consultant at the Hospital, said in 193710 that he started his day at the Hos? pital by lecturing to students in the Bearsted Clinical Theatre, proceeded to operate in a theatre provided by W. B. Levy, conducted pathological re? search in the Bernhard Baron Institute and attended patients in wards named after a Raphael, a Rothschild and a Stern. At the King Edward VIFs Hospital Fund (now the King's Fund), of which he was a commissioner, the Samuel Lewis Bequest11 was one of the main sources of income. 'In proportion to 6 A. E. Clark-Kennedy, The London (London 1962) (2 volumes); E. W. Morris, A History of the London Hospital (London 1910). 7 Thesis 206, 207. 8 N. Langton, The Prince of Beggars. A Biography of Lord Knutsford (London 1923); Viscount Knutsford, In Black and White (London 1926). 9 JC 21 May 1915. Similar unwritten arrangements were made by the Jewish establishment with other voluntary hospitals in London, particularly with the German Hospital and the Metropolitan Hospital, and elsewhere in the country. 10 JC 9 July 1937. 11 G. Black, Lender to the Lords; Giver to the Poor. A Biography of Samuel Lewis (London 1992). 96</page><page sequence="5">Health and medical care in the East End of London their numbers', he said, 'Jewish people give far more to the hospitals in this country than do other people'. The agreement between Knutsford and Lord Rothschild served the London Hospital and its Jewish patients well. Similar unwritten arrangements were made by the Jewish establishment with other voluntary hospitals in London and elsewhere in the country.12 The infirmaries The second type of hospital then available was the infirmary, funded out of rates. Originally infirmaries were Poor Law workhouse hospitals catering solely for sick workhouse inmates, but over time the general public was admit? ted.13 The main East End infirmaries were in Vallence Road, Whitechapel, and Bancroft Road, Mile End. The infirmaries never lost the taint of their connection with the harsh Poor Laws, and were generally inferior to the voluntary hospitals in staffing and equipment. They were not popular with East End Jews. The Revd A. A. Green, the minister of Hampstead Syn? agogue, said in 1909:14 'Much care is bestowed at the infirmary, and great desire exists to do all that is possible for the welfare of the patients. But a workhouse infirmary is a workhouse infirmary when all is said and done . . . and the Jew ... is regarded more or less as an alien, and when he can speak only Yiddish this is accentuated ... It often happens that a Jew who wants to put on his hat when he takes his meals, and who wants to put on tephillin and say his prayers in the morning, is assailed with all manner of comment, ribald and blasphemous, which renders his stay a perfect purgatory.' However, there were always bed-shortages at the voluntary hospitals and Jew and non-Jew alike had no alternative but to attend the infirmaries, unwill? ing as they might be to do so. Despite their deficiencies, the East End infirm? aries reached as least as high a standard as those in the rest of the country, if not higher, and were rapidly improving. Some also served kosher food and arranged Passover services if these were requested. Thus hospital services for poor Jews living in the East End were good for their time, but there was a large body of Yiddish-speaking immigrant Jews who were ill at ease in them. They believed that patients who felt comfortable in their surroundings were half way to a cure, and that the only hospital in which this would be the case was one in which the doctors and nurses, the general staff and even the porters were Jewish; one in which Yiddish would be widely understood and spoken. The movement that led to the establish? ment of a Jewish hospital in the East End began in 1907. It became a rare 12 Particularly with the German Hospital and the Metropolitan Hospital. Thesis 226-41. 13 R. Hodkinson, The Origins of the National Health Service (London 1967). 14 JC t Tunnorv innn 97</page><page sequence="6">Gerry Black example of wealthy Jews not only not helping to found such an institution, but actively working against it. It was an unpropitious moment for the supporters of the scheme to start. As medicine, surgical techniques and equipment improved, so costs increased and patients' expectations rose. Voluntary hospitals were finding it increas? ingly difficult to cope with the demand for their services and their financial state was parlous. Bed, ward and wing closures became commonplace in the first thirty years of the twentieth century. At one stage the London Hospital could not pay its milk-bills, and Knutsford threatened a complete closure of the hospital.15 It was obvious at the beginning of the century that the great voluntary hospitals could not survive in their existing form without considerable muni? cipal or State assistance or even a State takeover. So when in 1907 an East End barber called Isador Berliner and a few of his working-class friends met in a basement flat in Sydney Street and announced they were intending to raise sufficient money to build and maintain a voluntary hospital close to the London Hospital, it seemed a ludicrous undertaking, particularly as it soon became clear that Lord Rothschild opposed the scheme. He did so partly because of his agreement with Knutsford, partly from fear that Jewish contri? butions to the London and the other voluntary hospitals would decrease and that that would lead to a diminishing service to their Jewish patients, and partly because he thought it was an unnecessary and divisive move. He reso? lutely set his face against it, and influenced his wealthy friends to oppose the scheme too. Not a single wealthy member of the community came to the aid of these working men. The Jewish clergy were also against them as, initially, was the Jewish Chronicle. After a long and gruelling struggle and many setbacks, the barber and his friends overcame the opposition and succeeded in raising the necessary capital in donations from the East End poor. At their first meeting they collected the princely sum of one shilling and sixpence, but they persevered. As L. J. Greenberg, the editor of the Jewish Chronicle, described it:16 'They had to work and labour and strive and contrive for pennies and halfpennies and farthings, to canvass from house to house, night after night, in storm, in rain, in tempest or when the atmosphere in the alleys and byways they visited was well-nigh asphyxiating.' It was not until 1919 that they were able to open the out-patient depart? ment, and not until 1921 that the Hospital was fully operational. Berliner was elected President, but its first chairman, appointed in 1919, was Nathaniel's 15 Letter dated 27 May 1920, Viscount Knutsford to Sir George Newman, Chief Medical Officer of Health. A copy is in the archives of the London Hospital. 16 JfC 29 November 1926. 98</page><page sequence="7">Health and medical care in the East End of London son, the second Lord Rothschild. With him on board, the money flowed in. Prior to nationalization in 1948 the London Jewish Hospital, with no beds, was an outstanding success, open to persons of all religions. It was reasonably well funded; its consultant, resident and nursing staff, mostly Jewish, were of high calibre and it was described as one of the happiest hospitals in London. After the Second World War the Jewish population of the district was reduced to 10,000 or less, smaller hospitals fell out of fashion and the Hospital suffered from gross governmental underfunding. In a letter dated 22 February 1954, addressed to the chairman of the Hospital Council of Management, one of the consultants complained that the Regional Health Board felt that the London Jewish Hospital did not fit in with their scheme of things, and that they visualized it as 'an orphan left on their doorstep by the Health Act'. The quality of its service was inevitably affected. However, though after 1945 there were more non-Jewish than Jewish patients, its Jewish atmosphere was retained until it closed in 1979. The general practitioners Many East Enders, including some who could have afforded to pay for a doctor, used the out-patient departments of the hospitals as one would a doctor's surgery today - attending for simple matters such as coughs and colds - much to the consternation of local general practitioners who were struggling to establish themselves. However, despite the vast numbers who attended the hospital out-patient departments, the first person consulted by the sick poor was usually a general practitioner, either in private practice, often referred to as a 'sixpenny doctor', that being their usual charge, or a parochial district medical officer, employed by the local guardians. Some 'sixpenny doctors' achieved high earnings. The Daily Telegraph of 21 December 1910 referred to one East End practitioner who made between ?2000 and ?3000 a year from his patients, a remarkable income for the time. He saw sixty to seventy patients an evening between six and nine, payment was made at the time of the visit so that there was no sending out of accounts or bad debts and medicine was dispensed on the premises. There were com? paratively few Jewish doctors in the East End prior to the 1920s since it was the children of the first generation of immigrants who first qualified as doctors in any numbers. The district medical officers operated the system that the Jewish Board of Guardians had considered perfectly adequate in 1879 f?r those too poor to pay a private practitioner. To obtain their services a sick person had first to apply to a Relieving Officer of the local parochial Board of Guardians for a medical order. Some Relieving Officers could be cold and distant and com? paratively few Jews approached them for medical relief. They preferred to go 99</page><page sequence="8">Gerry Black to a private doctor and the pay sixpence that they could ill-afford or go to a hospital out-patient department despite the long queues. The dispensaries Several local dispensaries provided services similar to a doctor's surgery and were open to all. Some were entirely free. The oldest and one of the largest was the London Dispensary in Fournier Street. According to its 1917 Annual Report it had treated more than 400,000 patients since its inauguration in 1777. It depended on donations from the public, as did others, such as the Eastern Dispensary in Leman Street founded in 1782, and the East London Dispensary in Commercial Road. The East End Dispensary of the German Hospital was in Great Prescott Street, and the overwhelming majority of its patients were Jewish. There was a free dispensary within easy reach of most of the East End Jewish population. There were also several provident dispensaries. For the payment of a few pennies a week, families obtained the right to have medical treatment for all their members, usually with a choice of doctors. One of the largest organiza? tions, the Metropolitan Provident Medical Association, had many Jewish members on its ruling council, and had branches in Leman Street and Whitechapel Road. It had an upper limit of ?2 10s per week income for membership, to exclude the well-to-do who were, it was said, 'not above taking advantage of the medical attendance at the cheap rates offered by dis? pensaries'. The medical missions Christian organizations seeking to convert Jews were active in the East End from the beginning of the nineteenth century, opening free schools in the Jewish area. But it was their medical missions that caused the greatest heart? ache for the Jewish community, and these began to open shortly after the Jewish Board of Guardians ended its medical department in 1879. They made no secret of their objective, and their journal, The East End Mission, said:17 'The sole aim of our medical work is to lead these people from Judaism to the light of the Gospel, and to heal the disease of the soul through curing the sickness of the body. Hundreds owe their conversion to the Providence which, working through their sickness, brought them to the Medical Mis? sion.' In 1891 the London Society for Promoting Christianity among the Jews acquired premises in Goulstone Street for what was described as 'aggressive evangelistic work'. In his history of the Society,18 Revd W. T. Gidney wrote: 17 Quoted in the United Synagogue Mission Committee Report (1912). 18 W. T. Gidney, History of the London Society for Promoting Christianity Among the Jews 180g igo8 (London 1908). 100</page><page sequence="9">Health and medical care in the East End of London 'With thousands of Jews on every hand, it was admirably suited for this purpose, being in the midst of the dense and poor Jewish population of the East End, chiefly hailing from Russia and speaking Yiddish. The combination of a medical missionary organisation, with efforts of a more direct spiritual character, had tended to make the work very effective and telling.' At differ? ent times during the period 1880-193 5 there were at least nine medical mis? sions in the Jewish East End, including missions in Fournier Street, Whitechapel Road, Cambridge Road, Commercial Road, Buxton Street and Philpott Street. A correspondent of the Jewish Chronicle said19 those who attended 'had first to hear a lengthy sermon preached against our religion, which is held to ridicule, to which they listen in silence, afraid to say a word against the sermon for fear of not being able to see the doctor', and sometimes the doors were locked so that they could not escape it. According to a report in the Jewish Chronicle of 12 December 1913, every morning at about 8.30 am, and every afternoon at about 1 o'clock, there was a large crowd, 99 percent of whom were Jewish, outside the doors of the Philpott Street Mission. Its staff consisted of two full-time and two part-time doctors, a dentist, a consulting dentist, three lady dispensers and three assistants. A Yiddish-speaking nurse was always available. It was open every day of the week until 3 pm and a number of patients were allowed to recuperate at the Mission's Convalescent Home at Brentwood in Essex. The missions were undoubtedly popular. Many East End Jews could not afford the 'sixpenny doctors', resented the long waiting time in the hospital out-patient departments and were unhappy at the thought of undergoing a searching and sometimes unpleasant inquiry from a parochial Receiving Officer. Mission doctors won their confidence and enjoyed a reputation for skill. They did not hurry the patients and allowed time for general conversa? tion and sympathy. Importantly, they were an additional source of treatment. Many Jews (and non-Jews) went from hospital out-patient department to missionary dispensary and then to a doctor, all for the same complaint, taking a bottle of medicine from each, imbibing a spoonful from one in the morning, another in the afternoon, and a third in the evening. One witness to a United Synagogue Inquiry in 191220 into the work of the Missions said that if a fresh batch of doctors came into the East End they would all find work and none of the existing doctors would suffer. The Jews would consult both. East End Jews appear to have had few qualms about availing themselves of the missionaries' medical care - they took the leaflets, listened to the prayers and sermons (although some women stuffed their ears with cotton " 8 June 1923 20 United Synagogue Mission Committee Report (1912). 101</page><page sequence="10">Gerry Black wool so that they should not hear the name of Christ), and departed none the worse for wear. The evidence indicates that there were very few true converts. Jewish friendly societies Jewish friendly societies were another valuable source of medical care. By 1911 there were 25,000 individual members of Jewish friendly societies, con? tributing an average 2d per week for medical benefit. Many a Jewish father made it a condition of giving his consent for the marriage of his daughter that a prospective son-in-law should join a friendly society. Most societies gave full sickness benefit of 15s per week for about thirteen weeks, and half that for the next thirteen weeks. Members had the services of a doctor, and many Jewish general practitioners in the East End derived their staple income from their contracts with friendly societies. On average, Jewish friendly societies gave higher medical benefits than non-Jewish ones. During the passage of the Insurance Bill through Parlia? ment, the Federation of Jewish Friendly Societies secured changes to clauses that would have caused hardships for aliens who constituted a high proportion of their membership. They achieved this by convincing Lloyd George that overall Jewish societies paid out, per member, less in sickness benefit than the general societies. From this it was argued that Jews would be less of a burden on the National Insurance Scheme than the general public. How could Jewish societies pay higher benefits, and yet spend less per head? The answer is partly that there were fewer sickness claims by members of Jewish societies, but detailed examination revealed that much of the difference was accounted for by the duration of the claim for sickness benefit - Jews seemed to throw off sickness more quickly than non-Jews. It is course possible that the figures reflected a different attitude to work and to the return to it after illness rather than a quicker recovery time. Because Jewish societies paid out less for sick? ness benefit, they achieved surpluses that were used to improve other bene? fits - such as disablement and maternity benefits, and payment for consulta? tions with specialists. Some societies also paid for nursing, dental and hospital treatment. Convalescent homes The Association of Jewish Friendly Societies opened a convalescent home at Birchington-on-Sea in 1921, and three years later Isaac Seligman, a generous supporter of the Jewish Board of Guardians and a vice-president of the Jews' Deaf and Dumb Home, presented his country house, Shoyswell Manor, near Etchingham in Sussex, for the same purpose for members of the Achei Brith 102</page><page sequence="11">Health and medical care in the East End of London and Shield of Abraham Friendly Society. The Samuel Lewis Seaside Conval? escent home at Walton-on-the-Naze was opened in May 1910, built from the proceeds of a legacy of ?100,000 from the charitable moneylender. They were an important additional benefit to the Jewish community because there were very few convalescent homes in England at the time. The Jewish Board of Guardians By far the most important Jewish organization involved in the promotion of medical care for the Jewish poor was the Jewish Board of Guardians, founded in 1859 and now Jewish Care. Although in 1879 it gave up direct responsibil? ity for providing general practitioner services, it remained active in sanitary inspection of housing, health visiting and the fight against tuberculosis. It must be emphasized that most East End poor Jews did not live in slum property, but this still left many who did. In their First Annual Report in 1862 the Board's medical officers drew attention to the connection between disease and overcrowded and insanitary dwellings, and the Board set itself three housing targets: to remedy structural defects by ensuring that necessary work was carried out by landlords or local authorities, to assist tenants to keep their homes clean and whitewashed and to encourage the clearance and replacement of insanitary dwellings by more satisfactory accommodation. This should have been the responsibility of landlords or local or governmental authorities, but in 1880 public-health legislation was largely a matter of volun? tary adoption, slum clearance statutes had not yet appeared and the ineffi? ciency of the local statutory bodies theoretically required to carry out this work was notorious. The Board appointed its own full-time sanitary inspector. Although it had no legal power to exercise against landlords, the Board sent out official looking printed letters. If that persuasion did not provoke a response they referred the cases, with details, to the Board of Works of the Whitechapel and adjoining districts. If the Boards of Works were slow to respond, as Whitechapel originally was, pressure was exerted on them. By 1885 the Board's inspector had made 3831 home visits. He found considerable defects in 500 homes and persuaded the landlords to remedy 450 of them. By 1887 the Board was able to report that 'the sanitary condition of the districts in which the Jewish poor reside is being slowly but surely ameliorated', and the Whitechapel Board of Works were said to have changed their hitherto rather hostile attitude and to be 'most anxious' to assist in keeping the houses in a habitable condition. Slum clearance began in earnest in the 1880s, and the combined efforts of Lord Rothschild's 4 percent Industrial Dwellings Co. Ltd and the East End 103</page><page sequence="12">Gerry Black Dwellings Company21 provided Aldgate and Whitechapel with some solid and sanitary accommodation at a fair rent and helped relieve the squalor. When the Board's sanitary inspector retired in 1905 he was replaced by two lady health visitors who in that year dealt with only 140 cases of sanitary defects, an indication of the progress that had been made. But the enemy had changed and they had to attend nearly 3000 cases of tuberculosis, 'the terrible scourge', as Lloyd George described it. At the end of the nineteenth century the governmental, local authority and voluntary services available to wage war against tuberculosis were negligible. In 1897 the Board of Guardians appointed a special committee that called many distinguished and expert wit? nesses and made minutely detailed recommendations to avoid the spread of the disease.22 All Jewish cases notified to the Board by the family or the doctor of an afflicted person were visited. Families were taught elementary but effective precautions: they should not kiss a consumptive on the lips or use a spoon or cup used by a consumptive until it had been soaked in boiling water and carefully washed. The Board supplied each patient with a separate bed. Bedrooms were sealed and fumigated, ceilings stripped and walls dis? tempered. Floors and furniture were washed with carbolic soap of hospital strength, clothes worn by the patient and his bedding were taken to a disin? fecting station and an explanatory leaflet in Yiddish was distributed. It is no exaggeration to say that the Board's fight against tuberculosis brought incalculable benefit to thousands of families. A major part of the time of the two lady visitors was taken up with trying to obtain admission for their consumptive cases into a sanatorium since there were only a few sanatoria for tuberculosis sufferers in the whole of England. The Jewish population had a great advantage in that a sanatorium, Danes wood, had opened in 1903 at Woburn Sands, presented to the community by Louis Bischoffsheim and his wife Clarissa. It was in an ideal spot, situated among pine trees on a beautifully wooded hill over 400 feet above sea level. It was officially estimated that there was a need for one bed for tuberculosis sufferers for every 5000 of the population. Daneswood, with its twenty-two beds, provided room for approximately half of all Jewish sufferers. Care for infants, children and youth Special arrangements were made by the community to care for the health of infants in the 1890s, when the Jewish Board of Guardians arranged East End Jewish Mothers' Meetings to give help and advice to mothers of babies and 21 J. White, Rothschild Buildings. Life in an East End Tenement Block i88j-iq20 (London 1980); K. Rubens, 'The 4% Dwellings Company, its Formation and its East End Developments 1855-1901', in A. Newman (ed.) The Jewish East End (London 1981). 22 In its Report of 27 January 1898, reproduced in full in App. A of Thesis. 104</page><page sequence="13">Health and medical care in the East End of London young children. A Jewish Day Nursery was opened in 1896, moving to New Road in 1901. Initially, the charge was twopence a day, that covered a break? fast of bread and milk, a wholesome lunch and tea and milk in the afternoon. It had the best of facilities and was run on up-to-date hygienic lines. Dr Bernhard Morris visited daily from 1897 to 1943 when the nursery was evacu? ated, and as a result there was almost no risk of epidemics arising, and rickets, then a common problem, was recognized at an early stage. Lady Rothschild became its active President and remained so until her death in 1936. The 1905 Royal Commission into the Poor Laws discovered that in the whole of London there were places in day-nurseries for only 2000 children and that many of these nurseries were overcrowded, ill-ventilated and were staffed by people who showed an utter lack of knowledge of the most elementary prin? ciples of hygiene. The Commission reported that 'only a few' were good. The Jewish Day Nursery was one of these, another example of East End Jews enjoying a superior medical service. Health talks were also given to mothers at the Jewish Mothers' Welcome &amp; Infant Centre that opened in Great Alie Street in 1895. From 1902 it was under the auspices of Mrs Arthur E. Franklin who was its President and Chairman for more than a quarter of a century. After various moves it settled in Berner Street and had a qualified medical practitioner and two trained health-visitors on its staff. It had an ante-natal clinic, daily attendance for minor ailments and monthly social gatherings for the mothers and members of the committee who met in an informal atmosphere. All Jewish births in the district were notified to these Jewish centres by Stepney Borough Council, and the centres sent health visitors to homes to persuade mothers to bring their children in for supervision. It was rare for a Jewish child in need to be overlooked by the system. Mrs Alice Model (1856-1943) was the dominant figure in the East End for providing nursing assistance to sick or pregnant Jewish mothers and their children. Born into a comfortable middle-class family in West Hampstead, her activities embraced the Jewish Day Nursery and the Sick Rooms Help Society. The Society, based on an institution in Frankfurt, was opened in January 1895 by Mrs Model and Miss Bella Lowy, and sought to take the place of the mother in the home at a time when, by reason of confinement or illness, she was unable to cope by herself. The 'helps' were sent in to run a home only when there was no other woman, or girl old enough, to do so. They washed the baby, got the children ready and sent them to school, cooked the food, tidied and cleaned up the home and took care of the washing. Lady Samuel described them as 'scientific charwomen'.23 It gave the mother peace of mind, which helped her physical recovery for she knew that her 23 Interview in JC n July 1913. io5</page><page sequence="14">Gerry Black husband and children were well cared for. Although neighbourly help was perhaps more readily available in the Jewish East End than it would be today on a modern estate or in suburbia, there was still a need for such a service. With the financial assistance of Lady Rothschild, F. D. Mocatta, Sir Julian Goldsmid and a few other friends, two trained nurses were employed. In 1897 the Society started a provident section 'to encourage self-respect and thrift5 in accordance with the Victorian values that it shared. The sub? scription was one penny a week, and in Mrs Model's words the paying mem? bers were not simply beneficiaries of a charitable institution, but 'a combine of women for mutual help'. By 1904 the Society had six trained nurses and thirty-six helps, each case being nursed for a fortnight. By 1908 there were 3700 provident members. In the whole of London there were less than a dozen maternity hospitals, when at the Society's Annual General Meeting in 1909 Sir Isadore Spielman called for the establishment of a Jewish Maternity Home. The following year the Society received a bequest of ?5000 from the estate of Ada Lewis, the widow of Samuel Lewis, and, together with a grant from the executors of Louisa Lady Goldsmid, enough funds were raised to buy premises in Under? wood Street, off Vallence Road. The Maternity Home was opened in Sep? tember 1911 by Mrs Bischoffsheim. Sir Marcus Samuel donated ?2000 towards the equipment and Mrs Harris Lebus presented the furniture. The site was later extended and became a training school for midwives, with a high reputation. An Infant Welfare Centre was opened and there were meetings for both mothers and fathers on the subject of bringing up children. In 1925 a new, up-to-date welfare building was completed that included living accommodation for the district nursing staff and the health visitors. Adjoining land was purchased and in November 1927 an enlarged maternity home with fourteen beds was officially opened by Lord Reading. Mrs Model claimed, in an article in the Jewish Chronicle in May 1926, that in the midst of the Jewish area in Whitechapel a complete maternity and child-welfare centre had been established that was considered a model of its kind by the authorities. It was a striking tribute to her, to those who had worked with her and to those who supported the scheme financially, but its success could not have been achieved if ordinary Jewish East End mothers had not responded eagerly to the oppor? tunities afforded them and, as witness the success of the provident scheme, been prepared to pay something towards the essential costs. The Society was a pioneer in a very important sphere of social effort and Mrs Model was frequently asked to address public conferences to explain the Society's system. It was widely copied in other parts of the country and was a field in which the Jewish community led the way.24 24 In 1933 there were nearly 800 births at the Home. Thereafter the numbers declined, as did the general birth rate and, indeed, the Jewish population of the East End. Ironically, the io6</page><page sequence="15">Health and medical care in the East End of London Youth clubs played an important role in the social life of Jewish East End youth, and one of their main aims was to improve the physical condition of their members. The Brady Street Boys' Club sought to 'improve their stunted physique and raise their general tone and bearing', and other clubs followed their lead. Together with the Jewish Lads' Brigade, the Cadet Corps and the Jewish Athletic Association (later to be known as the Association for Jewish Youth), they provided facilities for the improvement of both physique and health. Jewish East End schools also helped by providing heavily subsidized school meals, and at the Jews' Free School in Bell Lane, courtesy of the Rothschild family, clothing and boots were supplied for every pupil at the school every Rosh Hashanah. Jewish and non-Jewish health compared As has been seen, East End Jews undoubtedly enjoyed several additional med? ical benefits, but did they as a result enjoy better health than their non-Jewish neighbours? Various programmes of research were carried out, and in three matters there was agreement between the various experts. Among Jews alco? holism and its associated diseases were practically non-existent, venereal dis? ease was comparatively rare and on the whole Jewish children were in better health than non-Jewish children of the same age living in similar conditions. Three government reports shed some light on the subject - the Select Committee on Emigration and Immigration of 1888, the Interdepartmental Committee on Physical Deterioration of 1904 and the Report upon the Phys? ical Examination of Men of Military Age by National Service Medical Boards in 1918. The last two were established following the discovery of the abys? mally low physical standard of recruits for the armed services during the Boer War and First World War respectively. Evidence given to the various inquiries25 suggested that although many Jews worked 100 hours a week, this did not materially injure their health. This was attributed to the fact that although they did not enjoy physical strength, they had stamina. Abraham Levy, the headmaster of Old Castle Street Board School, said that after a short time in England Jewish immi? grants were very clean, and although not sturdy men who could break stones or lift heavy loads, were tenacious. Dr Eustace Smith, who practised at East London Children's Hospital said Jewish children were seldom emaciated. Colonel Fox said he had visited several schools in Whitechapel and that the headteacher in every school had told him that the Jewish children were of good physique. home became known not as Mrs Model's Home, but Mrs Levy's, named after its long-serving superintendent. In 1938 the home moved to a new site, in Lordship Road, Stoke Newington, under the name 'The Bearsted Memorial Hosnital'. 25 Thesis, 21-6. 107</page><page sequence="16">Gerry Black If, as the evidence suggests, Jewish health was better, what were the reasons for this? The witnesses to the inquires had different theories, the most com? pelling of which was that because Jews spent less on drink, they had more to spend on food. Revd Moses Abrahams, Hebrew teacher at Stepney Jewish Schools, pointed out that every Jewish household was thoroughly cleaned at least once a year, at Passover. Dr Eichholz, a senior school medical officer, said that good nutrition was an even more important factor for ensuring good health than an absence of dirt and overcrowding, and that Jews made a great point of providing nutritious food for their young children. General Sir Fred? erick Maurice, General Officer Commanding at Woolwich, said that the Jewish child, although coming from extremely poor quarters and under very unsavoury conditions, was as a rule stronger and healthier than his non Jewish counterpart, and attributed this to the Jewish mother not only provid? ing proper food, but also staying at home looking after the children rather than going out to work. Charles Booth said kosher meat made the difference, because it came from animals certified as being healthy. And overlaying all this were the additional medical facilities that Jews enjoyed that have been discussed earlier. Conclusions Looking back over the past two centuries at the pattern of Anglo-Jewish charitable institutions providing welfare to the poor of the Jewish community, including medical care, education, clothing and housing, the evidence shows that the community has been well-served by its philanthropists. Rabbinic teachings assert that the genuinely needy are entitled to assistance and that the giving of charity is not a virtue, but a duty. Maimonides wrote 'we are duty bound to observe the commandment to give charity more than any other positive commandment'. Leopold Greenberg, editor of the Jewish Chronicle during the first part of the twentieth century, would headline details of the wills of recalcitrants with the words 'To charity, nil!' in order to encourage benevolence. Not all Jewish philanthropists were religious Jews, but many who were not were still imbued with Judaism's tenets. The motives of those making charitable donations are varied. Some are driven by a sense of religious duty, social idealism, civic patriotism, personal satisfaction, a desire for self-perpetuation or control, or they may simply belong to a culture that regards such actions as worthy. The charitable instinct can stem from sympathy for one's fellow beings, concern for the stability of society, ethnic sympathies, family tradition, self-interest or, most often, a combination of two or more of these. It is true that some seek personal publicity or the opportunity to climb the social ladder, but even if a donor's objective is purely selfish it is surely better that they should give than not give. 108</page><page sequence="17">Health and medical care in the East End of London Most Victorian Jewish philanthropists gave of their time as well as their money, and took a prominent part in the administration of the institutions they supported financially. The Rothschilds and others not only wrote the largest cheques, they made the management of institutions their personal concern. 'Natty' Rothschild ran the family bank and was consulted by govern? ments, but always made time to chair the regular meetings of the Board of Governors of the Jews' Free School and to meet and advise its headmaster at short notice. This hands-on approach in Jewish charitable institutions was essential because there was then no one else in the community capable of and willing to undertake the burden. Philanthropists, as others, must not be criticized for failing to adopt solu? tions that became fashionable or were indeed discovered only after their death. Some self-evident 'truths' in Victorian England became self-evident 'fallacies' in the twentieth century. So I find it sad when the efforts of Jewish Victorian philanthropists are denigrated as being nothing more than part of a class war and as an attempt to control the Jewish poor for their own selfish purposes. It has been suggested that wealthy Jews deliberately sought physical separation from the Jewish poor in the East End, as though the rich have not always set up home in more salubrious areas, or that the Jewish Board of Guardians availed itself of the facilities that the State provided simply in order to relieve itself of a burden, even though that was merely a sensible policy. The same critics would not now suggest that Jewish Care should refuse government and local authority funding. The evidence I have encountered in the course of my research leads me to a contrary conclusion. Although benefits given by the Jewish Board of Guard? ians in the nineteenth century might appear parsimonious by today's stand? ards, at the time they were generous. The Board followed the accepted wisdom of the time in order not to create what today might be called a benefit-dependency culture. Compared to its main contemporary non-Jewish counterparts, the Charity Organisation Society and the local Guardians, the Jewish Board of Guardians adopted a more humane approach. The C.O.S., founded a decade after the Board - Knutsford suggested its initials stood for 'Choke Off Sympathy' - considered the Board to be an indiscriminate distrib? utor of charity that gave too much, too easily.26 It is true that the Jewish rich feared that the Jewish poor, if they were not helped, could became a burden on the rates and in turn cause a backlash against all sections of the Jewish community, including themselves, but it is wrong to suggest that that was the sole, or indeed the main reason for the actions they took. They viewed the newcomers with a mixture of sympathy 26 C. W. Mowat, The Charity Organisation Society: Its Ideas and Work i86g-igij (London 1961) 114. 109</page><page sequence="18">Gerry Black and alarm, and feared that the sheer numbers involved might encourage the anti-Semitism that was increasing in English society in the late 1870s. Indeed, there were rumblings of discontent against the newcomers even among working-class Jews. For a time British Jews attempted to stem the flow of post-1881 immigrants, fearing they could not cope with the numbers, but once it was clear that these were here to stay they cared for them. Lord Rothschild was one of the foremost opponents of restrictions on immigration and was joined in this fight by many other wealthy Jews. Jewish Victorian charity organizations depended almost entirely on the support of the wealthy, as did their non-Jewish counterparts; half the income of the Jewish Board of Guardians came from just forty families. Inevitably this gave control over most of the community's organizations to a comparat? ively small band, but it was a benevolent control. In time, the old elite was superseded. The First World War brought a heavy loss of life among its young men and high levels of taxation in the inter war years reduced the capacity for largesse. The newly rich in the Jewish community were connected with profitable new commercial enterprises, and these men and their families, almost all of immigrant birth or first-generation British-born, mostly identified themselves with the Zionist movement and with the ever-increasing group in the Jewish middle class who by the 1920s were prepared, indeed anxious, to undertake the burden of supporting the Jewish social services, taking over control from the elite whose influence con? tinued to wane throughout the 1930s. Those with the courage to address a problem lay themselves open to criti? cism often from those who do the least. Whether the motives of the Jewish establishment in protecting the interests of the Jewish poor were altruistic or self-interested is of less importance than the fact that they took action success? fully on behalf of the Jewish poor. The charitable system they set up provided a cushion against the everyday problems with which the Jewish poor had to contend and the superior medical services enjoyed by the Jewish immigrant poor in the East End justified these efforts. Those who now say that the wealthy merely sought, for their own ends, to control the Jewish proletariat should consider in what conditions the Jewish poor would have lived had they not taken the action they did. There would surely have been a great deal of avoidable illness, pain and distress. In retrospect, the Jewish Board of Guardians must be said to have judged rightly whether and when to make its own provision for the sick Jewish poor or leave it to the State and local authorities. Strong contemporary criticism was expressed concerning the Board's ending of medical relief in 1879 and several unsuccessful attempts were made to persuade it to change its mind. Yet no such private organization could have funded the escalating cost of such services, and the Board recognized at an early stage that only the State no</page><page sequence="19">Health and medical care in the East End of London could do so, perhaps together with the private charitable sector, and saw this before others engaged in similar activities. The character of East End Jews greatly alleviated their situation. They were receptive to provident schemes for self-help, particularly through the Jewish friendly societies and the medical dispensaries, and East End Jewish mothers responded readily to new, improved, modern theories in child care. In almost every aspect of medical care, poor East End Jews enjoyed facilities superior to those of their non-Jewish neighbours and better health, and for this the community as a whole was entitled to share in the credit and be proud of its achievements. Their success was a testament to their humanity and to their commitment to a traditional sense of rachmanut, 'mercy'. The contrasting outlooks of established Jews and recent immigrants remained, but each contributed to remedying defects in the system, and their combined endeavours led to success.27 27 For the full history of the London <plain_text><page sequence="1">Health and medical care of the Jewish poor in the East End of London, 1880-1914* GERRY BLACK Some 35,000 Jews lived in the East End of London in 1880, most of them in Aldgate, Whitechapel and Stepney. Within thirty years, largely as a result of a mass exodus from Eastern Europe, their numbers had grown to 120,000, a high percentage of whom were recent immigrants and many of whom were poor on arrival.1 This massive increase set daunting challenges for the Anglo Jewish leadership, not least in the matter of health care. In the nineteenth century, primary responsibility for social welfare lay with voluntary agencies, particularly in health, education and housing. It was phil? anthropists who made themselves mainly responsible for new hospitals, schools, universities and university colleges; and it was they who financed medical and scientific research and who funded libraries, museums, art galler? ies, public parks and urban housing experiments. Facilities provided by the State were largely supplementary to their efforts. Parliament followed, but rarely initiated social reform. It was only gradually appreciated that voluntary organizations could not provide the complete answer and that the State would have to involve itself. There were three stages in the process. In their earliest days, social services were almost always provided by privately funded and administered organiza? tions. Later, when the State saw that the service met a social need, it assisted with grant-in-aid on a temporary basis while the management remained in private hands. In education, for example, the Jews' Free School largely depended on Rothschild charity throughout the nineteenth century, and gov? ernment financial aid came slowly and only after pressure was applied. In the third stage, the State took over the service and operated it as a public enter Presidential Address delivered to the Society on 18 October 1998. 1 This paper is based on the author's doctoral thesis (hereafter Thesis) of the same title (Leicester University 1987) and subsequent research. A copy of the thesis is in the Tower Hamlets Local History Library in Bancroft Road, Stepney. For further details of the Jewish population in nineteenth-century London see Jewish Chronicle (hereafter JC) 2 June 1876; V. Lipman, Social History of the Jews in England 1850-1Q50 (London 1954) 65, 99; J. Jacobs, Studies in Jewish Statistics (London 1891); L. Gartner, The Jewish Immigrant in England i8yo-igi4 (London i960; C. Russell and H. L. Lewis, The Jew in London (London 1900) App. A; J. Gerrard, The English and Immigration. A Comparative Study of Jewish Influx 1880 igio (London 1971) App. A. 93</page><page sequence="2">Gerry Black prise sometimes with and sometimes without voluntary assistance. Until the State intervened the work had to be done from within the general community, and in areas in which there were Jewish religious requirements, such as the need for kosher food and facilities to respect and celebrate the Sabbath and Festivals, Jews had to look after their own. To a Victorian philanthropist, the contemporary involvement of the State in social and welfare activities would have been inconceivable, and it is in that context that their efforts must be judged. Conversely, it is only with difficulty that an age that takes for granted large-scale public social services can fully comprehend the distinctive role assigned by the Victorians to char? ity. The crucial role in promoting health care for the Jewish poor was played by the wealthy members of the community. They not only provided the bulk of the required money, but undertook control of the institutions carrying out the work. The poor contributed too, sometimes giving more, pro rata, than the middle class. But with a few exceptions, notably that of the London Jewish Hospital and the Jewish workhouse, their payments were only a small proportion of the required total. By the mid-nineteenth century there were thirty-eight Jewish charitable organizations providing pensions, loans, grants, food and groceries, clothing, lying-in facilities, apprenticeships, care for the sick, homes for the aged and almshouses. Henry Mayhew wrote in his London Labour and the London Poor (1851) : 'The Jews ... are much to be praised, for they allow none of their people to live or die in a parish workhouse. It is true that among the Jews in London there are many individuals of great wealth, but there are also many rich Christians who care not one jot for the need of their brethren.' For many of the rich, one motive for helping the poor was certainly self-interest. As Haham Dr Moses Gaster said:2 'The boon of satisfactory health concerns the wealthy and the less wealthy members of the community alike. Assume for a moment that there were no hospitals at all: what would be the position of the well-to-do? They would be faced with a terrible cause of infection, and for their own sakes would have to take upon themselves the task of helping the poor sufferers.' Further, the wealthy sought to protect their standing in the general com? munity and sometimes associated themselves with the needs of the immigrant community only so long as it was virtually on their own terms. But self interest does not necessarily imply selfishness, and the wealthy Jews did a great deal for the sick poor out of compassion, benevolence and a sense of duty. Within a few years of the Resettlement in 1656, the Sephardi community employed a physician to treat its poor. The Ashkenazi synagogues too, the 2 JC 18 March 1912. 94</page><page sequence="3">Health and medical care in the East End of London Great, the New and the Hambro, employed a doctor who gave free treatment to those living within a one-mile radius of Duke's Place, an area that included the majority of London's Jewish poor. There were many spheres in which Jewish institutions were in the van? guard of progress - in care for the blind and the deaf, in providing home helps for pregnant and nursing mothers, health visiting and care for school? children, and in the fight against tuberculosis and poor sanitation. The Jewish Blind Society was established as early as 1819, and it was claimed by the Jewish Chronicle in 1842 that 'now, happily there does not remain in the metropolis a single blind Jew requiring aid without a stipend for life'.3 The Jews' Deaf and Dumb Home opened in Whitechapel in 1865 and was a pion? eer in this country of the oral- and lip-reading system.4 In 1861 the Jewish Board of Guardians took over from the synagogues the responsibility for providing doctors and medicines for the poor, but the Board soon discovered, as governments have found to their despair ever since, that it is extremely difficult to control the cost of medical care.5 The numbers calling on the Board's medical services quickly rose and the Board believed it was being taken advantage of by those who could afford to pay for their own medicines. As costs soared, the Board instigated an enquiry into the efficiency of the free services provided by doctors employed by the local authorities and found them to be adequate. The Board concluded that there was nothing of a specifically Jewish character in the dispensing of drugs and the giving of medical advice and decided in 1879 to end this service. So it was that immediately before the massive influx of the 1880s one of the strands of Jewish medical care was removed. The Board, however, continued to play an important role in safeguarding the health of the Jewish poor, as will be referred to later. The voluntary hospitals In 1880, although there was no National Health Service, a wide range of health services were available. London was generally better supplied with such services than the rest of Britain, and the East End of London better supplied than the rest of London. If you had to be Jewish, poor and ill, the East End was a good place to be. In the midst of the Jewish East End stood the great London Hospital (now the Royal London), at the time one of the 3 JC 12 August 1842. 4 I. Harris, Jubilee History of the Jew's Deaf and Dumb Home 1865-1915 (London 1915); The History of the Residential School for Jewish Deaf Children, written by ex-pupils and staff (Research by Joan Weinberg) (London 1992). 5 V. Lipman, A Century of Social Service 1859-1959. The History of the Jewish Board of Guard? ians (London 1959). 95</page><page sequence="4">Gerry Black foremost hospitals in the world. Instituted in 1741,6 it had from its earliest days provided Jewish patients with the opportunity to obtain kosher food by giving them an allowance of 2^d a day to purchase their own meat and broth. Over the next two centuries, and until after the Second World War, the London Hospital met requests from the Jewish community for kosher food, Jewish wards, facilities for celebrating the Sabbath and Jewish Festivals, spe? cial visiting hours, special arrangements for post-mortems and even separate ice chambers for Jewish bodies. They engaged Jewish almoners and on the death of a Jewish patient allowed wackers into the wards. At any given time there were several Jews on its Board of Governors and House Committee, although there does appear to have been a quota in operation; as one Jewish member died or retired he was replaced either the same year or the following year by another.7 Why was the London Hospital so generous to its Jewish patients? The answer lies in the generosity of the Jewish establishment towards the Hospital. The great voluntary hospitals such as Guy's, Bart's, St Thomas's and the London depended for their continued existence mainly on voluntary dona? tions from the public, and these came principally from the rich. Particularly strong ties existed between Nathaniel, the first Lord Rothschild, and Viscount Knutsford, the Chairman of the London from 1897 to 1931.8 Following the mass immigration of the 1880s Rothschild and Knutsford entered into an agreement9 according to which Knutsford would ensure that the London Hospital provided poor Jews with every facility they could reasonably require, while Rothschild agreed to ensure that wealthy Jews contributed handsomely to the Hospital. Both kept their word. The London provided the facilities, and wealthy Jews supported the London financially. Dr Eardley Holland, a consultant at the Hospital, said in 193710 that he started his day at the Hos? pital by lecturing to students in the Bearsted Clinical Theatre, proceeded to operate in a theatre provided by W. B. Levy, conducted pathological re? search in the Bernhard Baron Institute and attended patients in wards named after a Raphael, a Rothschild and a Stern. At the King Edward VIFs Hospital Fund (now the King's Fund), of which he was a commissioner, the Samuel Lewis Bequest11 was one of the main sources of income. 'In proportion to 6 A. E. Clark-Kennedy, The London (London 1962) (2 volumes); E. W. Morris, A History of the London Hospital (London 1910). 7 Thesis 206, 207. 8 N. Langton, The Prince of Beggars. A Biography of Lord Knutsford (London 1923); Viscount Knutsford, In Black and White (London 1926). 9 JC 21 May 1915. Similar unwritten arrangements were made by the Jewish establishment with other voluntary hospitals in London, particularly with the German Hospital and the Metropolitan Hospital, and elsewhere in the country. 10 JC 9 July 1937. 11 G. Black, Lender to the Lords; Giver to the Poor. A Biography of Samuel Lewis (London 1992). 96</page><page sequence="5">Health and medical care in the East End of London their numbers', he said, 'Jewish people give far more to the hospitals in this country than do other people'. The agreement between Knutsford and Lord Rothschild served the London Hospital and its Jewish patients well. Similar unwritten arrangements were made by the Jewish establishment with other voluntary hospitals in London and elsewhere in the country.12 The infirmaries The second type of hospital then available was the infirmary, funded out of rates. Originally infirmaries were Poor Law workhouse hospitals catering solely for sick workhouse inmates, but over time the general public was admit? ted.13 The main East End infirmaries were in Vallence Road, Whitechapel, and Bancroft Road, Mile End. The infirmaries never lost the taint of their connection with the harsh Poor Laws, and were generally inferior to the voluntary hospitals in staffing and equipment. They were not popular with East End Jews. The Revd A. A. Green, the minister of Hampstead Syn? agogue, said in 1909:14 'Much care is bestowed at the infirmary, and great desire exists to do all that is possible for the welfare of the patients. But a workhouse infirmary is a workhouse infirmary when all is said and done . . . and the Jew ... is regarded more or less as an alien, and when he can speak only Yiddish this is accentuated ... It often happens that a Jew who wants to put on his hat when he takes his meals, and who wants to put on tephillin and say his prayers in the morning, is assailed with all manner of comment, ribald and blasphemous, which renders his stay a perfect purgatory.' However, there were always bed-shortages at the voluntary hospitals and Jew and non-Jew alike had no alternative but to attend the infirmaries, unwill? ing as they might be to do so. Despite their deficiencies, the East End infirm? aries reached as least as high a standard as those in the rest of the country, if not higher, and were rapidly improving. Some also served kosher food and arranged Passover services if these were requested. Thus hospital services for poor Jews living in the East End were good for their time, but there was a large body of Yiddish-speaking immigrant Jews who were ill at ease in them. They believed that patients who felt comfortable in their surroundings were half way to a cure, and that the only hospital in which this would be the case was one in which the doctors and nurses, the general staff and even the porters were Jewish; one in which Yiddish would be widely understood and spoken. The movement that led to the establish? ment of a Jewish hospital in the East End began in 1907. It became a rare 12 Particularly with the German Hospital and the Metropolitan Hospital. Thesis 226-41. 13 R. Hodkinson, The Origins of the National Health Service (London 1967). 14 JC t Tunnorv innn 97</page><page sequence="6">Gerry Black example of wealthy Jews not only not helping to found such an institution, but actively working against it. It was an unpropitious moment for the supporters of the scheme to start. As medicine, surgical techniques and equipment improved, so costs increased and patients' expectations rose. Voluntary hospitals were finding it increas? ingly difficult to cope with the demand for their services and their financial state was parlous. Bed, ward and wing closures became commonplace in the first thirty years of the twentieth century. At one stage the London Hospital could not pay its milk-bills, and Knutsford threatened a complete closure of the hospital.15 It was obvious at the beginning of the century that the great voluntary hospitals could not survive in their existing form without considerable muni? cipal or State assistance or even a State takeover. So when in 1907 an East End barber called Isador Berliner and a few of his working-class friends met in a basement flat in Sydney Street and announced they were intending to raise sufficient money to build and maintain a voluntary hospital close to the London Hospital, it seemed a ludicrous undertaking, particularly as it soon became clear that Lord Rothschild opposed the scheme. He did so partly because of his agreement with Knutsford, partly from fear that Jewish contri? butions to the London and the other voluntary hospitals would decrease and that that would lead to a diminishing service to their Jewish patients, and partly because he thought it was an unnecessary and divisive move. He reso? lutely set his face against it, and influenced his wealthy friends to oppose the scheme too. Not a single wealthy member of the community came to the aid of these working men. The Jewish clergy were also against them as, initially, was the Jewish Chronicle. After a long and gruelling struggle and many setbacks, the barber and his friends overcame the opposition and succeeded in raising the necessary capital in donations from the East End poor. At their first meeting they collected the princely sum of one shilling and sixpence, but they persevered. As L. J. Greenberg, the editor of the Jewish Chronicle, described it:16 'They had to work and labour and strive and contrive for pennies and halfpennies and farthings, to canvass from house to house, night after night, in storm, in rain, in tempest or when the atmosphere in the alleys and byways they visited was well-nigh asphyxiating.' It was not until 1919 that they were able to open the out-patient depart? ment, and not until 1921 that the Hospital was fully operational. Berliner was elected President, but its first chairman, appointed in 1919, was Nathaniel's 15 Letter dated 27 May 1920, Viscount Knutsford to Sir George Newman, Chief Medical Officer of Health. A copy is in the archives of the London Hospital. 16 JfC 29 November 1926. 98</page><page sequence="7">Health and medical care in the East End of London son, the second Lord Rothschild. With him on board, the money flowed in. Prior to nationalization in 1948 the London Jewish Hospital, with no beds, was an outstanding success, open to persons of all religions. It was reasonably well funded; its consultant, resident and nursing staff, mostly Jewish, were of high calibre and it was described as one of the happiest hospitals in London. After the Second World War the Jewish population of the district was reduced to 10,000 or less, smaller hospitals fell out of fashion and the Hospital suffered from gross governmental underfunding. In a letter dated 22 February 1954, addressed to the chairman of the Hospital Council of Management, one of the consultants complained that the Regional Health Board felt that the London Jewish Hospital did not fit in with their scheme of things, and that they visualized it as 'an orphan left on their doorstep by the Health Act'. The quality of its service was inevitably affected. However, though after 1945 there were more non-Jewish than Jewish patients, its Jewish atmosphere was retained until it closed in 1979. The general practitioners Many East Enders, including some who could have afforded to pay for a doctor, used the out-patient departments of the hospitals as one would a doctor's surgery today - attending for simple matters such as coughs and colds - much to the consternation of local general practitioners who were struggling to establish themselves. However, despite the vast numbers who attended the hospital out-patient departments, the first person consulted by the sick poor was usually a general practitioner, either in private practice, often referred to as a 'sixpenny doctor', that being their usual charge, or a parochial district medical officer, employed by the local guardians. Some 'sixpenny doctors' achieved high earnings. The Daily Telegraph of 21 December 1910 referred to one East End practitioner who made between ?2000 and ?3000 a year from his patients, a remarkable income for the time. He saw sixty to seventy patients an evening between six and nine, payment was made at the time of the visit so that there was no sending out of accounts or bad debts and medicine was dispensed on the premises. There were com? paratively few Jewish doctors in the East End prior to the 1920s since it was the children of the first generation of immigrants who first qualified as doctors in any numbers. The district medical officers operated the system that the Jewish Board of Guardians had considered perfectly adequate in 1879 f?r those too poor to pay a private practitioner. To obtain their services a sick person had first to apply to a Relieving Officer of the local parochial Board of Guardians for a medical order. Some Relieving Officers could be cold and distant and com? paratively few Jews approached them for medical relief. They preferred to go 99</page><page sequence="8">Gerry Black to a private doctor and the pay sixpence that they could ill-afford or go to a hospital out-patient department despite the long queues. The dispensaries Several local dispensaries provided services similar to a doctor's surgery and were open to all. Some were entirely free. The oldest and one of the largest was the London Dispensary in Fournier Street. According to its 1917 Annual Report it had treated more than 400,000 patients since its inauguration in 1777. It depended on donations from the public, as did others, such as the Eastern Dispensary in Leman Street founded in 1782, and the East London Dispensary in Commercial Road. The East End Dispensary of the German Hospital was in Great Prescott Street, and the overwhelming majority of its patients were Jewish. There was a free dispensary within easy reach of most of the East End Jewish population. There were also several provident dispensaries. For the payment of a few pennies a week, families obtained the right to have medical treatment for all their members, usually with a choice of doctors. One of the largest organiza? tions, the Metropolitan Provident Medical Association, had many Jewish members on its ruling council, and had branches in Leman Street and Whitechapel Road. It had an upper limit of ?2 10s per week income for membership, to exclude the well-to-do who were, it was said, 'not above taking advantage of the medical attendance at the cheap rates offered by dis? pensaries'. The medical missions Christian organizations seeking to convert Jews were active in the East End from the beginning of the nineteenth century, opening free schools in the Jewish area. But it was their medical missions that caused the greatest heart? ache for the Jewish community, and these began to open shortly after the Jewish Board of Guardians ended its medical department in 1879. They made no secret of their objective, and their journal, The East End Mission, said:17 'The sole aim of our medical work is to lead these people from Judaism to the light of the Gospel, and to heal the disease of the soul through curing the sickness of the body. Hundreds owe their conversion to the Providence which, working through their sickness, brought them to the Medical Mis? sion.' In 1891 the London Society for Promoting Christianity among the Jews acquired premises in Goulstone Street for what was described as 'aggressive evangelistic work'. In his history of the Society,18 Revd W. T. Gidney wrote: 17 Quoted in the United Synagogue Mission Committee Report (1912). 18 W. T. Gidney, History of the London Society for Promoting Christianity Among the Jews 180g igo8 (London 1908). 100</page><page sequence="9">Health and medical care in the East End of London 'With thousands of Jews on every hand, it was admirably suited for this purpose, being in the midst of the dense and poor Jewish population of the East End, chiefly hailing from Russia and speaking Yiddish. The combination of a medical missionary organisation, with efforts of a more direct spiritual character, had tended to make the work very effective and telling.' At differ? ent times during the period 1880-193 5 there were at least nine medical mis? sions in the Jewish East End, including missions in Fournier Street, Whitechapel Road, Cambridge Road, Commercial Road, Buxton Street and Philpott Street. A correspondent of the Jewish Chronicle said19 those who attended 'had first to hear a lengthy sermon preached against our religion, which is held to ridicule, to which they listen in silence, afraid to say a word against the sermon for fear of not being able to see the doctor', and sometimes the doors were locked so that they could not escape it. According to a report in the Jewish Chronicle of 12 December 1913, every morning at about 8.30 am, and every afternoon at about 1 o'clock, there was a large crowd, 99 percent of whom were Jewish, outside the doors of the Philpott Street Mission. Its staff consisted of two full-time and two part-time doctors, a dentist, a consulting dentist, three lady dispensers and three assistants. A Yiddish-speaking nurse was always available. It was open every day of the week until 3 pm and a number of patients were allowed to recuperate at the Mission's Convalescent Home at Brentwood in Essex. The missions were undoubtedly popular. Many East End Jews could not afford the 'sixpenny doctors', resented the long waiting time in the hospital out-patient departments and were unhappy at the thought of undergoing a searching and sometimes unpleasant inquiry from a parochial Receiving Officer. Mission doctors won their confidence and enjoyed a reputation for skill. They did not hurry the patients and allowed time for general conversa? tion and sympathy. Importantly, they were an additional source of treatment. Many Jews (and non-Jews) went from hospital out-patient department to missionary dispensary and then to a doctor, all for the same complaint, taking a bottle of medicine from each, imbibing a spoonful from one in the morning, another in the afternoon, and a third in the evening. One witness to a United Synagogue Inquiry in 191220 into the work of the Missions said that if a fresh batch of doctors came into the East End they would all find work and none of the existing doctors would suffer. The Jews would consult both. East End Jews appear to have had few qualms about availing themselves of the missionaries' medical care - they took the leaflets, listened to the prayers and sermons (although some women stuffed their ears with cotton " 8 June 1923 20 United Synagogue Mission Committee Report (1912). 101</page><page sequence="10">Gerry Black wool so that they should not hear the name of Christ), and departed none the worse for wear. The evidence indicates that there were very few true converts. Jewish friendly societies Jewish friendly societies were another valuable source of medical care. By 1911 there were 25,000 individual members of Jewish friendly societies, con? tributing an average 2d per week for medical benefit. Many a Jewish father made it a condition of giving his consent for the marriage of his daughter that a prospective son-in-law should join a friendly society. Most societies gave full sickness benefit of 15s per week for about thirteen weeks, and half that for the next thirteen weeks. Members had the services of a doctor, and many Jewish general practitioners in the East End derived their staple income from their contracts with friendly societies. On average, Jewish friendly societies gave higher medical benefits than non-Jewish ones. During the passage of the Insurance Bill through Parlia? ment, the Federation of Jewish Friendly Societies secured changes to clauses that would have caused hardships for aliens who constituted a high proportion of their membership. They achieved this by convincing Lloyd George that overall Jewish societies paid out, per member, less in sickness benefit than the general societies. From this it was argued that Jews would be less of a burden on the National Insurance Scheme than the general public. How could Jewish societies pay higher benefits, and yet spend less per head? The answer is partly that there were fewer sickness claims by members of Jewish societies, but detailed examination revealed that much of the difference was accounted for by the duration of the claim for sickness benefit - Jews seemed to throw off sickness more quickly than non-Jews. It is course possible that the figures reflected a different attitude to work and to the return to it after illness rather than a quicker recovery time. Because Jewish societies paid out less for sick? ness benefit, they achieved surpluses that were used to improve other bene? fits - such as disablement and maternity benefits, and payment for consulta? tions with specialists. Some societies also paid for nursing, dental and hospital treatment. Convalescent homes The Association of Jewish Friendly Societies opened a convalescent home at Birchington-on-Sea in 1921, and three years later Isaac Seligman, a generous supporter of the Jewish Board of Guardians and a vice-president of the Jews' Deaf and Dumb Home, presented his country house, Shoyswell Manor, near Etchingham in Sussex, for the same purpose for members of the Achei Brith 102</page><page sequence="11">Health and medical care in the East End of London and Shield of Abraham Friendly Society. The Samuel Lewis Seaside Conval? escent home at Walton-on-the-Naze was opened in May 1910, built from the proceeds of a legacy of ?100,000 from the charitable moneylender. They were an important additional benefit to the Jewish community because there were very few convalescent homes in England at the time. The Jewish Board of Guardians By far the most important Jewish organization involved in the promotion of medical care for the Jewish poor was the Jewish Board of Guardians, founded in 1859 and now Jewish Care. Although in 1879 it gave up direct responsibil? ity for providing general practitioner services, it remained active in sanitary inspection of housing, health visiting and the fight against tuberculosis. It must be emphasized that most East End poor Jews did not live in slum property, but this still left many who did. In their First Annual Report in 1862 the Board's medical officers drew attention to the connection between disease and overcrowded and insanitary dwellings, and the Board set itself three housing targets: to remedy structural defects by ensuring that necessary work was carried out by landlords or local authorities, to assist tenants to keep their homes clean and whitewashed and to encourage the clearance and replacement of insanitary dwellings by more satisfactory accommodation. This should have been the responsibility of landlords or local or governmental authorities, but in 1880 public-health legislation was largely a matter of volun? tary adoption, slum clearance statutes had not yet appeared and the ineffi? ciency of the local statutory bodies theoretically required to carry out this work was notorious. The Board appointed its own full-time sanitary inspector. Although it had no legal power to exercise against landlords, the Board sent out official looking printed letters. If that persuasion did not provoke a response they referred the cases, with details, to the Board of Works of the Whitechapel and adjoining districts. If the Boards of Works were slow to respond, as Whitechapel originally was, pressure was exerted on them. By 1885 the Board's inspector had made 3831 home visits. He found considerable defects in 500 homes and persuaded the landlords to remedy 450 of them. By 1887 the Board was able to report that 'the sanitary condition of the districts in which the Jewish poor reside is being slowly but surely ameliorated', and the Whitechapel Board of Works were said to have changed their hitherto rather hostile attitude and to be 'most anxious' to assist in keeping the houses in a habitable condition. Slum clearance began in earnest in the 1880s, and the combined efforts of Lord Rothschild's 4 percent Industrial Dwellings Co. Ltd and the East End 103</page><page sequence="12">Gerry Black Dwellings Company21 provided Aldgate and Whitechapel with some solid and sanitary accommodation at a fair rent and helped relieve the squalor. When the Board's sanitary inspector retired in 1905 he was replaced by two lady health visitors who in that year dealt with only 140 cases of sanitary defects, an indication of the progress that had been made. But the enemy had changed and they had to attend nearly 3000 cases of tuberculosis, 'the terrible scourge', as Lloyd George described it. At the end of the nineteenth century the governmental, local authority and voluntary services available to wage war against tuberculosis were negligible. In 1897 the Board of Guardians appointed a special committee that called many distinguished and expert wit? nesses and made minutely detailed recommendations to avoid the spread of the disease.22 All Jewish cases notified to the Board by the family or the doctor of an afflicted person were visited. Families were taught elementary but effective precautions: they should not kiss a consumptive on the lips or use a spoon or cup used by a consumptive until it had been soaked in boiling water and carefully washed. The Board supplied each patient with a separate bed. Bedrooms were sealed and fumigated, ceilings stripped and walls dis? tempered. Floors and furniture were washed with carbolic soap of hospital strength, clothes worn by the patient and his bedding were taken to a disin? fecting station and an explanatory leaflet in Yiddish was distributed. It is no exaggeration to say that the Board's fight against tuberculosis brought incalculable benefit to thousands of families. A major part of the time of the two lady visitors was taken up with trying to obtain admission for their consumptive cases into a sanatorium since there were only a few sanatoria for tuberculosis sufferers in the whole of England. The Jewish population had a great advantage in that a sanatorium, Danes wood, had opened in 1903 at Woburn Sands, presented to the community by Louis Bischoffsheim and his wife Clarissa. It was in an ideal spot, situated among pine trees on a beautifully wooded hill over 400 feet above sea level. It was officially estimated that there was a need for one bed for tuberculosis sufferers for every 5000 of the population. Daneswood, with its twenty-two beds, provided room for approximately half of all Jewish sufferers. Care for infants, children and youth Special arrangements were made by the community to care for the health of infants in the 1890s, when the Jewish Board of Guardians arranged East End Jewish Mothers' Meetings to give help and advice to mothers of babies and 21 J. White, Rothschild Buildings. Life in an East End Tenement Block i88j-iq20 (London 1980); K. Rubens, 'The 4% Dwellings Company, its Formation and its East End Developments 1855-1901', in A. Newman (ed.) The Jewish East End (London 1981). 22 In its Report of 27 January 1898, reproduced in full in App. A of Thesis. 104</page><page sequence="13">Health and medical care in the East End of London young children. A Jewish Day Nursery was opened in 1896, moving to New Road in 1901. Initially, the charge was twopence a day, that covered a break? fast of bread and milk, a wholesome lunch and tea and milk in the afternoon. It had the best of facilities and was run on up-to-date hygienic lines. Dr Bernhard Morris visited daily from 1897 to 1943 when the nursery was evacu? ated, and as a result there was almost no risk of epidemics arising, and rickets, then a common problem, was recognized at an early stage. Lady Rothschild became its active President and remained so until her death in 1936. The 1905 Royal Commission into the Poor Laws discovered that in the whole of London there were places in day-nurseries for only 2000 children and that many of these nurseries were overcrowded, ill-ventilated and were staffed by people who showed an utter lack of knowledge of the most elementary prin? ciples of hygiene. The Commission reported that 'only a few' were good. The Jewish Day Nursery was one of these, another example of East End Jews enjoying a superior medical service. Health talks were also given to mothers at the Jewish Mothers' Welcome &amp; Infant Centre that opened in Great Alie Street in 1895. From 1902 it was under the auspices of Mrs Arthur E. Franklin who was its President and Chairman for more than a quarter of a century. After various moves it settled in Berner Street and had a qualified medical practitioner and two trained health-visitors on its staff. It had an ante-natal clinic, daily attendance for minor ailments and monthly social gatherings for the mothers and members of the committee who met in an informal atmosphere. All Jewish births in the district were notified to these Jewish centres by Stepney Borough Council, and the centres sent health visitors to homes to persuade mothers to bring their children in for supervision. It was rare for a Jewish child in need to be overlooked by the system. Mrs Alice Model (1856-1943) was the dominant figure in the East End for providing nursing assistance to sick or pregnant Jewish mothers and their children. Born into a comfortable middle-class family in West Hampstead, her activities embraced the Jewish Day Nursery and the Sick Rooms Help Society. The Society, based on an institution in Frankfurt, was opened in January 1895 by Mrs Model and Miss Bella Lowy, and sought to take the place of the mother in the home at a time when, by reason of confinement or illness, she was unable to cope by herself. The 'helps' were sent in to run a home only when there was no other woman, or girl old enough, to do so. They washed the baby, got the children ready and sent them to school, cooked the food, tidied and cleaned up the home and took care of the washing. Lady Samuel described them as 'scientific charwomen'.23 It gave the mother peace of mind, which helped her physical recovery for she knew that her 23 Interview in JC n July 1913. io5</page><page sequence="14">Gerry Black husband and children were well cared for. Although neighbourly help was perhaps more readily available in the Jewish East End than it would be today on a modern estate or in suburbia, there was still a need for such a service. With the financial assistance of Lady Rothschild, F. D. Mocatta, Sir Julian Goldsmid and a few other friends, two trained nurses were employed. In 1897 the Society started a provident section 'to encourage self-respect and thrift5 in accordance with the Victorian values that it shared. The sub? scription was one penny a week, and in Mrs Model's words the paying mem? bers were not simply beneficiaries of a charitable institution, but 'a combine of women for mutual help'. By 1904 the Society had six trained nurses and thirty-six helps, each case being nursed for a fortnight. By 1908 there were 3700 provident members. In the whole of London there were less than a dozen maternity hospitals, when at the Society's Annual General Meeting in 1909 Sir Isadore Spielman called for the establishment of a Jewish Maternity Home. The following year the Society received a bequest of ?5000 from the estate of Ada Lewis, the widow of Samuel Lewis, and, together with a grant from the executors of Louisa Lady Goldsmid, enough funds were raised to buy premises in Under? wood Street, off Vallence Road. The Maternity Home was opened in Sep? tember 1911 by Mrs Bischoffsheim. Sir Marcus Samuel donated ?2000 towards the equipment and Mrs Harris Lebus presented the furniture. The site was later extended and became a training school for midwives, with a high reputation. An Infant Welfare Centre was opened and there were meetings for both mothers and fathers on the subject of bringing up children. In 1925 a new, up-to-date welfare building was completed that included living accommodation for the district nursing staff and the health visitors. Adjoining land was purchased and in November 1927 an enlarged maternity home with fourteen beds was officially opened by Lord Reading. Mrs Model claimed, in an article in the Jewish Chronicle in May 1926, that in the midst of the Jewish area in Whitechapel a complete maternity and child-welfare centre had been established that was considered a model of its kind by the authorities. It was a striking tribute to her, to those who had worked with her and to those who supported the scheme financially, but its success could not have been achieved if ordinary Jewish East End mothers had not responded eagerly to the oppor? tunities afforded them and, as witness the success of the provident scheme, been prepared to pay something towards the essential costs. The Society was a pioneer in a very important sphere of social effort and Mrs Model was frequently asked to address public conferences to explain the Society's system. It was widely copied in other parts of the country and was a field in which the Jewish community led the way.24 24 In 1933 there were nearly 800 births at the Home. Thereafter the numbers declined, as did the general birth rate and, indeed, the Jewish population of the East End. Ironically, the io6</page><page sequence="15">Health and medical care in the East End of London Youth clubs played an important role in the social life of Jewish East End youth, and one of their main aims was to improve the physical condition of their members. The Brady Street Boys' Club sought to 'improve their stunted physique and raise their general tone and bearing', and other clubs followed their lead. Together with the Jewish Lads' Brigade, the Cadet Corps and the Jewish Athletic Association (later to be known as the Association for Jewish Youth), they provided facilities for the improvement of both physique and health. Jewish East End schools also helped by providing heavily subsidized school meals, and at the Jews' Free School in Bell Lane, courtesy of the Rothschild family, clothing and boots were supplied for every pupil at the school every Rosh Hashanah. Jewish and non-Jewish health compared As has been seen, East End Jews undoubtedly enjoyed several additional med? ical benefits, but did they as a result enjoy better health than their non-Jewish neighbours? Various programmes of research were carried out, and in three matters there was agreement between the various experts. Among Jews alco? holism and its associated diseases were practically non-existent, venereal dis? ease was comparatively rare and on the whole Jewish children were in better health than non-Jewish children of the same age living in similar conditions. Three government reports shed some light on the subject - the Select Committee on Emigration and Immigration of 1888, the Interdepartmental Committee on Physical Deterioration of 1904 and the Report upon the Phys? ical Examination of Men of Military Age by National Service Medical Boards in 1918. The last two were established following the discovery of the abys? mally low physical standard of recruits for the armed services during the Boer War and First World War respectively. Evidence given to the various inquiries25 suggested that although many Jews worked 100 hours a week, this did not materially injure their health. This was attributed to the fact that although they did not enjoy physical strength, they had stamina. Abraham Levy, the headmaster of Old Castle Street Board School, said that after a short time in England Jewish immi? grants were very clean, and although not sturdy men who could break stones or lift heavy loads, were tenacious. Dr Eustace Smith, who practised at East London Children's Hospital said Jewish children were seldom emaciated. Colonel Fox said he had visited several schools in Whitechapel and that the headteacher in every school had told him that the Jewish children were of good physique. home became known not as Mrs Model's Home, but Mrs Levy's, named after its long-serving superintendent. In 1938 the home moved to a new site, in Lordship Road, Stoke Newington, under the name 'The Bearsted Memorial Hosnital'. 25 Thesis, 21-6. 107</page><page sequence="16">Gerry Black If, as the evidence suggests, Jewish health was better, what were the reasons for this? The witnesses to the inquires had different theories, the most com? pelling of which was that because Jews spent less on drink, they had more to spend on food. Revd Moses Abrahams, Hebrew teacher at Stepney Jewish Schools, pointed out that every Jewish household was thoroughly cleaned at least once a year, at Passover. Dr Eichholz, a senior school medical officer, said that good nutrition was an even more important factor for ensuring good health than an absence of dirt and overcrowding, and that Jews made a great point of providing nutritious food for their young children. General Sir Fred? erick Maurice, General Officer Commanding at Woolwich, said that the Jewish child, although coming from extremely poor quarters and under very unsavoury conditions, was as a rule stronger and healthier than his non Jewish counterpart, and attributed this to the Jewish mother not only provid? ing proper food, but also staying at home looking after the children rather than going out to work. Charles Booth said kosher meat made the difference, because it came from animals certified as being healthy. And overlaying all this were the additional medical facilities that Jews enjoyed that have been discussed earlier. Conclusions Looking back over the past two centuries at the pattern of Anglo-Jewish charitable institutions providing welfare to the poor of the Jewish community, including medical care, education, clothing and housing, the evidence shows that the community has been well-served by its philanthropists. Rabbinic teachings assert that the genuinely needy are entitled to assistance and that the giving of charity is not a virtue, but a duty. Maimonides wrote 'we are duty bound to observe the commandment to give charity more than any other positive commandment'. Leopold Greenberg, editor of the Jewish Chronicle during the first part of the twentieth century, would headline details of the wills of recalcitrants with the words 'To charity, nil!' in order to encourage benevolence. Not all Jewish philanthropists were religious Jews, but many who were not were still imbued with Judaism's tenets. The motives of those making charitable donations are varied. Some are driven by a sense of religious duty, social idealism, civic patriotism, personal satisfaction, a desire for self-perpetuation or control, or they may simply belong to a culture that regards such actions as worthy. The charitable instinct can stem from sympathy for one's fellow beings, concern for the stability of society, ethnic sympathies, family tradition, self-interest or, most often, a combination of two or more of these. It is true that some seek personal publicity or the opportunity to climb the social ladder, but even if a donor's objective is purely selfish it is surely better that they should give than not give. 108</page><page sequence="17">Health and medical care in the East End of London Most Victorian Jewish philanthropists gave of their time as well as their money, and took a prominent part in the administration of the institutions they supported financially. The Rothschilds and others not only wrote the largest cheques, they made the management of institutions their personal concern. 'Natty' Rothschild ran the family bank and was consulted by govern? ments, but always made time to chair the regular meetings of the Board of Governors of the Jews' Free School and to meet and advise its headmaster at short notice. This hands-on approach in Jewish charitable institutions was essential because there was then no one else in the community capable of and willing to undertake the burden. Philanthropists, as others, must not be criticized for failing to adopt solu? tions that became fashionable or were indeed discovered only after their death. Some self-evident 'truths' in Victorian England became self-evident 'fallacies' in the twentieth century. So I find it sad when the efforts of Jewish Victorian philanthropists are denigrated as being nothing more than part of a class war and as an attempt to control the Jewish poor for their own selfish purposes. It has been suggested that wealthy Jews deliberately sought physical separation from the Jewish poor in the East End, as though the rich have not always set up home in more salubrious areas, or that the Jewish Board of Guardians availed itself of the facilities that the State provided simply in order to relieve itself of a burden, even though that was merely a sensible policy. The same critics would not now suggest that Jewish Care should refuse government and local authority funding. The evidence I have encountered in the course of my research leads me to a contrary conclusion. Although benefits given by the Jewish Board of Guard? ians in the nineteenth century might appear parsimonious by today's stand? ards, at the time they were generous. The Board followed the accepted wisdom of the time in order not to create what today might be called a benefit-dependency culture. Compared to its main contemporary non-Jewish counterparts, the Charity Organisation Society and the local Guardians, the Jewish Board of Guardians adopted a more humane approach. The C.O.S., founded a decade after the Board - Knutsford suggested its initials stood for 'Choke Off Sympathy' - considered the Board to be an indiscriminate distrib? utor of charity that gave too much, too easily.26 It is true that the Jewish rich feared that the Jewish poor, if they were not helped, could became a burden on the rates and in turn cause a backlash against all sections of the Jewish community, including themselves, but it is wrong to suggest that that was the sole, or indeed the main reason for the actions they took. They viewed the newcomers with a mixture of sympathy 26 C. W. Mowat, The Charity Organisation Society: Its Ideas and Work i86g-igij (London 1961) 114. 109</page><page sequence="18">Gerry Black and alarm, and feared that the sheer numbers involved might encourage the anti-Semitism that was increasing in English society in the late 1870s. Indeed, there were rumblings of discontent against the newcomers even among working-class Jews. For a time British Jews attempted to stem the flow of post-1881 immigrants, fearing they could not cope with the numbers, but once it was clear that these were here to stay they cared for them. Lord Rothschild was one of the foremost opponents of restrictions on immigration and was joined in this fight by many other wealthy Jews. Jewish Victorian charity organizations depended almost entirely on the support of the wealthy, as did their non-Jewish counterparts; half the income of the Jewish Board of Guardians came from just forty families. Inevitably this gave control over most of the community's organizations to a comparat? ively small band, but it was a benevolent control. In time, the old elite was superseded. The First World War brought a heavy loss of life among its young men and high levels of taxation in the inter war years reduced the capacity for largesse. The newly rich in the Jewish community were connected with profitable new commercial enterprises, and these men and their families, almost all of immigrant birth or first-generation British-born, mostly identified themselves with the Zionist movement and with the ever-increasing group in the Jewish middle class who by the 1920s were prepared, indeed anxious, to undertake the burden of supporting the Jewish social services, taking over control from the elite whose influence con? tinued to wane throughout the 1930s. Those with the courage to address a problem lay themselves open to criti? cism often from those who do the least. Whether the motives of the Jewish establishment in protecting the interests of the Jewish poor were altruistic or self-interested is of less importance than the fact that they took action success? fully on behalf of the Jewish poor. The charitable system they set up provided a cushion against the everyday problems with which the Jewish poor had to contend and the superior medical services enjoyed by the Jewish immigrant poor in the East End justified these efforts. Those who now say that the wealthy merely sought, for their own ends, to control the Jewish proletariat should consider in what conditions the Jewish poor would have lived had they not taken the action they did. There would surely have been a great deal of avoidable illness, pain and distress. In retrospect, the Jewish Board of Guardians must be said to have judged rightly whether and when to make its own provision for the sick Jewish poor or leave it to the State and local authorities. Strong contemporary criticism was expressed concerning the Board's ending of medical relief in 1879 and several unsuccessful attempts were made to persuade it to change its mind. Yet no such private organization could have funded the escalating cost of such services, and the Board recognized at an early stage that only the State no</page><page sequence="19">Health and medical care in the East End of London could do so, perhaps together with the private charitable sector, and saw this before others engaged in similar activities. The character of East End Jews greatly alleviated their situation. They were receptive to provident schemes for self-help, particularly through the Jewish friendly societies and the medical dispensaries, and East End Jewish mothers responded readily to new, improved, modern theories in child care. In almost every aspect of medical care, poor East End Jews enjoyed facilities superior to those of their non-Jewish neighbours and better health, and for this the community as a whole was entitled to share in the credit and be proud of its achievements. Their success was a testament to their humanity and to their commitment to a traditional sense of rachmanut, 'mercy'. The contrasting outlooks of established Jews and recent immigrants remained, but each contributed to remedying defects in the system, and their combined endeavours led to success.27 27 For the full history of the London Jewish Hospital, see Gerry Black, Lord Rothschild and the Barber (London 2000). III</page></plain_text>Jewish Hospital, see Gerry Black, Lord Rothschild and the Barber (London 2000). III</page></plain_text>