The approach of the East European Jewish population to health care made no distinction between what would now be considered “scientific” medicine and “folk” medicine. This openness to combining folk remedies and magical cures with modern medical techniques was typical of Hasidim and Misnagdim alike, of both the learned and the illiterate. From the late seventeenth century on, physicians with “Western” training together with health care reformers emerging from the developing Jewish bourgeoisie attempted to reshape the popular attitude toward health care.
Patient undergoing treatment at the Jewish Hospital, Grodno (now Hrodna, Bel.), 1926. Photograph by L. Gelgor. (YIVO)
As only a small number of professionally trained physicians, Jewish and non-Jewish, practiced in Poland prior to the mid-nineteenth century, and because most people generally avoided the hekdesh, which was both sick house and poorhouse, sponsored by the Jewish community, self-treatment was the most common course of action for the entire population, particularly those in rural areas. Among Jews, a rich oral tradition of folk remedies for physical, as well as emotional, ills existed. Babske refues (old wives’ medicine) included such treatments as inserting a clove of garlic into the ear to cure a toothache. Collections of zgules and refues, recipe books for an assortment of herbal remedies, charms, and amulets, had long been circulating but reached a new height of popularity in the eighteenth century. For any given ailment, the recitation of specific psalms might be recommended, together with the application of an herbal concoction.
“Taking a cure” at a spa became extremely popular in the nineteenth century. Belief in the curative powers of these sites was strong; thousands from all socioeconomic levels and all places on the religious spectrum traveled to both European and Russian spas every summer. The Jewish bourgeoisie, in particular, was captivated by the cachet of participating in spa culture.
Health Care Personnel
Women in a nursing course sponsored by OZE, Kaunas, 1930s. The graph (right) is titled (in Yiddish): “The progression of productivity in the course of a workday.” Written on the blackboard: “Meningi [meningococcus].” (YIVO)
A variety of Jewish and non-Jewish folk healers peopled the East European landscape. These included the non-Jewish znakhar, tatar, and keyder, and their female equivalents, who used charms, herbs, amulets, and magic formulas for dealing with such problems as sores, rashes, boils, and blisters. The services of opshprekerin were necessary for exorcising the evil eye. The experienced lay midwife provided crucial assistance during pregnancy, childbirth, and the initial postpartum period (akusherke). Barber-surgeons, known as royfes, sirulniks, or feldshers, were widely patronized, especially for carrying out the most common treatments: cupping, bleeding, and applying leeches. The level of knowledge and ability of feldshers varied greatly.
Also very popular were the “professional” makers of charms and amulets. From the sixteenth century on, significant numbers of ba‘ale shem, writers and wielders of amulets using holy names, were active as healers in Poland. The ba‘al shem employed a combination of practical Kabbalah, including the use of prayers, amulets, and incantations, together with herbal and folk remedies. From the inception of Hasidism in the second half of the eighteenth century, the rebbe, or tsadik, often continued this role as healer. Hasidim would travel great distances for an audience with a particular rebbe to seek his blessing or intervention with an ailment or barrenness.
In combination with any of these healers or treatments, or when none of them proved able to cure a patient, prayer was a standard recourse, along with other traditional measures, such as giving charity and visiting the graves of deceased relatives to beg for their intervention.
Health care was, in part, determined by social class. The wealthy summoned private doctors, while those with lesser means preferred feldshers. The majority of trained physicians, whether Jewish or non-Jewish, were regarded with both respect and fear; they had a reputation for arrogance. Jewish physicians with modern training, who were often regarded as heretics, engaged in a power struggle with folk healers and Hasidic leaders for control over the field of healing.
Health Care Facilities
The provision of medical care was considered a matter of communal concern, and accordingly, the Jewish community had a longstanding, well-developed internal system of sick care. Where no hospital existed, the local Jewish community, as a charitable measure, often engaged a local physician to treat the poor. In virtually every town, arrangements were made with local pharmacies to provide free or discounted medication for the poor. Serving as crucial links in this network were the bikur ḥolim (“visiting the sick”) societies that helped to provide treatment and medication for the poor. These societies, which had evolved out of the ḥevrah kadisha’ (burial society), tended the ill in the hospital, the hekdesh, and the home. In addition, such a society might hire a physician for the town or provide the means for the ill to travel to spas or larger cities for treatment. Unlike hospitals, bikur ḥolim societies also assisted the family of the sick person.
“Tuberculosis and consumption can be prevented! Helping the sick is a big mitzvah. Preventing illness is a bigger mitzvah.” Yiddish poster. Artist unknown. Published by OZE, Berlin, 1923, with support from the Fund for Relief of Jewish War Victims and Federation of Ukrainian Jews, London. The cartoons illustrate the perils of spitting, and coughing and sneezing without covering one’s mouth and nose, and tout the benefits of fresh air, cleanliness, and a balanced diet. (YIVO)
Until the late nineteenth century, hospital care in general lay somewhere between a social welfare service and a charitable measure throughout Europe and America. Within the Jewish community, the hekdesh had been poorhouse and sick house rolled into one, with notoriously little medical care actually provided. Very few Jewish hospitals existed before 1860, but the number began rising after that point and even more rapidly after 1880. In 1880, there were only 53 Jewish hospitals in European Russia, with 1,765 beds, but by 1908 the number of hospitals had risen to 130, a much greater number proportionate to the size of the Jewish population than the number of general hospitals relative to the non-Jewish population.
Conditions in many Jewish hospitals, particularly in the 1880s, were appalling. They were unhygienic, understaffed, unorganized, and financially corrupt, though they still ranked higher than general rural hospitals. Jews held a deeply rooted perception of the hospital as being only for the poor and being dangerous to one’s health; as a Yiddish newspaper expressed pointedly in 1903, “When a Jew is taken to the hospital, he accounts it as if he is already being taken to yene velt [the other world].” The hospital, then, was usually the avenue of last recourse, and, accordingly, a significant percentage of patients died upon arrival. Jewish politics also served to deter potential patients from turning to hospitals, as religious conflicts were sometimes carried into Jewish hospitals. In Dünaburg (Yid., Dvinsk; mod. Daugavpils, Latvia), for example, Hasidic–Misnagdic tensions were so acute that, in addition to separate rabbis, slaughterers, and other religious functionaries, each faction maintained a separate hospital. Even the most seriously ill of one faction were not accepted into the institution of the other. Jews had a particular distrust of non-Jewish hospitals, which often would not accept Jews and poorly treated those they did accept. Religious and cultural differences, including language and lack of kosher food, also discouraged Jewish patronage of non-Jewish hospitals.
In times of crisis, such as the outbreak of cholera, Jewish communities mobilized, forming committees to raise funds, set up aid stations, and provide medications for the poor. At the same time, more traditional factions organized responses such as local fast days. Some Hasidim sought to root out “sinners” whom they perceived as the cause of the affliction. In 1866 in Uman, Ukraine, for example, Hasidim reportedly lay in ambush for women wearing crinolines, a fashion the Hasidim labeled “non-Jewish” and blamed for the epidemic.
Children undergoing a sun treatment in a program sponsored by the Central Jewish People’s Relief Committee, Liepāja, Latvia, 1920s. Photograph by E. Jacubovits. (YIVO)
The most rapid and significant changes in Jewish health care occurred between the second half of the nineteenth century and the outbreak of World War I. Changes in Russian public health care, particularly the innovations of zemstvo medicine (a new system of social medicine), greatly influenced Jewish health reformers during this period. Health reformers began producing a steady stream of popular medical advice works written in Hebrew and Yiddish for the benefit of Russian Jewry. The authors of these works were proponents of the Haskalah, which they saw as a cure for the larger spiritual and political malaise of the Jewish people. Health care reform was, in their eyes, a vital element in the maskilic plan for the reform and improvement of the Jewish populace. The growing Russian Jewish bourgeoisie also recognized health care’s significance as an important gauge of the modernization of Jewish life. They sought to transform health care institutions to bring them into line with their standards and goals for the Jewish community, both for the betterment of Jewish life and as a sign to the outside world of the civilized, sanitized nature of Jewish society.
Not only was the hekdesh slowly transformed into a more modern, sanitary healing facility, but a more bourgeois variation of the bikur ḥolim society appeared in the Jewish community. Well-to-do Jewish women, emulating the charitable activities engaged in by women of non-Jewish bourgeois society, founded committees devoted to aiding the indigent sick. Jewish female philanthropists took particular interest in causes related to health care. In addition to donating to hospitals, they also supported summer colonies for poor children. The first Jewish summer colony in Russia was opened in Odessa in 1895. These institutions produced significant improvements in the health and growth of their young patients. Jewish communities also funded the colonies and they proliferated rapidly, soon numbering 38 in the southern provinces.
Professionalization and Nationalization of Jewish Medicine
The policies of the Russian government regarding Jews as medical students and practitioners lacked consistency. Because of quotas limiting the number of Jews in Russian universities, many Russian Jewish students went abroad to pursue medical studies. When the Russian government opened the doors of university medical faculties to Jews in the 1850s, Jews took advantage of the opportunity in significant numbers. They were soon highly overrepresented in adjunct branches of medicine, as well: pharmacy, midwifery, dentistry, and feldsher practice. While Jews were drawn to medicine for a variety of practical and ideological reasons, the extent of the phenomenon must be attributed, in part, to the inroads made by the Haskalah. Because choosing the medical profession often followed a rejection of traditional Jewish life, parents often opposed this career path. Jewish women took advantage of the short-lived Women’s Medical Courses in Saint Petersburg in the 1870s, as well as official courses in midwifery. Dentistry and, to a lesser extent, pharmacy were predominantly female and Jewish fields, in large part because they were low in prestige, pay, and privilege.
Staff of the Paul Natan Hospital in a kolkhoz named after Pyotr Smidovich, head of KOMZET (Committee for the Settlement of Jewish Toilers on the Land), Larindorf region, Crimea, ca. 1920s. (YIVO)
The first independent Jewish physicians’ organization, the Jewish Physicians Circle, was established in Vilna in 1908. That same year, the first national Jewish health journal, Evreiskii meditsinskii golos (The Jewish Medical Voice), was published in Odessa. The founding meeting of the Society for the Protection of Jewish Health (Obshchestvo Zdravookhraneniia Evreev; OZE) took place on 28 October 1912. Both nationalist ideology and professional concerns motivated its founders. One set of goals involved researching both the contemporary physical development of the Jews and the history of medicine, hygiene, and sanitation among Jews. Its other focus was to improve the physical conditions of Jews, both by developing treatment plans and by engaging in “medical politics,” seeking to gain control over public health facilities and services within the Jewish community. During World War I, the focus of its activities changed to relief efforts. OZE was forced to disband in 1919 after the Russian Revolution, but by then it had branches in other East European countries and in some West European countries, with headquarters in Berlin. In 1921, the Polish branches united to form Towarzystwo Ochrony Zdrowia (TOZ), which successfully ran a multitude of programs until it was shut down in 1942. Interwar Poland had 40 Jewish hospitals, staffed by many of the country’s 3,500 Jewish doctors.
Despite great inroads made first by OZE, then by TOZ, the Jewish physician in Eastern Europe continued to share the medical marketplace with the royfe and the znakhar. Though their numbers declined, none of these healers or their homespun remedies disappeared from the scene. A collection of interviews conducted with East European Jewish immigrants to the United States during the 1940s provides extensive evidence of the continuity of eclecticism in the health care behavior of East European Jews in the interwar period. They continued to regard the Jewish physician with a measure of suspicion. They still often called the feldsher first and employed amuletic cures.
Lisa Epstein, “Caring for the Soul’s House: The Jews of Russia and Health Care, 1860–1914” (Ph.D. diss., Yale University, 1995); Immanuel Etkes, “Mekomam shel ha-ma’giah u-va‘ale ha-shem be-ḥevrah ha-ashkenazit,” Tsiyon 60.1 (1995): 86–101; Louis Falstein, ed., The Martyrdom of Jewish Physicians in Poland (New York, 1963); Solomon Kagan, Jewish Medicine (Boston, 1952); Edward Kossoy and Abraham Ohry, The Feldshers: Medical, Sociological and Historical Aspects of Practitioners of Medicine with Below University Level Education (Jerusalem, 1992); Jacob R. Marcus, Communal Sick-Care in the German Ghetto (Cincinnati, 1947); Michael A. Nevins, The Jewish Doctor (Northvale, N.J., 1996); Avrom Rekhtman, Yidishe etnografye un folklor: Zikhroynes vegn der etnografisher ekspeditsye ongefirt fun Sh. An-ski (Buenos Aires, 1958); Leib Wulman, ed., In kamf farn gezunt fun yidishn folk (New York, 1968); Hirsch Jakob Zimmels, Magicians, Theologians, and Doctors: Studies in Folk-Medicine and Folk-Lore as Reflected in the Rabbinical Responsa, 12th–19th Centuries (London, 1952).