Covenant of Care: Newark Beth Israel and the Jewish Hospital in America (review)

Covenant of Care: Newark Beth Israel and the Jewish Hospital in America tells the story of New Jersey’s Newark Beth Israel Hospital (NBIH), from its earliest operations in a converted mansion to its present status as a “modern regional medical center” that is part of a major healthcare network. While primarily an institutional history, this case study reflects the fate of voluntary religious hospitals over the course of the twentieth century.

The first Jewish hospitals in America were established in the mid-nineteenth century, in response to outbreaks of disease in several major cities. Even more hospitals opened during the Progressive Era. The founding of Jewish hospitals resonated with the core values of tzedakah and tikkun olam. They also arose as a form of self-help at a time when both Jewish doctors and patients faced discrimination from a medical establishment that was largely gentile. The founding of Newark Beth Israel Hospital at the turn of the last century highlighted deep divisions in Newark’s Jewish community. It required the combined efforts of Jewish women’s groups, doctors, businessmen, and rabbis; these factions had competing agendas regarding health care provision, assimilation, and traditional religious life. Among other issues, there was no clear consensus on how Jewish “The Beth” should be; for example, parties grappled with whether to serve kosher meals when doing so would cost more and when few patients requested them. Tensions among stakeholders made many of them reluctant to support the project and left the hospital vulnerable to funding crises that seldom abated. Although the Krauts clearly love their subject, they do not hide the internal conflicts. Their book is a remarkable accomplishment, in fact, for shedding light on the kinds of factional disagreements that often lie beneath the surface of philanthropic endeavors.

Newark Beth Israel Hospital finally opened in 1902 and soon outgrew its High Street residence. A second building was added in 1908, and between 1915 and 1920 the hospital was able to expand further by adding properties on several adjacent streets. In the 1920s NBIH attained accreditation from the American College of Surgeons. The desire to maintain good standing with the ACS inspired hospital leaders to once again upgrade the facilities. By 1928 they had made the controversial decision to move the hospital out of the center of Newark to the Weequahic section, where Newark’s Jewish population was then migrating. Financial pressures troubled the hospital though, and increased during the Great Depression. As pledges to pay off the new building went unfulfilled, staff were forced to accept pay cuts and several wards were closed.

After World War II, Newark Beth Israel Hospital hit its stride. The hospital ran its own nursing school, published a medical journal, and became one of a small number of community hospitals authorized to run medical residency programs. Its physicians conducted pioneering research in endocrinology, reproductive physiology, and cardiac care. This transformation of “the Beth” reflected the rise of the “industrial medicine” of the 1950s as well as major changes in the American health care system, such as the proliferation of private insurance and the greater availability of federal money.

Paradoxically, the rise of NBIH as a state-of-the-art medical facility coincided with an erosion of support from the Jewish community in Newark. Weequahic was the center of Newark’s Jewish community in 1950, but families soon began to leave for the surrounding towns of Essex county. The explosion of the suburbs dispersed the population that formerly had supported the hospital financially and through volunteer work. At the same time, the shift of American industry toward the Sun Belt caused an exodus of jobs from the center of the city. Newark became known for poverty and crime, and for the dramatic riots of 1967. As a result, NBIH augmented its facilities for the treatment of trauma victims.

In the 1980s, the hospital redefined its mission to that of...