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

The growth of the American hospital system has been told at various levels, from local to national. Many studies examine the evolution of specific hospitals, while the broader perspective of the American hospital has been well chronicled in Charles Rosenberg’s The Care of Strangers (New York: Basic Books, 1987) and Rosemary Stevens’ In Sickness and in Wealth (New York: Basic Books, 1989). In this volume, the Krauts provide a welcome new perspective to this story. Their study examines the history of the Newark Beth Israel Hospital, known as the Beth, from its origins in the middle of Newark’s immigrant Jewish community in 1902. The real significance of this work is its illumination of the forces that created the American voluntary hospital beginning in the last half of the nineteenth century. While the focus remains on Jewish voluntary hospitals scattered in cities around the United States, the authors emphasize that similar activities were occurring in Catholic and Protestant voluntary hospitals at this time.

The Krauts blend a wide variety of historical subfields into their compelling account of the Beth’s history. Their creative use of American, immigration, minority, Jewish, medical, urban, economic, and women’s history presents a broader view than found in earlier histories of the religious voluntary hospitals in America, from the 1850s into the twenty-first century. The authors clearly illustrate the impact of these various aspects of history on the emergence, growth, and eventual disappearance of most Jewish voluntary hospitals by the late 1990s.

National events provided the backdrop for many of the broader changes in the American voluntary hospital. The Progressive Era saw the hospital redefined as a social service for the needy as well as a place to heal the sick. All hospitals faced the strains of surviving the Depression and the problems created by World War II. The growth of federal funding and supervision following this conflict presented new challenges to voluntary hospitals.

Immigration of thousands of Jews and other religious groups from the 1880s into the 1920s was a driving force behind the opening of many voluntary hospitals. The Beth, like other Jewish hospitals of this era, saw its mission as multi-faceted. There were needs to provide care for Jewish patients in an appropriate religious environment, the reality that anti-Semitism prohibited many Jewish doctors from gaining residencies and clinical positions in non-Jewish hospitals, and the desire to give back to the greater Newark community.

Changes in urban demographics would force the Beth to relocate to initially follow the movement of Newark’s Jewish population. The great migration of African Americans from the South to Northern cities around WWI altered Newark’s neighborhoods drastically, as well as heightening tensions between these new arrivals and the established Jewish community. Later in the twentieth century the continued expansion of the Newark African American community would lead to white flight to the emerging suburbs that included most of the Jewish community. The Beth had to decide whether to follow the Jewish community out of Newark or stay and meet the growing needs of the inner city populace, and the Beth’s leaders chose the latter path.

As with all such institutions, economic challenges were significant factors in the Beth’s history. The need to raise funds for new hospital construction, modern laboratories, and expanding staff and residency programs presented a constant challenge to the Beth’s leadership. A variety of Jewish women’s organizations played key roles in the creation and growth of the Beth throughout the twentieth century. The Krauts emphasize the role of similar Jewish women’s groups nationally in the rise of Jewish voluntary hospitals.

As with similar institutions nationally, the Beth faced major changes in the American health care system. The 1910 Flexner Report revamped American medical education, leaving voluntary hospitals out of these reforms. The impact of the American College of Surgeons...