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Reviewed by:
  • Covenant of Care: Newark Beth Israel and the Jewish Hospital in America
  • Morris J. Vogel
Alan M. Kraut and Deborah A. Kraut. Covenant of Care: Newark Beth Israel and the Jewish Hospital in America. New Brunswick, N.J.: Rutgers University Press, 2007. 304 pp. Ill. $37.95 (ISBN-10: 0-8135-3910-2, ISBN-13: 978-0-8135-3910-2).

Jewish hospitals are today an assumed feature of the American urban landscape. But it was hardly fated that a vulnerable and marginalized immigrant group, the greatest number of whom came to the United States from the least economically developed communities of Europe at the turn of the last century, should be identified with many of the nation's most advanced centers of medical practice. In this volume, Alan M. Kraut and Deborah A. Kraut tell the story of one such institution and draw on this story to offer insights about how this unusual circumstance came to be. Their inquiry lies in the intersection of urban history and the histories of immigration and medicine; their example is the story of Newark, New Jersey's Jewish community and how the Beth Israel Hospital came to be one of its most emblematic institutions.

The Krauts begin their narrative in the hazardous and congested conditions of late nineteenth-century immigrant Newark, the very situations associated with increasing recourse to hospitalization as a response to illness and accident. They note the often hostile reception that Jews received from mainstream Protestant hospitals. And they point also to the role of women who mobilized themselves as volunteers to build the communal infrastructure of Newark's Jewish community. Newark Beth Israel began as very much a charity, dependent on both Jewish business and working-class support, and it was sometimes troubled by fractious [End Page 477] relationships among their differing interests. The Krauts cover this account in the almost small-town detail one expects of an institutional biography: they list key staff, administrative, and board appointments, give dates for the opening (and naming) of specialty clinics and departments, and provide admissions data and budget and billing details. But they possess an admirable eye for the larger features of this narrative, contextualizing the hospital's evolution into a modern institution against the backdrop of the Flexner Report, Newark's public health infrastructure, the 1918 influenza pandemic, the Great Depression, the city's industrial decline, the suburbanization of Newark's Jewish population, the introduction of Medicare, the Newark riots, and the corporatization of medical care.

The reader is often grateful for the volume's granular history; the account, for example, of how Beth Israel responded successfully to the accreditation requirements of the new hospital standards movement in the early 1920s is particularly revealing, explaining both how the institution came to appoint a non-Jewish superintendent and how it committed to a program of upgraded facilities. This kind of discussion is at its best in focusing on the particularities of Jewish hospitals. The hospital's research agenda—staff, for example, played a leading role in the 1920s in developing treatment for Rh incompatibility in newborns—had much to do at the outset with the circumstances of Russian-Jewish immigrant physicians. Medical school quotas for Jewish students and outright bans on Jews in many internship programs led Beth Israel to adopt an aggressively scientific orientation to meet the needs of Jewish medical professionals. Similar exclusionary policies, as residencies became the standard for entry into medical practice, led Newark Beth Israel—like many other Jewish hospitals—to organize itself around what would later be called tertiary care.

As post–World War suburbanization accelerated, the Jewish patient population of Beth Israel fell; by 1949, it already constituted less than half. While some Jewish communal leaders sought to reaffirm the hospital's Jewish identity, the institution itself embraced "non-sectarianism under Jewish auspices" as a survival strategy. By the 1960s, the hospital was beginning to reconfigure itself as a regional medical center, though it continued to respond to the health issues of an increasingly impoverished city. Ultimately unable to negotiate the deepening financial crises of end-of-the-century health care, Beth Israel sacrificed its autonomy with its sale to the Saint Barnabas...

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