Montefiore Hospital: Jacob Schiff’s Enchanted Mountain (Part 2).

The following excerpt is from an unpublished biography The Benevolent Warrior: A Critical Study of Jacob Schiff, Robber Baron and Philanthropist by Robert Dannin. This is the second installment out of three. Read the first installment here.

One hundred years ago he was a Gotham presence without equal. The name Jacob Schiff (1847-1920) resonated among immigrant Jews from East Side tenements to Montefiore Hospital in the Bronx.

Some compared him to Moses leading his people from the wilderness while others cursed him, in Yiddish mostly, as a Teutonic overlord intent on grinding young cheder boys into fodder for countless sweatshops or other degrading acts of manual labor.

Politicians from opposite sides of the aisle, the Republican Charles Evans Hughes and the Democrat Samuel Untermeyer, excoriated his patrician business practices and sought his public humiliation.

Jacob Schiff. (CREDIT: The Collection of The Jacob Rader Marcus Center of the American Jewish Archive)

Enjoining the city’s wealthy Jewish families to become “co-workers in the great mission of our race” to rescue the poor and weak, Jacob Schiff soon announced plans to expand Montefiore hospital to one hundred beds and created a department of “outdoor relief” or homecare to bridge the gap between the present facilities and the planned expansion.

Careful to downplay the sectarian character of Montefiore he noted, “As Israelites we are compelled to provide for the needy of our own faith, but this must not induce us to exclude a human being because of religious beliefs.”

Nonetheless he appealed consistently to fellow Jews to exercise their faith outside the synagogue with “good deeds … the drying of a tear of the unfortunate … and in the very thought born by desire to benefit suffering humanity.” In the next breath he demonstrated non-sectarianism by announcing the donation of 84 kegs of beer by Jacob Ruppert, the gentile owner of the city’s largest brewery in Yorkville or “kleine Deutschland” as the area was known.

Dr. Simon Baruch. (CREDIT: Public Domain)

Schiff sometimes clashed with Dr. Simon Baruch over expenses and the delicate balance between expanded services and quality of care. Other board members dissented, but their comments were usually expunged from the minutes. It is easy to imagine the reasoning of more conservative individuals; if the mission of a hospital addressed only physical ailments, why was it also responsible for the patient once discharged, or his family?

Schiff argued against these narrow standards, insisting upon direct intervention in the immigrant community with a program of preventive healthcare. If consumption was social affliction and somatic disease, then public health must focus on supporting the families whose breadwinners had been stricken and hospitalized. It was the only way to prevent further cases from rapidly overwhelming the new facility.

He convinced the trustees that it would be expedient to use the new facility as an experiment in social medicine. Eventually the trustees ratified his idea for a Discharged Patient’s Fund to assist with rural relocation to places as nearby as the de Hirsch Fund’s Jewish colonies, located mainly in New Jersey but some as far away as Denver where the “clean air and altitude were believed to be therapeutic for all kinds of pulmonary conditions.” Schiff persuaded fellow banker Charles Hallgarten to fund an endowment for “economic and emotional support” to patients’ families while they were hospitalized. 

Scientific research and therapeutic advancement were priorities at Montefiore where physicians communicated regularly with doctors in Germany, the recognized world leader for innovative healthcare and medical research. In December 1890 when Germany’s Robert Koch discovered the tuberculin bacillus, Schiff dispatched a courier who quickly returned with a sample for Baruch. Although the specimen did not prove to be the heralded cure for the tuberculosis, Montefiore pathologists used it to create accurate tests for the disease.

Among other diagnostic innovations Montefiore was the first hospital to use X-ray machines. Baruch’s successor Dr. Siegfried Wachsmann started one of the county’s first cancer clinics in 1913. Yet another pioneering method was embodied in the Occupational Therapy department, a workshop really, where patients honed their skills at traditional crafts such as toy-making, woodworking, silversmithing, and bookbinding.

“Of two hundred-twenty patients treated at Montefiore in 1893 seventy-three were from Russia, eight from Rumania, nine from Poland, thirty-three from Hungary, fifty-one from Germany, and twenty-five from Austria. Twenty-six listed their occupations as “tailor” and there were enough shirtmakers, pressers, and cloak-makers to confirm Dr. Etinger’s aphorism, “Russians of nationality, and tailors as to occupation.” 

Home for Chronic Invalids, ca. 1890 (CREDIT: Public Domain)

The ethics of treating the whole patient derived from collaboration of the socially-minded Schiff and physicians cognizant of economic reality and eager to assure that “patients were not discharged until their homes were visited and evaluated. Employment was found for some patients, and for those who could not work arrangements were made with a charity organization to help the family.”  

In June 1894 the hospital reduced its patient intake by 20% to trim expenses while increasing the number of out-patients, free prescriptions, and baths. Schiff meanwhile appealed for more funds. He also repeatedly asked the city for money. On a yearly basis he applied for public hospital grants that were keyed to the total number of patients served. He bolstered his plea by insisting that Montefiore was a non-sectarian hospital.

“It will be a gain to the entire human race,” Schiff explained, “if our own continue to disregard the barriers of creed and solidly recognizes in every suffering human being the image of a common Father.” 

The 1893-96 a severe economic depression did not restrain the Schiff family from giving lavishly to the patients. In 1895 his in-laws Betty and Solomon Loeb made a substantial gift to commemorate the marriage of their daughter Nina to Paul Warburg.

The following summer Schiff chartered a boat to take the patients on a seaboard cruise to alleviate the unbearable heat. The cruise stopped at his seaside estate in Sea Bright, New Jersey where he feted the patients with a banquet on the lawn. Thereafter, Schiff’s prescription for relief from the sweltering summer heat became an annual tradition, giving Montefiore’s patients access to the cool ocean breeze, the delights of bourgeois luxury, and the tranquil setting to contemplate the great distances they had traveled to reach the “Promised Land” of America.

Schiff’s many detractors accused him of grandstanding. These outings neither cured the disease nor solved poverty. In some cases, they only fueled more resentment, yet for others it may have created a better understanding about opportunity in America. If a Jew like Schiff had scaled the commanding heights of the Hudson River’s western cliffs, why not one of them?

The restorative benefits of fresh-air therapy were firmly anchored in the medical canon of late nineteenth century Europe and the United States. For the Montefiore trustees and Schiff in particular the judicious use of the Discharged Patient’s Fund to send able-bodied men to live and work in rural Jewish settlements was consistent with the de Hirsch Fund’s mission. By 1895 these two prescriptive therapies, one addressing tuberculosis, the other addressing the urban concentration of refugees, found a concrete expression in the idea of a country sanitarium to transfer some Montefiore patients out of the city.

“It will be a gain to the entire human race,” Schiff explained, “if our own continue to disregard the barriers of creed and solidly recognizes in every suffering human being the image of a common Father.” 

The first donation of $25,000 came from the department store tycoon Lyman Bloomingdale to memorialize his deceased daughter. Schiff matched this donation and put the funds into a special endowment for the Country Sanitarium while directing the interest into Discharged Patients Fund until plans were fully developed. Two years later Montefiore purchased a 137-acre working farm in the northern Westchester Country town of Bedford.

A local farmer managed the property and supervised conversion of the existing structures into hospital dormitories for about a dozen patients from the Bronx, some of whom assisted with the improvements and tended the crops and livestock. Eight weeks later the farm began supplying Montefiore Hospital itself with fresh milk and eggs.

Another donation from the Lewisohn family helped build a pavilion to accommodate 24 patients. Within two years the sanitarium had demonstrated a 66% rate of total remission for the approximately seventy patients sent to work on the farm. This success convinced trustees to use the original endowment to build a permanent 150-bed facility that would reflect the highest standards of the fresh-air cure.

“The new structure presented a long clean-lined front, the whole was a pattern of brightness, of gleaming windows eager to attract the sun, a challenge to the drab closeness of the congested city quarters which were such a heavy contributing factor to the disease. The grounds were spacious, the attractive lawn bordered by trees.  … Another dream had become a reality … Four Greek-revival pavilions flanking a central pillared hall.” 

When it opened to much pomp and circumstance on May 30, 1901, the Montefiore Country Sanitarium consisted of four large pavilions, two each for male and female patients. The original farmhouse was transformed into a synagogue whose original benefactor Adolph Lewisohn memorialized his wife with an additional $40,000 for the two women’s pavilions. The entire facility was designed to expose the patients to the open air and constant seasonal temperatures.

Portrait and signature of Adolph Lewisohn (CREDIT: Prominent and Progressive Americans: An Encyclopædia of Contemporaneous Biography)

Schiff arranged for Vice President Theodore Roosevelt to give the keynote address at the dedication ceremony. Averring specific references to Jewish immigrants, Roosevelt celebrated the communitarian example of Montefiore as a meritorious example to the entire country. “There is an appropriate lesson to be learned in the citizenship which limits only the source from which it draws and leaves unlimited that to which it gives.” 

It is not difficult to parse Roosevelt’s sentiments provided one dispenses the myth surrounding his trust-busting policies and the image of a pro-labor, pro-farmer presidency. Roosevelt’s progressivism was based on traditional Whig conservatism, and it responded to the chaos of industrial capitalism by sanctioning government supervision of monopolies … by and for the monopolists themselves.   His allusion to Schiff’s ability to leverage funds from the Jewish community was clearly in step with subsequent Republican ideologies of communitarian self-help as the way to avoid answering popular demands for industrial regulation and economic justice.

Roosevelt’s patronage, or patronization, was an unsubtle nod to Schiff’s role in bringing Russian immigrants to America, but only as many as the Jewish community could absorb according to its own means. If immigration exceeded this self-regulating capacity the government would refuse to deliver humanitarian services of last resort and instead allow the forces of exclusion and xenophobia free reign to shut the door in the face of incoming refugees. In his position as chief fundraiser and designated steward, Schiff assumed responsibility for measuring this natural capacity for Jewish self-help as it was institutionally embodied in Montefiore, Henry Street, Galveston, and his other philanthropic works. 

The Country Sanitarium functioned as a modern tuberculosis treatment center with a large staff including four medical officers, ten nurses, orderlies, and other non-medical personnel. Dr. Leopold Rosenberg, the medical director, carefully screened all incoming patients for tuberculosis and diabetes. He handed them a set of very strict hygienic rules that prohibited spitting except in designated bottles. The penalty for even a first violation would be immediate expulsion from the facility. Like their fictional counterparts at Thomas Mann’s Magic Mountain, patients submitted to bodily temperature checks twice daily. Those with readings above 100° were confined to bed rest and received “fresh air, abundant food, or even ‘hyperalimentation’ or over-feeding and hydrotherapy.” Male and female patients were segregated except at mealtime. Entertainment included the patient-led theatrical productions, movies, concerts, and religious ceremonies on Sabbath and holidays.

 Like the fictional community on the Magic Mountain there were social discontents and rabble-rousers who sought to agitate fellow patients and undermine the institutional order. In 1904 Rosenberg complained of distractions occasioned by an “impetuous woman” and “a gang of anarchist agitators” led apparently by a “youthful malcontent, high priest of socialism and anarchism.” 

Socialist inmates heaped resentment on Montefiore’s benefactors whom they depicted as exploiters of cheap labor. They dismissed the progressive characteristics of Montefiore, its welfare ethos, and especially its compassionate doctors who regarded the patient’s family as the unit of treatment. Whereas Thomas Mann compacted these anti-establishment qualities into a single persona, the Italian dilettante Ludwig Settembrini, the reality facing Montefiore’s staff was a group of “politically minded consumptives.”  They viewed tuberculosis as a working-class affliction and repudiated the capitalists orchestrating their medical care.

Adding to the confusion, administrators at Bedford “confused political discussion with patient complaint seeing in both the specter of anarchism.” 

Schiff treated Montefiore and his other philanthropic projects in much the same way as his railroads. Relentless expansions and upgrades were a constant feature of its growth to satisfy demand and create new opportunities.

Rosenberg expressed unusual conceit in denouncing such patients as hellbent on destroying the sanitarium. “It will be readily understood by all intelligent lay-men how fatal to success in the treatment of tuberculosis is a state of dissatisfaction and rebellion against the sanitary discipline of a sanitarium; added to the pardonable bitterness which many patients feel against the hard fate which had made them victims of a dreadful disease, is the despair of betterment which goes with the belief that they are being underfed, maltreated, and neglected. Our patients are easily inclined by adroit ranters as they variably attribute their state to anything or anybody but the disease from which they suffer.” 

Schiff viewed the sanitarium as a microcosm of the larger immigrant community and worried about the 5% whom Rosenberg classified as disruptive. This statistic, if accurate, represented serious potential for social unrest. Demonstrations, strikes, boycotts, and protests not only jeopardized permissive immigration laws but also gave nativist legislators an excuse to exclude Eastern European Jews. On this evidence Schiff appealed to his fellow trustees for greater financial commitments.

“We feel the community has a the right to expect of us that we handle, without hesitation, the serious problem with which it has entrusted us, especially as there appears to be no limit to the growth of the population of Manhattan Island, and least to that of its Jewish population.” 

By 1902 Jews made up 25% of the borough’s total population, yet less than 1% of all Jews in New York contributed to Montefiore’s annual fund. The operating budget of $100,000 and an annual 8% rise in expenditures per patient would soon outstrip the hospital’s $1m endowment, dependent as it was on donations “mostly by board members to memorialize a relative, such as the recently deceased Betty Loeb whom Schiff honored by a $25,000 fund.”

This set the standard minimum for a memorial gift from the 1%. Funds were applied to the construction of an annex for patients with communicable diseases, a new state of the art operating room, and a pathology lab. At the urging of Dr. Henry S. Oppenheim, Schiff funded the lab himself to further develop Montefiore’s position as a leading research center.  Simultaneously, the Bedford sanitarium plans for growth were complicated by the inadequate water supply in Westchester County.

A well drilled in 1897 was quickly running dry and the surrounding area was too sparsely settled to support a municipal system, putting the onus on Montefiore trustees to construct a two-million-gallon reservoir and local sewer installation. It was later acknowledged that this initiative contributed to suburbanization and risubng property values in northern Westchester County. 

Schiff treated Montefiore and his other philanthropic projects in much the same way as his railroads. Relentless expansions and upgrades were a constant feature of its growth to satisfy demand and create new opportunities. In the case of railroads even the tracks were torn up for the sake of competition. The hospital, on the other hand, was trapped by the rampant urbanization in northern Manhattan rendering it pointless to consider any future expansions but also provoking local criticism of patients “strolling the adjacent streets” or “moaning from physical pain.”

Public fear of contagion had not abated and remained an important consideration in relocating the facilities. Schiff proposed selling the West 138th Street property and applying the money to construct a new hospital further north. The buildings would fetch about $500,000, a quarter of the total cost for the new hospital on land he eventually selected on Gun Hill Road in the Bronx.

With the announcement of a move in early 1909, Schiff dispatched the new medical director, Dr. Siegfried Wachsmann to Germany to observe the construction of a state-of-the-art hospital in Berlin. Based on his recommendations the estimated cost of the new Montefiore was $2m, much of it donated by Schiff and other family members.

The Montefiore Home and Hospital for Chronic Diseases opened in late 1913 on an eight-acre site in the North Bronx. Its campus comprised eight brick buildings interconnected by enclosed corridors “to protect staff and patients in transit.” There was a 300-seat synagogue and two fully equipped kitchens conforming to kosher dietary laws. Tuberculosis patients were housed in a separate pavilion with rooms opening to balconies for sunshine and fresh air.

“The sickest non-tubercular patients were in a five-story, 225-bed central pavilion. Each floor had three large wards and several smaller ones. The doors leading to the balconies were built for wheelchair access. In the ward for patients suffering from locomotor ataxia … a design of footprints was inlaid on the floor to help in teaching them to walk.”

Such meticulous attention to therapeutic details carried over to the physical plant whose structure, plumbing, and landscaping still remains the backbone of a greatly expanded medical center one hundred years later.

WORDS: Robert Dannin.


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