Montefiore Hospital: Jacob Schiff’s Magic Mountain (Part 3)

The following excerpt is from an unpublished biography The Benevolent Warrior: A Critical Study of Jacob Schiff, Robber Baron and Philanthropist by Robert Dannin.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

Illustration from Brockhaus and Efron Jewish Encyclopedia (1906—1913). Montefiore Home for Chronic Invalids in the Bronx, New York; this evolved into the present-day Montefiore Medical Center. I believe the central portion of this building still survives as part of the modern hospital (either that or it was replicated), although the wings have been replaced.

Schiff was the driving force behind the most modern hospital facility in the nation with 450 beds, a separate pavilion for private patients whose payments supplemented charitable contributions. An annual budget of $300,000 funded through the endowment and other revenues gave Schiff license to tout “the most extensive and perhaps best equipped private hospital in the city.”

By 1916 Montefiore’s role in advanced medical research was recognized with formal affiliation to the medical schools at Columbia, NYU, and Bellevue Hospital whose medical students would acquire expertise working in the departments of physiology, biochemistry, radiology, and pathology in addition to its commitment to every conceivable aspect of social service from the Discharged Patients Fund, dental care, occupational therapy, employment counseling and small business loans to preventive medicine for the patient’s family, visiting nurse services, and a most extraordinary real estate office to help patients find new homes. 

The opening of a small garment factory in an adjacent section of the Bronx completed the Owenite scheme of the hospital reconceptualized as a “social instrument.”  Patients were discharged to halfway houses where they installed their families and began transitioning back to society. The objective was to move tuberculosis-prone workers to healthier jobs “grading the work according to the strength and ability of [individuals] under the supervision of a nurse and physician with the flexibility to regulate the conditions, hours of work and rest … the hope being to gradually return the patients to full time work and efficiency. Nurses dealt with the details of family healthcare including referrals to dentists and the young to children’s preschools. As part of this after-care regimen the nurses organized the factory lunchroom to serve not only as a source of nutrition but also as a forum for community service works.

The factory itself was run as a for-profit business with a manager, marketing director, and foreman. Minimum wage was set to union scale. A total of 126 families were enrolled in this experiment. Rehabilitated patients could use the Montefiore Social Services department to obtain small business loans from the Hebrew Free Loan Society. They became entrepreneurs of candy stores, a toy kiosk in Coney Island, a boarding house, and newsstands throughout the city.”

Although the First World War brought an abrupt halt to immigration, the hospital’s financial difficulties nonetheless continued. In 1917 Schiff suspended the planned private pavilion and converted it into an infirmary for wounded U.S. military officers. He also refinanced the endowment’s investment portfolio, now less than $1 million, into Liberty War Bonds. Another $50,000 was spent to build a second halfway house nearby. Despite studies showing a stunning decline in the rate of relapse – from 45% to 15% attributed mainly to early diagnosis – the medical director anticipated a post-war spike of 25,000 new tuberculosis cases among the returning GIs, many of whom according to Dr. Jacobi, “will in due time add their quota to the applicants for institutional care.” 

Schiff turned once more to the Federation of Jewish Charities citing the loss of revenue from the delayed opening of private hospital pavilion and the increased payments to families from the Hallgarten Fund that now disbursed $5 per month plus a $3 per week supplement for families with school-age children. Frustrated by lingering prejudice toward the immigrants he tried again to obtain a grant from the city’s Hospital Fund, his application emphasizing Montefiore’s continuing commitment to assisting “mixed racial groups.”  While no records exist of any patients other than those classified “white,” Schiff insisted that “so many indigent patients … would otherwise have been public charges” and he eventually prevailed when the city granted Montefiore a maximum subsidy of $1.10 per patient per day. 

When Schiff retired in May 1920 his fellow directors bestowed the title, Honorary President for Life, in gratitude for his thirty-five years at the helm of “a monument that will for all time endure.” In a typical year during his long tenure Schiff never missed Montefiore’s ritual celebrations, secular and religious alike. The hospital’s synagogue doubled as a venue for theatrical productions and movies donated by the major film studios – Vitagraph, General Film, Universal, Fox, Mutual, World Film Corp. and Metro Pictures – all run by the first wave of Russian immigrants resettled in American under the aegis of the de Hirsch Fund. 

Paternalistic to the core Schiff’s philanthropy was also marked his repeated attempts to suppress anti-immigrant prejudices among fellow Jews and his devotion to the socially conscious ideals of healthcare. That patients could enjoy beer and cigars, fresh-cut flowers, good food, and varied entertainment and still freely express political dissent and their own personal resentment toward his plutocratic ways spoke directly to the sense of communal obligations he undertook as a form of religious duty. He summarized his motivations by quoting from his favorite novel, George Eliot’s Daniel Deronda, a popular Victorian appreciation of the Jewish spirit: “Israel is the heart of mankind, if we mean by heart the core of its affection which binds a race and its families in dutiful love and the reverence which lifts the need of our animal life into religion, and the tenderness that is merciful to the poor and weak.” 

The rational kernel of this invocation conveyed a message from the ancient philosophers, reinforced no doubt by Schiff’s Frankfurt upbringing, that by eschewing the animal spirits so often characteristic of those who hoard wealth, a single individual can help make life tolerable for the many. Schiff’s Montefiore offered community to a liminal population of displaced immigrants suffering from ill health and culture shock – the weakest among those newcomers trying to adjust to the New World. It was Schiff’s “Enchanted Mountain” where tuberculosis, the somatic affliction of the modern nomad, was treated scientifically and with compassion.

As a radical experiment in healthcare and protected from major financial constraints by Schiff and his fellow trustees, Montefiore’s staff were free to pursue a humanistic mission whose practice fused science and society. Absent the status-consciousness found in the more venerable Mt. Sinai and Beth Israel hospitals, Montefiore administrators were free to recognize the potential of young immigrant doctors like Maurice Fishberg who became chief of the tuberculosis ward.

Fishberg combined his medical research with the nascent science of anthropology into a study of Jewish diversity published in 1911 as The Jews: A Study of Race and Environment. Conferring with Bernard Sachs, the hospital’s chief neurologist who in 1887 had identified Tay-Sachs disease, a deadly genetic disorder prevalent among Eastern European Jews, Fishberg began to catalogue and analyze diverse physical and social traits of the “Jewish race.” Drawing his subjects from “a million Jews from Europe, Asia and Africa” his vast study combined the results of anthropometric measurements with encyclopedic research of cultural and demographic data about Jews worldwide. 

Fishberg’s book was a modern response to a genre of German literature devoted to explicating Jewish “racial” otherness in comparison to Christian Europeans. He targeted studies of “Jewish” physical and cultural traits that since at least the early eighteenth century were used to justify the exclusion of Jews from civil society and deny them the full rights and privileges of citizenship while confining them to secondary status.  

In contrast to the folklore, witticisms, random observations, intertextual allusions, and racial stereotypes in these books Fishberg sought a scientific explanation of Jewish diversity as a function of the interaction between genetics, culture, history, and environment. Jewish diversity, he argued, resulted directly from adaptation to local conditions and intermarriage with their gentile neighbors.

Jews living in North Africa, for instance, shared a great many characteristics with indigenous peoples there and were quite distinct from Western European Jews. Taken as whole, Jews displayed greater physiological and cultural variability among themselves than between themselves and the indigenous peoples of any country where they lived. Fishberg was perhaps the first scientist to explain Jewish identity as a culturally constructed phenomenon based on religious practices and marriage laws. 

Schiff’s interest in this work was far from academic; in his hands Fishberg’s anthropology became an instrument in the battle against anti-immigration legislators. Their nativist argument held that Russian Jews were incapable of assimilation, they represented a corrosive influence on American society and therefore should be permanently excluded. 

According to Fishberg, however, Jewish diversity proved the capacity to assimilate wherever the Jews settled. When assembled as a “nation,” Jews looked very different from each other precisely because they blended so well into all societies in which they lived. The reasoning was consistent not only with Schiff’s beliefs about the diaspora but also the tenets of Reform Judaism that originated as an expression of European Enlightenment ideals.

Fishberg’s findings were equally important to Jews seeking to preserve their ethnic identity within the melting pot. Despite superficial differences Jews possessed a unifying set of beliefs and practices whose perpetuation ought not be compromised by their capacity for social assimilation. Adaptability was a positive trait but hardly a prescription for abandoning the faith through intermarriage or cultural syncretism, a prospect he called “race suicide.”  

Fishberg’s work, researched and written at Montefiore, anticipated Horace Kallen’s doctrine of cultural pluralism as an important tool for Jews and other minorities negotiating questions of personal and group identity. It was based on the theory of cultural particularism developed by Franz Boas, founder of modern anthropology, who likewise had deep connections to Schiff and Montefiore.

Originally trained as a physicist in Germany, Boas immigrated to the United States where he became fascinated by the peoples and cultures of the Pacific Northwest. His uncle, Dr. Abraham Jacobi, introduced him to Jacob Schiff who funded his ethnographic research for the Natural History Museum. Boas eventually became the assistant curator for its permanent collection of Native American cultures but not without first struggling against prejudice. His efforts to stage interpretive exhibits of artifacts from his own fieldwork met with bitter opposition from the museum’s conservationist gatekeepers. They criticized his introduction of scientific taxonomy and stood in the way of modernizing the acquisitions process. They opposed the idea of an outsider, a Jew in fact, putting his imprimatur on the collections.

The presumptions of elitists seeking to defend their stewardship of American heritage, including the surviving indigenous tribal cultures, offered a supreme irony on the nativist approach to immigrants. Pressured by Schiff they eventually conceded by extending the young scholar’s appointment, but this was a halfway measure at best. Boas was already determined to move his project into the academic arena at Columbia University but found his career block by similar opposition. This forced Jacobi and Schiff to intervene once again in making Boas the university’s first professor of anthropology.

The scientific theory of human diversity championed by Boas emerged from the intellectual milieu created by Schiff’s enlightened philanthropy under the guidance of Dr. Jacobi, a friend of Karl Marx and like him a political refuge of the failed German revolution of 1848.  Boas’ contribution to Montefiore also included his son, Ernst, a graduate of Columbia College of Physicians and Surgeons. Appointed medical director shortly after Schiff’s death, Ernst Boas instituted a modernization of medical services and worked to further cement the hospital’s egalitarian traditions.

Before Fishberg resigned to pursue private medical practice, he recruited his successor in Palestine. Ephraim Michael Bluestone had been working at the Hadassah Medical Organization until realizing that he “temperamentally unfitted to the chaotic atmosphere of sectarian argument and physical violence that was Palestine at the time.” In plainer language Bluestone wanted no part of the Zionist dispossession of the Arabs.  At Montefiore he consolidated the services developed by Simon Baruch and Jacob Schiff into the Department of Social Medicine. He led the institution for more than two decades while championing the right to free, universal healthcare in steadfast opposition to the AMA and private insurers. His expression of this philosophy summarized the early legacy of Montefiore in a new, modern inflection. “I am an opponent of the fee-for-service principle. It leads to all kinds of dreadful things: splitting fees, unnecessary surgery. It affects the hospital structure because the man who calls in consultants is favored.” Given his respect and material support for the doctors who saw patients as human beings, not cash machines, one can hardly discredit Schiff’s enthusiastic support for Montefiore’s mission.

One hundred-thirty years later Montefiore encompasses a network of four hospitals and 125 health clinics across the Bronx and lower Westchester County. With a staff of 18,332 Montefiore Hospital is the borough’s largest employer providing services for primary care to fertility treatments and out-patient cardiac procedures. The hospital provides comprehensive medical care to about one-third of Bronx residents, and emergency or non-routine care to another one-third in one of the poorest and most health-challenged urban communities in the nation. More than 50% of Montefiore patients are first or second-generation immigrants from around the globe, only a small percentage of whom are Jewish. The current president Dr. Steven Safyer reflects the founder’s ethics having done his medical internship and residency at the hospital from where he was dispatched to supervise healthcare for inmates at New York’s Riker’s Island prison. Maintaining against all odds a fervent opposition to fee-for-service care, he asserts, “Healthcare is a human right not a privilege. On a sunny autumn day in 2017 the open-air courtyard was resplendent with ample shade and space given over to the local farmers market. Staff, doctors, nurses, ambulatory patients, and their visitors mingled freely; some conversed in small groups, others ate wholesome lunches on benches placed in grassy alcoves in a convivial ambience separated by several miles from the ‘industrial’ hospitals downtown. The mood was reminiscent of a sunny afternoon in a small village.

The very real practice of communitarian self-management gave Schiff the necessary latitude to support a healthcare program containing the basic elements of social welfare as it was then conceived. Did Schiff flirt with communitarian socialism? Uptown at Broadway and West 138th Street and even further “uptown” in Westchester County he was a partisan of practical solutions rather than idealist pursuits. He sought to implement an Owenite social program with a full range of benefits, services, and therapies designed as a prescription for cradle-to-grave social assistance. 

He regarded these programs as stopgap measures to assuage class tensions and promote assimilation. Moreover, they were designed to counter the growing chorus of right-wing nativists who wanted to foreclose Jewish immigration entirely. Similarly, his short-lived Galveston Plan (1907-1914) brought immigrants from Europe directly to the Gulf Coast port where they got train tickets to destinations west of the Mississippi. He expected them to settle in the vast heartland away from overcrowded tenements and far removed from political controvery. Yet many did not abide and quickly made their way east to the cities, their familiar faces and transplanted European traditions. This statistic was attested to Montefiore whose doctors reported that many tuberculosis patients gave Galveston, Texas as their last address. Perhaps because he saw no alternative Schiff persisted. His programs including the Educational Alliance aimed to prevent the formation of a permanent Jewish underclass. Unlike many uptown colleagues including some of the German-Jewish doctors at Montefiore he did not resist or prohibit the use of Yiddish. Schiff even furnished Montefiore’s library with a collection of often maligned “jargon” literature. 

Schiff proclaimed his views on immigration in a 1907 address to the Jewish Chautauqua Society later reprinted as a commentary in the popular magazine, Leslie’s Weekly. “The real Zion of the Jews is the United States,” he stated in opposition to the project of establishing a Jewish state in Palestine. “The Zionist movement which had for its object the concentration of all the world’s Jews in that locality is impractical, and its advocates are finding this out.” The article offered a vision of settling approximately five million Jews in the western United States. 

WORDS: Robert Dannin.

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