HOSPITALS

The modern name "hospital" must not be confused with that given to the institution which, throughout the Middle Ages in Europe, served the dual purpose of lodging poor or sick travelers and nursing the ailing poor. Hospitals of this nature were established as early as the fourth century C.E., and, according to Jerome (c. 347–c. 420), there was a continuation of institutions which had long been established in the Holy Land. The lepers' quarantine mentioned in the Bible cannot be taken as proof of the existence of hospitals, although, according to the Hebrew grammarian gesenius , the term beit ḥofshit ("house set apart"), used in II Kings 15:5 to describe the dwelling of King Azariah after he was stricken with leprosy has the meaning of an infirmary or hospital in the sense of a place for the dressing of wounds. In talmudic times the term beita de-shayish ("marble room") is used for an operating theater, but this again is not synonymous with a hospital (see medicine , in the Talmud). It can be assumed that by the time hospitals were being established in Christian Europe, they were also in existence in Jewish communities where private hospitality and charity were inadequate. There is evidence of one of these dual-purpose institutions in what is now Yugoslavia in the fifth century, and of another in Palermo, in Sicily, in the sixth century. -The Hekdesh In Germany, a Domus Hospitale Judaeorum is recorded in a Cologne document of the 11th century. The fact that it is described in Hebrew as a hekdesh ("a hostel for the poor") would suggest that it was intended as a lodging for travelers rather than a place for curing the sick. It has been suggested that the "Jewish inns" in medieval Spain and in Paris may have been similar establishments. The first definite evidence of a Jewish hospital in Spain comes from Barcelona, where in a manuscript of 1385 there is a description of some men as Procuratores et Rectores Hospitalem pauperum Judaeorum. At the beginning of the 13th century there is mention of a Jewish hospital in Regensburg, and others are known to have existed in three other German cities: Munich (1381), Trier (1422), and Ulm (1499). By the 16th century they had spread eastward to Vienna and Berlin. These were inns for foreign Jews where sick strangers may have been treated in a part of the building specially set aside for them. They were supported by the community, by benevolent societies (ḥevrot), and by charity boxes. While with the population growth in Christian Europe during the later Middle Ages the term "hospital" was confined more and more to institutions dealing exclusively with sick people, the Jewish hekdesh did not change its dual function. It was apparently a very primitive affair consisting of one or two rooms with a maximum of six beds, ill-equipped for nursing, and without any regular medical attention. It was sometimes also used for obstetric cases. The reason for the low standards was that most Jewish communities were small and poor, and they were socially insecure and subject to sudden expulsion, so that the provision of permanent facilities for the sick was a waste of money. It must also be remembered that the great physicians of the 16th to 18th centuries had no connection with hospitals. The hekdesh was last heard of in Eastern Europe at the beginning of the 20th century, when the term was still used for mental asylums. -The Hospital in Europe The transition to the hospital as known today began in Western Europe. From there it spread eastward with the 18th-century Enlightenment, when Jewish communities could look forward to a permanent settlement and better economic prospects, and when at the same time the idea of the modern, scientific "house for the sick" (Krankenhaus) was taking root. A small hospital of this type was opened by the Sephardi community in London in the 1740s. Berlin, Breslau, and Vienna followed in the second half of the 18th century, and the first Jewish hospital in France was founded in Paris in 1836. From then onward Jewish hospitals with general wards for the poor and private wards for the wealthier classes were built throughout Europe. By 1933 they existed in most countries, and usually had a high reputation. At this time there were 48 Jewish hospitals in Poland – nine percent of all hospitals in the country – having a total of over 3,500 beds, more than a thousand of them in Warsaw alone. Jewish hospitals of varying size were to be found in many towns in Lithuania, Latvia, and Romania, and in Salonika in Greece. In Germany, many towns of importance, such as Hamburg and Frankfurt, had their Jewish hospital. Italy's first Jewish hospital was established in Rome in 1881. The Jewish hospital in Vienna, built by the rothschilds , served not only the Austrian population but also patients from Eastern Europe. There was a Jewish hospital in Amsterdam from about 1840, and another in Basle, Switzerland. In England beds for Orthodox Jews were maintained by charitable organizations in a number of the great medical centers, such as the Middlesex Hospital in London. The first Jewish general hospital in the country was the Victoria Memorial Jewish Hospital, founded in Manchester in 1903. Two years later the Theodor Herzl Memorial Home for the Jewish Sick, later renamed the Herzl-Moser Hospital, was opened in Leeds. The London Jewish Hospital, in the East End, was founded in 1919. After the outbreak of World War II in 1939 most of the Jewish hospitals in Europe, apart from those in England, disappeared. Those in East Berlin, Hamburg, Vienna, Amsterdam, and Paris were reopened after 1945. With the exception of that in Hamburg, they are all far smaller than in prewar days. There are Jewish hospitals associated with other communities throughout the world. However, with the spread of state medical services, much of the original motivation has gone. They now serve primarily to assist those patients who feel more comfortable in a Jewish environment and who wish to receive kosher food. -In the U.S. The early purpose of Jewish hospitals in the U.S. was the treatment of Jewish patients, who it was believed needed a medical environment which was Jewish. In German Jewish immigrants' places of origin, medical care had long been a Jewish communal function, and it was they who founded the first Jewish hospital in the U.S., Jews Hospital (from 1869, Mount Sinai Hospital), in New York in 1852. It was followed in 1854 by the Jewish Hospital of Cincinnati, which in the traditional manner of the hekdesh also provided shelter for the poor and transients during its early years. Hospitals founded by American Jews before 1900 were paralleled in some large cities by new ones founded by East European immigrants, who sometimes expressed discontent with the "un-Jewish" atmosphere at the established hospitals. After approximately 1920, when Jewish patients needed the Jewish medical environment less and less and they began to lose their foreignness, the Jewish hospitals tended to find as a rationale the necessity of providing professional opportunities for Jewish physicians who were victims of severe discrimination in hospital staff appointments elsewhere. Some of the Jewish-sponsored hospitals in New York included Maimonides Hospital of Brooklyn, the largest general hospital in the United States observing kashrut, and among the first American hospitals to perform open-heart surgery; Mount Sinai Hospital; Montefiore Hospital, known for treatment of prolonged illness, teaching, and research; and Long Island Jewish Hospital with its outstanding premature nursery center; Beth Abraham Hospital for chronic disease; the Beth Israel Hospital; Bronx-Lebanon Hospital; Brookdale Hospital; Hospital for Joint Diseases; and Jewish Hospital of Brooklyn. Other hospitals under Jewish sponsorship in the U.S. included the Michael Reese and Mount Sinai hospitals in Chicago; Cedars-Sinai Medical Center in Los Angeles; the Albert Einstein Medical Center in Philadelphia; the Jewish Hospitals in St. Louis, Cincinnati and Louisville; the Sinai Hospitals in Baltimore, Cleveland, Detroit, Miami, Hartford, Milwaukee and Minneapolis; the Beth Israel Hospitals in Boston, Newark, Denver and Passaic; Cedars of Lebanon Hospital in Miami; Menorah Hospital in Kansas City; Miriam Hospital in Providence; and the Touro Infirmary in New Orleans. Jewish federations also supported chronic disease hospitals in Long Branch, New Jersey, Montreal and New York; tuberculosis and chest disease hospitals in Denver and Montreal; and psychiatric hospitals in Los Angeles, New York, and Philadelphia. When medical discrimination declined after about 1950, the Jewish hospitals, many of which by then had only 10% to 25% Jewish patients, tended to be rationalized once again, this time as a Jewish service to the community at large. Jewish hospitals and health services are still supported by Jewish federations. In addition to general hospitals, these federations maintain nursing homes and homes for the aged and infirm. Their help also extends to family welfare agencies, mental health programs, vocational counseling, child care centers, and summer camps. At present, Jewish physicians can obtain training and admitting privileges at hospitals throughout the United States, and Jews often occupy leadership positions on hospital boards and medical staffs. Furthermore, during the post-World War II period, Jewish communities tended to move to the suburbs. The traditionally Jewish inner-city hospitals experienced weakened financial positions as their patient bases included increasing percentages of uninsured or Medicaid patients. In 1975, there were 33 Jewish-sponsored acute-care general hospitals in the United States. However, by late 1999, due to demographic and financial trends, fewer than half of these   were being operated under their original ownership or sponsorship. Thirteen of the original 33 Jewish-sponsored hospitals formed or joined existing partnerships with nonsectarian or other facilities. For example, Beth Israel Hospital in Boston merged with Deaconess Medical Center, and New York's Mt. Sinai merged with New York University Hospitals. However, the sales contracts for such mergers often included stipulations for continuity of Jewish care, such as kosher food and ritual circumcision. Jewish chaplains (see below) at hospitals across the country continue to assist with these services, as well as leading Sabbath and holiday celebrations, providing Torahs, prayer books, Bibles, Sabbath candelabra and other ritual objects, and serving as spiritual and pastoral counselors as well as sources for guidance in making medical ethical decisions. Some communities came up with innovative solutions to the sale of their hospital properties. In Pittsburgh, for example, the Jewish community put the proceeds from the sale of its hospital into an endowment fund to be used solely to help needy Jews. Jewish communities continue to be prime supporters of medical institutions regardless of religious or other affiliations. Some Jewish sponsored-hospitals ultimately found that they were not economically viable or for other reasons shut their doors. Yet other Jewish facilities have succeeded in remaining important and prominent communal resources, such as Cedars-Sinai Medical Center in Los Angeles and the Jewish Hospital in Louisville, Kentucky. Levi Meier (2nd ed.) -Chaplaincy Chaplaincy provides spiritual support, counseling, and a Jewish connection for people in institutional or community settings outside of a synagogue. Chaplaincy may include crisis support to individuals or their families, worship services, help with ethical decision-making, staff education and support, training volunteers, and forging connections with synagogues and community organizations. Chaplains are trained professionals, including rabbis, cantors, and lay people, who provide this care. Currently, the terms chaplaincy, spiritual care, and pastoral care are often used interchangeably. The following does not focus on military chaplaincy (see (Military Service ) nor on the university setting (e.g., hillel ). Chaplaincy is based on Jewish values such as bikkur ḥolim (visiting the sick; Sot. 14a). However, this is a general obligation for Jews, not a professional discipline. The first individuals began working in chaplaincy in the late 19th century, and the field itself emerged in the late 20th century. The earliest examples of salaried Jewish chaplains involved service to people in public institutions. The New York Board of Jewish Ministers (now the New York Board of Rabbis) established a visiting chaplain program for prisoners in 1891 which continues today. In Britain in 1892, the London County Council appointed ḥazzan Isaac Samuel as Jewish chaplain to the Colney Hatch Asylum. Rabbi Regina Jonas, the first woman to be ordained, served as a chaplain in Germany in the late 1930s before her deportation and death during the Holocaust. A number of Jewish hospitals and nursing homes in the United States had a rabbi on staff by the early 20th century. Their roles generally focused on leading worship and providing kosher food. There was little recognition of patient care or counseling as key roles, nor did chaplains create a professional field. The experience of World War II, when over 300 rabbis served as U.S. military chaplains, advanced the civilian field as well. Between 1945 and 1955 Jewish chaplaincy programs through Boards of Rabbis or Jewish chaplaincy agencies expanded significantly in New York, Chicago, Los Angeles, and Philadelphia. Initially, Jewish chaplaincy focused on serving patients in Jewish hospitals and nursing homes and in state-run prisons or hospitals, although not every Jewish-sponsored facility had a Jewish chaplain. As health care changed by the 1980s, chaplains also began to serve Jewish patients in non-Jewish and secular facilities, and a number of community chaplains were appointed to serve multiple institutions. Jewish chaplaincy had few formal training programs. By the 1980s, some rabbis pursued chaplaincy as a career through Clinical Pastoral Education (CPE), an intensive supervised internship initially developed by Protestants but increasingly pluralistic. In 1990 the National Association of Jewish Chaplains (NAJC) was founded. In 1993 the group decided that nonrabbis could be full members, opening the door to women and men who were not ordained. In 1995 the NAJC instituted a program of certification, recognizing advanced chaplaincy training and experience. The organization collaborated with non-Jewish pastoral care organizations in the U.S. and Canada to advocate for increased chaplaincy in health care and to establish joint standards for certification, training, and professional ethics. By 2005, the NAJC included some 300 professional members from all streams of Judaism. The large majority were rabbis, but members also included cantors and lay people with advanced Judaic and CPE training. A significant number were women, including most of the non-rabbis. From 1996 the NAJC published a journal, Jewish Spiritual Care. Chaplains work with patients from all Jewish backgrounds, including the many who are unaffiliated. Large numbers of professional chaplains work for long-term care/geriatric facilities. Significant numbers also are employed in hospitals, hospices, and community chaplaincy. Smaller numbers work for secular or interfaith agencies or for government agencies, including prisons, facilities for people with mental illness, and the Veterans' Affairs department. Chaplaincy is organized in a number of ways. Many facilities employ chaplains directly. Local Jewish federations often support community chaplaincy programs through Boards of Rabbis, Jewish Family Services, or specialized agencies.   Some chaplaincy programs operate in coordination with Jewish Healing Centers. CHAPLAINCY OUTSIDE THE U.S. Chaplaincy programs exist in Canada and the United Kingdom. In Israel, the field is largely unknown, although a number of individuals work independently in the field of spiritual support. (Even the vocabulary for chaplaincy as understood in North America does not exist in Hebrew. Terms suggested include temikhah ruḥanit, "spiritual support," and livvu'i ruḥanit, "spiritual accompaniment.") In 2005, joint meetings were held in Philadelphia and Jerusalem between American Jewish chaplains and Israelis from the health care and social service fields, as well as from various streams of Judaism. (Robert P. Tabak (2nd ed.) -BIBLIOGRAPHY: IN EUROPE: H. Friedenwald, Jews and Medicine, 2 (1944), 514–22; R.R. Marcus, Communal Sick Care in the German Ghetto (1947); A. Phillipsborn, in: YLBI, 4 (1959), 220–34; IN THE UNITED STATES: T. Levitan, Islands of Compassion (1964), incl. bibl.; Council of Jewish Federations and Welfare Funds, Yearbook of Jewish Social Services (1969). ADD. BIBLIOGRAPHY: T. Weil, "America's Jewish-Sponsored Hospitals: Being Assimilated Too?" in: Social Work, 34 (1998–99), Wurzweiler School of Social Work, Yeshiva University, vol. 34 (Winter/Spring), incl. bibl.; The Dictionary of Pastoral Care and Counseling (1990), S.V. "Chaplaincy"; R. Tabak, "Jewish Chaplaincy: Into the Twenty-first Century," in: Journal of Jewish Communal Service (Fall 1997); D.A. Friedman (ed.), Jewish Pastoral Care: A Practical Handbook from Traditional and Contemporary Sources (2001, 20052); J.S. Ozarowski, To Walk in God's Ways: Jewish Pastoral Perspectives on Illness and Bereavement (1995).