As a religious duty and social service the Jewish community, like the city, took care of its sick. Many communities engaged communal physicians as well as making other necessary arrangements. Many ordinances, prayers, and descriptions of treatment tell the story of the special care organized during times of plague and epidemics. Later, special ḥavarot ("associations"; see Ḥevrah ) were organized for sick care but the communal board continued to supervise and control them. There is no record of such associations until 14th-century Spain. In Saragossa a shoemakers' guild provided for sick care in 1336. There was a specialized bikkur ḥolim ("visiting the sick") society in Perpignan in 1380. These associations multiplied in the 15th century under such names as confratrio visitandi infirmos or bicurolim. No such societies existed in the rest of Europe until the 16th century. The Spanish exiles introduced them in Italy and from northern Italy they spread to Prague, and then to Central and Eastern Europe. In the 17th century Germany had only a few such associations, but by the 18th century they had become widespread there. Whereas the religious-educational associations and the craft guilds cared primarily for their own members, there were bikkur ḥolim societies specially for the poor. A ḥevrah of this type paid for a physician, druggists, barber-surgeons, hospital attendants, midwives, and others. Care was provided not merely for the poor; all communal members and well-to-do visiting merchants or scholars could depend on the association for help. Thus Jewish merchants from the Polish cities of Lissa and Krotoszyn who did business for part of the year in Breslau paid an annual fee entitling them to free medical and hospital care. Through the provision of voluntary visitors special care was taken to ensure that no sick person, rich or poor, should be left alone. The legislation relating to the Jews in Galicia at the end of the 18th century, and in Russia in the first half of the 19th century, provided the organizations with legal status, and their regulations were published. A candidate for the association was usually required to pay an entrance fee, and to attend the association meeting regularly. The association obtained means for its activities from various sources. Apart from membership dues, generally collected on Fridays, which amounted to less only than those paid to the ḥevra kaddisha, the bikkur ḥolim association often administered legacies, investing the bequest in real estate, and apportioning the income to other charities and the legatees. The association also received a certain percentage of communal dues (e.g., those levied on meat or new clothing). Sometimes the bikkur ḥolim might levy a special tax of its own. The bikkur ḥolim association sometimes exercised a powerful influence in the community, since it might provide free loans and subsidize various charitable undertakings. It often also undertook provision of tickets for board and lodging to needy transients, the sponsorship, outlay, and celebration of circumcision, medical care in childbirth, and related necessities. It safeguarded the rights of the local physicians, who were exempted from communal taxes in lieu of the services they rendered to the poor. The leadership of the bikkur ḥolim was chosen by the members by the same method as adopted for electing the community leadership. The association aimed to obtain funds for its expenses from the wealthy members, and to free the needy from payments and material worry during illness. The articles of the bikkur ḥolim association defined the financial assistance to be afforded to those in need, stipulated the number of visits to the sick, enjoined members to submit regular reports on the condition of patients in the community, and designated night care in serious cases. Fraternal feasts were generally held during the three festivals of Passover, Shavuot, and Sukkot, for which the permissible outlay was regulated. Societies of women, usually called nashim ẓadkaniyyot ("pious women"), were formed in the 18th century to act as nurses, to visit women who were sick or in confinement, to   provide medical attention, offer prayers, sew shrouds, and ritually prepare the female dead. Middle-class sick persons were generally cared for at home, while the poor were placed in the hekdesh . By the end of the 18th century first-rate modern Jewish hospitals were opened in Breslau, Vienna, and Amsterdam. At first only transient merchants, travelers, and local servants used the new institutions, and it was not until well into the 19th century that local residents gained confidence in these modern hospitals. -BIBLIOGRAPHY: Baron, Community, index; I. Levitats, Jewish Community in Russia, 17721844 (1943), index S.V. sick visiting; J.R. Marcus, Communal Sick-Care in the German Ghetto (1947); J. Katz, Masoret u-Mashber (1958), 187. (Isaac Levitats / Natan Efrati)

Encyclopedia Judaica. 1971.

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