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Dr. Charles David Spivak
A Jewish Immigrant and the American Tuberculosis Movement
By Jeanne E. Abrams University Press of Colorado
Copyright © 2009 University Press of Colorado
All rights reserved.
ISBN: 978-0-87081-941-4
CHAPTER 1
Introduction
"Anything my father needed for his patients ... he got somehow. He was their miracle man, that's all I can say about my father." Although undoubtedly not an impartial observer, this is how Deena Spivak Strauss, the ninety-three-year-old daughter of Dr. Charles David Spivak, recalled his life and work in a 1988 interview. Charismatic, ambitious, highly intelligent, and articulate, but prone to pursue idealistic schemes, the reddish-blond-haired Spivak attracted followers wherever he went. In the first decades of the twentieth century he was a national leader in the crusade against tuberculosis as the executive secretary (director) of Denver's Jewish Consumptives' Relief Society (JCRS) sanatorium, one of the largest and best known of its kind in the United States. The JCRS opened in 1904 and served over 10,000 patients during its fifty-year existence as a tuberculosis sanatorium and hospital. Spivak was also a luminary in the American Jewish community, and his daughter's evaluation appears not to have been far off the mark. When he died in 1927, one of Spivak's eulogizers characterized him as "one of the most popular figures in American medicine and in American Jewish life." Physician, humanitarian, writer, linguist, journalist, administrator, social worker, ethnic broker, medical, public health, and social crusader — Dr. Charles Spivak was indeed a latter-day Renaissance man.
However, although Charles Spivak was certainly a fascinating, complex, and engaging figure, the story of his life rises above mere biography because it stands at the crossroads of so many critical junctures in American, western, Jewish, and medical history. Spivak's life and work serve as a wide lens through which to view myriad important topics, including the social construction of disease as related to ethnicity and class, the perceived connection specifically between immigrants and disease, and the transformation of the American hospital from a charitable, ethnic/religious–based voluntary institution to a modern corporate complex. They also reflect larger issues surrounding immigrant acculturation and intra-ethnic tensions, as well as how the concept of the Jew as an "outsider" at the turn of the twentieth century evolved into a phenomenon in which many of the outsiders became insiders who moved into the mainstream of American life. The story of Charles Spivak chronicles an immigrant's rise in America and the concurrent struggles between the Old World and the New World, reflecting the influence of class, religion, and regionalism. In addition, Spivak's career reflects pivotal emerging trends in public health, the culture of tuberculosis treatment, and changing medical thought about the nature of tuberculosis itself — encompassing the debate over whether tuberculosis was a physiological or a social-based disease, the best manner in which to deal with epidemics, and tensions between religion and science.
Between Spivak's birth in 1861 and his death in 1927, the United States experienced massive immigration, rapid industrialization, and increased urbanization. Some of the transformations on the American landscape were reflected in Progressive-Era ideology that influenced innovations in medical treatment and public health philosophy and the increased professionalization of health and medicine. The great tide of immigration between 1880 and 1925, with its significant Jewish component of well over 2 million, was particularly critical within the American Jewish community. During the peak years of immigration, from about 1900 to 1910, only Italians outnumbered East European Jewish arrivals; Jewish immigrants, driven out of their homelands by discrimination, persecution, and poverty, made America their permanent home. That near tidal wave of immigration became a major factor in the changing of the guard in the leadership of American Jewry from the older, established, and acculturated Jews — who had emigrated largely from German states — to the East European newcomers. In 1880 only one out of every six American Jews was of East European origin; by 1920, five out of six American Jews hailed from East Europe.
The peak of Jewish immigration intersected with the rise of the American tuberculosis movement and the proliferation of tuberculosis sanatoriums throughout the United States, especially in the West. Although East European Jewish immigrants actually demonstrated a lower incidence of tuberculosis compared to other religious and ethnic groups, anti-immigrant and anti-Semitic stereotypes often appeared that accused Jews of being carriers of a number of diseases, and tuberculosis was often referred to pejoratively as the "Jewish disease." The association of disease and germs with immigrants and the poor only exacerbated underlying feelings of nativism and prejudice that surfaced as the nation saw a significant increase in general immigration during the last decades of the nineteenth century and the beginning of the twentieth century. It is no accident that the American Jewish community played a leading role in the founding of tuberculosis sanatoriums or hospitals around the country, most of them at least formally nonsectarian. The opening of Jewish tuberculosis treatment centers had at least two underlying motivations: to demonstrate commitment to treating the disease as a reflection of the broader Jewish civic sense of responsibility and to dispel prevalent negative notions about Jewish immigrants.
No single accepted standard for tuberculosis treatment prevailed in America in the early years, but by the 1880s medical opinion had begun to emphasize fresh air, rest, diet, climate, and a controlled environment in the treatment of the disease. Physicians and public health officials increasingly viewed the sanatorium as the best place to aid victims and to isolate them from the general population as germ theory developed and fear of contagion spread. In a prize-winning booklet published in 1901, Dr. Adolphus Knopf lauded the curative benefits of the sanatorium lifestyle and maintained that in such a "modern" institution characterized by "hygienic and preventive measures ... one is in less danger of becoming infected with the germs of consumption there than anywhere else." In 1900 there were only 34 sanatoriums in the United States, but by 1925 the number had climbed to over 500, reflecting the growing popularity of the institution nationally.
Despite Robert Koch's discovery of the tubercle bacillus in 1882, through the late nineteenth and early twentieth centuries most physicians continued to view tuberculosis as caused by a combination of bacterial infection and specific social conditions. Tuberculosis therefore was unique as a disease, as during the modern era health crusaders increasingly perceived it as an illness with specific roots in congested urban environments, characterized by crowded and unsanitary working and living conditions, and as on one level a "social disease rooted in poverty and poor housing." Thus, the social as well as biological underpinnings of the disease were frequently emphasized, and sanatoriums like Denver's JCRS exhibited both a medical and a social component. In this context, the sanatorium served as an educational tool to alter "unhealthy" lifestyles and encourage good habits, as a means of removing the poor from crowded urban areas, and as a medical environment for treating infection through rest, nutritious foods, fresh air, sunlight, and at times surgical intervention.
While some upscale sanatoriums such as Cragmor in Colorado Springs served the upper and upper middle classes, most of them treated the genteel poor, the working classes, and the destitute. Additionally, many physicians prescribed a "certain climate" as part of tuberculosis treatment. The American West and Colorado in particular, with its dry, sunny environment and high altitude, fit the "prescription" perfectly. In short order the state became known as the "World's Sanatorium." Historians are increasingly beginning to recognize the connection between environmental and medical history and the perceived therapeutic landscape of region. Certain areas were seen as more efficacious for tuberculosis victims than others, and, as one author has observed in regard to consumptives, "for most Americans salvation lay not to the south but to the west."
By the time of Spivak's death in 1927, many health care institutions initially begun as ethnic hospitals to serve immigrants had evolved into something altogether different, with a progressive weakening of the hospitals' relationship to the ethnic communities from which they had originated. At the turn of the twentieth century, however, the ethnic component of the majority of health care institutions — the JCRS among them — was still of major importance, as "an ethnic or religious community's honor was in some sense at stake in providing for its own." Moreover, "ethnic and religious groups saw their [medical] institutions as symbols of community identity and responsibility." The JCRS had much in common with other sanatoriums around the country from a purely medical treatment standpoint. However, as a result of pervasive East European Jewish cultural, social, and religious influences, as well as western regional currents, it often differed in outlook and philosophy from other religious- and ethnic-based institutions. Animated by traditional Jewish concepts of tzedakah (commonly translated as charity but literally meaning "justice" or "righteousness"), the JCRS's emphasis on treating all patients at no charge, as well as accepting patients in all stages of the disease and rarely imposing limits for stays, contrasted markedly with common policy at most sanatorium/hospitals. In addition, according to Dr. Philip Hillkowitz, the first president of the JCRS, the institution also incorporated a "breezy western species" of democracy into its operation.
Although tuberculosis in the nineteenth century was certainly no respecter of class or ethnic group, by the turn of the century it was evident that the poor — especially immigrants — suffered disproportionately from the disease. Many in the Jewish community came to believe that treating Jewish patients, especially consumptives, in a welcoming environment that respected their cultural practices and religious beliefs contributed to an improvement in their health. This was one central factor in the founding of over sixty Jewish hospitals or sanatoriums in the United States between 1850 and 1930. In this context, Dr. Charles Spivak played a key role in the lives of Jewish immigrant patients from throughout the United States as an immigrant cultural "broker" or mediator in his central position at the JCRS. This was accomplished by simultaneously easing these immigrants into American society, introducing them to American culture, and nurturing their ethnic traditions at the same time — a role more commonly associated with politicians, journalists, and the clergy. Historian Alan Kraut has noted that immigrant physicians who belonged to a variety of ethnic groups around the country were becoming sensitive to the fact that in treating fellow immigrant newcomers, "the balance between assimilation and cultural integrity was at stake."
Paradoxically but not surprisingly considering his strong Jewish and socialist ties, while Spivak considered himself a "modern" and "scientific" man, he rejected the Progressive-Era business model for hospitals and other charitable institutions. In an early editorial written for the JCRS publication The Sanatorium, Spivak railed against what he termed the contemporary so-called scientific and sociological methods for dispensing aid. He claimed that personal and human elements were entirely lacking in such an approach and urged instead that charity be "of the heart, and not of the head."
While some historians have characterized early sanatoriums, particularly the larger ones, as "prison-like," this was not the case at the JCRS. Despite firm rules and regulations and a somewhat paternalistic tone at the sanatorium, the JCRS exhibited a family-like ambiance, largely because of the influence of Spivak and his close friend and longtime president of the JCRS, Dr. Philip Hillkowitz, the son of a leading Denver East European Orthodox Jewish rabbi. One early observer maintained that JCRS patients were fortunate to be "in an institution where they are treated as brothers and where they may maintain their self-respect and at the same time regain their health." A woman who had been a patient at both the Denver National Jewish Hospital for Consumptives (NJH) (founded by a group of largely acculturated German Jews) and, later, the JCRS in the 1920s commented that "NJH was a hospital, but the JCRS was a home."
Moreover, Spivak had great disdain for popular contemporary philanthropy that dispensed charity in an often condescending, patronizing, moralistic manner and only to those considered "worthy" recipients. Spivak insisted that charity patients be treated with dignity and respect. In 1905, in his first report as secretary, Spivak maintained that the JCRS intended to "inaugurate a radical departure from similar organizations, by eliminating from the conduct and management of the Sanatorium, anything and everything that would tend to remind the inmates of the fact that they are 'public charges.'" This statement reflected Spivak's outlook on life, a rather unique blend of Yiddishkeit, socialism, and secularism. While Spivak was foremost a physician and tuberculosis crusader, as two prominent medical historians have observed, "[m]edical history can inform us as much about general social and political change as about science and medicine." Spivak's life allows us a firsthand view into all these areas.
While the interactive style exhibited by many physicians and their patients in hospital/sanatorium settings in the late nineteenth and early twentieth centuries often appears highly paternalistic to our contemporary sensibilities, at the time, many patients in a fragile emotional and physical state welcomed the personal attention. Spivak was closely involved in the lives of his patients at the JCRS in a manner that extended far beyond mere medical treatment. He was affectionately called "Papa Spivak" by those he treated, and they often turned to him for advice and guidance. He was not reluctant to voice his opinions and offer his personal code of morality. A letter Dr. Spivak wrote in 1907 to a former patient who had returned to Des Moines, Iowa, reflects, in a humorous yet revealing manner, the close relationships he forged with patients. Spivak had been asked for advice concerning the possibility of the man marrying a young woman he had recently met. The good doctor replied that he felt the young man's tuberculosis condition had improved, but not to the point that he should marry: "Marriage will retard your recovery. ... You say that the girl is not good looking, but she has money. I don't think it is right to marry [for] money. You did not say a word whether you like the girl or not. If she likes you and you like her, then she can wait a year or two until you recover your health completely."
Always genial, optimistic, and energetic, his innate personality, up-bringing, and historical roots also made Dr. Charles David Spivak a man of intense contradictions. Born in 1861 into a traditionally observant Russian Jewish family, like many of his contemporaries he became attracted to Haskala, or Jewish Enlightenment, currents as a student. He became a revolutionary socialist in his youth and was forced to flee Russia in 1882 to escape being apprehended by the Russian secret police for his radical political activities. Spivak arrived first in New York City, where he began work as a typesetter for The Jewish Messenger and renewed acquaintances with other Russian-born Jewish socialists. He subsequently labored for a time as a road paver on New York's Fifth Avenue and as a mill hand in Maine before receiving a medical degree with honors from Jefferson Medical College in Philadelphia in 1890.
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Excerpted from Dr. Charles David Spivak by Jeanne E. Abrams. Copyright © 2009 University Press of Colorado. Excerpted by permission of University Press of Colorado.
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