Medicine and the German Jews: A History. .

Medicine and the German Jews: A History. By John M. Efron (New Haven and London: Yale University Press, 2001. viii plus 343 pp.).

Medicine and the German Jews is a work on two levels. On the whole, the book is not for the expert in Jewish history. It may be of interest, however, to those who know little about the history of the Jews in Central and Eastern Europe in the eighteenth, nineteenth, and early twentieth centuries and seek an introductory text. There is fundamental information about the Jews in general, anti-semitism, the Jewish Enlightenment (Haskalah), Zionism, the depiction of Jews as having "female" characteristics, and the professionalization and medicalization of antisemitism.

Those to whom these basic aspects of Jewish history are already well known, may benefit from an introduction to certain Jewish and Christian or Gentile (Efron uses the words interchangeably) physicians, and a consideration of the relation of Jewish religion to science. This expert audience will also be interested in two well-known episodes in the history of nineteenth and early twentieth century Austrian and German medicine, but nevertheless worth reading again because they are well told. Unfortunately, Efron's opening chapters on the middle ages and early modem times (though containing less well known information and potentially valuable) are not presented clearly. I read the material more than once, but Efron's narrative often contains contradictory passages, making it difficult to understand his major points.

Writing, as I am, for two audiences, I believe I can best do justice to Efron's book by summarizing its contents and then making some concluding remarks.

The modern Jewish doctor first appeared in Germany in the eighteenth century. Infused with the optimism of both the general and Jewish Enlightenment (Haskalah), he believed he could lead fellow Jews to good health. His goal also included the hope that he could aid in the drive for the political emancipation of the Jews. To this end, he encouraged Jewish assimilation, emphasizing particularly a life-style that would make the Jews appear attractive to their Christian neighbors. I would add that we today would look at this activity and see in it the beginnings of modem Jewish self-hatred.

Jewish physicians urged Jews to reduce their preoccupation with business because it resulted in digestive illnesses. The doctors, intent on assimilation, also advised Jews to adopt more refined table manners and not spend so much time in the heder, the Jewish religious school, because it led to weight loss, poor digestion, and unhealthy physical postures. They urged Jewish cooperation with state authorities and to that end became involved with the Scheintod (apparent death) controversy. In so doing, the doctors were also trying to assert their professionalism in place of rabbinical authority. The question at hand was the fear of being buried alive. Since Jews bury their dead within 24 hours, could they be sure their sick were truly dead? The state intervened and set up mortuaries where bodies would be watched. Enlightened Jewish physicians wanted to cooperate with the government and override rabbinic authority but were unable to change this long-standing Jewish custom.

In the nineteenth century, there was great interest in the Jews appearing sickly. The stereotype was used by anti-emancipation Christians, Jewish followers of the Enlightenment (both the Gentile and the Jewish ones), Zionists who wanted "strong" Jews, and assimilationists. Here is the start of racial stereotyping because on examination, Jews were actually healthier than the surrounding population. Anti-semitism was being medicalized. Efron concentrates on four areas of Jewish health in the nineteenth century: why Jews were not alcoholics; why Jews lived longer, enjoyed a lower rate of infant mortality, and suffered fewer deaths per 1,000 people; the lower rates of TB among Jews; and diabetes as a supposed Jewish disease. Here Efron brings in etiologic theories of these conditions by both Jewish and Christian physicians. The conclusion Efron reaches from detailed examination of these four areas is that they served primarily to make Jews appear as the "Other," always different from the population at large. More over, Christian doctors concluded that Jews were more concerned about their health, saw doctors more frequently, and displayed certain symptoms of diabetes, all of which were characteristics that made Jews "feminine." In the late nineteenth century, there could be no lower category than feminization.

The Jews could not escape their "Otherness." They were considered to have a higher rate of mental illness, which, unfortunately, Efron explains by adopting uncritically the nineteenth-century neurologist George Beard's long-since discarded theory of the mental disease of "neurasthenia," a disease supposedly brought about by modern life. After all, Efron says, Jews lived in big cities, so the pressures of urban life must have taken a disproportionate toll on them.

Zionist politics became involved in the issue of the Jews' mental health. Who was sicker: The Western Jews who had assimilated and lost their Yiddish tongue and culture or the poverty-stricken Eastern Jews, who still had their ties to their faith?

Yet other aspects of traditional Jewish culture marked the Jews as inescapably different: the mikvah (the ritual public bath), kashrut (the Jewish dietary laws), shehitah (ritual slaughter of animals), and brit milah (ritual circumcision). Jewish doctors attempted to demonstrate that Jewish "core customs" (p. 190) were compatible with those of the modern nation-state if one allowed for the updating and sanitization of the mikvah and brit milah/ Science and the Jewish religious practices could march hand in hand although no changes were needed for dietary laws and ritual slaughter, whose essences were sound.

Probably Efron's best chapter is his last (before the conclusion), presenting the ever-increasing late nineteenth and early twentieth centuries' anti-semitism against Jewish doctors, whose numbers far outweighed their proportion in the population. He retells well the notorious affair surrounding the Viennese physician Theodor Billroth, who though later fighting anti-semitism, published a book arguing that Jews were not racially fit to be doctors. His book set off riots at the university and brought attacks by the Christian medical students against the Jewish ones. Efron also brings special clarity to the complex issues of medical competition in Germany, where Jewish physicians dominated the medical insurance system and some doctors could not earn a living wage. This set the stage for the Christian physicians' strong support of Hitler, one of whose virtues, as far as they were concerned, was doing away with Jewish competition.

If Efron's book has a theme it is the sad one that Jewish doctors in Germany over hundreds of years struggled for the approbation of Gentile German doctors and the German population, but to no avail. From the middle ages on, Jewish physicians were accused of greed, charlatanry, and inflicting bodily harm on Germans, even as the former were used by the population in great numbers. In one way or another this heritage never remitted and came to a climax under National Socialism. The result is that medicine as a Jewish profession today has almost vanished from Germany.

Probably the most important criticism of Medicine and the German Jews is that Efron dilutes his arguments by using material that does not apply to his subject. He draws on evidence about Jews in other countries (e.g. the United States [p. 125] and England [p. 154]), uses commentators who are neither Jewish, nor German, nor even physicians (e.g. a French historian [p. 172]), draws on material not having to do with German Jews, e.g. a British rabbi who, Efron decides, "spoke for many Jews" (p. 206), and on supposed physicians who in reality are not, e.g. the psychoanalyst Otto Rank (p. 147). Above all, Efron's book is just as much about Polish Jews as German Jews, thereby giving it an entirely different character than if it had been confined to German Jews. The lengthy discussions on Zionism and what make a healthy Jew, for example, depend heavily on material about the eastern Jews. Efron's book would have benefited by his defining his topic more carefully and by his being more scrupulous in gathering his evide nce.