John Efron\u27s new book pursues two scholarly trajectories simultaneously. On the one hand, it offers a history of Jewish physicians and medical practice in Germany from the Middle Ages until the Holocaust period. On the other hand, it examines the uses of medicine and medical discourse to bolster or undermine political, racial, and national agendas, both Jewish and antisemitic, in the modern era. Although Efron seeks to link these two subjects as one, they do not mesh as organically as he intends. Moreover, while the second trajectory is generally well-conceived and well-argued, making a genuine contribution to modern Jewish cultural history, the first is more sketchy and uneven, and is clearly less accomplished

Ruderman, David B

English

ScholarlyCommons@Penn

University of PennsylvaniaScholarlyCommonsDepartmental Papers (History) Department of History1-2002Review of John M. Efron, Medicine and the GermanJews: A HistoryDavid B. RudermanUniversity of Pennsylvania, RUDERMAN@SAS.UPENN.EDUFollow this and additional works at: http://repository.upenn.edu/history_papersPart of the Cultural History Commons, History of Religion Commons, History of Science,Technology, and Medicine Commons, and the Jewish Studies CommonsThis paper is posted at ScholarlyCommons. http://repository.upenn.edu/history_papers/37For more information, please contact repository@pobox.upenn.edu.Recommended CitationRuderman, D. B. (2002). Review of John M. Efron, Medicine and the German Jews: A History. The Jewish Quarterly Review, 92 (3-4),638-643. http://dx.doi.org/10.1353/jqr.2002.0033Review of John M. Efron, Medicine and the German Jews: A HistoryAbstractJohn Efron's new book pursues two scholarly trajectories simultaneously. On the one hand, it offers a historyof Jewish physicians and medical practice in Germany from the Middle Ages until the Holocaust period. Onthe other hand, it examines the uses of medicine and medical discourse to bolster or undermine political,racial, and national agendas, both Jewish and antisemitic, in the modern era. Although Efron seeks to linkthese two subjects as one, they do not mesh as organically as he intends. Moreover, while the secondtrajectory is generally well-conceived and well-argued, making a genuine contribution to modern Jewishcultural history, the first is more sketchy and uneven, and is clearly less accomplished.DisciplinesCultural History | History | History of Religion | History of Science, Technology, and Medicine | JewishStudiesThis review is available at ScholarlyCommons: http://repository.upenn.edu/history_papers/37The Jewish Quarterly Review, XClI, Nos. 3-4 (January-April, 2002) 638-643John M. Efron. Medicine and the German Jews: A History. New Haven:Yale University Press, 2001. Pp. viii + 343.John Efron's new book pursues two scholarly trajectories simultaneously.On the one hand, it offers a history of Jewish physicians and medical prac-tice in Germany from the Middle Ages until the Holocaust period. On theother hand, it examines the uses of medicine and medical discourse to bol-ster or undermine political, racial, and national agendas, both Jewish andantisemitic, in the modern era. Although Efron seeks to link these twosubjects as one, they do not mesh as organically as he intends. Moreover,while the second trajectory is generally well-conceived and well-argued,making a genuine contribution to modern Jewish cultural history, the firstis more sketchy and uneven, and is clearly less accomplished.Already in the introduction of the book, the challenge of meshing the twonarratives together and unambiguously formulating the composite nature ofthe project is apparent. In the first place, Efrom attempts to justify both thelimited geographical area of his study and its timeframe. The story of Jew-ish doctors in Germany is unique, he argues, because there was such a highpercentage of Jewish doctors in Germany and because of the especially vir-ulent forms of German antisemitism that singled out the Jewish practice ofmedicine (pp. 3-5). Despite his attempt to focus exclusively on Germany,however, the history of his subject is not always nationally bounded and heconstantly crosses over in almost every chapter to southern, western andeastern Europe, and even to America, to illustrate his points about Jewishdoctors and about the antisemitic discourses accompanying their practice.For Efron, his book is a history of those moments from the early modernperiod to the rise of Hitler, when "the Jewishness of physicians and patientsactually counted for something meaningful" (p. 2). As becomes increasinglyclear as the book progresses, for Efron, these moments are primarily lo-cated from the 18th century on (see especially p. 64 and below). Such aconclusion is problematic, to say the least. Were Hasdai ibn Shaprut, Mosesand Abraham Maimonides, and hundreds of other pre-modern doctors anyless interested in their own Jewishness or that of their patients than theirmodern counterparts? Medicine, in its quest for curing human patients, theo-retically transcends national and ethnic boundaries. But in the complex so-cial realities that shaped Jewish medical practice, both in the medieval andmodern periods, Jewish doctors primarily treated Jewish patients, and con-stantly connected their individual physical well-being to the collective wel-fare of the Jewish community as a whole. One might even argue thatmedieval Jewish medical texts, composed in Hebrew and directed exclu-sively to a Jewish readership, reflect even greater "Jewish" concerns on thepart of pre-modern doctors than some modern ones. The notion that mod-EFRON, MEDICINE AND THE GERMAN JEWS—RUDERMAN 639ern Jewish doctors employ more intensely the discourse of contemporarymedicine to ponder the nature of their Jewish identity is also misleadingand ignores the significant place of medical discourse in legal, homiletic, andexegetical Jewish literature throughout the biblical, rabbinic, and medievalperiods.Similarly flawed is Efron's strange notion that only in the modern perioddo Jews have a physical as well as a spiritual identity in their self-discoveryof the "Jewish body" (p. 4). Did Jews lack a sense of their physicality be-fore 1800? What precisely does Efron mean by this distinction and is itsustainable, given the wealth of evidence for Jewish medical care and treat-ment of actual Jewish bodies long before the 19th century?Other examples of Efron's loose and imprecise formulations might bementioned. At one point, he lumps together the history of medicine andscience, assuming that the categories are the same both professionally andculturally (p. 3). But, of course, for some scientists, medicine is hardly ascience at all, and the long preponderance of Jews in medicine, comparedwith their recent success in the sciences during the last century, suggeststhat a differentiation is necessary. What about Eron's claim that in modernGermany, Jews are distinctively labeled as diseased (pp. 6-7)? As he him-self points out, the roots of this stereotype are decidedly medieval, and onemight argue that they are even rooted in antiquity. Is this exclusively oreven predominantly a modern phenomenon? And is Germany unique inpossessing the largest corpus of medical antisemitism (p. 5)? Without min-imizing the centrality of Germany, one might argue that in many respectsmedical antisemitism first developed in the Iberian peninsula, where theobsession with the Jewish doctor long preceded that of the Germans.1Moreover, the origin of hostility towards the Jewish doctor in Germanyfrom the 17th century on is directly related to the entry of converso physi-cians into German space, a point not made strongly enough by Efron in thefirst place. In other words, the German story is clearly a continuation andfurther expansion of one which began in Spain and Portugal.Finally, Efron's imprecise language is exemplified by his fleeting treat-ment of the Zionist thinker A. D. Gordon in the introduction (p.8). ShouldGordon's philosophy of nature really be linked to Zionist medical polemicsas Efron seems to suggest? Is medicine in fact the primary factor in Gor-don's ideology or can it be located more meaningfully in a broader anddeeper cultural context of romantic notions of land, self-labor, gendereddiscourse, and racial stereotyping, in which medicine and medical discourseoccupy only a small part? Does medicine, in the case of Gordon, ultimatelyshape the main contours of his thinking, as Efron seems to imply, or is itsimply an added dimension? This and previous formulations require greatercare and precision than Efron gives them.1 See, for example, J. Caro Baroja, Los Judíos en la Espana moderna y contempo-ranea (Madrid, 1961), 2:162-94.640THE JEWISH QUARTERLY REVIEWEfron's first two chapters describe the origins of the medieval Jewishphysician and specific circumstances of German Jewish medicine from themedieval period through the 18th century. Based heavily on the work ofothers, which Efron clearly acknowledges, both chapters offer a broad andgenerally conventional treatment of the subject. Efron initially claims thatJewish medicine dates only from the Middle Ages, since in the rabbinic pe-riod it did not possess a self-contained therapeutic discourse (p. 13). Giventhe incomplete picture we have of the actual practice of medicine in therabbinic period, it may be wiser to say that the more visible manifestationsof medical practice and writing emerge in the Middle Ages, but its originsare most likely earlier. This development is hardly unique to the Jews. Fur-thermore, one should not assume, as Efron seems to, that medicine inmedieval times was self-contained. Maimonides' medical concerns, for ex-ample, are hardly unconnected to either his halakhic or philosophical ones.2Efron's chapter on German Jewish developments attempts to offer a rathersketchy overview over some five centuries. Here as well, there are pointsone might chose to contest. Efron tries hard to argue for a medieval Ash-kenazic tradition of medicine as significant as that in Provence, Italy, andSpain (pp. 34ff ). While the evidence points to some medical literacy in thenorth, the southern communities are clearly more significant, as the evi-dence of Joseph Shatzmiller and others have made clear.3 Efron's interest-ing attempt to argue that German Jews were more suspicious of doctorsthan those in Eastern Europe is not fully persuasive either (pp. 40-44).While some doctors held communal positions in early modern Poland, theywere also considered suspect, especially those emanating from Italy or Por-tugal. In contrast to the remarkable alignment of rabbis and physicians inItaly, the situation in Germany and Eastern Europe appears to me quiteanalogous. Finally, Efron's treatment of medical antisemitism in the 17thand 1 8th centuries clearly adds to previous work by Harry Friedenwald andothers, but still does not tackle the topic sufficiently. Especially critical inthis history is its linkage to similar developments in Italy and the westernSephardic diaspora prior to and during the outbreak of hostility towardsJewish doctors in Germany. In making this episode primarily a Germanphenomenon, Efron understates these critical polemical links. He mentions,for example, the defenses of Jewish doctors by David de Pomis, an Italiandoctor, and Isaac Cardoso and Benedict de Castro, converso physicians inItaly and Hamburg, without pausing to consider that the vilification of2 See, for example, I. Twersky, "Aspects of Maimonidean Epistemology: Halakhaand Science," in From Ancient Israel to Modern Judaism: Intellect in Quest of Under-standing; Essays in Honor ofMarvin Fox, eds. J. Neusner, E. S. Frerichs, and N. Sarna(Atlanta, 1989), 3:3-24.3 As discussed in J. Shatzmiller, Jews, Medicine, and Medieval Society (Los An-geles, 1994) and in his articles cited in Efron, p. 274, n. 9.EFRON, MEDICINE AND THE GERMAN JEWS—RUDERMAN 64 1the Jewish doctor was not merely a German phenomenon but a Europeanone.4 Early modern medical antisemitism in Germany originated from aneconomic rivalry between Sephardic doctors and the Protestant medical es-tablishment (See pp. 50-51). The polemics were thus fueled by an under-standable tension over gaining the revenue of patients, over cultural andprofessional differences between immigrants and old-timers, and betweentwo distinct medical cultures. All of this is not sufficiently stressed inEfron's account.In the chapter called "Haskalah and Healing," originally published as anarticle, Efron presents the questionable assumption that the modern Jewishdoctor was the first to express Jewish concerns in the course of his medicalpractice and the first to be focused not on individuals alone but on the entiregroup (p. 64). While some pre-modern doctors primarily treated "royaltyand clergy" as Efron claims, the vast majority treated Jewish patients andsaw themselves as working within the Jewish community. Efron proceedsto offer only three examples to argue for the novelty of this modern Jewishdoctor. His broad conclusions, based on so small a sample, remain unsub-stantiated. But even when these three cases are examined more closely, hisposition is not so clear-cut.Nahman Gelber, in an essay Efron does not cite, had long ago under-scored the role of doctors in the Haskalah as agents of change and socialreform.5 On this point, there is hardly any disagreement and one wishesthat Efron had pursued this insight with more examples than those of ElkanIsaac Wolf, Moishe Marcuze, and Marcus Herz. It is when he stresses thatthese doctors were more focused on Jewish issues that his argument be-comes more questionable. Wolf indeed wrote a book on Jewish diseases,but this focus was not entirely unprecedented. Decades earlier, Tobias Co-hen also wrote on the Jewish disease that entangled the hair of AshkenazicJewish women.6 As Efron himself points out, the self-help manuals of earlymodern Jews were quite similar to Marcuze's Yiddish composition at theend of the 18th century (pp. 79-82). Also problematic in Efron's account ofGerman maskilic doctors is the inclusion of Marcuze in the first place.7 De-spite his German medical education, is the provenance of his Sefer Refuos4 Some of this is discussed in D. Ruderman, Jewish Thought and Scientific Discov-ery in Early Modern Europe (New Haven, 1995; Detroit, 2001), chapter 10.5N. M. Gelber, "On the History of Jewish Doctors in Poland in the EighteenthCentury" (Hebrew), in I. Tirosh, ed., Shai le-Yeshayahu, Sefer Yovel Le-YishayahuVolfsberg (Tel Aviv, 1956), especially pp. 351-353.6 See D. Sadan, "Plica Polonica," in The Field of Yiddish: Studies in Language,Folklore, and Literature, 4th collection, eds. M. I. Herzog et al (Philadelphia, 1980).7 Efron misses the important essay on Marcuze by A. Gutterman, "Sefer Refuotof Doctor Marcuze and his Proposals for Reforms in Jewish Life" (Hebrew), Gilad4-5 (1978-79) 35-53.642TOE JEWISH QUARTERLY REVIEWconnected to Germany at all? Marcuze's work, written in Yiddish for East-ern European Jews as a polemic against Hasidic and other forms of folk-medicine, is marginally connected to a German context. Given the largenumber of German Jewish doctors Efron might have considered in this chap-ter, Marcuze does not seem to be the best selection he could have made.Even more problematic is Efron's treatment of Marcus Herz and his rolein the debate over early burial in Germany.8 For Efron, Herz's critique of the"barbaric" practice by the rabbis and hevra kedisha of precipitously bury-ing the Jewish dead without proper medical supervision, admirably demon-strates the desire of the enlightened Jewish doctor "to wrest control of theJewish body from the Jews" (p. 104), and to focus on the needs of Jews asa group, who would be better guided in ethical matters by physicians thanclergy. While Efron is aware of Martin Davies' wonderful monograph onHerz,9 which he cites in a note, he ignores the broad philosophical under-pinnings of Herz's medical practice so clearly delineated in Davies' work.In contrast to his position on early burial, Herz took a radically differentposition against vaccinating Jewish children, based on philosophical pre-suppositions that he could not overcome at the end of his life, despite over-whelming empirical evidence that vaccination could save lives, and despitethe fact that most rabbis encouraged the practice, Herz's position had littleto do with Jewish concerns and with caring for the Jewish group.10 In otherwords, the characterization of Herz, the enlightenment doctor, as express-ing Jewish concerns in his medical practice is misleading and ultimatelywrong, certainly in this latter case. On the subject of early burial, he fitsEfron's model; in the case of vaccination, he does not. Thus, defining themaskilic Jewish doctor as Efron does is premature, based on the limited andcontradictory evidence he supplies. The subject requires further study.In the following chapter, Efron shifts to the subject of the pathology ofthe Jew as it is reflected in four discourses on alcohol abuse, the vital sta-tistics of the Jews, tuberculosis, and diabetes, which he sets out clearly andsuccinctly. Many of the medical writers Efron cites in this chapter will befamiliar to readers of his first book on race science. ' ' The treatment of thesediscourses extends into the 20th century and beyond Germany. Except in8 The most extensive treatment of this subject is found in M. Samet, "Burial ofthe Dead: On the History of the Polemic on Fixing the Time of Death" (Hebrew),Asufot 3 (1989-90) 613-665, which Efron misses.9M. Davies, Identity or History?: Marcus Herz and the End of the Enlighten-ment (Detroit, 1995).10 See D. Ruderman, "Some Jewish Responses to Smallpox Prevention in the LateEighteenth and Early Nineteenth Centuries: A New Perspective on the Modernizationof European Jewry," Aleph, Historical Studies in Science and Judaism 2 (2002)." See J. Efron, Defenders ofthe Race: Jewish Doctors and Race Science in Fin-de-Siècle Europe (New Haven, 1994).EFRON, MEDICINE AND THE GERMAN .ZfWS-RUDERMAN 643the case of diabetes, however, they do not appear to substantiate the stereo-type of the sickly Jew, the alleged theme of the chapter. This chapter leadsinto the next chapter on the psychopathology of everyday life, which looksespecially at the issue of Jewish mental disease from the perspective ofnon-Jewish, Jewish diaspora, and Zionist psychiatrists. Efron effectivelydevelops here the close connection between medical discourse and politicalagendas. My only quibble with him is his claim that Elkan Wolf was thefirst to treat Jewish mental disease. Surely Efron is aware of the rich liter-ature on Jews, melancholia, and Saturn, a staple of pre-modern culture.Efron's narrative would have been enriched by reference to the pre-modernreflections on Jewish insanity.12Efron's chapter on the use of medical arguments in defense of Jewishrituals (circumcision, ritual slaughter, and kashrut) is extremely well doneand perhaps the most interesting chapter of the book.13 His last chapter,on Jewish doctors prior to the Holocaust, is an able summary of the fieldalready well-researched by others.In sum, Efron's masterful account of the political and cultural uses ofmedicine by Jews and non-Jews in the 19th and early 20th centuries, itsintimate connection with the Jewish quest for civic emancipation, embour-geoisement, and national liberation, and its use in defense of Jewish in-terests, represents the most significant achievement of this book. As ahistory of Jewish doctors in pre-modern and modern Germany, it is unevenand less successful. But the former's strengths clearly compensate for thelatter's weaknesses.University of PennsylvaniaDavid B. Ruderman12 See, for example, M. Idei, "Saturn and Shabbetai Zevi: A new Approach to Sab-bateanism," (Hebrew) Mada cei ha-Yahadut 37 (1997) 161-87, and the earlier litera-ture cited there, especially Robert Burton's Anatomy ofMelancholy."Beth Wenger, "Mitzvah and Medicine: Gender, Assimilation, and the ScientificDefense of 'Family Purity'," Jewish Social Studies 5 (1998-99) 177-202, should beread in conjunction with this chapter.

Review of John M. Efron, \u3cem\u3eMedicine and the German Jews: A History\u3c/em\u3e

Kosmopolis

University of Pennsylvania
ScholarlyCommons
Departmental Papers (History) Department of History
1-2002
Review of John M. Efron, Medicine and the German
Jews: A History
David B. Ruderman
University of Pennsylvania, RUDERMAN@SAS.UPENN.EDU
Follow this and additional works at: http://repository.upenn.edu/history_papers
Part of the Cultural History Commons, History of Religion Commons, History of Science,
Technology, and Medicine Commons, and the Jewish Studies Commons
This paper is posted at ScholarlyCommons. http://repository.upenn.edu/history_papers/37
For more information, please contact repository@pobox.upenn.edu.
Recommended Citation
Ruderman, D. B. (2002). Review of John M. Efron, Medicine and the German Jews: A History. The Jewish Quarterly Review, 92 (3-4),
638-643. http://dx.doi.org/10.1353/jqr.2002.0033
Review of John M. Efron, Medicine and the German Jews: A History
Abstract
John Efron's new book pursues two scholarly trajectories simultaneously. On the one hand, it offers a history
of Jewish physicians and medical practice in Germany from the Middle Ages until the Holocaust period. On
the other hand, it examines the uses of medicine and medical discourse to bolster or undermine political,
racial, and national agendas, both Jewish and antisemitic, in the modern era. Although Efron seeks to link
these two subjects as one, they do not mesh as organically as he intends. Moreover, while the second
trajectory is generally well-conceived and well-argued, making a genuine contribution to modern Jewish
cultural history, the first is more sketchy and uneven, and is clearly less accomplished.
Disciplines
Cultural History | History | History of Religion | History of Science, Technology, and Medicine | Jewish
Studies
This review is available at ScholarlyCommons: http://repository.upenn.edu/history_papers/37
The Jewish Quarterly Review, XClI, Nos. 3-4 (January-April, 2002) 638-643
John M. Efron. Medicine and the German Jews: A History. New Haven:
Yale University Press, 2001. Pp. viii + 343.
John Efron's new book pursues two scholarly trajectories simultaneously.
On the one hand, it offers a history of Jewish physicians and medical prac-
tice in Germany from the Middle Ages until the Holocaust period. On the
other hand, it examines the uses of medicine and medical discourse to bol-
ster or undermine political, racial, and national agendas, both Jewish and
antisemitic, in the modern era. Although Efron seeks to link these two
subjects as one, they do not mesh as organically as he intends. Moreover,
while the second trajectory is generally well-conceived and well-argued,
making a genuine contribution to modern Jewish cultural history, the first
is more sketchy and uneven, and is clearly less accomplished.
Already in the introduction of the book, the challenge of meshing the two
narratives together and unambiguously formulating the composite nature of
the project is apparent. In the first place, Efrom attempts to justify both the
limited geographical area of his study and its timeframe. The story of Jew-
ish doctors in Germany is unique, he argues, because there was such a high
percentage of Jewish doctors in Germany and because of the especially vir-
ulent forms of German antisemitism that singled out the Jewish practice of
medicine (pp. 3-5). Despite his attempt to focus exclusively on Germany,
however, the history of his subject is not always nationally bounded and he
constantly crosses over in almost every chapter to southern, western and
eastern Europe, and even to America, to illustrate his points about Jewish
doctors and about the antisemitic discourses accompanying their practice.
For Efron, his book is a history of those moments from the early modern
period to the rise of Hitler, when "the Jewishness of physicians and patients
actually counted for something meaningful" (p. 2). As becomes increasingly
clear as the book progresses, for Efron, these moments are primarily lo-
cated from the 18th century on (see especially p. 64 and below). Such a
conclusion is problematic, to say the least. Were Hasdai ibn Shaprut, Moses
and Abraham Maimonides, and hundreds of other pre-modern doctors any
less interested in their own Jewishness or that of their patients than their
modern counterparts? Medicine, in its quest for curing human patients, theo-
retically transcends national and ethnic boundaries. But in the complex so-
cial realities that shaped Jewish medical practice, both in the medieval and
modern periods, Jewish doctors primarily treated Jewish patients, and con-
stantly connected their individual physical well-being to the collective wel-
fare of the Jewish community as a whole. One might even argue that
medieval Jewish medical texts, composed in Hebrew and directed exclu-
sively to a Jewish readership, reflect even greater "Jewish" concerns on the
part of pre-modern doctors than some modern ones. The notion that mod-
EFRON, MEDICINE AND THE GERMAN JEWS—RUDERMAN 639
ern Jewish doctors employ more intensely the discourse of contemporary
medicine to ponder the nature of their Jewish identity is also misleading
and ignores the significant place of medical discourse in legal, homiletic, and
exegetical Jewish literature throughout the biblical, rabbinic, and medieval
periods.
Similarly flawed is Efron's strange notion that only in the modern period
do Jews have a physical as well as a spiritual identity in their self-discovery
of the "Jewish body" (p. 4). Did Jews lack a sense of their physicality be-
fore 1800? What precisely does Efron mean by this distinction and is it
sustainable, given the wealth of evidence for Jewish medical care and treat-
ment of actual Jewish bodies long before the 19th century?
Other examples of Efron's loose and imprecise formulations might be
mentioned. At one point, he lumps together the history of medicine and
science, assuming that the categories are the same both professionally and
culturally (p. 3). But, of course, for some scientists, medicine is hardly a
science at all, and the long preponderance of Jews in medicine, compared
with their recent success in the sciences during the last century, suggests
that a differentiation is necessary. What about Eron's claim that in modern
Germany, Jews are distinctively labeled as diseased (pp. 6-7)? As he him-
self points out, the roots of this stereotype are decidedly medieval, and one
might argue that they are even rooted in antiquity. Is this exclusively or
even predominantly a modern phenomenon? And is Germany unique in
possessing the largest corpus of medical antisemitism (p. 5)? Without min-
imizing the centrality of Germany, one might argue that in many respects
medical antisemitism first developed in the Iberian peninsula, where the
obsession with the Jewish doctor long preceded that of the Germans.1
Moreover, the origin of hostility towards the Jewish doctor in Germany
from the 17th century on is directly related to the entry of converso physi-
cians into German space, a point not made strongly enough by Efron in the
first place. In other words, the German story is clearly a continuation and
further expansion of one which began in Spain and Portugal.
Finally, Efron's imprecise language is exemplified by his fleeting treat-
ment of the Zionist thinker A. D. Gordon in the introduction (p.8). Should
Gordon's philosophy of nature really be linked to Zionist medical polemics
as Efron seems to suggest? Is medicine in fact the primary factor in Gor-
don's ideology or can it be located more meaningfully in a broader and
deeper cultural context of romantic notions of land, self-labor, gendered
discourse, and racial stereotyping, in which medicine and medical discourse
occupy only a small part? Does medicine, in the case of Gordon, ultimately
shape the main contours of his thinking, as Efron seems to imply, or is it
simply an added dimension? This and previous formulations require greater
care and precision than Efron gives them.
1 See, for example, J. Caro Baroja, Los Judíos en la Espana moderna y contempo-
ranea (Madrid, 1961), 2:162-94.
640THE JEWISH QUARTERLY REVIEW
Efron's first two chapters describe the origins of the medieval Jewish
physician and specific circumstances of German Jewish medicine from the
medieval period through the 18th century. Based heavily on the work of
others, which Efron clearly acknowledges, both chapters offer a broad and
generally conventional treatment of the subject. Efron initially claims that
Jewish medicine dates only from the Middle Ages, since in the rabbinic pe-
riod it did not possess a self-contained therapeutic discourse (p. 13). Given
the incomplete picture we have of the actual practice of medicine in the
rabbinic period, it may be wiser to say that the more visible manifestations
of medical practice and writing emerge in the Middle Ages, but its origins
are most likely earlier. This development is hardly unique to the Jews. Fur-
thermore, one should not assume, as Efron seems to, that medicine in
medieval times was self-contained. Maimonides' medical concerns, for ex-
ample, are hardly unconnected to either his halakhic or philosophical ones.2
Efron's chapter on German Jewish developments attempts to offer a rather
sketchy overview over some five centuries. Here as well, there are points
one might chose to contest. Efron tries hard to argue for a medieval Ash-
kenazic tradition of medicine as significant as that in Provence, Italy, and
Spain (pp. 34ff ). While the evidence points to some medical literacy in the
north, the southern communities are clearly more significant, as the evi-
dence of Joseph Shatzmiller and others have made clear.3 Efron's interest-
ing attempt to argue that German Jews were more suspicious of doctors
than those in Eastern Europe is not fully persuasive either (pp. 40-44).
While some doctors held communal positions in early modern Poland, they
were also considered suspect, especially those emanating from Italy or Por-
tugal. In contrast to the remarkable alignment of rabbis and physicians in
Italy, the situation in Germany and Eastern Europe appears to me quite
analogous. Finally, Efron's treatment of medical antisemitism in the 17th
and 1 8th centuries clearly adds to previous work by Harry Friedenwald and
others, but still does not tackle the topic sufficiently. Especially critical in
this history is its linkage to similar developments in Italy and the western
Sephardic diaspora prior to and during the outbreak of hostility towards
Jewish doctors in Germany. In making this episode primarily a German
phenomenon, Efron understates these critical polemical links. He mentions,
for example, the defenses of Jewish doctors by David de Pomis, an Italian
doctor, and Isaac Cardoso and Benedict de Castro, converso physicians in
Italy and Hamburg, without pausing to consider that the vilification of
2 See, for example, I. Twersky, "Aspects of Maimonidean Epistemology: Halakha
and Science," in From Ancient Israel to Modern Judaism: Intellect in Quest of Under-
standing; Essays in Honor ofMarvin Fox, eds. J. Neusner, E. S. Frerichs, and N. Sarna
(Atlanta, 1989), 3:3-24.
3 As discussed in J. Shatzmiller, Jews, Medicine, and Medieval Society (Los An-
geles, 1994) and in his articles cited in Efron, p. 274, n. 9.
EFRON, MEDICINE AND THE GERMAN JEWS—RUDERMAN 64 1
the Jewish doctor was not merely a German phenomenon but a European
one.4 Early modern medical antisemitism in Germany originated from an
economic rivalry between Sephardic doctors and the Protestant medical es-
tablishment (See pp. 50-51). The polemics were thus fueled by an under-
standable tension over gaining the revenue of patients, over cultural and
professional differences between immigrants and old-timers, and between
two distinct medical cultures. All of this is not sufficiently stressed in
Efron's account.
In the chapter called "Haskalah and Healing," originally published as an
article, Efron presents the questionable assumption that the modern Jewish
doctor was the first to express Jewish concerns in the course of his medical
practice and the first to be focused not on individuals alone but on the entire
group (p. 64). While some pre-modern doctors primarily treated "royalty
and clergy" as Efron claims, the vast majority treated Jewish patients and
saw themselves as working within the Jewish community. Efron proceeds
to offer only three examples to argue for the novelty of this modern Jewish
doctor. His broad conclusions, based on so small a sample, remain unsub-
stantiated. But even when these three cases are examined more closely, his
position is not so clear-cut.
Nahman Gelber, in an essay Efron does not cite, had long ago under-
scored the role of doctors in the Haskalah as agents of change and social
reform.5 On this point, there is hardly any disagreement and one wishes
that Efron had pursued this insight with more examples than those of Elkan
Isaac Wolf, Moishe Marcuze, and Marcus Herz. It is when he stresses that
these doctors were more focused on Jewish issues that his argument be-
comes more questionable. Wolf indeed wrote a book on Jewish diseases,
but this focus was not entirely unprecedented. Decades earlier, Tobias Co-
hen also wrote on the Jewish disease that entangled the hair of Ashkenazic
Jewish women.6 As Efron himself points out, the self-help manuals of early
modern Jews were quite similar to Marcuze's Yiddish composition at the
end of the 18th century (pp. 79-82). Also problematic in Efron's account of
German maskilic doctors is the inclusion of Marcuze in the first place.7 De-
spite his German medical education, is the provenance of his Sefer Refuos
4 Some of this is discussed in D. Ruderman, Jewish Thought and Scientific Discov-
ery in Early Modern Europe (New Haven, 1995; Detroit, 2001), chapter 10.
5N. M. Gelber, "On the History of Jewish Doctors in Poland in the Eighteenth
Century" (Hebrew), in I. Tirosh, ed., Shai le-Yeshayahu, Sefer Yovel Le-Yishayahu
Volfsberg (Tel Aviv, 1956), especially pp. 351-353.
6 See D. Sadan, "Plica Polonica," in The Field of Yiddish: Studies in Language,
Folklore, and Literature, 4th collection, eds. M. I. Herzog et al (Philadelphia, 1980).
7 Efron misses the important essay on Marcuze by A. Gutterman, "Sefer Refuot
of Doctor Marcuze and his Proposals for Reforms in Jewish Life" (Hebrew), Gilad
4-5 (1978-79) 35-53.
642TOE JEWISH QUARTERLY REVIEW
connected to Germany at all? Marcuze's work, written in Yiddish for East-
ern European Jews as a polemic against Hasidic and other forms of folk-
medicine, is marginally connected to a German context. Given the large
number of German Jewish doctors Efron might have considered in this chap-
ter, Marcuze does not seem to be the best selection he could have made.
Even more problematic is Efron's treatment of Marcus Herz and his role
in the debate over early burial in Germany.8 For Efron, Herz's critique of the
"barbaric" practice by the rabbis and hevra kedisha of precipitously bury-
ing the Jewish dead without proper medical supervision, admirably demon-
strates the desire of the enlightened Jewish doctor "to wrest control of the
Jewish body from the Jews" (p. 104), and to focus on the needs of Jews as
a group, who would be better guided in ethical matters by physicians than
clergy. While Efron is aware of Martin Davies' wonderful monograph on
Herz,9 which he cites in a note, he ignores the broad philosophical under-
pinnings of Herz's medical practice so clearly delineated in Davies' work.
In contrast to his position on early burial, Herz took a radically different
position against vaccinating Jewish children, based on philosophical pre-
suppositions that he could not overcome at the end of his life, despite over-
whelming empirical evidence that vaccination could save lives, and despite
the fact that most rabbis encouraged the practice, Herz's position had little
to do with Jewish concerns and with caring for the Jewish group.10 In other
words, the characterization of Herz, the enlightenment doctor, as express-
ing Jewish concerns in his medical practice is misleading and ultimately
wrong, certainly in this latter case. On the subject of early burial, he fits
Efron's model; in the case of vaccination, he does not. Thus, defining the
maskilic Jewish doctor as Efron does is premature, based on the limited and
contradictory evidence he supplies. The subject requires further study.
In the following chapter, Efron shifts to the subject of the pathology of
the Jew as it is reflected in four discourses on alcohol abuse, the vital sta-
tistics of the Jews, tuberculosis, and diabetes, which he sets out clearly and
succinctly. Many of the medical writers Efron cites in this chapter will be
familiar to readers of his first book on race science. ' ' The treatment of these
discourses extends into the 20th century and beyond Germany. Except in
8 The most extensive treatment of this subject is found in M. Samet, "Burial of
the Dead: On the History of the Polemic on Fixing the Time of Death" (Hebrew),
Asufot 3 (1989-90) 613-665, which Efron misses.
9M. Davies, Identity or History?: Marcus Herz and the End of the Enlighten-
ment (Detroit, 1995).
10 See D. Ruderman, "Some Jewish Responses to Smallpox Prevention in the Late
Eighteenth and Early Nineteenth Centuries: A New Perspective on the Modernization
of European Jewry," Aleph, Historical Studies in Science and Judaism 2 (2002).
" See J. Efron, Defenders ofthe Race: Jewish Doctors and Race Science in Fin-de-
Siècle Europe (New Haven, 1994).
EFRON, MEDICINE AND THE GERMAN .ZfWS-RUDERMAN 643
the case of diabetes, however, they do not appear to substantiate the stereo-
type of the sickly Jew, the alleged theme of the chapter. This chapter leads
into the next chapter on the psychopathology of everyday life, which looks
especially at the issue of Jewish mental disease from the perspective of
non-Jewish, Jewish diaspora, and Zionist psychiatrists. Efron effectively
develops here the close connection between medical discourse and political
agendas. My only quibble with him is his claim that Elkan Wolf was the
first to treat Jewish mental disease. Surely Efron is aware of the rich liter-
ature on Jews, melancholia, and Saturn, a staple of pre-modern culture.
Efron's narrative would have been enriched by reference to the pre-modern
reflections on Jewish insanity.12
Efron's chapter on the use of medical arguments in defense of Jewish
rituals (circumcision, ritual slaughter, and kashrut) is extremely well done
and perhaps the most interesting chapter of the book.13 His last chapter,
on Jewish doctors prior to the Holocaust, is an able summary of the field
already well-researched by others.
In sum, Efron's masterful account of the political and cultural uses of
medicine by Jews and non-Jews in the 19th and early 20th centuries, its
intimate connection with the Jewish quest for civic emancipation, embour-
geoisement, and national liberation, and its use in defense of Jewish in-
terests, represents the most significant achievement of this book. As a
history of Jewish doctors in pre-modern and modern Germany, it is uneven
and less successful. But the former's strengths clearly compensate for the
latter's weaknesses.
University of PennsylvaniaDavid B. Ruderman
12 See, for example, M. Idei, "Saturn and Shabbetai Zevi: A new Approach to Sab-
bateanism," (Hebrew) Mada cei ha-Yahadut 37 (1997) 161-87, and the earlier litera-
ture cited there, especially Robert Burton's Anatomy ofMelancholy.
"Beth Wenger, "Mitzvah and Medicine: Gender, Assimilation, and the Scientific
Defense of 'Family Purity'," Jewish Social Studies 5 (1998-99) 177-202, should be
read in conjunction with this chapter.


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Review of John M. Efron, \u3cem\u3eMedicine and the German Jews: A History\u3c/em\u3e

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