Some 35,000 Jews lived in the East End of London in 1880, most of them in Aldgate, Whitechapel and Stepney. Within thirty years, largely as a result of a mass exodus from Eastern Europe, their numbers had grown to 120,000, a high percentage of whom were recent immigrants and many of whom were poor on arrival.1 This massive increase set daunting challenges for the Anglo Jewish leadership, not least in the matter of health care.
In the nineteenth century, primary responsibility for social welfare lay with voluntary agencies, particularly in health, education and housing. It was phil? anthropists who made themselves mainly responsible for new hospitals, schools, universities and university colleges; and it was they who financed medical and scientific research and who funded libraries, museums, art galler? ies, public parks and urban housing experiments. Facilities provided by the State were largely supplementary to their efforts. Parliament followed, but rarely initiated social reform.
It was only gradually appreciated that voluntary organizations could not provide the complete answer and that the State would have to involve itself. There were three stages in the process. In their earliest days, social services were almost always provided by privately funded and administered organiza? tions. Later, when the State saw that the service met a social need, it assisted with grant-in-aid on a temporary basis while the management remained in private hands. In education, for example, the Jews' Free School largely depended on Rothschild charity throughout the nineteenth century, and gov? ernment financial aid came slowly and only after pressure was applied. In the third stage, the State took over the service and operated it as a public enter prise sometimes with and sometimes without voluntary assistance. Until the State intervened the work had to be done from within the general community, and in areas in which there were Jewish religious requirements, such as the need for kosher food and facilities to respect and celebrate the Sabbath and Festivals, Jews had to look after their own.
To a Victorian philanthropist, the contemporary involvement of the State in social and welfare activities would have been inconceivable, and it is in that context that their efforts must be judged. Conversely, it is only with difficulty that an age that takes for granted large-scale public social services can fully comprehend the distinctive role assigned by the Victorians to char? ity.
The crucial role in promoting health care for the Jewish poor was played by the wealthy members of the community. They not only provided the bulk of the required money, but undertook control of the institutions carrying out the work. The poor contributed too, sometimes giving more, pro rata, than the middle class. But with a few exceptions, notably that of the London Jewish Hospital and the Jewish workhouse, their payments were only a small proportion of the required total. By the mid-nineteenth century there were thirty-eight Jewish charitable organizations providing pensions, loans, grants, food and groceries, clothing, lying-in facilities, apprenticeships, care for the sick, homes for the aged and almshouses. Henry