Despite the pioneering efforts of the Kaspare Cohn Hospital and the Hebrew Benevolent Society, the tuberculosis epidemic in the city continued to grow. In the 1910s, the influx of a new population of Jewish immigrants triggered new anxieties among the city’s Jewish residents about poverty and disease. In contrast to their predecessors, these new arrivals were largely of Eastern Europe descent, who, along with some three million other Jewish immigrants, came to America fleeing the violence and restrictive legislation that followed the assassination of Tsar Alexander II in 1880. Prior to coming west, most had already been in America for years, settling in the port cities of the East and industrial cities of Midwest. There they had worked in garment factories, steel mills and meat packing warehouses.  They had lived among their fellow immigrants in the overcrowded tenements of now famous working-class neighborhoods where tuberculosis continued to be rampant despite generally declining rates of new cases in the early 20th century. Some of the new arrivals were sent to Los Angeles by New York’s Industrial Removal Office, in an effort to place Jewish immigrants in areas with greater economic opportunities. But many were health seekers, moving west on their own in the hopes that they might find relief for their illnesses or those of loved ones.

These immigrants settled primarily in three areas: around Temple Street, on Bunker Hill downtown - both areas where cheap housing in boarding houses and residential hotels was available - and in Boyle Heights, a suburban subdivision east of the Los Angeles River. Temple Street housed the headquarters of several of the Hebrew Benevolent Society’s sibling organizations, and the surrounding area became home to the neediest of the new arrivals. Those with enough surplus cash to make a down payment on an undeveloped lot or house largely settled in Boyle Heights. The neighborhood had been home to wealthy landowners on large estates in the 19th century, but was “rapidly settling up” as landowners subdivided their holdings into smaller individual lots. Lots sold for prices ranging from a high end in “the hills” of $1,000 to $1,500, with single-family homes renting for $35 to $40 per month, to the low end in “the flats” with lots selling for $600 to $800 and smaller homes renting for under $10 a month. According to sociologist Cloyd Gustafson’s survey of the neighborhood in 1940, Boyle Heights’ reputation for healthfulness came from a real estate booster named Heinmann who travelled through Jewish communities on the East coast telling of Boyle Heights’ curative capabilities. [20]  Settlement in the neighborhood also may have been stimulated by the presence of Kaspare Cohn Hospital. Public health historian Sheila Rothman has shown that tuberculars often settled in “the shadow of the sanatorium,” relocating to towns and communities near sanatoriums in the hopes that they could glean some of the curative effects. [21] 

Regardless of motivational factors, the arrival of these new migrants in the city created a growing Jewish population that was distinctly different from their Jewish predecessors: they were Eastern European, rather than Central or Western European; they were more religiously observant, more often Orthodox rather than Reform or Conservative; and most considered Yiddish, a vernacular language that combined Hebrew, Germanic, and Slavic linguistic forms, to be their mother tongue. And, perhaps most significantly, many of these new arrivals were suffering from tuberculosis and other chronic lung diseases.

The Hebrew Benevolent Society, which was renamed the Jewish Social Service Bureau (JSSB) during this time, did its best to provide for the need to the new arrivals, but found itself completely overwhelmed by the demand. Whenever possible, they attempted to enroll applicants in existing public health programs by referring them to the Los Angeles County Department of Public Health which, like public health departments across the country, operated its own sanatorium. The Barlow Sanatorium near Elysian Park (Chavez Ravine) opened in 1902. Other tuberculars were recommended for treatment at Kaspare Cohn Hospital or given financial support. Applicants for aid at the JSSB were evaluated for their “fitness” for assistance: they had to show that they had a good “work ethic,” were willing to take the appropriate measures to treat their disease, and were likely to be rehabilitated and become “productive members of society.” Sometimes those deemed unworthy of aid were offered a train ticket home rather than any assistance. [22] Despite their best efforts, the JSSB simply could not keep up with demands for their assistance.

In the eyes of some of the city’s new residents, however, the JSSB’s shortcomings were by-products of their flawed approach to dispensing aid. They resented the implication that anyone was “un-fit” to receive aid and criticized the JSSB’s unwillingness to help all of their fellow Jews. According to an oft-repeated story, these critiques grew even louder after two impoverished Jewish tuberculars died homeless and alone, one dropping dead in the middle of Spring Street downtown in 1912, prompting a young man named Boris Flatte, an employee at Hamburger’s Department store, to call for action. [23]  Two weeks later, during Rosh Hashanah week of 1912, Flatte and other discontented, community-minded activists met at Blanchard Hall downtown to discuss their own ideas for helping the city’s Jewish tuberculars. Many had been involved in revolutionary, socialist and nationalist-minded movements in Eastern Europe, some among them fleeing to America to escape forceful threats of detention that resulted from their political activism. Their biographies reveal a variety of personal experiences and ideological influences that motivated their involvement in a sanatorium-building project. Calling themselves the Jewish Consumptive Relief Association, Flatte and his fellow activists vowed to “hereby band ourselves together and organize for the purpose of raising funds and establishing suitable quarters for the aid, cure and comfort of our brothers and sisters afflicted with tuberculosis.” [24] 

The Jewish Consumptive Relief Association aimed to build a sanatorium that could serve as an alternative to Kaspare Cohn Hospital. It would be based on their socialist principles of mutual aid and cooperative self-help and be a place where tuberculars could receive treatment regardless of their ethnicity, religion, partisan affiliation or ability to pay. Rather than solicit funds from wealthy donors, they targeted local Yiddish-based organizations and trade unions in the neighborhood, including the Arbeter Ring (Workmen's Circle), of which many of the JCRA’s leaders were members, as well as the local branch of the International Ladies’ Garment Workers Union (ILGWU) and the Bakers, Carpenters and Painters unions. These organizations in turn tapped their national and international networks, soliciting donations from members across the world, encouraging them to fund their own buildings on the nascent campus. For those outside of this organizational network, they offered membership in the Association, with dues of $3 per year that were used to pay for treatment. [25]  The members of the JCRA thereby strived to make their sanatorium a collective effort: by positioning it as a solution not only to the needs of local tuberculars in Los Angeles, but an alternative for those suffering from the disease across the country. They hoped to build a nation-wide social movement around the development of their institution. And after just a few months, they had raised $5,000 to purchase a 10-acre parcel of land 18 miles northeast of the city in the San Gabriel Valley in a town named Duarte.

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