“It is a sound instinct that warns people to keep out of hospitals if possible, and especially out of the public wards.” George Orwell may have written this in 1946, in his essay, “How the poor die”, but I can’t help thinking that it is still a sound instinct, something only too vividly confirmed by the experience of COVID-19, world-wide. How many people have contracted COVID-19 in hospital, for a start? How many hospitals have been so over-run that they’ve had patients in corridors, in foyers, in ambulances on ramps, in quickly erected marquee wards, not to mention people on the streets waiting to get in. This isn’t the experience of all patients in all hospitals in all countries, but as far as I can tell one or more of these things has happened in every place that COVID-19 has taken hold. It’s not pretty.
But, I digress. Back to Orwell. The essay was inspired by an experience he had in a public ward of a hospital in Paris in 1929, but why leave it to 1946 to publish? According to Wikipedia, the editor of Orwell’s Collected Works, Peter Davison, suggests that it may have been first written between 1931 and 1936, when Orwell was writing about “the unemployed, tramps and beggars”, and that he reworked it over 1940 to 1941. It was submitted to a journal around then but was rejected, “possibly because readers would have been unwilling to read about ‘how the poor die’ at such a time”. In the end, a section [which section, I wonder?] was retyped and it was published in November 1946.
Orwell’s experiences were awful. He had pneumonia, he says, and was placed in a packed ward – “a long, rather low, ill-lit room … with three rows of beds surprisingly close together” – and treated with cupping and a very painful mustard poultice. This, however, was not the worst of it. He describes the impersonal, disrespectful way in which the patients were treated by the doctors, medical students and nurses, the lack of basic cleanliness and care (with patients, not nurses, for example, often getting bedpans for those who couldn’t do it themselves). That this was going to be the sort of story he’d tell is heralded in the second paragraph where he describes having a bath on admission as “a compulsory routine for all newcomers, apparently, just as in prison or the workhouse”.
Anyhow, Orwell then moves on to death. He suggests that the lonely, ignored death of patient numéro 57, would be seen as “an example of a ‘natural’ death, one of the things you pray for in the Litany”. He considers it might be “better to die violently and not too old”, because, for all the horrors of war, he writes, death via a man-made weapon nowhere near “approaches in cruelty some of the commoner diseases”.
At this point, I was wondering about what hospital experiences Orwell had had, but he goes on to mention a Spanish hospital and an English cottage hospital, both of which he experienced in the 1930s. So, when he argues that the English cottage hospital was superior, he is speaking from experience. I wonder, though, whether a French cottage hospital might have been similarly decent? I don’t know.
Orwell next gives a brief history of hospitals through the nineteenth century, describing how they were places where medical students practised on the poor. He focuses on surgery, which, at that time, was “believed to be no more than a peculiarly gruesome form of sadism”. This apparently inspired a nineteenth century genre (though he doesn’t use that term) of horror-literature “connected with doctors and hospitals”. All you horror lovers will be familiar with this, I’m sure. Doctors in these stories had names like Slasher, Carver and Fillgrave. He also mentions Tennyson’s poem “The Children’s Hospital” (1880) as being part of this anti-surgery literature.
I found all this interesting, but wondered what his point was. A page or so before the end, I thought I found a hint, when, after referencing the improvements brought by anaesthetics and disinfectants, he says
Moreover, national health insurance has partly done away with the idea that a working-class patient is a pauper who deserves little consideration.
And yet … he concludes by saying that, despite improvements, hospitals are still not the best place to die, and that “the dread of hospitals probably still survives among the very poor”. It takes a long time, he implies, for past experiences and history to die out in the collective imagination. Not necessarily a bad thing, I think.
Wikipedia tells us that in 1948, two years after this story was published, and one year before Orwell died, Britain’s National Health Service was established “as publicly-funded medical provision for all”. The person behind it was the Minister of Health, Aneurin Bevan, who had once been Orwell’s colleague at the Tribune.
“How the poor die” (orig. 1946, in Now)
in Books v. cigarettes (Great Ideas)
London: Penguin Books, 2008
Available online at the Orwell Foundation.