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George Orwell, How the poor die (#Review)

October 10, 2021

“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.

Previous reviews from this book: “Books v. Cigarettes“, “Bookshop memories“, “Confessions of a book reviewer“, “The prevention of literature” and “My country right of left“?

George Orwell
“How the poor die” (orig. 1946, in Now)
in Books v. cigarettes (Great Ideas)
London: Penguin Books, 2008
pp. 50-64
ISBN: 9780141036618

Available online at the Orwell Foundation.

20 Comments leave one →
  1. October 10, 2021 22:38

    LOL Well, that was cheery reading!

  2. October 10, 2021 22:53

    Following on from Lisa – …but beautifully constructed – all those experiences and dates concluding with the Aneurin Bevan story! To think that the rightwing ideologues in Britain have been doing their best to turn that great institution the NHS so lauded in the TV series “Call the Midwife” into a US version of health care for money – as indeed the same variety of ideologues are doing, have been doing, will do – the moment they see their chances with Medicare here!

    • October 10, 2021 23:12

      Yes, to all of that, Jim, thanks. The NHS is one of the wonderful things about Call the Midwife isn’t it – and yes, the ideologues are certainly getting stuck in here too I agree. Tweak, tweak, tweak. Such vision Gough and the crew had. We were once such a visionary, socially aware nation.

  3. October 10, 2021 23:33

    Writing without the benefit of sources, I think Orwell was wounded in Spain and transported away from the front in a crowded open lorry. Not fair under those circumstances to compare Spanish hospitals with England in peace time. (You may remember too that Aileen Palmer, daughter of Nettie, served in a hospitals/ambulances in Spain and England).

    I wouldn’t be surprised from his experiences in Down and Out in Paris and London if Orwell believed the English government were deliberately killing the poor off.

    • October 11, 2021 08:41

      I think your memory us correct, and I did think he wasn’t quite comparing apples with apples. I think I had that line in my post but took it out.

      I’d forgotten about Aileen Palmer.

      I don’t get that sense from him in terms of English hospitals. But I’m not sure his English cottage hospital experience was a public ward so we get back to the apples.

  4. October 11, 2021 05:26

    I am an escapist. After reading your review, I have re-dedicated myself to this character trait. 😦

  5. Neil@kallaroo permalink
    October 11, 2021 09:36

    As a frequent client of hospitals, I guess I’m lucky I’m not poor!

  6. October 12, 2021 00:19

    Was her perhaps simply making the point that his experience happens to lots of people and that the general public is not yet fully aware of it, or if they are that they are not angry enough to demand political change in the way health care is handled? That title is certainly a form of click bait, and I’ll bet his essay caused quite the stir!

    • October 12, 2021 08:42

      Yes, you are probably right, Melanie , though he does praise English hospitals a bit more than l’d expect for that goal. But the title, as you point out, certainly suggests wanting to draw attention, and he did care about social injustice.

  7. October 12, 2021 12:33

    Don’t get me started on healthcare having come from America to Australia which is much better. Healthcare in America is criminal due to costs. Orwell sure touched on a great variety of topics in his life. He has and will continue to keep people talking for generations hopefully. Always best to try and avoid hospitals whenever possible. Staph infections, covid, pneumonia. Doesn’t bear thinking about. But when we need them we need them. Haha. Enjoyed your post. (as always).🐧🤠❤

    • October 12, 2021 14:20

      No, you are right Pam re the USA’s poor record in this area. It’s truly scary, I think the vulnerability of so many people over there if they get seriously ill.

      And, yes, always best to avoid even the best hospitals if you can

  8. Sue permalink
    October 12, 2021 19:27

    We have a fight on our hands to keep our public health care here Sue, and it was groaning at the seams when I left it. When I started nursing back in the 1970s it was brilliant.

    It’s tricky though isn’t it – I worked in palliative care in a large church-run hospital in Sydney – I hated patients dying in those small bleak grey cubicles, yet by that stage you really are in need of full time nursing care, and the care we gave was superb. They were still miserable little rooms to die in though.

    I think I might agree with Orwell that it’s better to go suddenly outside or at home…

    BTW, good old Flo was right about hospitals needing good ventilation and plenty of windows in light of covid 19!

    Stay well…

    • October 12, 2021 21:00

      As was tertiary education then too, eh, Sue?

      Interesting point about the care versus the rooms. The hospice room Mum died in wasnt quite like that and it opened out onto a lawn and the lake behind, but it was still a hospital room in so many ways. The care was beautiful.

      I think the “suddenly” is the thing.

      And, love your comment about old Flo!

  9. October 14, 2021 05:36

    Phew, boy. That does strike close to home, for sure. The spinoff TV series “The Good Fight” carrying on from where the American series “The Good Wife” left off, did an interesting episode about how one of the law firm’s employees was hospitalized for Covid, compared to how other people in the show coped during the pandemic (i.e. the lawyers). A two-track system, clearly. (And a show that takes substantial risks in exposing societal inequities, which came to production as a response to the American 2016 election results, with the inimitable Christine Baranski.)

    • October 14, 2021 08:29

      Thanks Buried… Interesting just to see COVID entering drama storylines. I don’t know The good fight at all. Great to hear though about shows exposing inequities. It’s important.

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