George Orwell, 1933

The next moment . . . the doctor and the students came across to my bed, hoisted me upright and without a word began applying the same set of glasses, which had not been sterilized in any way. A few feeble protests that I uttered got no more response than if I had been an animal . . . . They only put on six glasses in my case, but after doing so they scarified the blisters and applied the glasses again. Each glass now drew about a dessert-spoonful of dark-coloured blood. As I lay down again, humiliated, disgusted and frightened . . . there was another treatment coming, the mustard poultice . . . . Two slatternly nurses had already got the poultice ready, and they lashed it round my chest as tight as a strait-jacket while some men who were wandering about the ward in shirt and trousers began to collect round my bed with half-sympathetic grins. I learned later that watching a patient have a mustard poultice was a favorite pastime in the ward . . . . For the first five minutes the pain is severe, but you believe you can bear it. During the second five minutes this belief evaporates, but the poultice is buckled at the back and you can’t get it off. This is the period the onlookers enjoy most. During the last five minutes, I noted, a sort of numbness supervenes . . . .

There was a light in the ward, enough to see by. I could see old Numéro 57 lying crumpled up on his side, his face sticking out over the side of the bed, and towards me. He had died sometime during the night, nobody knew when. When the nurses came they received the news of his death indifferently and went about their work. After a long time, an hour or more, two other nurses marched in abreast like soldiers, with a great clumping of sabots, and knotted the corpse up in the sheets, but it was not removed till some time later . . . . This business of people just dying like animals, for instance, with nobody standing by, nobody interested, the death not even noticed till the morning—this happened more than once.

A recent review in the BMJ stimulated me to re-read George Orwell's essay, How the Poor Die. In this he described being treated for pneumonia in Paris in a hospital for the poor in 1929. He is put through a third degree by being interrogated at length by clerk, then marched without slippers through the snow while shivering from a high fever. He enters a low ill-lit room full of murmuring voices, three rows of beds so close that patients can touch each other. A foul, sweetish, fecal smell pervades the area, scraps of food and dirty dressings are discarded in the ward in a huge packing case infested by crickets. The nurses wake the patients at 5 am, take their temperature but do not wash them. Breakfast consists of a thin vegetable soup with slimy hunks of bread floating about in it. Rounds are made by a tall, solemn, black-bearded doctor followed by a retinue of interns and students. Day after day they walk past some of the beds, ignoring the imploring cries for help. They only stop at interesting cases, where students excitedly line up to palpate, percuss, auscultate. The patients have no privacy. They lie exposed, they suffer, urinate, and defecate in public view. They are treated like animals. They die alone, their organs already marked for a bottle in the museum, their bodies designated for dissection. Fortunately, as Dr. Davies points out in his review, such horrible conditions had become a thing of the past, even at the time when George Orwell wrote his classical essay.


Davies, P. How the Poor Die. BMJ 2012; 345:32.
Orwell, G. How the Poor Die, in Down and Out in Paris and London, 1946.


George Dunea, MD, Editor-in-Chief