James L. Franklin
Chicago, Illinois, United States
|Picture of George Orwell which appears in an old accreditation for the BNUJ. From: Archive.org Accessed via Wikimedia|
Robert Capa’s “The Fallen Soldier” is the iconic photograph of the Spanish Civil War (1936-1939). The original title was “Loyalist Militiaman at the Moment of Death, Carro Muriano, September 5, 1936.” The photograph captures a Republican soldier at the very moment of his death. Dressed in civilian clothing, a white shirt rolled up above the elbows, the soldier is shown collapsing backward, his rifle falling from his right hand, having been fatally shot in the head. The photograph, taken by the then twenty-three-year-old Capa, born Endre Ernő Friedman in Budapest, Austria-Hungary on October 22, 1913, is acclaimed as one of the greatest war photographs ever taken.1 The image conveys the essence of the struggle: a lightly armed civilian soldier dying in a burst of machine-gun fire from Franco’s Fascist-backed Falangists. The photograph embodies the brutality of the wars of the twentieth century and starkly depicts the frailty of the human condition and the unanswerable questions we have about human consciousness at the moment of death.
In Homage to Catalonia, George Orwell’s account of his participation in the Spanish Civil War, he provides a personal perspective on these issues in a description of what he experienced when he was shot by a sniper on the Aragon Front. From his text we can construct a narrative of the events as they unfolded. On May 20, 1937, at the first light of day, Orwell left his dugout and “was talking to the sentries preparatory to changing the guard.”
“It was five o’clock in the morning. This was always a dangerous time, because we had the dawn at our backs, and if you stuck your head above the parapet it was clearly outlined against the sky . . . Suddenly, in the very middle of saying something, I felt—it is very hard to describe what I felt, though I remember it with the utmost vividness.”2
Orwell continues: “The whole experience of being hit by a bullet is very interesting and I think it is worth describing in detail.” He likens it to being “at the centre of an explosion. There seemed to be a loud bang and a blinding flash of light all around me,” as one might experience from an “electric terminal . . . a sense of utter weakness and shriveled up to nothing . . . I fancy you would feel much the same if you were struck by lightning.”
Orwell fell to the ground, violently striking his head. An American, Harry Milton, was standing guard behind a wall of sandbags and recalled seeing Orwell stand and look over the parapet; a few seconds later he heard a rifle shot and “Orwell’s long body” crashed to the ground. At six feet, three inches, Orwell stood out among his fellow troops.
While he was fighting in Spain, Orwell’s comrades would have known him as Eric Blair. “George Orwell” was born Eric Albert Blair (1903-1950) and adopted his pen name in January 1933 with the publication of his first book, Down and Out in Paris and London. His reasons for adopting a pen name included not wanting to embarrass his family with an account of the squalor in which he had lived while gathering material for the book. He chose “George” as it was the name of England’s patron saint and also the name of his favorite author, George Gessing. “Orwell” was the name of a small river in Suffolk that evoked memories of an idyllic childhood.3 Eric was the name that he used with friends and family throughout his life. “Eric Blair: grocer” was how he was entered on the rolls of foreign enlistees, reflecting the enterprise he managed with his wife Eileen before traveling to Spain.
Harry Milton observed that the bullet had entered his throat, making a neat hole without much bleeding and that he had bitten down hard on his lip. While he was lying on the ground, people gathered round and he heard the “American” with whom he had been talking call for a knife to cut his shirt open. Orwell tried to retrieve the knife he carried in his pocket, only to discover that his right arm was paralyzed though he was in no pain. When he tried to speak, “I found that I had no voice, only a faint squeak.” As he was lifted onto a stretcher, blood poured out of his mouth. He heard one of the stretcher-bearers say that the bullet had gone clear through his neck. As he lay for several minutes on the ground, he was certain he would die. He reflected that he had never heard of survival from a bullet penetrating the middle of the neck and wondered how long one would live if the carotid artery was cut.
He describes his evacuation from the front through a series of aid stations where he was given a “shot of morphia” for severe pain as his paralyzed arm “came to life.” His wound was rebandaged and Orwell provides us with a glimpse of battlefield medicine at the time. He noted that “every time I breathed too hard the blood bubbled out of my mouth.” After a horrific ambulance ride to a hospital (a hurriedly constructed wooden hut) in Siétamo, he arrived later at a crowded hospital in Barbastro. The next morning, he was loaded on to a hospital train and sent to Lérida. Still “dopey from morphia,” in great pain, unable to move, and “swallowing blood constantly,” the nurses tried to force him to swallow the regulation hospital meal. He spent five to six days in a big hospital crowded with the sick and wounded. After a few days, he was able to walk about with his arm in a sling. He reports that he “never had a moment’s pain from the bullet wound itself.”
In Homage to Catalonia, he reports that the doctors were “able men” and there was no shortage of drugs or equipment. He finds two faults with the hospital system. First, the hospitals near the front were used as clearing stations, and no care was rendered except to those that were too badly wounded to be moved. Most of the wounded were taken to Barcelona or Tarragona, but a lack of transport meant delays of a week or ten days. The second problem he observed was a shortage of trained nurses. The result was that “men who were too ill to fend for themselves were often shamefully neglected.” As a result, he states: “I have no doubt, hundreds or thousands of men died who might have been saved.”
Thinking at first that he would go to Barcelona, he instead was taken to the hospital at Tarragona. At the hospital he noted they used what he believed to be the latest practice of keeping wounds open, but protected from flies with “butter-muslin.” He remained at Tarragona for three or four days and was met there by his wife, Eileen, and Major Georges Kopp, his commandant and friend. Together they arranged for him to be transferred to the Sanatorium Maurin. It was one of a number of sanatoria maintained by the POUM (Partido Obrero de Unificacion Marxista), the army in which Orwell had enlisted. It was a well-equipped sanatorium for convalescent troops in the suburbs of Barcelona on the slopes of Mount Tibidabo. Orwell arrived there on May 29 and remained there for two weeks. From the sanatorium, he would walk into Barcelona in the mornings to attend clinics at the General Hospital.
It was not until eight or nine days after leaving the front that his wound was examined. The doctor, “a brisk handsome man of about thirty,” grasped his tongue with gauze, pulling it out such that it bled, and with a dentist mirror determined that one of his vocal cords was paralyzed. The doctor informed Orwell “cheerfully” that he would never get his voice back. Writing about the examination five months later, Orwell also reported that the pain in his arm persisted for a month and the fingers of his right hand were semi-paralyzed but improving. There was numbness in the forefinger of his right hand.
A document that sheds more light on Orwell’s injury can be found in a letter written by Georges Kopp at the request of Orwell’s wife Eileen to her brother, Laurence O’Shaugnessy, who was a prominent thoracic surgeon in England.4 Georges Kopp (1902-1951) was a complicated figure, a soldier of fortune, whose background was not what it appeared to Orwell at the time. Orwell knew him as a Belgian engineer who had an expertise in munitions. He believed that Kopp had left a family and children at home to fight for the Republican cause in Spain. Although Kopp did not have any medical training, his letter is remarkable for the clinical details it provides.5
|Replication of illustration in George Kropp’s letter created by the author.|
The letter is dated “Barcelona, 31 May 1937,” and begins “Eric was wounded on 20 May at 5 a.m.” Kopp provides a carefully drawn frontal sketch of the patient’s head, neck, and shoulder. The larynx and trachea are accurately depicted. The imagined trajectory of the bullet is shown penetrating the neck just to the left of the midline and below the larynx and exiting on the “dorsal right side of the neck’s base.” Kopp reports that he was struck by a “normal 7 mm bore, copper-plated Spanish Mauser bullet, shot from a distance of some 175 yards.” The letter states that he had seen Orwell in Lerida along with his wife forty hours after he was wounded. The only treatment he had received was an external dressing and he was without a fever. His voice was “hoarse and feeble, but . . . conversational.” In addition to pain in his right arm that ran to the tip of his middle finger, he had pain on the lower left side of his rib cage and over the spleen, a result of his fall.
Kropp arranged for Eric to be “thoroughly examined” by Professor Grau of Barcelona’s University and was seen on June 1, 1937, at the Hospital General de Cataluña. The diagnosis was “incomplete semi-paralysis of the larynx due to abrasions of the right side larynx dilating nerve.” No vital organ was touched and “the bullet went right through between the trachea and the carotid.”
Professor Grau referred him to Dr. Barraquer for electrotherapy in an effort to restore his voice. Dr. Barraquer also diagnosed an “abrasion of the first right-side rachidean nerve accounting for the pain in his arm.” A course of electrotherapy treatment was recommended for both nerve injuries to be administered twice a week.
Kropp closes his letter expressing his favorable opinion of Doctors Grau and Barraquer. He finds the “machinery and instillations” of the General Catalonian Hospital “complete and modern,” adding “most of the nurses are brunettes.” And finally, “I advocate you writing to Dr. Barraquer (who speaks fairly good English) a ‘colleague’s letter’ in reply which you may be told something more than we mere mortals are permitted to hear.”
In Hommage to Catalonia, Orwell has this to say:
“In the morning I used to attend the General Hospital for electrical treatment of my arm. It was a queer business—a series of prickly electric shocks that made the various sets of muscles jerk up and down—but it seemed to do some good; the use of my fingers came back and the pain grew somewhat less.”
At this point, Orwell and Eileen decided that it would be best to return to England. The doctors had told him his voice was gone for good and that it would be months before he would be fit to fight. At the General Hospital he was certified as “medically unfit,” but to be officially discharged he had to see a medical board at one of the hospitals near the front. He left Barcelona on June 15th for five days, returning to Siétamo and POUM military headquarters to obtain his discharge papers. On returning to Barcelona, he faced dangers even greater than those he had endured on the battlefield. During the interval, the POUM had been declared an illegal organization by the Republican government now dominated by Communist Party officials. The POUM and its members were accused of collaborating with the Fascists and declared to be “Trotskyists.” The membership was being arrested and thrown into prison. Eileen’s apartment in the Continental Hotel had been searched and his war diaries confiscated. Eileen was not arrested but it was clear that she was being watched so that she could lead them to Orwell when he returned.
On the evening he returned to Barcelona, he went immediately to the Continental Hotel where Eileen was staying and found his wife sitting in the lounge.
“She got up and came toward me in what struck me as a very unconcerned manner; then put an arm round my neck and with a sweet smile for the benefit of other people in the lounge, hissed in my ear: Get out!”
After his wife filled him in on suppression of the POUM and the search of her apartment, he immediately went into hiding on the streets until they could leave Spain. Learning that his friend Georges Kropp had been arrested, he and Eileen boldly visited him in prison. Describing the deplorable crowded conditions under which Kopp was being held, Orwell recalled that he had to leave most of the talking to his wife because of his “squeaking voice.” Thinking that the official papers taken from Kopp when he was arrested documenting his service in the conflict would secure his release, Orwell put himself in great danger by going to the war department to recover them. In Homage to Catalonia, he describes the Kafkaesque nightmare of trying to find his way around a wren of unmarked offices to retrieve the documents and the office of the colonel who might authorize Kropp’s release. Finally, after finding the right office, he tried to explain to the colonel’s aide-de-camp in his “villainous Spanish which relapsed into French at every crisis” what he was seeking. “The worst was that my voice gave out almost at once and it was only by violent straining that I could produce a sort of croak.” It was all in vain and Kopp remained in prison for months. Orwell and Eileen managed to leave Spain by train, crossing into France with travel documents they had obtained from the British consulate identifying them as tourists.
Orwell made several references to his voice in his subsequent correspondence. He reported by the end of July 1937 that his voice was practically normal but that he could neither shout nor sing. He believed that he still had one vocal cord that was paralyzed and the functioning cord was compensating. Five months after he had been shot, he was also able to report that he had regained control of his arm.
Between 1941 and 1943, Orwell served as a broadcaster for the BBC’s Empire Service in the Indian Branch. Their mission was to somehow promote loyalty to the war effort among Britain’s colonial subjects through an appreciation of English literature. There was no mention of his poor speaking voice, though at this time it was described as “thin and high.”
In discussing Orwell’s wound let us start with his own words: “no one I met at this time—doctors, nurses, practicantes, or fellow-patients—failed to assure me that a man who is hit through the neck and survives is the luckiest creature alive.” The first factor in his survival is one of ballistics. He was struck by a 7 mm (25 gm) copper-plated Spanish Mauser Bullet. It would have had a velocity of 2,260 feet per second at approximately 200 yards. The high velocity and copper-plating accounted for the bullet passing through the neck without tumbling and injuring surrounding tissues.6 As Michael D. Schulman states in a recent article, “Orwell’s survival owed much to elementary ballistics and to the false assumption of munitions experts of that era that the fastest bullets did the most harm.”7
The neck can be visualized as a cylinder. It is densely packed with nerves, blood vessels, and vital organs: the trachea, esophagus, vertebral column, and spinal cord. If the cross-sectional anatomy is examined at the level Major Kropp provides on his drawing, what path would a bullet have to take without causing damage to any vital structures? At this point, a problem arises. First, there is Major Kopp’s careful drawing and statement in his letter that the bullet entered the neck “just under the larynx, slightly to the left side of its vertical axis” and exited on the “dorsal right side of the neck’s base.” Second, there is Professor Grau’s diagnosis of “incomplete semi-paralysis of the larynx due to abrasions of the right side dilating nerve.” This suggests that the bullet passed through the neck to the right of the trachea where it injured the right recurrent laryngeal nerve. How could a bullet entering the neck just left of the midline pass along the right side of the trachea without causing damage to that structure?
The only way this might be possible is if Orwell’s head was turned sharply over his left shoulder, exposing the right side of his neck to the line of fire. Then with his head facing forward, the bullet entry point might appear to be on the left of the midline. The trajectory of the bullet had to then be medial to the right carotid artery and proceeded through the musculature in the back of the neck (the middle and anterior scalene muscles) while sparing the spinous processes of the cervical vertebrae and causing non-permanent damage to the brachial plexus.
As Orwell notes:
“The wound was a curiosity in a way and various doctors examined it with much clicking of tongues and ‘Qué suerte! Qué suerte!’ One of them told me with an air of authority that the bullet missed the artery ‘by about a millimeter’.”
In Orwell’s account of his injury, he reports spitting or coughing up considerable amounts of blood. This must have resulted from injury to his tongue or lip, as reported by Harry Milton. Orwell noted that when his vocal cords were first examined, the doctor “grasped his tongue and pulled it out as far as it would go” resulting in “some bleeding.” This suggests he may have bitten his tongue when he fell to the ground. Had the bullet penetrated the trachea or esophagus, he probably would not have survived, especially when he was fed at the hospital in Lérida. Perhaps contusion to the larynx without perforation might account for the bleeding and his recollection that every time “I breathed too hard the blood bubbled out from my mouth.”
Kopp reported in his letter to Laurence O’Shaughnessy that Professor Grau’s diagnosis was “incomplete semi-paralysis of the larynx due to abrasions of the right side larynx dilating nerve.” The terminology is derived from a now obsolete classification of the laryngeal innervation into dilating and constricting function that dated from the second half of the nineteenth century.8 In modern terminology, it would be the right recurrent laryngeal nerve. The right and left recurrent laryngeal nerves are remarkable structures that branch off the vagus nerve, the tenth cranial nerve, at the level of the right subclavian artery and aortic arch respectively and ascend back into the neck along either side of the trachea to reach the larynx and the vocal folds (cords).
Orwell reported first paralysis of his right arm, and then subsequent pain. In his letter, Kopp reports that “Eric complained about his right arm aching from the shoulder down to the tip of the middle finger along a humer[o]-cubital line . . .” The symptoms and description of the trajectory of the bullet are felt to be consistent with an injury to the right brachial plexus. When Kopp refers to “Dr. Barraquer”9 in his letter, it is likely Orwell underwent electrotherapy with Dr. Luis Barraquer Ferre (1887-1959). Dr. Barraquer was the son of Dr. Lluis Barraquer Rivolta (1855-1926), considered the father of Catalan and Spanish neurology in Barcelona.10 The use of electrotherapy for vocal cord paralysis has subsequently been shown to be of no value. Reviewing the history of Orwell’s bullet wound, neurologist Ryan Jacobson localized the injury to the lateral cord of the right brachial plexus.11 Injury to the lateral cord of the brachial plexus would account for the sensations Orwell experienced in the fingers of his hand.
In the summer of 1936, Spanish workers had taken up arms to oppose General Franco, who was leading the revolt against the nation’s left-leaning elected government. The fighting broke out on July 18th and as Orwell would write in his essay “Looking Back on the Spanish Civil War,” it is probable that every anti-Fascist in Europe felt a thrill of hope. Orwell determined to go to Spain to witness the fighting and to possibly take part in it. He left England on December 23, 1936, uncertain if he would fight or had the stamina to be a soldier. He doubted he would be found medically fit because of the chronic “weakness of his lungs.”12 Traveling through Paris, he sought out the author Henry Miller, a friend from his “Down and Out Days” in the French capital, who pronounced his idea of going to Spain to fight “sheer stupidity.” Arriving by train in Barcelona in late December, Orwell was caught up in the optimistic egalitarian atmosphere of the city. It was the first town he had ever been in where the “working class was in the saddle.” It was a town “in which the wealth classes had practically ceased to exist.” Practically everyone “wore rough working-class clothes.”
He had wanted to join the International Brigade, but since the Independent Labor Party (ILP) had provided him with a letter of introduction, he felt obligated once in Barcelona to visit their representative. He met with John Mc Nair in the Executive Building of the POUM (the Workers Party of Unification). The ILP supported the POUM with funds raised in England of almost 10,000 pounds along with an ambulance and a plane load of medical supplies. Caught by the fervor of the town and naively believing that all the political groups were there to fight Fascism, Orwell volunteered to join the POUM. Mc Nair brought him to the Lenin Barracks and introduced him to the division commander, Jose Rivera. There he was assigned to a centuria that was forming to be sent to the Aragon front. By the time Orwell left Spain almost six months later, the harsh time he spent on the front, his near fatal brush with death and recovery in a series of Spanish hospitals, and the Stalinist betrayal of the POUM by the Communist-dominated Barcelona government served as an “arduous finishing school” for his political education.13 Recovering on the French Mediterranean coast he began preparing a series of articles to “spill the beans” about the Stalinist treachery in Catalonia. Eric Blair had truly become George Orwell and the seeds were planted for the great novels of his final years, Animal Farm and Nineteen Eighty-Four: Totalitarianism in Our Century.
- Kat Marton, The Great Escape: Nine Jews who fled Hitler and changed the world, Simon & Schuster, 2006, pp. 107-112. To view an image of The Fallen Soldier please see: https://en.wikipedia.org/wiki/The_Falling_Soldier
- George Orwell, Homage to Catalonia, Mariner Books, 2015, p. 143
- John Rodden, Becoming George Orwell: Life and Letters and Legacy, Princeton, University Press, 2020, p. 34
- Mr. Laurence Frederick O’Shaughnessy was a brilliant thoracic surgeon who was killed in 1940 in the retreat to Dunkirk at age thirty-nine. Harold Ellis, Br. J. Hosp. Med (London) 76(5):301, May 2015
- A facsimile of the letter can be found on the Internet: https://www.orwelltoday.com/orwellspainneck.jpg
- Richard A. Santucci and Yao-Jen Chang, Ballistics for Physicians: Myths about Wound ballistics and Gunshot Injuries, The Journal of Urology, 171 (April 2004), 1408-1414
- Michael D, Schulman, Down and Out in Aragon: George Orwell’s near fatal wounding in the Spanish Civil War, The Pharos/ Winter 2020, 8-13
- Lucian Sulica, War, Politics, and Voice: The Vocal Fold Paralysis of George Orwell, Laryngoscope, 2007 (February): 364-370
- In Spain, the first surname is that of the father, whereas the second is that of the mother’s maiden surname. Generally, the first suranme is the only one used.
- Lluis Barraquer Bordas, The History of Spanish clinical neurology in Barcelona 1882-1949, J Hist Neurology (1993): 2, 203-215
- Ryan Jacobson, The Luckiest Creature Alive: George Orwell’s Traumatic Brachial Plexus Injury, Neurology 84 (14 Supplement) April 23, 2015
- Michael Shelden, Orwell: The Authorized Biography, Harper Collins Publishers, 1991
- Ibid John Rodden, Becoming George Orwell, p. 40
JAMES L. FRANKLIN, MD, is a gastroenterologist and associate professor emeritus at Rush University Medical Center. He also serves on the editorial board of Hektoen International and as the president of Hektoen’s Society of Medical History & Humanities.