George Orwell Matters! discussion

This is the thread to discuss the essay How the Poor Die by George Orwell, which was suggested by Tom.

We will be reading this as a group in January 2022.

Here is the essay on the George Orwell website https://www.orwellfoundation.com/the-...

(Edited)

This read begins today! What do you think?

I just read it. How appalling the treatment at Hospital X! Not a place I would want to go or have a loved one go, for sure!

Orwell has a great sense of what macabre details will bring the situation home. For instance:

"It is strange to relate, but sometimes as some young student stepped forward to take his turn at manipulating you he would be actually tremulous with excitement, like a boy who has at last got his hands on some expensive piece of machinery."

It is the stuff of nightmares to encounter a medical professional with such attitudes, seeing their patients as almost an inanimate object, unworthy of being talked to or comforted or even being listened to!

And the lack of hygeine in Hospital X makes me shudder! I don't think modern hospitals are quite this bad, thank goodness, but they still do sometimes feel quite impersonal, even though many nurses try to counteract that with little kindnesses as much as they can.

In a few spots, the essay takes on a more philosophical flavor:

"One wants to live, of course, indeed one only stays alive by virtue of the fear of death, but I think now, as I thought then, that it’s better to die violently and not too old. People talk about the horrors of war, but what weapon has man invented that even approaches in cruelty some of the commoner diseases? ‘Natural’ death, almost by definition, means something slow, smelly and painful."

These philosophical parts felt somewhat morbid to me, though I can understand the sentiment. My uncle once told me, "I hate getting old, but it beats the alternative." I guess it's a similar idea, my uncle's gallows humor.

But I'm guessing Orwell was a younger man when he wrote this essay. Some of the more morbid philosophical parts feel more like a younger man's way of thinking, looking at things that are still hopefully very far away.

How the Poor Die was first published in 1946, but could have been written between 1931 and 1936, while George Orwell was writing mostly about the unemployed, tramps and beggars, e.g. Down and Out in Paris and London, which was first published in 1933. It's been suggested that he might have reworked it between summer 1940 and spring 1941.

If we think of the earlier date, that would make him about 30, but then George Orwell was only 47 when he died :(

I'll add a link to the first comment, so that it can be read online.

Bionic Jean wrote: "If we think of the earlier date, that would make him about 30, but then George Orwell was only 47 when he died :("

Wow, somehow I either never new this or had completely forgotten it! He wrote multiple hugely influential books in a relatively few years!

Greg - I like your thoughts very much. This sounds like an appalling hospital, but I have no doubt it is authentic. This makes me wonder whether it is the normal treatment for the poor of all so-called First World countries at that time.

Certainly the essay How the Poor Die predates Britain's NHS, whichever of those dates it was written. The NHS only began in July 1948. So George Orwell's experience would have been determined by how much money he had, whichever country he was in. And he had a lot of experience of medics; George Orwell was not a well man.

I find the psychology true to life. The young medics who are excited by an unusual case and so on. Many of us will find some of this touches on the edge of our own experiences, so we can well believe what life was like for our forbears. Far more primitive treatments, no ethical code to prevent rampant experimentation, no formal drugs trials, and no free medical care for all/medical insurance.

Also Greg I too felt that How the Poor Die took on a philosophical flavour, much as most of George Orwell's journalism does. He does not record his experiences, or his observations, just to entertain - or even to inform. He wants us to share his musings, and see where all this might lead to, or how it came to happen, and glean some sort of purpose in it all.

I somehow lost this post, so tried to recreate it :( )

I think this is a really good choice, thanks Tom. It's not an easy read, but perhaps puts some of our excesses and expectations into perspective. I can't help but think of the homeless, reading this.

The French public hospital for poor patients who could not afford to pay for their care certainly sounds underfunded, understaffed, and filthy. One doctor was responsible for the sixty patients in Orwell's ward as well as patients in several other wards. It seemed that the public hospital was mostly a place for medical students to learn from the doctor on rounds, and a source of bodies for dissection. The patients were treated like numbers, and ignored if their cases were not considered interesting.

Orwell also discusses literature set in hospitals:

"If you look at almost any literature before the later part of the nineteenth century, you find that a hospital is popularly regarded as much the same thing as a prison, and an old-fashioned, dungeon-like prison at that. A hospital is a place of filth, torture, and death, a sort of antechamber to the tomb."

One wonders if some of the distrust of hospitals that exists in people even today goes back to horror stories people heard from their ancestors. For some, hospitals were a place where you would go to die. The COVID crisis now is really bringing out the differences that exist in people's perception of health care and hospitals, especially among the poor and minority groups. The horrors of the past created long-term attitudes of distrust in some groups.

I tried a couple of pages the other day and decided to put it down. It was disturbing, too realistic, and too close to home. Good writing.

Connie wrote: "The COVID crisis now is really bringing out the differences that exist in people's perception of health care and hospitals, especially among the poor and minority groups."

This is true, unfortunately.

I don't think any hospitals in the USA are as bad as Hospital X nowadays, but there is still a real difference in care depending in how much one can afford.

When Ron had his stroke, I discovered that depending on the quality of insurance, patients can qualify for anywhere between 6 physical & occupational & speech therapy visits a year to 60 a year! When the visits run out, that's it - what a difference!

We have also been paying $8,000 a year out of pocket in addition to our normal insurance in copays and deductibles for stroke therapies. One of his doctors gave me a bill for thousands the first year afterward and sheepishly told us he couldn't do the next treatment unless we payed our portion for the prior ones. (Ron needs the treatments every 3 months). Luckily I was able to find a second night consulting job for extra money, and the doctor was willing to take a patial payment and agree upon monthly installments afterwards. The hospital and ambulance also agreed upon monthly installments until those bills were payed. I can easily see how medical emergencies result in bankruptcies! Luckily, I had a good job, a skill that made it possible to find a second job, and some savings. I imagine many in America are not as lucky, and I have no idea what they do.

When I volunteer with the homeless at church, they would often tell me about medical events that led to their homelessness, and I now have a strong understanding of how that could happen!

Technically, American hospitals have to take patients who cannot pay and give life-saving care, but that is minimal life saving care only. So much that is really needed, a person lacking enough money will not get. The hospitals are sometimes on the verge of bankruptcy themselves in covering the costs of those without money or insurance.

Another problem in the USA is that some areas are underserved medically and have fewer hospitals per capita; so they have to go to hospitals that are much further away. Emergency room waits regularly stretch to long intervals even for serious problems. Even pre-covid, one of the emergency rooms near where I live often has emergency room waits that stretch as long as 20 hours!

But at least the hospitals will be sanitary, and whatever treatments are actually given will be ethical. I have also found that most nurses nowadays do their best to humanize things for people in horrible situations.

Mark wrote: "I tried a couple of pages the other day and decided to put it down. It was disturbing, too realistic, and too close to home. Good writing."

You were wise to do that if it upset you Mark. I'm sorry about that. I had to take deep breaths and sit back a double of times too.

I often think that aspects of George Orwell's writing are timeless. As Greg said "most nurses nowadays do their best to humanize things for people in horrible situations" and there were caring individuals in How the Poor Die.

Even more surprising to me, were the Victorian doctors' records in an English insane asylum in Richard Dadd: The Artist and the Asylum. We have preconceived opinions of their "mad houses" but these doctors were extremely caring and diligent.

Bionic Jean wrote: "Even more surprising to me, were the Victorian doctors' records in an English insane asylum in Richard Dadd: The Artist and the Asylum. We have preconceived opinions of their "mad houses" but these doctors were extremely caring and diligent."

I love this Jean! I am very curious now to read the book you mention.

This makes sense to me, as I suspect that most people in every era really do try to do their best within the limits of their current understanding. Some older medical treatments would not have been efficacious, but I presume they were usually or at least often performed with the best intentions.

The 19th century medical records pertaining to Richard Dadd were photocopied, and included in the biography. I recognised the asylum doctors' motivation as equally concerned, but without the benefit of today's psychiatric drugs. They did recognise that a calm environment, and allowing the patient to follow their interests, (in Richard Dadd's case painting) helped.

So I have no doubt the hospital X had staff who were caring. But they were fighting a lack of money, drugs, modern medical knowledge, and so on.

I wonder if also they were looking at the bigger picture - hoping to cure diseases in the future by using their patients as guinea pigs? I expect there were no guidelines of appropriate medical practice and behaviour, as there would be now.

Of course the system would also allow people of questionable intentions to qualify as doctors, just as there would be occasional sadistic prison warders, I expect.

This book sounds so serious and needs to be read. I must look for it, or should. It does seem to be such a sad book and these times are so sad. Depressing as times are now and always have been.

Josephine wrote: "This book sounds so serious and needs to be read. I must look for it, or should. It does seem to be such a sad book and these times are so sad. Depressing as times are now and always have been."

At least it is quite short Josephine! Reading hundreds of pages on the theme might have got me down, but if I'm reading the correct thing, this is just a short essay:

https://www.orwellfoundation.com/the-...

Josephine wrote: "This book sounds so serious and needs to be read."

I'm not sure which you mean ... The book about Richard Dadd is large-format as it is an artist's biography and contains many reproductions of his paintings. I have reviewed it, if you are interested in that one. But the essay here is linked in the first comment.

Edit - sorry, cross-posted!

Bionic Jean wrote: "Josephine wrote: "This book sounds so serious and needs to be read.".."

Oh sorry Jean, I can't find the essay linked in the first comment. Am I missing something? The book link and author link take me to the Goodreads book and author info. Is the text of the essay also linked there somewhere?

No you're absolutely right Greg! Thanks for pointing that out, and I have added it now.

I remember exactly what happened ...

Goodreads always falls over every Jan. 1st, presumably because so many mods try to archive threads then. It fell over 3 times when I was working on it, and this is one of the threads I had tried to update several times. I even lost my original post 6 :(

I just forgot to come back and add the link, when things had settled down! Sorry.

So now we have 2 links to it ( ;) ) let's have some more comments. What do others think :)

It is good that writings by George Orwell are coming back in vogue, or have they ever been forgotten? I have to get back into reading his works, but there is so much good writing by so many others. Again, I need to read George Orwell.

With all the sickness that is going on these days, we do need to be very aware of health and how it affects people's pocketbooks. I got sick in June of this year and am now in very good health. I did have excellent health care policies and didn't have to worry. The doctors were excellent, did a good job, but they were well paid.

It is interesting how, when we read this essay which was written almost 90 years ago, it does make us think of similarities and differences in how we receive care, and how patients may be treated according to their financial support - wherever it comes from.

I am glad you are in better health now, Josephine :)

How the Poor Die is perhaps always going to be topical - in every country - to a greater or lesser extent. The homeless now may appreciate their hospital care to the alterative, but I think it may have felt to some of these poor that they were between a rock and a hard place.

Thank you for commenting on my good health, I am happy to be in such good health.

As for "How the Poor Die" is there an answer, or can there ever be one?

Thank you.

Great topic to discuss in the 3rd year of a pandemic which has clearly demarcated the gap between the haves and the have-nots. George Orwell's influence continues to clearly show the disparity from cradle to grave in both life and death.

I am interested how intelligent he was.

Some examples, and explanations:

The patient with the cirrhotic liver was showing evidence of ascites(fluid within the peritoneum of the abdominal cavity) and so he was being pushed to and fro to hear it sloshing around, as well as evidence of "ballottement".

The mouth being left open on death is known in medical speak as the "O sign" for obvious reasons.

The National Insurance scheme in the UK arose from the Lloyd George sponsored Act of 1911 and covered 70% of the workforce. This allowed for free primary care for those individuals though not Hospitals apart from Tuberculosis treatment which was covered in all forms. This ensured that treatments were often available in the community that would otherwise have only occurred in Hospitals such that free domiciliary consultations by specialists to bedbound patients at home happened not infrequently even up to the 1980s. That did, however, depend on the reputation of your GP as well as the goodwill of the said specialist!

Regarding the cleanliness of the British Hospital establishments, I think a combination of the exploits of Florence Nightingale, Crimean War nurse extraordinaire, John Snow, London cholera outbreak diagnostician, and Louis Pasteur, improved the health of the environment as well as advances in both medical and nursing care in the UK which were enhanced by well-supported training establishments encouraged this.

I worked for a short spell in a French Hospital in the 1983 and the nurses there were technicians and administrators but did not perform patient cares. I was surprised at the difference in attitude and job description.

I am certain that George Orwell had a very torrid time and was very glad to escape Hôpital X as I would have encouraged him to do!

Ah, and the other thought that I had, was his experience of death occurring during the day on the British Hospital ward but being unnoticed immediately by the residents. The staff would have euphemistically referred to Patient X needing to go to "Rose Cottage" aka "The Morgue". So, whenever I hear anyone's address is "Rose Cottage", I immediately reflect on another alternative location!;-)

Boadicea wrote: "Great topic to discuss in the 3rd year of a pandemic which has clearly demarcated the gap between the haves and the have-nots ..."

Yes, and the start of a new year, after all the festivities, seemed a good time to perhaps make us reflect a little. Some great thoughts here Boadicea :)

George Orwell would obviously be comparing his treatment with the treatment he had experienced in other countries. So that would be England (and perhaps India). Thanks for clarifying what health care was like in Great Britain before the NHS. It sounds as though it was a little more complicated than just being the private sector.

In a similar way, as well as taking on board George Orwell's past, present and future, when we read, we make comparisons too, but different additional ones, according to our own experience.

"I worked for a short spell in a French Hospital in the 1983 and the nurses there were technicians and administrators but did not perform patient cares."

That's extraordinary! It seems to turn the concept of a "nurse" on its head. In England now, under the NHS, we have "nurse specialists" who are senior nurses who take on more of a doctor's role, in consulting, diagnosing, and prescribing. This may have seemed odd to the Hôpital X management.

But then one of the things which strikes most about this essay, is that there were no accepted ethical procedures. Everything was done on a whim, and if a doctor was more interested in the case itself than the particular patient's welfare, then the outlook for that patient was a bit bleak!

Of course they wanted to experiment, and improve what was known in medicine, and George Orwell does say this. But there have to be some agreed standards. Simple hygiene procedures were known by then, as you say. Also, I would have thought then as now, there would be many whose conscience would prick at the thought of doing harm or causing unnecessary pain. I cannot believe that there was much difference. Yet at one point George Orwell seemed to be saying that a few were in the job because they were sadistic, which is a terrifying thought! (I'll try to find the reference.) Evidently they were not weeded out at an early point.

Now there is plenty of legislation in place (in most First World countries anyway) to prevent this experimentation, which amounts to a sort of vivisection. We have clinical trials, for instance, and - if we meet the criteria - may be offered a place on one of these, with the full knowledge that it may not help, and may even harm. In a similar way, we have elective surgery, to try to prevent future likely problems. I've had personal experience of both of these. But there's a huge difference, in having the choice!

I doubt very much whether such ideas had ever crossed the minds of those administering or working at Hôpital X. Yes, we have benefitted vastly from all the earlier knowledge, and our scans and diagnostic procedures are leaps and bounds ahead of that time. But I'm glad George Orwell did not cross that point when he was just a little too weak and ill to escape from this, and instead alerted the public to what had been going on, and perhaps still was, somewhere.

Hi Jean, thanks for your thoughts. The other useful reading I have done since I comnenced Goodreads was to undertake George Bernard Shaw's "Doctor's Dilemma," a 1906 take on the utilisation of a scarce and experimental treatment for Tuberculosis and the choices surrounding it. It's a good supplementary reading to this, albeit dated, and afflicted as ever with Shaw's hectoring zeal.

Oh I read that one years ago - great suggestion!

I am loving these comments about the doctors, nurses, diseases and what was being done in this time and place to cure, not to cure, or experiment with all of this. This is a fascinating study about medicine. So many people are interested in medicine and what is being done. I am one of them.

I've just finished reading this and it was a rough read, for sure.
The conditions in that hospital were horrendous, especially the attitude of the medical personnel.
It's a wonder Orwell got out of there alive!

I need to read this. I think this is all so terrible. Money and lack of money. Sad and bad.

Rosemarie wrote: "It's a wonder Orwell got out of there alive!..."

I thought that too! Grim determination perhaps, and maybe the passion to record it all for posterity.

Josephine - you can read it via the link in the first comment - no need to track a copy down if it's difficult.

It is a bit hard to find much about Orwell's writings in the United States.

Of course Orwell matters. He needs to be read more often.

It's also interesting that he called the article, "How The Poor Die" rather than "How The Poor Suffer", yet it's the suffering that's reveals the greatest load in rhe story in my opinion? Obviously, that increases the risk of their dying. A really good example of showing, rather than telling, I think.

"How the Poor Die," these poor folks are so worried about dying that worrying makes them sicker. It is hard not to. They become sicker and sicker. "How The Poor Die" was written many years ago. I hope things have changed for the better. I think all this remains the same. Money talks loud and clear.

Hi all.

Glad to be back online after the hiatus that was brought on by the sad, sudden and seemingly apt passing of my poor old laptop. I must take the liberty to note that he died at home, was loved, and the ambient surroundings on the night of his death could be described as warm, luxurious and comfortable. He died at the ripe old age of 7 years.

The aforementioned episode was a darn sight less squalid and pitiless than could be said for the conditions the poor folk in the horrific sounding Hospital X had to suffer!

I thought this might have been a good essay to read and discuss, as it is approached in a very 'Orwellian' way: Mr Orwell mentioned somewhere in his memoirs that he was blessed with "an ability to face unpleasant facts", very true, as I don't think there are many facts/observations that one could be faced with that are more unpleasant than the ones written about in this great, unsettling, unique and oftentimes philosophical essay.

Right at the beginning of the piece, when Orwell was talking about filling in the hospital forms in 'Latin countries', instantly reminded me of another great British writer Peter Mayle, who writes very humorously in his seminal memoir "A year in Provence" (Highly recommend to anybody who hasn't read this book)about the very same, endless form filling he experienced in the Latin Countries (France, respectively [obviously])

Some parts really left me aghast at the sheer stupidity of the actions of the nurses. Why did they make Orwell bathe in a few inches of water, then walk barefoot across the hospital grounds in the freezing winter winds when he was suffering from Pneumonia? The process of cupping he witnessed was positively mediaeval, almost like a scene from Blackadder. The mustard poultice had me shaking my head, while wincing, in shock and horror only to find myself chuckling at the seemingly impossible insertion of levity that Orwell managed to slip in.

"These things are normally applied for a quarter of an hour and certainly they are funny enough if you don't happen to be the person inside"
"For the first five minutes the pain is severe, but you believe you can bear it. During the second five minutes this belief evaporates..." Love it.

"Je Pisse!" I was also wincing at this part. The poor man sounded like he was in agony. Still, a humorous exclamation that Orwell witnessed and decided to include. "La Casserole"/ bedpan was rather revolting, but classic Orwell facing unpleasant facts and reporting them.

I was most disturbed when reading the parts about the doctors and students prodding ill or infirm patients, and taking notes on their observations. No expressions of even slight compassion by any of the professional staff. The whole place seemed bereft of humanity and I'm so happy not to have lived through that era in a country that treated its sick citizens in such a despicable way.

The haunting description of the alcoholic/cirrhotic liver case #57, was so spot on it was frightening. I was unfortunate enough to have witnessed this condition and its ruinous unstoppable onslaught first hand; but good on Orwell, these things need to be known.

I think we can all agree on how lucky we are to not have gone through any of this barbaric, mediaeval treatment of the sick.

Tom! Good to have you back :) I'd noted your silence with surprise, since this essay was your choice, but am very glad you are online again :)

Thanks for all these great points. At first, I wondered if the appalling routine the patients were subjected to was just that; a way of dominating them in case anyone should get stroppy. George Orwell did mildly protest at the mustard poultice, didn't he, but to no avail. He did immediately comment that it was like the workhouse, so the motives were probably the same. It can't have been for reasons of hygiene, as otherwise the nurses never seemed to wash them, or clean anything at all!

It is amazing to think all this was virtually within living memory, and certainly within some of our parents' or grandparents' memories. And George Orwell does compare it with the worst of 19th century practice.

"The whole place seemed bereft of humanity" yes this is what I think makes it so disturbing to read, as well as all the details of course. The detached air of the medics. and the sense of inevitability the patients display. Perhaps this explains how the medics got though their day. If they were completely detached and dispassionate, never engaging with their patients, they could treat them as objects. The more degraded the patients were, the less human they would seem to be. Once someone is deemed less than human, all sorts of atrocities can be perpetuated (and as we all know, have been, throughout history).

And then the patients are fair game for use as specimens to experiment on. One wonders if those who did this would argue that it was for the benefit of others in the future, (a slippery argument anyway) or whether their mindset stopped at curiosity and "extending humanity's knowledge".

We are indeed lucky to live in the 21st century, and in First World countries.

I can't believe this essay, being so cruel to the sick and poor. Who knows what goes on in life in certain places and times. I have always thought that France was such a good country, educated, thinking people. But everyone is not the same. There are always bad with good. Such is life.

I am enjoying the comments on George Orwell's works. These are such good comments, they make me wonder about this man.

I finally sat down to read the essay this morning, and to enjoy everyone's comments.

I'm so glad that we're reading these essays! They highlight Orwell's talent in political writing, which can be so important and powerful. I read this on the site Jean linked above, and the page was headed with the quote about him wanting to make political writing an art. He clearly achieved that and it's so interesting to read these essays and get a sense of how he did it.

Thank you, Greg, for sharing your recent experience (msg 10). It is shocking to me, every one of the many times I hear stories like yours, of how difficult it often is to get needed treatment in our country. Yes, I too am certainly glad we don't have to suffer what the people in this essay suffered. But, as our politicians are fond of saying, we still have so far to go.

"How the Poor Die" is so popular, so many comments, but this is such an important topic it needs to be read and commented about. So much could and should be done. When one gets sick if one can afford good medical care the person does not need to worry. But if this is not so, beware.

Kathleen wrote: "Thank you, Greg, for sharing your recent experience (msg 10)."

Thanks so much Kathleen! :)

I imagine there is a huge amount of variation in medical care around the world, especially in those areas wracked by war or poverty.

I like that Orwell brings to light what happens in places that many people don't see. I suppose that was partly what Down and Out in Paris and London was all about. I think of it as a spiritual forbear of books like Nickel and Dimed: On (Not) Getting by in America and many others.

Orwell didn't choose to be unwell, but at least according to my limited knowledge, he did go out of his way to gain an understanding of what people of lesser financial means faced. And I do respect that very much. Understanding is the basis of empathy.

We move on to another essay today, but thanks for everyone's insightful comments here. I'm really glad Tom suggested this one.

I won't mince words. This was a grim, sometimes gruesome, horrific read, but I found it such an important read - albeit shocking and sobering. But it was my first read this year - and what a way to start the year - with a 5 star essay! Here's my review for anyone who would like to read it.

How the Poor Die by George Orwell ⭐⭐⭐⭐⭐

Jean's review

Our next one is considerably lighter! I'll leave this current for a few days, then put it in our essays folder.

I finished this essay and have the same reactions as you've all had.

The cold, impersonal treatment the patients got was difficult to read about. A person in pain and scared of what they are going through deserves a kind word and some information & comfort from another human being.

I did wonder whether the "malingerers" and their treatment in the hospital during the winter months was intended to be a kindness towards them.
These homeless people had no shelter to go to. Keeping them in hospital, doing chores, could possibly be beneficial for both sides. The hospital seems terribly understaffed and the "malingerers" did some cleaning. In return, they got shelter and food during the coldest, most dangerous months for them.

We don't know exactly when Orwell wrote this. Jean mentions it could have been written between 1931-36, reworked in the early 1940's, and published in 1946.
If he did write it during the Wars, that would explain the lack of staff and their lack of experience towards the job. The best and most experienced would be at war, The hospitals would be struggling to find any staff at all and people who wouldn't normally get a job in such a position, now would. It is possible that the poor people requiring care during the Wars got sub-standard treatment because of this.

It was a positive note, perhaps, to see that new doctors were being trained. A training hospital ensures that there is a new generation of doctors coming up the pipeline.
Bedside manners are fairly new in health care, I believe. It's a shame that these doctors & nurses were so uninformed about treating their patients more gently and I'm glad that things have and are changing in today's medical system.
It's difficult to read about the cold, impersonal treatment the patients were subjected to in their weakest moments.
Even today, though, a patient is poked & prodded more often in a teaching hospital than otherwise. Each trainee has to poke & prod to learn their trade and know what to feel and look for in future. I believe it's a procedure entered on with consent but it still happens as a necessary part of training & education.

Orwell's look at hospitals in literature and history made me ponder how far we've come. Back in the days of the first hospitals, the system didn't know what it was doing, I imagine, except the concept of trying to find ways of healing people. It's a good concept. I guess there's that to say for the gruesome experiences people could experience in their most vulnerable days.
But we have learned a lot over the years about hygiene and safety. We're finally adding caring and compassion. Now.....if they could only improve the food! (hahaha)
Hospitals have evolved a long way.

Here, in Canada, there is access to health care for all, no matter the financial circumstances. The poor and homeless are treated for their illnesses in the same manner as the rich.
I have heard that there are differences in their treatment as people, though, and dignity & compassion are sometimes lacking. There seems to be a discrimination between the social levels.
I hope this continues to be addressed and bettered with education & training and that any form of discrimination is removed from the system (and the World). All people should be treated the same.

This was a difficult and informative essay to read. I'm glad I finally got to it. Orwell's eye for detail is, as always, amazing. The man saw a lot and thought about what he saw.

Petra wrote: "The man saw a lot and thought about what he saw ..."

So do you Petra! Thank you so much for sharing your reactions and thoughts.

Yes, it's clear that whenever he wrote it, How the Poor Die was about George Orwell's time in the hospital in France, so about a pre-war episode. The timing is significant.

It was first published in the very year when the British National Health Service (NHS) Act became law (1946), although the National Health Service started 2 years later, on 5th July 1948. So keeping the public’s mind on the issue, and focusing on what the alternative might be, must have seemed crucial. He did a good job!

Jean, that's interesting information and puts this essay into a different perspective.
George Orwell must be shining a light on how things "could" turn out if the NHS wasn't brought into action. It's good to have a universal Health Care system. I'm grateful that we have one.

Yes, a warning I think.