George Orwell's "How the Poor Die": Exploring Themes of Inequality, Neglect and Other Grim Realities

Though George Orwell is most famous today for his novels 1984 and Animal Farm, his prolific pen delivered to the world hundreds of essays, articles and book reviews along with several books of non-fiction. One of his essays that made an impression on me when I first read it was his painful and acutely insightful "Shooting an Elephant," which appears in a collection titled Facing Unpleasant Facts.

The essay “How the Poor Die,” written in 1946, appears near the end of this particular collection of essays. In it, Orwell reflects on his personal experience in a French charity hospital during the 1920s, offering a scathing critique of the medical treatment given to the impoverished. Hospitals have a special variety of indignities anyways, though nothing like the dehumanizing conditions in hospitals at that time, especially for the poor. The essay explores themes of inequality, neglect, and the grim reality of death in such institutions.

The descriptions brought to mind Solzhenitsyn's Cancer Ward, which took place in the Soviet Union. Just as some have described Solzhenitsyn's novel as a metaphor for the cancer at the heart of the Communist empire, so Orwell's essay could be a seen as a microscosm of the injustice and "cancer" wrenching the heart of Western civilization. His experience in the hospital serves as a larger metaphor for societal neglect of the poor, where their suffering is seen as inevitable or unimportant.

Orwell describes his time in the public hospital as deeply disturbing, recounting the neglect and lack of compassion that patients endured. He provides vivid details about the hospital ward, which was overcrowded, poorly sanitized, and severely lacking in resources. The poor, unable to afford private care, were treated with indifference, often subjected to experimental treatments or outright neglect. Orwell highlights the stark contrast between how the wealthy and the impoverished experience healthcare, emphasizing that for the poor, death in such hospitals is often undignified, almost mechanical. At one point he states that "the fear of death was the only thing keeping them alive."

A key theme in the essay is the depersonalization of the sick poor, an atitude that continues to this day. Orwell recalls how patients were stripped of their identities, treated not as individuals but as mere cases. Doctors performed medical procedures in a detached, clinical manner, often without explaining what was happening to the patients. This cold, distant approach created an atmosphere where the poor were treated as if their suffering or well-being was of little consequence.  

Orwell also explores the psychological impact of such treatment, noting the fear and hopelessness felt by patients. He contrasts this with the expectation that the sick should be comforted and treated with dignity, regardless of their financial status. 

After reading this essay I had a deeper appreciation for the authority with which Orwell writes. He lived with the miners in Manchester. He lived in a Burmese outpost of the British Empire. He was shot in the neck during the Spanish Civil War. He spent time in a hospital ward amongst the poorest of the poor in France. He experienced suffering and watched people die.

By using his own experience in “How the Poor Die,” Orwell exposes the grim reality of healthcare for the poor, drawing attention to the inequalities that persist in how society treats its most vulnerable members. As a critique of medical institutions it is unsentimentally frank, but it's also more than that. It's a broader commentary on social injustice and the lack of empathy for the suffering of the poor.

Related Links

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George Orwell on Wells, Hitler and "Patriotism vs. the World State"