Facing Unpleasant Facts: Narrative Essays

by George Orwell

  One morning my cobbler neighbour woke me by plucking at my pillow before the nurses arrived. "Numero 57!"--he flung his arms above his head. There was a light in the ward, enough to see by. I could see old Numero 57 lying crumpled up on his side, his face sticking out over the side of the bed, and towards me. He had died some time 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. Meanwhile, in the better light, I had had time for a good look at Numero 57. Indeed I lay on my side to look at him. Curiously enough he was the first dead European I had seen. I had seen dead men before, but always Asiatics and usually people who had died violent deaths. Numero 57's eyes were still open, his mouth also open, his small face contorted into an expression of agony. What most impressed me however was the whiteness of his face. It had been pale before, but now it was little darker than the sheets. As I gazed at the tiny, screwed-up face it struck me that this disgusting piece of refuse, waiting to be carted away and dumped on a slab in the dissectingroom, was an example of "natural" death, one of the things you pray for in the Litany. There you are, then, I thought, that's what is waiting for you, twenty, thirty, forty years hence: that is how the lucky ones die, the ones who live to be old. 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. Even at that, it makes a difference if you can achieve it in your own home and not in a public institution. This poor old wretch who had just flickered out like a candle-end was not even important enough to have anyone watching by his deathbed. He was merely a number, then a "subject" for the students' scalpels. And the sordid publicity of dying in such a place! In the Hopital X the beds were very close together and there were no screens. Fancy, for instance, dying like the little man whose bed was for a while foot to foot with mine, the one who cried out when the bedclothes touched him! I dare say "Je pisse!" were his last recorded words. Perhaps the dying don't bother about such things--that at least would be the standard answer: nevertheless dying people are often more or less normal in their minds till within a day or so of the end.

  In the public wards of a hospital you see horrors that you don't seem to meet with among people who manage to die in their own homes, as though certain diseases only attacked people at the lower income levels. But it is a fact that you would not in any English hospitals see some of the things I saw in the Hopital X. 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. You certainly would not see that in England, and still less would you see a corpse left exposed to the view of the other patients. I remember that once in a cottage hospital in England a man died while we were at tea, and though there were only six of us in the ward the nurses managed things so adroitly that the man was dead and his body removed without our even hearing about it till tea was over. A thing we perhaps underrate in England is the advantage we enjoy in having large numbers of well-trained and rigidly-disciplined nurses. No doubt English nurses are dumb enough, they may tell fortunes with tealeaves, wear Union Jack badges and keep photographs of the Queen on their mantelpieces, but at least they don't let you lie unwashed and constipated on an unmade bed, out of sheer laziness. The nurses at the Hopital X still had a tinge of Mrs. Gamp about them, and later, in the military hospitals of Republican Spain, I was to see nurses almost too ignorant to take a temperature. You wouldn't, either, see in England such dirt as existed in the Hopital X. Later on, when I was well enough to wash myself in the bathroom, I found that there was kept there a huge packing case into which the scraps of food and dirty dressings from the ward were flung, and the wainscotings were infested by crickets.

  When I had got back my clothes and grown strong on my legs I fled from the Hopital X, before my time was up and without waiting for a medical discharge. It was not the only hospital I have fled from, but its gloom and bareness, its sickly smell and, above all, something in its mental atmosphere stand out in my memory as exceptional. I had been taken there because it was the hospital belonging to my arrondissement, and I did not learn till after I was in it that it bore a bad reputation. A year or two later the celebrated swindler, Madame Hanaud, who was ill while on remand, was taken to the Hopital X, and after a few days of it she managed to elude her guards, took a taxi and drove back to the prison, explaining that she was more comfortable there. I have no doubt that the Hopital X was quite untypical of French hospitals even at that date. But the patients, nearly all of them working-men, were surprisingly resigned. Some of them seemed to find the conditions almost comfortable, for at least two were destitute malingerers who found this a good way of getting through the winter. The nurses connived because the malingerers made themselves useful by doing odd jobs. But the attitude of the majority was: of course this is a lousy place, but what else do you expect? It did not seem strange to them that you should be woken at five and then wait three hours before starting the day on watery soup, or that people should die with no one at their bedside, or even that your chance of getting medical attention should depend on catching the doctor's eye as he went past. According to their traditions that was what hospitals were like. If you are seriously ill, and if you are too poor to be treated in your own home, then you must go into hospital, and once there you must put up with harshness and discomfort, just as you would in the army. But on top of this I was interested to find a lingering belief in the old stories that have now almost faded from memory in England--stories, for instance, about doctors cutting you open out of sheer curiosity or thinking it funny to start operating before you were properly "under." There were dark tales about a little operating-room said to be situated just beyond the bathroom. Dreadful screams were said to issue from this room. I saw nothing to confirm these stories and no doubt they were all nonsense, though I did see two students kill a sixteen-year-old boy, or nearly kill him (he appeared to be dying when I left the hospital, but he may have recovered later) by a mischievous experiment which they probably could not have tried on a paying patient. Well within living memory it used to be believed in London that in some of the big hospitals patients were killed off to get dissection subjects. I didn't hear this tale repeated at the Hopital X, but I should think some of the men there would have found it credible. For it was a hospital in which not the methods, perhaps, but something of the atmosphere of the nineteenth century had managed to survive, and therein lay its peculiar interest.

  During the past fifty years or so there has been a great change in the relationship between doctor and patient. 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. No one who was not more or less destitute would have thought of going into such a place for treatment. And especially in the early part of the last century, when medical science had grown bolder than before without being any more successful, the whole business of doctoring was looked on with horror and dread by ordinary people. Surgery, in particular, was believed to be no more than a peculiarly gruesome form of sadism, and dissection, possible only with the aid of bodysnatchers, was even confused with necromancy. From the nineteenth century you could collect a large horror-literature connected with doctors and hospitals. Think of poor old George III, in his dotage, shrieking for mercy as he sees his surgeons approaching to "bleed him till he faints"! Think of the conversations of Bob Sawy
er and Benjamin Allen, which no doubt are hardly parodies, or the field hospitals in La Debacle and War and Peace, or that shocking description of an amputation in Melville's White-Jacket! Even the names given to doctors in nineteenth-century English fiction, Slasher, Carver, Sawyer, Fillgrave and so on, and the generic nickname "sawbones," are about as grim as they are comic. The anti-surgery tradition is perhaps best expressed in Tennyson's poem, The Children's Hospital, which is essentially a pre-chloroform document though it seems to have been written as late as 1880.3 Moreover, the outlook which Tennyson records in this poem had a lot to be said for it. When you consider what an operation without anaesthetics must have been like, what it notoriously was like, it is difficult not to suspect the motives of people who would undertake such things. For these bloody horrors which the students so eagerly looked forward to ("A magnificent sight if Slasher does it!") were admittedly more or less useless: the patient who did not die of shock usually died of gangrene, a result which was taken for granted. Even now doctors can be found whose motives are questionable. Anyone who has had much illness, or who has listened to medical students talking, will know what I mean. But anaesthetics were a turning point, and disinfectants were another. Nowhere in the world, probably, would you now see the kind of scene described by Axel Munthe in The Story of San Michele, when the sinister surgeon in top hat and frock coat, his starched shirtfront spattered with blood and pus, carves up patient after patient with the same knife and flings the severed limbs into a pile beside the table. Moreover, national health insurance has partly done away with the idea that a working-class patient is a pauper who deserves little consideration. Well into this century it was usual for "free" patients at the big hospitals to have their teeth extracted with no anaesthetic. They didn't pay, so why should they have an anaesthetic--that was the attitude. That too has changed.

  And yet every institution will always bear upon it some lingering memory of its past. A barrack-room is still haunted by the ghost of Kipling, and it is difficult to enter a workhouse without being reminded of Oliver Twist. Hospitals began as a kind of casual ward for lepers and the like to die in, and they continued as places where medical students learned their art on the bodies of the poor. You can still catch a faint suggestion of their history in their characteristically gloomy architecture. I would be far from complaining about the treatment I have received in any English hospital, but I do know that it is a sound instinct that warns people to keep out of hospitals if possible, and especially out of the public wards. Whatever the legal position may be, it is unquestionable that you have far less control over your own treatment, far less certainty that frivolous experiments will not be tried on you, when it is a case of "accept the discipline or get out." And it is a great thing to die in your own bed, though it is better still to die in your boots. However great the kindness and the efficiency, in every hospital death there will be some cruel, squalid detail, some thing perhaps too small to be told but leaving terribly painful memories behind, arising out of the haste, the crowding, the impersonality of a place where every day people are dying among strangers.

  The dread of hospitals probably still survives among the very poor, and in all of us it has only recently disappeared. It is a dark patch not far beneath the surface of our minds. I have said earlier that when I entered the ward at the Hopital X I was conscious of a strange feeling of familiarity. What the scene reminded me of, of course, was the reeking, pain-filled hospitals of the nineteenth century, which I had never seen but of which I had a traditional knowledge. And something, perhaps the black-clad doctor with his frowsy black bag, or perhaps only the sickly smell, played the queer trick of unearthing from my memory that poem of Tennyson's, The Children's Hospital, which I had not thought of for twenty years. It happened that as a child I had had it read aloud to me by a sick-nurse whose own working life might have stretched back to the time when Tennyson wrote the poem. The horrors and sufferings of the old-style hospitals were a vivid memory to her. We had shuddered over the poem together, and then seemingly I had forgotten it. Even its name would probably have recalled nothing to me. But the first glimpse of the ill-lit, murmurous room, with the beds so close together, suddenly roused the train of thought to which it belonged, and in the night that followed I found myself remembering the whole story and atmosphere of the poem, with many of its lines complete.

  Such, Such Were the Joys1

  1939?--June 1948?

  Soon after I arrived at St. Cyprian's (not immediately, but after a week or two, just when I seemed to be settling into the routine of school life) I began wetting my bed. I was now aged eight, so that this was a reversion to a habit which I must have grown out of at least four years earlier.

  Nowadays, I believe, bed-wetting in such circumstances is taken for granted. It is a normal reaction in children who have been removed from their homes to a strange place. In those days, however, it was looked on as a disgusting crime which the child committed on purpose and for which the proper cure was a beating. For my part I did not need to be told it was a crime. Night after night I prayed, with a fervour never previously attained in my prayers, "Please God, do not let me wet my bed! Oh, please God, do not let me wet my bed!," but it made remarkably little difference. Some nights the thing happened, others not. There was no volition about it, no consciousness. You did not properly speaking do the deed: you merely woke up in the morning and found that the sheets were wringing wet.

  After the second or third offence I was warned that I should be beaten next time, but I received the warning in a curiously roundabout way. One afternoon, as we were filing out from tea, Mrs. Wilkes, the headmaster's wife, was sitting at the head of one of the tables, chatting with a lady of whom I know nothing, except that she was on an afternoon's visit to the school. She was an intimidating, masculine-looking person wearing a riding habit, or something that I took to be a riding habit. I was just leaving the room when Mrs. Wilkes called me back, as though to introduce me to the visitor.

  Mrs. Wilkes was nicknamed Flip, and I shall call her by that name, for I seldom think of her by any other. (Officially, however, she was addressed as Mum, probably a corruption of the "Ma'am" used by public schoolboys to their housemasters' wives.) She was a stocky square-built woman with hard red cheeks, a flat top to her head, prominent brows and deepset, suspicious eyes. Although a great deal of the time she was full of false heartiness, jollying one along with mannish slang ("Buck up, old chap!" and so forth), and even using one's Christian name, her eyes never lost their anxious, accusing look. It was very difficult to look her in the face without feeling guilty, even at moments when one was not guilty of anything in particular.

  "Here is a little boy," said Flip, indicating me to the strange lady, "who wets his bed every night. Do you know what I am going to do if you wet your bed again?" she added, turning to me. "I am going to get the Sixth Form to beat you."

  The strange lady put on an air of being inexpressibly shocked, and exclaimed "I-should-think-so!" And here there occurred one of those wild, almost lunatic misunderstandings which are part of the daily experience of childhood. The Sixth Form was a group of older boys who were selected as having "character" and were empowered to beat smaller boys. I had not yet learned of their existence, and I mis-heard the phrase "the Sixth Form" as "Mrs. Form." I took it as referring to the strange lady--I thought, that is, that her name was Mrs. Form. It was an improbable name, but a child has no judgement in such matters. I imagined, therefore, that it was she who was to be deputed to beat me. It did not strike me as strange that this job should be turned over to a casual visitor in no way connected with the school. I merely assumed that "Mrs. Form" was a stern disciplinarian who enjoyed beating people (somehow her appearance seemed to bear this out) and I had an immediate terrifying vision of her arriving for the occasion in full riding kit and armed with a hunting whip. To this day I can feel myself almost swooning with shame as I stood, a very small, round-faced boy in short corduroy knickers, before the two women. I could not speak.
I felt that I should die if "Mrs. Form" were to beat me. But my dominant feeling was not fear or even resentment: it was simply shame because one more person, and that a woman, had been told of my disgusting offence.

  A little later, I forget how, I learned that it was not after all "Mrs. Form" who would do the beating. I cannot remember whether it was that very night that I wetted my bed again, but at any rate I did wet it again quite soon, Oh, the despair, the feeling of cruel injustice, after all my prayers and resolutions, at once again waking between the clammy sheets! There was no chance of hiding what I had done. The grim statuesque matron, Margaret by name, arrived in the dormitory specially to inspect my bed. She pulled back the clothes, then drew herself up, and the dreaded words seemed to come rolling out of her like a peal of thunder:

  "REPORT YOURSELF to the headmaster after breakfast!"

  I put REPORT YOURSELF in capitals because that was how it appeared in my mind. I do not know how many times I heard that phrase during my early years at St. Cyprian's. It was only very rarely that it did not mean a beating. The words always had a portentous sound in my ears, like muffled drums or the words of the death sentence.

  When I arrived to report myself, Flip was doing something or other at the long shiny table in the ante-room to the study. Her uneasy eyes searched me as I went past. In the study Mr. Wilkes, nicknamed Sambo, was waiting. Sambo was a round-shouldered, curiously oafish-looking man, not large but shambling in gait, with a chubby face which was like that of an overgrown baby, and which was capable of good-humour. He knew, of course, why I had been sent to him, and had already taken a bone-handled riding crop out of the cupboard, but it was part of the punishment of reporting yourself that you had to proclaim your offence with your own lips. When I had said my say, he read me a short but pompous lecture, then seized me by the scruff of the neck, twisted me over and began beating me with the riding crop. He had a habit of continuing his lecture while he flogged you, and I remember the words "you dir-ty lit-tle boy" keeping time with the blows. The beating did not hurt (perhaps, as it was the first time, he was not hitting me very hard), and I walked out feeling very much better. The fact that the beating had not hurt was a sort of victory and partially wiped out the shame of the bed-wetting. Perhaps I was even incautious enough to wear a grin on my face. Some small boys were hanging about in the passage outside the door of the ante-room.