How the Poor Die

"How the Poor Die" is an essay first published in 1946 in Now by the English author George Orwell. Orwell gives an anecdotal account of his experiences in a French public hospital which triggers a contemplation of hospital literature in the context of 19th-century medicine.

In 1928 Orwell went to Paris for 18 months. In March 1929 he was feeling unwell and spent two weeks in the Hôpital Cochin, rue Faubourg Saint-Jacques, in the 15th arrondissement of Paris. Ill with une grippe (the flu), he was treated at the hospital from 7 to 22 March 1929. While in the hospital he continued writing, as he gave it as an address to a publisher. Orwell was subject to bronchial conditions throughout his life, but it is not certain whether he was suffering from influenza or pneumonia. In Paris, he was checked for tuberculosis and found to be unaffected.

In December 1933, while Orwell was teaching in Uxbridge, he developed pneumonia. He was taken to a cottage hospital at Uxbridge where for a time his life was believed to be in danger. He was kept in hospital over Christmas and the New Year. When he was discharged in January 1934, he returned to Southwold to convalesce and was supported by his parents for several months. He did not return to teaching.

In 1937 Orwell spent some months on the Republican side in the Spanish Civil War. He was twice hospitalized during the war. Once with an infection of his hand, and again after he was shot in the throat by a sniper.

It is not known precisely when the article was written. Peter Davison, editor of Orwell's Collected Works, has suggested a possible history for its composition that places its writing between 1931 and 1936 – a time when Orwell's work revolved around the unemployed, tramps and beggars – reworked it between summer 1940 and spring 1941, – submitted it to Horizon – but it was rejected – possibly because readers would have been unwilling to read about 'how the poor die' at such a time – and finally, a section retyped and then published in Now, a magazine established by George Woodcock, in November 1946.

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