Essay

In the year 1929 I spent several weeks in the H�pital X, in the fifteenth

ARRONDISSEMENT of Paris. The clerks put me through the usual third-degree

at the reception desk, and indeed I was kept answering questions for some

twenty minutes before they would let me in. If you have ever had to fill

up forms in a Latin country you will know the kind of questions I mean.

For some days past I had been unequal to translating Reaumur into

Fahrenheit, but I know that my temperature was round about 103, and by

the end of the interview I had some difficulty in standing on my feet. At

my back a resigned little knot of patients, carrying bundles done up in

coloured handkerchiefs, waited their turn to be questioned.



After the questioning came the bath--a compulsory routine for all

newcomers, apparently, just as in prison or the workhouse. My clothes

were taken away from me, and after I had sat shivering for some minutes

in five inches of warm water I was given a linen nightshirt and a short

blue flannel dressing-gown--no slippers, they had none big enough for

me, they said--and led out into the open air. This was a night in

February and I was suffering from pneumonia. The ward we were going to

was 200 yards away and it seemed that to get to it you had to cross the

hospital grounds. Someone stumbled in front of me with a lantern. The

gravel path was frosty underfoot, and the wind whipped the nightshirt

round my bare calves. When we got into the ward I was aware of a strange

feeling of familiarity whose origin I did not succeed in pinning down

till later in the night. It was a long, rather low, ill-lit room, full of

murmuring voices and with three rows of beds surprisingly close together.

There was a foul smell, faecal and yet sweetish. As I lay down I saw on a

bed nearly opposite me a small, round-shouldered, sandy-haired man

sitting half naked while a doctor and a student performed some strange

operation on him. First the doctor produced from his black bag a dozen

small glasses like wine glasses, then the student burned a match inside

each glass to exhaust the air, then the glass was popped on to the man's

back or chest and the vacuum drew up a huge yellow blister. Only after

some moments did I realize what they were doing to him. It was something

called cupping, a treatment which you can read about in old medical

text-books but which till then I had vaguely thought of as one of those

things they do to horses.



The cold air outside had probably lowered my temperature, and I watched

this barbarous remedy with detachment and even a certain amount of

amusement. The next moment, however, the doctor and the student came

across to my bed, hoisted me upright and without a word began applying

the same set of glasses, which had not been sterilized in any way. A few

feeble protests that I uttered got no more response than if I had been an

animal. I was very much impressed by the impersonal way in which the two

men started on me. I had never been in the public ward of a hospital

before, and it was my first experience of doctors who handle you without

speaking to you or, in a human sense, taking any notice of you. They only

put on six glasses in my case, but after doing so they scarified the

blisters and applied the glasses again. Each glass now drew about a

dessert-spoonful of dark-coloured blood. As I lay down again, humiliated,

disgusted and frightened by the thing that had been done to me, I

reflected that now at least they would leave me alone. But no, not a bit

of it. There was another treatment. coming, the mustard poultice,

seemingly a matter of routine like the hot bath. Two slatternly nurses

had already got the poultice ready, and they lashed it round my chest as

tight as a strait-jacket while some men who were wandering about the ward

in shirt and trousers began to collect round my bed with half-sympathetic

grins. I learned later that watching a patient have a mustard poultice

was a favourite pastime in the ward. 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, but the poultice is buckled at the back and you

can't get it off. This is the period the onlookers enjoy most. During the

last five minutes, I noted, a sort of numbness supervenes. After the

poultice had been removed a waterproof pillow packed with ice was thrust

beneath my head and I was left alone. I did not sleep, and to the best of

my knowledge this was the only night of my life--I mean the only night

spent in bed--in which I have not slept at all, not even a minute.



During my first hour in the H�pital X I had had a whole series of

different and contradictory treatments, but this was misleading, for in

general you got very little treatment at all, either good or bad, unless

you were ill in some interesting and instructive way. At five in the

morning the nurses came round, woke the patients and took their

temperatures, but did not wash them. If you were well enough you washed

yourself, otherwise you depended on the kindness of some walking patient.

It was generally patients, too, who carried the bedbottles and die grim

bedpan, nicknamed LA CASSEROLE. At eight breakfast arrived, called

army-fashion LA SOUPE. It was soup, too, a thin vegetable soup with slimy

hunks of bread floating about in it. Later in the day the tall, solemn,

black-bearded doctor made his rounds, with an INTERNE and a troop of

students following at his heels, but there were about sixty of us in the

ward and it was evident that he had other wards to attend to as well.

There were many beds past which he walked day after day, sometimes

followed by imploring cries. On the other hand if you had some disease

with which the students wanted to familiarize themselves you got plenty

of attention of a kind. I myself, with an exceptionally fine specimen of

a bronchial rattle, sometimes had as many as a dozen students queuing up

to listen to my chest. It was a very queer feeling--queer, I mean,

because of their intense interest in learning their job, together with a

seeming lack of any perception that the patients were human beings. 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. And then ear after ear--ears of young men, of girls,

of negroes--pressed against your back, relays of fingers solemnly but

clumsily tapping, and not from any one of them did you get a word of

conversation or a look direct in your face. As a non-paying patient, in

the uniform nightshirt, you were primarily A SPECIMEN, a thing I did not

resent but could never quite get used to.



After some days I grew well enough to sit up and study the surrounding

patients. The stuffy room, with its narrow beds so close together that

you could easily touch your neighbour's hand, had every sort of disease

in it except, I suppose, acutely infectious cases. My right-hand

neighbour was a little red-haired cobbler with one leg shorter than the

other, who used to announce the death of any other patient (this happened

a number of times, and my neighbour was always the first to hear of it)

by whistling to me, exclaiming "NUM�RO 43!" (or whatever it was) and

flinging his arms above his head. This man had not much wrong with him,

but in most of the other beds within my angle of vision some squalid

tragedy or some plain horror was being enacted. In the bed that was foot

to foot with mine there lay, until he died (I didn't see him die--they

moved him to another bed), a little weazened man who was suffering from I

do not know what disease, but something that made his whole body so

intensely sensitive that any movement from side to side, sometimes even

the weight of the bedclothes, would make him shout out with pain. His

worst suffering was when he urinated, which he did with the greatest

difficulty. A nurse would bring him the bedbottle and then for a long

time stand beside his bed, whistling, as grooms are said to do with

horses, until at last with an agonized shriek of "Je fissel" he would get

started. In the bed next to him the sandy-haired man whom I had seen

being cupped used to cough up blood-streaked mucus at all hours. My

left-hand neighbour was a tall, flaccid-looking young man who used

periodically to have a tube inserted into his back and astonishing

quantities of frothy liquid drawn off from some part of his body. In the

bed beyond that a veteran of the war of 1870 was dying, a handsome old

man with a white imperial, round whose bed, at all hours when visiting

was allowed, four elderly female relatives dressed all in black sat

exactly like crows, obviously scheming for some pitiful legacy. In the

bed opposite me in the farther row was an old bald-headed man with

drooping moustaches and greatly swollen face and body, who was suffering

from some disease that made him urinate almost incessantly. A huge glass

receptacle stood always beside his bed. One day his wife and daughter

came to visit him. At sight of them the old man's bloated face lit up

with a smile of surprising sweetness, and as his daughter, a pretty girl

of about twenty, approached the bed I saw that his hand was slowly

working its way from under the bedclothes. I seemed to see in advance the

gesture that was coming--the girl kneeling beside the bed, the old man's

hand laid on her head in his dying blessing. But no, he merely handed her

the bedbottle, which she promptly took from him and emptied into the

receptacle.



About a dozen beds away from me was Num�ro 57--I think that was his

number--a cirrhosis-of-the-liver case. Everyone in the ward knew him by

sight because he was sometimes the subject of a medical lecture. On two

afternoons a week the tall, grave doctor would lecture in the ward to a

party of students, and on more than one occasion old NUM�RO 57 was

wheeled in on a sort of trolley into the middle of the ward, where the

doctor would roll back his nightshirt, dilate with his fingers a huge

flabby protruber-ance on the man's belly--the diseased liver, I suppose

--and explain solemnly that this was a disease attributable to

alcoholism, commoner in the wine-drinking countries. As usual he neither

spoke to his patient nor gave him a smile, a nod or any kind of

recognition. While he talked, very grave and upright, he would hold the

wasted body beneath his two hands, sometimes giving it a gentle roll to

and fro, in just the attitude of a woman handling a rolling-pin. Not that

NUM�RO 57 minded this kind of thing. Obviously he was an old hospital

inmate, a regular exhibit at lectures, his liver long since marked down

for a bottle in some pathological museum. Utterly uninterested in what

was said about him, he would lie with his colourless eyes gazing at

nothing, while the doctor showed him off like a piece of antique china.

He was a man of about sixty, astonishingly shrunken. His face, pale as

vellum, had shrunken away till it seemed no bigger than a doll's.



One morning my cobbler neighbour woke me up plucking at my pillow before

the nurses arrived. "NUM�RO 57!"--he flung his arms above his head.

There was a light in the ward, enough to see by. I could see old NUM�RO

57 lying crumpled up on his side, his face sticking out over the side of

the bed, and towards me. He had died some rime during the night, nobody

knew when. When the nurses came they received the news of his death

indifferendy and went about their work. After a long dme, 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 dme later. Meanwhile, in the better light, I had

had time for a good look at NUM�RO 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. NUM�RO 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 die sheets. As I gazed at the tiny,

screwed-up face it struck me that dlis disgusting piece of refuse,

waiting to be carted away and dumped on a slab in the dissecting room,

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 H�pital 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 H�pital 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 tea-leaves, 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 H�pital 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 H�pital 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 wainscodngs were

infested by crickets. When I had got back my clothes and grown strong on

my legs I fled from the H�pital 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

Han-aud, who was ill while on remand, was taken to the H�pital 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 H�pital 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 H�pital 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 Sawyer and Benjamin Alien, which no doubt are hardly parodies, or the

field hospitals in LA D�B�CLE and WAR AND PEACE, or that shocking

description of an amputation in Melville's WHITEJACKET! 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. 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, the 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, something

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 H�pital 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.































