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 wainscotings 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
Hanaud, 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 body snatchers, 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 m
otives 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.
JAMES BURNHAM AND THE MANAGERIAL REVOLUTION
[Note: This essay was originally printed in POLEMIC under the title
"Second Thoughts on James Burnham", and later reprinted as a pamphlet
with the present title.]
James Burnham's book, THE MANAGERIAL REVOLUTION, made a considerable stir
both in the United States and in this country at the time when it was
published, and its main thesis has been so much discussed that a detailed
exposition of it is hardly necessary. As shortly as I can summarise it,
the thesis is this:
Capitalism is disappearing, but Socialism is not replacing it. What is
now arising is a new kind of planned, centralised society which will be
neither capitalist nor, in any accepted sense of the word, democratic.
The rulers of this new society will be the people who effectively control
the means of production: that is, business executives, technicians,
bureaucrats and soldiers, lumped together by Burnham, under the name of
"managers". These people will eliminate the old capitalist class, crush
the working class, and so organise society that all power and economic
privilege remain in their own hands. Private property rights will be
abolished, but common ownership will not be established. The new
"managerial" societies will not consist of a patchwork of small,
independent states, but of great super-states grouped round the main
industrial centres in Europe, Asia, and America. These super-states will
fight among themselves for possession of the remaining uncaptured
portions of the earth, but will probably be unable to conquer one another
completely. Internally, each society will be hierarchical, with an
aristocracy of talent at the top and a mass of semi-slaves at the bottom.
In his next published book, THE MACHIAVELLIANS, Burnham elaborates and
also modifies his original statement. The greater part of the book is an
exposition of the theories of Machiavelli and of his modern disciples,
Mosca, Michels, and Pareto: with doubtful justification, Burnham adds to
these the syndicalist writer, Georges Sorel. What Burnham is mainly
concerned to show is that a democratic society has never existed and, so
far as we can see, never will exist. Society is of its nature
oligarchical, and the power of the oligarchy always rests upon force and
fraud. Burnham does not deny that "good" motives may operate in private
life, but he maintains that politics consists of the struggle for power,
and nothing else. All historical changes finally boil down to the
replacement of one ruling class by another. All talk about democracy,
liberty, equality, fraternity, all revolutionary movements, all visions
of Utopia, or "the classless society", or "the Kingdom of Heaven on
earth", are humbug (not necessarily conscious humbug) covering the
ambitions of some new class which is elbowing its way into power. The
English Puritans, the Jacobins, the Bolsheviks, were in each case simply
power seekers using the hopes of the masses in order to win a privileged
position for themselves. Power can sometimes be won or maintained without
violence, but never without fraud, because it is necessary to make use of
the masses, and the masses would not co-operate if they knew that they
were simply serving the purposes of a minority. In each great
revolutionary struggle the masses are led on by vague dreams of human
brotherhood,
and then, when the new ruling class is well established in
power, they are thrust back into servitude. This is practically the whole
of political history, as Burnham sees it.
Where the second book departs from the earlier one is in asserting that
the whole process could be somewhat moralised if the facts were faced
more honestly. THE MACHIAVELLIANS is sub-titled DEFENDERS OF FREEDOM.
Machiavelli and his followers taught that in politics decency simply does
not exist, and, by doing so, Burnham claims, made it possible to conduct
political affairs more intelligently and less oppressively. A ruling class
which recognised that its real aim was to stay in power would also
recognise that it would be more likely to succeed if it served the
common good, and might avoid stiffening into a hereditary aristocracy.
Burnham lays much stress on Pareto's theory of the "circulation
of the ?lites". If it is to stay in power a ruling class must
constantly admit suitable recruits from below, so that the ablest
men may always be at the top and a new class of power-hungry
malcontents cannot come into being. This is likeliest to happen, Burnham
considers, in a society which retains democratic habits--that is, where
opposition is permitted and certain bodies such as the press and the
trade unions can keep their autonomy. Here Burnham undoubtedly
contradicts his earlier opinion. In THE MANAGERIAL REVOLUTION, which was
written in 1940, it is taken as a matter of course that "managerial"
Germany is in all ways more efficient than a capitalist democracy such as
France or Britain. In the second book, written in 1942, Burnham admits
that the Germans might have avoided some of their more serious strategic
errors if they had permitted freedom of speech. However, the main thesis
is not abandoned. Capitalism is doomed, and Socialism is a dream. If we
grasp what is at issue we may guide the course of the managerial
revolution to some extent, but that revolution IS HAPPENING, whether we
like it or not. In both books, but especially the earlier one, there is a
note of unmistakable relish over the cruelty and wickedness of the
processes that are being discussed. Although he reiterates that he is
merely setting forth the facts and not stating his own preferences, it is
clear that Burnham is fascinated by the spectacle of power, and that his
sympathies were with Germany so long as Germany appeared to be winning
the war. A more recent essay, "Lenin's Heir", published in the PARTISAN
REVIEW about the beginning of 1945, suggests that this sympathy has since
been transferred to the USSR. "Lenin's Heir", which provoked violent
controversy in the American left-wing press, has not yet been reprinted
in England, and I must return to it later.
It will be seen that Burnham's theory is not, strictly speaking, a new
one. Many earlier writers have foreseen the emergence of a new kind of
society, neither capitalist nor Socialist, and probably based upon
slavery: though most of them have differed from Burnham in not assuming
this development to be INEVITABLE. A good example is Hilaire Belloc's
book, THE SERVILE STATE, published in 1911. THE SERVILE STATE is written
in a tiresome style, and the remedy it suggests (a return to small-scale
peasant ownership) is for many reasons impossible: still, it does
foretell with remarkable insight the kind of things that have been
happening from about 1930 onwards. Chesterton, in a less methodical way,
predicted the disappearance of democracy and private property, and the
rise of a slave society which might be called either capitalist or
Communist. Jack London, in THE IRON HEEL (1909), foretold some of the
essential features of Fascism, and such books as Wells's THE SLEEPER
AWAKES (1900), ZAMYATIN'S WE (1923), and Aldous Huxley's BRAVE NEW WORLD
(1930), all described imaginary worlds in which the special problems of
capitalism had been solved without bringing liberty, equality, or true