Fifty Orwell Essays

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