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March 17, 1993

Substandard Care, Antidumping, and George Orwell

Author Affiliations

Birmingham (Ala) VA Medical Center

JAMA. 1993;269(11):1384-1385. doi:10.1001/jama.1993.03500110052024

To the Editor.  —Shortly before writing 1984, George Orwell (pen name Eric Blair) wrote an essay, "How the Poor Die,"1 an analysis of his own hospitalization in 1929 in "Hôpital X" in Paris' 15th arrondissement. His inside report illustrates, in my opinion, common problems leading to hospitalized, uninsured patients' receiving substandard care and having a high risk of adverse events, as shown by the article by Burstin et al.2With "pneumonia," a fever (temperature of 39.4°C), and no money, Orwell went to Hôpital X for medical care. He waited in line, then spent 20 minutes answering the hospital receptionist's questions. After a bath and a forced march barefoot over frosty ground, he was admitted to a full ward of extremely sick patients, "except, [he] supposed, acutely infectious cases." Since Orwell died at age 47 years of pulmonary tuberculosis,3 one can wonder whether Orwell himself was acutely infectious