George Orwell (1903 -1950) During Activation

Home , Indian Imperial Police, Victor Gollancz

6. Spitznagel JK. Antibiotic proteins of human neutrophils. J Clin Invest 1990; 86: 1381 HISTORY OF MEDICINE 1386. 7. Carlos TM. Harlan J. Membrane proteins involved in phagocyte adherence to endothelium. Immunol Rev 1990; 114: 5-28. 8. Borregard N, Heiple JM, Si mons ER, Clark RA. Subcellular localization of the b cytochrome component of the human neutrophil microbicidal oxidase. Translocation George Orwell (1903 -1950) during activation. J CeJ/ Bioi 1983; 97: 52-61. 9. Weiss SJ. Tissue destruction by neutrophils. N Engl J Med 1989; 320: 365-376. 10. Butcher EC. Leukocyte-endothelial cell recognition: Three (or more) steps to - writer, socialist, eccentric specificity and diverSity. CeJ/1991; 67: 1033-1036. 11. Zimmerman GA. Prescott SM, Mclntyre T. Endothelial cell interactions with granulocytes: tethering and signaling molecules. Immunol Today 1992; 13: 93-100. and tuberculosis sufferer 12. Abo A, Boyhan A, West I, Thrasher AJ. Segal AW. Reconstitution of neutrophil NADPH oxidase activity in the cell-free system by four components: p67-phox, p47

phox, p21racl, and cytochrome b ' J Bioi Chem 1992; 267: 16767-16770. 24s H.Dubovsky 13. Segal AW. West I. Wientjies F, Nugent JHA. Chavan AJ. Haley B, et al. Cytochrome

b2<15 is a f1avocytochrome containing FAD and the NADPH-binding site of the microbicidal oxidase of phagocytes. Biochem J 1992; 284: 781-788. 14. Bauldry SA, Wykle RL. Bass DA. Phospholipase A..z activation in human neutrophils. J George Orwell, born Eric Blair in India in 1903, the third Bio/ Chem 1988; 263: 16787-16795. 15: Sadler KL, Badwey JA. Second messengers involved in superoxide production by generation of colonial service stock, joined the Indian neutrophils: function and metabolism. Hematol Oncol Clin North Am 1988; 2: 182 200. Imperial Police in Burma in 1922 after leaving school in 16. Fa-lIman M. GUllberg M. HeJlberg C. Andersson T. Complement receptor-mediated phagocytosis is associated with accumulation of phosphatidylcholine-derived England. Rejecting the racial and cultural barriers of diglyceride in human neutrophils. J Bioi Chem 1992; 267: 2656-2663. 17. Watson F. Robinson J, Edwards SW. Protein kinase C-dependent and -independent colonial rule he encountered there, he returned to England activation of the NADPH oxidase of human neutrophils. J Bioi Chem 1991; 266: to become a writer. He became allied to leftist '¥ld labour 7432-7439. 18. Ramos CL, Pou S, Britigan BE, Cohen MS, Rosen GM. Spin trapping evidence for causes and, based on personal participation, documented myeloperexidase-dependent hydroxyl radical formation by human neutrophils and monocytes. J Bio/ Chem 1992; 267: 8307-8312. the life and work of the underprivileged and w6r~ing 19. Steinbeck MJ. Khan AU. Karnovsky MJ. Intracellular singlet oxygen generation by phagocytosing neutrophils in response to particles coated with a chemical trap. J classes in England and Paris. He also fought w~th the Bioi Chem 1992; 267: 13425-13433. 20. Anderson R. Phacogyte-derived reactive oxidants as mediators of inflammation leftist alliance in the Spanish Civil War against Franco's associated tissue damage. S Atr J Sci 1991; 87: 594-596. 21. El-Hag A. Upsky PE, Bennett M, Clark RA. Immunomodulation by neutrophil army revolt against the Republican Government. Although myeloperoxidase and hydrogen peroxide: differential susceptibility of human a fine essayist and master of English prose, he is best Iymphocyte functions. J Immuno/1987; 139: 2406-2413. 22. Templeton AC. Acquired diseases. In: Fraumeni JF jun, ed. Persons at High Risk of known for Animal Farm and Nineteen Eighty-Four, two Cancer: An Approach to Cancer Etiology and Control. New York Academic Press, 1975: 69-84. political satires on the Soviet system and totalitarianism 23. Weitzman SA. Weitberg AB, Clark EP, Stossel TP. Phagocytes as carcinogens: malignant transformation produced by human neutrophils. Science 1985; 227: 1231 respectively. These brought him fame and financial 1233. 24. Jackson JH. Gajewski E, Schraufstatter IU, Hyslop PA, Fuciarelli AFt Cochrane CG, security shortly before his death of tuberculosis at the age Dizdaroglu M. Damage to the bases in DNA induced by stimulated human neutrophils. J Clin Invest 1989; 84: 1644-1649. of 47, after a life of recurrent ill health and economic 25. Van Rensburg CEJ, Van Staden AM, Anderson R. Inactivation of poly (ADP-ribose) polymerase by hypochlorous acid. Free Radical Bioi Med 1991; 11; 285-291. hardship. 26. Rice WG, Weiss SJ. Regulation of proteolysis at the neutrophil substrate interface by secretory le.ukoprotease inhibitor. Science 1990; 249: 178-181. S Afr Med J 1995; 85: 1028-1030. 27. Desrochers PE, Mookhtiar K, Van Wart HE. Hasty KA. Weiss SJ. Proteolytic inactivation of Q,-proteinase inhibitor and Q,-antichymotrypsin by OXidatively activated human neutrophil metaJloproteinases. J 8iol Chem 1992; 267: 5005-5012. 28. Patel KO. Zimmerman GA, Prescott SM, McEver RP, Mclntyre TM. Oxygen radicals induce human endothelial cells to express GMP-140 and bind neutrophils. J CelJ BioI Orwell was born Eric Blair in India, where his father and 1991; 112: 749-759. grandfather were minor officials in the civil service. His 29. Palluy 0, Morliere L, Gris JC t Bonne C, Modat G. HYPoxialreoxygenation stimulates endothelium to promote neutrophil adhesion. Free Radical Bioi Med 1992; 13: 21 family moved to England, where he attended a private 30. 30. Grimm RH jun, Neaton JD, Ludwig W. Prognostic importance of the white blood cell preparatory school at a reduced fee on account of his count for coronary cancer, and all-cause mortality. JAMA 1985; 254: 1932-1937. father's low pension. His brillia.nce won him a scholarship to 31. Phillips AN. Neaton JO. Cook DG t Grimm AH, Shaper AG. The leukocyte count and risk of lung cancer. Cancer 1992; 69: 680-684. Eton. On leaving school he joined the Indian Imperial Police, 32. De Labry La, Campion E:W, Glynn RJ, Vokonas PS. White blood cell count as a predictor of mortality: results over 18 years from the normative aging study. J Clin and served in Burma for 5 years until his resignation'in 1927. Epidemio/1990; 43: 153-157. He was motivated by the ambition to become a writer and 33. Frei G, England L, Ames BN. Ascorbate is an outstanding anti-oxidant in human blood plasma. Proc Natl Acad Sci USA 1989; 86: 6377-6381. his abhorrence of colonialism, reflected in his breaking with 34. Burton GW, Ingold KU. Beta-carotene: an unusual type of lipid-soluble anti-oxidant. the past and his family's tradition of service to imperial Science 1984; 242: 569-573. 35. Anderson A, Theren AJ, Myer MS. Richards GA, Savage JE. Vitamin E is a potent Britain. Eric Blair then became George Orwell. He chose the inhibitor of superoxide generation by neutrophils activated with soluble, but not particulate stimuli of membrane-associated oxidative metabolism. J Nutr Immunol pseudonym Orwell in 1933 from a river in Suffolk where he 1992; 1: 43-63. was teaching at the time to supplement his writing income. 36. Kazura JW, Wenger JD, Salata RA, Budzynski AS, Goldsmith GH. Modulation of polymorphonuclear leukocyte microbicidal activity and oxidative metabolism by George Orwell was gerierally used by new acquaintances, fibrinogen degradation products 0 and E. J Clin Invest 1989; 83: 1916-1924. 37. Shephard EG, Beer SM. Anderson A, Strachan AF, Nel AE, De Beer FC. Generation while he retained Eric Blair for legal purposes. Orwell of biologically active C-reactive protein peptides by a neutral protease on the supplemented a precarious existence as a writer by working membrane of phorbol myristate acetate-stimulated neutrophils. J Immuno/1989; 143: 2974-2981. in a bookshop. He experienced repeated attacks of pneumonia at this stage. After the death of his first wife in Accepted 15 Apr 1993. 1945 he brought up an adopted son with the help of his sister. During the war he worked for the BBC in the Talks Abbreviations. GM-CSF - granulocyte-macrophage colony-stimulating Department of the Indian Service. factor; TNF - tumour necrosis factor; G-CSF - granulocyte colony stimulating factor; IL - interleukin; PAF - platelet-activating factor; LTB, - leukotriene 8,; MPO - myeloperoxidase; CR - complement receptor; API- alpha-1-protease inhibitor; NADPH - nicotinamide-adenine dinucleotide phosphate (reduced form); FAD - flavine adenine dinucleotide; SOD - superoxide dismutase; ATP - adenosine 32 St Andrew Street, Bloemfontein triphosphate. H. Dubovsky, M.B. CH.B., OJ'H.

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ARTICLES

Literary heritage Orwell was wounded in the throat during the 7 months from Orwell's best known work is Animal Farm (1945),' an December 1936 that he spent on the battlefront. Historians allegorical fable that attacks the Soviet system. It was consider his account a valuable reference work on the written in the wake of his experience as a member of the Spanish Civil War. International Brigade, which consisted of several factions Orwell considered his novels inferior. The first, Burmese and in 1937 supported the Spanish republic against the Days,' reflected his sensitivity to the barriers of race and army revolt led by General Franco. The latter was supported caste he observed while serving with the Burma police and by the fascist governments of Germany and Italy. Although his rejection of the imperial system. an ardent socialist, Orwell became disillusioned with Russia, which favoured the Spanish communist group of the leftist Tuberculosis alliance. The latter regarded the Marxist fighting group which Orwell's recurrent chest problems commenced at the age of Orwell had joined as too extreme in its socialism. Its 2 years when his mother records in her diary that he had members were arrested by the Spanish republican attacks of 'bronchitis' and was kept in bed for long periods. government and some died in prison. Orwell barely A friend relates· that when Orwell lived alone in cheap managed to escape to England. Animal Farm is a parody of lodgings in London in 1928 while trying to establish himself the Soviet system and its events and characters are as a writer after his return from India, he was 'far from well', caricatures of those of the Russian revolution. with inadequate heating, clothing and food. She considered Orwell's other great work, Nineteen Eighty-Four! written in him to be 'pre-tubercular'. That was in 1929 when he began 1948, is also a satire. It describes life in the dystopia, a 3-year period of living and working with the Oceania, as one without privacy, indiViduality and activity underprivileged in England and Paris for the purposes of which the state may consider a threat to itself. It is set in documentary research. On his return to England in 1933 he England and recounts the tribulations of two young lovers, had a serious attack of pneumonia while teaching to Winston and Julia, who attempt a human relationship in a supplement his writing income. While investigating working system controlled by 'Big Brother', who monitors all activity conditions in th~ coalfields at Wigan in 1936, he developed on a telescreen transmitted from every home. The adjective a severe bronchitis after an underground observation spell. Orwellian, used to describe these concepts, has entered our Only in 1938 was Orwell finally diagnosed as having vocabulary and is applied today to any technology such as tuberculosis. This was on his return from trench warfare in bugging. The term 'newspeak' describes the use of Spain, and it is probable that the repeated episodes of language as a political tool. Examples thereof include winter chest infections from infancy were progressions from 'pacification' for bombardment of defenceless villages and - primary tuberculosis to tuberculosis pneumonia or 'fraternal assistance' and 'protective reaction' for attack. secondary infections on tubercle. He had a sudden severe These two well-known works have diverted attention from haemoptysis· in March 1938 and was admitted to a Orwell's essays,' considered to be his best writing; they sanatorium in Kent. Its source was a tuberculosis lesion in display a mastery of English prose and show Orwell to have the left lung. He was treated with strict bed rest and only been a perceptive student of his times. The essays handle allowed to use his typewriter after 3 months. Orwell divergent subjects and include an account of How the Poor progressed well enough to be discharged after 6 months to Die, his experience as an indigent patient with pneumonia in recuperate in Morocco with the financial help of a Paris in 1929 while working there as a kitchen hand. This benefactor. After spending some years in London, from was the first of his elective experiences of the life of the where he made trips to France, Germany and Austria as a poor and outcast in order to obtain literary material. He war correspondent in 1945, Orwell moved in 1946 to what refers in the essay to callous treatment by students and was to be his last home, an isolated farmhouse on the island staff, and an agonising experience of scarification and of Jura in the Hebrides. Here he commenced writing his final cupping to his chest that caused blistering prior to the work, Nineteen Eighty-Four, but had a relapse requiring application of a mustard plaster pack. He subsequently admission to a sanatorium" in Glasgow with an extensive spent periods in doss-houses with tramps and the cavity of the left lung with a right apical lesion. He unemployed in London in 1932, and recounted these underwent crushing of the phrenic nerve in the cervical experiences in Down and Out in Paris and London.4 His next region to paralyse and elevate the diaphragm, followed by documentary was a study of unemployment in the coal artificial pneumoperitoneum - the introduction of air to the mining areas around Wigan. This was published as The abdominal cavity as a form of lung relaxation therapy to Road to Wigan Pier.' Orwell considered his last enhance this effect. Through contacts in the USA, he was documentary, Homage to Catalonia," which dealt with the able to secure 70 g of the new drug streptomycin at a cost Spanish Civil War, to be his best writing. There were two of $300, which he could now afford given an adequate reasons for satisfaction. He considered the camaraderie of income from the publication of Animal Farm. After 50 days the battlefield and the casual discipline of his group as of 1 g per day he developed a hypersensitivity to representative of true socialism. As a member of the Officers streptomycin with a general rash, exfoliation, oral ulceration Training Corps at Eton, he had also wished to experience and loss of hair and nails. These resolved on cessation of the trench warfare of World War I, which fascinated his treatment and he was able to return to Jura after 7 months generation. In reality he found the civil war in Spain a 'bad to complete Nineteen Eighty-Four. This was done with copy of 1914 - 1918' with 'mud lice and stagnation' in cold difficulty, as he was too weak to work more than half a day. conditions. This illustrates his contradictory character: His condition deteriorated, he was forced to give up living in having experienced serious chest infections every winter Jura and in 1949 was admitted to a private sanatorium," in since childhood, he still chose to undergo these hardships. the Cotswold hills. This provided superior accommodation in

SAMJ Volume 85 No. 10 October 1995 1029 private chalets with luxuries such as central heating; rest country churchyard of All Saints, Sutton Courtenay, near the and fresh air were the basic treatments. He was well able to family estate of David Astor and through his good offices. afford these amenities, not only on account of the He was the owner of the newspaper The Observer and had extraordinary success of Animal Farm but because Ninety befriended Orwell during his last years. It required the Eighty-Four, published that year, had been selected Book of influence of a newspaper magnate to get the left-wing the Month in the USA. Orwell comments in his notebook sceptic buried in sacred ground. that 'one cannot help feeling the difference in the texture of Contrary to the international ethics of left-wingers, Orwell life when one is paying one's own keep', as opposed to that was essentially nationalistic in his love for England, in the government-subsidised institutions he had especially its language and the liturgies of the English experienced. He appreciated the quietness with 'none of Church. Furthermore his personal tastes, as quoted by those abominable rattling trolleys' as everything was brought Crick," were closer to capitalism than socialism: by hand. There was 'not much noise of radios either - all 'I like English cookery and English beer, French red wines, the patients have headphones', and the left-wing socialist Spanish white wines, Indian tea, strong tobacco, 'coa~·fires, evidently enjoyed the benefits of capitalism! However, his candle-light and comfortable chairs. I dislike big towns, radicalism came to the fore in a notebook entry commenting noise, motor cars, the radio, tinned food, central heating and on the 'cultivated accents' of 'upper-class English voices' of "modern furniture".' visitors to this most expensive block of chalets. 'And what voices! A sort of over-fedness, a fatuous self-confidence, a REFERENCES constant bah-bahing of laughter about nothing, above all a 1. Orwell G. Animal Farm. London: Seeker and Warburg, 1945. t.:-' 2. Orwell G. Nineteen Eighty-Four. London: Seeker and Warburg, 19.49. sort of heaviness and richness combined with a fundamental 3. Orwell G. Co//ected Essays. London: Seeker and Warburg, 1961. ~ ill-will ... People one instinctively feels ... are the enemies 4. Orwell G. Down and Out in Paris and London. London: Victor Gollancz, 1933. 5. Orwell G. The Road to Wigan Pier. London: Seeker and Warburg. f937. of anything intelligent or sensitive or beautiful.' 6. Orwell G. Homage to Catalonia. London: Victor Gollancz. 1938. .- As Orwell's progress was not satisfactory he was moved 7. Orwell G. Burmese Days. New York: Harper, 1934. 8. Crick B. George Orwell. A Life. Rev. ed. London: Seeker and Warburg, 1981. to University College Hospital" in London. The consultant 9. Conolly C. The Evening Colonnade. London: David Bruee and Watson, 1973: 377. reported 'severe disease of the left lung and a relatively slight amount on the right' and as his 'prognosis was Accepted 29 Dec 1993. hazardous' he was warned that 'if he ceases to try to get well and settles down to write another book he is almost certain to relapse quickly'. Another book would not have been necessary financially as Nineteen Eighty-Four had tbe prospect of bringing in £10 000 - 15 000 and he could afford the £17 per day for his private room. ~gr ~llntg Despite his poor condition he married Sonia Bronell, a §1frirau 3l1rhiral jnuruaI. journalist, in a ward ceremony in October 1949. She was 31 and they had been friends for some years. He was 46. They had been married for 95 days when he died suddenly and alone of a massive haemoptysis on 21 January 1950. At the 50 years ago . .. time arrangements were in progress to move him by chartered aircraft to a sanatorium in Switzerland, a venture Measures by British doctors of the Indian Army Medical regarded by his physician and friends as a forlorn hope. Corps on the Indo-Burmese Border during World War 11 Cyril Conolly," friend and writer, offered this perspective on have resulted in three important discoveries. These will Orwell's illness: . profoundly influence future military malaria control. 'The tragedy of Orwell's life is that when at last he ... They are: achieved fame and success he was a dying man and knew (a) The use of suppressive mepacrine, which must lead it. He had fame and was too ill to leave his room; money to "a considerable reduction of malaria once its and nothing to spend it on; love in which he could not administration is finally placed on a firm basis. participate; he tasted the bitterness of dying. But in his (b) The introduction of D.D.T., which will enable a more years of hardship he was sustained by a genial stoicism, by rapid and a more complete control of larger areas than his excitement about what was going to happen next and by has been possible with the methods hitherto employed. his affection for other people.' (c) The use of repellent fish-nets, which will protect patrols and troops in contact with the enemy, malaria Epilogue in whom has so far been difficult if not impossible to prevent. Orwell's funeral arrangements (Crick," p. 403) epitomise his It is felt that the narrow margin of safety conferred by ambivalent character. These were left in the hands of his the anti-malarial measures hitherto employed [including friends and fellow writers, Anthony Powell and Malcolm anti-larval drainage and pyrethrum spraying] will be Muggeridge, his executors, whom he had requested to greatly widened by the introduction of the above three arrange that his 'body shall be buried (not cremated) methods of protection, but strict and expert supervision according to the rites of the Church of England in the will still be necessary if the ultimate" goal of one hundred nearest convenient cemetery .. .' with 'Eric Arthur Blair' on a per cent. protection is to be attained. plain brown stone." This created a problem, as Orwell had had no connection with any church. A vicar who had never (Brigadier M. K. Afridi and Lieut.-Col. J" Hay Arthur, S A Medical heard of Orwell was found to perform the ceremony in the Journal, 13 Ocrober 1945, p. 361.)

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