Indian doctor jailed over sex tests on foetuses

Indian doctor jailed over sex tests on foetuses

An Indian court sentenced a doctor to two years in prison for using ultrasound tests to determine the sex of foetuses - information the mothers could use to abort baby girls.

Anil Sabsani, a radiologist who officials say told an undercover investigator she was carrying a female fetus but that her pregnancy could be "taken care of," is reportedly the first doctor convicted under a law designed to prevent gender-selective abortions — a widespread problem in India, where many regard daughters as a liability.

Sabsani and his assistant were sentenced to two years in prison and fined 5,000 rupees (US$125) each, said Sushma Saini, an information officer for the Haryana state government.

They were tried in Palwal, a Haryana city about 95 miles south of New Delhi where Sabsani had his practice.

Hundreds of thousands of female foetuses are believed aborted every year in India in sex-selective procedures.

In 2001, authorities responsible for monitoring physicians sent an undercover team to Sabsani's office to see if he would reveal the gender of a fetus, said R.C. Aggarwal, Haryana's chief medical officer.

Sabsani told the undercover team he would reveal the sex if he was paid an additional 1,500 rupees (US$35). After being paid, he told the woman the fetus was female, adding: "But that can be taken care of," Aggarwal said.

It was not clear how many sex-determination tests Sabsani had conducted, Aggarwal said.

"However, we had received complaints about him, which is why we set up the appointment," he said.

Aggarwal, who was part of the team monitoring the state's doctors, said there were cases pending against three other doctors on similar charges in Haryana courts. He was not certain when those cases would go to trial.

Cases can take years to make it through India's severely overburdened judicial system.

While abortions are legal in India, revealing the sex of the baby and aborting on grounds of gender are not. In 1994, the government outlawed prenatal sex-determination tests, but the law is widely flouted — especially among better-off Indians — despite pledges by officials of a crackdown.

There has long been a preference for boys among parents in India, where a bride's family traditionally gives cash and gifts to the groom's relatives.

A study published January in the Lancet, a leading British medical journal, reported that up to 10 million female foetuses may have been aborted in India over the past two decades following prenatal gender checks.

The researchers studied data on female fertility from a continuing Indian national survey, analyzing information on 133,738 births.

Based on the natural gender ratio from other countries, they estimated that 13.6 million to 13.8 million girls should have been born in 1997 in India. However, only 13.1 million were reported, the study said.

Thus, they concluded that 500,000 girls were "missing" annually — most likely the result of abortions — giving them the figure of 10 million over 20 years. The researchers called the estimate conservative.

India's census in part backs up the finding. The number of girls per 1,000 boys declined in the country from 945 in 1991 to 927 in 2001, according to census figures.



New foot-and-mouth vaccine developed

By Clive Cookson, Science Editor March 27, 2013 11:09 pm (foot and mouth disease = la fièvre aphteuse)

British scientists have developed a new vaccine against foot-and-mouth disease that they say could turn the tide against a virus which is the scourge of livestock farmers.

The breakthrough is the result of a seven-year, £6m collaboration between between publicly funded researchers at the Pirbright Institute, Diamond Light Source and Oxford and Reading universities. The Wellcome Trust and Department for Food, Environment and Rural Affairs funded most of the work.

The new “synthetic” vaccine uses the empty protein shell of a foot-and-mouth virus to trigger a strong immune response in animals but lacks the infectious genetic material inside the real virus. The old vaccine is made from live virus.

Early trials in cattle show the new vaccine works as well as the conventional one while being far safer and easier to store and use. A particular advantage is that it does not require the expensive cold chain that limits use in poor countries where foot and mouth is rampant.

Tests can distinguish between animals given the new vaccine and those that have been infected with foot and mouth. This distinction cannot be made when the older vaccine is used – a serious disincentive for farmers to vaccinate their animals in regions such as Europe, where foot and mouth-free status is critical.

Bryan Charleston, head of livestock viral diseases at the Pirbright Institute, said the trigger for the research was the 2001 UK foot-and-mouth epidemic, which cost an estimated £8bn in control measures, compensation and lost rural activity.

“Using our detailed knowledge of the immune responses to foot-and-mouth virus in cattle, we were able to define the characteristics that needed to be incorporated into the new vaccine platform to induce protection,” he said.

“What we have achieved here is close to the holy grail of foot-and-mouth vaccines,” added David Stuart, professor of structural biology at Oxford university. “Unlike the traditional vaccines, there is no chance that the empty shell vaccine could revert to an infectious form.”

Diamond Light Source in Oxfordshire played a crucial role in the project. The scientists used its X-ray technology to determine the structure of the vaccine, ensuring it matched the outer shell of the virus as closely as possible.

In collaboration with MSD Animal Health, a subsidiary of the US pharmaceutical giroup Merck, the team has produced a trial batch of the vaccine in a pilot plant. However, Ted Bianco, acting director of the Wellcome Trust, said the commercial arrangements for further development were still under discussion.

Before the vaccine can be licensed for use by farmers, extensive clinical trials are needed to prove safety and efficacy, a process that could take six to eight years, according to Mr Charleston.

The scientists are also considering applying the technology to other diseases.

“This work will have a broad and enduring impact on vaccine development, and the technology should be transferable to other viruses from the same family, such as polio and hand, foot and mouth disease, a human virus currently endemic in southeast Asia,” said Prof Stuart.

'We need slaves to build monuments'

It is already home to the world's glitziest buildings, man-made islands and mega-malls - now Dubai plans to build the tallest tower. But behind the dizzying construction boom is an army of migrant labourers lured into a life of squalor and exploitation. Ghaith Abdul-Ahad reports

• 
  Ghaith Abdul-Ahad The Guardian, Wednesday October 8 2008
  

Workers sleep on the street in Dubai. Photograph: Ghaith Abdul Ahad

The sun is setting and its dying rays cast triangles of light on to the bodies of the Indian workers. Two are washing themselves, scooping water from tubs in a small yard next to the labour camp's toilets. Others queue for their turn. One man stands stamping his feet in a bucket, turned into a human washing machine. The heat is suffocating and the sandy wind whips our faces. The sprinkles of water from men drying their clothes fall like welcome summer rain.

All around, a city of labour camps stretches out in the middle of the Arabian desert, a jumble of low, concrete barracks, corrugated iron, chicken-mesh walls, barbed wire, scrap metal, empty paint cans, rusted machinery and thousands of men with tired and gloomy faces.

I have left Dubai's spiralling towers, man-made islands and mega-malls behind and driven through the desert to the outskirts of the neighbouring city of Abu Dhabi. Turn right before the Zaha Hadid bridge, and a few hundred metres takes you to the heart of Mousafah, a ghetto-like neighbourhood of camps hidden away from the eyes of tourists. It is just one of many areas around the Gulf set aside for an army of labourers building the icons of architecture that are mushrooming all over the region.

Behind the showers, in a yard paved with metal sheets, a line of men stands silently in front of grease-blackened pans, preparing their dinner. Sweat rolls down their heads and necks, their soaked shirts stuck to their backs. A heavy smell of spices and body odour fills the air.

Next to a heap of rubbish, a man holds a plate containing his meal: a few chillies, an onion and three tomatoes, to be fried with spices and eaten with a piece of bread.

In a neighbouring camp, a group of Pakistani workers from north and south Waziristan sit exhaustedly sipping tea while one of them cooks outside. In the middle of the cramped room in which 10 men sleep, one worker in a filthy robe sits on the floor grinding garlic and onions with a mortar and pestle while staring into the void.

Hamidullah, a thin Afghan from Maydan, a village on the outskirts of Kabul, tells me: "I spent five years in Iran and one year here, and one year here feels like 10 years. When I left Afghanistan I thought I would be back in a few months, but now I don't know when I will be back." Another worker on a bunk bed next to him adds: "He called his home yesterday and they told him that three people from his village were killed in fighting. This is why we are here."

Hamidullah earns around 450 dirhams (£70) a month as a construction worker.

How is life, I ask.

"What life? We have no life here. We are prisoners. We wake up at five, arrive to work at seven and are back at the camp at nine in the evening, day in and day out."

Outside in the yard, another man sits on a chair made of salvaged wood, in front of a broken mirror, a plastic sheet wrapped around his neck, while the camp barber trims his thick beard. Despite the air of misery, tonight is a night of celebration. One of the men is back from a two-week break in his home village in Pakistan, bringing with him a big sack of rice, and is cooking pilau rice with meat. Rice is affordable at weekends only: already wretched incomes have been eroded by the weak dollar and rising food prices. "Life is worse now," one worker told me. "Before, we could get by on 140 dirhams [£22] a month; now we need 320 to 350."

The dozen or so men sit on newspapers advertising luxury watches, mobile phones and high-rise towers. When three plastic trays arrive, filled with yellowish rice and tiny cubes of meat, each offers the rare shreds of meat to his neighbours.

All of these men are part of a huge scam that is helping the construction boom in the Gulf. Like hundreds of thousands of migrant workers, they each paid more than £1,000 to employment agents in India and Pakistan. They were promised double the wages they are actually getting, plus plane tickets to visit their families once a year, but none of the men in the room had actually read their contract. Only two of them knew how to read.

"They lied to us," a worker with a long beard says. "They told us lies to bring us here. Some of us sold their land; others took big loans to come and work here."

Once they arrive in the United Arab Emirates, migrant workers are treated little better than cattle, with no access to healthcare and many other basic rights. The company that sponsors them holds on to their passports - and often a month or two of their wages to make sure that they keep working. And for this some will earn just 400 dirhams (£62) a month.

A group of construction engineers told me, with no apparent shame, that if a worker becomes too ill to work he will be sent home after a few days. "They are the cheapest commodity here. Steel, concrete, everything is up, but workers are the same."

As they eat, the men talk more about their lives. "My shift is eight hours and two overtime, but in reality we work 18 hours," one says. "The supervisors treat us like animals. I don't know if the owners [of the company] know."

"There is no war, and the police treat us well," another chips in, "but the salary is not good."

"That man hasn't been home for four years," says Ahmad, the chef for the night, pointing at a well-built young man. "He has no money to pay for the flight."

A steel worker says he doesn't know who is supposed to pay for his ticket back home. At the recruiting agency they told him it would be the construction company - but he didn't get anything in writing.

One experienced worker with spectacles and a prayer cap on his head tells me that things are much better than they used to be. Five years ago, when he first came, the company gave him nothing. There was no air conditioning in the room and sometimes no electricity. "Now, they give AC to each room and a mattress for each worker."

Immigrant workers have no right to form unions, but that didn't stop strikes and riots spreading across the region recently - something unheard of few years ago. Elsewhere in Mousafah, I encounter one of the very few illegal unions, where workers have established a form of underground insurance scheme, based on the tribal structure back home. "When we come here," one member of the scheme tells me, "we register with our tribal elders, and when one of us is injured and is sent home, or dies, the elders collect 30 dirhams from each of us and send the money home to his family."

In a way, the men at Mousafah are the lucky ones. Down in the Diera quarter of old Dubai, where many of the city's illegal workers live, 20 men are often crammed into one small room.

UN agencies estimate that there are up to 300,000 illegal workers in the emirates.

On another hot evening, hundreds of men congregate in filthy alleyways at the end of a day's work, sipping tea and sitting on broken chairs. One man rests his back on the handles of his pushcart, silently eating his dinner next to a huge pile of garbage.

In one of the houses, a man is hanging his laundry over the kitchen sink, a reeking smell coming from a nearby toilet. Next door, men lie on the floor. They tell me they are all illegal and they are scared and that I have to leave.

Outside, a fistfight breaks out between Pakistani workers and Sri Lankans.

The alleyways are dotted with sweatshops, where Indian men stay until late at night, bending over small tables sewing on beads.

A couple of miles away, the slave market becomes more ugly. Outside a glitzy hotel, with a marble and glass facade, dozens of prostitutes congregate according to their ethnic groups: Asians to the right, next to them Africans, and, on the left, blondes from the former Soviet Union. There are some Arab women. Iranians, I am told, are in great demand. They charge much higher prices and are found only in luxury hotels.

Like the rest of the Gulf region, Dubai and Abu Dhabi are being built by expat workers. They are strictly segregated, and a hierarchy worthy of previous centuries prevails.

At the top, floating around in their black or white robes, are the locals with their oil money. Immaculate and pampered, they own everything. Outside the "free zones", where the rules are looser, no one can start a business in the UAE without a partner from the emirates, who often does nothing apart from lending his name. No one can get a work permit without a local sponsor.

Under the locals come the western foreigners, the experts and advisers, making double the salaries they make back home, all tax free. Beneath them are the Arabs - Lebanese and Palestinians, Egyptians and Syrians. What unites these groups is a mixture of pretension and racism.

"Unrealistic things happen to your mind when you come here," a Lebanese woman who frequently visits Dubai tells me as she drives her new black SUV. "Suddenly, you can make $5,000 [£2,800] a month. You can get credit so easy, you buy the car of your dreams, you shop and you think it's a great bargain; when you go to dinner, you go to a hotel ... nowhere else can you live like this."

Down at the base of the pyramid are the labourers, waiters, hotel employees and unskilled workers from India, Pakistan, Sri Lanka, Ethiopia, the Philippines and beyond. They move deferentially around the huge malls, cafes, bars and restaurants, bowing down and calling people sir and madam. In the middle of the day, during the hottest hours, you can see them sleeping in public gardens under trees, or on the marble floors of the Dubai Mosque, on benches or pieces of cardboard on side streets. These are the victims of the racism that is not only flourishing in the UAE but is increasingly being exported to the rest of the Middle East. Sometimes it reminds you of the American south in the 1930s.

One evening in Abu Dhabi, I have dinner with my friend Ali, a charming Iraqi engineer whom I have known for two decades. After the meal, as his wife serves saffron-flavoured tea, he pushes back his chair and lights a cigar. We talk about stock markets, investment and the Middle East, and then the issue of race comes up.

"We will never use the new metro if it's not segregated," he tells me, referring to the state-of-the-art underground system being built in neighbouring Dubai. "We will never sit next to Indians and Pakistanis with their smell," his wife explains.

Not for the first time, I am told that while the immigrant workers are living in appalling conditions, they would be even worse off back home - as if poverty in one place can justify exploitation in the other.

"We need slaves," my friend says. "We need slaves to build monuments. Look who built the pyramids - they were slaves."

Sharla Musabih, a human rights campaigner who runs the City of Hope shelter for abused women, is familiar with such sentiments. "Once you get rich on the back of the poor," she says, "it's not easy to let go of that lifestyle. They are devaluing human beings," she says. "The workers might eat once a day back home, but they have their family around them, they have respect. They are not asking for a room in a hotel - all they are asking for is respect for their humanity."

Towards the end of another day, on a fabulous sandy beach near the Dubai marina, the waves wash calmly over the beautiful sand. A couple are paragliding over the blue sea; on the new islands, gigantic concrete structures stand like spaceships. As tourists laze on the beach, Filipino, Indian and Pakistani workers, stand silently watching from a dune, cut off from the holidaymakers by an invisible wall.

Behind them rise more brand-new towers.

"It's a Green Zone mentality," a young Arab working in IT tells me. "People come to make money. They live in bubbles. They all want to make as much money as possible and leave."

Back at the Mousafah camps, a Pakistani worker walks me through his neighbourhood. On both sides of the dusty lane stand concrete barracks and the familiar detritus: raw sewage, garbage, scrap metal. A man washes his car, and in a cage chickens flutter up and down.

We enter one of the rooms, flip-flops piled by the door.

Inside, a steelworker gets a pile of papers from a plastic envelope and shoves them into my lap. He is suing the company that employed him for unpaid wages. "I've been going to court for three months, and every time I go they tell me to come in two weeks." His friends nod their heads. "Last time the [company] lawyer told me, 'I am in the law here - you will not get anything."

Economically, Dubai has progressed a lot in the past 10 years, but socially it has stayed behind," says Musabih. "Labour conditions are like America in the 19th century - but that's not acceptable in the 21st century.

In 1946 Observer editor David Astor lent George Orwell a remote Scottish farmhouse in which to write his new book, Nineteen Eighty-Four. It became one of the most significant novels of the 20th century. Here, Robert McCrum tells the compelling story of Orwell's torturous stay on the island where the author, close to death and beset by creative demons, was engaged in a feverish race to finish the book.

• 
  Robert McCrum The Observer, Sunday 10 May 2009
  
• 
  
  

"It was a bright cold day in April, and the clocks were striking thirteen."

Sixty years after the publication of Orwell's masterpiece, Nineteen Eighty-Four, that crystal first line sounds as natural and compelling as ever. But when you see the original manuscript, you find something else: not so much the ringing clarity, more the obsessive rewriting, in different inks, that betrays the extraordinary turmoil behind its composition.

Probably the definitive novel of the 20th century, a story that remains eternally fresh and contemporary, and whose terms such as "Big Brother", "doublethink" and "newspeak" have become part of everyday currency, Nineteen Eighty-Four has been translated into more than 65 languages and sold millions of copies worldwide, giving George Orwell a unique place in world literature.

"Orwellian" is now a universal shorthand for anything repressive or totalitarian, and the story of Winston Smith, an everyman for his times, continues to resonate for readers whose fears for the future are very different from those of an English writer in the mid-1940s.

The circumstances surrounding the writing of Nineteen Eighty-Four make a haunting narrative that helps to explain the bleakness of Orwell's dystopia. Here was an English writer, desperately sick, grappling alone with the demons of his imagination in a bleak Scottish outpost in the desolate aftermath of the second world war. The idea for Nineteen Eighty-Four, alternatively, "The Last Man in Europe", had been incubating in Orwell's mind since the Spanish civil war. His novel, which owes something to Yevgeny Zamyatin's dystopian fiction We, probably began to acquire a definitive shape during 1943-44, around the time he and his wife, Eileen adopted their only son, Richard. Orwell himself claimed that he was partly inspired by the meeting of the Allied leaders at the Tehran Conference of 1944. Isaac Deutscher, an Observer colleague, reported that Orwell was "convinced that Stalin, Churchill and Roosevelt consciously plotted to divide the world" at Tehran.

Orwell had worked for David Astor's Observer since 1942, first as a book reviewer and later as a correspondent. The editor professed great admiration for Orwell's "absolute straightforwardness, his honesty and his decency", and would be his patron throughout the 1940s. The closeness of their friendship is crucial to the story of Nineteen Eighty-Four.

Orwell's creative life had already benefited from his association with the Observer in the writing of Animal Farm. As the war drew to a close, the fruitful interaction of fiction and Sunday journalism would contribute to the much darker and more complex novel he had in mind after that celebrated "fairy tale". It's clear from his Observer book reviews, for example, that he was fascinated by the relationship between morality and language.

There were other influences at work. Soon after Richard was adopted, Orwell's flat was wrecked by a doodlebug. The atmosphere of random terror in the everyday life of wartime London became integral to the mood of the novel-in-progress. Worse was to follow. In March 1945, while on assignment for the Observer in Europe, Orwell received the news that his wife, Eileen, had died under anaesthesia during a routine operation.

Suddenly he was a widower and a single parent, eking out a threadbare life in his Islington lodgings, and working incessantly to dam the flood of remorse and grief at his wife's premature death. In 1945, for instanc e, he wrote almost 110,000 words for various publications, including 15 book reviews for the Observer.

Now Astor stepped in. His family owned an estate on the remote Scottish island of Jura, next to Islay. There was a house, Barnhill, seven miles outside Ardlussa at the remote northern tip of this rocky finger of heather in the Inner Hebrides. Initially, Astor offered it to Orwell for a holiday. Speaking to the Observer last week, Richard Blair says he believes, from family legend, that Astor was taken aback by the enthusiasm of Orwell's response.

In May 1946 Orwell, still picking up the shattered pieces of his life, took the train for the long and arduous journey to Jura. He told his friend Arthur Koestler that it was "almost like stocking up ship for an arctic voyage".

It was a risky move; Orwell was not in good health. The winter of 1946-47 was one of the coldest of the century. Postwar Britain was bleaker even than wartime, and he had always suffered from a bad chest. At least, cut off from the irritations of literary London, he was free to grapple unencumbered with the new novel. "Smothered under journalism," as he put it, he told one friend, "I have become more and more like a sucked orange."

Ironically, part of Orwell's difficulties derived from the success of Animal Farm. After years of neglect and indifference the world was waking up to his genius. "Everyone keeps coming at me," he complained to Koestler, "wanting me to lecture, to write commissioned booklets, to join this and that, etc - you don't know how I pine to be free of it all and have time to think again."

On Jura he would be liberated from these distractions but the promise of creative freedom on an island in the Hebrides came with its own price. Years before, in the essay "Why I Write", he had described the struggle to complete a book: "Writing a book is a horrible, exhausting struggle, like a long bout of some painful illness. One would never undertake such a thing if one were not driven by some demon whom one can neither resist or [sic] understand. For all one knows that demon is the same instinct that makes a baby squall for attention. And yet it is also true that one can write nothing readable unless one constantly struggles to efface one's personality." Then that famous Orwellian coda. "Good prose is like a window pane."

From the spring of 1947 to his death in 1950 Orwell would re-enact every aspect of this struggle in the most painful way imaginable. Privately, perhaps, he relished the overlap between theory and practice. He had always thrived on self-inflicted adversity.

At first, after "a quite unendurable winter", he revelled in the isolation and wild beauty of Jura. "I am struggling with this book," he wrote to his agent, "which I may finish by the end of the year - at any rate I shall have broken the back by then so long as I keep well and keep off journalistic work until the autumn."

Barnhill, overlooking the sea at the top of a potholed track, was not large, with four small bedrooms above a spacious kitchen. Life was simple, even primitive. There was no electricity. Orwell used Calor gas to cook and to heat water. Storm lanterns burned paraffin. In the evenings he also burned peat. He was still chain-smoking black shag tobacco in roll-up cigarettes: the fug in the house was cosy but not healthy. A battery radio was the only connection with the outside world.

Orwell, a gentle, unworldly sort of man, arrived with just a camp bed, a table, a couple of chairs and a few pots and pans. It was a spartan existence but supplied the conditions under which he liked to work. He is remembered here as a spectre in the mist, a gaunt figure in oilskins.

The locals knew him by his real name of Eric Blair, a tall, cadaverous, sad-looking man worrying about how he would cope on his own. The solution, when he was joined by baby Richard and his nanny, was to recruit his highly competent sister, Avril. Richard Blair remembers that his father "could not have done it without Avril. She was an excellent cook, and very practical. None of the accounts of my father's time on Jura recognise how essential she was."

Once his new regime was settled, Orwell could finally make a start on the book. At the end of May 1947 he told his publisher, Fred Warburg: "I think I must have written nearly a third of the rough draft. I have not got as far as I had hoped to do by this time because I really have been in most wretched health this year ever since about January (my chest as usual) and can't quite shake it off."

Mindful of his publisher's impatience for the new novel, Orwell added: "Of course the rough draft is always a ghastly mess bearing little relation to the finished result, but all the same it is the main part of the job." Still, he pressed on, and at the end of July was predicting a completed "rough draft" by October. After that, he said, he would need another six months to polish up the text for publication. But then, disaster.

Part of the pleasure of life on Jura was that he and his young son could enjoy the outdoor life together, go fishing, explore the island, and potter about in boats. In August, during a spell of lovely summer weather, Orwell, Avril, Richard and some friends, returning from a hike up the coast in a small motor boat, were nearly drowned in the infamous Corryvreckan whirlpool.

Richard Blair remembers being "bloody cold" in the freezing water, and Orwell, whose constant coughing worried his friends, did his lungs no favours. Within two months he was seriously ill. Typically, his account to David Astor of this narrow escape was laconic, even nonchalant.

The long struggle with "The Last Man in Europe" continued. In late October 1947, oppressed with "wretched health", Orwell recognised that his novel was still "a most dreadful mess and about two-thirds of it will have to be retyped entirely".

He was working at a feverish pace. Visitors to Barnhill recall the sound of his typewriter pounding away upstairs in his bedroom. Then, in November, tended by the faithful Avril, he collapsed with "inflammation of the lungs" and told Koestler that he was "very ill in bed". Just before Christmas, in a letter to an Observer colleague, he broke the news he had always dreaded. Finally he had been diagnosed with TB.

A few days later, writing to Astor from Hairmyres hospital, East Kilbride, Lanarkshire, he admitted: "I still feel deadly sick," and conceded that, when illness struck after the Corryvreckan whirlpool incident, "like a fool I decided not to go to a doctor - I wanted to get on with the book I was writing." In 1947 there was no cure for TB - doctors prescribed fresh air and a regular diet - but there was a new, experimental drug on the market, streptomycin. Astor arranged for a shipment to Hairmyres from the US.

Richard Blair believes that his father was given excessive doses of the new wonder drug. The side effects were horrific (throat ulcers, blisters in the mouth, hair loss, peeling skin and the disintegration of toe and fingernails) but in March 1948, after a three-month course, the TB symptoms had disappeared. "It's all over now, and evidently the drug has done its stuff," Orwell told his publisher. "It's rather like sinking the ship to get rid of the rats, but worth it if it works."

As he prepared to leave hospital Orwell received the letter from his publisher which, in hindsight, would be another nail in his coffin. "It really is rather important," wrote Warburg to his star author, "from the point of view of your literary career to get it [the new novel] by the end of the year and indeed earlier if possible."

Just when he should have been convalescing Orwell was back at Barnhill, deep into the revision of his manuscript, promising Warburg to deliver it in "early December", and coping with "filthy weather" on autumnal Jura. Early in October he confided to Astor: "I have got so used to writing in bed that I think I prefer it, though of course it's awkward to type there. I am just struggling with the last stages of this bloody book [which is] about the possible state of affairs if the atomic war isn't conclusive."

This is one of Orwell's exceedingly rare references to the theme of his book. He believed, as many writers do, that it was bad luck to discuss work-in-progress. Later, to Anthony Powell, he described it as "a Utopia written in the form of a novel". The typing of the fair copy of "The Last Man in Europe" became another dimension of Orwell's battle with his book. The more he revised his "unbelievably bad" manuscript the more it became a document only he could read and interpret. It was, he told his agent, "extremely long, even 125,000 words". With characteristic candour, he noted: "I am not pleased with the book but I am not absolutely dissatisfied... I think it is a good idea but the execution would have been better if I had not written it under the influence of TB."

And he was still undecided about the title: "I am inclined to call it NINETEEN EIGHTY-FOUR or THE LAST MAN IN EUROPE," he wrote, "but I might just possibly think of something else in the next week or two." By the end of October Orwell believed he was done. Now he just needed a stenographer to help make sense of it all.

It was a desperate race against time. Orwell's health was deteriorating, the "unbelievably bad" manuscript needed retyping, and the December deadline was looming. Warburg promised to help, and so did Orwell's agent. At cross-purposes over possible typists, they somehow contrived to make a bad situation infinitely worse. Orwell, feeling beyond help, followed his ex-public schoolboy's instincts: he would go it alone.

By mid-November, too weak to walk, he retired to bed to tackle "the grisly job" of typing the book on his "decrepit typewriter" by himself. Sustained by endless roll-ups, pots of coffee, strong tea and the warmth of his paraffin heater, with gales buffeting Barnhill, night and day, he struggled on. By 30 November 1948 it was virtually done.

Now Orwell, the old campaigner, protested to his agent that "it really wasn't worth all this fuss. It's merely that, as it tires me to sit upright for any length of time, I can't type very neatly and can't do many pages a day." Besides, he added, it was "wonderful" what mistakes a professional typist could make, and "in this book there is the difficulty that it contains a lot of neologisms".

The typescript of George Orwell's latest novel reached London in mid December, as promised. Warburg recognised its qualities at once ("amongst the most terrifying books I have ever read") and so did his colleagues. An in-house memo noted "if we can't sell 15 to 20 thousand copies we ought to be shot".

By now Orwell had left Jura and checked into a TB sanitorium high in the Cotswolds. "I ought to have done this two months ago," he told Astor, "but I wanted to get that bloody book finished." Once again Astor stepped in to monitor his friend's treatment but Orwell's specialist was privately pessimistic.

As word of Nineteen Eighty-Four began to circulate, Astor's journalistic instincts kicked in and he began to plan an Observer Profile, a significant accolade but an idea that Orwell contemplated "with a certain alarm". As spring came he was "having haemoptyses" (spitting blood) and "feeling ghastly most of the time" but was able to involve himself in the pre-publication rituals of the novel, registering "quite good notices" with satisfaction. He joked to Astor that it wouldn't surprise him "if you had to change that profile into an obituary".

Nineteen Eighty-Four was published on 8 June 1949 (five days later in the US) and was almost universally recognised as a masterpiece, even by Winston Churchill, who told his doctor that he had read it twice. Orwell's health continued to decline. In October 1949, in his room at University College hospital, he married Sonia Brownell, with David Astor as best man. It was a fleeting moment of happiness; he lingered into the new year of 1950. In the small hours of 21 January he suffered a massive haemorrhage in hospital and died alone.

The news was broadcast on the BBC the next morning. Avril Blair and her nephew, still up on Jura, heard the report on the little battery radio in Barnhill. Richard Blair does not recall whether the day was bright or cold but remembers the shock of the news: his father was dead, aged 46.

David Astor arranged for Orwell's burial in the churchyard at Sutton Courtenay, Oxfordshire. He lies there now, as Eric Blair, between HH Asquith and a local family of Gypsies.