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He fell seriously ill in February 1929 and was taken to the Hôpital Cochin in the 14th arrondissement, a free hospital where medical students were trained.
His experiences there were the basis of his essay How the Poor Die, published in 1946.
He chose not to identify the hospital, indeed was deliberately misleading about its location.
Shortly afterwards, he had all his money stolen from his lodging house.
Whether through necessity or simply to collect material, he undertook menial jobs like dishwashing in a fashionable hotel on the rue de Rivoli, which he later described in Down and Out in Paris and London.
In August 1929, he sent a copy of The Spike to New Adelphi magazine in London.
This was owned by John Middleton Murry, who had released editorial control to Max Plowman and Sir Richard Rees.
Plowman accepted the work for publication.

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