The 1937 club started this week, hosted by Karen at Kaggsy’s bookish ramblings and Simon from Stuck in a book. I very much like books from the 1930s so I was delighted when this year was chosen, it was the year my dad was born. I had a couple of books I could have chosen to read but the first one I settled on was one I first had to buy for my Kindle.
The Citadel by A J Cronin is a book I have been dimly aware of for many years, at least I think I can remember seeing some old paperbacks of his novels on my parents bookshelves back in the day. The tagline on the cover of this Bello books Kindle version – ‘the classic novel that inspired the NHS’ is quite the claim, how true that is I don’t know, although Wikipedia seems to suggest the same and it’s conceivable that the politicians involved in the push for the establishment of the NHS might have read it. A J Cronin was himself a doctor, and he used his experiences to write his best selling novels. Funnily enough a character in my current read, also for the 1937 club, is struggling to read another Cronin novel, The Stars Look Down. The Citadel was a marvellous read, a real saga – and enormously compelling.
The novel opens in 1924 as newly qualified Scottish doctor Andrew Manson arrives in a small Welsh mining town to take up a position as assistant doctor with a Dr Page. This fictitious town is realistically portrayed by Cronin, who himself had worked in Welsh mining towns. Andrew arrives to discover Dr Page is severely disabled by a stroke, cared for by his sister who runs the house and insists her brother will be up and about soon. Andrew realises that isn’t the case, but he gets down to work, and all the work of Dr Page’s practice falls to him. It’s a massive learning curve – and Andrew is naturally nervous of making a mistake with his first patients.
“All at once, with a quick pang, he was conscious of his nervousness, his inexperience, his complete unpreparedness, for such a task.”
There is a lot of poverty in the town, many miners suffering from lung diseases and a huge amount for Andrew still to learn. Another doctor in the town is Philip Denny, a hard drinking cynic, who had previously worked as a surgeon before falling foul of colleagues and ending up as an assistant doctor like Andrew. It is with Dr Denny that Andrew conspires to blow up a sewer in order to force the council to rebuild it – as nobody will listen to their concerns of its effects on public health.
Andrew begins to see how the system really doesn’t help the people it should. He is keen, hardworking and idealistic, he won’t just prescribe unnecessary medicine to patients (which costs them money) even when they think they want it, and he won’t just keep signing men off work when they are capable of returning to their jobs. Some doctors lack the competence they should have – others are too concerned with making money from private patients.
“…But Bramwell was not inexperienced and because of that his ignorance was inexcusable. Unconsciously Andrew’s thoughts returned to Denny who never failed in his derision towards this profession to which they belonged. Denny at first had aggravated him intensely by his weary contention that all over Britain there were thousands of incompetent doctors distinguished for nothing but their sheer stupidity and an acquired capacity for bluffing their patients.”
Andrew is outspoken and principled – and there are those who don’t like that. Everywhere he goes he makes both friends and enemies. Having fallen foul of Dr Page’s rather unpleasant and difficult sister, Andrew decides to leave and takes a position in another mining town in South Wales. His new job is as an assistant in a miners’ medical aid scheme and it comes with a house. The committee wants a married man, which delights Andrew as it means he can now marry the woman he loves, Christine, a young school teacher.
Andrew and Christine are happy, they don’t have much money but Andrew is busy and continually excited by his work. He enlists the help of Christine to carry out his research into lung disorders. He studies for his MRCP, to make him a more attractive candidate in the future and publishes a paper about his research.
Andrew is ambitious – and soon London beckons – and with it the lure of private practice, wealthy patients. Andrew has his head turned – Christine is dismayed to see his ideals falter – their lives begin to change.
What Cronin does brilliantly is to show the huge inequalities and corruption that existed within the medical profession. There are many ups and downs for Andrew and his wife over the course of a few short years, but it makes for a brilliant immersive read.
heavenali 