'A Blow with a Word strikes deeper than a Blow with a Sword'

A. J. Cronin | The Citadel

A Medical Novel that Heralded a Revolution!

#onhisbirthdaytoday

Cronin - A conscientious medical doctor who had the boldness and courage to relinquish his surgeon’s call, and opted to become a writer instead, when he perceived ‘something rotten’ in the affairs of the medical fraternity!

The Citadel, his revolutionary anti-establishmentarian novel, was published in 1937, to an astonishing reception from the reading public, selling millions of copies in a short span of time.  Interestingly, an opinion poll in 1938, voted The Citadel as the most influential book, next in line to the Bible.

A book that heralded the formation of Britain’s National Health Service, ten years later. 

Even today, many medical doctors have testified to the influence of The Citadel, for them to take up medicine as their vocation.

Such is the power of Cronin’s revolutionary pen against the medical establishment of his day. 

“A blow with a word strikes deeper than a blow with a sword,” said Robert Burton, in his The Anatomy of Melancholy, a medical text book, published in the year 1621, and republished any many times thence on! 

Fine-tuning on it still further, Edward Bulwer-Lytton famously said that “The pen is mightier than the sword,” in his 1839 historical play titled, Richelieu: Or the Conspiracy.

Such has been the power of the pen over and above the sword, across the ages!

And when a physician writes something that’s gotta be candid about his own profession, and strongly advocates an ethical code that would govern medical doctors and the medical profession alike, how much more powerful and how much more mightier that pen could really be, is, well, anybody’s guess! 

That’s A. J. Cronin for us all, who like A. P. Chekhov, is quite an amazing physician-turned-writer whose writings have rattled and baffled the medical fraternity all over!

The reasons are not far to seek!

Well, Cronin is one amongst a chosen few conscientious physicians who weaves social criticism with realism and romance!

His experience as a doctor practising amongst the coal-mining communities in South Wales, helped him immensely, in getting a first-hand account of the health problems faced by miners and their occupational health hazards. 

Later on, he was also elevated as the Medical Inspector of Mines for Great Britain. 

Cronin thus heavily drew on his experience as a doctor when he wrote his novels. The Citadel is a case in point.

The Citadel, published in the year 1937, proved an immense hit with the masses as it exposed the arbitrary, atrocious medical ethics of the medical doctors during his days. 

Well, on an aside, the NHS restricts medical doctors from minting money from the mini purses of its pavapetta patients, because the entire health care system was, from thence on, funded by the government, with the Department of Health and Social Care, overseeing the administration of the funding. 

The NHS then, seeks to provide free healthcare to all legal residents of England!

In short, quality health care at almost no expense for the patient, became a possibility in Great Britain, just because of the visionary power of Cronin’s pen! 

Coming back to Citadel! 

Well, the novel deals with a doctor by name Andrew Manson, an idealistic, efficient and newly qualified doctor who takes up duty as an assistant doctor to Dr. Page, in quite unhygienic conditions all around him in a remote mining village. 

Determined to improve the living conditions as well as the health conditions of his patients, who were chiefly miners, Dr. Manson researches much on his specialized area of lung disease. Soon his research gets recognized and he gets elevated to the Mines Fatigue Board in London. 

But eventually he soon resigns and sets up private medical practice where his ‘business’ booms out of proportion!

The lure of easy money traps his conscience into a darky cage, and he is soon on a roll, wading into the wallets of his wealthy patients from thence on!

No spoilers for y’all, though!

But giving y’all dear readers, an excerpt that speaks to some little shocks you might not have otherwise heard or seen or read about, on medical doctors and their tryst with surgery!

Just an excerpt –

Wait! Horror alert! Read on, only if you have a heart that can read through a botched up surgery! 

Excerpts from the novel Citadel, pages 284 to 287!

Realisation broke on Andrew in a blinding flash. He thought: God Almighty! He can’t operate, he can’t operate at all.

The anaesthetist, with his finger on the carotid, murmured in a gentle, apologetic voice:

‘I’m afraid – he seems to be going, Ivory.’

Ivory, relinquishing the clamp, stuffed the belly cavity full of blooded gauze. He began to suture up his great incision. There was no swelling now. Vidler’s stomach had a caved-in, pallid, an empty look, the reason being that Vidler was dead.

‘Yes, he’s gone now,’ said the anaesthetist finally.

Ivory put in his last stitch, clipped it methodically and turned to the instrument tray to lay down his scissors. 

Paralysed, Andrew could not move. Miss Buxton, with a clay coloured face, was automatically packing the hot bottles outside the blanket. By great force of will she seemed to collect herself. She went outside.

The porter, unaware of what had happened, brought in the stretcher. Another minute and Harry Vidler’s body was being carried upstairs to his bedroom.

Ivory spoke at last.

‘Very unfortunate,’ he said in his collected voice as he stripped off his gown.

‘I imagine it was shock – don’t you think so, Gray?’

Gray, the anaesthetist, mumbled an answer. He was busy packing up his apparatus.

Still Andrew could not speak. Amidst the dazed welter of his emotion he suddenly remembered Mrs Vidler, waiting downstairs. It seemed as if Ivory read that thought. He said:

‘Don’t worry, Manson. I’ll attend to the little woman. Come. I’ll get it over for you now.’

Instinctively, like a man unable to resist, Andrew found himself following Ivory down the stairs to the waiting-room. He was still stunned, weak with nausea, wholly incapable of telling Mrs Vidler. It was Ivory who rose to the occasion, rose almost to the heights.

‘My dear lady,’ he said, compassionate and upstanding, placing his hand gently on her shoulder, ‘I’m afraid – I’m afraid we have bad news for you.’

She clasped her hands, in worn brown kid gloves, together. Terror and entreaty were mingled in her eyes.

‘What!’

‘Your poor husband, Mrs Vidler, in spite of everything which we could do for him –’

She collapsed into the chair, her face ashen, her gloved hands still working together.

‘Harry!’ she whispered in a heartrending voice. Then again, ‘Harry!’

‘I can only assure you,’ Ivory went on, sadly, ‘on behalf of Doctor Manson, Doctor Gray, Miss Buxton and myself that no power on earth could have saved him. And even if he had survived the operation –’ He shrugged his shoulders significantly.

She looked up at him, sensing his meaning, aware even at this frightful moment of his condescension, his goodness to her.

‘That’s the kindest thing you could have told me, doctor.’ She spoke through her tears.

‘I’ll send sister down to you. Do your best to bear up. And thank you, thank you for your courage.’

He went out of the room and once again Andrew went with him. At the end of the hall was the empty office, the door of which stood open. Feeling for his cigarette-case, Ivory walked into the office. There he lit a cigarette and took a long pull at it. His face was perhaps a trifle paler than usual but his jaw was firm, his hand steady, his nerve absolutely unshaken.

‘Well, that’s over,’ he reflected coolly. ‘I’m sorry, Manson. I didn’t dream that cyst was haemorrhagic. But these things happen in the best regulated circles, you know.’

‘Of course,’ Ivory inspected the end of his cigarette. ‘He didn’t die on the table. I finished before that – which makes it all right. No necessity for an inquest.’

Andrew raised his head. He was trembling, infuriated by the consciousness of his own weakness in this awful situation which Ivory had sustained with such cold-blooded nerve. He said, in a kind of frenzy: ‘For Christ’s sake stop talking. You know you killed him. You’re not a surgeon. You never were – you never will be a surgeon. You’re the worst botcher I’ve ever seen in all my life.’

There was a silence. Ivory gave Andrew a pale hard glance. ‘I don’t recommend that line of talk, Manson.’

‘You don’t.’ A painful hysterical sob shook Andrew. ‘I know you don’t! But it’s the truth. All the cases I’ve given you up till now have been child’s play. But this – the first real case we’ve had – Oh, God! I should have known – I’m just as bad as you –’

‘Pull yourself together, you hysterical fool. You’ll be heard.’

‘What if I am?’ Another weak burst of anger seized Andrew. He choked: ‘You know it’s the truth as well as I do. You bungled so much – it was almost murder!’

It was a sultry night. He suffered abominably but still he went on, half to torture himself and half in empty deadness because he could not stop. 

As he passed backwards and forwards in a daze of pain he kept asking himself: Where am I going? Where, in the name of God, am I going?

On and on he went, marking the book, a cross for a visit, a circle for consultation, marking the total of his iniquity. 

When it was finished she asked, in a voice whose wincing satire he only then observed:

‘Well! How much to-day?’

He did not, could not, answer. She left the room. He heard her go upstairs to her room, heard the quiet sound of her closing the door. 

He was alone: dry, stricken, bemused. Where am I going? Where in the name of God am I going?

Suddenly his eyes fell upon the tobacco sack, full of money, bulging with his cash takings for the day. 

Another wave of hysteria swept over him. He took up the bag and flung it into the corner of the room. It fell with a dull and senseless sound.

He jumped up. He was stifling, he could not breathe. Leaving the consulting room he rushed into the little back yard of the house, a small well of darkness beneath the stars. Here he leaned weakly against the brick dividing wall. He began; violently, to retch.

*****

Well, it's time to thank Cronin, by remembering this mighty brave heart on his birthday today for having the guts to cleanse the rut and the rot that has been thus far ‘plaguing’ the medical profession beyond redemption, and thus having helped much in making most of the health services free of cost or affordably priced in Great Britain.

The pen is indeed mightier than the sword, ain’t it?