Out of Hours bJGp library: The Citadel A pOtent reminder Of life befOre Address fOr COrrespOndenCe tHe nHs “It is said that the novel’s Graham Watt THE CITADEL General Practice & Primary Care, AJ Cronin effect on public opinion, 1 Horselethill Road, Glasgow G12 9LX, UK. Panmacmillan, 2013, PB, 432pp, £16.99 e-mail: [email protected] 978-1447244554 when it was published in 1937, paved the way for strength of doctors working together within Bevan’s NHS.” an organised system. The sensation of the novel, however, came from its description of the medical profession at that time, as Manson with sensational the novel was at the time, MD and MRCP, moves to Harley Street scandalising the medical profession and and private practice, socialises with the alarming the public, with a narrative rich and famous, loses his moral compass, showing that, while the interests of patients commits adultery, and becomes rich, and doctors usually overlapped, they did not selling bogus treatments to the worried always coincide. well. After he assists at a botched operation Cronin worked as a doctor for 11 years, and accuses the surgeon of murder, the before a 6-month period of convalescence profession closes ranks, charging Manson from duodenal ulcer (now curable with a with unprofessional conduct, as a result of The BJGP Library is a new regular column in short course of antibiotics) allowed him his having referred a tuberculous patient to the Out of Hours section where contributors to write his first novel. He never practised a medically-unqualified pioneer of induced write a 600-word article relating to a single medicine again, but mined his clinical pneumothorax. The patient recovered. book, usually a novel, that is important to experience to literary effect, becoming best Manson’s speech to the GMC, supporting them. It could be a recently read book, still known to television audiences for Dr Finlay’s scientific advance from whatever source fresh in the mind; or it could be one etched Casebook, a series produced in black and (including the medically-unqualified into your memory from many years past. white in the 1960s by the BBC, and re-made Louis Pasteur), and attacking closed It doesn’t have to be a medical book and in colour in the 1990s by STV. professionalism, is the climax of the novel. it doesn’t have to be a recognised ‘classic’ I had read The Citadel as a medical King Vidor’s classic black and white film, of literature — although many contributors student, and now encountered the starring Robert Donat as Manson, stays may well choose books that fall into one truthfulness of Cronin’s account of general true to most of the actions and dialogue in or both of those camps. The aim is to give practice in South Wales in the 1920s. From the book, especially in South Wales. His wife free rein to inform, educate, and inspire Julian Tudor Hart in Glyncorrwg, I learned Christine (played by Rosalind Russell) and our readers in the best traditions of the that Cronin’s tale of a GP dynamiting a best friend Dr Philip Denny (the young Ralph BJGP. Over time we will build up a library leaking sewer, which was infecting the Richardson) hold firm to Manson’s starting of essential books for the discerning reader local water supply and causing endemic values and are horrified by his professional and, en route, offer an illuminating insight to typhoid, so that the town council finally had rise and moral descent. Only one survives the contributors and their own motivations. to deal with it, was based on a true event at to see his redemption; Cronin chose to kill Aberdare in the Cynon Valley. off one of them, while King Vidor killed off When I went to work in general practice in Manson’s first big clinical success was the other. South Wales in the early 1980s, I kept in to revive an apparent still birth, transferring It is said that the novel’s effect on public touch with Stuart Douglas, Regius Professor the child rapidly between baths of hot and opinion, when it was published in 1937, of Medicine at the University of Aberdeen, cold water. Although Cronin based this on a paved the way for Bevan’s NHS. It remains where I had graduated. real case of his own,1 I could never find out, a riveting read, a work of fiction, but As a houseman at Glasgow Royal from my mystified paediatric teachers at the nevertheless, a potent reminder of what the Infirmary in the 1930s, he had injected the medical school in Aberdeen, the basis of this NHS replaced. And for one of my colleagues, first dose of penicillin given to a patient in unorthodox approach. with no family background in the profession, the west of Scotland. My letters reminded Cronin worked in Tredegar, Aneurin it was why she entered medicine. him of The Citadel, AJ Cronin’s partly- Bevan’s home village, and had first-hand autobiographical novel about a young experience of the ‘mini-NHS’, organised Graham Watt, Scottish doctor, Dr Andrew Manson, who around miners and their families, which Norie Miller Professor of General Practice, University of Glasgow, Glasgow. started, as Cronin did, in general practice provided the example and template for in South Wales, before getting his medical the universal coverage that Bevan later DOI: 10.3399/bjgp15X686641 degree by research, becoming an Inspector introduced. A theme of the book is the of Mines, and setting up in private practice in essentially limited nature of individual referenCe Harley Street, London.1 clinical practice, especially when doctors 1. Cronin AJ. Adventures in two worlds. Kessinger Professor Douglas recalled how compete for patients, and the potential Publishing: Whitefish, MT, 2007. 480 British Journal of General Practice, September 2015.