The Citadel by the Scottish author A.J. Cronin was first published in 1939. It was the fifth book that he had had published and prior to taking up writing he had been a doctor for ten years. The Citadel must have been cooking away in his head for several years before he wrote it. This book is much more important than most fiction as it has been regarded as having been instrumental in the setting up of the National Health Service.
At the beginning the setting is 1924 in a coalmining village called Drineffy in Wales where Dr Andrew Manson has taken his first position after graduating. He’s going to be the assistant to a doctor who has worked there for years and is popular, but Andrew quickly discovers that he will have to do all of the work as Dr Page is bed-ridden, having had a stroke. This doesn’t stop Page’s spinster sister from grabbing the vast majority of the money from the ‘business’ leaving Andrew with less than a pound a week for pocket money. It’s a miserable dirty and poverty stricken place but Andrew works hard and is popular and he’s interested in doing research into lung diseases so he has plenty of interesting case, and to cap his happiness he marries Christine, a young schoolteacher. But not everyone is happy with the young doctor, he has made some enemies and that culminates with Andrew leaving the village to work in a larger Welsh town.
Andrew and Christine eventually end up moving to London where he buys a deceased doctor’s practice, but most of his patients are poor so life is still a struggle. When Andrew meets up with one of his friends from university he can’t help being jealous of his riches. He wasn’t as clever or hard working as Andrew but had concentrated on looking prosperous and soon was, with wealthy patients, most of whom were not at all ill but were lonely or hypochondriacs. The successful medics were selling medicine which was mainly made up of coloured water with a bit of ether added. In fact they weren’t any better than snake oil salesmen. Andrew is seduced by the high lifestyle and as he gets richer his marriage deteriorates until he and Christine are barely speaking to each other. She longs for the countryside and a garden but spends her days standing in a cupboard making up the fake medicines.
A tragedy wakes Andrew up to what he has been doing, and he realises that so many of his Harley Street colleagues are charlatans doing much more harm than good and doing very well out of it financially.
This is a sad book at times, but is a great read and when it was published it was Gollancz’s highest selling book. As you can imagine Cronin made plenty of enemies, and a group of medical specialists tried to have the book banned which probably just about guaranteed its success.