When A Book Makes a Difference

from Jacqueline

I’ve set about reading a few classics lately.  Not Dickens, or Austen, or Hemingway or Ftizgerald – though I like to go back to them.  Instead I’ve been picking up novels I enjoyed when I was younger, some of them you might never have even heard of.  And I’ve not wanted an ebook or even a brand new paperback; instead I’ve gone to the used book websites looking for old copies. Not first editions, but instead the books with slightly battered bindings and foxing on the pages.  I’ve wanted to read the book as it was when it was first published – minus the moldy bits, that is.    But that’s not all. I’ve been looking for books that had an impact beyond the bestseller list, beyond whatever it was that made the book a classic. I’m looking for books that changed something in the world – and that’s a tall order.

Over the past few days I’ve read a book you may be familiar with:  The Citadel by A. J. Cronin, first published in 1937.  

First of all, let’s look at the author, if you’ve never come across the book.  Archibald Joseph Cronin was a Scottish physician and novelist, though we know which one came first, and where he acquired the passion for his stories.  

He not only qualified as a physician, but also achieved many other prestigious letters of affiliation after his name – including M.D. (In Britain M.D. is an advanced medical research degree; a medical doctor's designation is M.B., MBBS or MBChB)  Cronin spent many years working as a doctor in mining towns, and became the Medical Inspector of Mines for Great Britain.  He engaged in ground-breaking research pointing to the link between inhalation of dust and pulmonary disease, though he was no desk-job doc – he went down the mines to treat men involved in all manner of accidents and disasters, often putting his life at risk to save the injured.  But he also experienced the other side of the medical coin, quite literally, and held a practice in Harley Street, London – where all the best and highest-paid doctors still like to hang out their shingle.  And this was at a time when a poor person would stand little chance of being admitted to any hospital.  To give you some context, in the year the book was published, my grandmother carried her six-year-old son on her back from hospital to hospital trying to get him admitted because he was suffering from an acute appendicitis.  They hadn’t the money to pay for surgery.  By the time a doctor agreed to see him, the appendix had burst and he almost died due to peritonitis. 

The Citadel is the story of a doctor who begins his career in a Welsh mining village and who, as time goes on, loses his way.  He starts out with such integrity – he’s poor, yet dedicated – but upon moving to London he sees the money other doctors are making, and he realizes how easy it is if you do a deal here and a deal there and keep the patients coming back for this treatment and that medicine.  In a way it’s the story of Icarus flying too high – though Manson doesn’t completely lose his wings.  But here’s the thing – via the novel Cronin advocated a free public health service in order to stop those doctors who "raised guinea-snatching and the bamboozling of patients to an art form.”  (FYI:  A guinea was one pound and one shilling).  He also believed fiercely in a more equitable system, that the poor should enjoy the same medical services as the rich.

For publisher Victor Gollancz the book became the biggest bestseller in his career until that point, yet at the same time Cronin made enemies within the medical profession (the fat cats) and there were those who tried to get the book banned.  In the United States The Citadel won the National Book Award in 1937.  But perhaps the greatest legacy of the book was the impact it had on healthcare in the United Kingdom. It became one of the powerful contributory factors in the establishment of the National Health Service.  The Citadel's message and its success created the tipping point, along with the women’s vote and the fact that the colossal number of civilian casualties in the 1939-45 war changed the way comprehensive health provision was viewed (you couldn't ethically charge people for injuries inflicted by the enemy in a time of war, could you?) - it also helped that a new Prime Minister, Clement Atlee, believed that if a country could raise the money to go to war, it could find the money to take care of the people.  Like it or not, The Citadel had tidal wave effect on public opinion.

I remember exactly why I first picked up The Citadel from our local library.  On a rainy Sunday afternoon when I was a kid, when old black and white movies were the only thing on either of the two available TV channels in Britain at the time, I was completely captivated by Robert Donat in the role of the young doctor, Andrew Manson, in the original movie version of The Citadel.  In one scene a baby has apparently been stillborn to an older mother who had dearly wanted a child.  Remembering something obscure in his training, Manson calls for a bowl of water as cold as can be, and another hot to the touch.  Fiercely he immerses the baby first in one bowl and then another, back and forth until at last a cry is heard and the child survives.  It was a harrowing scene as only an actor like Donat could make it. 

 I’m not saying The Citadel is everyone’s cup of tea, but even some 77 years after publication, it has worth and is thought provoking – as an aside, in one scene Andrew Manson, even complains of the many reps from drug companies who are pursuing him to promote their products. Cronin said of his novel, "I have written in The Citadel all I feel about the medical profession … this is not an attack against individuals, but against a system."

Well, good for him.  He made a difference from the moment that book hit the stands.

Now I’m interested in what you have to say – if there was a list of novels that made a real measurable difference in the world, what books do you think should be on the list? I’m thinking of books that changed the way people look at the world, stories that have affected public opinion, that – dare I say it – impacted legislation, or made life easier for people who needed it to be so. 

Take care, and have a good weekend. I’ll be in Cannon Beach, Oregon for a couple of days – I’m honored to be the guest speaker at a conference for nurses and am doing a couple of events in honor of National Nurses Week.  How great is that?