The Citadel

by A. J. Cronin

  Doctor Thoroughgood smiled with dry asperity.

  ‘Our London physicians have always managed to get along very well in these same London conditions, Doctor Manson. We may not have the exotic devices of which you speak. But I venture to suggest that our solid, well-tried methods – though less spectacular – bring equally satisfactory and probably more lasting results.’

  Andrew, keeping his eyes lowered, did not answer. He felt that as a new member of the staff he had been indiscreet in voicing his opinion so openly. And Doctor Thoroughgood, to show that he had intended no snub, went on very pleasantly to turn the conversation. He talked about the art of cupping. The history of medicine had long been his special hobby and he had a mass of information on the subject of the surgeon-barbers of ancient London.

  As they rose he declared agreeably to Andrew:

  ‘I actually have an authentic set of cups. I must show you them one day. It really is a shame cupping has gone out. It was – still is – an admirable way of inducing counter-irritation.’

  Beyond that first slight breeze, Doctor Thoroughgood set himself out to be a sympathetic and helpful colleague. He was a sound physician, an almost unerring diagnostician, and he was always glad to have Andrew round his wards. But in treatment, his tidy mind resented the intrusion of the new. He would have nothing to do with tuberculin, holding that its therapeutic value was still completely unproved. He was chary of using pneumothorax and his percentage of inductions was the lowest in the hospital. He was, however, extremely liberal in the matter of cod-liver oil and malt. He prescribed it for all his patients.

  Andrew forgot about Thoroughgood in beginning his own work. It was wonderful, he told himself, after months of waiting, to find himself starting again. He gave, at the outset, quite a good imitation of his old ardour and enthusiasm.

  Inevitably his past work on the tubercular lesions induced by dust inhalation had brought him forward to the consideration of pulmonary tuberculosis as a whole. He planned vaguely, in conjunction with the Von Pirquet test, to investigate the earliest physical signs of the primary lesion. He had a wealth of material available in the undernourished children brought by their mothers in the hope of benefiting in Doctor Thoroughgood’s well-known liberality with extract of malt.

  And yet, though he tried very hard to convince himself, his heart was not in the work. He could not recapture the spontaneous enthusiasm of his inhalation investigations. He had far too much upon his mind, too many important cases in his practice, to be able to concentrate upon obscure signs which might not even exist. No one knew better than he how long it took to examine a case properly. And he was always in a hurry. This argument was unanswerable. Soon he fell into an attitude of admirable logic – humanly speaking, he simply could not do it.

  The poor people who came to the dispensary did not demand much of him. His predecessor had, it appeared, been something of a bully and so long as he prescribed generously and made an occasional joke his popularity was never in doubt. He got on well, too, with Doctor Milligan, his opposite number, and it was not long before he found himself adopting Milligan’s method of dealing with the regular patients. He would have them up, in a bunch, to his desk at the beginning of dispensary and rapidly initial their cards. As he scribbled Rep.Mist. – the mixture as before – he had no time to recollect how he had once derided this classic phrase. He was well on the way to being an admirable honorary physician.

  Chapter Nine

  Six weeks after he had taken over at the Victoria, as he sat at breakfast with Christine, he opened a letter which bore the Marseilles postmark. Gazing at it unbelievingly for a moment, he gave a sudden exclamation:

  ‘It’s from Denny! He’s sick of Mexico at last! Coming to settle down, he says – I’ll believe that when I see it! But, Lord! It’ll be good to see him again. How long has he been away? It seems ages. He’s coming home via China. Have you got the paper there, Chris? Look up when the Oreta gets in.’

  She was as pleased as he at the unexpected news, but for a rather different reason. There was a strong maternal strain in Christine, a queer Calvinistic protectiveness towards her husband. She had always recognised that Denny, and indeed, in a lesser degree, Hope, exerted a beneficial effect upon him. Now, especially, when he seemed changing, she was more anxiously alert. No sooner had this letter arrived than her mind was at work planning a meeting which would bring these three together.

  The day before the Oreta was due at Tilbury she broached the matter.

  ‘I wonder if you’d mind, Andrew – I thought I might give a little dinner next week – just for you and Denny and Hope.’

  He gazed at her in some surprise. In view of the vague undercurrent of constraint between them it was strange to hear her talk of entertaining. He answered:

  ‘Hope’s probably at Cambridge. And Denny and I might as well go out somewhere.’ Then, seeing her face, he relented quickly. ‘Oh!

  All right. Make it Sunday though; that’s the best night for all of us.’

  On the following Sunday Denny arrived, stockier and more brick-red of face and neck than ever. He looked older, seemed less morose, more contented in his manner. Yet he was the same Denny, his greeting to them being:

  ‘This is a very grand house. Sure I haven’t made a mistake.’ Half turning gravely to Christine. ‘This well-dressed gentleman is Doctor Manson, isn’t he? If I’d known I’d have brought him a canary.’

  Seated, a moment later, he refused a drink.

  ‘No! I’m a regular lime juicer now. Strange as it may seem I’m going to set to and get a real pull on the collar. I’ve had about enough of the wide and starry sky. Best way to get to like this blamed country is to go abroad.’

  Andrew considered him with affectionate reproof.

  ‘You really ought to settle down, you know, Philip,’ he said. ‘After all you’re on the right side of forty. And with your talents –’

  Denny shot him an odd glance from beneath his brows.

  ‘Don’t be so smug, Professor. I may still show you a few tricks one of these days.’

  He told them he had been lucky enough to be appointed Surgical Registrar of the South Hertfordshire Infirmary, three hundred a year and all found. He did not consider it a permanency, of course, but there was a considerable amount of operative work to be done there and he would be able to refresh his surgical technique. After that he would see what could be done.

  ‘Don’t know how they gave me the job,’ he argued. ‘It must be another case of mistaken identity.’

  ‘No,’ said Andrew rather stolidly, ‘it’s your MS, Philip. A first class degree like that will get you anywhere.’

  ‘What have you been doing to him?’ Denny groaned. ‘He don’t sound like the bloke what blew up that sewer with me.’

  At this point Hope arrived. He had not met Denny before. But five minutes was enough for them to understand one another. At the end of that time, as they went in to dinner, they were agreeably united in being rude to Manson.

  ‘Of course, Hope,’ Philip sadly remarked as he unfolded his napkin. ‘You needn’t expect much food here. Oh, no! I’ve known these people a long time. Knew the Professor before he turned into a woolly West-ender. They were thrown out their last home for starving their guinea-pigs.’

  ‘I usually carry a rasher in my pocket,’ said Hope. ‘It’s a habit I acquired from Billy Buttons on the last Kitchen-gunga expedition. But unfortunately I’m out of eggs, Mother’s hens are not laying at the moment.’

  There was more of this as the meal went on – Hope’s facetiousness seemed especially provoked by Denny’s presence – but gradually they settled down to talk. Denny related some of his experiences in the Southern States – he had one or two negro stories which made Christine laugh – and Hope detailed for them the latest activities of the Board. Whinney had at last succeeded in steering his long contemplated muscular fatigue experiments into action.

  ‘That’s what I’m doing now,’ Hope gloomed. ‘But thank heaven my sch
olarship has only another nine months to run. Then I’m going to do something. I’m tired of working out other people’s ideas, having old men stand over me’ – his tone dropped into ribald mimicry – ‘“How much sarco-lactic acid did you find for me this time, Mr Hope?” I want to do something for myself. I wish to God I had a little lab of my own!’

  Then, as Christine had hoped, the talk became violently medical. After dinner – despite Denny’s melancholy prognostication, they had stripped a brace of ducks – when coffee was brought in, she pleaded to remain. And though Hope assured her that the language would not be ladylike she sat, her elbows on the table, chin upon her hands, listening silently, forgotten, her eyes fixed earnestly on Andrew’s face.

  At first he had appeared stiff and reserved. Though it was a joy to see Philip again he had the feeling that his old friend was a little casual towards his success, unappreciative, even mildly derisive. After all, he had done pretty well for himself, hadn’t he? And what had Denny – yes, what had Denny done? When Hope chipped in with his attempts of humour he had almost told them, pretty sharply, to stop being funny at his expense.

  Yet now that they were talking shop he was drawn into it unconsciously. Momentarily, whether he wished it or not, he caught the infection from the other two and with not a bad copy of his old rapture, he made himself heard.

  They were discussing hospitals which caused him suddenly to express himself upon the whole hospital system.

  ‘The way I look at it is this.’ He took a long breath of smoke – it was not now a cheap Virginian cigarette but a cigar, from the box which he had, braving the devil in Denny’s eye, self-consciously produced – ‘The whole layout is obsolete. Mind you, I wouldn’t for anything have you think I’m knocking my own hospital. I love it down there at the Victoria and I can tell you we do great work. But it’s the system. Nobody but the good old apathetic BP would put up with it – like our roads, for instance, a hopeless out-of-date chaos. The Victoria is falling down. So is St John’s – half the hospitals in London are shrieking that they’re falling down! And what are we doing about it? Collecting pennies. Getting a few quid out of the advertisement hoardings we stick up on our frontage. Brown’s Beer is Best. Isn’t that sweet! At the Victoria, if we’re lucky, in ten years’ time, we’ll start to build a new wing, or a nurses’ home – incidentally you should see where the nurses sleep! But what’s the use of patching up the old carcase. What is the use of a lung hospital in the centre of a noisy foggy city like London? – damn it all, it’s like taking a pneumonia down a coal-mine. And it’s the same with most of the other hospitals, and the nursing-homes, too. They’re bang in the middle of roaring traffic, foundations shaken by the Underground, even the patients’ beds rattle when the buses go past. If I went in there, healthy, I’d want ten grains of barbitone every night to get to sleep. Think of patients lying in that racket after a serious abdominal, or running a temperature of a hundred and four with meningitis.’

  ‘Well, what’s the remedy?’ Philip lifted an eyebrow in that new irritating fashion. ‘A joint hospitals’ board with you as director in chief?’

  ‘Don’t be an ass, Denny,’ Andrew answered irritably. ‘Decentralisation is the remedy. No, that isn’t just a word out of a book, it’s the result of all that I’ve gone through since I came to London. Why shouldn’t our big hospitals stand in a green belt outside London, say fifteen miles outside. Take a place like Benham, for instance, only ten miles out, where there’s still green country, fresh air, quiet. Don’t think there would be any transportation difficulties. The tube – and why not a specially run hospital service – one straight, silent line, could take you out to Benham in exactly eighteen minutes. Considering that it takes our fastest ambulance forty minutes on the average to bring in an emergency, that sounds to me an improvement. You might say if we moved the hospitals we’d denude each area of its medical service. That’s rot! The dispensary stops in the area, the hospital moves on. And while we’re talking about it this question of area service is just one large hopeless muddle. When I came here at first, I found here in West London that the only place I could get my patient in was the East London hospital. Down at the Victoria too, we get patients from all over the shop – Kensington, Ealing, Muswell Hill. There’s no attempt to delimit special areas – everything comes pouring in to the centre of the city. I’m telling you fellows straight, the confusion is often unbelievable. And what’s being done? Zero, absolute zero. We just drag on in the old, old way, rattling tin boxes, holding flag days, making appeals, letting students clown for pennies in fancy dress. One thing about these new European countries – they get things done. Lord, if I had my way I’d raze the Victoria flat and have a new Chest Hospital setting out at Benham with a straight line of communication. And by God! I’d show a rise in our recovery rate!’

  This was merely by way of introduction. The crescendo of discussion rose.

  Philip got on to his old contention – the folly of asking the general practitioner to pull everything out of the one black bag, the stupidity of making him carry every case on his shoulders until that delightful moment when, for five guineas, some specialist he had never seen before drove up to tell him it was too late to carry anything at all.

  Hope, without mildness or restraint, expressed the case of the young bacteriologist, sandwiched between commercialism and conservatism – on the one hand, the bland firm of chemists who would pay him a wage to make proprietary articles, on the other a Board of blithering dotards.

  ‘Can you imagine,’ Hope hissed, ‘the Marx brothers sitting in a rickety motor-car with four independent steering wheels and an unlimited supply of motor-horns. That’s us at the MFB.’

  They did not stop until after twelve o’clock and then, unexpectedly, they found sandwiches and coffee before them on the table.

  ‘Oh, I say, Mrs Manson,’ Hope protested with a politeness which showed that, in Denny’s gibe, he was a Nice Young Man at Heart. ‘We must have bored you stiff. Funny how hungry talking makes one. I’ll suggest that to Whinney as a new line of investigation – effect upon the gastric secretions of hot-air fatigue. Ha! Ha! That’s a perfect Nag-ism!’

  When Hope had gone, with fervent protestations that he had enjoyed the evening, Denny remained a few minutes longer, exacting the privilege of his older friendship. Then, Andrew having left the room to ring for a taxi, he apologetically brought out a small, very beautiful Spanish shawl.

  ‘The Professor will probably slay me,’ he said. ‘But this is for you. Don’t tell him till I’m safely out of the way.’ He arrested her gratitude, always for him the most embarrassing emotion. ‘Extraordinary how all these shawls come from China. They’re not really Spanish. I got that one via Shanghai.’

  A silence fell. They could hear Andrew coming back from the telephone in the hall.

  Denny got up, his kind, wrinkled eyes avoiding hers.

  ‘I wouldn’t worry too much about him, you know.’ He smiled. ‘But we must try, mustn’t we, to get him back to Drineffy standards.’

  Chapter Ten

  At the beginning of the Easter school holidays Andrew received a note from Mrs Thornton asking him to call at Brown’s Hotel to see her daughter. She told him briefly, in the letter, that Sybil’s foot had not improved and, since she had been much struck by his interest at Mrs Lawrence’s she was anxious to have his advice. Flattered by this tribute to his personality, he made the visit promptly. The condition which he found upon examination was perfectly simple. Yet it was one which demanded an early operation. He straightened himself, with a smile to the solid, bare-legged Sybil now seated upon the edge of the bed, pulling on her long black stocking, and explained this to Mrs Thornton.

  ‘The bone has thickened. Might develop into a hammer toe if it’s left untreated. I suggest you have it seen to at once.’

  ‘That’s what the school doctor said.’ Mrs Thornton was not surprised. ‘We are really prepared. Sybil can go into a home here. But – well! – I’ve got confidence in
you, doctor. And I want you to undertake all the arrangements. Who do you suggest should do it?’

  The direct question placed Andrew in a dilemma. His work being almost entirely medical he had met many of the leading physicians, yet he knew none of the London surgeons. Suddenly he thought of Ivory. He said pleasantly:

  ‘Mr Ivory might do this for us – if he’s available.’

  Mrs Thornton had heard of Mr Ivory. Of course! Wasn’t he the surgeon who had been in all the newspapers the month before through having flown to Cairo to attend a case of sunstroke? An extremely well-known man! She thought it an admirable suggestion that he should undertake her daughter’s case. Her only stipulation was that Sybil should go to Miss Sherrington’s Home. So many of her friends had been there she could not think of letting her go anywhere else.

  Andrew went home and rang up Ivory, with all the hesitation of a man making a preliminary approach. But Ivory’s manner – friendly, confident, charming – reassured him. They arranged to see the case together on the following day and Ivory asserted that though he knew Ida to be bunged up to the attics, he could persuade her to make room for Miss Thornton should this be necessary.

  Next morning, when Ivory had agreed emphatically in Mrs Thornton’s presence with all that Andrew had said – adding that immediate operation was imperative – Sybil was transferred to Miss Sherrington’s Home and two days later, giving her time to settle down, the operation was performed.

  Andrew was there. Ivory insisted that he be present, in the most genuine and friendly fashion imaginable.