The Citadel

by A. J. Cronin

  When Ivory mentioned the object of his visit Gadsby had no need to assume interest. He leaned forward in his chair, his small eyes fastened upon Ivory, listening intently to the story.

  ‘Well! I’m damned!’ he exclaimed with unusual vehemence at the end of it. ‘I know this Manson. We had him for a short time on the MFB and I assure you we were extremely relieved to see the end of him. A complete outsider, hasn’t the manners of an errand boy. And do you actually mean to tell me that he took a case from the Victoria, it must have been one of Thoroughgood’s cases – we’ll hear what Thoroughgood has to say about that – and turned it over to Stillman?’

  ‘More than that, he actually assisted Stillman at the operation.’

  ‘If that is true,’ Gadsby said, carefully, ‘the case is one for the GMC.’

  ‘Well,’ Ivory hesitated becomingly. ‘That was precisely my own view. But I rather held back. You see I knew this fellow at one time rather better than you. I didn’t really feel like lodging the complaint myself.’

  ‘I will lodge it,’ said Gadsby authoritatively. ‘If what you tell me is indeed a fact I will lodge it personally. I should consider myself failing in my duty if I did not take immediate action. The point at issue is a vital one, Ivory. This man Stillman is a menace, not so much to the public, as to the profession. I think I told you my experience of him the other night at dinner. He threatens our status, our training, our tradition. He threatens everything that we stand for. Our only remedy is to ostracise him. Then, sooner or later, he runs into disaster over the question of certification. Observe that. Ivory! Thank God! we have kept that in the hands of the profession. We alone can sign a death certificate. But if – mark you – if this fellow and others like him can secure professional collaboration then we’re lost. Fortunately the GMC have always come down like a ton of bricks upon that sort of thing in the past. You remember the case of Jarvis, the manipulator, several years ago, when he got some cad of a doctor to anaesthetise for him. He was struck off, instanter. The more I think of that bounder Stillman the more I’m determined to make an example of this. If you’ll excuse me one minute now I’ll ring Thoroughgood. And then tomorrow I shall want to interrogate that nurse.’

  He rose and telephoned Doctor Thoroughgood. On the following day, in Doctor Thoroughgood’s presence he took a signed statement from Nurse Sharp. So conclusive was her testimony he immediately put himself in touch with his solicitors, Messrs Boon & Everton of Bloomsbury Square. He detested Stillman, of course. But he had already a soothing premonition of the benefit likely to accrue to a public upholder of the medical morality.

  While Andrew, oblivious, went to Llantony, the process raised against him moved steadily upon its way. It is true that Freddie, coming, in dismay, on a paragraph reporting the inquest upon Christine’s death, had telephoned Ivory to try to stop the case. But by then it was too late. The complaint had been lodged.

  Later the Penal Cases Committee considered that complaint and upon its authority a letter was dispatched summoning Andrew to attend at the November meeting of the Council to answer the charge laid against him. This was the letter which he now held in his hand, white with anxiety, confronted by the menace of its legal phrasing:

  ‘That you, Andrew Manson, knowingly and wilfully, on August 15th, assisted one Richard Stillman, an unregistered person practising in a department of medicine, and that you associated yourself in a professional capacity with him in carrying out such practice. And that in relation thereto you have been guilty of infamous conduct in a professional respect.’

  Chapter Twenty-Two

  The case was due to be heard on the 10th November and Andrew was in London a full week before that date. He was alone, for he had asked Hope and Denny to leave him entirely to himself. And he stayed, with a bitter, melancholy sentiment, at the Museum Hotel.

  Though outwardly controlled, his state of mind was desperate. He swung between dark fits of bitterness and an emotional suspense which came not only from his doubts about the future but from the vivid remembrance of every past moment of his medical career. Six weeks ago the crisis would have found him still benumbed by the agony of Christine’s death, heedless, uncaring. But now, recovered, eager and ready to begin work again, he felt the shock of it with cruel intensity. He realised, with a heavy heart, that if all his reborn hopes were killed then he too might just as well be dead.

  These and other painful thoughts perpetually thronged his brain, producing at times a state of bewildering confusion. He could not believe that he, Andrew Manson, was in this horrible situation, really facing the dreaded nightmare of every doctor. Why was he called before the Council? Why did they wish to strike him off the register? He had done nothing disgraceful. He was guilty of no felony, no misdemeanour. All that he had done was to cure Mary Boland of consumption.

  His defence was in the hands of Hopper & Co, of Lincoln’s Inn Fields, a firm of solicitors Denny had strongly recommended to him. At first sight Thomas Hopper was not impressive, a small red-faced man with gold-rimmed glasses and a fussy manner. Through some defect in his circulation he was subject to attacks of suffusion of his skin which gave him a self-conscious air, a peculiarity that certainly did not serve to inspire confidence. Nevertheless Hopper had decided views upon the conduct of the case. When Andrew, in his first burst of agonised indignation, had wished to rush to Sir Robert Abbey, his one influential friend in London, Hopper had wryly pointed out that Abbey was a member of the Council. With equal disapproval the fussy little solicitor had vetoed Andrew’s frantic plea that they cable Stillman to return immediately from America. They had all the evidence that Stillman could give them and the actual presence of the unqualified practitioner could serve only to exasperate the Council members. For the same reason Marland, now acting at Bellevue, must stay away.

  Gradually Andrew began to see that the legal aspect of the case was utterly different from his own. His frenzied logic as, in Hopper’s office, he protested his innocence, caused the solicitor disapprovingly to wrinkle up his brow. At last Hopper was forced to declare:

  ‘If there is one thing I must beg of you, Doctor Manson, it is that you will not express yourself in such terms during the hearing on Wednesday. I assure you nothing would be more fatal to our case.’

  Andrew stopped short, his hands clenched, his eyes burning on Hopper.

  ‘But I want them to know the truth. I want to show them that getting this girl cured was the best thing I’d done for years. After mucking about for months doing ordinary material practice I’d actually done something fine and that – that’s what they’re having me up for.’

  Hopper’s eyes behind the glasses were deeply concerned. In his vexation the blood rushed into his skin.

  ‘Please, please, Doctor Manson. You don’t understand the gravity of our position! I must take this opportunity to tell you frankly that at the best I consider our chances of – of success to be slender. Precedent is dead against us – Kent in nineteen-nine, Louden in nineteen-twelve, Foulger in nineteen-nineteen, they were all deleted for unprofessional associations. And, of course, in the famous Hexam case, in nineteen-twenty-one, Hexam was struck off for administering a general anaesthetic for Jarvis the bonesetter. Now, what I wish to entreat of you is this – answer questions in the affirmative or negative or, failing that, as briefly as possible. For I solemnly warn you that if you launch into one of these digressions which you have recently been offering me we will unquestionably lose our case and you will be struck off the register as sure as my name is Thomas Hopper.’

  Andrew saw dimly that he must try to hold himself in check. Here he must, like a patient laid upon the table, submit to the formal operations of the Council. But it was difficult for him to reach that passive state. The mere idea that he must forgo all attempt at self-exoneration and dully answer ‘ yes’ or ‘no’ was more than he could bear.

  On the evening of Tuesday the 9th November, when his febrile expectation of what the next day would bring had reached its zenith, he fou
nd himself unaccountably in Paddington, walking in the direction of the Vidlers’ shop, driven by a strange subconscious impulse. Deeply buried in his mind lay the morbid, still unconquered, fancy that all the calamity of these last months came in punishment for Harry Vidler’s death. The inference was involuntary, unadmitted. Yet it was there, springing from the deep roots of his earliest belief. He was drawn irresistibly to Vidler’s widow as though the mere sight of her might help him, give him, in some strange manner, appeasement from his suffering.

  It was a wet, dark night and there were few people in the streets. He had a sense of queer unreality, walking unrecognised in this district where he had been known so well. His own dark figure became a shadow amongst other phantoms all hurrying, hurrying through the teeming rain. He reached the shop just before closing time, hesitated, then as a customer came out, hurriedly went in.

  Mrs Vidler was alone, behind the counter of the cleaning and pressing department, folding a woman’s coat which had just been left with her. She wore a black skirt and an old blouse, dyed black, gaping a little at the neck. Her mourning made her somehow smaller. Suddenly she lifted her eyes and saw him.

  ‘It’s Doctor Manson,’ she exclaimed, her face lighting up. ‘ How are you, doctor?’

  His answer came stiffly. He saw that she knew nothing of his present trouble. He remained standing in the doorway, rigid, gazing at her, the rain dripping slowly from his hat brim.

  ‘Come in, doctor. Why, you’re drenched. It’s a wicked night –’

  He interrupted her, his voice strained, unreal.

  ‘Mrs Vidler, I’ve wanted to come and see you for a long time. I’ve often wondered how you were getting on –’

  ‘I’m managing, doctor. Not so bad. I’ve a new young man in the cobbling. He’s a good worker. But come in and let me give you a cup of tea.’

  He shook his head.

  ‘I’m – I’m just passing.’ Then he went on, almost desperately. ‘You must miss Harry very much.’

  ‘Well, yes, I do. At least, at first I did. But it’s wonderful’ – she even smiled at him – ‘ how you come to get used to things.’

  He said rapidly, confusedly:

  ‘I reproach myself – in a way. Oh! it all happened so suddenly for you, I’ve often felt you must blame me –’

  ‘Blame you!’ She shook her head. ‘How can you say such a thing, when you done everything, even to the home, and getting the finest surgeon –’

  ‘But you see,’ he persisted huskily, a rigid coldness in all his body, ‘ if you had done differently, perhaps if Harry had gone to hospital –’

  ‘I wouldn’t have had it any different, doctor. My Harry had the best that money could give him. Why, even his funeral, I wish you could have seen it, the wreaths. As for blaming yourself – why, many’s the time I’ve said in this shop Harry couldn’t have had a better nor a kinder nor a cleverer doctor than yourself–’

  As she went on talking he saw with a conclusive pang that, though he made open confession, she would never believe him. She had her illusion of Harry’s peaceful, inevitable, costly passing. It would be cruelty to shake her from this pillar to which she clung so happily. He said, after a pause:

  ‘I’m very glad to have seen you again, Mrs Vidler. As I’ve said – I wanted to look you up.’

  He broke off, shook hands with her, bade her good night, and went out.

  The encounter, far from reassuring or consoling him, served only to intensify his wretchedness. His mood underwent a complete revulsion. What had he expected? Forgiveness, in the best fictional tradition? Condemnation? He reflected bitterly that now she probably thought more highly of him than ever. As he tramped back through the sopping streets he had the sudden conviction that he must lose his case tomorrow. The conviction deepened to a terrifying certainty.

  Not far from his hotel, in a quiet side street, he passed the open doorway of a church. Once again impulse caught him, caused him to stop, retrace his steps and enter. It was dark inside, empty and warm, as though a service had not long ended. He did not know what church it was, nor did he care. He simply sat down in the back seat of all and fixed his haggard gaze upon the dark enshrouded apse. He reflected how Christine in their estrangement had fallen back upon the thought of God. He had never been a church-goer, but now, here he was, in this unknown church. Tribulation brought people here, brought people to their senses, brought people to the thought of God.

  There he sat, bowed, like a man resting at the end of a journey. His thoughts flowed outwards, not in any considered prayer, but winged with the longing of his soul. God! don’t let me be struck off. Oh, God! don’t let me be struck off. For perhaps half an hour he remained in this strange meditation, then he rose and went straight to his hotel.

  Next morning, though he had slept heavily, he woke to an even greater sense of sick anxiety. As he dressed his hands trembled slightly. He blamed himself for having come to this hotel with its associations of his membership examination. The feeling he now experienced was exactly that pre-examination dread, intensified a hundredfold.

  Downstairs he could eat no breakfast. The time of his case was eleven o’clock and Hopper had asked him to be early. He estimated it would take him not more than twenty minutes to get to Hallam Street and he fretted, in nervous pretence, with the newspapers in the hotel lounge until half past ten. But when he started his taxi was caught in a long traffic jam due to an obstruction in Oxford Street. It was striking eleven when he reached the GMC offices.

  He hurried into the Council Chamber with only a disturbed impression of its size, of the high table where the Council sat with the President, Sir Jenner Halliday, in the chair. Seated at the far end were the participants in his own case, oddly like actors waiting for their cue. Hopper was there, Mary Boland, accompanied by her father, Nurse Sharp, Doctor Thoroughgood, Mr Boon, Ward Sister Myles – his glance travelled along the line of chairs. Then hastily he seated himself beside Hopper.

  ‘I thought I told you to be early,’ the solicitor said in an aggrieved tone. ‘ This other case is almost over. With the Council it’s fatal to be late.’

  Andrew made no answer. As Hopper had said, the President was even now pronouncing judgment on the case before his own, an adverse judgment, erasure from the register. Andrew could not keep his eye from the doctor convicted of some drab misdemeanour, a seedy down-at-heel individual who looked as though he had struggled hard to make a living. His utterly hopeless expression as he stood condemned by this august body of his fellows, sent a shiver over Andrew.

  But he had no time for thought, for more than a passing wave of pity. The next minute his own case was called. His heart contracted as the proceedings began.

  The charge was formally read through. Then Mr George Boon, the prosecuting solicitor, rose to open. He was a thin, precise, frock-coated figure, clean shaven, with a wide black ribbon to his eyeglasses. His voice came deliberately.

  ‘Mr President, gentlemen, this case which you are about to consider has, I submit, nothing to do with any theory of medicine as defined under Section Twenty-eight of the Medical Act. On the contrary, it exhibits a clear-cut instance of professional association with an unregistered person, a tendency which, I may perhaps observe, the Council has recently had cause to deplore.

  ‘The facts of the case are these. The patient, Mary Boland, suffering from apical phthisis, was admitted to the wards of Doctor Thoroughgood at the Victoria Chest Hospital on the 18th of July. There she remained under the care of Dr Thoroughgood until the 14th of September when she discharged herself on the pretext that she wished to return to her home. I say pretext because, on the day of her discharge, instead of returning home, the patient was met at the lodge of the hospital by Doctor Manson, who immediately took her to an institution by the name of Bellevue which purports, I believe, to undertake the cure of pulmonary disorders.

  ‘On arrival at this place, Bellevue, the patient was put to bed and examined by Doctor Manson in conjunction with the proprietor of t
he establishment, Mr Richard Stillman, an unqualified person and – er – I understand, an alien. Upon examination, it was decided in consultation – I particularly call the Council to mark that phrase – in consultation, Doctor Manson and Mr Stillman, to operate upon the patient and to induce the condition of pneumothorax. Thereupon Doctor Manson administered the local anaesthetic and the induction was performed by Doctor Manson and Mr Stillman.

  ‘Now, gentlemen, having briefly outlined the case I propose with your permission to call further evidence. Doctor Eustace Thoroughgood, please.’

  Doctor Thoroughgood rose and came forward. Removing his eye-glasses, and holding them in readiness to emphasise his points, Boon began his interrogation.

  ‘Doctor Thoroughgood, I have no wish to embarrass you. We are well aware of your reputation, I might say your eminence, as a consulting physician upon diseases of the lungs and I have no doubt you may be actuated by a sense of leniency towards your junior colleague, but, Doctor Thoroughgood, is it not the fact that on Saturday, the morning of the 10th of September, Doctor Manson pressed you to a consultation upon this patient Mary Boland?’

  ‘Yes.’

  ‘And is it not also the fact that in the course of this consultation he pressed you to adopt a line of treatment which you thought to be unwise?’

  ‘He wished me to perform APT.’

  ‘Exactly! And in the best interests of the patient you refused.’

  ‘I did.’

  ‘Was Doctor Manson’s manner in any way peculiar when you refused?’

  ‘Well –’ Thoroughgood hesitated.

  ‘Please, Doctor Thoroughgood! We respect your natural reluctance.’

  ‘He didn’t seem altogether himself that morning. He seemed to disagree with my decision.’

  ‘Thank you, Doctor Thoroughgood. You had no reason to imagine that the patient was dissatisfied with her treatment at the hospital’ – at the mere idea a watery smile touched Boon’s arid face – ‘ that she had any grounds for complaint against you or the staff.’