The Citadel

by A. J. Cronin

  ‘None whatever. She always seemed well pleased, happy and contented.’

  ‘Thank you, Doctor Thoroughgood.’ Boon picked up his next paper. ‘And now, Ward Sister Myles, please.’

  Doctor Thoroughgood sat down. Ward Sister Myles came forward. Boon resumed:

  ‘Sister Myles, on the forenoon on Monday, the 12th of September, the next day but one after this consultation between Doctor Thoroughgood and Doctor Manson, did Doctor Manson call to see the patient?’

  ‘He did.’

  ‘Was it a usual hour for him to call?’

  ‘No.’

  ‘Did he examine the patient?’

  ‘No. We had no screens that morning. He just sat and talked with her.’

  ‘Exactly, Sister – a long and earnest conversation, if I may use the wording of your statutory declaration. But tell us, Sister, in your own words now, what took place immediately subsequent to Doctor Manson’s departure.’

  ‘About half an hour after, Number Seventeen, that’s to say, Mary Boland, said to me, “ Sister, I’ve been thinking things over and I’ve made up my mind to go. You’ve been very kind to me. But I want to leave next Wednesday.”’

  Boon interrupted quickly.

  ‘Next Wednesday. Thank you, Sister. It was that point I wished to establish. That will be all at present.’

  Ward Sister Myles stepped back.

  The solicitor made a politely satisfied gesture with his beribboned eyeglasses.

  ‘And now – Nurse Sharp, please.’ A pause. ‘Nurse Sharp. You are in a position to bear out the statement relating to Doctor Manson’s movements on the afternoon of Wednesday the 14th of September.’

  ‘Yes, I was there!’

  ‘I gather from your tone, Nurse Sharp, that you were there unwillingly.’

  ‘When I found out where we were going and who this man Stillman was, not a doctor or anything, I was –’

  ‘Shocked,’ Boon suggested.

  ‘Yes, I was,’ shot out Nurse Sharp. ‘I’ve never had to do with anybody but proper doctors, real specialists, all my life.’

  ‘Exactly,’ Boon purred. ‘Now, Nurse Sharp, there is just one point which I wish you to make quite clear once again for the benefit of the Council. Did Doctor Manson actually co-operate with Mr Stillman in – in performing this operation?’

  ‘He did,’ Nurse Sharp answered vindictively.

  At this point Abbey leaned forward and put a question suavely, through the President.

  ‘Is it not the case, Nurse Sharp, that when the events in question took place you were under notice to Doctor Manson?’

  Nurse Sharp reddened, violently, lost her composure and stammered: ‘Yes, I suppose so.’

  As she sat down a minute later Andrew was conscious of a faint spark of warmth – Abbey, at least, remained his friend.

  Boon turned to the Council table, mildly aggrieved at the interruption.

  ‘Mr President, gentlemen, I might continue to call witnesses but I am too sensible of the value of the Council’s time. Moreover, I submit that I have proved my case conclusively. There seems not the slightest doubt that the patient Mary Boland was removed, entirely through the connivance of Doctor Manson, from the care of an eminent specialist in one of the best hospitals in London to this questionable institute – which in itself constitutes a grave breach of professional conduct – and that there Doctor Manson deliberately associated himself with the unqualified proprietor of this institute in the performance of a dangerous operation already stated to be contra-indicated by Doctor Thoroughgood, the specialist ethically responsible for the case. Mr President, gentlemen, here, I submit, we are not dealing, as might appear at first sight, with an isolated instance an accidental misconduct, but with a planned, preconceived, and almost systematic infringement of the medical code.’

  Mr Boon sat down, well pleased, and began to polish his glasses. There was a moment’s silence. Andrew kept his eyes firmly upon the floor. It had been torture for him to endure the biased presentation of the case. Bitterly he told himself they were treating him like some hole-and-corner criminal. Then his solicitor came forward and prepared to address the Council.

  As usual, Hopper seemed flustered, his face was red and he had difficulty in arranging his papers. Yet, strangely, this seemed to gain him the indulgence of the Council. The President said:

  ‘Yes, Mr Hopper?’

  Hopper cleared his throat.

  ‘May it please you, Mr President, gentlemen – I am not in dispute with the evidence brought by Mr Boon. I have no wish to go behind the facts. But the manner of their interpretation gravely concerns us. There are, besides, certain additional points which throw a complexion upon the case much more favourable to my client.

  ‘It has not yet been stated that Miss Boland was primarily Doctor Manson’s patient, since she consulted him, previous to seeing Doctor Thoroughgood, on the 11th of July. Further, Doctor Manson was personally interested in the case. Miss Boland is the daughter of a close friend. Thus, all along, he regarded her as his own responsibility. We must frankly admit that Doctor Manson’s action was completely misguided. But I suggest respectfully it was neither dishonourable nor malicious.

  ‘We have heard of this slight difference of opinion over the question of treatment between Doctor Thoroughgood and Doctor Manson. Bearing in mind Doctor Manson’s great interest in the case it was not unnatural for him to wish to take it back into his own hands. Naturally, he wished to cause his senior colleagues no distress. That, and nothing more, was the reason of the subterfuge upon which Mr Boon has laid such stress.’ Here Hopper paused, pulled out a handkerchief and coughed. He had the air of a man approaching a more difficult hurdle. ‘And now we come to the matter of association, of Mr Stillman and Bellevue. I assume members of the Council are not ignorant of Mr Stillman’s name. Although unqualified, he enjoys a certain reputation and is even reported to have brought about certain obscure cures.’

  The President interrupted gravely:

  ‘Mr Hopper, what can you, a layman, know of these matters?’

  ‘I agree, sir,’ Hopper said hurriedly. ‘My real point is that Mr Stillman would appear to be a man of character. It so happens that he introduced himself to Doctor Manson many years ago through a letter complimenting Doctor Manson upon some research work he had done upon the lungs. The two met later on a purely unprofessional footing when Mr Stillman came here to establish his clinic. Thus, though it was ill-considered, it was not unnatural that Doctor Manson, seeking a place where he could himself give treatment to Miss Boland, should avail himself of the convenience offered him at Bellevue. My friend Mr Boon has referred to Bellevue as a “questionable” establishment. On that point I feel the Council might be interested to hear evidence. Miss Boland, please.’

  As Mary rose the scrutiny of the Council members fell upon her with marked curiosity. Though she was nervous and kept her gaze on Hopper, not once glancing at Andrew, she seemed well, in normal health.

  ‘Miss Boland,’ said Hopper, ‘ I want you to tell us frankly – did you find anything to complain of while you were a patient at Bellevue?’

  ‘No! Quite the reverse.’ Andrew saw at once that she had been carefully instructed beforehand. Her answer came with guarded moderation.

  ‘You suffered no ill effects?’

  ‘On the contrary. I am better.’

  ‘In fact the treatment carried out there was really the treatment Doctor Manson suggested for you at your first interview with him on – let me see – on July the 11th.’

  ‘Yes.’

  ‘Is this relevant?’ the President asked.

  ‘I have finished with this witness, sir,’ Hopper said quickly. As Mary sat down he threw out his hands towards the Council table in his deprecatory style. ‘What I am venturing to suggest, gentlemen, is that the treatment effected at Bellevue was in actuality Doctor Manson’s treatment carrried out – unethically perhaps – by other persons. There was, I contend, within the meaning of the act, no professional c
o-operation between Stillman and Doctor Manson. I should like to call Doctor Manson.’

  Andrew stood up, acutely conscious of his position, of every eye directed towards him. He was pale and drawn. A sense of cold emptiness lay in the pit of his stomach. He heard Hopper address him.

  ‘Doctor Manson, you received no financial gain in respect of this alleged co-operation with Mr Stillman?’

  ‘Not a penny.’

  ‘You had no ulterior motive, no base objective, in doing as you did?’

  ‘No.’

  ‘You meant no reflection on your senior colleague, Doctor Thoroughgood?’

  ‘No. We got on well together. It was just – our opinions did not coincide on this case.’

  ‘Exactly,’ Hopper intervened rather hastily. ‘You can assure the Council then, honestly and sincerely that you had no intention of offending against the medical code nor the remotest idea that your conduct was in any degree infamous.’

  ‘That is the absolute truth.’

  Hopper suppressed a sigh of relief as, with a nod, he dismissed Andrew. Though he had felt himself obliged to produce this evidence he had feared his client’s impetuosity. But now it was safely over, and he felt that, if his summing up were brief, they might now possibly have a slender chance of success. He said with a contrite air:

  ‘I have no wish to keep the Council further. I have tried to show that Doctor Manson made merely an unhappy mistake. I appeal not only to the justice, but to the mercy of the Council. And I should like finally to draw the Council’s attention to my client’s attainments. His past history is one of which any man might be proud. We are all aware of cases in which brilliant men have been guilty of a single error, and failing to secure mercy, their careers were eclipsed. I hope, and indeed I pray, that this case which you are about to judge may not be such as these.’

  The apology and humility in Hopper’s tone were quite admirable in their effect upon the Council. But almost at once Boon was on his feet again, craving the indulgence of the President.

  ‘With your permission, sir, there are one or two questions I should like to put to Doctor Manson.’ He swung round, inviting Andrew to his feet by an upward movement of his eyeglasses. ‘Doctor Manson, your last answer was scarcely clear to me. You say you had no knowledge that your conduct was in any degree infamous. Yet you did know that Mr Stillman was not a qualified gentleman.’

  Andrew considered Boon from beneath his brows. The attitude of the finicky solicitor had, during the entire hearing, made him feel guilty of some disgraceful act. A slow spark kindled in the chilly void within him. He said distinctly:

  ‘Yes, I knew he was not a doctor.’

  The little wintry smirk of satisfaction showed on Boon’s face. He said goadingly:

  ‘I see. I see. Yet even that did not deter you.’

  ‘Even that didn’t,’ echoed Andrew with sudden bitterness. He felt his control going. He took a long breath. ‘Mr Boon, I’ve listened to you asking a great many questions. Will you allow me to ask you one? Have you heard of Louis Pasteur?’

  ‘Yes,’ Boon was startled into the reply. ‘Who hasn’t!’

  ‘Exactly! Who hasn’t? You are probably unaware of the fact, Mr Boon, but perhaps you will allow me to tell you that Louis Pasteur, the greatest figure of all in scientific medicine, was not a doctor. Nor was Ehrlich – the man who gave medicine the best and most specific remedy in its entire history. Nor was Haffkine – who fought the plague in India better than any qualified gentleman has ever done. Nor was Metchnikoff, inferior only to Pasteur in his greatness. Forgive me for reminding you of these elementary facts, Mr Boon. They may show you that every man fighting disease who hasn’t got his name on the register isn’t necessarily a knave or a fool!’

  Electric silence. Hitherto the proceedings had dragged along in an atmosphere of pompous dreariness, a musty staleness, like a second-hand law court. But now every member at the Council table sat erect. Abbey, in particular, had his eyes upon Andrew with a strange intentness. A moment passed.

  Hopper, with his hand before his face, groaned in dismay. Now, indeed, he knew the case was lost. Boon, though horribly discomfited, made an effort to recover himself.

  ‘Yes, yes, these are illustrious names, we know. Surely you don’t compare Stillman with them?’

  ‘Why not,’ Andrew rushed on in burning indignation. ‘They’re only illustrious because they’re dead. Virchow laughed at Koch in his lifetime – abused him! We don’t abuse him now. We abuse men like Spahlinger and Stillman. There’s another example for you – Spahlinger – a great and original scientific thinker. He’s not a doctor. He has no medical degree. But he’s done more for medicine than thousands of men with degrees, men who ride about in motor-cars and charge their fees, free as air, while Spahlinger is opposed and disparaged and accused, allowed to spend his fortune in research and treatment, and then left to struggle on in poverty.’

  ‘Are we to take it,’ Boon managed a sneer, ‘that you have an equal admiration for Richard Stillman?’

  ‘Yes! He’s a great man, a man who has devoted his whole life to benefiting mankind. He’s had to fight jealousy and prejudice and misrepresentation too. In his own country he has overcome it. But apparently not here. Yet I’m convinced that he’s done more against tuberculosis than any man living in this country. He’s outside the profession. Yes! But there are plenty inside it who have been running up against TB all their lives and have never done an atom of good in fighting it.’

  There was sensation in the long high room. Mary Boland’s eyes now fixed on Andrew were shining between admiration and anxiety. Hopper, slowly and sadly, was gathering his papers, slipping them into his leather case.

  The President intervened.

  ‘Do you realise what you are saying?’

  ‘I do,’ Andrew gripped the back of the chair tensely, aware that he had been carried into grave indiscretion but determined to stand by his opinions. Breathing quickly, strung to breaking pitch, a queer kind of recklessness took hold of him. If they were going to strike him off, let him give them cause to do so. He rushed on, ‘I’ve listened to the pleading that’s been going on to-day on my behalf and all the time I’ve been asking myself what harm I’ve done. I don’t want to work with quacks. I don’t believe in bogus remedies. That’s why I don’t open half the highly scientific advertisements that come pouring into my letter box by every post. I know I am speaking more strongly than I should, but I can’t help it. We’re not nearly liberal enough. If we go on trying to make out that everything’s wrong outside the profession and everything is right within, it means the death of scientific progress. We’ll just turn into a tight little trade protection society. It’s high time we started putting our own house in order, and I don’t mean the superficial things either. Go to the beginning, think of the hopelessly inadequate training doctors get. When I qualified I was more of a menace to society than anything else. All I knew was the names of a few diseases and the drugs I was supposed to give for them. I couldn’t even lock a pair of midwifery forceps. Anything I know I’ve learned since then. But how many doctors do learn anything beyond the ordinary rudiments they pick up in practice. They haven’t got time, poor devils, they’re rushed off their feet. That’s where our whole organisation is rotten. We ought to be arranged in scientific units. There ought to be compulsory post-graduate classes. There ought to be a great attempt to bring science into the front line, to do away with the old bottle-of-medicine idea, give every practitioner a chance to study, to co-operate in research. And what about commercialism? – the useless guinea-chasing treatments, the unnecessary operations, the crowds of worthless pseudo-scientific proprietary preparations we use – isn’t it time some of these were eliminated? The whole profession is far too intolerant and smug. Structurally, we’re static. We never think of advancing, altering our system. We say we’ll do things and we don’t. For years we’ve been bleating about the sweated conditions under which our nurses work, the wretched pittances we pay the
m. Well? They’re still being sweated, still paid pittances. That’s just an example. What I really mean is deeper than that. We don’t give our pioneers a chance. Doctor Hexam, the man who was brave enough to give anaesthetics for Jarvis, the manipulator, when he was beginning his work, got struck off the register. Ten years later when Jarvis had cured hundreds of cases which had baffled the best surgeons in London; when he had been given a knighthood, when all the “best people” proclaimed him a genius, then we crawled back and gave him an honorary MD. By that time Hexam was dead of a broken heart. I know I have made plenty of mistakes, and bad mistakes, in practice. And I regret them. But I made no mistake with Richard Stillman. And I don’t regret what I did with him. All I ask you to do is to look at Mary Boland. She had apical phthisis when she went to Stillman. Now she’s cured. If you want any justification of my infamous conduct here it is, in this room, before you.’

  Quite abruptly he ended and sat down. At the high Council table there was a queer light upon Abbey’s face. Boon, still upon his feet, gazed at Manson with mixed feelings. Then, reflecting vengefully that he had at least given this upstart doctor enough rope to hang himself with, he bowed to the President and took his chair.

  For a minute a peculiar silence filled the chamber, then the President made the customary declaration.

  ‘I ask all strangers to withdraw.’

  Andrew went out with the rest. Now his recklessness was gone and his head, his whole body was throbbing like an overtaxed machine. The atmosphere of the council chamber stifled him. He could not endure the presence of Hopper, Boland, Mary and the other witnesses. He dreaded especially that melancholy reproach on the face of his solicitor. He knew he had behaved like a fool, a wretched declamatory fool. Now he saw his honesty as sheer madness. Yes, it was madness to attempt to harangue the Council as he had done. He ought to have been not a doctor but a stump orator in Hyde Park. Well! Soon he would cease to be a doctor. They would simply wipe him off the list.