Introduction

Literature is a powerful thing which can change the world more efficiently than anything else. We are all familiar with the saying “knowledge / (good) words are food for the soul.” Some might argue about this statement and give more arguments about how money changes the world (like the Gulf miracle case), but I think that nothing is more durable and efficient as the influence left behind by a great novel, which can enrich souls, change the individuals and thus, entire collective mentalities. Long-lasting change, in opposition to the artificial, quick, fragile change driven by money, is created from within, from the individual level. How can we talk about a Build Back Ever Better if we are not referring to the individual level first? Hard to tell… and sadly, no one can buy wisdom, health, or happiness with money.

A great example, about how a novel influenced the collective mentality and how it contributed to change an entire medical system is The Citadel (1937) of the Scottish novelist Archibald Joseph Cronin (19 July 1896 – 6 January 1981). Further I will debate the novel and hopefully I will whet your appetite for a good read.

Although it was not part of the school curriculum, I read this book when I was a high school student, a long time ago. The plot, which is inspired from reality, remained imprinted in my mind and also the author’s biography, which gives so much credibility to this Realist masterpiece. Several years later, being at a cultural studies course at the University of Würzburg, I found out incredible scientific articles containing discussions on the importance of the novel, and I focused my attention on it again. I even wrote a term paper on this subject, and I was rewarded with an amazing grade, making my entire investigation even more fulfilling.   

About A. J. Cronin – the journey from a brilliant medic to a famous novelist

With a beautiful childhood and many early achievements, Cronin won a Carnegie scholarship to study medicine at the University of Glasgow in 1914. He graduated with highest honors in 1919 and began his medical career on the same year as ship's surgeon on an ocean liner. However, during the First World War, Cronin already served as a surgeon sub-lieutenant in the Royal Navy Volunteer Reserve. After the war, he trained and worked in several hospitals, and later, he undertook general practice at a small village on the Clyde, a mining town in South Wales. His personal life reflects very well the story of his best-selling novel, The Citadel – the subject of this article. During his medical career, he observed many problems of the medical practice of the time, among which inequity and incompetence. 

Due to a chronic duodenal ulcer, Cronin needed to interrupt his medical practice and take a prescribed half-year rest with a specific diet, time during which he satisfied his lifelong desire to write a novel, something much different from the medical prescriptions and scientific papers. In just three months he finished his first novel and became accepted by a publisher after a single application. The novel became an instant success and he never returned to medicine. His journey becoming a famous novelist started. Back in his days, each of his novels was a great success, a best-seller and his work was translated in many languages (I have it in my mother language and in English too).

The Citadel (1937) and the founding of the National Health Service (NHS) in the United Kingdom

Although The Citadel (1937) is a work of fiction, not a scientific piece of research, and not autobiographical, its plot is based on the medical experience and career of the author and shows several realities of the medical system of the time, in a critical way. It is a Realist novel, which due to its unmatched rising in popularity, disseminated the corruption in the medical system to the public, and this action led to a full reform. There were also attempts to get The Citadel banned by groups of medical specialists, however, they were unsuccessful.

The Citadel  tells the story of Andrew Manson, an idealistic young Scottish doctor, modelled closely on Cronin himself. His journey starts with him freshly graduated and in a search for a job, however, the barriers he will have to overcome on his right way are fit for a hero. The novel shows nicely that the right path is not always paved and is not the shortest, and yet, a just man, with principles, will always follow the righteous, just, correct path, regardless of the difficulty.

A full summary can be consulted here.

Clicking on the book cover will direct you to a free online version of the book.

Among the most interesting aspects of the novel are:

• An old, neglected leaking sewage system, source of typhoid in the town, was not ameliorated by the local administration, therefore, the medics decided to blow it up: “We could write a dozen letters,” Philip answered, with grim restraint. “And all we’d get would be a doddering commissioner down here in six months’ time. No! I’ve thought it all out. There’s only one way to make them build a new sewer.” “How?” “Blow up the old one!”  
• The righteous young medic faces many times the obligation to share a part of his salary with the head doctors.
• The righteous medic will make many enemies because he is sticking to the work ethics, for example, refusing to sign sick notes for healthy miners.
• The young medic starts researching the lung disease, caused by coal dust, so common for miners, and carries out experiments on animals, however, many of his enemies are accusing him of using animals without obtaining a license from the Home Office.
• The young medic studies hard and achieves great medical recognition.
• The confession of a medic about how he used colored water to fool patients: “Three guineas a time injections — of sterile water! Patient came in one day for her vaccine. I’d forgotten to order the damn thing, so rather than disappoint, pumped in the H2O. She came back the next day to say she’d had a better reaction than from any of the others. So, I went on. And why not? It all boils down to faith and the bottle of colored water. Mind you I can plug the whole pharmacopoeia into them when it’s necessary. I’m not unprofessional. Lord, no!”
• The young medic almost abandons his high ethical standards for wealth, becoming corruptible, however, he will come back to his righteous standards after an incident and vows to practice honest, scientific medicine.
• His private life suffers a lot from the loss of a child and in the end, the loss of his wife in an accident.
• In the end, he is establishing his dream to open a clinic and to practice honest medicine. 

Not only were the author's pioneering ideas instrumental in creating the National Health Service (NHS), but according to the historian Raphael Samuel, the popularity of Cronin's novels played a major role in the Labour Party's landslide victory in 1945 (North and South by Raphael Samuel, in London Review of Books, Vol. 17 No. 12 · 22 June 1995) 

The Citadel, had fomented extensive debate about the severe inadequacies of healthcare. The author's innovative ideas were essential to the conception of the National Health Service (NHS), publicly funded healthcare system in England, which was formed soon after the book's great success, on 5 July 1948. 

The book had great success in the United States also, and it was even voted as one of the most interesting book readers had ever read.

The Northern Light by A.J. Cronin is another amazing book, which I liked as much as the Citadel, but that will remain for another story. 

Conclusions

The righteous, just, correct path is never paved and is never the shortest way. With all the difficulties involved, a just person, with principles, will always follow that path, no matter the costs. 

Long-term change comes from within, not from without. True change happens within not without. 

If we want to Build Back Ever Better, then we need to start with ourselves, we need to find our better selves first. 

A good novel is an amazing way to enrich our souls with more experiences than we could absorb in just one lifetime. Literature is also one of the closest thing we have to time travel. 

A literature masterpiece can change an entire society, Cronin's Citadel did it! (I was always wondering, if Cronin would have continued his medical career, would he had the same impact on the health care system as he had with his novel? Good question, amazing life course).