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The NHS and the Works of A J Cronin

Right from its beginnings, the NHS has been represented in broadcast media such as radio, print, and film. Given the percentage of people both employed in and using the service, it is unsurprising that healthcare should provide a setting for so much of our culture too. 

With the 70th anniversary of the NHS just around the corner – it was founded on 5 July 1948 – this post looks at a novel (later made into a film) which raised issues of medical inequalities in the years before we had a National Heath Service. 

A J Cronin and The Citadel

In 1937 real life doctor Archibald Joseph Cronin  (1896-1981), published his second novel The Citadel. The novel was controversial in the way that it raised questions of medical ethics, and flagged up some important questions which some credit for the founding of the service at all. Briefly, the novel was the story of 24 year old, Andrew Manson, a newly qualified Scottish doctor who takes up a position in a fictitious Welsh mining town where he is shocked at the insanitary conditions he finds. On his first evening he is called to a patient suffering from typhoid fever. He soon realises how widespread this is, and is told almost immediately that the source of this is a contaminated water source. Manson orders all his patients to boil their water which does seem to help their recoveries. Eventually, the doctor and fellow medic Phillip Denny resort to the drastic measure of blowing up the source of the outbreak which he has traced to an old sewer. The book is credited with holding sway over people like Aneurin Bevan (1897-1960)  the government Minister for Health responsible for founding the NHS,  as it showed a socialised medicine model, in which the miners had a weekly sum deducted from their wages, paid to group of doctors in the town which paid for the medical care of the miner and his family. The novel rather unsubtly contrasts this model with the high fees and exclusivity of private practitioners in London’s Harley Street. 

The Citadel Film

Such was the popularity of his books that ‘Our NHS Scotland’ describes Cronin as the J. K. Rowling of his day.[1] The Citadel was only Cronin’s second book, but it was made into a film starring Rex Harrison the following year. The film was an astonishing success being nominated for four Oscars, including one for best picture, with nine million people going to the cinema to watch it.  The trailer for the film calls Manson ‘A Crusader’ and has suitably dramatic music alongside the clips for the film. Rosalind Russell starred as Manson’s young wife, Christine, standing by ‘helping and hoping’. Published in America by Little, Brown the book broke records in print like it did in film. The significance of the film to the NHS was made more pronounced when the film was re-released in 1948.

Dr Finlay’s Casebook

Aside from The Citadel, Cronin is remembered for the TV series Dr Finlay’s Casebook. This ran throughout the 1960s and began a radio show in the 1970s, but was based on an early novella, The Country Doctor, written by Cronin in 1935. It was set in the fictional Scottish village of Tannochbrae.  In 1993 Dr Finlay returned in a new four season TV series. This was set in the post World War II era and naturally included story lines depicting the newly set up NHS.

As Dr Finlay’s Casebook shows there is a huge public appetite for novels set in healthcare scenarios in the period immediately pre-NHS, which shows readers enjoy looking back on this period and remembering the challenges and exciting opportunities in the era in which the State was playing an increasing role in health care provision but in which finding affordable treatment was still a challenge for many. Since the founding of the NHS this has been the topic of many works of fiction too.

Further Reading

You can read more about the impact of The Citadel on the drive to found a nationalised health system in this 2012 article ‘A J Cronin and The Citadel: did a work of fiction contribute to the founding of the NHS’ by S O’Mahony.[2]

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[1] http://www.ournhsscotland.com/history/birth-nhs-scotland/expectant-public

[2] https://www.rcpe.ac.uk/sites/default/files/omahony_0.pdf

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