The Citadel

This book was published in Great Britain in 1937 and also received the National Book Award (U.S.) for 1937. Written by A.J. (Archibald Joseph) Cronin, who was himself trained and practiced as a physician, the main character is a newly graduated Scottish doctor, Andrew Manson. He takes a paying job in a mining town in south Wales in order to pay back monies he was given to  complete his education. When he turns up to serve as physician's assistant to Dr. Page, he discovers that Page has been incapacitated by a stroke and is no longer able to practice. But in order to preserve the income that comes from his roster of patients with the local mining company, his wife makes Andrew carry the full case load at a meager salary and pockets the rest. Manson is zealous in wanting to provide medical care to the miners and to improve their living conditions and, at one point, in order to have new infrastructure built, helps another physician's assistant, Philip Denny, blow up the sewers, which are so defective that they are causing water-borne diseases to spread. Eventually resigning his position, he is hired to work in a large and somewhat more prosperous mining town, which allows him to marry Christine. His budding interest in miners' lung diseases propels him to do research on the effects of the working environment and, with his wife's support, he writes a paper on his findings and is awarded an MRCP. This qualification, in turn, leads him to London where he takes up the position of the Medical Officer of the Mines Fatigue Board. Thwarted in his pursuit of further research on lung diseases, he buys a private practice and begins a slide down a slippery slope of treating wealthy hypochondriacs in order to get more income. This change in focus estranges him from his wife. When  patient dies due to an inept surgical procedure by a colleague, Andrew is shocked back to his focus on patient care and reconciles with his wife. Andrew offers to help an old friend's daughter who has contracted TB. But the outdated methods of the London hospital where she is admitted fail to help her and Andrew takes the radical step of spiriting her away to a private clinic established by an American researcher, Richard Stillman, where she is treated with his new methods and gets better. Manson's soured relationships with his money grubbingy physician colleagues and his work with Stillman, who was unlicensed as a doctor in Britain, result in Andrew being brought before the General Medical Council. Against the advice of his lawyer, Manson offers an impassioned defense of his actions and is exonerated.

This book, along with many others of Cronin's, was made into a movie. Cronin's criticism of the corruption in private medical practice is also widely credited for setting an expectation among the public for a change, paving the way for the NHS.