TOWN DOCTOR WAS THE INSPIRATION FOR THE NHS

NOTEBOOK by BILL HEANEY

‘Only in his home town, among his relatives and in his own house is a prophet without honour’ (Mark 6:1-6).

It is Sunday after all, and so I believe I am entitled to take my introduction for this Notebook from the gospel according to St Mark.

I thought of this after asking myself why Dunbarton-born AJ Cronin has not been recognised for the fact that his work as a young, recently demobbed GP in an impoverished Welsh mining village was the inspiration for establishing the NHS.

Why then is there no statue of the great author outside the Municipal Buildings, for example?

Or why not even outside the Scottish Parliament at Holyrood in Edinburgh?

A plaque and a portrait in Dumbarton Library is not sufficient tribute to Cronin, who was born in a cottage in Cardross and lived in Round Riding Road, Dumbarton.

If William Denny, the shipbuilder whose statue is in College Park Street, merits this for having brought jobs and prosperity – for some – to Dumbarton, then what tributes does this community, and the whole country indeed, owe to AJ Cronin?

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Di Cronin, grand-daughter of AJ Cronin, was in Dumbarton. Picture by Bill Heaney

The National Health Service (NHS) has brought free healthcare – for all – and saved hundreds of thousands of lives since it was founded in 1948, not least during the past two months of the Corona virus pandemic.

Yet, while, and deservedly so, the frontline NHS doctors, nurses and their back-up staff from porters to cleaners to paramedics have been praised from the high heavens, I haven’t read anything at all in praise of Dr Cronin.

Who was he then, this brilliant young man who once studied at Dumbarton Academy in Church Street and St Aloysius College in Glasgow before going on to distinguish himself as a scholar in medicine at Glasgow University?

And as a best-selling author who became a millionaire before settling down with his family in Switzerland.

One of Cronin’s most successful books was The Citadel which was serialised for television and distributed throughout the world.

The Citadel was an immediate success, selling over 150,000 copies in Britain in the first three months’ after publication and 10,000 copies a week for the rest of the year.

It was equally successful in the US and in Europe, particularly in Germany and Russia. Readers in Communist Eastern Europe admired the technical modernisation and social criticism, while in Nazi Germany the book was regarded as useful anti-British propaganda.

The novel’s success was partly due to Victor Gollancz’s astute marketing of the book. He launched a major advertising campaign and the book became a favourite of book clubs, including Gollancz’s own Left Book Club.

He successfully sold the book as an exposé of corrupt institutions. A Gallup poll conducted in 1938 reported that The Citadel ‘impressed’ more people than any other book except the Bible.

The BBC broadcast ten readings from the novel in 1938. It went on to become a successful film, directed by King Vidor, garnering four Oscar nominations, including best actor (Robert Donat) and best picture. It was the most commercially successful film in Britain in 1939.

Contemporary reviews of the book however were not uniformly positive. Leonora Eyles, writing in The Times Literary Supplement, accused Cronin of demonising the entire medical profession.

It is claimed, with some justification, that the book strongly influenced the result of the 1945 British general election, when the voters rejected the war hero Winston Churchill in favour of the less charismatic social reformer, Labour leader Clement Attlee.

Is there a message in this? Will the voters at the next General Election reject the bombastic Boris Johnston for the self-effacing Nigel Starmer?

Will Nicola Sturgeon be forced to leave the stage by Labour’s Richard Leonard or, more likely, by Jackie Baillie, the MSP for Dumbarton, Vale of Leven, Helensburgh and Lomond, who is currently vice chair of the Scottish Labour Party?

Anyway, so it was that the Labour government that established the NHS in 1948 was elected to post war power.

Many of the seeds of the NHS were sown in Tredegar, home town of the NHS’s architect, Aneurin Bevan.

When Bevan introduced the NHS he wrote: “All I am doing is extending to the entire population of Britain the benefits we have had in Tredegar for a generation or more. We are going to ‘Tredegarise’ you.”

Cronin spent three formative years in this town which he calls ‘Aberlaw’ in The Citadel, and although there is no evidence that they met, it seems likely that they did.

They were certainly exposed to the same influences and the Medical Aid Societies set up by the miners’ unions in South Wales inspired Bevan to extend free healthcare to the entire nation.

In a review of another of his books, Adventures in Two Worlds, it is written of Cronin’s work as a GP in Tredegar: “In actual fact this scheme can definitely be regarded as the foundation of the plan of socialised medicine, which was eventually adopted by Great Britain.

Casci’s Cafe in Church Street and Di Cronin at the door of the house where Cronin lived with his aunt at Round Riding Road.

Aneurin Bevan, the Minister of Health, who was mainly responsible for the national project, was at one time a miner at Tredegar, and there, under the local aid organisation, the value of prompt and gratuitous (free) treatment for the worker was strongly impressed upon him.

It is difficult to quantify the influence of The Citadel though. Cronin was no socialist,  it seems, complaining that people who had free healthcare did not value it.

Nevertheless, its timing – the parliamentary bill on the health service was published in 1937 – was opportune. The 1920s and 30s were decades of scientific and social advance, yet British medicine was still essentially Victorian in its ideas and practice.

The Second World War accelerated the process of change and it is not surprising that when the war finally ended, the British electorate unsentimentally cast off Churchill.

The theme of The Citadel is the struggle of the idealistic young hero against the medical establishment, which is corrupt, venal, unscientific and self-serving.

Private practice is shown to be a shabby, money-grabbing business, exploiting the rich and gullible.

Quack treatments are commonplace and most doctors are too lazy to keep themselves abreast of scientific developments.

GPs are portrayed as ignorant drudges, peddling useless and outdated drugs (‘no more than a poultice mixer or medicine slinger’).

They rarely cooperate with each other, interested only in protecting their own interests.

Cronin, through one of the characters, Manson, almost prophesises the advent of evidence-based medicine (‘an absolute allegiance to the scientific ideal, no empiricism, no shoddy methods, no stock-prescribing, no fees snatching, no proprietary muck, no soft-soaping of hypochondriacs’) and continuing professional education (‘There ought to be a law to make doctors up to date … compulsory post-graduate classes – to be taken every five years’). He had his doubts, however, about socialised medicine.

Cronin is reported as having said there was certainly value in the scheme [The Miners’ Medical Aid Society], but that it also has its defects, of which the chief one, in Tredegar, was this – with complete carte blanche in the way of medical attention, the people were not sparing by day or night, in ‘‘fetching the doctor’’. A malingerer’s and hypochondriac’s paradise.

Manson delivers a long speech to his friends Denny and Hope on the inadequacies of the hospital system, particularly in London. He seems to suggest some form of state control: ‘And what’s being done? Zero, absolute zero. We just drag on in the old, old way, rattling tin boxes, holding flag days, making appeals, letting students clown for pennies in fancy dress. One thing about these new European countries – they get things done.’

One assumes these ‘new European countries’ are Hitler’s Germany and Mussolini’s Italy. The final chapter, when Manson, in a speech from the dock-style oration, addresses the General Medical Council, could be read on its own as a political manifesto, summarising Cronin’s views: on the failures of the system: Go to the beginning: think of the hopelessly inadequate training doctors get …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.

Cronin’s main argument, therefore, is not for the establishment of a state-controlled nationalised health service, but rather for education, training and reverence for the scientific method.

For a twenty-first century reader, Cronin’s clinical details are unfamiliar: the radical, allegedly scientific treatments espoused by Manson for tuberculosis seem to modern readers to be as ineffective as the quack patent medicines he rails against. Stallman, the charismatic American, is portrayed as achieving remarkable results

in patients with pulmonary tuberculosis by inducing a pneumothorax in the infected lung. In little over a decade and a half after the publication of The Citadel, effective antibiotic therapy for tuberculosis would become available making the idea of inducing pneumothorax to ‘rest the lung’ appear archaic, although in many cases it was effective.

The character of Dr Thorough good, the chest physician who, although kind and hard-working, is portrayed as irredeemably old-fashioned and outdated: But in treatment, his tidy mind resented the intrusion of the new. He would have nothing to do with tuberculin, holding that its therapeutic value was still completely unproved. He was chary of using pneumothorax and his percentage of inductions was the lowest in the hospital. He was, however, extremely liberal in the matter of cod-liver oil and malt he prescribed it for all his patients.

Ironically, Thorough good’s practice strikes the modern reader as more evidence-based than Manson’s or Stallman’s. The description of the botched operation by Ivory is unconvincing: exactly what sort of ‘cyst’ did this patient bleed from? It is not clear how a polyclinic comprising a physician, a surgeon and a microbiologist would bring cutting-edge medical care (our idea of ‘specialised cooperation’) to a market town in the West Midlands.

Talks were underway between a TV production company and the literary executor of AJ Cronin, the Cardross-born GP turned best-selling author, who created Dr Finlay’s Casebook.

Richard Madden and Bill (Dr Finlay) Simpson.

Once a staple Sunday night viewing for millions in the Sixties, there was media speculation that Dr Finlay’s Casebook could be set for a makeover with Bodyguard star Richard Madden  as Dr Finlay himself.

Di Cronin, the great man’s grand-daughter, was in Dumbarton when she visited the old Dumbarton Academy within the Burgh Hall in Church Street, where her grandfather was once a pupil.

Cronin went on to study at St Aloysius College in Glasgow and the University of Glasgow where he graduated in medicine.  She also visited Dumbarton Library in Strathleven Place and the site of the old Hatter’s shop in the High Street, which was at the centre of AJ Cronin’s most successful novel, Hatter’s Castle.

Di was also shown photographs of Casci’s Café in Church Street, which Cronin frequented after school, and made a brief visit to St Patrick’s Church in Strathleven Place.

And then, in the company of Professor Frank Dunn, an expert on Cronin, and consultant surgeon, Dumbarton-born Bernard Ferrie, took a stroll along the Quay where she saw Dumbarton Rock and the old Dumbarton Bridge.

And where the distant floodlights in the shadow of the Rock marked the new home of Dumbarton FC, which Cronin followed all his life from the days when he was lifted over the turnstiles at Boghead to support The Sons of the Rock.

Earlier, Di Cronin had met Frances Slorach, the grand-daughter of Dr Cameron Slorach, the Dumbarton GP on whom the character of Dr Cameron in Dr Finlay’s Casebook was based.

And she visited Dr Slorach’s grave in Dumbarton Cemetery before making her way to Willlowbrook, the house where Cronin lived next door to Miller’s Farm in Round Riding Road.

AJ Cronin with his own family and his own birthplace, Rosebank Cottage, Cardross.

The West Dunbartonshire Library Services heritage staff, including Sarah Christie, Jo Sherrington and Mary Frances McGlynn, had done their homework for the visit.

They had all the books, photographs, maps and other items relating to AJ Cronin on display and ready for examination by Di Cronin, who is married to Michael Platz and has two children, Christine and Andrew, both of whom have Cronin as their name.

Di and her husband live in Toronto and spend the winter in Miami, Florida.

She was first in Dumbarton in 1975 in the company of her grandfather who was “making a pilgrimage” to Dalchenna Farm in Inverary, which is where he wrote Hatter’s Castle during a period of ill health.

The Cronins stayed for the duration of their holiday at Inverary Castle with the Duke and Duchess of Argyll.

Di’s father, Patrick Cronin, was a cardiologist who became the Dean of Medicine at McGill University in Montreal before moving to Switzerland.

He was consultant to the Aga Khan and involved in the AK Foundation, a charity for research into heart disease, and her mother was Shirley-Gian Robertson – “a good Scottish name”.

Di herself was a researcher in neurology at McGill before moving into funding with a healthcare charity.

Disappointingly, Bailie Denis Agnew, the convener, nor any member of West Dunbartonshire’s the Arts and Culture Committee, was present to welcome Ms Cronin to Dumbarton, the town her grandfather repeatedly told the world he loved so well.

She told me, as we travelled around together, that talks were taking place to have Dr Finlay’s Casebook reproduced for cinema or television and was interested to know about the BBC Scotland at Gooseholm, where so many successful series and short films have been produced.

She later told Maggie Ritchie, of the Scottish Daily Mail, that she was “really excited about Dr Finlay’s Casebook being introduced to a whole new generation of viewers.

“I love the idea of Netflix picking it up – it would be perfect for binge-viewing,” she said. “I would love to see Richard Madden as Dr Finlay, who was played from the outset of the original series by actor Bill Simpson.”

Later, Di Cronin attended a symposium on the life and works of AJ Cronin in the University of Glasgow hosted by the Chancellor, Professor Sir Kenneth Calman.

Speakers at the event in the Hunterian Museum were Professor Dunn, who presented a biography of AJ Cronin; Professor Dame Anna F Dominiczak, who spoke about the ground-breaking work taking place today in the College of Medical, Veterinary and Life Sciences, and Professor Gerard Carruthers, Head of Scottish Literature, who spoke about the complete works of AJ Cronin.

However, the edge was taken off the visit by the fact that West Dunbartonshire Council virtually ignored the whole thing.

That is summed up in a note sent to The Democrat at the time by Elspeth Crocket, a retired teacher who lives in Dumbarton.

She wrote: “Quite outrageous that neither Baillie Agnew nor anyone else from the Arts and Culture committee turned up. Unbelievable.”

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