The Citadel

I recently finished The Citadel over spring break.  Cronin is a great writer and some day I may read one of his other books.  The comparison to Arrowsmith is warranted as the protagonist, Andrew Manson, is a young, idealistic physician who contends with a culture of corruption and materialism among his peers.

There are some really great moments in this book and as a doctor himself, Cronin is able to add a certain credibility to the medical scenes.  One of my favorite parts is when Manson has a eureaka moment diagnosing a patient, Emrys Hughes.  Hughes has had recent changes in temperament.  In the night, he goes mad and goes after his wife with a knife.  One of Manson's colleagues, Dr. Bramwell, wants to commit Hughes and needs a second opinion to do so.  He calls Manson, who wants to do his own examination and finds a better explanation:

       Emrys Hughes was in bed, and seated beside him - in case restraint should be necessary - were two of his mates from the mine...
      He went over to Emrys, and at first he hardly recognized him.  The change was not gross; it was Emrys true enough, but a blurred and altered Emrys, his features coarsened in some subtle way.  His face seemed swollen, the nostrils thickened, the skin waxy, except for a faint reddish patch that spread across the nose.  His whole appearance was heavy, apathetic.  Andrew spoke to him.  He muttered an unintelligible reply.  Then, clenching his hands, he came out with a tirade of aggressive nonsense, which, added to Bramwell's account, made the case for his removal only too conclusive.
     A silence followed.  Andrew felt that he ought to be convinced.  Yet, inexplicably, he was not satisfied.  Why, why, he kept asking himself, why should Hughes talk like this?  Supposing the manhad gone out of his mind, what was the cause of it all?  He had always been a happy, contented man - no worries, easygoing, amicable.  Why, without apparent reason, had he changed to this?  
     There must be a reason, Manson thought doggedly; symptoms don't just happen of themselves.  Staring at the swollen features before him, puzzling, puzzling for some solution of the conundrum, he instinctively reached out and touched the swollen face, noting subconsciously, as he did so, that the pressure of his finger left no dent in the [edematous] cheek.
     All at once, electrically, a terminal vibrated in his brain.  Why didn't the swelling pit on pressure?  Because - now it was his heart which jumped! - because it was not true [edema], but [myxedema].  He had it, by God, he had it!  No, no , he must not rush.  Firmly, he caught hold of himself.  He must not be a plunger, wildly leaping to conclusions.  He must go cautiously, slowly, be sure!
     Curbing himself, he lifted Emrys' hand.  Yes, the skin was dry and rough, the fingers slightly thickened at the ends.  Temperature - it was subnormal.  Methodically he finished the examination, fighting back each successive wave of elation.  Every sign and every symptom - they fitted superbly as a complex jigsaw puzzle.  The clumsy speech, dry skin, spatulate fingers, the swollen inelastic face, the defective memory, slow mentation, the attacks of irritability culminating in an outburst of homicidal violence.  Oh! the triumph of the completed picture was sublime.