The Citadel by A. J. Cronin

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 man had gone out of his mind, what was the cause of it all. He had always been a happy contented man – no worries, easy going, 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 oedematous 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 oedema but myxoedema. 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 Emlyn’s 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 of every symptom, they fitted as superbly as a complex jig-saw 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.
    Rising, he went down to the parlour where Doctor Bramwell, standing on the hearth-rug with his back to the fire, greeted him.
    ‘Well? Satisfied? The pen’s on the table.’
    ‘Look here, Bramwell,’ Andrew kept his eyes averted, battling to keep impetuous triumph from his voice. ‘I don’t think we ought to certify Hughes.’
    ‘Eh, what?’ Gradually the blankness left Bramwell’s face. He exclaimed in hurt astonishment, ‘ But the man’s out of his mind!’
    ‘That’s not my view,’ Andrew answered in a level tone, still stopping down his excitement, his elation. It was not enough that he had diagnosed the case. He must handle Bramwell gently, try not to antagonise him. ‘In my opinion Hughes is only sick in mind because he’s sick in body. I feel that he’s suffering from thyroid deficiency – an absolutely straight case of myxoedema.’
    Bramwell stared at Andrew glassily. Now, indeed, he was dumbfounded. He made several efforts to speak, a queer sound, like snow falling off a roof.
    ‘After all,’ Andrew went on persuasively, his eyes on the hearth-rug, ‘Pontynewdd is such a sink of a place. Once Hughes gets in there he’ll never get out. And if he does he’ll carry the stigma of it all his life. Suppose we try pushing thyroid into him first.’
    ‘Why, doctor,’ Bramwell quavered, ‘I don’t see –’
    ‘Think of the credit for you,’ Andrew cut in quickly. ‘If you should get him well again. Don’t you think it’s worth it. Come on now, I’ll call in Mrs Hughes. She’s crying her eyes out because she thinks Emlyn is going away. You can explain we’re going to try a new treatment.’
    Before Bramwell could protest Andrew went out of the room. A few minutes later when he came back with Mrs Hughes the Lung Buster had recovered himself. Planted on the hearth-rug he informed Olwen in his best manner ‘that there might still be a ray of hope’ while, behind his back, Andrew made a neat tight ball of the certificate and threw it in the fire. Then he went out to telephone to Cardiff for thyroid.
    There was a period of quivering anxiety, several days of agonised suspense, before Hughes began to respond to the treatment. But once it had started, that response was magical. Emlyn was out of bed in a fortnight and back at his