The Citadel (novel)

 

The Citadel
Author(s)	A. J. Cronin
Country	United Kingdom
Language	English
Genre(s)	Novel
Publisher	Gollancz (UK) Little, Brown (US)
Media type	Print (hardcover & paperback)
Pages	446 pp. (UK hardcover)
ISBN	0-450-01041-4

The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking with its treatment of the contentious theme of medical ethics. It is credited with laying the foundation in Great Britain for the introduction of the NHS a decade later.^{[citation needed]} In the U.S. it won the National Book Award for 1937 novels, voted by members of the American Booksellers Association.

For his fifth book, Dr. Cronin drew on his experiences practising medicine in the coal mining communities of the South Wales Valleys —as he had for The Stars Look Down two years earlier. Specifically, he had researched and reported on the correlation between coal dust inhalation and lung disease in the town of Tredegar. He had also worked as a doctor for the Tredegar Medical Aid Society at the Cottage Hospital, which served as the model for the National Health Service.

Cronin once stated in an interview, "I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug ... The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system."

The novel was made into a 1938 film with Robert Donat, Rosalind Russell, Ralph Richardson and Rex Harrison, and television versions include one American (1960), two British (1960 & 1983), and two Italian (1964 & 2003) adaptations of the novel. There are also three Indian film adaptations: Tere Mere Sapne (1971) in Hindi, Jiban Saikate (1972) in Bengali and Madhura Swapnam (1982) in Telugu.

Plot summary

In October 1921, Andrew Manson, an idealistic, newly qualified doctor, arrives from Scotland to work as assistant to Doctor Page in the small Welsh mining town of 'Drineffy'. He quickly realises that Page is an invalid and that he has to do all the work for a meagre wage. Shocked by the unsanitary conditions he finds, he works to improve matters and receives the support of Dr Philip Denny, a cynical semi-alcoholic. Resigning, he obtains a post as assistant in a miners' medical aid scheme in 'Aberalaw', a neighbouring coal mining town in the South Wales coalfield. On the strength of this job, he marries Christine Barlow, a junior school teacher.

Christine helps her husband with his silicosis research. Eager to improve the lives of his patients, mainly coal miners, Manson dedicates many hours to research in his chosen field of lung disease. He studies for, and is granted, the MRCP, and when his research is published, an MD. The research gains him a post with the 'Mines Fatigue Board' in London, but he resigns after six months to set up a private practice.

Seduced by the thought of easy money from wealthy clients rather than the principles he started out with, Manson becomes involved with pampered private patients and fashionable surgeons and drifts away from his wife. A patient dies because of a surgeon's ineptitude, and the incident causes Manson to abandon his practice and return to his former ways. He and his wife repair their damaged relationship, but Christine is killed in a traffic accident. It is Denny, now teetotal, who whisks him off to the Welsh countryside to recover.

Since Manson had accused the incompetent surgeon of murder, he is vindictively reported to the General Medical Council for having worked with an American tuberculosis specialist who does not have a medical degree, even though the patient had been successfully treated at his nature cure clinic.

Despite his lawyer's gloomy prognosis, Manson forcefully justifies his actions during the hearing and is not struck off the medical register.

He joins Denny and bacteriologist Dr Hope in opening an integrated, multi-specialty practice, then uncommon, in a country town.

External links

• The Literature, Arts, and Medicine Database
• Book summary
• Analysis of The Citadel
• Excerpt from "Health in Gwent"
• History of healthcare in the South Wales Coalfield
• Article about Cronin and the NHS
• The Campbell Playhouse's radio dramatization of The Citadel from 1940, starring Orson Welles

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