The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking in its treatment of the contentious subject of medical ethics. It has been credited with laying the foundation in Britain for the introduction of the NHS a decade later.[1][2]
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."
Plot summary
In October 1924, Andrew Manson, an idealistic, newly qualified doctor, arrives from Scotland to work as assistant to Doctor Page in the small (fictitious) Welsh mining town of Drineffy (Blaenelly is the name given in some adaptations). He quickly realises that Page is unwell and disabled and that he has to do all the work for a meagre wage. Shocked by the unsanitary conditions he discovers, Manson works to improve matters and receives the support of Dr Philip Denny, a cynical semi-alcoholic who, Manson finds out in due course, took a post as an assistant doctor after having fallen from grace as a surgeon. 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, Manson 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 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 principles. He and his wife repair their damaged relationship, but then she is run over by a bus and killed.
Since Manson has accused the incompetent surgeon of murder, he is vindictively reported to the General Medical Council for having worked with an American tuberculosis specialist, Richard Stillman, who does not have a medical degree, even though the patient had been successfully treated at his clinic. Stillman's treatment, that of pneumothorax, involved collapsing an affected lung with nitrogen, and was not universally accepted at the time.
Despite his lawyer's gloomy prognosis, Manson forcefully justifies his actions during the hearing and is not struck off the medical register.
Characters
Part I: Drineffy
Dr. Andrew Manson, the protagonist
Christine Manson (née Barlow), the Drineffy schoolteacher who marries Manson
Dr. Edward Page, a gentle, simple and hardworking doctor, to whom Andrew was brought in as assistant. Dr. Page was a bachelor and had literally worked himself out in the unswerving pursuit of duty.
Miss Blodwen Page, Dr. Page's unmarried sister
Dr. Nicolls, described as a "tight little money-chasing midwife" by his assistant Denny
Dr. Philip Denny
Dr. Bramwell, nicknamed the Lung Buster, the third practicing doctor of Drineffy, described as cordial, but naive and ignorant. His practice was not extensive, and did not permit the luxury of an assistant.
Mrs. Gladys Bramwell, his adulterous wife
Dai Jenkins, dispenser at Drineffy
Annie, kitchen maid at Page's
Olwen & Emlyn Hughes
Dr. Griffiths, lazy, evasive, incompetent district Medical Officer at Toniglan
Glyn Morgan, Councillor for Drineffy
Aneurin Rees, bank manager and Miss Page's sweetheart
Joe Morgan & Susan Morgan
Part II: Aberalaw
Dr. Idris Llewellyn
Dr. Urquhart
Dr. Medley
Dr. Oxborrow
Ed Chenkin, a miner at Aberalaw
Ben Chenkin, a miner at Aberalaw
Con Boland, the dentist of Aberalaw
Nurse Lloyd, the district nurse
Mr. & Mrs. Vaughan
Mr. Owen, the secretary to Aberalaw Medical Aid Society
Part III: CMFB
Gill Jones
Dr. Hope
Dr. Maurice Gadsby
Sir Robert Abby
Part IV: Private Practice
Frau Schmidt
Dr. Frederick "Freddie" Hamson
Dr. Ivory
Dr. Deedman
Harry Vidler & Mrs. Vidler
Richard Stillman, an American tuberculosis specialist who doesn't have a medical degree
Frances Lawrence
Hopper
Mary Boland
Nurse Sharp
Nurse Trent
Dr. Thoroughgood
Mr. Boon
Historical context
The novel is of interest because of its portrayal of a voluntary contribution medical association which is based (not entirely uncritically) on the Tredegar Medical Aid Society for which Cronin worked for a time in the 1920s, and which in due course became the inspiration for the National Health Service as established under Aneurin Bevan.
The Citadel was extremely popular in translation, being sold in book shops in the Third Reich as late as 1944. The scholar and Holocaust survivor Victor Klemperer noted, "English novels are banned of course; but there are books by A.J. Cronin in every shop window: he’s Scottish and exposes shortcomings of social and public services in England."[4] After the Second World War, it proved popular in Communist bloc countries as well, where Cronin was one of the few contemporary British authors to be published.[5]
^"Booksellers Give Prize to 'Citadel': Cronin's Work About Doctors Their Favorite--'Mme. Curie' Gets Non-Fiction Award ...", The New York Times, 2 March 1938, page 14. ProQuest Historical Newspapers The New York Times (1851–2007).
Ballots were submitted by 319 stores; there had been about 600 ABA members one year earlier.
• At the Hotel Astor luncheon, presenter Clifton Fadiman said, "Unlike the Pulitzer Prize committee, the booksellers merely vote for their favorite books. They do not say it is the best book or the one that will elevate the standard of manhood or womanhood. Twenty years from now we can decide which are the masterpieces. This year we can only decide which books we enjoyed reading the most."
