The Citadel (novel)
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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]
In the United States, it won the
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
Christine helps her husband with his
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.
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
Adaptations
The novel was made into a
References
- ^ "An expectant public: 1948–2008 60 years of the NHS". Birth of NHS in Scotland. Scottish Government. 2008. Retrieved 25 March 2013.
- ^ "A.J. Cronin: Biography on Undiscovered Scotland". www.undiscoveredscotland.co.uk. Retrieved 13 August 2023.
- ^ "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 theHotel Astor luncheon, presenter Clifton Fadiman said, "Unlike the Pulitzer Prizecommittee, 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." - ^ "I Will Bear Witness A Diary Of The Nazi Years". archive.org. Retrieved 18 March 2020.
- ISSN 0013-8266.
- ^ "IN FOCUS - Dreaming of a better tomorrow". The Times of India. Retrieved 30 November 2016.
- ^ "15 Minute Drama, The Citadel". BBC Radio 4. Retrieved 2 November 2017.
- ^ "The Citadel episode 1". BBC Sounds. Retrieved 17 June 2021.
- "The Citadel episode 2". BBC Sounds. Retrieved 17 June 2021.
External links
- The Literature, Arts, and Medicine Database
- Book summary (Archived version)
- Analysis of The Citadel
- Excerpt from "Health in Gwent"
- History of healthcare in the South Wales Coalfield
- Article about Cronin and the NHS
- "The Citadel" on The Campbell Playhouse (January 21, 1940) with Orson Welles and Geraldine Fitzgerald