 | This articleneeds additional citations forverification. Please helpimprove this article byadding citations to reliable sources. Unsourced material may be challenged and removed. Find sources: "The Citadel" novel – news ·newspapers ·books ·scholar ·JSTOR(April 2018) (Learn how and when to remove this message) |
 First edition | |
| Author | A. J. Cronin |
|---|---|
| Language | English |
| Published | 1937 Gollancz (UK) Little, Brown (US) |
| Publication place | United Kingdom |
| Media type | Print (hardback & paperback) |
| Pages | 446 pp. (UK hardcover) |
| ISBN | 0-450-01041-4 |
The Citadel is a novel byA. J. Cronin, first published in 1937, which was groundbreaking in its treatment of the contentious subject ofmedical ethics. It has been credited with laying the foundation in Britain for the introduction of theNHS a decade later.[1][2]
In the United States, it won theNational Book Award for 1937 novels, voted by members of theAmerican Booksellers Association.[3]
For his fifth book, Dr. Cronin drew on his experiences practising medicine in the coal-mining communities of theSouth Wales Valleys, as he had forThe 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 ofTredegar. He had also worked as a doctor for theTredegar Medical Aid Society at theCottage Hospital, which served as the model for theNational Health Service.
Cronin once stated in an interview, "I have written inThe 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."
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 theSouth Wales coalfield. On the strength of this job, Manson marries Christine Barlow, a junior school teacher.
Christine helps her husband with hissilicosis 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, theMRCP, 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 theGeneral Medical Council for having worked with an Americantuberculosis 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 ofpneumothorax, involved collapsing an affected lung withnitrogen, 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.
The novel is of interest because of its portrayal of a voluntary contribution medical association which is based (not entirely uncritically) on theTredegar Medical Aid Society for which Cronin worked for a time in the 1920s, and which in due course became the inspiration for theNational Health Service as established underAneurin Bevan. (As trivia, Cronin has used the two names of Aneurin Bevan in two different characters, one of whom, Aneurin Rees, is an unpleasant bank manager while the other, Sam Bevan, is a simple, highly thankful miner who Manson saved once under risky conditions.)
The Citadel was extremely popular in translation, being sold in book shops in theThird Reich as late as 1944. The scholar andHolocaust survivorVictor 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 inCommunist bloc countries as well, where Cronin was one of the few contemporary British authors to be published.[5]
The novel was made into a1938 film withRobert Donat,Rosalind Russell,Ralph Richardson andRex Harrison, and television versions include one American (1960), two British (1960 and1983), and two Italian (1964 and2003) adaptations of the novel. There are also three film adaptations of the novel in Indian languages:Tere Mere Sapne (1971) inHindi,Jiban Saikate (1972) inBengali andMadhura Swapnam (1982) inTelugu.[6] In 1989, Korean TV Series “Angel’s Choice (MBC)” was featured as a storyline by mixing with “The Green Years”. In 2017, anadaptation for radio by Christopher Reason was featured as theBBC Radio 4 15 minute drama.[7] In June 2021, a longer radio adaptation was broadcast by Radio 4 as two 45-minute episodes, written by Christopher Reason and Tom Needham.[8]