The Citadel (novel)

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The Citadel is a novel by A. J. Cronin, first published in 1937, which caused an outcry in England due to its scathing criticism of the state of medical care at the time. The book was groundbreaking with its treatment of the contentious theme of medical ethics, laying the foundation for the introduction of the NHS a decade later. For his fifth book, Dr. Cronin drew on his experiences practicing medicine in the mining communities of South Wales, specifically Tredegar, where he had researched and published reports on the correlation between dust inhalation and lung disease. Additionally, he 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, Ralph Richardson and Rex Harrison, with at least one American (1960) and another BBC television adaptation (1983).

Plot summary

Hippocrates conquers hypocrisy in this story of an idealistic young doctor, Andrew Manson, whose first job is working for an older doctor in 'Blaenelly,' a small town in the Welsh mountains. Shocked by the conditions there, he determinedly works to improve matters before marrying Christine, a school teacher. They move to 'Aberalaw', a mining town in the Welsh valleys, where she helps Manson with his silicosis research. The couple later moves to London, where Manson works for a government department before going into private practice.

Seduced by the thought of easy money from wealthy clients rather than the good works that he originally set out to, Manson becomes involved with pampered private patients and fashionable surgeons, until a patient dies due to a surgeon's ineptitude. When Manson accuses the surgeon of murder, he is vindictively reported to the General Medical Council for having worked with a nature cure practitioner, even though the patient had been successfully treated.

Christine is tragically killed in a road accident, but Manson manages to justify his actions satisfactorily during the hearing and is not struck off the register. He finally decides to join two friends in opening an integrated, multispecialty practice in a country town.