The Citadel was a hugely popular novel when it was published in 1937. Demand was so high there were more than a dozen reprints issued within a year, a surprising feat for a book that largely focuses on issues of medical ethics and access to healthcare. The film version that was released a year later, starring Robert Donat ( a heart throb of the era) gave it an added boost in the popularity stakes.
Cronin based on his novel on his own experience as a doctor in the valleys of South Wales and later in Harley Street, London. His central figure is Andrew Manson, a newly-qualified doctor who arrives in the the small (fictitious) Welsh mining town of Drineffy in 1921 to take up a post of a medical assistant.
He is shocked by the conditions he discovers, but even more shocked by the attitudes of the town’s medical men. They are putting their patient’s lives at risk by their callous disregard for sound medical practices and unwillingness to try any new approaches.
Unable to make headway he escapes to a a new job as assistant in a miners’ medical aid scheme in the bigger coal mining town of “Aberalaw”. There he prospers, gaining a reputation as a caring and skilled doctor and recognition for his pioneering research into the relationship between dust inhalation of turberculosis. But once again he meets such strong opposition from a faction in the town, that he leaves Wales for London.
In the city he becomes seduced by the prospects for wealth and prestige by tending to well-heeled and influential members of society, putting aside all his ideals and principles. Until a disaster occurs which brings him to his senses.
Ups and Downs of A Doctor’s Life
My summary only barely touches on all the twists and turns in the life of Cronin’s doctor. Manson is a highly principled man who burns with the desire to see a change in medical practices. But he doesn’t have an ounce of sense about how to persuade people to his point of view. He repeatedly rushes ahead without considering the effect of his action, only to come up against jealousy, rivalries and complete opposition. He ends up moving from one post to another in search of his ideal system, only to end up more disillusioned.
As a work of fiction, The Citadel, has its flaws. I found it overly long and too full of dramatic “episodes”. I won’t go into details of these to avoid the book for other readers, but the sheer number of crisis moments in Manson’s life did push at the boundaries of credibility.
What kept me reading was the fact that the town of “Aberalaw” is actually based on the town of Tredegar, where I was born.
An Indictment of A Health System
Beyond the personal resonance I enjoyed learning more about the healthcare system in the early twentieth century. It was a bleak picture.
Patients who couldn’t afford prescriptions were often left to suffer. Those who scraped up some money, often got given drugs and treatments their doctor knew wouldn’t work but since the general practitioners relied upon prescriptions for an income there was no incentive to change. At the other of the scale were wealthy doctors and surgeons who behaved as members of a select club, passing cases to other medical men that they knew personally — without any regard for their capabilities.
Unsurprisingly the medical profession reacted with scorn to The Citadel. They shunned Cronin because they objected to his criticisms of their practices. They also censured the liberal attitudes he expressed through is protagonist.
In the end there was what you could class as a form of poetic justice. The Citadel — and especially its descriptions of a subscription based medical welfare system in “Aberalaw” — was credited with influencing one of the most significant health care reforms of the twentieth century: the foundation of a free-to-all National Health Service.
Sadly I bet few people have heard of Cronin let alone his connection to the NHS.
I read The Citadel as part of my second Classics Club list. it was the book chosen through the Classics Club spin back in March. I did manage to read it in time though I’m late getting this review done.