A. J. Cronin (1896–1981)

A good, old-fashioned novel (in the best sense): a story of engaging people doing interesting things, well-told.

The theme is the public health in the UK before the 1948 Act which introduced the National Health service. Incompetence and corruption amongst the medical class are exposed; our hero, Manson, works doggedly towards his own solutions, soon to be sanctioned in law (after the end of the narrative).

On the human side, we join Manson as a new graduate serving in the Welsh valleys, and show more follow this pilgrim's progress through triumph and disaster until, in the end, we leave him on the brink of fulfilling his dream: a group medical practice founded with the patients' interests at heart.

Interesting, from an historical perspective; important politically; refreshing artistically. show less

I can enjoy vintage fiction works that have something important to say, even when the writing styles may be dated—as is the case with this classic novel. What's more, it isn't a short or fast-paced read, but Andrew's experiences in the first phases had me interested enough to see where his journey would go.

It was something to watch his idealist's eyes open to lamentable realities concerning the state of the medical field he'd entered. Then with the thickening of the plot, the heightening show more of the conflict, and my growing care for some of the characters, I truly became invested.

And I appreciate a flawed protagonist; it isn't my thing for lead characters to come off as virtually perfect. Still, during the phase when Andrew changes into a fairly colossal jerk, although the author does show the gradual process of Andrew's reasoning and how he justifies himself on his way down, I found it a little hard to put up with his jerkiness and keep reading.

Also, I'm not a fan of the story's handling of the character Christine, ultimately, or how some critical matters play out in her marriage to Andrew. A big part of the issue may come down to this 1937 novel being a product of its period, as the author aimed to write a morality tale during a time when the culture/media promoted certain "wifely ideals."

On a different note, while the instances of more colorful language are left to the reader's imagination, I'd say that as the characters' uses of "damn" and "hell" in their nonliteral senses eventually increased, they became repetitive to the point of excess.

Nevertheless, I was sure that Andrew's journey as a man and as a doctor would come around in this story that, again, has something important and meaningful to say—including something about the folly of valuing, defending, and upholding institutions for their own sake while lacking or losing what should be the institutions' real concerns: human lives and wellbeing.

Plus, the reading made me curious to watch the 1983 British television mini series based on the novel. So! We'll see how that goes.

(Does that screen adaptation handle Christine's character any differently? Just asking. If you happen to know the answer—don't tell me.) show less

"If we go on trying to make out that everything's wrong outside the profession and everything is right within, it means the death of scientific progress."

First published in 1937 and set during the interwar years 'The Citadel' shines a light on the medical establishment in Britain at the time through the eyes of a young newly qualified Scottish doctor. Andrew Manson, takes up his first clinical post as an assistant to a GP in a small Welsh mining community where disease and poverty is rife, show more sanitation poor and operations are performed on kitchen tables before moving as his career progresses to the fashionable, greedy world of London with its private clinics, hypochondriac patients and rich awards. Manson arrives with a bagful of enthusiasm and idealism but soon comes face to face with the realism of his chosen profession.

Archibald Joseph Cronin was born in Cardross, Dunbartonshire, in 1896, and was destined either for the Church or medicine: he chose medicine. Cronin trained in various hospitals in Scotland, Dublin and South Wales. He was appointed as a Medical Inspector of Mines and reported on coal-dust inhalation and lung disease before subsequently moving to London and private practice. This novel is therefore semi-autobiographical in nature as he draws on his professional career as a background.

The novel has two specific areas of emphasis. Firstly, the work of the doctor in a poor community and how his work is transformed when he moves to a city and private practice. Secondly the competence, or incompetence, of doctors and their need to keep their skills up to date. Manson is often critical of the quality of other doctors' work.

In the small Welsh mining village, the men, as miners, can change doctors through a company insurance scheme whenever they wish, their choices often based on the doctor's own popularity rather than his ability. Manson is outspoken and critical of the way in which the service is funded which lands him in trouble.

But the climax comes when Manson is asked to treat the daughter of an old friend who has tuberculosis. Manson has her admitted to an established London hospital but when the treatment provided there shows no signs of benefit he recommends a new therapy. His senior disagrees and Manson removes his young patient to a newly built hospital with an un-medically qualified boss. However, despite the success of the treatment and his patient's subsequent discharge, when Manson’s London colleagues hear about this he is referred to the General Medical Council (GMC) to be investigated with the potential outcome of him being struck off the Medical Register.

In many respects this novel is a creature of its time. Cronin identified many of the issues in clinical practice which needed to be tackled , including better supervision of young doctors, postgraduate education programmes and the novel's popularity along with the cinematic portrayal helped towards the establishment of the NHS a decade or so later. However, some of the issues, in particular affordability, are still relevant today.

This isn't perhaps great literature. Manson despite his revolutionary zeal isn't always a particularly likeable character, he is often, selfish, arrogant and uncaring, but Cronin still manages to present an interesting and entertaining story. I am always interested in novels that feature social history and this book had the power to change public attitudes and behaviour towards health as well as professional thinking and for that reason alone deserves to be more widely read today. show less

Set in the 1920s in a Welsh mining town, protagonist Andrew Manson is a newly qualified Doctor of Medicine. He is idealistic and eager to make his mark. He wants to change the traditional ineffective methods and use the latest science in his treatments. He becomes fascinated with analyzing the source of miners’ lung diseases. As he moves upward in his career, he loses his idealism and becomes more interested in accumulating wealth. His wife grows disillusioned, wondering what happened to show more the man she married.

This book explores ethics in the medical profession. It portrays doctors of varying competence. Some keep up their skills and others become wedded to traditional remedies. Some compete vigorously with other doctors. The story contains descriptions of diagnoses, medical procedures, and surgeries. Published in 1937, this book was helpful in pointing out changes needed in the UK’s health care system. show less