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Manson finds that his medical training is inadequate, that as a GP he has to be family doctor, diagnostician, surgeon, dispenser, anaesthetist, that other doctors are often incompetent, that local conditions are unsanitary resulting in an outbreak of cholera in the village, and that fee structures are open to abuse. When he moves to be an assistant doctor with the Aberalaw Medical Aid Society, for instance, he finds that all the assistant doctors have to pay one fifth of their fees to the suave Doctor Llewellyn, the head physician and surgeon.

Manson is very idealistic and principled at the start of his career. One can sympathise with his refusal to issue sick certificates to miners who are quite fit to work, with his run-in with the district nurse and her antiquated remedies which do more harm than good and his desire to overcome resistance to vaccination but when it comes to showing up another doctor for mis-diagnosis and to reviving a stillborn baby that others have given up on he comes across as rather sanctimonious.

It is when Manson sets up in private practice in London that Cronin unleashes the full force of his attack. Manson is gradually seduced by the idea of material success and resorts to the same stock remedies, pointless operations and endorsing commercial products which have no medical benefit as so many other doctors did.

Indeed, some of them went even further by making a lot of money from carrying out illegal abortions. Cronin also attacks the hospital system which saw the less well off condemned to be treated in crumbling, ancient buildings, funded by penny collections and advertising displays, whilst those who could afford it opted for private clinics, usually unsuitable former houses that were badly converted and ill-equipped.

He paints a picture of a profession that has no qualms about milking wealthy hypochondriacal ladies. She did not sleep because she did not exercise her muscles. She did not even exercise her brain. She had nothing to do but cut coupons and think about her dividends and scold her maid.

If only she would walk out of [the] room and do something real. Give some of her money to the poor. Help other people and stop thinking about herself!

Early in his career Manson marries Christine Barlow, the schoolteacher in Drineffy. She supports him through thick and thin, encourages him in his work and helps with his research into lung diseases. However, when they move to London she becomes distressed and alienated by his abandonment of his principles and his pursuit of wealth. Granted that women had to give up their careers on marriage at the time but the portrayal of her as the meek, uncorruptible wife who is constantly making do and forever knitting feels patronising.

In the closing chapter Manson gives an impassioned speech about scientific advance and the short-comings of the medical profession when summoned before the General Medical Council for so-called unethical conduct. As Cronin states, The Citadel is semi-autobiographical but because it was written to convey a powerful message, which it has been argued contributed significantly to the founding vision of the NHS, it has several flaws as a work of fiction.

However, it is an excellent social document and makes one very grateful for our modern medical system. It also achieved fame and influence of a less welcome sort.

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Notify me of new posts via email. Main menu Skip to content. There is quite a lot of social commentary like this in the book. Share this: Twitter Facebook. Like this: Like Loading It sounds very grim though. Leave a Reply Cancel reply Enter your comment here Fill in your details below or click an icon to log in:. Email required Address never made public. Name required.



A book which inspired the creation of the NHS. The Citadel is a moving story of tragedy, triumph and redemption. When newly qualified doctor Andrew Manson takes up his first post in a Welsh mining community, the young Scot brings with him a bagful of idealism and enthusiasm. Both are soon strained to the limit as Andrew discovers the reality of performing operations on a kitchen table and washing in a scullery, of unspeakable sanitation, of common infantile cholera and systemic corruption. There are no X-rays, no ambulances - nothing to combat the disease and poverty. It isn't long before Andrew's outspoken manner wins him both friends and enemies, but he risks losing his idealism when the fashionable, greedy world of London medicine claims him, with its private clinics, wealthy, spoilt patients and huge rewards. Adam Kay is a British comedian, former doctor and the bestselling author of the phenomenally popular This is Going to Hurt.


The Citadel

Cronin, a Scottish physician whose novels, including ''Hatter's Castle,'' ''The Citadel'' and ''The Keys of the Kingdom,'' made him one of the most popular authors in the English-speaking world, died at the age of 84 on Tuesday in a clinic in the village of Glion, near Montreux, Switzerland, where he had lived for the last 25 years. Cronin's death was made known yesterday after a private Roman Catholic service at the Notre Dame Church in Vevey that was attended by his three sons. Cronin had worked in the British Ministry of Information, spending several years in the United States. He had lived in Blue Hills, Me. In recent years, his books had not been major factors in the marketplace, and he did not turn out any of the best-sellers that had once captivated readers. Nevertheless, several of his famous titles remain in print, including ''The Citadel'' , ''The Keys of the Kingdom'' , ''Shannon's Way'' and ''Adventures in Two Worlds'' , his autobiography. He became a medical inspector of mines in South Wales and later built up a practice in Glasgow and London.


The Citadel is a novel by A. Cronin , first published in , which was groundbreaking in its treatment of the contentious theme of medical ethics. It has been credited with laying the foundation in Great Britain for the introduction of the NHS a decade later. 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.

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