The Citadel (novel)

The Citadel

Company type	Novel
Industry	Literature
Founded	1937
Founder	A. J. Cronin
Products	Fiction novel

The Citadel is a novel published in 1937 by A. J. Cronin, recognized for its groundbreaking examination of medical ethics. It is often credited with playing a role in the creation of the NHS in the United Kingdom approximately ten years later.

In the United States, the novel received the National Book Award for 1937 works, an honor determined by votes from members of the American Booksellers Association. This distinction reflected the book’s widespread acclaim among booksellers rather than serving as an assessment of its literary quality.

Cronin drew extensively from his medical experience in the coal mining regions of the South Wales Valleys to shape the story. His investigations into the relationship between coal dust exposure and lung diseases took place in Tredegar, where he also worked at the Tredegar Medical Aid Society and its Cottage Hospital, institutions that influenced the founding principles of the NHS.

The author characterized The Citadel as an indictment of systemic problems within the medical field, emphasizing its injustices, resistance to scientific advancement, and institutional shortcomings. His critique was based on personal observations rather than targeting specific individuals.

Plot summary

In October 1924, Andrew Manson, a newly graduated and idealistic Scottish physician, arrives in Drineffy, a small Welsh mining community, to assist Doctor Page. He quickly learns that Page is physically disabled and that he must manage a demanding workload for minimal pay. Disturbed by the poor sanitary conditions, Manson strives to improve them with help from Dr Philip Denny, a disillusioned and partially alcoholic former surgeon. Manson eventually resigns and accepts a position as an assistant within a miners’ medical aid scheme in nearby "Aberalaw," located in the South Wales coalfields. It is during this period that he marries Christine Barlow, a junior school teacher.

Christine supports Manson’s research on silicosis, dedicating significant effort toward enhancing miners’ respiratory health. Following publication of his findings, Manson obtains his MRCP and MD qualifications. He secures a role with the Mines Fatigue Board in London but leaves after six months to start a private practice.

Drawn by affluent clients and prestigious surgeons, Manson gradually distances himself from his original ideals and estranges himself from his wife. After a fatal surgical error occurs under his care, he abandons private practice and returns to his foundational principles. He reconciles with Christine; however, she later dies in a bus accident.

Following accusations against a surgeon for murder, Manson faces backlash when reported to the General Medical Council for collaborating with Richard Stillman, an American tuberculosis expert lacking formal medical credentials. Stillman’s disputed pneumothorax treatment involved collapsing an affected lung using nitrogen gas.

Despite pessimistic legal predictions, Manson successfully defends his conduct at the hearing and retains his medical license.

Part I: Drineffy

• Dr. Andrew Manson, main character
• Christine Manson (née Barlow), schoolteacher and wife of Andrew
• Dr. Edward Page, disabled physician assisted by Andrew
• Miss Blodwen Page, unmarried sister of Dr. Page
• Dr. Nicolls, described by Denny as a "tight little money-chasing midwife"
• Dr. Philip Denny
• Dr. Bramwell ("Lung Buster"), friendly yet naive doctor without an assistant
• Mrs. Gladys Bramwell, his unfaithful wife
• Dai Jenkins, dispenser at Drineffy
• Annie, kitchen maid at Page’s residence
• Olwen & Emlyn Hughes
• Dr. Griffiths, inept district Medical Officer at Toniglan
• Glyn Morgan, Councillor representing Drineffy
• Aneurin Rees, bank manager courting Miss Page
• Joe Morgan & Susan Morgan

Part II: Aberalaw

• Dr. Idris Llewellyn
• Dr. Urquhart
• Dr. Medley
• Dr. Oxborrow
• Ed Chenkin, miner working in Aberalaw
• Ben Chenkin, miner employed at Aberalaw
• Thomas Evans, Aberalaw miner who suffers loss of use in his left arm due to a domestic accident
• Con Boland, Aberalaw dentist
• Nurse Lloyd, community nurse
• Mr. and Mrs. Vaughan
• Mr. Owen, secretary of the Aberalaw Medical Aid Society

Part III: CMFB

• Gill Jones
• Dr. Hope
• Dr. Maurice Gadsby
• Sir Robert Abby

Part IV: Private Practice

• Frau Schmidt
• Dr. Frederick "Freddie" Hamson
• Dr. Ivory
• Dr. Deedman
• Harry Vidler and Mrs. Vidler
• Richard Stillman, American tuberculosis expert lacking formal medical credentials
• Frances Lawrence
• Hopper
• Mary Boland
• Nurse Sharp
• Nurse Trent
• Dr. Thoroughgood
• Mr. Boon

Historical context

The novel is distinguished by its portrayal of a voluntary medical aid society inspired by the Tredegar Medical Aid Society, where Cronin was employed during the 1920s. This organization served as a model for the creation of the National Health Service initiated by Aneurin Bevan. (Cronin alludes to Bevan through characters such as Aneurin Rees, an unsympathetic bank manager, and Sam Bevan, a miner whose life is saved by Manson.)

The Citadel achieved significant international acclaim, including distribution within the Third Reich as late as 1944. Holocaust survivor Victor Klemperer noted its unusual availability despite the ban on English literature, underscoring Cronin’s critique of British social and healthcare systems. After World War II, the book found popularity in Communist bloc nations, where Cronin was among the few contemporary British authors whose works were published.

Adaptations

The story was transformed into the 1938 film The Citadel, featuring performances by Robert Donat, Rosalind Russell, Ralph Richardson, and Rex Harrison. Television renditions include American (1960), British (1960 and 1983), and Italian productions (1964 and 2003). Indian cinema adapted the narrative into several languages: Hindi (Tere Mere Sapne, 1971), Bengali (Jiban Saikate, 1972), and Telugu (Madhura Swapnam, 1982). In 1989, the Korean television series “Angel’s Choice (MBC)” incorporated elements from this novel along with “The Green Years.” Radio dramatizations by Christopher Reason were broadcast on BBC Radio 4 in 2017 as a 15-minute drama and later expanded into a two-episode series in June 2021.

External links

• The Literature, Arts, and Medicine Database
• Archived book summary
• Critical analysis of The Citadel
• Excerpt from "Health in Gwent"
• History of healthcare personnel in South Wales Coalfield
• Article discussing Cronin’s influence on the NHS
• "The Citadel" episode on The Campbell Playhouse (21 January 1940) featuring Orson Welles and Geraldine Fitzgerald