The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking with its treatment of the contentious theme of medical ethics. It is 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 practicing medicine in the coal mining communities of the South Wales Valleys, specifically the town of Tredegar, where he had researched and published reports on the correlation between coal 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, and television versions include one American (1960), two British (1960 & 1983), and two Italian (1964 & 2003) adaptations of the novel.
Plot summary
Hippocrates conquers hypocrisy in this story of an idealistic, young Scottish doctor, Andrew Manson, fresh out of medical school and embarking upon his career. Committed to helping mankind and hardworking though of modest means, he arrives in Wales, where his first job is working for an older doctor in the small town of 'Drineffy'. Shocked by the conditions there, he works to improve matters before marrying Christine, a school teacher. They subsequently move to 'Aberalaw', a mining town in the Welsh valleys, where she helps her husband with his silicosis research. Eager to improve the lives of his rustic patients, Manson dedicates many hours to private study in his chosen field of lung disease. The couple later moves to London, where the doctor 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 medical register. He finally decides to join two friends in opening an integrated, multispecialty practice in a country town.
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