Book Review: The Citadel by A.J. Cronin

The Citadel

Author: A.J. Cronin

Publisher: Little, Brown & Company, paperback, 368 pages

Reviewed by Rev. Garth Wehrfritz-Hanson

The Author 

Dr. Archibald Joseph Cronin was born in Cardross, Scotland, in 1896. He studied medicine at Glasgow University, served as surgeon sub-lieutenant in the Royal Navy Volunteer Reserve in the first World War, practiced in South Wales for four years, and studied pulmonary disabilities, moved to London and practiced there, and became an author of a number of books, including the brilliant, 1941 novel, The Keys Of The Kingdom. 

Brief Observations 

The Citadel begins with 24-year-old Dr. Andrew Manson (several details of Dr. Manson’s life in the novel seem to parallel Dr. Cronin’s) arriving at his first post in Blaenelly, southern Wales. He is to be the assistant to Dr. Page, who is not well, suffering from a stroke. Manson had won “the Hunter Gold Medal, awarded annually at St. Andrews to the best student in clinical medicine (p. 14).”

Dr. Manson agonizes about his first patient’s illness, and struggles to diagnose her. He also thinks there are a few cases of typhoid fever, and contacts Dr. Griffiths of Toniglan, the District Medical Officer to inform him. Dr. Griffiths was unreliable, so Dr. Manson asked the advise of Dr. Denny. Dr. Denny told him it was caused from the contaminated well water. So Dr. Manson told everyone to boil the water before using it, and the typhoid problem was solved.

One night, because of the contaminated sewer, Denny and Manson secretly blew it up, and a new one was constructed.

There was a measles problem, and Manson thought Idris Howell should be isolated at home. So he went to school and had it out with the schoolteacher, Christine Barlow. Later he attends a gathering where Christine Barlow is present and he apologizes to her. 

Christine and Andrew become fond of each other. Andrew eventually is interviewed at Aberalaw, and is offered the appointment on one condition—that he is married. He tells the interview Committee that he is “engaged to someone in Blaenelly. I’ve—I’ve just been waiting on a suitable appointment—such as this—to get married (p. 86).” On his way back to Blaenelly, he agonizes over whether Christine would marry him or reject him. When he arrived back at Blaenelly, Andrew proposed to Christine. She accepted, they were married, and then moved to Aberalaw.

As Dr. Manson begins his new practice, he gets off to a bad start—he’s determined to employ the scientific method; however, he ends up losing patients because of an influential man and a nurse in the community who disagree with his approach.

Eventually Dr. Manson decides to write the most difficult medical exam, the M.R.C.P. It took him some time, and a lot of struggles, however he wrote the exam and passed. 

Back at Aberalaw, as he continues his practice, the community comes to trust and respect Dr. Manson, and more people choose him as their doctor. 

He then researched pulmonary diseases in relation to mining. As a result, he leaves Aberalaw and becomes Medical Officer of the Coal Mines and Metalliferous Fatigue Board in London. However, he soon resigned because he was not able to do what he believed was supposed to be his proper work. 

After some time, Andrew purchased Dr. Foy’s rather run-down practice. At first, he and Christine struggled financially. Eventually, he gains more affluent patients, and becomes more successful financially. Sadly, he loses his ethical idealism, and becomes more obsessed with climbing the financial and social ladder. He and Christine grow further apart because of his lack of ethical practice and growing affluence.

Manson was appointed to work with patients having specialized lung and bronchial conditions at the Victoria Chest Hospital. 

After much financial success, along with respect gained among both patients and colleagues, Andrew reached a breaking point of deep regret for having lost his ethical-moral idealism. He tells his colleague Dr. Freddie Hampton: “But I’m going to try and stop thinking of money and material success. That isn’t the test of a good doctor. When a doctor earns five thousand a year he’s not healthy. And why—why should a man try to make money out of suffering humanity (p. 321)?”

Andrew then expressed his deep remorse to Christine and is reconciled with her.

There are two trying events—one tragic—that brought on much grief and suffering for Andrew. In the closing pages of the novel, Andrew’s speech regarding the state of the medical profession was instrumental in determining Andrew’s future. 

Some readers of this review may recall that PBS dramatized The Citadel on Masterpiece Theatre. After reading the novel, I think—in part at least—I can see why.