You can buy The Citadel...Here
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.
Very timely in that it is set exactly 100years ago.
I must confess a great affinity for this book, for two reasons. Firstly it was famous as an influence in setting the NHS, which I believe is the UKs greatest acheivement. It was based on a model that was run by the miners of Tredegar, South Wales. Secondly, because I was born in Tredegar in StJames Hospital (formerly the old workhouse) and that is where Cronin went to work after qualifying as a doctor.
The book is of its time and today would seem to some to be mysoginistic (see selected quotes.) In addition its everyday language may seem a little archaic.
This two minor gripes not withstanding, this is great read.
There are two main parts. Firstly the morality tale. If you read the "about the author" section you will see that the Citadel is basically an autobiography. Set in a time before the NHS. A young, keen, newly qualified doctor full of vim and vigour comes to the South Wales valleys in 1924. He battles through adversity, finds himself a wife. Slowly but surely the way of the world grinds him down. His lofty ideals wither against the elements. He gradually sells out his soul for money. He turns on his wife and becomes one of the many corrupt sharks feeding on those that can afford to pay for healthcare. A catastrophe occurs, something akin to Ebeneezer Scrooge in a Christmas Carol, and he decides to mend his ways, but is it too late? Will karma play its part.
Second is the cautionary tale. I think to myself look how far we have come since medicine and health became free at the point of contact. Since the inception of the NHS. The medical system (or lack of it) Cronin portays is horryfing. If you're poor you die, if you're rich you've got a chance but it'll cost you. The whole system was there to benefit only the corrupt money guzzling companies, politicians and doctors who parasite off it. But dont feel too good about our progress. We appear to be heading back to that system and that is truly terrifying.
The version I read had a very enjoyable introduction by Adam Kay author This is going to hurt.
The characters are not one dimensional. Doctor Manson has a huge charcater arc. He goes from brave, idealisitic and keen through to jaded and money driven. He treats his wife poorly when young and worse when older. Is this how Cronin saw himself I wonder?To make the main protaganist so unlikable at times must have been a bit of a gamble.
I found this to be an excellent reading experience, deftly entwinning real human lives in the social-medical history of the times. A very difficult book to put into a genre but sad and heartwarming at the same time. Yet more than anything this is a warning from history not to repeat the mistakes of the past with our health care system.
Andrew had known Urquhart, for instance, when a patient of Oxborrow’s transferred his card to him, take the half-finished bottle of medicine from the man’s hand in the surgery, uncork it, smell it with contempt, and explode: ‘So this is what Oxborrow’s been givin’ ye! Damn it to hell! He’s been slowly poisonin’ ye!’
She also permitted him to shout, gesticulate, and, as his nerves grew more ragged, to hurl abuse at her. At eleven o’clock as she brought him fresh coffee he became liable to snarl: ‘Why can’t you leave me alone? What’s this slush for anyway? Caffeine – it’s only a rotten drug. You know I’m killing myself, don’t you. And it’s all for you. You’re hard! You’re damnably hard. You’re like a female turnkey, marching in and out with skilly!
He told her they might be in Provence, or some place like that, in a great castle by a lake. He told her she was a sweet, exquisite child. He told her he had been a brute to her but that for the rest of his life he would be a carpet – not red, since she interjected her objection to that colour – on which she might tread. He told her much more than that. By the end of the week he was telling her to fetch his slippers.
Up, up they shot, out of the depths. The keen bite of the wind met them, as they stepped out of the cage. With a kind of ecstasy Andrew drew a long breath. He stood at the foot of the steps holding on to the guard rail. It was still dark, but in the mine yard they had hung a big naphtha flare which hissed and leaped with many tongues. Around the flare he saw a small crowd of waiting figures. There were women amongst them, with shawls about their heads.
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Cronin was born in Cardross, Scotland in 1896. His father was of Irish descent and Catholic; his mother’s family was Protestant. Cronin’s father died when he was 7, forcing Cronin and his mother to move in with her parents. Cronin excelled academically and at sports, and won a Carnegie Foundation Scholarship to study medicine at Glasgow University, where he graduated in 1919. He subsequently worked as a GP in South Wales, moving then to London, where he established a successful private practice. In his mid-30s, he experienced some form of crisis – ascribed to peptic ulcer in his autobiography3 – and sold his practice, with plans to write a novel. This he duly did, and the resulting book, Hatter’s Castle, was accepted by the first publisher he sent it to – Victor Gollancz – and was an immediate best-seller. He never returned to medical practice. The 1930s were his most productive and successful years; following the success of Hatter’s Castle, he wrote two more best-sellers, The Stars Look Down, and The Citadel. His novels were successfully adapted for film, and Cronin became a wealthy man. He spent much of the subsequent war years in America, and eventually settled permanently in Switzerland. Although he published several more novels until the early 70s, he never repeated the success of the 1930s.
Cronin’s novels have common themes: the struggle of poor catholic scholarship boys to overcome sectarian bigotry and make their way in the world, usually through academic achievement; idealistic young men (usually doctors or priests) losing their moral compass through the temptations of money and sex; Catholic themes of sin, guilt and redemption. He re-cycled these themes and plots in his less successful later novels. He is probably best known to the television generation as the author of the Adventures of a Black Bag stories, whose characters formed the basis for the hugely popular Dr Finlay’s Casebook TV series which ran from 1962 to 1971.
