The Citadel by A.J. Cronin tells the story of Andrew Manson, a young Scottish medical doctor, who began his career in a Welsh mining town in 1924.
Manson was ardent and idealistic and was appalled to discover the general condition of health care in the small community.
He hadn’t been there long when an outbreak of typhoid fever revealed just how dire the situation was. He also discovered that his medical training had taught him a lot of rubbish.
The people of the town were superstitious and loathe to put aside their old ideas about the treatment of burns, for example, and Manson made a few enemies at first as he tried to change things. He was staggered when he found that one of the doctors in the community didn’t know the difference between the pancreas and the thymus.
His outspoken manner was not appreciated by the young school teacher he chastised for allowing one of her students to be at school when he thought the boy might be an infection risk. This part of the story reminded me of James Herriott’s account of meeting his future wife when he just didn’t think he stood a chance – he was poor, awkward, and had no social graces.
As time went on, Andrew moved to a different area and had a small but very loyal group of patients.
He reconnected with a young man he had known in medical school and was introduced to a group of money-hungry doctors living the highlife in London on proceeds from private clinics and wealthy hypochondriacs.
Sick of being poor, Andrew decided he would make money – ‘What can you do without it?’
He started associating with the highfliers and attending their parties and gatherings. He updated his wardrobe and bought a sport’s car. Once he started earning good money, he needed even more to satisfy him but his wife felt more and more anxious about him and hated his greedy ‘friends.’ He was well on the way to loosing her as well as his soul, until one dreadful event changed everything.

This is the third book I’ve read by the author and I have enjoyed each of them very much. His main characters tend to be flawed in many ways but at heart they are humble and self-deprecating, which I find refreshing. The Citadel is also a story of true friendship that develops between Andrew and Philip Denny, an embittered and cynical but brilliant doctor, who drinks himself into a stupor from time to time.

A. J. Cronin (1896 – 1981) was a Scottish doctor who, like his fictional character, practised in Wales and later in London.
The Citadel was a controversial book at the time of its publication in 1937 but the author’s depiction of medical practice and his innovative ideas inspired the creation of the National Health Scheme (NHS) in the United Kingdom in 1948.