My thoughts on the book: "The Citadel", by AJ Cronin

How I discovered this book

I discovered this book in a corner of a living room that my landlady decided to open to me after she had not opened it for many years.

The poor old lady knew my interest in books and literature, and offered this book to me as a gift.

I believe it’s no coincidence that one of her sons was a doctor at the time, which explains how this literature masterpiece about the practice of medicine in the UK about one century ago found its place in her living room, forgotten there for years.

I am sure the adventures that Andrew Manson went through during his medical career reminded her very well of similar situations that her doctor son had to go through.

Is “The Citadel” a political novel?

Although the romantic element is strong in this novel, there is an equally important political dimension, especially as a result of the impact that the book has had over the years.

When things get hard, the main hero of the book, Andrew Manson, adopts a more philosophical stance in life, in an effort to overcome the various professional and social hurdles and barriers that makes a physician’s life unnecessarily difficult; he starts wondering what can be done to increase the level of health service provided to citizens.

In turn, the views that are expressed by Andrew Manson, and which actually reflect Cronin’s own views about how the UK’s healthcare system can be improved, is believed to have, even indirectly led to change in the health sector, finally leading to the decision for the foundation of the UK’s NHS.

Therefore, whether it was A.J. Cronin’s initial purpose, or not, to affect decision-making on a political level, his novel definitely contributed in that direction.

Is “The Citadel” still relevant today?

It is true that most of the situations and medical conditions that are described in the book are outdated today.

However, it should be pointed out that human nature and the variables that determine the character of humans have not changed much since the book was written.

For example, the greed for money is something that can be found in the practice of many professions and trades; physicians have not managed to escape this.

Furthermore, although the standards that determine the practice of the medical profession have been largely benefited by the ideas expressed in this books, strong debate continues regarding the degree of idealism that physicians should adopt in their professional conduct.

For instance, is it worth spending your life studying and practicing medicine and saving lives to end up earning an average salary, which is perhaps lower than that earned by an unskilled factory worker?

This is an ethical question that refers to the relationship between the level of professional expertise, experience, reputation, etc. and the corresponding level of pay, and it hasn’t lost its impact even today.

Further reading:

A Cronin and The Citadel: how a “middlebrow” novel contributed to the foundation of the NHS, by Seamus O’Mahony, Consultant Physician/Gastroenterologist, Cork University Hospital, Wilton, Cork, Ireland