Read for our local book group. Compelling reading at times, about a young, idealistic doctor starting out in a Welsh mining village in the 1920s. He learns a lot, makes friends (and enemies), and his idealistic principles are challenged - even abandoned for a while.

The characters and situations are realistic, based on the author's own experiences, and demonstrate some of the horrors of medicine before the NHS. I didn't really relate to any of the characters, and found some of the events shocking, but definitely think it's worth reading.

I'd give it three and three-quarters stars if I could!

Longer review here: https://suesbookreviews.blogspot.com/2024/03/the-citadel-by-aj-cronin.html ( )

"If we go on trying to make out that everything's wrong outside the profession and everything is right within, it means the death of scientific progress."

First published in 1937 and set during the interwar years 'The Citadel' shines a light on the medical establishment in Britain at the time through the eyes of a young newly qualified Scottish doctor. Andrew Manson, takes up his first clinical post as an assistant to a GP in a small Welsh mining community where disease and poverty is rife, sanitation poor and operations are performed on kitchen tables before moving as his career progresses to the fashionable, greedy world of London with its private clinics, hypochondriac patients and rich awards. Manson arrives with a bagful of enthusiasm and idealism but soon comes face to face with the realism of his chosen profession.

Archibald Joseph Cronin was born in Cardross, Dunbartonshire, in 1896, and was destined either for the Church or medicine: he chose medicine. Cronin trained in various hospitals in Scotland, Dublin and South Wales. He was appointed as a Medical Inspector of Mines and reported on coal-dust inhalation and lung disease before subsequently moving to London and private practice. This novel is therefore semi-autobiographical in nature as he draws on his professional career as a background.

The novel has two specific areas of emphasis. Firstly, the work of the doctor in a poor community and how his work is transformed when he moves to a city and private practice. Secondly the competence, or incompetence, of doctors and their need to keep their skills up to date. Manson is often critical of the quality of other doctors' work.

In the small Welsh mining village, the men, as miners, can change doctors through a company insurance scheme whenever they wish, their choices often based on the doctor's own popularity rather than his ability. Manson is outspoken and critical of the way in which the service is funded which lands him in trouble.

But the climax comes when Manson is asked to treat the daughter of an old friend who has tuberculosis. Manson has her admitted to an established London hospital but when the treatment provided there shows no signs of benefit he recommends a new therapy. His senior disagrees and Manson removes his young patient to a newly built hospital with an un-medically qualified boss. However, despite the success of the treatment and his patient's subsequent discharge, when Manson’s London colleagues hear about this he is referred to the General Medical Council (GMC) to be investigated with the potential outcome of him being struck off the Medical Register.

In many respects this novel is a creature of its time. Cronin identified many of the issues in clinical practice which needed to be tackled , including better supervision of young doctors, postgraduate education programmes and the novel's popularity along with the cinematic portrayal helped towards the establishment of the NHS a decade or so later. However, some of the issues, in particular affordability, are still relevant today.

This isn't perhaps great literature. Manson despite his revolutionary zeal isn't always a particularly likeable character, he is often, selfish, arrogant and uncaring, but Cronin still manages to present an interesting and entertaining story. I am always interested in novels that feature social history and this book had the power to change public attitudes and behaviour towards health as well as professional thinking and for that reason alone deserves to be more widely read today. ( )

Andrew Manson, un joven idealista recién licenciado en medicina, llega al pueblo minero de Drineffy en las montañas de Gales. Contratado oficialmente como ayudante del Dr. Page, Andrew se verá obligado, pese a su inexperiencia, a enfrentarse en solitario a las complicadas enfermedades y epidemias que sufren los habitantes del lugar, debido a la convalecencia del médico titular. Sin embargo, las dificultades puramente médicas no serán las únicas preocupaciones de Manson, ya que éste pronto descubrirá la negligencia profesional y la corrupción de sus colegas.

Set in the 1920s in a Welsh mining town, protagonist Andrew Manson is a newly qualified Doctor of Medicine. He is idealistic and eager to make his mark. He wants to change the traditional ineffective methods and use the latest science in his treatments. He becomes fascinated with analyzing the source of miners’ lung diseases. As he moves upward in his career, he loses his idealism and becomes more interested in accumulating wealth. His wife grows disillusioned, wondering what happened to the man she married.

This book explores ethics in the medical profession. It portrays doctors of varying competence. Some keep up their skills and others become wedded to traditional remedies. Some compete vigorously with other doctors. The story contains descriptions of diagnoses, medical procedures, and surgeries. Published in 1937, this book was helpful in pointing out changes needed in the UK’s health care system.
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A cidadela oferece um panorama das condições de trabalho dos médicos no início do século XX. Por meio do protagonista, o recém-formado Dr. Andrew Manson, jovem idealista e sonhador, o autor apresenta as dificuldades do exercício da profissão na região do sul do País de Gales, onde a mineração era a atividade principal, o que acarretava tragédias, fosse em acidentes ou em consequências na questão respiratória.

Andrew Manson inicia sua jornada profissional em uma pequena aldeia, chamada Drineffy, onde se dedica com paixão aos seus pacientes, revelando um lado mais humanitário e altruísta do ofício da medicina. Com o passar do tempo, o rapaz encontra novas oportunidades de trabalho e, claro, também encontra o amor, ao lado da professora Christine Barlow. É em Londres que Manson se depara com os maiores questionamentos de sua vida até então: entra em contato com a classe médica mais conceituada e com os luxos aos quais eles têm acesso.

O texto de Cronin em A cidadela evidencia o drama das escolhas éticas na prática da medicina e o confronto entre abdicar de luxo e conforto pelo ofício mais humano e a esperteza de saber enriquecer por meio da profissão. Essas questões são, ainda, muito relevantes e atuais, tornando esta obra fundamental para aqueles que praticam medicina e também para aqueles que têm um ideal ao qual se apegar.