The Citadel: The Classic Novel that Inspired the NHS (Bello)

A Window on the Medical world of the 1920s.In this story A.J Cronin relates the deeds of Andrew Manson. A young and headstrong doctor, setting out to cure the world. Working in the mining villages of South Wales he experiences both the warmth and prejudices of the mining communities. Moving to London he experiences the innate conservatism of the medical establishment and the greed of a particular kind of medical practitioner. Manson and his wife Christine also experience the highs and lows of their personal relationship. While I would not place Cronin on the same level as Hemmingway or Greene, nevertheless this is an excellent read, which leaves you looking for more by the same author.

The NHS is under scrutiny as never before during the current Coronavirus pandemic, so it is good to be reminded of the days before its inception when only those with money could afford medical treatment and even then not be guaranteed adequate treatment. AJ Cronin obviously drew on his own experience of an outdated system and his own desire for change, and he must have been exhilarated when what he had envisaged actually came to pass. How fortunate for him that he did not live to see its decimation and near-destruction by successive governments. Hopefully it will now be given the funding, proper management and status it deserves and which it should never have lost.

Andrew Manson takes up his first post as a newly qualified doctor – in a Welsh mining town. The tight-knit communities of the Welsh valleys present Manson with plenty of daily challenges, not only with regard to the poor sanitation and the spread of disease, but in opposition to those who suspect his honesty and outspokenness. His refusal to take the line of least resistance lands him in trouble with some of the established members of society, but he does make a good friend in Philip Denny, and meets his future wife in Christine Barlow, the local, equally idealistic school teacher. Manson is offered a better position in a larger town, but once again when his integrity does not allow for unscrupulous dispensing and money-making schemes, Andrew and Christine are forced yet again to move on. Andrew's research into lung diseases takes the Manson’s to London, but Andrew misses front-line diagnosis and he soon takes the plunge in buying a run-down surgery.Frustrated at not earning enough money to live on, Manson’s principles begin to fray at the edges, and when lucrative ways of making easy money from wealthy patients and private clinics begin to take-over from his everyday surgeries and pioneering work, his standards begin to slip. Christine is unhappy with the change in her husband, dislikes the city, and cares nothing for fur coats and fancy furniture. When matters come to a crisis point and Manson is in danger of losing everything, he’s forced to examine everything he holds dear.Astonishing to discover that this novel written in 1937 and set in 1924 inspired the creation of the NHS. There are many enlightening passages and ideas which clearly illustrate the need of trustworthy medical care for all, regardless of social standing and the ability to pay.Manson is deliberately challenging, and I enjoyed the journey of his development through the stages of his career. As a work of fiction it didn’t have the huge impact of The Stars Look Down, but this is a straightforward novel written in a biographical style and because the author was a medical professional, full of interesting facts and plenty to say.

I had never read The Citadel before, although I had heard adaptations of it on the radio. What a fantastic book ! I loved it and could not bear to put it down. The descriptions of the Welsh valleys and the people are wonderful, as is the daily life of a young doctor constantly having to struggle against the poverty and traditions of his patients and at the same time not lose sight of his ideals. There is some humour throughout the book too, which was nice. As you can tell, I really loved this book and would recommend it to anyone.

I first read this book over 40 years ago and was tempted to reread it by a serialisation on Radio4. It is worth reading again if only to make people aware of the value of our NHS system and of the dangerous state of medicine Pre 1948. It is a compelling study of a young doctor’s progress from young idealist to money chasing consultant before he is shaken into seeing the error of his ways.

You can tell that this was written by a doctor, he accurately portrays the medical profession and it's protagonists, and if you've ever worked within the health service you will readily identify characters you've come across. His central character is not one of the most sympathetic heroes despite his good intentions and the "little woman" at home goes from feisty school teacher to practise dogsbody, which given this is set in the 1920/30's is both accurate and also written with the same arrogance that could only come from a male doctor.I remember watching the screen adaptation many years ago and again on reading this thought thank goodness things have changed, not a lot but at least we've got the NHS and group practises.