Cronin, A.J.: The Citadel

The host for the evening and the proposer of “The Citadel” (1937) was a retired General Practitioner. He opened proceedings by explaining the reasons for his choice of book and detailing the author’s background.

 He explained that he first became aware of A. J. Cronin (“AJ”) when his family watched Dr Finlay’s Casebook. BBC TV broadcast the series between 1962 and 1971 and, while he did not admit to watching all 191 episodes, the programme had undoubtedly influenced his subsequent career choice. He was smitten by the writings of “A.J” after reading “Hatters Castle”, and subsequently sought out most of Cronin’s other books. He first read “The Citadel” in the 1970’s.

 “The Citadel” was published in 1937 and was a global best seller. It sold 100,000 copies in the first three months of becoming available and was reprinted at a rate of 10,000 per week. It established Cronin as one of the most popular novelists of the 1930’s. By today’s standards the novel elevated Cronin to multi-millionaire status. In common with a number of his books it was turned into a successful film in 1938, winning four Oscar nominations and grossing $2.5 million.

 Cronin was born in Cardross in Dumbartonshire in 1896. His father was an Irish Catholic and his mother was from a staunchly Protestant family.  They lived in Cardross for six years, but his father’s deteriorating health forced them to move to Helensburgh. There he died suddenly from pulmonary T.B. when Cronin was only seven years old. His mother then took “AJ” to stay with her parents in Dumbarton. She later moved to Glasgow where she obtained employment as a sanitary inspector.

 “AJ” was an all rounder. He was gifted academically, and also excelled in athletics and football. He moved from St Aloysius College to Glasgow University having won a Carnegie Scholarship to study medicine. After a short spell in the Royal Navy, he returned to Medical School, graduating in 1919 with honours. He met his future wife, May, also a medical student about this time. He went on to obtain the additional higher medical degrees of MRCP and MD, as well as the Diploma in Public Health.

 After graduating he worked in various hospitals in Glasgow and Dublin. Whilst employed as medical superintendant in Lightburn Hospital near Glasgow, a post for an unmarried doctor, he was pressured into marrying May as she had announced that she was pregnant. Following a quiet wedding in Glasgow, they moved to the Welsh mining town of Treherbert where he was briefly employed as a GP assistant. He moved again to a GP post in the larger nearby mining town of Tredegar where in 1924 May gave birth to their first son Vincent. 

In the same year they moved to London, where “AJ” took up an appointment as the Medical Inspector of Mines for Great Britain.

 While in this post he published reports linking coal dust exposure to pulmonary disease. In 1926 he bought a medical practice in the City. His second son, Patrick was born in the same year. He successfully built up his practice, but he suffered from a chronic gastric ulcer.  This, together with significant profits from investments made by an Investment Group to which “AJ” had been introduced to by a grateful patient, influenced his decision to leave medicine.  In 1930 he put down the stethoscope and picked up the pen, thereby fulfilling a longstanding ambition.

 AJ’s third son, Andrew was born in 1937 by which time he had become a successful author. In 1939 he moved to the USA where his reputation was already established. “The Citadel” won the National Book Award in the USA in 1937 and in a Gallup poll in 1939 it was voted the most interesting book that readers had read.

 He was in great demand and moved around the country promoting his work. The family never stayed more than a year in any one house until he eventually purchased a house in Connecticut in1947. He remained there until moving to Switzerland in 1955. By this time he was a very wealthy man, and his move was probably motivated by his tax situation.  He died in 1981.

 Some members of our group had experienced difficulty in acquiring a copy of the book and there was a concern that there would be differences between the various editions read. This concern proved unfounded. More amusingly, kindle editions of Cronin’s novels, including “The Citadel”, had newly become available on the day of our meeting. Some thought that the demand created by our members and followers had forced Amazon’s hand. Others suggested that this simply confirmed a growing interest in Cronin’s writings as a result of the publication of the second biography of his life (“The man who created Dr Finlay” by Alan Davies, 2011). This publication, and a discussion paper published in the journal of the Royal College of Physicians of Edinburgh on the possible influence that “The Citadel had on the formation of the NHS, seem to have stimulated renewed interest in Cronin’s work.  Whatever the truth, the coincidence, if that is what it was, proved a source of great frustration to all of those who had had difficulty obtaining a copy.

 There was a unanimous view that the book was an “easy” read. It was a “good yarn” written in what one of our group described as “stage direction” style. It was agreed that the strength of the book came partly from AJ being able to draw on his own experiences, both personal and professional. While the autobiographical basis of the novel successfully captured the nature of the challenges encountered by Dr Andrew Manson, it was also extremely controversial, as a number of people threatened to sue Cronin over his depiction of them in his characters.

 The group spent some time trying to understand the reasons for their generally positive view of the book. It was described as a polemic, challenging the social conventions of the time and dealing with the exploitative nature of parts of the medical profession in the 1930’s. The crusading theme of the novel was a major factor in its popularity. The book was dedicated to uncovering systematically the unsatisfactory practices of significant sections of the medical profession, and to confirming the view that money was indeed the root of all evil. The book was shocking, and it generated controversy and moral outrage. It uncovered the practices of a profession which hid behind the mysteries of medical science. This sensational content was an important factor in the group’s enjoyment of the novel.

 We discussed the wider impact of the book. Its popularity both here in the UK and in the USA focussed attention on medical services and the way they were organised. The criticisms of the medical profession delivered through the eyes of those working within the service, and from the perspective of those on the receiving end, had undoubtedly had an influence on the debate that eventually led to the creation of the NHS in 1948. Indeed some suggested that the book had a profound affect on these deliberations. Nye Bevan, one of the architects of the NHS, probably knew Cronin when Bevan served on the Tredegar Hospital Committee, and may well have been influenced by the book.

 Many of our Group considered that at least part of their enjoyment of the book could be attributed to their familiarity with the social conventions of the time. All were anxious to point out that they were too young to be directly involved but they were all able to relate to the experiences of their parents!

 Other factors contributing to our enjoyment were AJ’s persuasive narrative skills, his acute observations, graphic descriptions and his impressive characterisations. Other compelling features were the idealistic nature of the plot, combined with the “feel good” factor, and the triumph of right over wrong.

 On the negative side some thought that the novel was “wordy” and that the writing was “pedestrian” particularly when compared with other notable authors. One member questioned the pace of the novel. He pointed out that the first part of the book, describing Manson’s life in Wales, occupied some 56% of the book, his period in London 36% and the passages dealing with his wife’s death, his selling up and the “trial” only 8%. He suggested that one explanation was that the earlier passages were autobiographical while the rest was not. This raised a question about the writing process adopted by “AJ” and speculation over whether or not he planned the structure of the novel or simply allowed it to emerge as he wrote.

 One member pointed to apparent contradictions in the book, such as investigations into lung disease but the acceptance of heavy smoking, and the toleration of the unhygienic practices of his dentist friend, Boland, while being very critical of poor hygienic standards elsewhere.

 The discussion moved on to consider whether or not the characteristics associated with the provision of medical practice, as described by “AJ”, still exist today. The increasing importance of private practice and the presence of more and more competition were cited as examples of factors that have remained features common to medical service delivery, both pre and post NHS. It was, however, accepted that such a comparison had little meaning. The NHS, having brought structure to the previously unstructured organisation of medical services, had had to meet the challenges of rapid medical advances and growing individual expectations, and these factors ruled out any serious attempt at comparison.

 Our host encouraged us to read more of “AJ’s” work and some of the group seemed motivated to do so. However, no one anticipated a profound career changing impact as a consequence.