A. J. Cronin, a physician as well as a writer, himself lived much of the life he attributes to his protagonist, Andrew Manson, in The Citadel. Therefore, he knows whereof he speaks. The novel begins by recounting the life of a medical doctor newly graduated from the not-quite-fashionable University of Dundee, as he commences his first full-fledged medical assignment, to maintain the established practice of Dr. Edward Page, an elderly physician in the industrial town of Blaenelly in Wales’s coal-mining region.
In Blaenelly, Manson meets Christine, a local schoolteacher who is to become h.is wife, and Dr. Philip Denny, who is to become the most influential person in his professional life. As he goes about carrying on Dr. Page’s practice in Blaenelly, Manson begins to realize that the older doctor was not always meticulous in his practice of medicine—Manson’s first awakening to the realities of how a profession that he had idealized is actually practiced day-to-day.
Before long, Mrs. Page unjustly accuses Manson of taking from a patient payment that should have gone to her husband. Actually, the grateful patient has given Manson a small gratuity in appreciation for his attention when he was ill. Manson realizes, however, that he can no longer continue in his present arrangement. The nearby town of Aberalaw needs a physician, and Manson goes before the committee there as an applicant for the job. He impresses the committee and accepts its offer to come to Aberalaw, taking with him Christine, whom he marries on the very day he leaves Blaenelly for his new post.
Manson remains the good, overworked physician. His idealism keeps him working at the highest level of competence of which he is capable. Although he begins to prosper modestly, his concern is with patients more than with the fees they pay him. Before long, it is evident that his patients have great faith in him as a doctor. His greatest professional problem in Aberalaw is the same as his greatest professional problem had been in Blaenelly: The citizenry with whom he must deal have old-fashioned notions of how medicine should be practiced, and the resistance that meets his new ways frustrates him enormously.
As a result, Manson is not always tactful in dealing with people. When a local clergyman comes to him saying that he and his wife do not want to have children yet and asking for advice, Manson, who has just suffered the loss of his first and only child, lashes out at this prominent patient, asking him why he married if he did not want children. Nevertheless, Manson maintains a successful practice in Aberalaw and is able to continue his research, which ultimately leads him to suspect that a cause-and-effect relationship exists between breathing coal dust in the anthracite mines all day and certain serious pulmonary disorders.
The local people do not understand Manson’s research, and some of them harass him and try to prevent him from continuing it. One of them breaks into his laboratory, takes his laboratory animals, and drowns them. Still, Manson persists in his investigations.
When Manson publishes his findings, he is called before the committee that initially hired him. This committee, which is composed of workingmen, is empowered not to renew his contract and, if they find against him, can demand that he be tried before the Medical Aid Society. The hearings are tense, but in the end Manson prevails and is invited to continue in Aberalaw. He and Christine, however, have lived through too much humiliation there, and he declines to remain.
Manson next becomes a physician for the Coal and Metalliferous Mines Fatigue Board. There his idealism is further put to the test. Ignorant men try to limit his research and make it difficult for him to practice the kind of medicine in which he believes. After due consideration, he and Christine leave Wales and go to London, where Manson buys the practice of the late Dr. Foy. It is a somewhat humble practice in a mediocre neighborhood...
(The entire section is 1,060 words.)