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Last Reviewed on March 12, 2020, by eNotes Editorial. Word Count: 341

The Citadel by A. J. Cronin is a novel heavily based on actual events. Its journalistic treatment of its subject matter is akin to Upton Sinclair's 1906 novel The Jungle. Although a novel, the structure and voice of the narrative is similar to that of an investigative reportage on the pubic health crisis within a small Welsh mining town. The protagonist Andrew Manson is the character that Cronin uses as kind of morality instrument. The young Dr. Manson begins his post at the mining town as an idealist who becomes obsessed with lung disease research pertaining mostly to the impoverished miners in the area.

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Manson's work is a reflection of Cronin's own medical background before becoming a novelist. The author presents realistic scenes that are based on actual practices—as well as malpractices—he observed during his medical career. When Manson drifts away from his wife, who was helping him with his research, he also drifts towards greed. He becomes disillusioned with his social work as a physician and soon begins to treat more wealthy patients.

The death of his wife symbolizes an awakening, and Manson returns to his principles. When he concludes his own personal investigation on corrupted practitioners, he is reported for working with a non-licensed American physician. This part of the novel shows the cutthroat environment of the medical field, in which egotistical physicians compete with each other viciously, all the while protecting their careers and wealth. The unethical medical practices, which Manson himself also participates in briefly, are based on the dysfunctional healthcare system and the medical field at large.

The novel's theme of unethical medical practices is still applicable in the present-day, especially as the medical technology, health insurance, and pharmaceutical industries have increased their annual profits and power. Cronin himself has stated in interviews that he was not targeting specific individuals with his novel, but was fighting against an entire system that has strayed from its righteous path. The novel would go on to influence healthcare reform and help establish the United Kingdom's National Health Service.

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