Doctor’s novels which sparked health debate
Aria Roche celebrates the impact on public welfare of AJ Cronin’s life and work in medicine
Today marks 121 years since the birth in Cardross of Archibald Joseph Cronin, the physician who went from writing “nothing but prescriptions and scientific papers” to sparking debate on medical ethics still relevant today.
The life and work of the Scottish doctor is linked to critical phases in the history of Britain’s welfare system. His 1937 novel The Citadel, credited with laying the foundation for the National Health Service, gives an insightful perspective into the conditions, mentalities and criteria that gave birth to this key welfare system.
The story tells of a 24-yearold medical doctor, Andrew Manson, who takes up a position in a small Welsh mining town. There, he is confronted with the corruption of unregulated private medical practice but manages to solve the town’s typhoid problem by blowing up a contaminated leaking sewer. When he moves to London, disillusioned by bureaucracy and the temptation of easy profit, he gradually abandons his ideals for prestige and wealth.
Cronin’s concern for personal and professional integrity in medical practice is a consistent theme. The doctors in his stories are portrayed as able and conscientious but also incompetent and greedy. Yet, Cronin’s concern does not limit itself to the behavioural traits or moral crises of the individual. It relocates, challenges and tests these in the territory of ‘the system’. A system inherently corrupt and dysfunctional that was attacked vehemently during the 1920s and early 1930s in mining towns around the UK.
Cronin worked at the Rotunda, Dublin, and was later appointed Medical Inspector of Mines, making significant contributions with his study of medical regulations in collieries, and his research on coal dust inhalation and lung disease.
He witnessed the mining disaster at Ystfad colliery in Pengelly which left 38 miners drowned and recorded this experience in the novels The Citadel, set in Wales, and The Stars Look Down, set in Northumberland.
History linked Cronin’s life with similar events as well as with individuals who later proved key figures in the establishment of the NHS. It was during the General Strike of May 1926 when a young trades union activist emerged as leader of the South Wales miners. He was Aneurin Bevan, future architect of the NHS as a Labour health minister.
Cronin was working as a GP at the Tredegar Cottage Hospital in Wales, one of the first models for the NHS. Tredegar was Bevan’s home town, though there is no evidence that they ever met.
Cronin wrote: “I have written in The Citadel all I feel about the medical profession, its injustices, its hidebound unscientific stubbornness, its humbug ... the horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.”
Though a work of fiction, it does not cease to remind us of what the NHS replaced, and the vision that its founders first cherished. ● Aria Roche is a postgraduate student at the University of Edinburgh.