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The story Birth is an excerpt from The Citadel.

It relates how a medical


fresher handles a child delivery case in a mysterious way and brings back
life in a seemingly dead born child. In doing so he applies his medical text
book knowledge as well as intuition. He finds that text book knowledge
alone is not sufficient to handle such cases. The story expresses the
anxiety and excitement of the doctor, Andrew Manson and his team.

About the author: A. J. Cronin

Archibald Joseph Cronin was born on 19th July 1896 in Cardross near
Glasgow on the west coast of Scotland to a Scottish mother and Irish
father.

Cronin graduated with honours from medical school at the end of the First
World War in 1919. In the mining towns of Wales, he saw the human spirit

fighting poverty and hardship. In his London practice, he encountered the


spoilt, neurotic rich, happy to spend money like water.

Thus, he worked with the miners, then the rich, eventually grew
disillusioned with the medical profession entirely. This disillusionment is
reflected in the novel 'Citadel' which is the origin of the extract in the class
XI CBSE textbook.

His career as an author was very successful. He had a great following in


America and in 1939 moved with his wife and three sons, to New England.
However, at the height of his fame, success and wealth, Cronin was deeply
dissatisfied.

CITADEL: fortress, bastion, fort, castle, refuge, sanctuary

THE NAME: The symbol of the citadel is central to the book. It symbolises
ideals in Mansons case medical integrity which are enclosed in a castle
on a hill. Manson fights against great odds to free himself from materialistic
temptation, and climb that hill. At the end of the book we are left with the
sense that, with Denny and Hope at his side, Manson will scale the walls of
the citadel to realise his ideals.

SUMMARY FROM THE NOVEL TILL OUR EXTRACT:


Newly qualified, Dr Manson takes a job as assistant to Dr Page in a small
mining town. On arrival, he finds to his surprise that Page is partly
paralysed and will never work again. This means Dr. Andrew Manson will
have to do most of the clinics work in this mining town at a meagre pay.

A junior doctor, Denny proposes to blow up the old sewer in order to oblige
the authorities to build a new safe one. Andrew helps and the plan works.
Andrew falls in love with a schoolteacher, Christine Barlow. Manson cures

someone no other doctor has been able to help, with a hormone treatment.
Andrew contemplates marrying Christine. He has a little tiff with her. On
returning home, he is called by a minor to help deliver a baby.

Andrew managed to help a difficult birth and save a babys life and walks
away from the incident more confident as a doctor and feeling as if he had
finally done something real in his life.

WHAT ELSE TO DO
Watch the movie 'Three Idiots' again with special focus on the birth scene
towards the end of the movie. Reflect upon the expressions on the face of
all the people involved, from the immediate relatives to the friends to
acquaintances. Before you read, understand that a birth is an extremely
emotional and exacting event.

The Birth - As You Read

CHAPTER VOCABULARY

KEY POINTS TILL PART 1


Andrew was returning home after a disappointing visit with his lady love,
Catherine.
Andrew Mason did not expect this to be a particularly monumental night of
his career
He was returning from a long journey which saw him home as late as
midnight.

Exhausted, he found Joe Morgan, anxious and somewhat scared, waiting


for him.
Morgan's wife was in labour, before the expected date. This is their first
child in a marriage of nearly twenty years.
Joe Morgan seems to trust Andrew implicitly. However, the community may
not.
But the presence of the midwife before the doctor arrived and Mrs.
Morgan's reluctance to take anaesthesia reflects the lack of complete faith
in modern medicine
Hopes riding on the delivery: the parents' as well as the grandmother's. He
reassures the grandmother telling her both the mother and the baby shall
be fine.
Andrew waits in the kitchen reflecting on the information he gleaned earlier
in the night which showed him that most marriages were dismal failures.
However, he feels Catherine is an exception.
The labour leads to a stillborn baby.
Initially, Andrew feels suddenly overwhelmed with the enormity of the
situation and the many hopes he had dashed despite his initial
reassurance.
In moments though, Andrew's training kicks in. He instinctively decides to
save the mother first, handing the baby over to the midwife.
The midwife, who has had no medical training, sees the body in her arms
as a lifeless lump and places it under the bed among sodden newspapers.
Andrew draws the baby out and quickly diagnoses the most probable
cause for the still birth i.e. Asphyxia, pallida.
He recalls a method he had once observed through which a child had been
successfully resuscitated.
He tries: the simultaneous hot and cold dips to shock the body and get the
heart to jump start, then rubbed the baby's body with a rough towel
crushing and releasing the little chest as a form of CPR.
On the verge of giving up, a medical miracle occurs.

The child finally breathes. Notice the author's description of the mucus as a
joyful iridescent bubble.
Andrew redoubles his efforts till the baby is breathing freely and safe.
As he left the house, he realised that he had truly saved a life that night
fulfilling the purpose of his profession. For the first time in his life, he felt he
had done something 'real', something worthwhile.

THE MIDWIFE AND ANDREW

Beliefs of the small town: The midwife is present in the house before the
doctor arrives. The mining community did not have complete faith in
modern medicine and perhaps, preferred to have someone older, more
experienced and traditional present during a birth. Yet, Joe Morgan trusted
Andrew completely.
Contrasting personalities: The midwife is a foil to Andrew. She feels
hopeless, resigned, helpless, fearful and untrained. On the other hand,
Andrew proves to be more optimistic, diligent, efficient, self-sufficient,
spontaneous and well-trained.

THE TITLE OF THE EXCERPT

The 'Birth' is not only of the child but also of the many relationships the birth
ushers. It is the birth of a grandmother, father and mother. Most
significantly, it was the birth of Andrew as a true doctor worthy of his title
and confident of his future.

QUESTION BANK
Q.1. Andrew had no premonition that,that night would influence his whole
future in Blaenelly. How did this happen?

Q.2. Why was Joe Morgan relieved to see Andrew? Did Andrew justify his
hope?
Q.3. Why was Andrew called in? How did he react to this call of duty?
Why does Andrew say, 'Usually perceptive, Andrew now felt dull and
listless'?
Q.4. 'Don't fret mother. I will not run away.' Why does Andrew say this?
Q.5. Why did Andrew choose to remain till everything was over?
Q.6. What were Andrews thoughts as he waited for the childbirth? Why
were they heavy and muddled?
Q.7. What was the conflict in Andrews mind regarding marriage?
Q.8. Why was Andrew surprised during the wait, when the grandmother
made a sound? What did the grandmother tell Andrew as he sat by the
fire?
Q.9. Why did a shiver of horror pass over Andrew?
Q.10. What dilemma did Andrew face during the course of events? How did
he resolve the same?
Q.11. How did Andrew revive Susan Morgan?
Q.12. What did the child look like when Andrew pulled it out?
Q.13. What was the cause of the still birth? Which methods did the doctor
try to resuscitate the child?
Q.14.
Q.15. What was the child suffering from? What treatment did Andrew
apply?
Q.16. What were Andrews thoughts after he had successfully overcome
the crisis?
Q.17.What unexpected miracle took place to turn Andrews desperation into
joy?
Q.18. How did the old Mrs. Morgan react to the entire ordeal?
Q.19. What did the room look like when Andrew had finished?

Q.20. Do you think that at the end of the story Andrew is justified in saying
Ive done something? Support your answer suitably.
Q.21. How did Dr. Mason prove worthy of his title by the end of the story?
Q.22. What opinion do you form of Andrew Mason from this excerpt? Which
values can we learn from him?
Q.23. Which values should the nurse have demonstrated during the
ordeal?
Q.24. Giving specific instances from the chapter, demonstrate how the
midwife proved to be a foil for Dr. Mason.
Q.25. There lies a great difference between textbook medicine and the
world of a practising physician. Comment with reference to the chapter,
'Birth' by A. J. Cronin.
Q.26. Compare and contrast Andrew's emotional, mental and physical state
at the beginning of the story with his condition at the end.
Q.27.'I've done something; oh, God! I've done something real at last'. This
statement justifies the title of the story. Discuss.
Q.28. Why do you think Andrew said, 'I'll fetch my bag later, nurse'?
Q.29. Describe in your own words, how Joe Morgan must have been
feeling during his wait and eventually when Andrew spoke to him on the
latter's way out.
Q.30.The original title of the novel is 'Citadel' meaning 'fortress'. Attempt a
parallel of the title with the context of the story.

The Citadel
In October 1921, Andrew Manson, an idealistic, newly qualified doctor,
arrives from Scotland to work as assistant to Doctor Page in the small
Welsh mining town of Blaenelly.
He quickly realizes that Page is an invalid and that he has to do all the work
for a low wage.

Shocked by the unsanitary conditions he finds, he works to improve


matters and receives the support of Dr. Philip Denny, a cynical semialcoholic.
Resigning, he obtains a post as assistant in a miners medical aid scheme
in Aberalaw, a neighboring coal mining town in the South Wales coalfield.
On the strength of this job, he marries Christine Barlow, a junior school
teacher.
Dr. Andrew Manson moves away from his strong medical ethics and is
lured by money.
He drifts away from his wife for a while.
A patient at his Hospital dies and Manson is accused by the Medical
Council.
Manson returns to Christine but a few days later Christine is hit by a bus.
Mansons life wrecks and he takes time to recover from the wreckage.
At the end, Dr. Andrew Manson opens a multi-specialty practice with a few
medical friends and experts.
I will not come in, he said, and his voice showed signs of strain. But man,
I know ye will do well for us.
Name the speaker.
Joe Morgan, the miner, is the speaker.
Why is the speaker not intending to go in?
Joe Morgan, a highly anxious husband of the woman who was about to
give birth after their 20 years of waiting, is not prepared to see his wife
labor so he is not intending to go in with the doctor.
What for did Susans mother offer to make a cup of tea for Dr. Manson?
Susans mother was apprehensive. She feared that Dr. Manson would
leave upon an excuse and would not return seeing that the case was
complicated. To keep the doctor at home, she offered a cup of tea and
when she got it made, the tea was extremely hot to keep the doctor cooling
it for long.

What did the elderly midwife think of the young doctor?


The midwife in the story remains doubtful about the young doctors success
throughout the story. She was skeptic about modern medicine on one side
and quite worried about the glowing demand for modern doctors in front of
her eyes, quite experienced and not ready to accept a change. Her act of
placing the stillborn under the cot cements this suspicion about her
character. She was indirectly establishing the failure of modern medicine by
doing so.
Why was Susans case one that called all Dr. Mansons attention?
Susan Morgan was about to bring forth her first baby after twenty years of
married life. Susan herself was keenly particular that the baby should
survive any danger during her labor, even at the cost of her life. The Miner
family had been awaiting this childbirth and therefore, from the old woman
to the rest, everyone trusted Dr. Mansons entire potential and skill for the
babys safety.
Why was Dr. Andrew Mansons mind heavy when he rushed to attend a
case at Joes Morgans?
Dr. Manson was already a lot of exhausted, physically from his work and
mentally because of his doubtfully considering matrimony. He was worried
about his own marriage that was yet to happen on one side and on the
other he had to answer to the shattered and meaningful married life of his
friends.
The Citadel is a novel by A. J. Cronin, first published in 1937, which
was groundbreaking with its treatment of the contentious theme of medical
ethics. It has been credited with laying the foundation in Great Britain for
the introduction of the NHS a decade later.[1] In the United States, it won
the National Book Award for 1937 novels, voted by members of the
American Booksellers Association.[2]

For his fifth book, Dr. Cronin drew on his experiences practising
medicine in the coal mining communities of the South Wales Valleys, as he
had for The Stars Look Down two years earlier. Specifically, he had
researched and reported on the correlation between coal dust inhalation

and lung disease in the town of Tredegar. He had also worked as a doctor
for the Tredegar Medical Aid Society at the Cottage Hospital, which served
as the model for the National Health Service.

Cronin once stated in an interview, "I have written in The Citadel all I
feel about the medical profession, its injustices, its hide-bound 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."

October 1924, Andrew Manson, an idealistic, newly qualified doctor, arrives


from Scotland to work as assistant to Doctor Page in the small (fictitious)
Welsh mining town of Drineffy (Blaenelly is the name given in some
adaptations). He quickly realises that Page is invalid and that he has to do
all the work for a meagre wage. Shocked by the unsanitary conditions he
finds, he works to improve matters and receives the support of Dr Philip
Denny, a cynical semi-alcoholic who has, Manson finds in due course,
taken a post as an assistant doctor after having fallen from grace as a
surgeon. Resigning, he obtains a post as assistant in a miners' medical aid
scheme in 'Aberalaw', a neighbouring coal mining town in the South Wales
coalfield. On the strength of this job, he marries Christine Barlow, a junior
school teacher.

Christine helps her husband with his silicosis research. Eager to improve
the lives of his patients, mainly coal miners, Manson dedicates many hours
to research in his chosen field of lung disease. He studies for, and is
granted, the MRCP, and when his research is published, an MD. The
research gains him a post with the 'Mines Fatigue Board' in London, but he
resigns after six months to set up a private practice.

Seduced by the thought of easy money from wealthy clients rather than the
principles he started out with, Manson becomes involved with pampered
private patients and fashionable surgeons and drifts away from his wife. A

patient dies because of a surgeon's ineptitude, and the incident causes


Manson to abandon his practice and return to his former ways. He and his
wife repair their damaged relationship, but then she is run over by a bus
and killed.

Since Manson had accused the incompetent surgeon of murder, he is


vindictively reported to the General Medical Council for having worked with
an American tuberculosis specialist, Richard Stillman, who does not have a
medical degree, even though the patient had been successfully treated at
his clinic. Stillman's treatment, that of pneumothorax involved collapsing an
affected lung with nitrogen, and was not universally accepted at the time.

Despite his lawyer's gloomy prognosis, Manson forcefully justifies his


actions during the hearing and is not struck off the medical register.

The novel is of interest because of its portrayal of a voluntary contribution


medical association which is based (not entirely uncritically) on the
Tredegar Medical Aid Society for which Cronin worked for a time in the
1920s, and which in due course became the inspiration for the National
Health Service as established under Aneurin Bevan.