Birth (Citadel) – AJ Cronin

‘Birth’ is an extract from ‘The Citadel’ by A J Cronin which was published in 1937. To better understand ‘Birth,’ you may first understand The Citadel in a few words. However, you can skip this section.


  • It is the birth of two – the birth of a child and the birth of a wonderful physician who brought the stillborn baby to life.
  • Dr. Andrew Manson was recently out of the medical college and he was a struggling practitioner.
  • One night he returned late and waiting for him was a man – Joe Morgan – the most stressed out man in the world at that time.
  • His wife Susan was about to give birth to a baby tonight, after their 14 years of wait.
  • Though tired to death, Dr. Andrew Manson agreed to attend the case but in spite of prayers and attempts, the baby was lifeless when it was born!


Dr. Andrew Manson – A doctor working in the mining town of Blaenelly

  1. Optimistic –
  2. Doubtful – About marriages
  3. Analytical
  4. Highly patient – He showed extreme patience during the labor and later.

Joe Morgan – A mine-worker

  1. Loving
  2. Caring
  3. Escapist
  4. Responsible
  5. Optimistic
  6. Trusting

Susan Morgan – Joe Morgan’s wife

  1. Loving
  2. Caring
  3. Sacrificing

Susan’s mother – Joe Morgan’s mother-in-law

  1. Experienced
  2. Diplomatic or tactic
  3. Presence of mind

An elderly midwife (nurse)

  1. Pessimistic
  2. Discouraging
  3. Condescending

Christine – Dr. Andrew’s girlfriend

Start – Dr. Andrew Manson confused about Marriages

  • Dr. Andrew Manson was returning home after a disappointing visit with his lady love, Christine and he had no notion that this night was going to mark a turning point in his life and career.
  • Exhausted, he found Joe Morgan, a poor miner, anxious and somewhat scared, waiting for him. Morgan’s wife was in labor, before the expected date. This is their first child in a marriage of nearly twenty years.
  • Joe Morgan seems to trust Andrew implicitly though many people were averse to modern medicine during those days. The presence of the midwife who had arrived before the doctor and Mrs. Morgan’s reluctance to take anesthesia reflect the lack of complete faith in modern medicine.


  • Haggard – Tired

Questions & Answers

  1. “I will not come in,” he said, and his voice showed signs of strain. “But man, I know ye will do well for us.”
    1. Name the speaker.
      Joe Morgan, the miner, is the speaker.
    2. 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.
  2. What did the elderly midwife think of the young doctor?
    The midwife in the story remains doubtful about the young doctor’s 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.
  3. Why was Susan’s case one that called all Dr. Manson’s attention?
    Susan Morgan was about to bring forth her first baby after fifteen 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. Manson’s entire potential and skill for the baby’s safety.
  4. Why was Dr. Andrew Manson’s mind heavy when he rushed to attend a case at Joe’s Morgan’s?
    Dr. Manson was already a lot of exhausted, physically from his work and mentally because of his doubtfully considering marriage. 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 meaningless married life of his friends.
  5. Why did Joe Morgan come to Dr. Andrew Manson’s residence? (2 marks)
    Though it was nearly midnight when Andrew reached Bryngower, he found Joe Morgan waiting for him, walking up and down with short steps between the closed surgery and the entrance to the house. At the sight of him the burly driller’s face expressed relief. “Eh, Doctor, I’m glad to see you. I been back and forward here this last hour. The missus wants ye — before time, too.” Andrew, abruptly recalled from the contemplation of his own affairs, told Morgan to wait.
  6. ‘He had no premonition that this night call would prove unusual, still less that it would influence his whole future in Blaenelly.’ Comment. (4 marks)
    1. Susan Morgan’s case was very complicated.
    2. The baby was born ‘stillborn.’
    3. Dr. Morgan exhibited unparalleled patience and hope.
    4. The baby got resuscitated.
  7. Walking to Number 12 Blaina Terrace, Dr. Andrew Manson was quite a lot less than himself. What had reduced Dr. Manson into this state?
    1. He went into the house for his bag, then together they set out for Number 12 Blaina Terrace.
    2. Usually so perceptive, Andrew now felt dull and listless.
  8. What set of character traits of Joe Morgan do you find interesting?
    1. The two men walked in silence until they reached the door of Number 12, then Joe drew up short.
    2. “I’ll not come in,” he said, and his voice showed signs of strain.
    3. “But, man, I know ye’ll do well for us.”
  9. Inside, a narrow stair led up to a small bedroom, clean but poorly furnished, and lit only by an oil lamp. Here Mrs. Morgan’s mother, a tall, grey-haired woman of nearly seventy, and the stout, elderly midwife waited beside the patient, watching Andrew’s expression as he moved about the room.
  10. “Let me make you a cup of tea, Doctor, bach,” said the former quickly, after a few moments. Andrew smiled faintly. He saw that the old woman, wise in experience, realized there must be a period of waiting that, she was afraid he would leave the case, saying he would return later. “Don’t fret, mother, I’ll not run away.”
  11. Down in the kitchen he drank the tea which she gave him. Overwrought as he was, he knew he could not snatch even an hour’s sleep if he went home. He knew, too, that the case here would demand all his attention. A queer lethargy/tiredness of spirit came upon him. He decided to remain until everything was over.
  12. An hour later he went upstairs again, noted the progress made, came down once more, sat by the kitchen fire. It was still, except for the rustle of a cinder in the grate and the slow tick-tock of the wall clock. No, there was another sound— the beat of Morgan’s footsteps as he paced in the street outside. The old woman opposite him sat in her black dress, quite motionless, her eyes strangely alive and wise, probing, never leaving his face.


  • He reassures Mrs. Morgan’s mother 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 Christine is an exception.

Questions & Answers

  1. Who all were in the room other than Dr. Manson? (1 mark)
  2. What for did Joe Morgan’s mother offer to make a cup of tea for Dr. Manson? Susan’s 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 him a cup of tea.
  3. What made Dr. Manson think that he would not sleep that night? (1 mark)
  4. What sounds disrupted the silence of the night? (1 mark)
  5. When did Dr. Andrew reach Bryngower? (1 mark)
  6. What for was Joe Morgan waiting for Dr. Andrew? (1 mark) Joe Morgan’s wife was about to give birth at their home. Being a very caring husband, Joe Morgan had come to take Dr. Andrew to help her in the delivery because this childbirth had been long awaited by everyone at Joe Morgan’s home.
  7. How do we get to know that Joe Morgan was tensed and restless? (1 mark)
  8. Which line informs you that Dr. Andrew had been himself worried? (Quote the entire line, 1 mark)
  9. Where did Joe Morgan live? (1 mark)
  10. Why did Joe Morgan stop short at his own doorstep? (1 mark) Joe Morgan stopped short at his own door step because he was not prepared to see his wife labor. He had his trust placed on the doctor.
  11. After reading the whole story, how do you explain the line, ‘He had no premonition that this night call would prove unusual?’ (2 marks) The line refers to the future of Dr. Andrew in Blaenelly as a doctor. If Dr. Manson had failed in Susan’s delivering the baby safely, he would have made a bad start. However, with his great knowledge and presence of mind, he resusciated the stillborn baby and became a sensation in Blaenelly.

Confused about Marriage

His thoughts were heavy, muddled. The episode he had witnessed at Cardiff station still obsessed him morbidly. He thought of Bramwell, foolishly devoted to a woman who deceived him sordidly, of Edward Page, bound to the shrewish Blodwen, of Denny, living unhappily, apart from his wife. His reason told him that all these marriages were dismal failures. It was a conclusion which, in his present state, made him wince. He wished to consider marriage as an idyllic state; yes, he could not otherwise consider it with the image of Christine before him. Her eyes, shining towards him, admitted no other conclusion. It was the conflict between his level, doubting mind and his overflowing heart which left him resentful and confused. He let his chin sink upon his chest, stretched out his legs, stared broodingly into the fire. He remained like this so long, and his thoughts were so filled with Christine, that he started when the old woman opposite suddenly addressed him. Her meditation had pursued a different course.

Morgan and Susan – Ideal Couples!

“Susan said not to give her the chloroform if it would harm the baby. She’s awful set upon this child, Doctor, bach.” Her old eyes warmed at a sudden thought. She added in a low tone: “Ay, we all are, I fancy.” He collected himself with an effort. “It won’t do any harm, the anaesthetic,” he said kindly. “They’ll be all right.” Here the nurse’s voice was heard calling from the top landing. Andrew glanced at the clock, which now showed half-past three. He rose and went up to the bedroom. He perceived that he might now begin his work.

  1. Why had Susan instructed not to give her chloroform? Susan had her life spent in anticipation of a baby for twenty years and so was her mother, Joe and so many others. Having grown old, she only wished if she could leave behind her a baby for the family. Besides, in her society, infertility was considered to be a curse. For fear of chloroform harming the baby, as believed by the miners, she wanted to make sure that nothing harmed the baby against any amount of physical pain.

The Child is Born, Lifeless


  • The labor leads to a stillborn baby. The baby was born, but no sign of life, no breathing, nothing.
  • Initially, Andrew feels suddenly overwhelmed with the enormity of the situation and the many hopes he had dashed despite his initial reassurance.

Questions & Answers

  1. An hour elapsed. It was a long, harsh struggle. Then, as the first streaks of dawn strayed past the broken edges of the blind, the child was born, lifeless.
  2. As he gazed at the still form a shiver of horror passed over Andrew.
    After all that he had promised! His face, heated with his own exertions, chilled suddenly. He hesitated, torn between his desire to attempt to resuscitate the child, and his obligation towards the mother, who was herself in a desperate state. The dilemma was so urgent he did not solve it consciously.
  3. Dr. Andrew’s primary concern was the mother – not the child. Do you agree with him?
    Blindly, instinctively, he gave the child to the nurse and turned his attention to Susan Morgan who now lay collapsed, almost pulseless, and not yet out of the ether, upon her side. His haste was desperate, a frantic race against her ebbing strength. It took him only an instant to smash a glass ampule and inject the medicine. Then he flung down the hypodermic syringe and worked unsparingly to restore the flaccid woman. After a few minutes of feverish effort, her heart strengthened; he saw that he might safely leave her. He swung round, in his shirt sleeves, his hair sticking to his damp brow. “Where’s the child?” The midwife made a frightened gesture. She had placed it beneath the bed.

A Doctor’s Labor


  • 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.
  • Once the mother was out of danger, 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 tried 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 realized 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.


  • Consternation – Anxiety
  • Flaccid – Soft and hanging
  • Asphyxia Pallida – An abnormal state of a newborn baby in which it appears pale and numb
  • Plunge – Sink
  • Lunge – Thrust
  • Consternation – Anxiety
  • Giddy – Dizzy
  • Linoleum – A material consisting of a canvas backing thickly coated with a preparation of linseed oil and powdered cork, used especially as a floor covering.
  • Ewer /ˈjuːə/ – A large jug with a wide mouth, formerly used for carrying water.
  • Spent – Tired
  • Oblivious – Unaware of

Questions & Answers

  1. What did Andrew feel when he saw the lifeless baby?
    Initially, Andrew was lost for a while. He didn’t know what was there to do. He felt like his dreams melting into thin air. He had two obligations – one to Susan Morgan who lay collapsed and the other to the stillborn baby. Both equally worth saving. He smashed a glass ampule and injected a medicine into Susan’s blood. Throwing the syringe in haste, he made all attempts to bring Susan to breathing. Susan began to breathe though still half alive.
  2. Bring out the clash between the experienced midwife and the professional doctor.
    Hints – Seeing all this, the midwife repeated what she believed to be right – “For mercy’s sake, Doctor, it is stillborn.”
  3. Describe the frantic attempts Dr. Andrew made to resuscitate the still-born baby.
    Dr. Andrew Manson swung around and looked for the baby. The midwife had placed the stillborn under the cot. A very important aspect to note – the midwife was trying to laugh at the modern physician by declaring the baby ‘dead.’ Andrew knelt down, pulled the boy baby out and studied its condition. It was warm, its cord had been hastily slashed, it had a wax-like body, perfectly formed though its limbs (hands and legs) lay like broken stem and boneless. Andrew saw the cause – asphyxia pallida (an abnormal condition in which a newborn appears pale and limp and marked by a heartbeat of 80 beats/min or less). Andrew recalled to his mind a similar incident at Samaritan Hospital sometime in the past and decided to apply his knowledge on the baby. He got basins, kettle, ewer and extremely cold water and hot water for a special treatment. He filled one basin with cold and the other with hot water, took the baby, dipped it in one then in the other. There was no sign of life about the baby and Andrew was dead tired, no life left in him body. Dr. Andrew stumbled and almost fell with the baby over a slippery floor. Another half an hour followed and Dr. Andrew was still working, rubbing the baby with a rough towel, crushing and releasing the little chest. Miraculously the baby stirred, breathed and finally behaved normally.
  4. In a flash Andrew knelt down. Fishing amongst the sodden newspapers below the bed, he pulled out the child. A boy, perfectly formed. The limp, warm body was white and soft as tallow1. The cord, hastily slashed, lay like a broken stem. The skin was of a lovely texture, smooth and tender. The head lolled on the thin neck. The limbs seemed boneless.
  5. Still kneeling, Andrew stared at the child with a haggard frown. The whiteness meant only one thing: asphyxia, pallida2, and his mind, unnaturally tense, raced back to a case he once had seen in the Samaritan, to the treatment that had been used. Instantly he was on his feet. “Get me hot water and cold water,” he threw out to the nurse. “And basins too. Quick! Quick!” “But, Doctor—” she faltered, her eyes on the pallid body of the child. “Quick!” he shouted. Snatching a blanket, he laid the child upon it and began the special method of respiration. The basins arrived, the ewer, the big iron kettle. Frantically he splashed cold water into one basin; into the other he mixed water as hot as his hand could bear. Then, like some crazy juggler, he hurried the child between the two, now plunging it into the icy, now into the steaming bath. Fifteen minutes passed. Sweat was now running into Andrew’s eyes, blinding him. One of his sleeves hung down, dripping. His breath came pantingly. But no breath came from the lax body of the child. A desperate sense of defeat pressed on him, a raging hopelessness. He felt the midwife watching him in stark consternation, while there, pressed back against the wall where she had all the time remained—her hand pressed to her throat, uttering no sound, her eyes burning upon him— was the old woman. He remembered her longing for a grandchild, as great as had been her daughter’s longing for this child. All dashed away now; futile, beyond remedy…
  6. The floor was now a draggled mess. Stumbling over a sopping towel, Andrew almost dropped the child, which was now wet and slippery in his hands, like a strange, white fish. “For mercy’s sake, Doctor,” whimpered the midwife. “It’s stillborn.” Andrew did not heed her. Beaten, despairing, having laboured in vain for half an hour, he still persisted in one last effort, rubbing the child with a rough towel, crushing and releasing the little chest with both his hands, trying to get breath into that limp body.
  7. And then, as by a miracle, the pigmy chest, which his hands enclosed, gave a short, convulsive heave, another… and another… Andrew turned giddy. The sense of life, springing beneath his fingers after all that unavailing striving, was so exquisite it almost made him faint. He redoubled his efforts feverishly. The child was gasping now, deeper and deeper. A bubble of mucus came from one tiny nostril, a joyful iridescent bubble. The limbs were no longer boneless. The head no longer lay back spinelessly. The blanched skin was slowly turning pink. Then, exquisitely, came the child’s cry. “Dear Father in heaven,” the nurse sobbed hysterically. “It’s come— it’s come alive.” Andrew handed her the child. He felt weak and dazed. About him the room lay in a shuddering litter: blankets, towels, basins, soiled instruments, the hypodermic syringe impaled by its point in the linoleum, the ewer knocked over, the kettle on its side in a puddle of water. Upon the huddled bed the mother still dreamed her way quietly through the anaesthetic. The old woman still stood against the wall. But her hands were together, her lips moved without sound. She was praying. Mechanically Andrew wrung out his sleeve, pulled on his jacket. “I’ll fetch my bag later, nurse.” He went downstairs, through the kitchen into the scullery. His lips were dry. At the scullery he took a long drink of water. He reached for his hat and coat.
  8. Outside he found Joe standing on the pavement with a tense, expectant face. “All right, Joe,” he said thickly. “Both all right.” It was quite light. Nearly five o’clock. A few miners were already in the streets: the first of the night shift moving out. As Andrew walked with them, spent and slow, his footfalls echoing with the others under the morning sky, he kept thinking blindly, oblivious to all other work he had done in Blaenelly, “I’ve done something; oh, God! I’ve done something real at last.”

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 semi-alcoholic.
  • 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. Manson’s 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.

What do you think?

-1 points
Upvote Downvote

12.12 Consumer Protection

I Can Play Schools – May C Jenkins