Birth by A. J. Cronin

BIRTH

   By A. J. Cronin

 

The Citade l ( ‘Birth’ is an extract from this novel)  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 is credited with laying the foundation in Great Britain for the introduction of the NHS a decade later.

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."

 

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 'Drineffy'. He quickly realises that Page is an 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. 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 Christine is killed in a traffic accident. It is Denny, now teetotal, who whisks him off to the Welsh countryside to recover.

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 who does not have a medical degree, even though the patient had been successfully treated at his nature cure clinic.

Despite his lawyer's gloomy prognosis, Manson forcefully justifies his actions during the hearing and is not struck off the medical register. He joins Denny and bacteriologist Dr Hope in opening an integrated, multi-specialty practice, then uncommon, in a country town.   

(FOR READY  REFERENCE OF AVN STUDENTS)

 

BIRTH

   By A. J. Cronin

 Value Points

●  People’s sense of responsibility towards work.

●  A doctor’s sense of duty, dedication, and humanistic approach towards his patients.

● The supreme joy of motherhood.

● The real sense of fulfilment and peace and joy that a piece of good work done brings to human mind.

● The real piece of work in human life lies in bringing joy in other people’s life.

● The tremendous sense of expectation and anxiety that is caused in other family member’s heart when a baby is on the way.

● The technical aspects of the resuscitation method as regards a new-born.

 Short Question Answers:

1. What was the dilemma that Andrew faced after the baby was born?

Answer: After the baby was born, Andrew was faced with the dilemma whether to attend to the baby which was still-born in order to try to resuscitate it or to turn his attention rather to the mother, Susan Morgan, who was in a desperate state of health because of loss of blood and labour pain.

2. Why was Joe and Susan Morgan’s case special for Andrew?

Answer: Joe and Susan Morgan’s case was special for Andrew because Joe and Susan were expecting their first child although they had been married for twenty years.

3. What was Susan Morgan’s suggestion to Andrew which she informed through her mother-in-law?

Answer: Susan Morgan wished that she was not to be given the chloroform if it would harm the baby.

4. What did Andrew guess could be cause of the baby being still born?

Answer:   Andrew found out that the baby had turned white and it could mean only one thing: asphyxia which is suffocation or unconscious condition caused by lack of oxygen and excess of carbon dioxide in the blood, accompanied by paleness of the skin, weak pulse, and loss of reflexes.

5. What is your impression about Dr. Andrew as a doctor and a human being?

Answer: The story ‘Birth’ is a comment on what a doctor should really be as a doctor and a human being. Dr. Andrew is an exceptionally dutiful and kind and passionate human being. Not only he sets aside mental and bodily fatigue to visit Joe Morgan’s house dead at night, but also he almost rebels against nature’s laws to keep trying to bring breath back to the still born baby wherein he succeeds.

 Long Questions with answer and hints

 1. Describe the efforts that Andrew made in order to bring the still born baby back to life.

Answer: After pulling the still born baby out from beneath the bed, Andrew could guess why the baby had lost its breath. The cause was asphyxia which is a condition in which insufficient or no oxygen and carbon dioxide are exchanged on a ventilator basis caused by choking or drowning. Therefore, he realized that there was point in trying to resuscitate the baby with the help of the traditional resuscitation methods applied in such cases. So he first laid the baby upon a blanket and began the special methods of respiration. Thus he poured hot and cold water in two basins and frantically went on pushing the baby into the water of both the basins alternately for almost half an hour. But no breath emerged from the baby and a sense of desperation and defeat set in his mind. Still he wanted to put in another last effort. So this time, he rubbed the baby with a rough towel and then he crushed and released the little chest with both his hands, trying to get breath into that lax body. And after this, the miracle happened and the tiny chest of the baby gave a heave and then another and then another and Andrew was victorious as the baby was finally revived.

2. Why was Andrew so emotionally attached to his efforts to bring the lifeless baby back to life?
Answer:
Hints:

-Joe Morgan and Susan Morgan were expecting the birth of their first birth

-They were married for twenty years.

-It was Dr. Andrew who had been handling the case.

-Andrew had assured the couple of no complication and safe delivery of the baby.

-All others in Morgan’s family were anxious

-Susan Morgan feels labour pain before due date -Susan’s mother-in-law informs Andrew about Susan’s wish to go through labour pain without anaesthesia in case the same would hurt the baby.

-Andrew goes on with anaesthesia

-A still baby is born

-Andrew has to do something to revive the baby because he had held a promise.

3. Why does Andrew comment that he had done something ‘real at last’ in Blaenelly?

Answer:
Value Points:
-Andrew Manson is a young doctor just out of medical school.

-The place where he works is a small mining town named Blaenelly.

-He had been handling the case of Joe and Susan Morgan who were expecting their first child after twenty years of marriage.

-Andrew had assured the couple of no complication and safe delivery of the baby.

-He visits Joe Morgan’s house dead at night as Susan Morgan has premature labour pain

-In an atmosphere of anxiety and expectation, he works for the safe delivery of the baby

-A lifeless baby is born and Susan is on the verge of death too -Andrew is crushed

-He first helps Susan’s condition improve

-Then he works massively for resuscitating the breathless baby

-After half an hour’s harsh struggle, the baby breaths

-At last Andrew can be true to the promise he had held.

-Saving the lives of two this way and guaranteeing joy to a whole family is thus ‘ something real’

Questions for Practice:

Long Questions

1. Compare and contrast Dr. Andrew’s contrasting emotional status at the beginning of the story and in the end.

2. What does the story highlight about the essence of true happiness and joy and sense of fulfillment through Dr. Andrew’s experience.

3. Is there any supernatural element about the baby being brought back to life from being dead? Or the writer has presented the phenomenon as natural in the story?

Short Questions:

1. What is Dr. Andrew’s concept about women? What led him to think that way?

2. What was the expression and attitude of the mid wife/nurse towards what Dr. Andrew was doing?

3. What is the setting of the story? (Time and place where it is set)

4. Bring out the atmosphere of expectation and anxiety in the mind of the Morgan family members.

5. Why did the baby lose its breath?

Value based question

Do you feel that modern day doctors are rather mechanical medical machines without human emotions? Or it is rather a prejudiced opinion about these professionals who are also considered human gods?

 

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