Chapter 4 — Birth

'Birth' is an excerpt from A.J. Cronin's novel The Citadel. It follows young Dr Andrew Manson, who is called late at night to attend the difficult delivery of Susan Morgan in the Welsh mining town of Blaenelly. The baby is born lifeless at dawn, but Andrew refuses to give up and, after more than half an hour of determined effort, revives the child. The story explores a doctor's sense of duty, the miracle of life, and the gap between theoretical training and real medical practice.

Dr Andrew Manson is a newly qualified doctor who has just begun working as an assistant to Dr Edward Page in Blaenelly, a small Welsh mining town. At the opening of the story he is returning late from a disappointing evening with Christine, the girl he loves, and feels dull and listless — with no premonition that the night call he is about to answer will prove so significant.

Joe Morgan is a burly driller who meets Andrew near the surgery just before midnight. He and his wife Susan have been married nearly twenty years and are expecting their first child. Joe waits anxiously on the pavement outside Number 12 Blaina Terrace throughout the long night, pacing up and down, while Susan is attended to indoors.

Andrew arrives at Number 12 Blaina Terrace around midnight. He waits through the night while Susan's mother and the midwife tend to the patient. He goes upstairs around half-past three in the morning and assists through a long, harsh struggle. Just as the first streaks of dawn appear, the baby boy is born — but he is completely lifeless.

Andrew sees that the baby's whiteness indicates asphyxia pallida — a condition caused by lack of oxygen and excess of carbon dioxide in the blood, accompanied by pale skin, weak pulse, and loss of reflexes. His mind races back to a case he had once seen at the Samaritan hospital and the treatment that had been used there.

Andrew first hands the baby to the nurse and urgently stabilises Susan Morgan, who is collapsed and almost pulseless, with a hypodermic injection. He then retrieves the baby from beneath the bed where the midwife had placed it. He applies a special method of respiration — alternately plunging the infant into basins of very hot water and ice-cold water — while also rubbing it with a rough towel and manually compressing and releasing the small chest. After more than half an hour, with sweat running into his eyes and the midwife urging him to stop, the baby's chest gives a convulsive heave; it begins to breathe deeper and deeper, its skin slowly turns pink, and it cries.

Susan Morgan's mother, a tall grey-haired woman of nearly seventy, is present throughout the night. She is wise and experienced enough to fear Andrew might leave before the birth, so she offers him tea to keep him there. During Andrew's exhausting resuscitation attempt she stands pressed against the wall, her hand at her throat, watching in silence. At the moment the baby cries, she is seen praying silently with her hands clasped and lips moving.

Andrew walks out to find Joe on the pavement and tells him, 'All right, Joe. Both all right.' Then, walking home among the first miners heading to the morning shift, he keeps thinking to himself, 'I've done something; oh, God! I've done something real at last.' This reflects his profound sense of achievement and the feeling that, for the first time in his short career, he has performed an act of genuine consequence — saving a life against seemingly impossible odds.

The central themes are a doctor's dedication and the irreplaceable value of human life. Andrew does not give up on the baby even when the midwife declares it stillborn and his own sense of defeat is overwhelming. His perseverance — driven by instinct and training rather than hope — ultimately brings the child to life. The story also contrasts theoretical medical knowledge with the emotional and physical reality of practice, as captured in the textbook exercise question that follows the excerpt.

The title operates on two levels. Literally, it refers to the delivery of Susan Morgan's baby. Figuratively, it marks the birth of Andrew Manson as a true doctor — the moment he moves from being a newly qualified graduate to someone who has faced a real crisis, acted decisively under pressure, and saved two lives. His closing thought, 'I've done something real at last,' captures this personal transformation.

Andrew is torn between two urgent duties: Susan Morgan has just given birth and is herself collapsed, almost pulseless, and still under the anaesthetic — she needs immediate attention. At the same time he desperately wants to attempt to revive the lifeless baby. He resolves the dilemma instinctively by first attending to Susan with an injection to stabilise her heart, then immediately turning to the infant.

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