Chapter 4, A.J. Cronin ‘Birth’ Summary, Vocabulary/Word Meanings, Theme, Character Sketch, Textbook Questions Answers and Extra Questions.

Chapter 4- ‘Birth’ by A.J. Cronin

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Vocabulary/ Word Meanings:

Idiomatic Expressions present in the text:

Underlying Theme in ‘The Citadel’:

Summary ‘Birth’ by A.J. Cronin:

In Birth, an excerpt from The Citadel by A.J. Cronin, young doctor Andrew Manson is called to assist Joe Morgan’s wife, Susan, deliver their first child after twenty years of marriage. The tense scene unfolds late at night in their small, humble home. Andrew is troubled by personal issues, but he dedicates himself to the difficult task at hand. 

When the baby is born lifeless, he faces a heartbreaking dilemma: help the child or save the mother. Acting instinctively, Andrew revives Susan and then tries various methods to revive the baby. After half an hour of intense effort, the baby finally takes its first breath. Exhausted yet triumphant, Andrew feels he has done something significant.

Theme ‘Birth’ by A.J. Cronin:

1. Medical Ethics:

Medical ethics is an important theme in this excerpt. Dr. Andrew Manson faces a serious ethical dilemma when the baby is born lifeless and the mother, Susan, is in critical condition. He must decide quickly whom to prioritise: the mother or the child. This moment tests his values, pushing him to make a tough decision based on what he believes is right. 

Andrew chooses to save the mother first, honouring the principle of preserving life as best as possible. After helping Susan, he still works tirelessly to revive the baby, showing his commitment to both patients. The scene reflects the ethical responsibility of doctors to make fast, difficult choices to protect life, even in extreme situations.

2. Contrast Between Theory and Real-World Experience:

The excerpt emphasises how, in medical school, students learn standard procedures and ideal outcomes, but real-life practice often presents unpredictable and complex challenges. Doctors must rely on their knowledge and intuition, adaptability, and perseverance when faced with unique cases or urgent ethical decisions. 

This theme also highlights that true medical expertise is gained through hands-on experience, where doctors learn the importance of empathy, resilience, and quick decision-making beyond what textbooks can teach.

3. Dedication and Perseverance:

Another critical theme of this excerpt from Birth by A.J. Cronin is dedication and perseverance. Dr. Andrew Manson is committed to his work despite being troubled and tired. Despite the difficult situation, he never gives up, trying every possible method to save the mother and the baby. 

His determination finally brings success, giving life to a lost newborn. Another theme is the value of life—Andrew’s hard work and care give him a renewed sense of purpose as he realises he has made a real difference in someone’s life. This excerpt highlights how dedication to helping others can lead to personal fulfilment.

Character Sketch of Andrew Manson: 

1. Youthful and Inexperienced:

• New to Practice: Dr. Andrew Manson has just completed his medical studies and is starting his career in a small town, which reflects his lack of real-world experience. This inexperience is evident as he struggles to handle the challenges of his first real medical case.

• Eager but Uncertain: His enthusiasm to prove himself is tempered by moments of doubt and confusion, especially as he tries to balance his emotions and professional duties.

2. Emotionally Torn:

• Personal Conflict: Andrew is deeply affected by his feelings for Christine, which distract him throughout the night. His internal conflict between his idealised view of love and the realities of his life and career shapes his thoughts and actions.

• Resentment and Confusion: He feels torn between his overwhelming emotions for Christine and his logical side, which recognises the challenges of marriage based on his observations of other troubled relationships around him.

3. Compassionate and Caring:

• Concern for Patients: Andrew remains compassionate and attentive to Mrs Morgan’s needs despite his emotional distractions. He reassures the elderly woman in the house and ensures that the case gets his full attention, showing his nurturing nature.

• Emotional Support: He offers kind words to the elderly woman, calming her fears and letting her know he won’t leave. His gentle, reassuring attitude reflects his ability to empathise with others in their times of need.

4. Professional Dedicated:

• Focus on the Task: As the night progresses, Andrew consciously decides to stay and see the case through, knowing it will require his full attention. This shows his sense of duty and professionalism.

• Hardworking: Even when the situation seems dire, he works tirelessly to save both mother and child. His commitment to his work is evident when he decides to remain despite his exhaustion.

5. Relentless and Determined:

• Perseverance in the Face of Failure: When the child is born lifeless, Andrew’s immediate reaction is a desperate attempt to revive the infant. His persistence is crucial in this situation, even when the odds seem stacked against him.

• Desperate Effort: His frantic actions, including applying an unconventional method of resuscitation, highlight his determination not to give up, even when others, like the midwife, think it’s hopeless.

6. Emotional and Physical Exhaustion:

• Drained Yet Fulfilled: Andrew is physically and emotionally drained after the miracle of the child’s revival. His weariness, reflected in his dishevelled appearance and slow movements, is contrasted with the relief and satisfaction he feels knowing he has saved the child and mother.

• Reflective: As he walks outside, he feels a sense of accomplishment; Andrew realises he has done something meaningful, something real, which marks a turning point in his personal and professional life.

7. Moral and Ethical Dilemmas:

• Conflicted Decision-Making: Throughout the night, Andrew is faced with difficult decisions—whether to prioritize the mother’s health over the child’s or to continue fighting for the child’s life. His inner conflict highlights his struggle between doing what is medically right and what feels emotionally just.

• Growing Confidence: Despite the challenges, Andrew’s final success—reviving the baby—marks a significant shift in his confidence and understanding of his role as a doctor, transitioning from doubt to belief in his ability to make a difference.

8. Pragmatic and Quick-Thinking:

• Swift Action Under Pressure: When faced with a stillborn child, Andrew quickly recalls a medical technique he had once witnessed and immediately puts it into action. His ability to think on his feet and remain calm under pressure showcases his adaptability and resourcefulness.

Quick Revision 💡

Questions Answers ‘Birth’ by A.J. Cronin: 

Q1: “I have done something; oh, God! I’ve done something real at last.” Why does Andrew say this? What does it mean? 

A1: Andrew says, “I have done something; oh, God! I’ve done something real at last,” because he feels a deep sense of achievement. After working hard to save the newborn, who appeared lifeless at birth, Andrew finally succeeds. 

The baby’s first breath and cry fill him with joy and relief, making him feel that his work as a doctor has true meaning. Andrew has seen many unhappy marriages and feels doubtful about life and relationships. 

However, he realises he can make a positive difference by bringing the baby to life. This moment makes him feel proud and fulfilled, as he has finally done something vital and meaningful for another family.

Q2: There lies a great difference between textbook medicine and the world of a practising physician. Discuss. 

A2: The difference between textbook medicine and real-life practice is that textbooks give basic knowledge, but real-life situations are unpredictable. Textbooks often teach medical theories, procedures, and treatments in clear, controlled steps. 

However, when a doctor faces actual patients, each case can be unique, requiring quick thinking and adjustments. Doctors often face intense challenges in practice, like emergencies or unusual symptoms, which are not detailed in books. 

For example, Andrew in Birth saves a seemingly lifeless baby with his instincts, experience, and improvisation, going beyond textbook knowledge. His experience shows that while textbooks are essential for learning, practical experience, intuition, and compassion are equally crucial for a successful doctor.

Q3: Do you know of any incident when someone has been brought back to life from the brink of death through medical help. Discuss medical procedures such as organ transplant and organ regeneration that are used to save human life.

A3: Yes, there are many cases where medical help has saved someone close to death. One example is CPR (Cardiopulmonary Resuscitation), where doctors or paramedics use chest compressions and artificial breathing to restart someone’s heart and breathing. 

Another life-saving procedure is organ transplant, where doctors replace a damaged organ with a healthy one from a donor. For example, a heart, kidney, or liver transplant can save the lives of people whose organs have stopped working. 

Further, medical research is working on organ regeneration, which could help grow new organs using stem cells, reducing the need for transplants. These procedures, along with advances in medical technology, continue to help bring people back from the brink of death and improve survival chances.

Extra Questions ‘Birth’ by A.J. Cronin:

Short Answer Type Questions: 

Q1: How does Andrew Manson feel when he arrives at the Morgans’ house for the birth?

A1: When he arrives, Andrew feels dull and listless. He is tired and absorbed in his thoughts, particularly about Christine. He does not expect the birth to be unusual and feels mentally distant from the situation, but he decides to stay and help.

Q2: What is the significance of the old woman’s presence in the room during the birth?

A2: Susan’s mother, the old woman, is important because she represents experience and tradition. She silently observes Andrew’s actions and is emotionally connected to the birth, showing concern for her daughter and the child. Her presence brings a sense of continuity and care during the difficult moment.

Q3: How does Andrew respond to the situation when the baby is born lifeless?

A3: When the baby is born lifeless, Andrew feels a mix of horror and uncertainty. He is torn between trying to save the baby and focusing on the mother, Susan, who is also in danger. He quickly hands the baby to the nurse and works to save Susan.

Q4: Describe Andrew’s emotions when the child comes to life after being declared stillborn.

A4: Andrew feels a wave of relief and astonishment when the child starts to breathe. His exhaustion and despair turn into joy and disbelief. The moment of life returning to the baby feels like a miracle to him, making him feel like he has finally achieved something meaningful.

Q5: How does Andrew’s experience with the stillborn child affect his view of his medical career?

A5: Andrew’s experience with the stillborn child makes him realise the importance of his work. After saving the child, he feels he has done something real and meaningful in his medical career. This moment changes how he views his doctor role, giving him a new purpose.

Q6: What is Andrew’s internal conflict as he works to save the child?

A6: Andrew feels torn between his duty to save the lifeless child and his responsibility to Susan, the mother, who is also in critical condition. His mind races with doubt, but his instincts push him to keep trying, leading to a desperate, intense effort to save the baby’s life.

Q7: How does the story’s setting (time and place) influence Andrew’s experience during the birth?

A7: The story occurs in a small Welsh mining town at night, creating a quiet, tense atmosphere. The isolation and the late hour add to Andrew’s exhaustion and mental fog. The setting also emphasises his sense of duty, as he works alone in a modest, old house.

Q8: What role does Joe Morgan play in the events of the night?

A8: Joe Morgan’s role is mainly as a concerned, supportive husband. He waits anxiously outside while Andrew works. Joe’s presence shows the emotional weight of the situation, and his quiet support adds to the urgency of the birth, especially when he reassures Andrew to do well for them.

Q9: How does Andrew’s interaction with the mother differ from his work with the child?

A9: Andrew’s interaction with the mother, Susan, is focused on saving her life, as she is in a fragile state. His work with the child is more urgent and emotional, trying to bring the lifeless baby back to life—his attention shifts between them, driven by different concerns.

Q10: What emotional impact does the birth experience have on Andrew?

A10: The birth experience profoundly impacts Andrew. He goes from despair and confusion to immense relief and joy when the child comes to life. The emotional impact of the moment gives him a sense of accomplishment and a renewed purpose in his medical career, changing how he views his work.

Q11: What is the significance of Andrew’s thoughts about marriage during birth?

A11: During the birth, Andrew reflects on failed marriages he has seen, feeling confused about his thoughts on marriage. His mind is torn between seeing marriage as a happy ideal, influenced by his feelings for Christine, and the reality of troubled relationships he’s witnessed.

Q12: How does Andrew react to the old woman’s concern about the chloroform?

A12: Andrew reassures her kindly when the old woman expresses worry about the chloroform affecting the baby. He calmly explains that the anaesthetic won’t harm the child, showing his professional confidence and understanding of the situation, even though he’s emotionally affected by the ongoing birth process.

Q13: What is the significance of the moment Andrew realises the child is alive?

A13: When Andrew realises the child is alive, it’s a moment of relief and triumph. After struggling to save the baby, the child’s first cry shows that Andrew’s efforts weren’t in vain. The moment gives him a sense of real achievement in his medical work.

Q14: How does the birth affect Andrew’s sense of accomplishment in his career?

A14: The birth gives Andrew a deep sense of fulfilment. After many doubts, this successful birth is the first time he feels he’s made a meaningful difference. It gives him confidence and a sense of purpose in his medical career, making him feel accomplished.

Q15: What does Andrew’s physical exhaustion symbolise at the end of the story?

A15: At the end of the story, Andrew’s physical exhaustion symbolises his emotional and mental strain. After struggling to save the baby and help the mother, he is drained but feels a sense of accomplishment. His tiredness reflects the intense effort and the emotional toll of the experience.

Long Answer Type Questions: 

Q1: How does Andrew’s internal conflict affect his actions during the birth?

A1: Andrew’s internal conflict deeply affects his actions during the birth. He enters the scene troubled by his thoughts on love and marriage, especially after witnessing unhappy relationships. He doubts whether marriage can be truly joyful, yet he feels a strong love for Christine, which confuses him. 

These conflicting feelings make him distracted and emotionally distant at first. However, as the delivery becomes critical, Andrew shifts his focus to the mother and child, setting aside his worries. His inner conflict fades as he uses his medical skills to save both lives. 

It shows that, despite his emotional struggle, Andrew’s commitment to his duty as a doctor is stronger, helping him succeed in a life-saving situation.

Q2: What role does the old woman play in the birth scene, and how does she influence Andrew?

A2: Susan Morgan’s mother, the old woman, plays a steady, supportive role during the birth scene. She quietly watches Andrew, deeply caring for her daughter and the unborn child. Her calm presence, experience, and wisdom help Andrew stay focused and committed. 

She offers him tea and reassures him that he can take his time, which helps him feel more grounded and patient. When Susan is close to giving birth, the old woman expresses her strong hope for a healthy baby, reminding Andrew of the family’s deep desire for this child. 

Her silent prayers and trust in Andrew’s abilities motivate him to keep working hard, even when things look hopeless, influencing his determination to save the newborn.

Q3: What does Andrew’s reaction to the child’s survival reveal about his character?

A3: Andrew’s reaction to the child’s survival shows that he is a dedicated, compassionate, and determined doctor. Despite feeling tired, frustrated, and doubtful about his career, he pushes himself to try every possible method to revive the lifeless newborn. 

Even when others think it’s hopeless, he refuses to give up. His intense focus and effort reveal a strong sense of responsibility and a deep commitment to saving lives. Andrew feels profound relief and pride when the baby finally breathes, realising he has done something significant. 

It hints that, beneath his doubts, Andrew cares deeply about his work and finds true purpose in helping others, even in challenging and uncertain situations.

Q4: How does Cronin create a sense of urgency and tension in the birth scene?

A4: Cronin creates urgency and tension in the birth scene through Andrew’s actions and the vivid descriptions of his struggle. As soon as the baby is born lifeless, Andrew feels panic but quickly decides to fight to save the child. 

Cronin describes Andrew’s fast movements, such as shouting for hot and cold water, repeatedly switching the baby between basins, and performing chest compressions. Short sentences and urgent words, like “quick” and “frantically,” add to the intense pace. The midwife’s fearful reaction and the old woman’s silent prayers emphasise the critical situation. 

Andrew’s exhaustion and the messy, chaotic room also add to the suspense, making readers feel the pressure as he tries desperately to bring the baby to life.

Q5: In what ways do Andrew’s personal experiences and the cases he has seen in the past influence his approach to birth?

Q5: Andrew’s experiences and past cases strongly influence his approach to birth. He recalls witnessing failed marriages and feeling doubtful about love, initially making him feel emotionally distracted. 

However, he remembers a specific medical case from the Samaritan hospital, where he saw a similar situation of a lifeless newborn. The memory gives him an idea for trying to revive the baby. His experience allows him to quickly organise and perform the unusual treatment, shifting between hot and cold water and using chest compressions. 

Despite his emotional struggles, his past training and determination help him focus on saving the child. This experience ultimately renews his belief in his purpose as a doctor, giving him new confidence.

Q6: How does the birth experience impact Andrew’s view of his role as a doctor?

A6: The birth experience deeply changes Andrew’s view of his role as a doctor. Before this, he felt uncertain and discouraged, questioning his career and personal life. 

But his efforts to save the newborn, despite the struggle and near-hopelessness, give him a strong sense of achievement. When he finally hears the baby’s first cry, he realises that he has done something valuable, not just routine work. 

The success fills him with pride and purpose, making him feel that he has a real impact on people’s lives. Andrew understands that his role as a doctor is not just about knowledge but compassion, perseverance, and the difference he can make. His experience strengthens his dedication to his profession.

Q7: How does the author use physical descriptions of the child to create a sense of tension and urgency?

A7: The author uses vivid physical descriptions of the child to build tension and urgency. When Andrew first sees the newborn, he notices that the baby is pale, limp, and lifeless, with skin “white and soft as tallow,” suggesting it isn’t breathing. 

The body appears “boneless,” and the head droops, making the child seem very fragile and close to death. These descriptions make the reader feel the seriousness of the situation and emphasise how critical it is for Andrew to act quickly. 

By showing the baby’s delicate state, Cronin highlights Andrew’s desperation and the intense effort required to save the child. The reader shares Andrew’s anxiety and hopes for the child’s survival, which creates a gripping and urgent atmosphere.

Q8: What does Andrew’s reaction to the lifeless child reveal about his medical knowledge and emotional state?

A8: Andrew’s reaction to the lifeless child shows both his medical knowledge and his emotional intensity. He feels immediate horror, but his training quickly guides him to recognise the baby’s condition as “asphyxia pallida,” a form of severe lack of oxygen. 

This knowledge prompts him to remember a treatment he saw before, showing his ability to recall past experiences under pressure. Emotionally, Andrew is deeply invested and refuses to give up, even when the midwife suggests the child is stillborn. 

His determination and persistence reflect his compassion and strong sense of responsibility. Despite his inner struggles, Andrew puts his emotions aside to focus on saving the baby, highlighting his dedication and commitment as a doctor.

Q9: How does Cronin use the interactions between the characters to highlight the themes of life, death, and hope?

A9: Cronin uses interactions between characters to explore life, death, and hope. Joe Morgan’s nervous pacing shows his fear and hope for safe delivery, while his trust in Andrew suggests his faith in life’s possibilities. 

Mrs. Morgan’s mother watches Andrew closely, praying silently, reflecting her strong hope for her grandchild. When the baby is born lifeless, Andrew faces a difficult choice between saving the mother or reviving the child. His intense efforts to save the baby symbolise his deep respect for life and his unwillingness to give in to despair. 

Finally, when the child begins to breathe, both the nurse’s joy and the grandmother’s quiet prayer capture a moment of miraculous hope, celebrating life’s power to overcome death.

Important Passages from the Excerpt ‘Birth’ by A.J. Cronin: 

Passage 1: “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.’”

Context: Joe Morgan is anxiously waiting outside for Dr. Andrew Manson, who has been called to help deliver Joe’s first child. Joe’s nervousness reflects how much he and his wife, Susan, have anticipated this child after nearly twenty years of marriage. The passage shows the seriousness of Andrew’s task and hints at the high stakes involved for the Morgans.

Passage 2: “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.”

Context: The excerpt shows Andrew’s fatigue and determination to stay and ensure he is there for the Morgans. He knows the delivery will require his full attention. It also reflects his dedication as a doctor, emphasising his commitment to his patients.

Passage 3: “The whiteness meant only one thing: asphyxia, pallida, and his mind, unnaturally tense, raced back to a case he once had seen in the Samaritan, to the treatment that had been used.”

Context: Here, Andrew realises that the baby is not breathing and is at risk of death. He remembers a technique he learned at medical school and decides to try it, even though it’s difficult and tiring. The excerpt shows Andrew’s quick thinking and determination to save the baby, emphasising his sense of duty and resilience.

Passage 4: “And then, as by a miracle, the pigmy chest, which his hands enclosed, gave a short, convulsive heave, another… and another…”

Context: After working tirelessly, Andrew finally revives the baby, who begins to breathe independently. The moment is triumphant and emotional, highlighting Andrew’s success after a long struggle. It also relieves everyone involved, especially Joe and the family, showing the impact of Andrew’s dedication and skill.

Passage 5: “Outside, he found Joe standing on the pavement with a tense, expectant face. ‘All right, Joe,’ he said thickly. ‘Both all right.’”

Context: After successfully reviving both the mother and baby, Andrew delivers the good news to Joe. The excerpt marks the story’s resolution, with Andrew feeling pride in his accomplishment and Joe experiencing profound relief. The phrase “both all right” is simple but powerful, capturing the sense of relief, hope, and the value of Andrew’s work.

Passage 6: “Andrew’s 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.”

Context: Andrew is reflecting on his troubled thoughts about love and relationships. He struggles with doubts about marriage and the meaning of life, especially after seeing several unhappy marriages. The text shows his internal conflict, which contrasts with the life-or-death situation he faces with Mrs Morgan’s childbirth. His confusion and disillusionment influence his approach to the world around him, including his views on his relationship with Christine.

Passage 7: “He let his chin sink upon his chest, stretched out his legs, stared broodingly into the fire.”

Context: The excerpt reveals Andrew’s exhaustion and mental strain. He is overwhelmed by the weight of his thoughts about love and marriage. The fire represents a source of comfort but contrasts with the heat and intensity of his inner turmoil. The moment of reflection is critical to understanding Andrew’s state of mind as he prepares for the challenges ahead in the delivery room.

Passage 8: “The nurse’s voice was heard calling from the top landing. Andrew glanced at the clock, which now showed half-past three.”

Context: The text marks a shift in the action as Andrew is called to return to work. The time mentioned emphasises the long hours he has already worked, creating a sense of urgency and mounting pressure. The lines mark a crucial point in the story, as Andrew is nearing the critical moment in the childbirth process.

Passage 9: “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.”

Context: Here lies the moment of great tragedy. After a long and difficult delivery, the baby is born without life. This incident is critical because it represents Andrew’s first major failure in this story, as he is faced with the reality of death after all his efforts. It heightens the emotional intensity of the scene and sets the stage for Andrew’s desperate actions to save the baby.

Passage 10: “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.”

Context: The above lines show Andrew’s desperation and determination. Despite all the signs of failure, he refuses to give up on the child. His refusal to accept defeat shows his deep sense of duty and emotional investment in the outcome. The passage illustrates Andrew’s resilience, which is crucial in his development as a doctor and a person.

Passage 11: “The limbs were no longer boneless. The head no longer lay back spinelessly. The blanched skin was slowly turning pink.”

Context: This is a moment of victory in the story. After Andrew’s frantic efforts, the baby shows signs of life. The physical description of the child’s transformation from lifeless to alive serves as a metaphor for Andrew’s personal growth and triumph over his earlier doubts and despair. The change in the child reflects the change in Andrew’s outlook.

Passage 12: “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.”

Context: The chaotic scene in the room symbolises the emotional and physical toll the event has taken on Andrew. The mess and the state of disarray contrast with the joyous outcome of the child’s survival, highlighting the cost of the effort and the exhaustion Andrew feels.