Norman Bethune

Norman Bethune: The Doctor Who Drove Blood to the Front

Generations of Chinese schoolchildren have read an essay about a Canadian surgeon, written by Mao Zedong six weeks after the man died of blood poisoning from a cut finger in a Hebei village. In Canada he went largely unmarked for decades. Norman Bethune reached that village by way of a shrapnel wound at Ypres, a tuberculosis ward in the Adirondacks, a Montreal operating theatre, and the front line outside Madrid.

Gravenhurst

Henry Norman Bethune was born on 4 March 1890 in Gravenhurst, Ontario, into a Scottish-Canadian family thick with clergymen and surgeons. His great-great-grandfather founded Montreal's first Presbyterian congregation; his grandfather, Norman Bethune Sr., became a Fellow of the Royal College of Surgeons of Edinburgh in 1860 and co-founded the Upper Canada School of Medicine. His father Malcolm was a small-town pastor; his mother Elizabeth Ann Goodwin was an English immigrant. The son of that household became an atheist and carried, by his own account, a fear of being mediocre.

He left Owen Sound Collegiate in 1908, taught primary school briefly, and entered the University of Toronto. In 1911 he spent a season as a labourer-teacher with the Reading Camp Association — later Frontier College — at a lumber camp near Whitefish, in the Sudbury district, teaching men who worked twelve-hour days. He returned to Toronto in 1912 and switched into medicine.

The war interrupted. In 1914 he joined the Royal Canadian Army Medical Corps and went to France as a stretcher-bearer with No. 2 Field Ambulance. He was hit by shrapnel at the Second Battle of Ypres and evacuated to England, returning to Canada in October 1915 and taking his M.D. in 1916. Further service in the Royal Navy followed, then postgraduate training in Britain.

The Sanatorium

In 1920 he met Frances Penney and married her in 1923. They spent much of her inheritance on a European tour and settled in Detroit, where he practised privately and taught part-time at the Detroit College of Medicine and Surgery. In 1926 he contracted pulmonary tuberculosis and went to the Trudeau Sanatorium at Saranac Lake, New York. Frances divorced him and returned to Scotland; they remarried in 1929 and divorced finally in 1933.

At Saranac he read about artificial pneumothorax — deliberately collapsing a diseased lung so it could rest and heal — a radical procedure his own physicians were reluctant to attempt. He insisted. He recovered completely, and the experience decided his career.

In 1928 he joined Edward Archibald, the pioneer of thoracic surgery in Canada, at McGill's Royal Victoria Hospital in Montreal. Between 1929 and 1936 he invented or redesigned around a dozen surgical instruments and published fourteen papers on thoracic technique. The Bethune rib shears are still in clinical use.

"Bread at the Price of Jewels"

The Depression radicalised him. He treated Montreal's poor for nothing and concluded that the disease he was cutting out of people's chests was a symptom of how they lived. "Medicine, as we are practising it, is a luxury trade," he wrote. "We are selling bread at the price of jewels.... Let us take the profit... out of medicine." He founded the Montreal Group for the Security of the People's Health and pushed, unsuccessfully, for state medicine in Canada — decades before Canada had it.

In 1935 he went to the Soviet Union to see universal free healthcare in operation, came back a committed communist, and joined the Communist Party of Canada.

Madrid

When the Spanish Civil War broke out in 1936 he went, backed by the North American Committee to Aid Spanish Democracy, arriving in Madrid on 3 November. Unable to get surgical work, he built something else instead: the Servicio Canadiense de Transfusión de Sangre, a mobile blood transfusion service formally presented to Republican forces in 1937. Blood was collected from civilian donors in the city, refrigerated, and driven to casualty stations near the front — first in a Renault, later a modified Ford station wagon — across an operational area covering something on the order of a thousand kilometres. A comparable service was running in Barcelona, but Bethune's covered far more ground.

He came home on 6 June 1937 and toured Canada raising money and volunteers, saying plainly what he now believed about fascism and about medicine.

Yan'an

In January 1938 he went to China, to Yan'an in Shaanxi, to serve the Eighth Route Army of the Chinese Communist Party. The Lebanese-American physician George Hatem helped him organise. What he did there was less about his own hands than about multiplying them: he operated close to the fighting in mobile units, and he built training for Chinese doctors, nurses and orderlies — writing manuals for people who in many cases had no formal medical education at all, so that care would continue after any individual surgeon was gone. He treated casualties without regard to which side they had fought on. In the summer of 1939 he was made medical adviser to the Jin-Cha-Ji border region military district under General Nie Rongzhen.

On 29 October 1939 he cut his left middle finger while removing bone fragments from a wounded soldier. On 1 November, operating on a man with erysipelas of the neck, the wound reopened and was infected. Malnourished and without antibiotics — penicillin was still in an Oxford laboratory — he developed septicaemia and died on 12 November 1939 in Tang County, Hebei. He was forty-nine.

On 21 December Mao published "In Memory of Norman Bethune," praising "Comrade Bethune's spirit, his utter devotion to others without any thought of self" and urging Chinese communists to emulate his internationalism. It became one of the three prescribed texts of the Cultural Revolution and required reading in Chinese primary schools.

Why Norman Is Called a Genius

The word fits Bethune awkwardly, and the honest version is more interesting than the hagiography. He made no scientific discovery. His instruments were refinements of existing tools, brilliantly practical but incremental; his fourteen papers are technique, not theory. He was not the only person to think of moving blood to the wounded — a similar transfusion service was operating in Barcelona at the same time.

What he had was a rarer and more uncomfortable faculty: he saw the whole system rather than the patient in front of him, and then acted on what he saw at cost to himself. Confronted with tuberculosis he demanded an experimental procedure on his own lung. Confronted with poverty-driven disease in Montreal he concluded the fee-for-service model was the pathology and said so, unpopularly, in the 1930s. Confronted with soldiers dying of blood loss because blood stayed in cities, he built the logistics to take it to them. Confronted with a Chinese army with almost no trained medical staff, he stopped trying to be the surgeon and became the teacher, on the correct calculation that manuals and trained orderlies would outlive him. That is not raw intellect; it is diagnostic imagination applied to institutions, combined with an almost pathological unwillingness to be comfortable. It is also fair to note that his sanctification in China served a political purpose that had nothing to do with his surgery: Mao needed a model of selflessness, and a dead foreigner made an ideal one.

Legacy

Bethune is buried in the Revolutionary Martyrs' Cemetery in Shijiazhuang. The Bethune Medal, created in 1991, is China's highest medical honour. The Norman Bethune University of Medical Sciences in Changchun, founded in 1939, is now the Norman Bethune Health Science Center of Jilin University. In Canada, recognition came late: Bethune Memorial House in Gravenhurst opened as a National Historic Site in 1976, he entered the Canadian Medical Hall of Fame in 1998, a bronze statue was unveiled in his birthplace in 2000, and in the 2004 CBC vote he placed twenty-sixth among the greatest Canadians. The country he argued with for a decade about socialised medicine eventually built it.

Achievements

• Held posts at Great Ormond Street Hospital, Wayne State University School of Medicine and Royal Victoria Hospital, Montreal
• Fields: thoracic surgery and battlefield medicine