A physician for the ages

Updated: 2014-05-16 23:21

By Professor Edward Shorter in Toronto, Medical historian at the University of Toronto (China Daily Canada)

The Road to China (1928–37)

Norman Bethune emerged from his personal struggle with tuberculosis determined to battle the disease by becoming a thoracic specialist. He approached Dr. Edward Archibald, a pioneer in the field who had just opened a TB research centre at Montreal's Royal Victoria Hospital. By March 1928 Bethune was already 38 years old, so this was a bold move. Yet his qualifications and enthusiasm impressed Archibald, who accepted him as his first assistant. They worked together until January 1933, when Bethune – now impatient to lead his own service – became chief of pulmonary surgery at Sacré-Cœur Hospital, a Catholic-run facility located just north of Montreal.

During this period he emerged as a talented innovator who introduced new procedures, invented or improved several surgical instruments, trained surgeons and made a series of contributions to the Canadian and international medical literature. In 1932 he became a member of the American Association for Thoracic Surgery, and three years later was elected to its council.

At the same time Bethune became involved in Montreal's vibrant cultural scene, mingling with artists, intellectuals and activists. In addition to taking up painting and creative writing, he became increasingly conscious that social inequities were the root cause of tuberculosis.

In 1935 he attended an international physiology conference in Russia along with his former classmate and fellow artist Banting (now world renowned for the discovery of insulin) and several other prominent Canadian physicians. Impressed by the Soviet medical system, Bethune organized a study group with representatives from various health professions, which in 1936 developed and promoted a plan calling for universal health care. The Canadian medical establishment of the day was not ready for socialized medicine, and its reaction was hostile.

Bethune was deeply disappointed by this rejection, and with the outbreak of the Spanish Civil War in July 1936, he resolved to help the Republican forces in their struggle against Franco and his Fascist allies. Supported by the Toronto-based Canadian Committee to Aid Spanish Democracy, he sailed to Spain in late October, armed with medical supplies. Bethune's major contribution in Spain was the establishment of the first mobile transfusion service to bring blood to front-line battle units, an approach which became the model for blood services during World War II and subsequent conflicts.

Although a Spanish blood service had previously been set up in Barcelona, the Madrid-based Servicio Canadiense de Transfusión de Sangre, created in December 1936, was located closer to the fighting and served a larger area. Keenly aware that transfusing the wounded as quickly as possible would save lives, Bethune took the team's ambulance to the edge of the combat zone. At least once they got too close: during the battle of Guadalajara in March 1937, Bethune drove through a hail of gunfire, (literally) dodging a bullet that pierced the windshield while he scrambled out to aid a wounded combatant.

But Bethune's relations with the Republican authorities soured. The Spaniards assumed control of the transfusion service, and in May 1937 he was sent home.

Back in Canada, Bethune was honoured by leftists and undertook a successful fundraising tour in support of the Spanish Republican cause. When the Japanese invaded China in 1937, he was determined to continue the war on fascism by aiding the Chinese. This mission would be his last and greatest achievement.

The Heroic Years (1938–39)

With support from several aid agencies, Bethune's Canadian-American Mobile Medical Unit – its other two members were Jean Ewen, a Chinese-speaking Canadian nurse, and American physician Charles Parsons – sailed from Vancouver to Hong Kong in January 1938. In February they flew to Hankou, where after meeting there with Communist leader Zhou Enlai, Bethune and Ewen made the long and dangerous trek to Yan'an in northern China to support Mao Zedong's 8th Route Army. Parsons declined to make this trip, but the unit was joined temporarily by Canadian missionary surgeon Richard Brown.

While in Yan'an, Bethune spent several hours with Mao Zedong, a meeting which deeply impressed both men. He worked briefly at the primitive regional hospital there, but was anxious to serve at the front. After sending Ewen south to retrieve the group's supplies (which had finally reached Xi'an from Hong Kong), Bethune and Brown travelled to the northeastern frontier region, reaching the village of Jingangku in June. A month later Brown was forced to return to his mission work, leaving Bethune the only trained doctor in a war-torn region of 13 million people.

Appalled by the lack of medical support, Bethune worked feverishly, performing surgery and training his Chinese colleagues in basic surgical and nursing techniques. An extension of the training program was the construction of a Model Hospital in the village of Songyankou. It opened on September 15, but was destroyed by advancing Japanese forces at the end of October. Undeterred, Bethune focused instead on bringing mobile medical units directly to the wounded.

On March 4, 1939, Bethune celebrated his 49th birthday with “the proud distinction of being the oldest soldier at the front.” He continued to work relentlessly, sleeping very little and sharing his food and clothing with patients. During a battle in April, Bethune and his Chinese assistants performed 115 operations in 69 straight hours. His selfless dedication inspired the soldiers, who went into battle crying, “Attack! If we are wounded we have Bai Qiuen to treat us!” But these ceaseless efforts were taking a great toll on his health. Bethune had grown alarmingly thin, and by August his teeth and eyes were in bad shape and he was deaf in one ear.

There was as well a desperate shortage of supplies. The China Aid Council had collected a good deal of medical equipment and medication, including a small supply of the new antibacterial sulfa drugs, but most of it never reached the front.

By August 1938, Bethune's fingers were already becoming infected from operating in contaminated wounds because he had no surgical gloves. The following summer he was treated for two more serious infections, a sign of weakening immunity. On October 28, 1939, his scalpel slipped during a procedure, slicing the middle finger of his left hand. Several days later he contracted septicemia (blood poisoning) after operating barehanded on a suppurating head wound. As his condition worsened, his comrades tried to carry him to the Huapen base hospital on a stretcher. But lacking the sulfa drugs that might have saved him, Norman Bethune died on November 12. He was buried in an American flag as no Canadian or British one was available, and solemn memorial ceremonies were held in his honour in both the frontier region and in Yan'an.