Bethune in Spain

by Roderick Stewart and Jesus Majada

(McGill-Queen’s University Press, £18.99)

Norman Bethune was one of those rare and charismatic individuals who lead colourful, tempestuous lives but who are also able to channel their energies into the service of humanity. 

Today he is an almost forgotten figure but deserves to be commemorated and, using biographical details, his letters and reports, this new book does just that. 

Of Scottish-Canadian heritage, Bethune was born in 1890 in Canada. The son of a poor, small-town evangelical pastor, as a young man he took up lumbering and teaching with Frontier College in remote Northern Ontario in order to finance his medical studies.

He served as a medical orderly in the first world war and  later in Spain on the Republican side. Later he was in China with Mao in the civil war, where he died. 

In 1977, his life was made into a two-part film starring Donald Sutherland but,  despite its good intentions, the film was unable to capture the full drama of his life.

In 1914 when war was declared in Europe, Bethune once again suspended his medical studies to join the Canadian army’s field ambulance service as a stretcher-bearer in France. 

There he was wounded and spent three months recovering in an English hospital. When he had recovered he returned to Toronto to complete his medical degree. After graduation in 1916 he continued his medical studies in Britain and enjoyed a rather dissolute time, collecting paintings from around Europe as well as indulging in several romantic liaisons. His views at this time were still mainstream conservative and his chief goal was to become wealthy and successful.

After returning to Canada via Detroit, he began establishing a successful practice but in 1926 found he had tuberculosis. At the time the established treatment for TB was total bed rest in a sanatorium. While convalescing Bethune read about a radical new treatment for tuberculosis called pneumothorax. This involved artificially collapsing the tubercular lung, allowing it to rest and heal itself — a very dangerous procedure.

Against the advice of his colleagues, he insisted on having the operation performed and made a full and complete recovery.

In 1928 Bethune joined the thoracic surgical pioneer, Dr Archibald, the surgeon-in-chief of the Royal Victoria Hospital in Montreal. From 1928 to 1936 he perfected his skills in thoracic surgery and developed or modified more than a dozen new surgical tools. His most famous instrument was the Bethune rib shears, still in use today.

During his research into TB he saw how this widespread disease affected the poor and the rich in very different ways — the rich could afford a cure, the poor just died.

In 1935 he visited the Soviet Union to look at medical practice there. Ironically, this visit changed his whole outlook on life. He was on the cusp of becoming perhaps one of Canada’s leading surgeons with the potential to make a lucrative living, having already gained considerable expertise and renown, but he threw it all away.

On his return from the Soviet Union, he gave a talk at the  Montreal Chemico-Chirurgical Society where he said, in words that still ring more than appositely  today: “Socialised medicine and the abolition or restriction of private practice should appear to be a realistic solution of the problem. Let us  take the profit, the private economic profit, out of medicine, and purify our profession of rapacious individualism. Let us make it disgraceful to enrich ourselves at the expense of the miseries of our fellow men … Let us redefine medical ethics — not as a code of professional etiquette between doctors but as a code of fundamental morality and justice between medicine and the people.”

During that same year of 1935, he joined the Canadian Communist Party and in 1936 went to Spain where he developed innovative mobile blood transfusion units for front-line use in the civil war there. When returning to Canada to raise support for the loyalist cause, he openly identified with  communism and became increasingly concerned with the socioeconomic aspects of disease. 

As a concerned doctor in Montreal during the depression years of the 1930s, he provided free medical care for the poor, challenged his professional colleagues and agitated, with little success, for the government to radically reform health services in Canada.

He did not remain back in Canada for long before deciding to go and assist the Chinese communists fighting the Japanese while defending themselves against the machinations of Chiang Kai-shek’s nationalists.

 It was his service with the Chinese Eighth Route army during the Sino-Japanese War that earned him enduring acclaim. 

Bethune was a key figure helping to introduce modern medicine to rural China, while his selfless commitment to the Chinese people made such an impression on Mao Zedong that generations of Chinese students were required to memorise the chairman’s eulogy to him. 

He marched with the army, treating soldiers and peasants alike in makeshift field hospitals with scant medical necessities. He performed emergency battlefield surgical operations on war casualties and also established training for doctors, nurses and orderlies.

Bethune died in China in 1939 of blood poisoning after nicking himself on a scalpel during an operation. In his already weakened condition and lacking basic medicines, he was unable to overcome the fatal infection.

Statues in his honour can be found in cities throughout China.

In 2006  Chinese television produced a 20-part drama series Dr Norman Bethune, which was then the most expensive Chinese TV series to date.

He lived an extraordinary life and it’s one which is memorably recounted by the authors of this book, which will surely interest anyone in a radical pioneer of medicine.