Born 4 March 1890. Died 12 November 1939.
There are few famous surgeons even amongst those of the highest professional and scientific distinction whose achievements have won for them general, popular acclaim in their own countries, and fewer still have gained widespread international celebrity. Only one has ever become a posthumous national hero and nearly 7 decades after his death he not only retains his heroic stature, but is held up as a role model to the school children of the most populous nation on Earth.
Henry Norman Bethune, the son of a Presbyterian minister of Scottish ancestry and the grandson of Norman Bethune (qv), Fellow of the College, was born in Gravenhurst, Ontario in 1890. After graduating from high school he worked as a teacher and as a newspaper reporter before entering the medical faculty of the University of Toronto in 1912.
On the outbreak of World War I in 1914, Norman Bethune immediately volunteered for military service and was posted to a RCAMC Field Ambulance for duty as a stretcher bearer. His unit went to France early in 1915 and he was wounded in action later that year. As a result of this, he was invalided out of the Army and having returned to Canada he completed his medical training course at the University of Toronto from which he graduated in December 1916. He then went back to England and was commissioned as a Surgeon Lieutenant in the Royal Navy, from which he was demobilised early in 1919. It was at this stage that he decided to become a surgeon and, after holding various junior posts in England and Canada and attending a postgraduate course in Edinburgh, he obtained the Fellowship of the College in 1922.
Bethune started his surgical career in Detroit where he sought to establish himself in private practice but in 1926 he contracted pulmonary tuberculosis and had to spend many months in a sanatorium where his treatment included artificial pneumothorax. This experience inspired him to devote himself to thoracic surgery, a specialty then in its infancy. He obtained the necessary training in the professional surgical department of the Royal Victoria Hospital, Montreal where his “chief” was Dr Edmond Archibald, Professor of Surgery in McGill University and a pioneer of thoracic surgery in Canada.
In 1930 he was appointed first assistant to Dr Archibald and although carrying a heavy clinical workload he became actively involved in research and published several original papers. He also invented a number of ingenious instruments and appliances, some of which featured in medical suppliers’ catalogues and were widely used.
Bethune was inherently a man of independent spirit and although his surgical abilities were impressive, this characteristic, combined with impetuosity, a contempt for established convention and an idiosyncratic temperament, conspired to make him a “difficult” colleague. His relationship with his chief, Dr Archibald, which had originally been cordial, became strained beyond breaking point and, in 1932, he resigned his post at the Royal Victoria Hospital.
Soon afterwards he was appointed surgeon to the tuberculosis unit of the Sacré Coeur Hospital on the outskirts of Montreal and it was at this stage that he began to express publicly his radical opinions on the provision of health care .His Scottish Presbyterian roots and his family’s long tradition of service to those less fortunate, were probably responsible for his highly developed social conscience. He was deeply concerned with the medical implications of poverty and deprivation. Over the next three years, he became a vehement and sometimes strident advocate of the establishment in Canada of a comprehensive national health service. A visit to Soviet Russia in 1935 powerfully reinforced his beliefs and in the following year he joined the Communist Party in Canada.
When the Spanish Civil War broke out in July 1936, Norman Bethune resigned his hospital appointment in Montreal and went to Spain where he was enrolled in the Republican military medical services with the rank of Major. He was stationed in Madrid which was then under almost constant air and land attack by the rebel nationalist forces but, although there were heavy casualties to be dealt with, he was not given the opportunity of exercising his surgical skills.
On his own initiative, and with the help of other Canadian volunteers, he set up a blood transfusion service which, within a few weeks, was supplying blood not only to hospitals in the beleaguered capital, but also to field surgical units on the other battle fronts.
The Republican medical bureaucracy which Bethune considered to be both incompetent and corrupt, sought to impose increasingly restrictive control upon his activities and this created what was, for him, an unacceptable situation. He resigned his commission in May 1937 and returned to Canada where he received a hero’s welcome from all who dreaded the prospect of a fascist victory in Spain. He engaged actively in fund raising on behalf of the Spanish Republican cause but later in 1937 his attention became focused on the Japanese invasion of China. Bethune regarded this as a major extension of the worldwide struggle between democracy and fascism and he was determined to be personally involved in it as a military surgeon with the Chines Communist forces.
He travelled to China in January 1938 and made his way to Han Kow which since the Japanese capture of Peiping (Beying) and NanKing had become the temporary capital and there he informed the Chinese military authorities that he had come to serve in the Communist 8th Route Army and would not go elsewhere.
After an extremely hazardous journey during which he only narrowly avoided capture by the Japanese, Bethune reached 8th Route Army Headquarters in the mountains of Shansi province where he outlined his plans for establishing a base hospital. Soon after his arrival, he was summoned to meet the Communist leader, Mao Tse-tung, who opposed this project on the grounds that there was a much greater need for mobile field surgical units capable of functioning close to the battlefield. Bethune was in no position to argue with Mao and over the next 20 months the volume and scope of Bethune’s operative and organisational activity was prodigious, but such was his energy and dedication that, in addition he was able to establish a field hospital with an associated medical training school. Later he planned and set up a special school of military surgical practice and wrote a training manual entitled “Organisation and Techniques for Divisional Mobile Operating Units”.
Bethune’s charismatic personality combined with his selfless devotion to duty and his operative skill to make him an almost legendary figure throughout the Chinese Communist forces and in spite of the appalling problems which confronted him daily, it is clear from his letters that this was the happiest time of his life during which he felt for the first time that he was fulfilling his destiny. Constant intense surgical activity without respite under primitive and often highly dangerous conditions and, in November 1939, having accidentally cut one of his fingers whilst operating on an infected patient, he developed septicaemia from which, a few days later, he died.
His funeral was attended by more than 10,000 people and one month later the essay “In memory of Norman Bethune” by Mao Tse-tung was published. After China became a Communist state ten years later, this essay became one of “the three most read articles” that all Chinese were urged to study and the story of Norman Bethune’s life was made part of the elementary school curriculum. Postage stamps bearing his image were issued, statues of him were erected and in the 21st century, he is remembered and revered in China as the personification of “selflessness, dedication and responsibility”.
