Norman Bethune’s mobile blood transfusions

Irving Rosen
Toronto, Ontario, Canada

 

Dr. Norman Bethune and an unnamed woman stand in front of a mobile blood unit
Canadian Blood Transfusion Unit which operated during the Spanish Civil War. Dr. Norman Bethune is at the right. ca. 1936 – 1937 / Spain. From the Library and Archives Canada. Public Domain.

Norman Bethune was born in Ontario’s cottage country in 1895 to missionary parents who influenced him to try to improve conditions for mankind. This resulted in his drive to elaborate grandiose plans that were often unrealized. One important exception was a Spanish sojourn that provided him with a unique opportunity as well as some heartache.

He graduated MD from the University of Toronto (UT) in 1916 having served in World War I as a stretcher-bearer. By 1923 he had acquired a surgical education in Edinburgh and married. Although he began a successful practice in 1924, he was forced into bedrest at Trudeau’s Lake Saranac Sanitarium with bilateral tuberculosis. He pressured his doctors to perform an artificial pneumothorax, which facilitated the resolution of his tuberculosis so he could “find something I can do for the human race.” McGill’s ace surgical chief, Edward Archibald, took Bethune on for thoracic surgical training in 1928. After four years of training tainted by social misbehavior and questionable surgical results, he was dismissed by Archibald. He carried on credibly at Montreal’s Sacre Coeur Hospital, lecturing colleagues about social and medical issues and leaving a trail of negative impressions. After a visit to the USSR in 1935 he became a member of the Canadian Communist party. In 1936 the Spanish Civil War broke out between Franco’s rightist Nationalists backed by Hitler and Mussolini, and the elected Popular Front Republicans backed by Stalin. Many viewed this conflict as a prelude to World War II. Unbidden, Bethune resigned his hospital responsibilities and, supported by the Canadian Society to Aid Democracy (CSAD), which was headed by protestant ministers but constituted by leftist politicians, set out for Spain to personally stop fascism.

Bethune arrived in besieged Madrid in November 1936, six miles from the front. Bethune offered his surgical skill to various hospitals, the Red Cross, and the International Brigade of Volunteers, but there were no takers. He felt frustrated and anxious to be part of the struggle. Together with an acquaintance named Sorenson he traveled to Valencia, the temporary capital, as thoughts rambled through his feverish mind. During his visits to Madrid hospitals he had seen many wounded and bleeding patients who were not receiving any treatment. He was reminded of his experiences as a stretcher bearer, carrying wounded soldiers to rear stations for treatment where some died for lack of timely transfusions. He was aware of his former chief Archibald’s work in fluid replacement for surgical shock during World War I and his own organization of the first blood banks at McGill University hospitals. These memories percolated and produced a compelling idea. He wished to start a mobile blood transfusion service in which blood was collected at a center, typed for compatibility in transfusion, and stored in banks at an appropriate temperature. When blood was needed by a hospital or dressing station at a battle site, the center would bring the blood to the patient, saving time and life. Transfusion techniques were still evolving and nothing like this usually existed in war zones, particularly so at Madrid.

In Valencia, he proposed this idea to Republican government representatives. Local physicians were skeptical, but the government recognized the need for this type of program and gave their approval, especially when Bethune promised CSAD funding support. Bethune and Sorenson headed for London where Bethune refurbished his transfusion expertise and set about purchasing a suitable vehicle for his proposed service. He modified a Ford station wagon with space for a kerosene-operated fridge, sterilizer, gas-operated autoclave, kerosene-operated incubator, water distiller, and bottles to hold blood. He also made plans for uniforms, manpower, and a collection strategy. Reporting to the CSAD, he described overcoming Canadian consular obstruction and coming into Madrid with the truck containing IV solutions of sodium, glucose, and sodium citrate; sterilized tin boxes with instruments; testing serum sets, microscopes, and chest instruments; gas masks, hurricane lamps, and the ability to start work at once when called. The group, now known as the Canadian Transfusion Service, was installed in a fifteen-room suite and acquired additional staff including armed guards, technicians, students, and servants.

In December 1936 Bethune stated, “In Madrid today there are 57 hospitals with 10,000 beds . . . as we were working at our job, staccato machine guns came through the windows. . . . To these dangers are added attacks of fascist bombers.” In January 1937 he wrote, “We have been having 2&4 raids a day . . . many thousands of non-combatants have been killed. . . . our night work is eerie . . . we get a call for blood . . . take 2 bottles of blood out of the fridge, go through pitch dark streets and guns and rifle shots . . . the man is lying on a stretcher . . . prick the finger . . . is shocked and exsanguinated . . . inject novocaine over the vein . . . insert small glass cannula . . . run the blood in . . . the pulse can be now felt. Yesterday we did three transfusions–about the average.” Bethune had conceived and started a unique life-saving operation. In January 1937 he went to Valencia to speak to Colonel Dr. Cerrada about the idea of a unified service to supply blood to the entire Republican army. Cerrada was in favor of Bethune’s plan but advised him to meet first with Dr. Duran-Jorda of Barcelona before launching the project.

Dr. Frederic Duran-Jorda was no medical dilettante. Bethune knew of him and possibly his creation of a mobile transfusion service in Barcelona. However, Barcelona had not been as heavily involved in warfare, and so Duran-Jorda’s activities were not well known. He was a trained hematologist and had been involved with transfusion activity for a long time, heading a blood unit at Montjuic and making innovative contributions for the donation, storage, and administration of blood. After the fratricidal civil war ended, Duran-Jorda fled to England and took part in the management of blood depots that sustained England during its own years of bombing and civilian injuries.

Drs. Duran-Jorda and Bethune exchanged experiences and thoughts while inspecting Duran-Jorda’s equipment and operation. Bethune left CSAD funds for Duran-Jorda’s work, recognizing his superiority in knowledge and technology of blood management. Duran-Jorda agreed with Bethune’s ideas about a unified blood service, except he believed that he should be head and Barcelona the service center. In February 1937 Bethune reported to CSAD, “We are serving 100 hospitals . . . the new name is Hispano-Canadense de Transfusion . . . have been given rank of Commandante. . . . This is the first unified blood transfusion in army and military history. . . . we have 5 cars working day and night in this sector.” His team now counted thirty-five people.

Southern Malaga was to be next for the team’s transfusion work when they were informed in transit that the Nationalists had captured the city. A mass of fleeing refugees was clogging the coastal road, in dire distress, having undergone naval shelling, bombing, and shooting resulting in “a shamble of dead.” The transfusion trucks were compelled to transport the desperate people to protective hamlets. Bethune then met again with Colonel Dr. Corrida who asserted that Bethune was not to be the head of the unified service and he was ordered to share his Madrid directorship with his team’s Spanish doctors. Duran-Jorda’s influence was apparent.

Bethune was dismayed by this news but continued risking his life by performing battlefront transfusions. However, everything was beginning to unravel. The team’s Spanish doctors demanded authority, and his Canadian aides had become rebellious when a recent recruit became Bethune’s mistress. Bethune was drinking heavily and Spanish communists criticized his behavior. Sydney Gordon, his publicist and future biographer, reported all. In April 1937 Bethune resigned his command, the team dissolved, and he returned to Canada for a fundraising tour. Alone, without family, job, or prospects, Bethune arranged to join Mao Tse Tung’s guerilla fight against the “fascist” Japanese in northern China in March 1938, in what became a transformative experience of selfless labor. He operated endlessly, assisted by idealistic but untutored young people, and became unwell. He gladly shared his meager rations and made plans for medical schools, hospitals, and services. He felt fulfilled and beloved.

On October 29, 1939, after eighteen months in China, Bethune lacerated his finger while operating, developed fatal septicemia, and died at age forty-nine. He lies buried beneath his statue in northern China in front of a medical school and hospital that bear his name. After the war he was largely forgotten in the West until a wheat-buying group of Chinese came to Canada in the 1970s asking after Bethune. This led to his “discovery” and “heroization” and consequent Canadian and American recognition of Red China. In his biographies, much was made of the uniqueness of Bethune’s transfusion work in an attempt to fortify his heroic image. His achievement, remarkable as it was, did not rank with Landsteiner or Levine in their work with blood groups, or pioneer Harvey, or many others who developed techniques in processing blood. His Canadian contemporaries had been adamantly critical of Bethune, like Dr. Archibald who said he was “a little dangerous,” Dr. R. Janes who called him “a drunkard,” Dr. Robertson who stated his “fame should not be as a thoracic surgeon,” and Dr. Bliss who proclaimed that Bethune’s life was “full of failure.” However Mao’s eulogy, in part, said, “Comrade Bethune had utter devotion to others” and “no one failed to express his admiration” for him. Bethune had become the best-known westerner in China and an undeniable hero, transfusion activity notwithstanding.

 

References

  1. Roderick Stewart and Jesus Majada. Bethune in Spain. McGill-Queen’s University Press London 2014
  2. Roderick Stewart. Bethune. New Press Toronto 1973
  3. Adrienne Clarkson. Norman Bethune. Penguin Press Toronto 2009
  4. Martin Entin. Edward Archibald. McGill University Montreal 2004
  5. Ted Allan and Sydney Gordon. The Scalpel, The Sword. Mclelland and Stewart: Toronto 1989
  6. Roderick Stewart. The Mind of Norman Bethune. Fitzhenry & Whiteside Don Mills 1977
  7. Frederic Duran-Jorda-Wikipedia (2 June 2019(UTC))
  8. Irving Rosen. “Dr Norman Bethune as a Surgeon.” CJS 72-77 vol.39 #1 1996

 

Further Reading

  1. “Dr. Norman Bethune: a tale of military heroism.” Satish Saroshe. Hektoen International, War and Veterans, Summer 2016. https://hekint.org/2017/01/22/dr-norman-bethune-a-tale-of-military-heroism/

 


 

IRVING B. ROSEN, M.D. FRCS(C), trained in general surgery at the University of Toronto (UT) and Memorial Center For Cancer where he took a fellowship in Head and Neck Cancer surgery. Longstanding affiliation with UT Dept of Surgery was followed with retirement and membership in the Toronto Medical History Club and Canadian Association for History of Medicine. Bethune is of special interest.

 

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