Norman Bethune Operating in China

While researching tuberculosis and its treatment, he came across the writings of the famous American thoracic surgeon, John Alexander from Ann Arbor, Michigan, and instantly put his hopes for cure on a form of collapse therapy called ‘artificially induced pneumothorax’, a technique that had first been described at the end of the 19th century by an Italian physician, Carlo Forlanini.

Initially, the physicians at the sanatorium were reluctant to perform a procedure that they considered to be risky and advocated bed rest (the preferred therapy). After much discussion, however, one of the physicians, Dr Earle Warren, agreed to induce a therapeutic pneumothorax on Bethune’s left lung. Unfortunately, Dr Warren accidentally punctured the lung, creating a tension pneumothorax, which had to be drained on an urgent basis. 

Despite this complication, Bethune made a complete recovery and, within two months, his sputum had turned negative and he was discharged from the sanatorium in December 1927. For several years thereafter, Bethune continued to have ‘pneumothorax refills’ and even had a left phrenicectomy performed by John Alexander himself. His tuberculosis apparently never recurred despite the extreme conditions of deprivation of food and rest on the battlefields of China.

Bethune always felt that if poverty could be eliminated, tuberculosis would disappear. On joining l’hôpital du Sacré-Coeur, he freely provided his services to the poor and established a free-of-charge clinic, which was held on Saturday mornings in the Montreal suburb of Verdun. 

He was way ahead of his time in using radio broadcasts for public education on tuberculosis. In a paper published in 1932 in the Canadian Medical Association Journal, Bethune quoted a remark made by Edward Livingston Trudeau, the sanatorium founder:

There is a rich man’s tuberculosis and a poor man’s tuberculosis. The rich man recovers and the poor man dies.

Bethune added:

We, as a people, can get rid of tuberculosis, when once we make up our minds it is worthwhile to spend enough money to do so. Better education of doctors, public education to the point of phthisiophobia, enforced periodic physical and X-ray examinations, early diagnosis, early bed-rest, early compression, isolation and protection of the young are our remedies.