From the archives: 'Disgraceful to enrich ourselves,' Dr. Bethune told MDs

John Kalbfleisch, Special to the Montreal Gazette
More from John Kalbfleisch, Special to the Montreal Gazette

Published on: August 6, 2017 | Last Updated: August 6, 2017 6:00 AM EDT

Dr. Norman Bethune (right) created the Canadian Blood Transfusion Unit, the world's first mobile blood-transfusion service, which operated during the Spanish Civil War. circa 1936 - 1938 / Library and Archives Canada

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This story was first published on August 13, 2011, in the Montreal Gazette.

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Even when working, the great majority of the population have little money to spare to spend on the doctor or the dentist.
The Gazette, Monday, Aug. 10, 1936

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The Great Depression didn’t so much create a crisis in health care in Montreal as cruelly exaggerate a long-standing one.
In April 1936, a 46-year-old surgeon and member of the Communist Party stepped to the podium to address the Montreal Medico-Chirurgical Society. He told his audience that four out of 10 people had not seen a doctor or dentist during the previous year. Not just the poor but doctors suffered, too: with the fee-for-service system then prevalent, he continued, you have more than three doctors out of 10 receiving inadequate incomes.
This was the case nationwide. The situation in Montreal was significantly worse. The speaker that day was Norman Bethune, the stormy petrel of Canadian medicine, and the remedy, he made clear, was state-supported medical care.
“Let us take the profit, the private economic profit, out of medicine, and purify our profession of rapacious individualism,” Bethune exhorted. “Let us make it disgraceful to enrich ourselves at the expense of the miseries of our fellow men. 
“The people are ready for socialized medicine. The obstructionists to the people’s health security lie within the profession itself.”
Late the previous December, Bethune and some like-minded medical professionals had begun studying the problem of inadequate medical coverage. Never numbering more than 16, they soon evolved into the awkwardly named Montreal Group for the Security of the People’s Health.

Dr. Norman Bethune performing surgery in an unused Buddhist temple in central Hopei, China, 1939. National Film Board / Library and Archives Canada

Roderick Stewart and Sharon Stewart, in a new biography of Bethune titled Phoenix, say he was firmly committed to socialized medicine, by which he meant government control of health care and of salaries for medical practitioners. However, accepting the need to proceed in stages, Bethune went along with the MGSPH’s decision to press merely for government-managed universal health insurance at first.
His Montreal speech that April was badly received by the assembled doctors; perhaps they were from the two-thirds whose incomes were holding up. At a later meeting, the Med-Chi Society seems to have drummed Bethune from its ranks.
Surprisingly, however, given its conservative outlook on politics and society, The Gazette would prove more receptive. Several months after Bethune’s speech, Liberal Premier Adélard Godbout called an election for Aug. 17, and the MGSPH drew up a manifesto that it hoped would spark debate during the campaign. A week before the election, The Gazette back-handily endorsed what the MGSPH was up to, though we did draw the line at identifying the group by name.
“Compulsory health insurance, as all unbiased observers agree, has paid rich dividends in the Old Country,” we said in our editorial.
Bethune and his colleagues distributed their plan to Godbout, to opposition leader Maurice Duplessis, to all 50 candidates running in the Montreal area, and to many charities and professional groups. It called for three pilot programs, one of which might then be chosen for Quebec as a whole.
In the first, salaried health workers would care for a chosen municipality’s entire population, the cost to be borne by the municipality and the province. In the second, all wage earners in a comparable municipality would pay for compulsory health insurance. In the third, voluntary health insurance would be offered in yet another municipality.
The MGSPH plan also demanded free medical care for the unemployed throughout Quebec.
Apart from the Gazette editorial, the plan was met by indifference. For most noses, it smelled too much of communism. And for a majority of doctors in particular, it threatened their chances for enriching themselves. Universal health care across Canada would have to wait for another 30 years.
Bethune was downcast. Ever since recovering from a life-threatening encounter with tuberculosis in 1927, he had dedicated himself to fighting the disease in others. As the Stewarts write, “It was not enough to deal surgically with the ravages of the disease.  Now his attempt to cut to the real root of the menace of tuberculosis, inadequate health care, had been frustrated by ignorance, apathy and professional prejudice. He had failed in the mission he had set himself.”
Feeling rejected in Montreal, he searched for something to give new meaning to his restless, radical spirit.
He found it in Spain where later that year he began organizing a mobile blood-transfusion service, the world’s first, on behalf of the Republicans fighting Francisco Franco’s Nationalist rebels.
By 1938 he was in China, treating wounded Chinese soldiers fighting Japanese invaders. His accidental death from septicemia in 1939 and his subsequent eulogizing by Mao Zedong have made him perhaps the world’s best-known Canadian.

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