Palfreeman, Linda

When a failed military coup provoked civil war in Spain in July 1936, the tremendous numbers of casualties obliged the Spanish government to make a worldwide plea for medical assistance. Many thousands of people around the world rallied to the call, transforming the Republican Medical Service into a truly international effort. Some of those volunteers worked in emergency blood transfusion facilities, carrying out pioneering transfusion work in primitive and often dangerous conditions. Among the most notable of these volunteers were Canadian surgeon Norman Bethune and British doctor Reginald Saxton. Working alongside them were American, Italian and Spanish assistants, many of whom remain nameless. All played vital roles in the saving of lives and all took their lead from one man—the young Catalan haematologist, Frederic Duran Jordà, director of the Blood Transfusion Service of the Republican Army, and indisputable pioneer of Civil War blood transfusion medicine.

During the First World War blood transfusion progressed from being a rarely used treatment to a major component of the resuscitation of exsanguinated casualties, relying on local donation and availability of medical expertise. In the 1920s and early 1930s, clinical use of transfusion gradually increased supported by growing civilian, often volunteer, blood donor systems. The Spanish Civil War (1936–1939) introduced the first systematic use of aerial bombardment to intimidate the civilian population and to destroy infrastructure; it also saw more mobile battlefronts, replacing the relatively static trench warfare of 1914-1918. New measures for the delivery of transfusion services emerged rapidly from primitive beginnings. These included large civilian blood donor organizations providing anti-coagulated “stored” blood for civilian and military medical use and land delivery services to civilian and military hospitals. Surgical units for the emergency management of casualties were required to be agile in moving as battlefronts evolved and carefully concealed to avoid air attack. Ideally the blood supply would follow. Under threat of a wider European conflict in 1938–1939, British authorities started developing plans for transfusion support in the management of civilian casualties of air attack and military casualties of armed conflict. The involvement, directly and indirectly, of British and other volunteer physicians returned from Spain, together with their Spanish colleagues, ensured that awareness of the Spanish experience was available to the British authorities. The system that was eventually put in place involved a civilian blood donor capability with one centre dedicated particularly to military supplies. Separate distribution systems were organized for civilian and military purposes, with the latter including distribution overseas by air. The military system delivered blood and components through a supply chain to mobile field transfusion units under command of a medical officer specially trained in transfusion and resuscitation, supporting mobile surgical units in the immediate rear of battlefronts. The broad principles developed in Spain (1936-39) for delivery of military blood transfusion practice still support current measures in battlefield casualty resuscitation.

When Civil War broke out in Spain in July 1936, the Republic made a worldwide plea for humanitarian assistance. Many thousands of people around the world rallied to the call, the Scottish Ambulance Unit among them. The only woman in the twenty-strong team was the unit’s commandant, Fernanda Jacobsen. She would remain at the unit’s helm on each of its successive expeditions to Spain, spanning a period of roughly two years, from September 1936 to July 1938. Despite its tremendous and sustained humanitarian contribution in and around the besieged Spanish capital of Madrid, the Scottish unit has not received the recognition afforded similar enterprises in the now vast literature on the Spanish Civil War. This article will examine the possible reasons for this. It will discuss previously unexplored documentary evidence and re-examine existing records in an attempt to shed light on the causes of internal struggles in the unit that led, eventually, to the resignation of some of its members.

Al final de la Primera Guerra Mundial, el valor de la transfusión sanguínea era ampliamente reconocido, pero no fue hasta la Guerra Civil Española (1936-1939) cuando se crearon grandes organizaciones civiles de donantes de sangre para proporcionar sangre conservada (citratada) para la transfusión en pacientes civiles y militares en ambos bandos. Se desarrollaron técnicas de transfusión indirecta para administrar esta sangre, con instrumental de fácil manejo, capaz de ser llevado a cabo en cualquier lugar y por cualquiera con experiencia en la administración de inyecciones endovenosas. También se establecieron sistemas eficaces de transporte y distribución, a fin de abastecer adecuadamente las instalaciones sanitarias que prestaban servicio en los frentes de batalla en movimiento. Este trabajo pionero permitió la creación, por primera vez en la historia, de servicios militares de transfusión de sangre. Si bien este fue el caso tanto de las fuerzas insurgentes (nacionalistas) como del Gobierno republicano español, es este último el que constituye el foco de estudio aquí. Esto es posible gracias a las publicaciones del hematólogo catalán Frederic Duran Jordà, creador y director del Servicio Republicano de Transfusión de Sangre, que detallan las técnicas y procedimientos desarrollados durante la guerra para la recogida, análisis, distribución y transfusión de sangre. Esta información se amplía, especialmente con respecto a la aplicación práctica de la transfusión en primera línea, gracias a diferentes publicaciones del Dr. Reginald Saxton, voluntario británico integrado en la Sanidad Militar de la Republica. Es nuestra intención demostrar que las autoridades británicas se beneficiaron de la experiencia española en vísperas del estallido de la Segunda Guerra Mundial en 1939. Les ayudó a desarrollar planes para los servicios de transfusión que resultarían cruciales en el tratamiento de bajas civiles y militares durante la contienda. Frederic Duran Jordà y Reginald Saxton fueron asesores clave, junto con otros que regresaban de España, incluyendo a la reconocida hematóloga británica, Janet Vaughan. Además, los principios desarrollados en España (1936-39) para la práctica militar de transfusiones de sangre siguen respaldando las medidas actuales de reanimación de heridos en el campo de batalla.

When a failed military coup provoked civil war in Spain in July 1936, British Quakers were among the first t respond to the tremendous need for humanitarian aid among the civilian population. They distributed food and clothing, set up canteens and hospitals, provided schooling and workshops, and organized the evacuation of children from war zones. Then, in January 1939, when the Spanish Republic finally succumbed to the might of the rebel forces, the Quakers accompanied thousands of refugees in their flight towards the French border. This became known as ‘la retirada’ (the Retreat). Once in French territory, the refugees were herded into improvised internment camps. These were simply vast open spaces on the beaches encircled by barbed wire, with no shelter, no latrines and barely any food. Quakers were the first to obtain permits to access the camps in order to alleviate the suffering and deprivation found there. They distributed not only the most basic aid such as food and clothing, but also pencils and notebooks, as well as tools and materials of all kinds to work with. Thus, in characteristic fashion, they provided people with the means by which they could help themselves.

After the outbreak of war in Europe in 1914, the British government’s call to arms caused a moral and religious dilemma for members of the Religious Society of Friends (Friends or Quakers), whose fundamental principle was (and is) the rejection of war and violence. Many Friends sought means of reconciling their duty to God with their duty to their country, and the prospect of helping to alleviate the suffering of the civilian victims of the fighting provided them with an acceptable alternative. Together with fellow Friend T. Edmund Harvey MP, Dr Hilda Clark set about rallying the support of Friends and sympathisers willing to go out to France to administer humanitarian aid to non-combatants. The committee adopted the name used by the distinguished organisation that had administered relief in the Franco-Prussian War—the Friends’ War Victims’ Relief Committee (FWVRC). Extensive and multifaceted aid work was carried out in much of northern France by the FWVRC’s general relief team. The following essay, however, examines more closely the medical assistance provided under the leadership of Hilda Clark. In particular, it focuses on the maternity hospital created and run by the FWVRC in Châlons-sur-Marne, which became a lasting legacy of the Friends to the people of the Marne.