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Review of Linda Palfreeman’s Spain Bleeds

It has become a tired cliché that necessity is the mother of invention, but it is nevertheless true that the demands of warfare have spurred the advance of technologies; some of them fortunately designed to preserve lives rather than cut them short. The war in Spain was no exception, with the pioneering work in the treatment of fractures and front-line surgery by the Catalan surgeons Josep Trueta and Moisès Broggi offering one pointed example. Developments in blood transfusion, the subject of Linda Palfreeman’s latest study, is another. As the author points out, ‘the Spanish Civil war marked a new era in battlefield blood transfusion.’

Though written in an academic style, the book is accessible to a non-specialised reader. It begins with a useful overview of developments from ancient times to the present, covering the use of direct arm-to arm transfusions established in the nineteenth century, Karl Landsteiner’s vital (and Nobel prize-winning) discovery of blood-groups in 1900, and subsequent improvements in storage. And for anyone with an interest in haematology, there is plenty of detail on the actual processes of transfusion: overcoming the limitations of direct arm-to-arm transfusion, mixing donations to minimise rejection and the use of sodium citrate to prevent coagulation.

The book focuses on the contribution of a number of key players involved in the developments of transfusion in Spain, including a brief chapter on the Nationalist efforts, led by Carlos Elósegui Sarasola. Interestingly, many Nationalists appear to have been singularly unenthusiastic about the use of stored blood, preferring traditional direct transfusions.

Amongst those working on the Republican side, the ground-breaking work of the Canadian Doctor, Norman Bethune, obviously features strongly. Described as an ‘explosive and unpredictable virtuoso’, Bethune does not seem to have been the easiest person to work with. However, as he has already been the subject of a previous volume in the Cañada Blanch/Sussex series, this study spends less time on the personal politics that underpinned his downfall, instead concentrating on his undeniable contribution to the Republican blood service and the mechanics of transfusions.

British readers will be pleased to find a chapter on Reginald Saxton, whose transfusions helped save the lives of numerous British and Irish casualties at Jarama and Brunete in 1937. Intriguingly, Saxton experimented with the use of cadaverous blood during the battle of Teruel in the winter of 1937-8. However his work was apparently brought to a halt by a Spanish law which prohibited any experimentation on corpses within twenty-four hours of death.

The author is clearly an admirer of Frederick Duran Jordà, for two chapters are devoted to the influential Catalan surgeon. However, a little explicit bias does not do the book any harm. Certainly Duran and his work were admirable and, as the author convincingly argues, political malice and the professional envy of colleagues has prevented his ground-breaking work from receiving the fame it should have. In fact, the author chooses to conclude the book with Duran’s exile to Britain in 1939 following the Republic’s defeat. Unwilling or unable to the take up of the lessons learned during the Spanish war, the British Government initially refused Duran permission to practice as a doctor and he could only find work as a laboratory technician. It was only in 1941 that he was at last able to take up a job as a pathologist. As the relatives of brigaders will know, it is an all too familiar tale.

This review appears in the January edition of the IBMT newsletter.

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