Unfortunately, during the twentieth century we had to wait for a war to see a significant breakthrough in the technology involved in Transfusion Medicine. This occurred during the First War World where sodium citrate started to be used as an anti-coagulant for the first indirect blood transfusions, or during the Second World War when hundreds of thousands of blood donations collected from civilian donors in the rearguard were brought to the front to try to save injured soldiers. But before Second World War broke out, there was what many have considered a terrible rehearsal in Spain of what would occur later, the Spanish Civil War. A fratricidal fight between the Republican Government and the Nationalists, a group of army officers and politicians led by Francisco Franco who organised a coup d’état to remove the republican government elected in the 1933 elections. What initially was just a confrontation between Spaniards soon became an international conflict with the involvement of other countries. For instance, Germany and Italy sent warships or provided air force units that fought together with Nationalist army, carrying out what have been considered the first raids on a defenceless civilian population by a modern air force (Guernica 1937, Barcelona 1938). By contrast, the support that the Republican army received was in form of military equipment (mainly from the Soviet Union) and voluntary soldiers (the International Brigades) gathered through the Communist Parties of different countries in Europe and North America whose governments officially followed a policy of non-intervention.

Dr Linda Palfreeman’s book describes one of the aspects of modern war that was developed in the Spanish Civil War, blood transfusion at the battle front. Until then, blood transfusion was performed using direct techniques which involved the connection of the blood donor to the recipient or, at most, the drawing of blood from the donor and its immediate infusion into the recipient. For the first time in the history, a new strategy was developed in Barcelona by Dr Frederic Duran Jordà. From scratch, an organisation and technology was created which allowed the collection of blood donations from civilians in the rearguard in an anti-coagulant solution and the preparation of glass flasks with a connected rubber tubing and a needle which allowed transfusion at the battle front, to which the blood was transported in refrigerated trunks.

The author, who works as Lecturer in Journalism at the University of Cardenal Herrera in Elche, Spain has been interested in the Spanish Civil War for many years and she has researched different aspects of the conflict. As a result of her research two previous books were published describing the activities of British volunteers in the Republican Medical Service. The book reviewed here is the final book in the informal trilogy that she has devoted to the Spanish Civil War. It is the product of much hard work in documentation and research in the field of blood transfusion, as the reader can infer from the long list of references, notes and photographs found in the book. The non-specialist reader will be grateful that the first two chapters of the book provide a brief history of blood transfusion and the techniques available that are extremely useful in understanding the state of blood transfusion when the Spanish Civil War broke out, and in appreciating the enormous merit of those pioneers who were able to create out of nowhere an organisation that was a model for other countries for the imminent Second War World.

After the first two introductory chapters, the book describes in the same readable and comprehensible way the contributions of the different players in the field of blood transfusion on the Republican and Nationalists sides, paying a particular tribute to the work of Dr Frederic Duran Jordà and his collaborators, particularly Alfred Benlloch, who created the Barcelona Blood Transfusion Service in August 1936, which continued functioning until January 1939, when the Nationalists conquered Barcelona. The personality of Duran Jordà stands out for several reasons. One of them is his commitment to social aspects of Medicine such as improving the health of the working class that made him become a member of the Catalan Communist Party. Another is the scientific bent of his mind. He was a man of great intelligence and unlimited curiosity and these characteristics led him to investigate a wide variety of topics with an analytical and practical focus, and to publish his results. In Spanish he published a dozen studies about different aspects of the storage of blood, and in 1937 he published in English in the The Lancet the method he had developed in Barcelona. This interest never diminished throughout his life. Indeed, his last study was published in the Nature in June 1957, three months after his death. His achievements are particularly impressive given the rather inconspicuous Spanish contribution to science in the first half of the twentieth century.

But in Dr Palfreeman’s book other important contributors to blood transfusion in Spain during the Civil War are recognised. One of them was the Canadian surgeon Norman Bethune. After his arrival in Spain in November 1936 he visited the Barcelona Blood Transfusion Service and there he knew the method developed by Duran Jordà and decided to create a similar organisation in Madrid. His work in Spain was very well known in English-speaking countries thanks to his very active presence in the media supported by the Spanish Government that had already identified the importance of propaganda in getting the support of the international community. Norman Bethune was in Spain until the end of May 1937 but in just those six months, according to Dr Palfreeman, he made a ‘contribution of monumental proportions’ to the Republican Blood Transfusion Service.

Another important contributor to blood transfusion during the Spanish Civil War is deservedly recognised in the book, Dr Carlos Elósegui Sarasola. He was the creator of the Blood Transfusion Service in the Francoist army and after the Civil War he continued as a director of the Haematology and Haemotherapy Institute, the first civil haemotherapy organisation created in Europe to meet the blood transfusion needs of an entire nation.

In summary, the book provides an informed, thorough and informative review of the development of battlefield blood transfusion during the Spanish Civil War. The writing is clear and readable and will meet the expectations of scholars in their research as well as those of general readers interested in blood transfusion or Spanish Civil War history.