Introduction
One of the most relevant medical innovations produced in the Spanish Civil War (1936–39) was the technique of blood transfusion developed in Barcelona by Frederic Duran Jordà (1905–57).Footnote 1 This article analyses how this method was exported to Czechoslovakia thanks to Duran’s travels in 1938 and the disseminating role of Czech doctor Karel Holubec (1906–77). Both Duran Jordà and Holubec were part of larger social movements that called for international solidarity between the countries affected by what they perceived as a common threat of global fascism. The blood transfusion method of Duran Jordà involved the massive participation of blood donors who, in the heated atmosphere of the Civil War, responded to appeals broadcast over the radio. This article claims that Duran’s innovation and its diffusion to Czechoslovakia cannot be detached from this particular context. The historical circumstances of this transfer, as it will be argued, determined both the success of this method and its further oblivion from the medical records.
In March 1937, when the blood donation campaigns in Spain were at their peak, the American doctor Bernard Fantus (1874–1940) introduced another innovative blood transfusion system at the Cook Hospital in Chicago. It was a different context. This was the first blood transfusion institution to be called a ‘blood bank’: the system incorporated banking methods with a system of paid donors where blood would be stored as deposits or taken on credit.Footnote 2 Instead, Duran Jordà relied on mass voluntary donations and internationalist aid. He received ambulances as a gift from the United Kingdom (UK)-based Spanish Medical Aid Committee (SMAC) and, when he travelled to Prague, a campaign to donate Czechoslovak blood to Spain was in full swing. The ideological and political terrain thus shaped the ways in which Duran Jordà and Fantus innovated in the field of blood transfusion. This article focuses on the former and frames the transfer of Duran’s method with internationalism, wartime antifascism, and socialism.
While the biographies of doctors who participated in the International Brigades have attracted academic attention, there is also a rich bibliography concerning the Spanish republican doctors who migrated to other countries carrying their war experiences and know-how.Footnote 3 While this article adopts the circulation of two persons as a methodology of ‘local storytelling’ that, according to Zemon Davis, allows for a decentralized global approach, we are not so much interested in individual agencies and biographies but in the less explored terrain of how the geopolitical environment of two side-by-side conflicts – the Spanish Civil War and the occupation of Nazi Germany of Czechoslovakia – shaped the process of innovation and transfer.Footnote 4
Duran Jordà was born in Barcelona and studied medicine in the Hospital Clínic, a pioneering medical centre in Spain. He graduated in 1928 and worked as a lab analyst attached to the chair of surgical pathology and as a blood transfusion expert at the Maternity Hospital of Barcelona.Footnote 5 After the coup of Francisco Franco in July 1936, he organised a pioneering blood transfusion centre, supported by the Socialist political parties, with the mission to extend blood transfusions to Barcelona and the Aragon front.Footnote 6 In October, Duran Jordà led the Frontline Blood Transfusion Service (Servei de Transfusió de Sang al Front) that was created by the War Medicine Bureau of the Catalan Government (Consell de Sanitat de Guerra) and, in July 1937, the Transfusion Service of the Spanish Republican Army (Servicios de Transfusión de Sangre).Footnote 7 Previous research has analysed how Duran Jordà improved the technique of blood extraction, preservation, and transfusion, with a pre-packed device, enabling the extraction, preservation, and transfusion of unprecedented amounts of blood with greater facility and efficiency.Footnote 8
Holubec was born in Pržno, a small village on the Moravian–Silesian–Polish border, into the Czech evangelical family of a rural teacher. Karel’s father died when he was three years old and the family lived in difficult material conditions. This experience shaped his later ideological attitudes, including his socialist and antifascist views, and his medical career. Thanks to a scholarship for gifted poor students, he was able to graduate from high school and pursue his studies in the capital. He was educated as a surgeon and graduated from Charles University in Prague two years after Duran, in 1930. He directed the Komenský Hospital which entered Spain in May 1937.Footnote 9 This mobile hospital was a donation of the Czechoslovak Committee to Aid Spanish Democracy (Výbor pro pomoc demokratickému Španělsku, VPDŠ). It was a part of a larger international medical aid movement that rose in support of the Spanish Republican government against Franco’s coup and against his Italian and German allies. Most of these international teams, like the Komenský Hospital, joined the sanitary services of the International Brigades: the International Sanitary Service (Servicio Sanitario Internacional). This institution became a disseminator of medical practices, bringing together hundreds of doctors of more than thirty nationalities.Footnote 10
This case study aims to analyse the international diffusion of medical innovations through semi-peripheral channels. It is based on unpublished archival material complemented by contemporary publications in Catalan, Spanish, Czech, French and English. The existing literature on the diffusion of medical innovations tends to focus, on one hand, on the most developed countries and scientific production centres and, on the other hand, on the colonial and postcolonial worlds, leaving aside the relations and diffusions on the semi-peripheries such as Spain and Czechoslovakia.Footnote 11 Between 1937 and 1938, Duran Jordà’s method was published in Catalan, Spanish, French, and English journals but it was not until 1939, after he had migrated to the UK, that his method became well-known to the international scientific audience thanks to an article published in The Lancet. Footnote 12 The transfer of Duran Jordà’s method to the UK has thus been well studied.Footnote 13 However, before that, in 1938, Duran’s method was exported to Czechoslovakia through interpersonal contact, conferences, and demonstrations. This transfer had a massive impact and further influenced Czechoslovak doctors. This article aims to move beyond technological determinism to engage with social and political contingencies that shaped the circulation of this method. Both Duran and Holubec were involved in a highly mobilised political movement that sought to defend both countries from the threats of Spanish Francoism and Nazi Germany. Whereas this movement was unsuccessful, as both countries succumbed to these threats, Duran Jordà’s method was effectively transferred to Czechoslovakia. However, as the post-war evolution of Czechoslovak science gravitated towards Sovietisation, this successful case of knowledge transfer was sidelined from both the international streams of scientific records and the national narrative of Czechoslovak socialist medicine history.
Duran Jordà and the Komenský Hospital in the Spanish Civil War
Blood transfusions existed since the seventeenth century but they were a tool of last resort and were only used sporadically due to the high risk involved.Footnote 14 In the first decades of the twentieth century, the advancement in the classification of blood groups, and the innovations in anti-coagulants and medical instruments (syringes, cannulas, glass storages), allowed blood transfusions to spread from university surgical clinics and experimental labs to smaller hospitals.Footnote 15 In the mid-1930s, the Soviet doctor Sergei Yudin (transliterated also as Yudine/Judin/Judine) extracted blood from corpses, mixed it with anti-clotting agents, preserved it in refrigeration stores, and transported it with vehicles. He was the first doctor to experiment extensively with preserved blood, documenting a thousand transfusions in 1937.Footnote 16 Furthermore, the Russian surgeon gave a conference at the first institute of blood transfusion in Barcelona created by Dr Antoni Trias Pujol. Duran Jordà, at that time a young doctor in the digestology department, attended the speech and experimented with the extraction of cadaveric blood.Footnote 17 This method was discussed at the First and Second Congress of the International Society of Blood Transfusion celebrated in Rome (1935) and Paris (October 1937).Footnote 18 However, both events gave priority to direct blood transfusions and ignored the importance of preserved blood as late as October 1937; at that time, the innovations of Duran Jordà were only available in a Catalan article.Footnote 19
In the 1930s, Duran Jordà became involved with political movements that mixed socialism with Catalan nationalism. He joined a political party called Unió Socialista de Catalunya (Socialist Union of Catalonia), in which important Catalan socialist leaders like Joan Comorera and Rafael Campalans were members.Footnote 20 Duran Jordà was interested in state-building as a way to implement a socialist health system, especially to protect workers who were unable to afford private medical care.Footnote 21 He followed the studies of the new countries that emerged after the First World War, especially the Soviet Union and Czechoslovakia. According to his friend, the doctor Josep Trueta, Duran Jordà learned from a few studies of preserved blood before the clash of the Spanish Civil War: one was Yudin and the other were publications from Czechoslovakia.Footnote 22 Trueta may have provided this information himself and travelled to Prague in 1932 with a delegation of Catalan surgeons led by Dr Corachán to meet Dr Arnold Jirásek (1887–1960). This delegation was moved by the modernization process of the young state of Czechoslovakia.Footnote 23
In the days after the coup d’état of General Francisco Franco in July 1936, Barcelona experienced an episode of extreme violence. Because of the chaos that broke out at the military garrisons and the revolutionary atmosphere that ensued, the health systems had to be improvised by the leftist political parties and partisans.Footnote 24 Duran Jordà was entrusted to organise a blood transfusion centre for attending the wounded in Barcelona at the ‘Hospital de Sangre No. 18’. At first, it did not have enough blood to cover the needs. However, over a few weeks, Duran Jordà was able to take twenty blood samples a day, thanks to the selfless collaboration of the volunteers who responded to public calls broadcast on the radio. In August, the relative pacification of Barcelona and the consolidation of the front in the province of Aragon, 200 km from Barcelona, led Duran Jordà to send blood by car with a refrigeration system.Footnote 25 The innovation of Duran Jordà stemmed from the simplification of the process of extraction from living donors, conservation (following the solution of sodium citrate and refrigeration of Yudin), and the injection with a new device called the auto-injectable (Figure 1), designed by the Laboratori Químic Biològic Pelayo, with a ‘rapide’ patent they had bought from Madrid. The material was given to Duran without economic interest but through the mediation of the Socialist authorities.Footnote 26 In contrast to other devices, it did not require medical specialisation in blood transfusions to use it. Moreover, in October 1936 the Catalan government created a new military health administration (Consell de Sanitat de Guerra) and named Duran’s hospital the Blood Transfusion Service at the Front (Servei de Tranfusió de Sang al Front).Footnote 27
The auto-injectable, 1937.
Source: Duran Jordà, op. cit. (see note 6), Frederic Duran Jordà, ‘El servei de transfusió de sang al front: Organització-Utillatge’ [The Blood TransfusionCentre at the Front: Organization-Tooling], La Medicina Catalana, 43-44 (1937), 514.
From November 1936, the city of Madrid was endangered by the Francoist troops. In December, the Canadian doctor Norman Bethune set up the Canadian Blood Transfusion Institute (Instituto Canadiense de Transfusión de Sangre), with medical equipment purchased in London and Paris with the funds of the Canadian Committee to Aid the Spanish Democracy (CASD).Footnote 28 It had also a pioneering character in the extraction, preservation, and transport of blood in refrigerated cars. However, because Bethune had bought the medical equipment before knowing Duran Jordà, his technique was less sophisticated: there was no mixing of blood and the preservation bottles were simpler than the auto-injectable.Footnote 29 Both innovators shared the same progressive idea that blood should be donated free of charge in voluntary campaigns through public appeals broadcast on the radio and also delivered to hospitals as a public service. However, the performance of Bethune’s laboratory in Madrid was erratic and Bethune resigned in April 1937, only some months after its foundation. The Institute of Madrid was renamed Instituto Hispano-Canadiense de Transfusión de Sangre and kept operating in the city. From April 1937, the mobile blood transfusion services in wartime Republican Spain were entrusted to Duran Jordà and his method by the Military Health Headquarters (Jefatura de Sanidad Militar). At that time, the first article of his innovative method appeared in a Catalan medical journal, with the first sample of a thousand donors. The Catalan doctor was cautious in his conclusions, emphasising the need to keep investigating.Footnote 30
This was the situation when the fourteen-member Czech convoy of the Komenský Hospital crossed the French border and entered Spain (Figure 2).Footnote 31 Karel Holubec was the chief surgeon, followed by the doctors Pavel Bulatý (or Bulatty), Pavel (Avraam) Elik, Josef (Maxim) Laufer, and Vlasta Veselá; the nurses Marie Holubcová (Holubec’s wife), Marie Veselská, Dáda Hůrková-Drozdová, the organizer Otto Schling (Šling), the pharmacist Helena Petránková, the administrator Jan Eisner, the electrotechnician (and later possibly also anaesthetist) Karel Fisher (Fišer), and two drivers: Eugen Doubrava and Karel Vlček. On 9 May, the team joined the International Sanitary Service of the International Brigades and was assigned to the Guadalajara Hospital, near Madrid.Footnote 32 The hospital was located in a garden area of the city and was divided into two areas: one for infectious diseases and the other for the wounded.Footnote 33 The Komenský Hospital also functioned as a diffusion platform, with weekly medical lectures, meetings, and case-study demonstrations.Footnote 34 After the first battle of Guadalajara in March (where Bethune still delivered blood), the military action spread to the eastern mountain ranges of Madrid: Guadarrama, Navacerrada, and El Escorial.Footnote 35 On 15 June 1937, Holubec and other members of the Komenský Hospital were assigned to El Escorial to support the sanitary team of the XI International Brigade, under the orders of another Czech doctor, František Kriegel (1908–1979), and the mobile hospital of Douglas Jolly.Footnote 36
The Komenský Mobile Hospital, 1937.
Source: Národní archiv [National Archives], Prague, collection NAD 1915, Sbírka “Paměti a memoáry – M. Tauchmanová”. Holubec is the first man sitting on the left.
In July, El Escorial became a key hospital during the battle of Brunete, one of the deadliest fights of the Spanish Civil War. The surgical teams worked in exhausting shifts and, despite the short distance from Madrid, the blood used by the surgeons of the International Sanitary Service was provided by Duran Jordà from Barcelona.Footnote 37 Holubec was impressed by the blood transfusion system and the new surgical techniques developed in mobile hospitals by Jolly and Kriegel.Footnote 38 At that time the activity of Duran Jordà reached its peak, with 3,000 registered donors, mostly from Barcelona, coming from different backgrounds: railway labour unions, public servants of the city government of Barcelona, and employees of a department store.Footnote 39
After the battle of Brunete, a new Czechoslovak team arrived in Spain, led by Bedřich Kisch (1894–1968). In August, Holubec met Kisch in Guadalajara and, two weeks later, the Komenský Hospital was relocated to Benicàssim on the Mediterranean coast.Footnote 40 Karel Holubec and his wife Marie, who was pregnant, returned to Czechoslovakia. Shortly after their departure, the doctors of the Komenský Hospital met with Duran Jordà directly in Barcelona.Footnote 41 They likely met after the evacuation of the hospital of Benicàssim that took place in April 1938, under the threat of the Francoists’ advance; all the doctors from that hospital left northwards and spread to other hospitals in the Catalan region.Footnote 42 At that time, the Republicans were losing ground and most of the foreign medical missions were planning to leave the country.
The transfer
Despite the cosmopolitan environment of the International Brigades and the international exposure of the Spanish Civil War, the innovations of Duran Jordà did not have a remarkable impact on the scientific community. Apart from the Czechs, in July 1937, Duran Jordà received a visit from a Soviet health specialist named (or, rather, codenamed) ‘Colonel Christof’ and, in December, from the British physiologist and activist J. B. S. Haldane, who donated blood for Duran’s laboratory and took one of the devices to the UK.Footnote 43 In February 1938, Duran Jordà was invited to Paris to give a conference at the headquarters of the Centrale Sanitaire Internationale d’Aide à l’Espagne Républicaine (CSIAER), the main organisation which managed the international medical aid to Spain. According to a CSIAER report, by February 1938 Duran Jordà had managed to collect 6,400 litres of blood, from which 1,900 had been delivered to the front, something unprecedented. This was made possible not only by the technical advances of Duran Jordà and his team but also by the frequent campaigns of donation, especially in the biggest cities of Barcelona, Madrid, and Valencia. Furthermore, in its short existence, the lab also improved the auto-injectable, now called ‘Aeron’, which included a two-compartment set.Footnote 44
However, the attempts to export the method of Duran Jordà were confronted by a network of experts who were still wary of experimenting with preserved blood, as was evident at the Second Congress of the International Society of Blood Transfusion held in Paris in October 1937. Duran Jordà’s communications were limited to a leftist audience involved in the Spanish conflict and did not reach mainstream academic circles. In Czechoslovakia, however, the political situation of the country and a massive blood donation campaign organised by associations supporting Republican Spain provoked a huge response from the population and the scientific circles, whose members praised the new Duran Jordà method. This was also possible thanks to the disseminating role of Karel Holubec.
After his return to Czechoslovakia, Holubec shared the knowledge he had acquired as director of the Komenský Hospital with colleagues in seminars and medical journals, where he communicated the basics of the organisation of blood transfusion service in Spain.Footnote 45 In the autumn of 1937, the Society of Friends of Democratic Spain (Společnost přátel demokratického Španělska, SPDŠ – formerly the VPDŠ) carried out extensive campaigns to promote blood donation for Spain through the pages of its monthly magazine Španělsko (Spain). The organisation printed 30,000 copies of its first few issues, something quite remarkable by Czechoslovakian standards.Footnote 46 The SPDŠ’s campaign to promote blood donation for the Spanish cause channelled through Španělsko was a success. An impressive number of applications arrived at the SPDŠ’s headquarters in a short time: between December 1937 and May 1938, 2,000 people were interested in donating.Footnote 47 Over time, however, the Spanish cause lost ground and blood donation and blood transfusion became more of an internal issue. The editors of Španělsko mixed appeals aimed at donating blood to the Spanish and those aimed at donating for the future needs of Czechoslovakia, something apparent in the use of the campaign slogan ‘Blood for Democracy’.Footnote 48 Furthermore, the SPDŠ aimed to ‘hand over the established organisation of blood donors to Czechoslovak institutions’, expressing the hope that it was the duty of the state to ‘take care of the supply of medical services for mass transfusions in cases of emergency, war, epidemics, etcetera.’Footnote 49 In the summer of 1938, 120,000 volunteers had registered by the SPDŠ to donate blood in the ‘Blood for Democracy’ campaign.Footnote 50 Even though signing up for a blood donation did not automatically imply that a person became a donor (we do not know how many of these people actually donated), this was unprecedented and surpassed Duran Jordà’s original campaigns.Footnote 51
In the spring of 1938, during the partial mobilisation of the Czechoslovak army, the Ministry of National Defence appointed some individuals to organise a blood transfusion service. Holubec was chosen to lead, with an improvised character similar to what had happened in Spain, several stations for blood collection and its preservation in the Army.Footnote 52 Although no further sources about these stations, their locations, equipment and procedures are today available, it is not an exaggeration to assume that this was the first sui generis transfusion network established in Czechoslovakia. In September 1938, after the general mobilisation had already taken place, ‘a certain amount of preserved blood was created in the Army’ and Holubec’s part in this action is out of doubt.Footnote 53
Duran Jordà’s visit to Prague in June 1938 was a major event in Czechoslovakia in the months before the Munich Agreement (Figure 3). His new technique of blood conservation and transfusion and its application in the battlefields of Spain aroused the interest of the local medical community. Duran was invited by the SPDŠ where Holubec was one of the most active members.Footnote 54 Another key player was Captain Emanuel V. Voska (1875–1960), the chairman of the SPDŠ and a prominent social democrat who had left the Austro–Hungarian Empire for the US at the age of nineteen and worked with Tomáš Garrigue Masaryk (later first President of independent Czechoslovakia) during the First World War. In 1919 he returned to Czechoslovakia and, among other activities, collaborated in the foundation of the Czechoslovak Red Cross. In 1936 he was behind the solidarity campaigns in support of the Spanish Republican government.Footnote 55
Duran Jordà performing in Czechoslovakia, June 1938.
Source: Anonymous author, ‘MUDr. Duran v Československu’ [Doctor Duran in Czechoslovakia], Španělsko, 2, 4 (1938), 11.
During his two-week stay, Duran lectured on blood transfusion and demonstrated his method in several cities, under the close attention of hundreds of doctors and representatives of the Ministry of Health and the Czechoslovak Red Cross.Footnote 56 At the first conference in Prague, Spanish Ambassador Jiménez de Asúa introduced Duran to an audience of 600 civilian and military doctors. Duran accompanied his lectures with an instructional film and, then, he ‘demonstrated both his instrumentarium and preserved blood for transfusion, and performed a blood transfusion directly in the lecture hall to a patient, as it is done on the battlefield’.Footnote 57 Discussions were held at the First Czech Surgical Clinic and Bulovka Hospital in Prague (five lectures were given in Prague altogether) and were followed by other lectures in Hradec Králové, Brno, Zlín, and Moravská Ostrava. Duran Jordà performed at least six blood transfusions with blood imported from Spain and all cases bore ‘excellent results’, according to the reports of the time.Footnote 58 On his return to Spain, he shared the following thoughts with a journalist: ‘Today we have told the Czechoslovaks that in eighteen months our blood transfusion service has managed to obtain no less than 4,000 litres of blood from eleven thousand extractions from voluntary donors in our country. This shows both our scientific progress and the magnificent spirit of the citizens of the Spanish Republic’.Footnote 59
Furthermore, Duran Jordà agreed to deliver his patents free of charge, ‘as a gift to Czechoslovak hospitals so that they could increase the strength of our [Czechoslovak] Army and our [Czechoslovak] state’.Footnote 60 The device for filling glass vials with preserved blood (the apparatus) and the method of filling (the procedure) formed a complete ‘system protected by two Catalan patents’, and it was this ‘two-pack’ that was to be made available to the Czechoslovak state.Footnote 61 Duran came with an assistant or collaborator named L. Montagut/Montagud who was the technical director of the Barcelona Institute for Transfusion and also an employee of Cobosa (Comercial Bonin S.A.). Montagut ended up staying in Prague longer in order to assemble the necessary equipment and set up a blood collection apparatus. He taught the medical staff how to fill the bottles with pressure and close them and the equipment was put at the disposal of the State Institute of Health (Státní zdravotní ústav).Footnote 62
However, despite the expectations of the authorities, the medical and military circles, and the considerable publicity which was raised around the planned donation, the handover of the patent fizzled out: ‘Until the day of publication – November 1938 – there has been no written notification about the possibility of free use of the patent, as promised,’ complained one of the interested doctors on the pages of the Czech Medical Journal. Footnote 63 Did Duran as author of the patent, and the firm Cobosa, the trader of the patent, expect a financial profit from the visit to Czechoslovakia even though this was in contradiction to what was originally stated?
It would not be incomprehensible, after all, Cobosa was not a charity organisation, and Duran Jordà could be thinking of a possible source of revenue as the war in Spain continued unfavourably for the Republic. In the early 1940s, Cobosa’s founders, the brothers Joan Lluís and Bonaventura Pujol Font (the latter a surgeon who had served at the front in Catalonia-Aragon), both members of the Catalan Socialist Republican Party Esquerra Republicana de Catalunya (ERC), recognized that they had done their best to sell auto-injectables in Europe but that the war situation made it impossible. They tried to restart the business of auto-injectables in Cuba and suffered economic hardships as exiles.Footnote 64 It is also possible that in the maelstrom of wartime events, both Duran and Cobosa had other concerns to attend to, or could not attend to the petition, and simply dropped the matter. In February 1939, Duran left Spain and migrated to Great Britain, invited by the British Red Cross. He left his wife, Carola Tort, and a two-year-old daughter, Carola Duran, in Barcelona and travelled with the nurse of his lab, Vicenta Villaró, who was pregnant. He was accompanied by Josep Trueta, general surgeon of the General Hospital of Barcelona who became famous for his innovations in the treatment of war fractures.Footnote 65 Shortly after Duran Jordà’s departure, the house of Carola Tort and her daughter was searched by the Francoist police and all suspicious objects (including a doll Duran Jordà had brought to his daughter as a gift from Czechoslovakia) were taken away.Footnote 66
Trueta and Duran Jordà gave detailed accounts of their innovations to the Home Office and the British Army Blood Transfusion Service, without referring to the patent.Footnote 67 In April, Duran Jordà published his main innovations at The Lancet and, in 1941, the British Ministry of Information launched a video recognising the innovation of Duran Jordà and showing images of the laboratory of Barcelona.Footnote 68 However, the integration of Duran Jordà and Trueta into the UK was not a bed of roses. The British intelligence often considered the commitment to the Spanish Republic to be indicative of communist affiliation and/or Soviet espionage. Consequently, both doctors encountered significant challenges in their efforts to find a stable position as refugees. They ultimately succeeded: Trueta in Oxford and Duran Jordà in Manchester. The value of their know-how was acknowledged thanks to the imminence of war and the support of some influential doctors who went beyond political suspicion and criticism, like in the case of Trueta, who was supported by doctor Gathorne Robert Girdlestone (1881–1950).Footnote 69 Doctor Janet Vaughan (1899–1993), who lodged Duran Jordà in his first days in London, was paramount in the organization of the Blood Supply Depots in London which, by June 1940, had registered 113,500 volunteer donors through a massive campaign, similar to those conducted in Spain and Czechoslovakia.Footnote 70
The vicissitudes of Duran’s method in Czechoslovakia
Despite the lack of concretion on the patent transfer, Duran Jordà’s tour in Czechoslovakia had both immediate and long-term effects. Not only was his method widely used, copied, and experimented with, but massive campaigns for blood donation and blood transfusion were organised under his influence.Footnote 71 The opening article of the November 1938 issue of the Czech Medical Journal provides a detailed description of how Jaroslav Drbohlav (1893–1946), bacteriologist and the head of the diagnostic department of the State Institute of Health, had modified Duran’s blood transfusion devices ‘in cooperation with Mr Jejkal’ (about whom we have no further information). As a result of this medical–engineering collaboration, they presented a skilful copy of the apparatus and the procedure on the basis of what they had observed in Duran’s demonstrations.Footnote 72 This new method was called the ‘Duran-Drbohlav conservation method’ (Duránova-Drbohlavova konservační metoda, Figure 4) and underwent further modifications in the hospitals of Zlín and Brno.Footnote 73
Duran-Drbohlav conservation method, 1938.
‘The principle of the [Duran’s] method is a closed circuit consisting of four vessels (A-D), [figures upper left]. It requires a special apparatus in the form of an autoclave [upper right] into which the pressure of two atmospheres is filled and then the neck of the bottle is sealed. After the bottle is closed, an injection set made of thick-walled hose is fitted over the sealed part, ending in a metal cannula for insertion of the needle … [whereas Drbohlav’s modification consists in] the elimination of thin-walled bottles which are too fragile, and the narrow necks of which cannot be easily cleaned, and their substitution by a thick-walled bottle of the normalised type, which can be easily cleaned as well as in the substitution of negative pressure, which is only available in well-equipped laboratories, by overpressure, which can be easily obtained using a compressor or a bomb … The circuit has been shortened by one container.’
Source: Časopis lékařů českých [Czech Medical Journal], 77, 44 (1938), 1282-4.
If Duran’s visit had caused a rising interest amongst surgeons in the use of preserved blood, Karel Holubec was one of the most experienced in this field.Footnote 74 His first experiments with blood transfusion and preservation ‘à la Duran’ took place in Třebíč, a district town in western Moravia, where he had worked since 1936, and where he returned after his Spanish experience. However, after the German occupation of Czechoslovakia, he left the town and moved to Prague, seeking greater anonymity. There, no later than 1942, Holubec found refuge at the Surgery Department of the Vinohrady Hospital under Professor Emerich Polák who was known as the protector and saviour of persecuted patients, often Jews.Footnote 75 Under the auspices and protection of Polák, who himself had experimented with blood transfusions before the war,Footnote 76 Holubec continued with his experiments which followed and adapted Duran’s method, depending on the availability of materials during the war years.Footnote 77
In Prague, Holubec also collaborated with Dr Bohumír BudínFootnote 78 and his resistance group. This group of left-leaning doctors worked within the Czech National Council (Česká národní rada), an illegal resistance body operating in the Protectorate of Bohemia and Moravia. Since 1943, Holubec was instrumental in establishing blood storage and transfusion stations for the Czech resistance, ‘so that the whole of Prague would be secured by this method’.Footnote 79 In the last months of the war he managed to prepare ‘a large amount of blood cans for the wounded and sick in Prague and [the liberated concentration camp of] Theresienstadt.’Footnote 80 An active member of the team which created blood reserves during the Prague Uprising in May 1945 (and which used a blood collection kit provided by the State Institute of Health called ‘Drbohlav’s bottles with vacuum’),Footnote 81 Holubec also took care of the material and financial resources and the training of personnel for the blood transfusion service, mainly relying on his previous experiences from the Spanish battlefields.Footnote 82
In addition to the blood transfusion service, Holubec was actively involved in another crucial activity that should be mentioned in the context of the medical innovations associated with the Second World War, namely the eradication of the typhus epidemic that struck the Terezín/Theresienstadt concentration camp at the end of the war. Although the eradication of the epidemic is a somewhat forgotten story today, it can be argued that it is one of the greatest feats of Czech doctors and medical professionals in Czech modern history. Since April 1945, transports of prisoners from the closed concentration camps elsewhere in Europe began arriving at the Terezín concentration camp by the thousands, suffering from various infectious diseases (most often dysentery and typhoid fever), including typhus fever (louse-borne). The danger of a typhus epidemic was already evident at the end of April but the German camp commanders were more concerned with their own escape, while more evacuation transports arrived in Terezín with groups of prisoners coming from the death marches.Footnote 83
Dr Budín with a group of colleagues had been preparing measures to prevent the spread of contagious diseases as early as the end of 1944. After his death in the Prague Uprising in early May 1945, his work was continued by the Czech epidemiologist Karel Raška and other doctors. Volunteer convoys of health workers began to arrive at Terezín, full of impoverished, dead, and dying prisoners. Among them was Karel Holubec, who had known Raška since school. He may have responded to Raška’s personal appeal, or to the appeals broadcast on the radio which – like the radio appeals for blood in the times of the Spanish Civil War – called on doctors, pharmacists, and nurses to join the aid in Terezín. In mid-May, the epidemic was suppressed by widespread measures and vaccinations. Between the end of April and June 1945, however, around 2,000 people died in Terezín, with typhus fever being among the immediate causes of their deaths.Footnote 84
After the Second World War Duran Jordà’s contributions were not forgotten in Czechoslovakia. In 1948, the Czech Medical Journal published a study about blood transfusions by the aforementioned epidemiologist Raška who referred to Duran Jordà, ‘a name known to all of us’ and his role in the development of blood transfusions in Great Britain.Footnote 85
At the beginning of 1948, the Czechoslovak Ministry of Health, instructed by the Ministry of National Defence, established the so-called Transfusion Commission, and by a government resolution of 7 December 1948, the health administration of the now communist state built a network of transfusion stations.Footnote 86 The first stations began operating in the spring of 1949 in Prague and Brno. In the summer, other stations appeared, such as in the relatively small district town of Třebíč.Footnote 87 In the Transfusion Commission which administered these stations, Holubec was well positioned for being ‘our leading expert with international experience’, not only from Spain but also from the Soviet Union, where he had also made a study trip in 1938.Footnote 88 Furthermore, in the spring of 1950, the Transfusion Commission came under the direct leadership of the Deputy Minister of Health, a military physician and former boss of Holubec in Spain, Dr František Kriegel. After Spain, Kriegel served at China’s Red Cross Medical Relief Corps and in the medical army of the Allied Forces in China, India, and Burma.Footnote 89 Upon his return to Czechoslovakia, he entered politics and became an organiser of the People’s Militias (Lidové milice) and an active player in the process of the communist takeover.Footnote 90
Holubec’s career skyrocketed, too. Soon after the liberation of Czechoslovakia in 1945, he officially joined the Communist Party (having sympathised with it since much earlier), left Prague in early 1946, and returned to Třebíč where he became head of the surgery department.Footnote 91 In Třebíč he fully developed his experience as a war surgeon from Spain specialising in open fractures, burns, and blood transfusions. He became an associate professor and lectured on war surgery at Masaryk University in Brno.Footnote 92 His wife Marie, who had practiced as an operating theatre nurse in Spain and had since long been active in the Czechoslovak Red Cross, decided to devote herself exclusively to the household and family.Footnote 93
Marie’s decision to withdraw from the Red Cross activities may of course be read in the personal context of a woman who just gave birth to their third child, whose husband was often absent from home, and whose domestic helper was taken away by the local authorities after the communist coup in February 1948, but also in the context of the new refugee policy of the communist state: although at first glance the Czechoslovak Red Cross represented a guarantee of continuity with pre-war practice in the care of refugees, in fact after 1948 it fell fully under the control of the Communist Party and functioned as a transmission lever between the International Section of the Central Committee of the Communist Party of Czechoslovakia and the state security apparatus, which kept an eye on the foreigners (at the moment mostly Greeks, but also Italians, Yugoslavs, and Spaniards). In the eyes of local communist authorities, Marie may not have appeared to be the most suitable, i.e. politically reliable, person to be employed in such an organisation.Footnote 94
Holubec renewed his contacts with Czech and Slovak comrades from Spain when the Society of Friends of Democratic Spain resumed its activities. At the same time, members of the Spanish Republican exile began to arrive in Czechoslovakia enjoying extraordinary support, as did – for the time being – the Czechoslovak International Brigaders, who were hailed as heroes for having taken up the fight against fascism before it was fully unleashed in Central Europe.
In 1947 and 1948, as a scholarship holder of the Ministry of Health, Holubec went on several months of trips to France (autumn 1947) and England (autumn 1948), the aim of these trips being, inter alia, to study medical innovations in the field of blood transfusion.Footnote 95 It cannot be ruled out that he met Duran while in England. By then, Duran Jordà was working at the Ancoats Hospital in Manchester and was in touch with other Republican exiles, who visited him and praised his work, giving him the Prat de la Riba award (1947). However, in a 1949 letter to a friend, he defined himself as the ‘outcast of Manchester’ and he laughed at himself as he had once gained fame as a cold-blood doctor (because of the preserved blood) and now he was in need of heating his blood, as he was not getting used to the cold-weathered Manchester.Footnote 96 He passed away in 1957 at the age of 51.
At the turn of 1948–49, in connection with another planned study trip to the UK, Holubec was contacted for the first time by Czechoslovak intelligence and was offered free access to the West in exchange for an agreement to cooperate. Although we know, in view of later developments, that Holubec was not suitable for cooperation with the secret services and that he was unable to carry out the given tasks (mainly because of his scientific absent-mindedness and impracticality, and possibly, too, his personal reluctance), he did not turn the agent down. At the same time, however, he himself became an object of interest for the State Security (Státní bezpečnost).Footnote 97
Around the same time that the State Security opened a file on him, Holubec was engaged in two projects of his own, in the spirit of humanist-oriented socialism and socialist internationalism: the first was to make a promotional documentary about blood transfusion and its preservation. The second was the promotion of Gypsy/Romani culture and the public empowerment of Czechoslovak Gypsies/Roma.
As far as the documentary film was concerned, the intended format was not dissimilar to the one Duran Jordà had presented in Prague in 1938. The largest medical institutions in Czechoslovakia still referred to the original video that Duran Jordà had shown in the summer of 1938 as a solid source of knowledge.Footnote 98 How the idea for this project was born and developed, is revealed by a unique source, which is Holubec’s communication with Vítězslav Nezval, a prominent writer, poet, leading figure of Czech surrealism, and pre-war communist who became very active politically after the Second World War.Footnote 99 The men were friends. In February 1949, Holubec turned to Nezval for help. He attached a film script, ‘as I drafted it between evening and midnight work’, to promote blood donation and support the idea of establishing a network of transfusion stations.Footnote 100 He asked Nezval to review his script and help promote it, as the poet had connections to the highest political circles. At the same time, the doctor admitted that ‘the whole Blood Transfusion Commission is working unsatisfactorily slowly’.Footnote 101 Later that year, a fifteen-minute film, entitled ‘Dar nejcennější’ [A Most Precious Gift] was produced for promotional and educational purposes, matching the format that Holubec envisioned.Footnote 102 Whether Nezval’s ‘cultural patronage’ was behind the making of this film, as Holubec kept suggesting, or not, the film, as a medium whose popularity grew steeply after the war, certainly played a significant role in promoting the idea of donation and blood transfusion.
The doctor’s relationship with the Czechoslovak Roma is another aspect of Holubec’s personality demonstrating – just as much as the documentary project – his struggle for greater social justice after the war. The Roma who lived during the war in the territory of the Protectorate of Bohemia and Moravia and the Sudetenland, i.e. the Czech part of the former Czechoslovakia, overwhelmingly perished in the Holocaust. After the war, Slovak Roma began to migrate en masse to the Czech lands, especially to border areas and large cities, in search of job opportunities. Although formally equal to the rest of the population, their integration was difficult and the communist regime struggled to respond effectively to these challenges, resulting in various policy proposals ranging from repressive measures to support for Roma self-government.Footnote 103 Holubec sought to shift public discourse towards enlightenment and openness, promoting the development of Roma culture and their active participation in public life. From 1950 until well into the 1960s, he studied Roma culture, customs, and language and although he was an autodidact, he gradually became a recognised expert.Footnote 104 Holubec visited Roma families in Brno and Třebíč, advocating for their integration and proposing to the Communist Party ways to involve the Roma in the construction of socialism. He criticized racial discrimination and believed that Roma should be allowed to develop their culture and language, proposing the use of Romani for educational and political materials and even translating and publishing Roma folk poetry.Footnote 105
The penetration of Soviet ideology into Czechoslovak science and medicine, which, according to several scholars, met with some resistance in 1948–49, gained momentum from the turn of the year 1950–51, and Czechoslovak science found itself under the growing isolation from the other side of the Iron Curtain. Only a few individuals or small groups were able to cross borders and there were explicit efforts to expel ‘deeply rooted Western influences’ from Czech medical science.Footnote 106 Sovietisation was spread using a variety of methods: the introduction of planning into scientific research and the attempts at centralisation; propaganda campaigns in the scientific press; the influence of Soviet advisors; the transfer of organisational models in higher education and the Czechoslovak Academy of Sciences; pressure for translations of Russian literature; and the necessary ‘shielding’, i.e. the very carefully monitored number of citations from Soviet literature. In the Czechoslovak medical press, Soviet production displaced the studies and monographs by Anglo–Saxon authors that had dominated until then.Footnote 107
By 1951, the Transfusion Commission was criticised (and criticised itself) for being led by ‘reactionaries’, Western-oriented cosmopolitans, Trotskyists, or Jews: ‘It turned out that our transfusion service has been built on erroneous foundations according to Western experience and needs to be rebuilt according to the Soviet model’.Footnote 108 As a result, the activities of the Commission were paralysed and many non-conforming or independent experts were laid off and left the country (most of them illegally and irreversibly). Meanwhile, in small and medium-sized Czechoslovak hospitals transfusions were done with a pre-Duran method with a syringe without citrate directly from the donor’s vein into the patient’s vein, or the donor’s blood was allowed to drain into an open container with citrate, where it was stirred with a whisk and then injected into the recipient with a syringe.Footnote 109 The blood transfusion service continued to be voluntary but with some rewards in terms of food and other product allowances. A 1951 report informed that ‘often there are defective canned meats, chocolate is wormy, tea is missing and complaints from affected donors are not given a hearing’.Footnote 110 The food package had to be ‘covered’ by a reference to the Soviet Union and its ‘perfectly established system of voluntary blood donation’.Footnote 111
On the other hand, the network of transfusion stations began to expand, as did the number of voluntary donors, and blood transfusion gradually established itself as a functioning part of the health system of communist Czechoslovakia. The dense network, as conceived by Soviet expertise in view of the risks of a possible nuclear war, guaranteed a good blood supply to all medical facilities. The examination of donors was improved, and the safety of transfusions was increased (again largely due to the Russian emphasis on aseptic practice, Figure 5).Footnote 112
Aseptic box of the transfusion station in Czechoslovakia, mid-1950s.
Source: Eduard Dobrý and Jaroslav Fiala, Dárcovství krve [Blood Donation] (Prague: Ministerstvo zdravotnictví, 1957), 62.
In the climate of political purges and scientific isolation of Czechoslovakia from Western Europe, Duran Jordà was remembered as a distinctive and enduring figure, as a Republican emigrant, who stood somewhat outside the divide of the Cold War. It is within this context, too, that we must read the relative longevity of Duran’s practices in Czechoslovak medicine. His findings were referred to by Czechoslovak experts in the treatment of human blood well into the mid-1960s.Footnote 113 By that time, Holubec stepped out of his involvement in the institutions of blood transfusions and ceased publishing and lecturing in this field.Footnote 114 In the late 1950s and the early 1960s, he worked in Congo, Algeria, and Ethiopia on various Czechoslovak development aid missions. Despite the isolation between Eastern and Western Europe, Czechoslovakia, and other Communist countries, he engaged in diverse international activities with other territories from both the Socialist world and with countries of the so-called Third World. Although we do not know whether Duran’s blood transfusion method had a role in Holubec’s work in Africa, he used Trueta’s method of treating splinter fractures, with which he had become familiar in Spain, ‘with fair results, even in combat situations’Footnote 115 in Algeria, where he was sent a member of a Czechoslovak medical expedition to help the rebel Algerians in the last months of the struggle for a free Algerian state,Footnote 116 or the 1960 Congo at the time of Patrice Lumumba.Footnote 117 Having retired from his position as chief medical officer in 1967, Holubec died of cancer in 1977. His wife Marie Holubcová (1913–2004) lived to see the fall of the communist regime and, in 1996, became an honorary citizen of Spain.Footnote 118
Conclusions
The beginnings of blood transfusion and blood conservation in Czechoslovakia were strongly influenced by the expertise of the Catalan doctor F. Duran Jordà, whose method was diffused by Duran himself and a group of experts led by Karel Holubec, a volunteer doctor who had experienced how this method was applied in wartime Spain. During the Second World War, this method was further transformed and adapted in some Czechoslovak hospitals. References to Duran’s method persisted in post-war and communist Czechoslovakia well into the 1950s, despite the influx of expertise from the Soviet Union. However, as much as the Czechoslovak blood transfusion and its actors tried to keep up with world developments in the 1950s and 1960s, the isolation from Western Europe and the imposed Sovietisation caused a growing technological backwardness and the method of Duran Jordà was overlaid and covered by other influences. Today, his contribution to Czech and Slovak medical histories, while unquestionable, has been largely forgotten.
Duran Jordà and Holubec were both heavily influenced by the political milieu in which they worked: the Spanish Civil War and occupied Czechoslovakia. Their methodology implied massive campaigns of solidarity which were broadcast in the media and received strong popular support, bringing blood to their laboratories for free and being allocated by public and military administrations who were facing a situation of war. Their ‘socialist’ understanding of medicine and blood transfusion was determined by the military needs of two countries that were under the pressure of a total war. Furthermore, they both developed an internationalist approach, which enabled them to transport blood from both countries and link both blood transfusion campaigns in Spain and Czechoslovakia. This was unprecedented and pioneered in the international solidarity campaigns that would develop after the Second World War.
Duran Jordà’s transfer to Czechoslovakia has not been registered or recognised as a relevant step in the history of blood transfusions partly due to its semi-peripheral character. The main tools of transmission, besides the direct performance, were publications in Catalan, Spanish, French, and Czech which appeared in journals and bulletins of leftist organisations that did not reach a wider scientific audience, even though – as this article has shown – they could be massively followed by citizens. Meanwhile, the mainstream international medical community did not recognise the value of Duran Jordà’s innovation, at least in the key years of 1937–39, which makes the transfer from Spain to Czechoslovakia even more relevant in historical terms. Thus, if the revision of Duran Jordà’s method transfer can fall in the ‘novelty-mongering’ trend that is common in the historians of science, technology, and medicine, it is also a ‘history of content and context together’Footnote 119, a history from below and a case study that conflates the innovation and its dissemination with the history of wartime Spain and Czechoslovakia. The Spanish Civil War, the International Brigades, and the invasion of Czechoslovakia by Nazi Germany were thus not only the historical context of medical innovation but an integral part of it.
This article also shows a process of invisibilisation and paths not taken. The Second World War and the first years of the Cold War implied a reconfiguration of the international scientific networks and contacts, affecting the relationship of Duran Jordà and Holubec. After Duran Jordà had migrated to the UK, although his identity as a Spanish Republican refugee was not without problems, his method was absorbed by the Western international medical community. In contrast, Holubec and other Czechoslovak doctors kept working and adapting Duran Jordà’s method according to their needs, but their channels of communication, especially during the German occupation, were narrowed. When the Sovietisation campaigns became pressing in the 1950s, these channels were further censored and cut off from their original source, although new waves of communication were opened with other territories, which remain outside the possibilities of this article. As a consequence, the transfer of Duran Jordà’s method to Czechoslovakia and its relevance in the international history of blood transfusions seemed to enter into a dead-end road.
Acknowledgements
We would like to thank the following colleagues, friends, and family members of Duran Jordà and Karel Holubec who have helped us in this research: Carola Duran Tort, Jiří Holubec, Guillem Casañ, and Alberto Ortiz. We would also like to thank the peer reviewers for their insightful and valuable comments.
Funding
This research has been funded by the Ramón y Cajal Fellowship of the Spanish Ministerio de Ciencia e Innovación and the European Social Fund (RYC2018-024078-I). It is a part of the research project called TACK, which has received funding from the Spanish Ministerio de Ciencia e Innovación (PID2019-108637GB-100). It has also received funds from the Czech Science Foundation GA ČR (project no. 410/23-05753S Minuty mezi životem a smrtí: Proměny zdravotnické záchranné služby a profesní identita jejích zaměstnanců v českých zemích 1952–2003).
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