La transfusión de sangre conservada

La transfusión de sangre conservada is the method that made blood transfusion portable during the Spanish Civil War: blood collected from Madrid volunteers could be preserved in a refrigerator, matched to a recipient, and carried to the front rather than supplied directly from one person to another. Its first successful use, on 23 December 1936, reverses a soldier’s expected death and gives the novel’s medical innovation a human scale. The method also recurs in the life of Guillermo García Medina, linking a public act of international aid to his work as a doctor and, decades later, to the concealed history of his family.

From direct transfusion to a stored supply

Before the Canadian Institute of Blood Transfusion began work in Madrid, transfusions were possible only directly, from donor to recipient, with the two people connected by needles and tubing. Norman Bethune and his collaborators set out to overcome that limitation. Their equipment included an Electrolux refrigerator, large sterilizers and autoclaves, and fifteen portable packs. Each pack carried bottles and containers for saline and glucose, as well as a sterilized kit containing a towel, forceps, a knife, a syringe, and suture thread. The institute’s rooms were rapidly converted from a furnished residence into a laboratory and treatment facility, with the unfamiliar apparatus filling spaces previously occupied by beds and furniture.

The team appealed for volunteers through newspaper notices and three days of radio broadcasts, asking people to donate blood for soldiers at the front. On 19 December, before the institute had opened for its first donation day, the queue already stretched around the corner. The donors included civilians and soldiers of different ages and occupations, with more women than men among those filling the treatment tables. Volunteers had to arrive fasting and gave half a litre of blood. A small quantity of sodium citrate was added; the filled bottle was labeled with the blood group, date of extraction, and donor’s identity. Donors received a food voucher and a drink of brandy, and, as the siege made daily life harder, a tin of beef was later offered for each donation.

The Madrid collection and the first test at the front

The response quickly exceeded the institute’s expectations. In little more than three days, collected bottles filled the largest commercial refrigerator available, while donors continued to queue each morning outside the building on Príncipe de Vergara Street. Bethune reported uncertainty about how long citrated blood would remain usable in cold storage, hoping it would last several weeks. The scale of the collection nevertheless made a practical test possible: the team could take stored blood away from the donors and use it where wounded soldiers needed it.

On 23 December 1936, Bethune’s team filled the portable equipment with blood of all groups, loaded the packs onto a truck, and drove to the Hospital de Sangre de la Casa de Campo, near the front. Bethune looked among the gravely wounded for a patient who might be saved. He chose a young soldier suffering hypovolemic shock after massive blood loss. The Spanish doctor attending him considered him beyond help. The patient was barely breathing; his skin was pale, cold, and damp, and his lips had lost their color. Through an interpreter, Bethune asked permission to try to revive him. The hospital director agreed, though skeptical, and stayed to watch.

Bethune pricked the soldier’s finger and collected a sample on a glass rod to identify his blood group. Two minutes later, he began transfusing the first bottle. The soldier moved and opened his eyes, but the blood loss had been so severe that Bethune gave him a second bottle. Before that transfusion was finished, the patient looked at him and smiled. The intervention did not merely demonstrate that stored blood could be used away from its donor: it changed the immediate prospect of a man the hospital staff had expected to die.

A portable service and its human consequences

The novel presents the procedure as a practical as well as a technical advance. Because the blood could be stored and transported, a donor no longer had to lie beside the recipient, connected by needles and a length of tubing. Transfusion became easier to organize and carry out, and Bethune’s team could take supplies to hospitals near the fighting. That morning at the Casa de Campo hospital, the intervention revived twelve soldiers; the first survivor’s name is not recorded. His comrades put a lit cigarette in his mouth, and he drew on it while those present celebrated the return of a man they had just believed lost. Their cheers joined Canada, Bethune, the Republic, working-class struggle, and international solidarity in a single response to the scene.

Bethune’s work also supplies a model for Guillermo García Medina’s later medical service. After Guillermo helped save Pepe Moya in Aravaca, the newspaper coverage and pressure from doctor Quintanilla helped secure a change at the hospital. On 11 January, Bethune visited Guillermo at San Carlos to say goodbye before taking his team to other fronts. Though Spanish staff would keep the Canadian institute operating, Bethune asked Guillermo to take charge of the mobile service. Guillermo later recalled that the method was simple enough for him to organize half a dozen mobile units in less than a month while continuing his hospital work. With a donation from Canada in the form of a refrigerator, he also became head of the transfusion service established at San Carlos. The technique thus passes from its pioneer to a Spanish doctor who makes it part of his working life.

Medical practice inside a concealed family history

The blood-transfusion service is woven into the novel’s account of Guillermo’s relationship with Amparo and their son. Years later, while searching for papers he had put away, Guillermo finds a hidden envelope among the family documents. It contains a family book naming Guillermo García Medina and Amparo Priego Martínez as husband and wife, their son’s birth record, a wedding photograph, and a short note dated 28 March 1939 in which Amparo apologizes. Among the other items in the folder is the photograph of Guillermo with Bethune that had appeared on the cover of El Heraldo. A record of medical work and a record of private life occupy the same cache, though their meanings have been kept apart.

The child grows up under another name. Amparo’s son is called José Antonio Urbieta, and a photograph of a Falangist who supposedly died in Russia is displayed as the boy’s father. Experta tells Guillermo that this is the identity presented to the child through the papers, although she doubts Amparo knows the man in the photograph. Guillermo watches his son from a distance, sometimes seeing him arrive with scraped knees and his shirt hanging out. The medical history does not itself explain the concealment, but it makes Guillermo’s public identity tangible: he is the doctor who worked with Bethune and served the besieged Republic, while the boy is being raised within a different account of his parentage.

Recognition and the reach of an earlier act

At fourteen, José Antonio falls seriously ill with rheumatic fever, and Guillermo comes to see him every afternoon. In 1958, searching his mother’s underwear drawer for money, the boy instead discovers papers in an envelope: his birth record, a Republican family book, a photograph of an apology, and a photograph of his pregnant mother beside the doctor who had visited him and taught him to play chess. Those objects prompt him to ask questions. Experta eventually tells him that Guillermo had lived across the hall, hidden Amparo, buried her great-grandfather, and shared her life until 1939; she also tells him that Guillermo is his father and a leftist. The son’s discovery turns medical care, a form of attention he has known since childhood, into one clue in the recovery of his family history.

The technique’s historical reach and Guillermo’s personal history meet again in the novel’s image of two men who have repeatedly saved one another. When Guillermo and Manuel Arroyo embrace at Barajas Airport on 30 December 1976, their bodies bear scars, and Guillermo’s hands are described as the hands that had sewn Manuel’s wounds. Both men have lived under names that were not their own; each calls the other by his real name. They recognize that each owes the other his life. The transfusion method is not credited with this later rescue, but its place in Guillermo’s work helps establish the medical practice through which the novel repeatedly connects bodily survival with obligation, memory, and the lives that continue after war.