By Dr Carles Brasó Broggi
Editorial Note: On 22-23 June 2017, the Second World War Research Group held its annual conference on the theme of ‘When East meets West: The Second World War in Global Perspective.’ We have been posting short articles written by some of the conference’s presenters.
When the Spanish Civil War clashed in July 1936, international medical volunteers from all over the world went to Spain to collaborate with local doctors in the Republican front along with the International Brigades. These international teams made important innovations in war medicine. However, only two years later, the Republican government announced the withdrawal of the International Brigades and by mid-1939 all volunteers were gone, as Spain fell under the Francoist regime. Most of the doctors went back to their home countries but a small group of them travelled to China and became known as the ‘Spanish doctors.’
About twenty medical volunteers moved to China after Spain. This group, even though small, made a great contribution to the international spread of modern medicine. The role of these doctors that participated in both conflicts has been researched by Chinese historians, but no attempt has been made to put the Chinese and Spanish sources together. The Canadian doctor Norman Bethune is the most famous case, but other doctors followed his path and have remained relatively unknown. These ‘Spanish doctors’ – even though they were not Spanish – not only helped to heal the wounds of the blessed soldiers and civilians, but also contributed to important medical innovations, such as the emergency surgical units near the front, the blood banks and the ambulances equipped with surgery capacity.
The ‘Spanish doctors’ can be divided into two groups. The first reached Communist China individually and were non-Europeans: Norman Bethune, Menhanlal Atal, Tio Oen Bik (or Bi Daowen in Chinese transliteration) and Leo Eloesser. The second group came from Eastern and Central Europe and worked in the Chinese Nationalist area: Herbert Baer, Rolf Becker, Karl Coutelle, Samuel Moses Flato, Walter Freudman, David Iancu, Fritz Jensen, Wolf Jungermann, Leo Kamieniecki, Ianto Kaneti, Heinrich Kent, Frederick Kisch, Frantisek Kriegel, Iacob Kranzdorf, Otto Schoen, Victor Taubenfligel, Alexander Volokhine, Edith Markus and Miriam Kamieniecka. Both groups brought medical innovations and practices from Spain to China, and this transfer of knowledge has not been researched at all.
In the summer of 1936, air bombings in Spanish cities created a massive problem of crushing and contusions that had to be treated with blood transfusions. At the end of the year, the first blood bank in history with a complete classification of blood types and a methodology for blood preservation and transport was put into place in Barcelona by Catalan doctor Frederic Duran Jordà. The Canadian doctor Norman Bethune met Duran Jordà in Barcelona in November 1936 when the centre was in full working capacity. He then set up an equivalent blood transfusion bank in Madrid that was called The Canadian Blood Transfusion Centre. Both Bethune and Duran Jordà created the first comprehensive blood transfusion service in medical history that covered an extensive area surrounding the two most important cities of Spain. One year later, Chinese cities began suffering from severe air raids.
Another important medical innovation came from the organization of self-sufficient mobile surgical teams that operated near the front. One doctor was responsible of classification of the wounded, sending them to different front hospitals that stood only several kilometers away from the front. Front hospitals were not big hospitals that could be easily bombed but small makeshift medical units or even ambulances equipped with surgical capacity. Mortality rates for abdominal wounds were reduced of near 100 percent to a half, thanks to these innovations. These doctors did not work in laboratories or big hospitals but in makeshift units in the battlefield. They developed strong skills of intercultural relationship and education, providing with basic trainings of hygiene and first aid to soldiers, stretcher bearers and local civilians.
Norman Bethune was the first ‘Spanish doctor’ to arrive in China after Spain and the most famous one. He travelled to Hong Kong in January 1938 and from there to Hankou, where the Republican government had just evacuated after the Japanese occupation of Nanjing. At that time, it was still possible to move from the Nationalist side to the Communist parts of China. So, Bethune continued northwards until finally reaching Yan’an, where he met Mao Zedong in April. Then, Bethune visited the field hospitals of the Communist area, where he found that the sanitary situation was worse than in Spain, due to the extreme isolation of the region, the shortage of medical material and the lack of doctors and nurses.
According to communication in early spring 1939, the International Peace Hospital lead by Bethune consisted on 25 houses placed in different villages that were looked after by a staff of two doctors and eighteen nurses for each place. That organisation had similarities with the mobile surgical units of Spain. Other ‘Spanish doctors’ reached the Communist zone in different periods: the Indian doctor Menhanlal Atal in 1939, the Chinese Indonesian doctor Tio Oen Bik (Bi Daowen) in 1940, and finally the American surgeon Leo Eloesser, in 1946. They all worked in Spain and followed a methodology that was primarily inspired by their Spanish experiences.
In 1939, medical volunteers from Eastern and Central Europe were stuck in the refugee camps of France with no hopes of returning to their home countries. In February, the Internationalist Communist organization selected 17 volunteers, and the Comintern, and other associations that funneled medical aid to China. Doctors Becker, Jensen and Kisch departed in May and were followed by another group of 14 doctors, who were welcomed in Hong Kong by Song Qingling (Madame Sun Yatsen) and the China Defense League in September. All of them had experience in Spain, were given a salary by the Chinese Red Cross and were taken to a remote town in Guizhou province called Tuyunguan. They were integrated into China’s Red Cross’s Medical Relief Commission, under the supervision of a doctor named Dr Robert Kho-seng Lim (A.K.A. Robert K.S. Lim or Lin Kesheng).
The ‘Spanish doctors’ worked on several fronts of South and Central China: in Hubei, Hunan, Jiangxi, Guangxi, Guiyang, Yunnan, and Sichuan. Besides putting into practice, the innovations, they learned in Spain (such as the organization of small and mobile medical units), they also invented new methods adapted to China, such as the use of bamboo for stretcher and bathing buckets that allowed soldiers to bath and clothes to be disinfected, avoiding the spread of infectious diseases, which were one of the leading causes of death. They also participated in the formation of doctors.
In November 1943, the US General Joseph Warren Stilwell sent a telegram to the Chinese Red Cross and demanded for 10 Spanish doctors to be employed in the Indian Hospital of Ramgarh (India) and eventually in the Burma Campaign. Freudmann, Iancu, Kriegel, Kisch, Volokhine, Baer, Coutelle, Flato and Taubenfligel worked with the Chinese army that advanced in Burma under the command of American generals Seagrave and Stilwell. They showed strong working skills under extreme conditions and some of them received the ‘Award for Asia-Pacific Theater Ribbon,’ by the US army in 1945. After the war, most of the ‘Spanish doctors’ returned to their home countries after almost a decade of experience abroad as war doctors. But some of them chose to stay in China even longer.
The UN Relief and Rehabilitation Administration (UNRRA) had the mission to help the reconstruction of postwar China and were looking for doctors for the sanitary administration. Famous American surgeon Leo Eloesser, the last of the 'Spanish doctors,' decided to go to China at the age of 64 and worked in the UNRRA like Becker, Bik, Jungerman, Kamieniecki and Jensen. He also reached the Communist area in Northern China in March 1946 and visited the Bethune Medical School near the city of Kalgan (Zhangjiakou, Hebei province). After Bethune, Atal, and Bik, Eloesser continued with the methodology of scattered hospitals near the front, following the Spanish formula.
In conclusion, the ‘Spanish doctors’ worked in small groups mixing up with the local population and often in the isolated regions. Their hospitals and base camps were always temporary and unstable, and their innovations were produced in a context of scarcity of resources. This situation allowed them to be experimental in their medical practice and forced them to communicate their skills to the local population. These innovations and the transfer of basic medicine knowledge had a strong impact in the reduction of mortality in both countries.
Dr Carles Braso Broggi is Assistant Professor at Universitat Oberta de Catalunya, Spain. He holds a PhD from the Universitat Pompeu Fabra and is the author of Trade and Technology Networks in the Chinese Textile Industry. Opening Up Before the Reform (2015).