During the First World War blood transfusion progressed from being a rarely used treatment to a major component of the resuscitation of exsanguinated casualties, relying on local donation and availability of medical expertise. In the 1920s and early 1930s, clinical use of transfusion gradually increased supported by growing civilian, often volunteer, blood donor systems.The Spanish Civil War (1936)(1937)(1938)(1939) introduced the first systematic use of aerial bombardment to intimidate the civilian population and to destroy infrastructure; it also saw more mobile battlefronts, replacing the relatively static trench warfare of 1914-1918. New measures for the delivery of transfusion services emerged rapidly from primitive beginnings. These included large civilian blood donor organizations providing anti-coagulated "stored" blood for civilian and military medical use and land delivery services to civilian and military hospitals. Surgical units for the emergency management of casualties were required to be agile in moving as battlefronts evolved and carefully concealed to avoid air attack. Ideally the blood supply would follow.Under threat of a wider European conflict in 1938-1939, British authorities started developing plans for transfusion support in the management of civilian casualties of air attack and military casualties of armed conflict. The involvement, directly and indirectly, of British and other volunteer physicians returned from Spain, together with their Spanish colleagues, ensured that awareness of the Spanish experience was available to the British authorities. The system that was eventually put in place involved a civilian blood donor capability with one centre dedicated particularly to military supplies. Separate distribution systems were organized for civilian and military purposes, with the latter including distribution overseas by air.The military system delivered blood and components through a supply chain to mobile field transfusion units under command of a medical officer specially trained in transfusion and resuscitation, supporting mobile surgical units in the immediate rear of battlefronts. The broad principles developed in Spain (1936-39) for delivery of military blood transfusion practice still support current measures in battlefield casualty resuscitation.
The Friends' Ambulance Unit (FAU) was created shortly after the outbreak of the First World War. It was an attempt to provide young Friends (Quakers) with the opportunity to serve their country without sacrificing their religious principles. However, it was considered by some members to be in direct opposition to the Society's fundamental religious tenets, and thus remained a cause of internal conflict throughout the war. Nevertheless, the civilian relief work that was carried out by the FAU early in the war, in the region of Flanders, aligned the unit's activities much more closely with the religious principles of the Society. The FAU assisted thousands of civilians trapped in the besieged and battered town of Ypres, working intensively in the containment and treatment of the typhoid epidemic that swept the region, locating sufferers, providing them with medical care, and inoculating people against the disease. It helped in the purification of the town's contaminated drinking water, and distributed milk for infants and food and clothing to the sick and needy. It helped found hospitals and orphanages, made provision for schooling, and organised gainful employment for refugees.
After the outbreak of war in Europe in 1914, the British government’s call to arms caused a moral and religious dilemma for members of the Religious Society of Friends (Friends or Quakers), whose fundamental principle was (and is) the rejection of war and violence. Many Friends sought means of reconciling their duty to God with their duty to their country, and the prospect of helping to alleviate the suffering of the civilian victims of the fighting provided them with an acceptable alternative. Together with fellow Friend T. Edmund Harvey MP, Dr Hilda Clark set about rallying the support of Friends and sympathisers willing to go out to France to administer humanitarian aid to non-combatants. The committee adopted the name used by the distinguished organisation that had administered relief in the Franco-Prussian War—the Friends’ War Victims’ Relief Committee (FWVRC). Extensive and multifaceted aid work was carried out in much of northern France by the FWVRC’s general relief team. The following essay, however, examines more closely the medical assistance provided under the leadership of Hilda Clark. In particular, it focuses on the maternity hospital created and run by the FWVRC in Châlons-sur-Marne, which became a lasting legacy of the Friends to the people of the Marne.
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