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Aristocrats, Adventurers and Ambulances

British Medical Units in the Spanish Civil War


Linda Palfreeman


The Canada Blanch/Sussex Academic Studies on Contemporary Spain

Brighton: Sussex Academic Press, 2014

Paperback. xx + 249 p.  ISBN 978-1845196103. £25.00


Reviewed by Jonathan Sebastian Browne

University of Kent (Canterbury)



Aristocrats, Adventurers and Ambulances : British Medical Units in the Spanish Civil War is a welcome new addition to the growing, but still extremely limited corpus of work that takes as its focus what can be broadly described as a history-of-medicine approach to the Spanish Civil War. This limited engagement with the history of medicine in relation to the conflict is surprising, as the international efforts to aid the beleaguered Spanish Republic between 1936 and 1939 has engendered thousands of books on the subject.(1) Only a handful of these books, however, deal directly with medical aid, despite the need for the provision of medical and humanitarian assistance being one of the main focuses of the many campaigns internationally for offering succour to the loyalist cause, and which therefore inform the wider historiography. (2) Thus Aristocrats, Adventurers and Ambulances : British Medical Units in the Spanish Civil War, alongside Linda Palfreeman’s previous monograph ¡Salud! British Volunteers in the Republican Medical Service during the Spanish Civil War, 1936-1939, first published in 2012, are important contributions to this slowly growing corpus of work. (3)

Linda Palfreeman’s latest book looks at the role played by the Scottish Ambulance Unit (SAU) created by the Glaswegian philanthropist Sir Daniel Macaulay Stevenson and which was led by Fernanda Jacobson, and Sir George Young’s University Ambulance Unit (GYAU) founded and led by the British aristocrat Sir George Young, during the Spanish Civil War. Part One of the book examines the evolution of, and the work carried out by the SAU, predominantly in and around Madrid, with part two dedicated to the formation of the GYAU and its role in providing humanitarian aid close to the Southern Front during the conflict. Palfreeman in her Prologue emphasises that her study of these two organisations is ‘specific in focus’ and is centred on the important role they played in ‘providing medical and humanitarian aid to the Spanish Republic’ [xix]. It is also in the Prologue that she highlights why this story has received such scant attention, namely, the ‘paucity of detailed records on the structure and functioning of the units in question and their service in the field’. She goes on to explain how new evidence, namely in the form of Sir George Young’s personal correspondence, and a re-evaluation of the existing documentary evidence on the SAU (parts of which are relatively unexplored), has allowed her to shed new light on these events [xx].

Part One ‘¡Salud! Scotland’ offers a chronology of events from early fund-raising efforts centred on Glasgow, ‘the hub of Scottish aid for Spain’ [13], through the organisation and setting up of the SAU, to the first unit’s leaving Scotland on 17 September 1936, its arrival in Spain and its two subsequent deployments there. Part One concludes with the unit having to leave Madrid after its surrender to Franco in March 1939. Their departure was in part the result of having no further funds to be able to continue, but also due to the fact that its work was taken over by the Insurgent aid organisation Auxilio Social set up by Mercedes Sanz Bachiller and which was based upon the Nazi Winterhilfe (Winter Help) organisation, as Franco wanted nothing to do with foreign aid groups who had helped the Republic.(4) What quickly becomes evident in Part One is how despite its avowed aim being to provide an ambulance service to assist ‘the sick and wounded irrespective of politics or party’ [21], it was soon to become much more than this, and additionally offered invaluable aid by providing food to sections of Madrid’s population who faced severe food shortages and at times near-starvation.

As part of Palfreeman’s examination in this first half of the book she also examines the role played by the ‘Spanish Pimpernel’, Captain Edwin Christopher Lance DSO, who helped Insurgent sympathisers to escape from Madrid. It was these activities which involved the use of the SAU ambulances for smuggling out a number of right wing individuals masquerading as injured patients which led to the name of the SAU being besmirched, as Lance a character of somewhat shady repute, blackened their name by association. What emerges, however, from her analysis of the role of the SAU was its clear humanitarian mission, despite any difficulties arising from problems with personnel, problems largely associated with the resignation of three of its members, Len Crome, Roderick MacFarquhar and Morris Linden in March 1937 (the recent departure of another member George Burleigh had not helped matters) [62], or its association with the Spanish Pimpernel.(5) Centre stage in highlighting the work of the SAU and the backbone of this first part of the book is a sympathetic depiction of Fernanda Jacobson whose humanity is deftly portrayed throughout.

Part Two of Palfreeman’s monograph takes as its focus the work of the GYAU. As part of providing the background to the motives for the formation of this unit Palfreeman devotes several pages to the plight and then the fall of Malaga to the forces under the leadership of the ‘Butcher of Andalucia’, General Queipo de Llano, in early February 1937.(6) It was the threat posed to the city and its inhabitants from the combined forces of Spanish, Italian and Moroccan troops from the Spanish Protectorate of Morocco that prompted Sir George Young into forming the ambulance unit with the aim of providing medical assistance and other humanitarian aid to the beleaguered city [127]. Unfortunately by the time the unit had been formed with the collaboration of both the main British and American Quakers’ organisations, with the not inconsiderable work carried out by Lady Young, an important factor in coordinating these efforts, Malaga had fallen to the Insurgents. Upwards of 100,000 inhabitants of the city, which included many thousands of refugees from other parts of Andalucía, fled the fall of Malaga rightly fearing the terrible reprisals that would befall them if they stayed, and took to the road to Almeria where at least three thousand were to die, victims of fascist aggression.(7) Their fears of what would happen if they stayed were in no way unfounded, as the Insurgents promptly went about the systematic extermination of their ‘enemies’ in Malaga, executing at least 1,574 people alone in the first seven weeks after its fall.(8)

Despite the fall of Malaga and the rather naïve idea of Sir George Young that he could use his house in Torremolinos as a base, notwithstanding it being in Insurgent territory, Palfreeman goes on to describe how the GYAU travelled overland to Spain, arriving in an Almeria bursting at the seams with refugees. The Unit’s main work, like that of its counterpart the SAU, was in providing humanitarian aid to the civil population and the refugees, and with the help of the Quakers helped to provide medical aid, feed thousands of people (many of them refugees), first in Almeria and then in Murcia, additionally setting up Children’s hospitals in both of these locations [154, 180].

Also described in this section is how the GYAU during it time in Spain helped establish frontline medical services on a sector of the Southern Front. This included establishing a hospital at Motril which was then transferred to Torviscon in the foothills of the Sierra Nevada [161]. As part of the examination of the work carried out in this sector of the front, Palfreeman also looks at the evacuation of the wounded from high in the Sierra Nevada. The hospital at Torviscon played an important role in the treatment of casualties on this front, casualties who otherwise would have faced a long and arduous journey for treatment in Adra fifty miles away, or in Almeria, an eighty miles trip [163].

This second part of the book finishes with a look at the efforts, ultimately unsuccessful, by Sir George Young in the final days of the tragic conflict to facilitate the evacuation of ten thousand refugees from the ports of Gandia and Alicante who desperately sought to escape the Francoist forces known for their brutal reprisals [191]. In the end only 650 refugees were able to be evacuated, nevertheless, it was a testament to Sir George Young’s humanity that despite these doomed attempts to evacuate a large number of refugees he tried up until the last possible minute to secure their evacuation [191]. Part Two ends, as does Part One, with an appendix that includes the name of personnel who served with the respective units and primary documents that reflect and supplement the contents of each section of the book.

Linda Palfreeman succeeds in her monograph in combining the history behind these two separate ambulance units into a narrative that not only highlights the important humanitarian work that each organisation carried out but also reflects the wider context in which this aid took place. By the end of the Spanish Civil War over £2,000,000 had been raised in Britain alone with the majority of this money going towards medical and food aid for Spain, and the SAU and the GYAU both made valuable contributions in this regard.(9)

The book’s valuable contribution towards one of the few remaining relatively unexplored aspects of Spanish Civil War historiography, humanitarian relief and medical aid, is a comprehensive study that engages extensively with a wide array of contemporary sources. These sources include personal correspondence, newspapers, and a wide assortment of documentation from a number of archives including the Marx Memorial Library and Warwick University’s digital collection ‘Trabajadores : The Spanish Civil War through the eyes of organised labour’.(10) This is one of the great strengths of the book; however, with so many of these documents having a propagandist slant to them, a discussion of how these strong elements of propaganda informed the author’s own reading of these sources could have been deployed to give additional breadth to the overall narrative. In refuting some of the baseless claims that were made against the SAU that arose out of the resignation of the aforementioned staff members, and its facilitating the work of the Spanish Pimpernel in helping right-wing sympathisers escape from Madrid, Palfreeman not only draws upon Captain Lance’s own account of events and those of his biographer, accounts that could be more closely scrutinised, but also utilises a press release by Sir Daniel Stevenson occasioned by the awarding of an OBE to Jacobson to highlight her exemplary conduct. This document contains a number of testimonies including one from the president of the Spanish Republic Manuel Azaña and praises the invaluable work carried out by Fernanda Jacobson [78]. The press release with its obvious propagandist message is nevertheless a valuable source, with this praise for Jacobson repeated fifty years later by the second Republican Military Health Chief for the Central Sector during the Spanish Civil War, José Estelles Salarich [95].(11)  Nevertheless, like many of the documents used by Palfreeman in her research, they were not only meant to record occasions and events but were also arguably constructed so as to gain the maximum propaganda possible from their dissemination.

Aristocrats, Adventurers and Ambulances, with its emphasis on the work carried out by the SAU and the GYAU provides the reader with an interesting, evocative and thoughtful account of how these units were organised and then deployed. However, this specific focus on the work carried out by these units means that the only contemporary reference to the Red Cross ambulances already existent in Spain get their only direct mention on page 173. Contrary to claims made by Cabinet Ministers of the Spanish Government that in September 1936 they had ‘neither ambulances, ambulance-men or drivers’, and reported in a letter by Sir Daniel Stevenson of 4 September 1938 [99], shortly after the outbreak of the Spanish Civil War the Spanish Red Cross in Madrid had at its disposal a number of ambulances.(12) Admittedly, many of these were too large and made too much of an easy target with their large white crosses on their roofs, and the Loyalist Government would have struggled to provide proper medical aid without international help, but there were nevertheless concerted efforts by the Army of the Centre to recycle and reclaim materials so as to construct smaller more mobile ambulances, with cars and other vehicles modified for this purpose.(13) Furthermore on 15 February 1937, the President of the Red Cross in Madrid offered a list of personnel who could drive ambulances in Madrid in the event of an Insurgent entry into the capital as these drivers ‘knew perfectly the streets of the capital’.(14) This specific focus does not detract in any way from the overall narrative strength of the monograph, nevertheless a closer engagement with some of the Spanish sources could have been used to more fully show how the SAU fitted into the wider care provision from both a national and an international perspective.

It is not the purpose of this review to look for faults in what is a valuable and worthwhile study of a largely forgotten piece of history. Even though the propagandist elements of Palfreeman’s evidence is not analysed or questioned she nevertheless is judiciously selective in how she uses this material. There are, however, some minor historical inaccuracies, the bane of even the best historians, but these as stated are minor. Thus it was not La Pasionara who coined the phrase ‘No Pasaran’, rather it was Pétain at Verdun who originally gave life to this slogan.(15)

Palfreeman draws attention in her introduction to the fact that ‘no British doctors offered their services to Franco’ during the Spanish Civil War [6]. This may well be correct, as the anaesthetist Dr (later Sir) Robert Reynolds Macintosh from Oxford who went out in the late summer of 1937 at the request of the Irish-born plastic surgeon Eastman Sheehan to anaesthetise for him at the Insurgent Hospital General Mola in San Sebastian, was born in New Zealand.(16) But the colleague who replaced him when his services were requested again was Kenneth Boston from the Radcliffe Infirmary in Oxford, about whom little is known, but he may well have been British, and therefore to state that no British doctors offered their services to Franco may not be entirely correct.(17)  It was Macintosh, a British resident if not a British citizen at the time who had lived in the UK since 1915 and trained as a doctor there, who provided the first ever recorded use in Spain of anaesthesia with the use of an endotracheal tube to protect the airway during surgery, events he recorded in his diary.(18) Boston left detailed notes of the patients he anaesthetised during his two-week stay in San Sebastian and these medical notes offer a fascinating insight into the ground-breaking surgery that was happening across the lines, albeit in a very limited capacity, in the Insurgent zone.(19)

There is one other small historical inaccuracy in this otherwise thoroughly researched monograph that is worth examining. Palfreeman states that the renowned Canadian thoracic surgeon and the man behind the Canadian Blood Transfusion Institute in Madrid, Norman Bethune, his colleagues Hazen Sise and Cuthbert (T.C.) Worsley, were forced when helping refugees who fled the Fall of Malaga to only take in their ambulance (which was normally used for transporting conserved blood) children under the age of ten [143]. This in fact was not the case. The anarchist journalist Alardo Prats in the introduction to the The Crime on the Road Malaga-Almeria : Narrative with Graphic Documents Revealing Fascist Cruelty states that Bethune helped ferry to safety hundreds of women and children.(20) Bethune, the author of the main article, states that even though at first they decided to take only children and mothers, the pain of ‘separation between father and child, husband and wife became too cruel to bear. We finished by transporting families with the largest number of young children and the solitary children of which there were hundreds without parents’.(21)

To highlight these small historical inaccuracies is not to denigrate in any way Palfreeman’s achievement in bringing to light a little-explored area of Spanish Civil War History. In Aristocrats, Adventurers and Ambulances : British Medical Units in the Spanish Civil War Palfreeman has rescued from the shadows the invaluable contribution made by the SAU and the GYAU during the Spanish Civil War, in the process illuminating the complex nature of the war-time organisational relationships that developed during this period. It is through such studies that a more nuanced understanding becomes possible of how something seemingly as simple as the provision of what by today’s standards and even by the standards of the day were two small ambulance units, could have such a big impact upon the lives of those people it touched.


1. The historiography of the Spanish Civil War has resulted in a considerable body of literature which was estimated as numbering as many as 40,000 examples in 2007. See Blanco Rodríguez, J. A., “La Historiografía de la guerra civil española”, en Gálvez, S. (Coord.), Dossier generaciones y memoria de la represión franquista : un balance de los movimientos por la memoria en Hispania Nova. Revista de Historia Contemporánea, Núm. 7 (2007) : 4.  Available at

2. Ibid.

3. Palfreeman, L., ¡Salud! British Volunteers in the Republican Medical Service during the Spanish Civil War, 1936-1939. (Brighton, 2012).

4. Preston, P., Doves of War : Four Women of Spain (London, 2003) : 238-242. For a history of Auxilio Social during the Spanish Civil War see Orduña Prada, M., El Auxilio Social (1936-1940) : La Etapa Fundacional y los Primeros Años (Madrid, 1996). Available at:

5. Preston, P., “Two doctors and one cause : Len Crome and Reginald Saxton in the International Brigades” in the International Journal of Iberian Studies 19-1 (2006) : 5-24. An excellent article about Len Crome and the British GP from Reading Reginald Saxton who worked as a blood transfusionist. It does, however claim, that it was Norman Bethune who solved the problem of delivering stored blood to the frontline, whereas this honour was in fact due to Frederic Durán-Jordà. See British Medical Journal 1-5024 (April 20, 1957) : 903-962 (p. 953); The Service of Blood Transfusion at the Front : Organisation-Apparatus. by Frederic Duran-Jorda, Technical Chief of the Service , Director of Emergency Hospital No. 18 (Barcelona, 1937) : 8; & Stewart, R. & Stewart, S., Phoenix : The Life of Norman Bethune (Montreal, 2011) : 164.


7. Preston, P., The Spanish Holocaust : Inquisition and Extermination in Twentieth-Century Spain (London, 2012) : 177-178.

8. Ibid.

9. Overy, R., “Saving Civilization : British Public Opinion and the Coming of War in 1939”, in Justifying War : Propaganda, Politics and the Modern Age, eds. D. Welch & J. Fox (Basingstoke, 2012) : 187.

10. The digital archive Trabajadores : The Spanish Civil War through the eyes of organised labour, can be accessed at:

11. Estelles Salarich, J., “La Sanidad del Ejercito Republicano de Centro”, in Los Médicos y la Medicina en la Guerra Civil Española : Monografías Beecham (Madrid, 1986) : 45.

12. Ibid. : 45-6.

13. Ibid. : 45.

14. Massons, J.M., Historia de la Sanidad Militar : Tomo II (Barcelona, 1994) : 203.

15. Beevor, A., The Battle for Spain : The Spanish Civil War 1936-1939 (London, 2006) : 55.

16. Browne, J., “History of anaesthesia : anaesthetics and the Spanish Civil War : The start of specialisation”, in European Journal of Anaesthesiology 31-2 (February 2014) :  65-67. Available at:

17. Ibid.

18. Ibid.

19. Ibid.

20. Bethune, N., The Crime on the Road Malaga-Almeria : Narrative with Graphic Documents Revealing Fascist Cruelty (Spain, 1937), unpaginated. This original document is available to view at:

For a brief biography of Alardo Prats, see:

21. Bethune, The Crime on the Road Malaga-Almeria.



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