Spain and the World: Aspects of the Spanish Revolution and Civil War (3)

Writing about medicine and health care in the Spanish Civil War


Angela Jackson, Beyond the Battlefield: Testimony, memory and remembrance of a cave hospital in the Spanish Civil War. Pontypool, Warren & Pell Publishing, 2005.

Nicholas Coni, Medicine and Warfare: Spain, 1936-1939. London, Routledge, 2008.


Jim Fyrth, The Signal Was Spain: The Aid Spain Movement In Britain, 1936-39. London, Lawrence and Wishart, 1986.

Jim Fyrth, Sally Alexander, eds. Women's Voices from the Spanish Civil War. London, Lawrence & Wishart, 1991.

Paul Preston. Doves of War: Four Women of Spain. London, HarperCollins, 2002.

These books deal with the civil war rather than the revolutionary aspects of events in late 1930s Spain. Some information on healthcare in relation to the latter can be found in the ‘Libertarian Medicine’ posting on this blog, May 2010.

The focus of Angela Jackson’s analysis in Beyond the Battlefield is memory and remembrance – an angle that has special significance in Spain after the decades-long suppression and willed forgetting of those times, institutionalised until quite recently in the post-Franco ‘pacto de olvido’ (‘Don’t mention the civil war’). She looks at the hospital set up in a cave to treat casualties from the battle of the Ebro, summer 1938. By this stage the People's Army medical services were bringing their most seriously wounded to improvised hospitals as near to the front line as possible. Many patients were International Brigade volunteers, interspersed with injured prisoners-of-war and civilian victims of bombing raids. (Caves were also used as bomb shelters.)

Many foreigners were sent to help set up and run the hospital; others came later. Memoirs, letters and interviews are used extensively in the book, along with photographs. Conditions were, inevitably, incredibly difficult – up to a hundred beds, ‘all higgledy-piggledy’ – but somehow the work proceeded. At least one nurse ‘even began to doubt that anything could be worth the suffering that she saw around her … this misery and this horror’. Still the staff managed some improvements: in wound treatment, a new system of triage, blood transfusion (sometimes direct arm-to-arm), and training Spanish nurses. There were of course numerous patients who did not survive, buried in a grave outside the village. Eventually the cave, which had featured in pro-Republican reportage, had to be evacuated, at the end of 1938.

Parts of the broader medical history of the Spanish Civil War were being written up in professional journals as they happened, but the comprehensive treatment of the subject provided by Nicholas Coni’s book was long overdue.
As he explains, he concentrates on doctors and on secondary or hospital care: circumstances, sufferings, and responses in the changing situation. He claims to have included ‘almost everything it has been possible to discover’ about medicine on the Nationalist side, given that Republican medical advances are better known already. The author confesses a certain inadequacy in his account of nursing, which may be related to some limitations in the book generally. The Nationalist zone receives noticeably disproportionate attention here, with the remarkable Republican nursing effort given scant credit or even disparaged in one or two quotations. There is no acknowledgement of the role played by the anarchist women’s organisation Mujeres Libres in nursing, training and health education.


Coni’s evident medical knowledge is, however, used to good effect in discussion of wound care and blood transfusion, without too much technicality, and in relation to the more general subjects of famine, disease, and organisation of medical services. He adds a short but useful look at the neglected (in this context) topic of psychiatry. He is suitably scathing about the quaint Nationalist project to study the ‘biopsychiatric roots of fanatical Marxism’, while noting as a possible ‘first’ the Republican attempt to inaugurate screening for ‘war neurosis risk’.

Unfortunately coverage of medical services does not extend to the initiatives of the collectives; sources sympathetic to these are largely ignored. Thus the writing-out of the libertarian contribution is perpetuated. Apart from that, while taking account of the International Brigades (and of what foreign medical support there was for Franco), the role of Spanish practitioners is refreshingly prominent. Male ones, that is: the only woman who gets into the list of biographical notes is Priscilla Scott-Ellis, a nurse on the Nationalist side and one of Paul Preston’s Doves of War (‘Doves’ – Coo!), so a bit of a usual suspect. Notes on individual campaigns bring out the ways in which the war was waged and varieties of damage inflicted, then a survey of the post-war aftermath shows the detrimental effects of Franco’s victory, on medicine as in other aspects of life in Spain. At £70, this was not going to be a best-seller but it’s worth getting hold of if possible for anyone interested in the conflict.


As well as the case of the Nationalist-supporting volunteer Scott-Ellis (not without interest in its way, pp. 11-118 in Doves of War), Paul Preston supplies an extended profile of Nan Green (pp. 121-201 in same) whose work as an administrator and compiler of statistical records was recognised as contributing to Republican medical successes. Parallels are discernible, ironically, between those ‘enemies’, in their frankness not only about the horrendous conditions but about their respective sides’ disharmony and failings, and their own clashes with hard-line authoritarian politicos.


The campaign to provide medical aid from Britain to the Republican cause is the subject of Jim Fyrth’s detailed analysis of the groups, organisations and individuals involved, the difficulties they encountered, and their varied achievements. In the later book co-authored with Sally Alexander there are contributions from nurses to supplement this account and bring home its reality. As in some other publications, especially of memoirs, there is an understandable tendency to accentuate the positive and preserve an impression of a united front. To realise the problems and disillusion connected with the communist-led militarisation of Republican medical services, for example, we need to look elsewhere, e.g. the chapter on medical aid in Tom Buchanan’s Britain and the Spanish Civil War (Cambridge, 1997). A ‘pact of [selective] forgetting’ among veterans and their supporters, perhaps? Something for historians to address.

Liz Willis

March 2011

A longer article about medicine in the Spanish Civil War and Revolution can be found here