London in the thirties was very political, and though I was working hard, realising that I would be a late qualifier, I became involved. I had come back from Europe strongly anti-fascist but critical of the communists, who had not done enough to support the socialists in Germany and Austria against the fascists. The communist idea that fascism was the last stage of capitalism and would soon disappear seemed too facile. I saw fascism as a true menace to western civilisation.

It was the time of the Hunger March, Mosley's Blackshirts, and a round of anti-fascist meetings. Then came the Popular Fronts in France and Spain, and a stream of refugees. Finally, in the summer of 1936, Franco and his Moors invaded Spain' and the pot boiled over. My friends and I feared that if Spain went fascist and joined with Hitler and Mussolini, France and the UK were doomed; but we were admittedly ignorant of the complexities of Spanish politics. We were incensed by the UK's commitment to a non-intervention pact, especially when it became clear that Germany, Italy, and Portugal were openly flouting such a policy.

Behind the scenes in the UK an important Spanish Medical Aid Committee was set up. The president was Dr Christopher Addison MP, and the main committee contained a galaxy of important names, with peers, MPs, professors, and leading communists appearing united. There was also a working committee, which I gather was left wing. Ostensibly, the intention was to organise and fund a field ambulance unit to serve the Spanish Republican cause. When an advertisement appeared asking for "offers" from doctors and medical students who were prepared to serve in Spain I began to think of joining them.

I thought I knew more about fascism and its probable effect on Western European civilisation than most other British medical students. I was unmarried and had no one dependent on me. My friends and family would miss me if I were killed, but they would believe that I had died in a worthwhile cause. Those were my conscious thoughts, but I suspect there were other factors. I do not remember how conscious they were underneath my political excitement, but there were the elements of a real depression. I still sincerely wanted to do some worthwhile medical research, but the prospects seemed to get worse and worse. I had developed grave doubts about psychoanalysis and also knew that I was no good at laboratory research.

Everyone liked and admired Aileen Palmer, an Australian, for her friendliness, devotion, and hard work. Everyone trusted her, although she was a self-confessed party member. Another self-confessed party member was Thora Silverthorne, a highly skilled surgical theatre sister. Despite a hard streak, she was friendly and amusing. I also liked Ruth Prothero, a charming, migrant doctor from Vienna. I talked fluent German and she introduced me to some of her Swiss and German friends. Margot Miller, another Australian, was a journalist and party member. She was a robust, efficient hard worker and later became a well known writer of detective stories. I enjoyed her company. A fifth female member of the original party I never did get to know. She was a complete loner and soon separated from us.

The males were worse than the females. Lord Peter Churchill was a good public relations figure, a fair administrator, and a friendly person; but I was worried that his fairly obvious homosexuality or bisexuality might run the unit into legal trouble, although I knew little of the laws in Spain. Kenneth Sinclair-Loutit, the official leader of the unit, was a likeable medical student and an obvious secret party member, but I did not think that he would be a good leader. He had a weak streak. O'Donnell, the chief administrator, who had made the bad speech in Paris, was even worse when I met him. I thought him stupid, conceited, and erratic. I certainly did not like the idea of his being in charge. The quartermaster, Emmanuel Julius, also seemed second rate and rather schizoid. The only surgeon, Dr. A. A. Khan, who was studying in the UK for the FRCS, was reserved, non-political, and rather worried. Of the other two male doctors, one was an American, Sollenberger, and the other, Martin, a former member of the Royal Army Medical Corps. I took a poor view of them both. In addition there were two other medical students.

I did not have very close contact with the drivers. Harry Forster, a cheerful London taxi driver, proved a great success as an electrician on one occasion, but he moved on all too quickly. Alec Wainman, a Quaker photographer, was a charming, if neurotic, character, whom I liked but never got to know. Leslie Preger, an open communist, was rather a shocker. He admitted that he had only got into the unit because he had claimed that he spoke Spanish and knew about first aid. Both claims were false, but no one seems to have checked. The remaining drivers were the two Charlies, Hunt and Hurling. They were two young, extrovert, working class volunteers who wanted adventure and women. I enjoyed their presence at first, but they quite definitely disliked me, particularly my Cambridge accent. Fortunately they were not permanent. They motored backwards and forwards between London and Spain, so that I saw them only infrequently.

We felt cut off. We even lost our radio. I cannot remember whether it was broken, stolen, or confiscated, but its loss increased our sense of isolation. The most political subject discussed was the problem of secret communist meetings and separate reports to the committee and the British Communist party. I was by this time on friendly terms with Sinclair-Loutit, Thora Silverthorne, and Aileen Palmer, and I think I raised the subject with them, pointing out that although we accepted that the communists and secret communists made up most of the unit, we did not think it reasonable for them to hold secret meetings. These were undoubtedly disruptive. I pointed out that three people had already left the unit, possibly because of this. For a time a compromise was reached, in which I was allowed a seat on their committees. I was able to speak but not to vote. Later O'Donnell came up and denounced this, but I think finally the secret meetings were given up. There was also a lot of criticism of Dr Sollenberger as a disruptive element, but he did not leave until much later.

I was glad to leave Grañén. I had never been happy there and looked forward to the trip, although I was rather worried when I got my travel document from O'Donnell. With his usual inefficiency it was undated, did not say where I was going, and merely stated that I could negotiate on behalf of the Spanish Medical Aid Committee. This was the one thing I was sure I was not entitled to do. In the event the trip to Albacete went off smoothly. I had one interesting meeting in a bar in Barcelona with a tall Englishman with big feet, who had been fighting with the POUM militia. In the course of the conversation I criticised the anarchist and POUM militia for not capturing Huesca and Zaragoza and linking up with the Basques. He argued fiercely that the anarchists and the POUM had been perfectly correct to consolidate their revolution before thinking of assistance for the communists in Madrid. I later asked him why he had joined the POUM. As far as I remember he admitted it was by chance. They were the first people he met and he liked them. He said his name was Blair (George Orwell). I often wonder what would have happened to his literary output if he had joined the International Brigade. I later enjoyed his books more than I had that conversation.

When the mobile team finally arrived in Albacete only four of its original members remained - Kenneth (Sinclair-Loutit), Thora (Silverthorne), Aileen (Palmer), and myself - a situation which I feel reflected the inadequacy of the original selection process. There were, of course, others from subsequent waves of volunteers. I was glad that Reggie Saxton and Keith Anderson were there. Recent arrivals included Dr Tudor Hart, who had some surgical experience, Joan Purser, a nurse, and Max Colin, a mechanic. Reorganisation and membership changes led to a new leadership contest. To non-communists this proved an amusing open battle for power between two communists. Usually they settled things in secret. Tudor Hart won and Kenneth became his chief administrator.

The train journey to Valencia was uneventful, but it was interesting how the atmosphere changed from one of happy victory to that of a depressing war zone. I think I briefly met Peter Churchill and Lady Hastings (a real charmer) in Valencia before moving on in some haste to Albacete, where I was apparently expected. After being allocated board and lodging I received the news that I could see Marty that evening. I was nervous. He was already well known as an intolerant leader who was prepared to shoot those he did not like. My only hope seemed my flourishing red beard, although I did take care to prepare a short, cautiously worded speech in French. The meeting went off well. Someone introduced me, while I had a look at Marty. He was an impressive figure - tall, with a bushy beard and small dark hard eyes. I then made my speech offering the services of the Spanish Medical Aid Committee field hospital unit. He replied briefly in French, thanked me, and embraced me. We then sat down and had a drink and I was introduced to the chief medical officer of the International Brigade, a Dr Neumann, who was Austrian, and to Dr Dubois of the XIV Brigade, to which it was thought our mobile unit would be attached. We talked in French and German for a time and then, with a broad grin, Marty turned and asked, "Do tell me, what are you, an English gentleman, doing in Spain?" I replied that I was a Scots anti-fascist who had experienced fascism in Germany and Austria and feared its spread. I also made it clear that I was not a member of the Communist party, but that I was a strong supporter of the Popular Front. He laughed, embraced me for a second time, and handed me over to Dr Neumann and Dr Dubois. The latter, a dashing Pole educated in France, although a communist was much more interested in practical than doctrinal matters. The former, a charming, intelligent Viennese doctor, seemed pleased to have the opportunity to tell me, in German, about the difficulties of building up a medical service for the brigades.

The battle of Brunete was quite different from that of Jarama. Jarama had been essentially a defensive measure. Brunete started with the great hope that it was going to end the encirclement of Madrid. The plan was to advance on the small village of Brunete and break through enemy lines to cut off troops besieging Madrid from their supplies and reinforcements from the west. At first all went well. There was a rapid advance and casualties were slight, with the hospital functioning well and within its capacity. But soon the atmosphere changed. The casualties mounted rapidly and we were all put under real strain. What I particularly remember of this exhausting period are the valiant efforts of the ambulance drivers, who were always under pressure and often under fire. I also think that we in triage coped rather well and that jolly ran a remarkably efficient ward for abdominal cases. There was so much activity that inevitably much of it is hazy in retrospect. Towards the end of the battle there was a small incident which upset me, possibly unreasonably, but I was tired and emotionally overexcited after two or more weeks of triage. An ambulance arrived. The stretchers were brought in and I hurried to classify the wounded. The first case was lying on his right side with his face partially hidden. His left thorax was completely shattered. I could see a heart faintly beating. I signalled to the nurse, by dropping my thumb, that the case was hopeless (language was dangerous). I moved left to see the next case and, by chance, glanced back. To my horror I recognised the face of Julian Bell. (I suppose one must accept the probability of putting a good friend amongst the hopeless category. I have never met anyone who had run a triage in any war, but I am sure the effect is always devastating. A still small voice from your unconscious mutters, "You have condemned your friend to death!") I rushed off, telling my nurse to carry on, to find a surgeon or physician to confirm or refute my diagnosis. Fortunately I found Philip D'Arcy Hart, who was visiting the unit. I showed him the wound. He agreed with my opinion. I did not know whether to be pleased or sorry. We moved Julian to a ward, where he died some time afterwards, and I went back to triage, a changed man.

The battle ended towards the end of July. There had been little to lighten my depression. Julian had died. Another colleague was missing and others, including Dubois, were wounded. I was further depressed by the poor results of the Spanish Republic's efforts to build an army. The pathetic young Spaniards whom I tried to comfort in triage were not trained soldiers. I began to doubt that the Republic could win. But I kept this doubt to myself.

Back at Alcala de Henares, to where many of us were returned, there were dramatic changes. Nearly all the old gang of British volunteers had been given leave in the UK. Rather more surprisingly, all medical students were ordered to return home to qualify. This was just what my unconscious wanted, but my conscious, as a volunteer, had been too proud to suggest it. I was delighted.

On my flight back to the UK I tried to sum things up. I was glad I had gone to Spain; glad that I had not given up in despair at Grañén. Given my limited abilities, I had made a reasonable contribution to the anti-fascist cause, rather than merely talking about it. I had also learned a lot. Although I had come to hate war, I now knew that fascism would have to be fought and that pacifism was impossible. I had, too, become increasingly suspicious of the communists. There had been valuable opportunities to discuss political theories with knowledgeable people of different persuasions - anarchists and Trotskyites; Russian, German, French, and American communists; British socialists and communists; and a few

British liberals. I realised that no one knew how to run a country or a revolution... Overall I had a general feeling of satisfaction that I had risked my life for a cause I believed in.

The train journey to Valencia was uneventful, but it was interesting how the atmosphere changed from one of happy victory to that of a depressing war zone. I think I briefly met Peter Churchill and Lady Hastings (a real charmer) in Valencia before moving on in some haste to Albacete, where I was apparently expected. After being allocated board and lodging I received the news that I could see Marty that evening. I was nervous. He was already well known as an intolerant leader who was prepared to shoot those he did not like. My only hope seemed my flourishing red beard, although I did take care to prepare a short, cautiously worded speech in French. The meeting went off well. Someone introduced me, while I had a look at Marty. He was an impressive figure - tall, with a bushy beard and small dark hard eyes. I then made my speech offering the services of the Spanish Medical Aid Committee field hospital unit. He replied briefly in French, thanked me, and embraced me. We then sat down and had a drink and I was introduced to the chief medical officer of the International Brigade, a Dr Neumann, who was Austrian, and to Dr Dubois of the XIV Brigade, to which it was thought our mobile unit would be attached. We talked in French and German for a time and then, with a broad grin, Marty turned and asked, "Do tell me, what are you, an English gentleman, doing in Spain?" I replied that I was a Scots anti-fascist who had experienced fascism in Germany and Austria and feared its spread. I also made it clear that I was not a member of the Communist party, but that I was a strong supporter of the Popular Front. He laughed, embraced me for a second time, and handed me over to Dr Neumann and Dr Dubois. The latter, a dashing Pole educated in France, although a communist was much more interested in practical than doctrinal matters. The former, a charming, intelligent Viennese doctor, seemed pleased to have the opportunity to tell me, in German, about the difficulties of building up a medical service for the brigades.

As the lull in the battle still continued, he proposed driving out to fill in the shell-holes in the road, which would make the evacuation of the wounded quicker and less painful. It was a practical, concerned, and enterprising thing to have done; it showed that Julian Bell was thinking about the situation, and working to improve the efficiency of his unit. But he would not have the time to complete the job. Suddenly on that day, July 18, 1937, the first anniversary of the outbreak of the Civil War, the battle of Brunete was renewed, with a violent counter-attack by the Nationalists. Their planes roared overhead, dropping bombs indiscriminately. Julian was driving his ambulance along the road outside Villanueva de la Canada. This time his luck was at an end.

Later in the day, a wounded ambulance driver, so covered with dirt as to be unrecognizable, was brought into the Escorial hospital on a stretcher. Cochrane was in charge of the receiving room; he ordered the man to be cleaned. It was only after this was done that he recognized him as Julian. As soon as he examined him, he realized that he had been mortally wounded: a shell fragment had penetrated deep in his chest. All that could be done now was to make him as comfortable as possible.

Julian was still conscious, still cheerful. He murmured to Cochrane, "Well, I always wanted a mistress and a chance to go to the war, and now I've had both." Then he lapsed into French, reciting indistinctly lines of what Cochrane thought might be Baudelaire. Soon after he fell into a coma from which he never awakened.

Archie Cochrane, a Spanish veteran and pioneering epidemiologist, became impatient with the grand political pseudo sciences that mesmerized his generation of intellectuals in the thirties. He said, "I have given up any attempt to change the world as I once wanted to do and this is where I disagree with my Marxist friends. I feel that I should just concentrate on changing a small bit of it. It's a bit more effective if one does that." Born of a privileged background, Cochrane attended Cambridge, where he took a first in both parts of the natural science tripos. He worked at the "English" hospital in Granen. After a year in Spain, he returned to University College Hospital in London to complete his medical studies, no longer the callow young student but one who had played a part in five major battles, and, moreover, with his Spanish tan and red beard looked the man of experience he had become. The most politically conservative of the physicians on the staff said to him, "Ah, Cochrane, back again. Had an interesting weekend?"

After finishing his medical course, Cochrane went to the Rhondda, which had sent large numbers of its young men to Spain. It was here in the valleys of South Wales, where the suffering was so acute in the interwar years, and the Communist party and Spain seemed so woven into the very fabric of politics and culture, that Cochrane chose to practice medicine. Ultimately he revolutionized the science of epistemology, for which he was much honored. He became a Fellow of the Royal College of Surgeons and received the MBE and CBE. He returned to his hospital in Spain forty years later, and found it turned into a bar and apartments. "I moved towards a window and suddenly found myself in our old so-called 'operating suite.' It was now a sitting room and two bedrooms, but it was unmistakable, and from this stable point I was able to recognize much else."

Above all was the feeling of having done something against fascism, even as comparatively insignificant as he believed his efforts were, instead of simply talking about it. And unlike some other veterans, he had not transformed Spain into a land of constant nostalgia. Rather he knew it to be an essential stage of a larger journey on which he had embarked, and, nearing the end, acknowledged that it had gone well. Archie Cochrane asked that his obituary read, "He lived and died, a man who smoked too much, without the consolation of a wife, a religious belief or a merit award. But he didn't do so badly." What he said of himself could have been said of many others who had volunteered for Spain. In spite of it all, they hadn't done too badly, and, for many, their lives and political education did not stop when the British Battalion was welcomed home at Victoria Station, or when Franco marched triumphantly into Madrid on May 19, 1939.

Thora, who was able to combine a very Welsh intuitive mind with an amazing sense of discipline, told me that something odd was going on. She, along with everyone else, had expected that, before any commitment could be made to move to the Madrid front and to direct the Unit into the International Brigade, the word would have to come back with me from London. Why else had I gone there? But, while I was away, Archie Cochrane had seen André Marty, the Chief Commissar of the Brigades, on the basis of an introduction arranged by Hugh O'Donnell. Marty gave Cochrane an unusually warm welcome, kissing him on both cheeks and expressing his surprise and joy that an English intellectual of middle-class background should be in Spain as a volunteer...

The general meeting came in a day or two. It was not André Marty but Colonel Domanski-Dubois, PMO of the 35th Division, who presided. Later I got to know him well and can see him to this day with his little smile and firm but somehow comforting manner. He was to give his life in the Aragon offensive of August 1937. For him the meeting was called to induct a group of newly recruited personnel into his Division and to give them their assignments. We were going as a Unit into the 14th (French speaking) International Brigade. He had brought with him all that he needed, namely the badges of rank for the new officers. This he would not have been able to do without prior briefing about the persons concerned. In a genial, informal way he put into Tudor Hart's hands the insignia of a Major, into Archie Cochrane's that of a Captain and into mine the single stripe of a sub-lieutenant, saying, "C'est tous qui me reste" Externally Tudor Hart did not register surprise; Cochrane, who was, like me, a. medical student and who had worked happily with me in Grañen was visibly disconcerted. We had worked together very easily in Grañen, and he had accepted without second thoughts the fact of my being in charge - a seniority that had well ante-dated his own arrival. As the Spanish Medical Aid Administrator, I had been responsible for the Unit in all but the strictly medical sense.

Saxton's most famous patient was Julian Bell, son of the artist Vanessa Bell. This was at Villanueva de la Canada near the Escorial when the ambulance Bell drove came under attack by Nationalist bomber aircraft. Saxton had already noted how they were repeatedly attacked - bombed or strafed by fighter planes, often German or Italian. Bell sought shelter beneath the ambulance but a vast piece of shrapnel hit him in the chest, causing a terrible wound. He was brought into the clearing station and seen by Archibald Cochrane (then a medical student, but later the Professor at Cardiff after whom the Cochrane Library of medicine databases is named), who triaged him to hopelessly wounded.

Cochrane indicated to the orderlies to put him to one side. But he suddenly recognised the human face beyond the wound. Saxton was called, and the brilliant Spanish surgeon Moisés Broggi i Vallés, who examined him and retrieved from the gaping chest wound his wallet and passport which had been blown into the cavity. "His heart was visible through the wound," Saxton remembered: "I gave him a blood transfusion and dressed him again. But we realised we had to let him die and he died that night. When he saw me all he said was, 'Thank goodness it's you.' And I gave him morphine."

I remember at that time reading one of those propaganda pamphlets, considered suitable for POW [prisoner of war] medical officers about "clinical freedom and democracy". I found it impossible to understand. I had considerable freedom of choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge. I had never heard of "randomized controlled trials", but I knew that there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention.

I was assigned to the medical section where there were two other British doctors, who had been captured at Dunkirk. My first reaction was to the food situation. German rations at about 2,500 calories a day and regular Red Cross parcels, which took us over the 3,000 calorie mark, were heaven on earth. This transformed me. I lost my oedema and jaundice, put on weight, and became, I hope, a more useful doctor and more reasonable human being.

I slowly assessed the situation and decided on the jobs I could most usefully do. I knew a certain amount about tuberculosis and offered to take over that section of the work, which was not popular with others. With my knowledge of German I tried to arrange facilities with the local clinic for screening and x raying patients. In this I was successful, and the local doctor, who was a lady, was cooperative. (This early specialisation in patients with tuberculosis had one unfortunate consequence. When the International Red Cross visited us they asked to see the cemetery, and one of them inquired who had looked after the patients who had been buried there. I had to admit that all of them were mine. The fact that tuberculosis was the sole cause of death amongst prisoners did not salvage my reputation. There was a tendency afterwards to refer to the cemetery as Cochrane's Corner. This tuberculosis work took up only a small part of my time. I realised that the rest of my efforts must be devoted to "care," as the chance of a cure among the other cases was minimal. I also realised that "care" in a prisoner of war hospital was far more than the

"tender, loving care" in a London teaching hospital. It involved looking after the total morale of a lot of very worried human beings. In particular, there were the Yugoslavs in the hospitals. They needed total care more than the British as they knew no English and none of the doctors knew Yugoslav; they also got no food parcels.

Another event at Elsterhorst had a marked effect on me. The Germans dumped a young Soviet prisoner in my ward late one night. The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I examined him. He had obvious gross bilateral cavitation and a severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect.

I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. I was ashamed of my misdiagnosis and kept the story secret."