Extract from Frontline Surgeon by Mark Derby

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‘Crouched in a shallow foxhole, focusing each of her cameras in turn, Gerda Taro blazed with determination to record the debacle that surrounded her. Across the arid Brunete plain, Republican troops were retreating by the thousands, targeted by artillery and pursued by enemy aircraft. As each wave of heavy Heinkel bombers or smaller pursuit planes approached, Taro ducked below the shrapnel-scarred rim of the trench to take cover and could see her young Canadian companion Ted Allan mouthing terrified pleas to leave the battlefield. She ignored him and continued to juggle her compact Leica and more awkward movie camera, seeking images that might capture the despair of the men fleeing in disarray.

Early that Sunday morning in the searing midsummer of 1937, she had collected Allan, who worked with a Canadian blood transfusion service, from his Madrid hotel. She then persuaded a driver to take them twenty kilometers west of the central city, as close to the disintegrating front as he dared to go. From there they left his car and walked toward the explosions. Taro wore her battlefield outfit of khaki overalls, with a dark beret over her cropped and sun-bleached hair. La pequeña rubia, the twenty-six-year-old “little blonde,” was already well known and widely adored by Republican troops, and the much younger Allan was just one of her admirers.

The pair reached a dugout, the command post of the shaven-headed former Red Army officer General Walter. It was not his real name, but then neither was Taro’s. She had been Gerta Pohorylle in her hometown of Stuttgart. As a fervent anti-Nazi in Paris in the summer of 1935, she had met Endre Friedmann, like herself Jewish, émigré, youthful, undeniably dashing, and ambitious. He was a photographer, a rising star of the Cartier-Bresson school of urgent realism, and she soon became one, too, barely surviving on the occasional magazine commission. To break into the international market, they created a joint brand name devoid of association with national or ethnic origins. For a time both sold their photos under the name “Robert Capa,” until Pohorylle’s growing ability and vivid personality demanded a distinct identity, one equally succinct and easily pronounced in many languages.

The civil war that fractured Spain in late 1936, after a military coup attempted to overthrow its progressive Republican government, was an irresistible vortex for this passionately leftist couple. In a testamentary series of sparely beautiful black-and-white images, Capa and Taro recorded the exhilaration of newly enlisted Republican troops on the Aragón front, the homeless residents of bombed apartment buildings in Madrid, and an armored column paused in a pine forest in Segovia.

In early July 1937, Capa had returned to Paris to negotiate the couple’s next overseas contract, while Taro remained in Madrid, traveling to the front each day in the pitiless heat and earning the admiration even of toughened veterans like General Walter. On this Sunday, however, Taro and Allan found him gray with fatigue and anxiety—harsh, frantic, and in no mood to deal with two youthful idealists strung with cameras. Over the previous two weeks, the Republican forces had pushed their lines five kilometers into enemy territory and captured the small town of Brunete. Gen. Francisco Franco, commanding the Nationalist rebel forces, then ordered reinforcements from the north, including the latest German and Italian fighter and bomber planes. Field Marshal Wolfram von Richthofen’s Condor Legion, whose pilots were still reveling in their destruction of the undefended Basque town of Guernica three months earlier, was among the crack squadrons summoned to drive the Republicans back from Brunete. Franco’s maneuver succeeded. As General Walter watched the first of his shattered units stumbling back from their lines, he ordered Taro and her companion to turn back immediately. “In five minutes, this will be hell.”

Allan was eager to comply, but Taro dragged him to a small trench nearby and began filming in the shadow of enemy aircraft sweeping over them. As fast as she could reload her cameras, she captured the unprecedented spectacle of thousands of infantry and armored troops fleeing before an aerial onslaught. She ignored the bombs and machine-gun bullets landing lethally close to them and gave in to Allan’s desperate pleas to withdraw only once she had shot her last roll of film. Choosing a momentary break between bombing runs, the pair scrambled onto a dusty road already strewn with corpses and wrecked vehicles, and joined the mass of dazed and demoralized men trudging toward the small village of Villanueva de la Cañada. At times, to take cover from successive formations of enemy aircraft, they plunged through head-high fields of ripe grain lining the road.

In the village, they found a badly wounded soldier, his legs shattered. A small and battered Russian-made tank rumbled up behind them, and they managed to halt it, load the wounded man on board, and gain a dangerous perch on its fiercely hot hatch cover. The tank stopped at a first aid post where General Walter’s long, black Hispano Suiza staff car, now doing duty as an ambulance, was about to carry three other wounded men to a field hospital. In an exchange of shouts, its harried driver agreed to take two extra passengers on the running boards. Taro, exulted with the results of her frenetic day’s work, laid her cameras and precious cans of exposed film on the front passenger seat. She and Allan each hooked an arm around a door pillar as the car lurched back onto the cratered road.

“There was some confusion ahead of us,” Allan wrote later. “A tank was approaching. It had been strafed by a Nationalist plane and was driving erratically, weaving across the road. Our car swung to the left to avoid it. ‘Hold on,’ Gerda laughed. The car went out of control; began to roll.” The heavy vehicle lumbered off the road and into a ditch, where it overturned, its tires gradually stilling. Allan was flung clear, crushing his leg as he landed, but Taro, lying unconscious on the roadside, was run over by another Republican tank and critically injured.

An ambulance was somehow summoned, and the two crash victims were transferred to it. A British field hospital had been established nearby in a former seminary beside the vast sixteenth-century monastery of El Escorial. At the height of the Brunete battle, three surgeons had worked there simultaneously, but only one now remained on duty to treat casualties of the retreat—a New Zealander in his early thirties named Doug Jolly. It was early evening when Taro’s mangled body was carried into the hospital’s ground-floor reception room on a stretcher. She was alive, but barely. Irene Goldin, an operating theater nurse from New York, recalled that “her intestines were hanging out.”

After she was given a blood transfusion, Taro regained consciousness and pleaded with Jolly to send telegrams to Capa in Paris and to the French magazine Ce Soir, which commissioned their work. He promised to do this but could see that little more could be done for her, and he instructed nurse Goldin to move the young woman to a room by herself and “maintain her as well as possible without pain.” Eviscerated and dying, Taro nevertheless managed to ask Goldin in English, “Are my cameras all right? They’re new.”

Ted Allan was receiving treatment for his leg on another floor of the hospital when Jolly appeared at his bedside. The two men had already met several times when Allan delivered supplies of preserved blood to the hospital. The young Canadian begged to see his friend, but Jolly told him Taro was in shock and that no visits were possible at that time. Later a nurse brought a message from her, asking whether Allan had managed to save her cameras. He replied that he had not, and a second note was dropped off by Jolly relaying her reaction: “C’est la guerre.”

“Doctor Jolly was a very good surgeon,” remembered Goldin, “but I don’t think he was able to do anything for [Taro] except look at her, put a dressing on her and send her to us. We gave her fluid as much as we could and did all that we could to keep her alive but I doubt very much that anything could have helped her. It was one of those massive wounds that are absolutely lethal, you know. And that night, she died.”


*


By the time he lost this courageous patient, Douglas “Doug” Jolly had been serving with Spain’s Republican Army for just six months, and he had no prior experience of battlefield surgery. In that brief period, he had already dealt with so much gushing blood and perforated organs that this particular death is unlikely to have struck him as exceptional. In letters to friends in England, he acknowledged that he had become hardened to seeing patients dying on his operating table and to denying them treatment when their chances of recovery had vanished. Yet he was determined, he wrote, not to fall into the habit of regarding the endless flow of mutilated bodies simply as “cases” whose survival or otherwise might be regarded with clinical detachment.

As nurse Goldin noted, even in the few months Jolly had spent operating close to the front lines, his colleagues had come to regard the New Zealander as an outstandingly skilled surgeon and selected him to carry out the most demanding and critical operations. In addition, he had gained a reputation as a humane and dedicated medical officer, known to treat even captured enemy combatants with the same expertise and compassion he gave to injured women, children, old people, and the troops of his own side. After the Republicans’ devastating defeat at Brunete, he remained in the physically and emotionally punishing role of frontline surgeon for a further eighteen months, until the Republican Army ordered all its overseas volunteers to withdraw from Spain. During those two years, he developed a breadth of clinical experience, especially in the intricate work of abdominal surgery, that would later be authoritatively assessed as unmatched in the world.

The Spanish Civil War of 1936–39 continues to provoke a lively and seemingly insatiable interest among both academics and the wider public in many countries. Successive generations derive fresh significance from the conflict’s distinctive characteristics, such as the geopolitical shock waves generated by the Spanish people’s resistance to a military revolt backed by the forces of an expansionist fascism, and the scale of voluntary participation from abroad. After the attempted coup began, would-be fighters and medical workers arrived from more than fifty countries to support the Republic.

The battles fought between Spain’s Republican, or pro-government, and Nationalist, or insurgent, forces constitute modern history’s earliest instance of a “total war,” one in which the entire population was engaged and that incurred many more civilian than combatant casualties. The vast and ever-expanding historiography tracing the course and consequences of the war includes a number of works on the medical services developed to treat both the combatants and the civil population. These works have established that several globally significant advances in health service organization and trauma medicine were initially developed and trialed in Spain under the chaotic conditions of wartime and of the country’s own primitive health system, which reflected a society yet to fully evolve from semi-feudalism. Large Republican-held cities such as Madrid and Barcelona endured prolonged and concentrated air raids on some of their most densely populated neighborhoods. The use of high-explosive and incendiary bombs on multistory dwellings produced thousands of casualties, many with injuries that were largely new to medical science. Residents were forced to improvise strategies and structures to withstand these raids, and the underdeveloped civilian medical service was tasked with treating survivors. The local medical staff members in Republican sectors of Spain who addressed these unaccustomed challenges were eventually supported by hundreds of volunteer medical professionals arriving from other countries. Most had no previous experience of the conditions they encountered, but they generally proved dedicated, resolute, and resourceful. Faced with extreme levels of need, they responded by improvising highly innovative techniques and systems that influenced the later course of medical practice.

Of the medical advances originated or greatly developed during the Spanish Civil War, the most significant include the establishment of blood banks and the widespread use of preserved blood for transfusions. In an era shortly before the introduction of penicillin, the Republican medical services also greatly improved on earlier methods for controlling infection in traumatic orthopedic injuries. Jolly made extensive use of these developments in his field hospitals, but he is credited in particular for his contribution to a more general innovation—organizing and linking the various components of army medical services to reduce, as much as possible, the time delay between the infliction of a wound and its treatment. He played a key role in developing a system for strategically positioning each successive stage of treatment, including his own mobile field hospitals, so that injured troops could be admitted and treated within a few hours—a far shorter time span than had been achieved in all previous wars.

This unprecedented method of battlefield health provision, which Jolly named the “three-points-forward” system, evolved in stages as costly lessons were learned from successive battles in the war, including the battle of Brunete in which Gerda Taro died. Jolly energetically advocated for it at medical conferences held during the civil war, publicized it through Republican propaganda channels, and repeatedly refined it. In doing so, he drew both on the surgical training he had received in New Zealand and British public hospitals, and, just as significantly, on his nonsectarian Christian socialist principles. Since his student days at medical school in New Zealand, he had regarded his chosen profession, in accordance with biblical precepts, as a means of relieving social inequity and hardship. Later, in London in the early 1930s, those Christian imperatives were infused with Marxist ideology, and Jolly became a convinced anti-fascist.

That broad-spectrum political standpoint appeared urgently necessary in a period when countries across Europe were succumbing, one by one, to totalitarian rule. When Spain elected its left-leaning coalition government in 1936, it appeared at first a heartening exception to that dismaying tendency. However, six months after the election, the Republican government was confronted by an armed insurrection backed by the most powerful fascist forces in Europe. Both within Spain and around the world, leftists felt compelled to convert their democratic rhetoric into action. “Madrid is the centre of gravity of the world,” concluded the Canadian surgeon Norman Bethune, as he made his way there in November 1936. Capa and Taro did the same, and so did Jolly, although to the lasting cost of his later career.

The rampant Axis powers led by Adolf Hitler and Benito Mussolini regarded Spain, coldly and deliberately, as a testing ground for their newest military equipment and strategies. By contrast, the health services hastily assembled to support pro-government forces and their civilian supporters lacked resources of almost every kind apart from determination and inventiveness. Those qualities, however, ultimately proved capable of delivering a standard of medical organization and treatment that exceeded, in some respects, any achieved elsewhere to that date, including in peacetime. Even as Franco’s victory appeared imminent and absolute, Jolly could take pride in the advances he and his colleagues had achieved under the worst circumstances imaginable.

When he was withdrawn from the civil war in late 1938, the vastly experienced yet still not fully qualified surgeon faced a watershed in his career. He might have chosen to embark on a prestigious and rewarding civilian practice, but he foresaw that the defeat of democracy in Spain made the prospect of a worldwide conflict against the Axis powers all but inevitable. Jolly therefore took an active part in the campaign to convince British medical authorities of the urgent need to prepare for a new and terrible form of warfare based on massive assaults from the air. He condensed his recent frontline experience into a handbook of military medicine intended to aid those army surgeons who would be treating casualties of battles similar to those Spain, before any other country, had just endured. His book was published as the Luftwaffe was raining bombs on English coastal towns and cities. Jolly then enlisted with Britain’s Royal Army Medical Corps and, with customary stoic dedication, served for five years in North Africa and Italy.

After his demobilization as a decorated commissioned officer, Jolly’s subsequent peacetime career in Britain was less action-packed than the decade he had spent in uniform, yet it was intriguing in other respects. While he remained highly regarded by former colleagues, and his wartime patients remembered him with profound gratitude, he retreated within the British medical establishment into obscurity to the point of invisibility, and in his country of birth, he was almost entirely forgotten. This book aims to explain and redress that remarkable historical lacuna and reestablish Jolly as a foremost medical pioneer of the twentieth century: an outstanding surgical practitioner, an internationally significant innovator in the field of trauma medicine, and a figure of exemplary courage and compassion.

Although he was a fluent writer who more than once contemplated abandoning medicine for a literary career, Jolly was a modest and unassuming character, and his many press interviews and journal articles contain only fleeting references to his own wartime and later activities. It has been necessary to supplement those sources with official records and with the recollections of his colleagues and patients. Even so, this book could not have been written without the full cooperation of Jolly’s relatives in several countries. With great generosity and goodwill, they have made available his extensive personal papers, including letters, photographs, and unpublished writings, and placed no restrictions or other conditions on their use—a rare gift to a biographer.

Through the medium of one outstanding surgeon’s experience, this book aims to recount the haphazard, heroic development of medical services under conditions of total war—a conflict between highly mechanized, air-dominated armies deployed across entire countries and continents and affecting all levels of the civilian population. Jolly chose to enter this conflict with no formal military experience but with a family and educational background that prepared him remarkably well for its extreme demands. In particular, his Christian socialist personal ethos, which he retained throughout his life, equipped him to endure emotional pressures that overwhelmed many of those he worked alongside. His nonaligned anti-fascist politics also guided him through the hypocrisies, internecine struggles, and subsequent disillusionments of a low, dishonest decade and enabled him to resolve the swift ethical transition from antiwar activist to noncombatant serving officer. During nine years of near-continuous service in frontline warfare, there is no record of him using, or even bearing, a weapon.

In the course of my researching and writing this book, Douglas Jolly emerged as much more than the one-dimensionally high-minded and admirable figure that he may present at first sight. His personality and career encompassed curious contradictions that both complicated and enriched the project of recording his life. Consequently, further layers of significance were added to the project of retracing the path taken by a storekeeper’s son from the remotest corner of a small and remote country to the epicenter of world events, where he made distinguished and enduring contributions to trauma medicine and thereby to the relief of human suffering.’

 

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Frontline Surgeon: New Zealand medical pioneer Douglas Jolly by Mark Derby ships 11 July. Order here.