at the start of the first world war spencer was keen to enlist but his mother persuaded him, given his poor physique, to apply for ambulance duties. in 1915 spencer volunteered to serve with the royal army medical corps, ramc, and worked as an orderly at the beaufort war hospital, bristol, a large victorian gothic building that had been a lunatic asylum. after thirteen months at beaufort, the ramc transferred spencer to overseas duties. he left beaufort in may 1916 and after ten weeks' training at tweseldown camp in hampshire, the 24-year-old spencer was sent to macedonia, with the 68th field ambulance unit. in 1917 he subsequently volunteered to be transferred to an infantry unit, the 7th battalion, the berkshire regiment. in all, spencer spent two and a half years on the front line in macedonia, facing both german and bulgarian troops, before he was invalided out of the army following persistent bouts of malaria. his survival of the war that killed so many of his fellows, including his elder brother sydney, who died in action in september 1918, indelibly marked spencer's attitude to life and death. such preoccupations came through time and again in his subsequent works.