Brilliant British train ambulances 1914-18 - thank goodness wounded men were saved.

Many thanks to "Rapid Relief by Rail",  History of Medicine, 2021. Trains had already been used in the C19th and early C20th, in the Crimean War, American Civil War and Boer War. But railways weren’t fully utilised until the first truly industrial war, WW1.

Even before WW1, the British government was secretly prepar­ing for battle. By 1912 the British govern­ment created the Railway Executive Com­mittee to ensure the smooth run­ning of the railways into the future. Antic­ipating mass cas­ualties of a Europe-wide war, they met the manag­ers of Britain’s rail­ways  to design capacious ambulance trains.

Wounded soldiers in their bunks

being checked by medical staff

Motor ambulances taking patients from New Zealand Stationary Hospital in Wisques, France

to the ambulance train, Wiki

Pharmacy being loaded up before ambulance train departs

But just as thousands of British workers were leaving to join the ar­my, many railmen were barred from volunteering; they were ess­ent­ial workers during the war eff­ort. For indust­rial labourers and engine­ers far from the front, this was their chance to contribute, and they did so with great speed. They built ambul­ance trains and railway companies supplied stretchers, guns, shells and veh­ic­les.

In Aug 1914, car­r­iage builders worked around the clock to prep­are the trains and to build the vital fittings. The Comm­ittee dev­ised plans to build 12 ambulance trains, to move casualties around once they got back to Brit­ain. With patriotism booming, the rail com­panies geared up.

It was quickly clear that the hospital trains would­n’t be needed just in Britain. So in Dec 1914, the first Contin­ental Amb­u­l­ance Trains to be used in France were sent. There they provided support close to the front lines and a vital link in the military medical system. The Fren­ch railways were already struggling to evacuate injured soldiers.

In WW1 huge numbers of injured sold­iers needed to get away from the front lines, often carried by stret­cher bearers. At Reg­imental Aid Posts (just behind the lines) and Advanced Dressing St­ations (further behind the lines), men received basic treat­ment. This included deter­mining wh­ether they’d survive long enough to just­ify ongoing treat­­ment. If so, they were taken onto a Continent­al Amb­ul­ance Train, where they were treated and taken to a Base Hosp­it­al in a port city: Rouen, Calais or Boulogne.

For Britons being evacuated home, hospital ships provided the next leg of their trip - converted passenger liners carrying med­ic­al staff and facilities just like the trains. But here was an extra dan­g­er: being torp­ed­oed by enemy submarines in the Chan­n­el.

The first casualties arriving back in Britain were tak­en from hos­p­ital ships at Southampton to Netley Military Hosp­ital. But as more casual­t­ies arrived, Home Ambulance Trains took pass­en­g­ers to newly opened hospit­als across the country, as distant as the Scottish highlands.

All ambulance trains needed 15-20 carriages, to include wards for in­jured soldiers, pharm­acies, emer­g­ency operating rooms, kitchens and medical staff quarters. Each train had French cooks working in the kitchen car to feed every­body. The rationed food served was basic, but the meat stew was very wel­c­ome. Med­ical officers and nurses shared a mess carr­iage for meals and recreat­ion.

Ambulance trains were run by 3 Royal Army Corps medical off­ic­ers who examined each wounded sold­ier, and 3 Queen Alexander Nur­s­­ing Ser­vice nur­ses who prov­ided medical care under doctors’ ord­ers. The army doc­t­ors, all officers, kept records in the train office, record­ed the drugs of the wounded men and decided their treatment. The 6 med­ical staff lived onboard the trains semi comfort­ably eg baths. The pharm­ac­ies were stocked with morph­ine, medicines and bandages, to keep the wounded stable on route to hospital.

As soldiers boarded the train, medical officers checked their wounds, tri­aged the men, decided on treatments and separated the off­icers from enlisted men. Working on the am­bulance trains involved endless effort; doctors and nurses worked day & night treating their patients’ wounds. Even when the pat­ients were fin­ally unloaded, nobody rested until the train was cleaned and beds made.

Each ambulance train could carry 500 patients and was run by 50 staff. The majority of these were orderlies, who gave water to pat­ients, ch­anged dress­ings, fed all the passengers and cleaned the train. For ev­ery new load of passengers, there was a long list of jobs to be done. Staff regularly worked through the night to ensure their pat­ients’ needs were met. They all ran the constant risk of catching lice or infectious diseases, or being bombed.

For patients, life aboard an ambulance train could be a life-saving experience or a horror. Firstly pat­ients were thankful to be on board and mo­ving away from the Wes­­tern Front, and were supplied with beds, food and medical care. And soldiers from all over the world symp­ath­ised together, Brit­­ish, French, Ind­ians, Australians, New Zealanders, Canad­ians, Americans and captured German casualties.

But travelling on an ambulance train could be gruelling. Ward cars had to carry as many men as possible in the three-tiered bunk beds, so patients often felt cramp­ed and uncomfortable. When the train jolted, broken bones hurt. Some of the men had been shot or stabbed. Others were the victims of pois­on gases that burned the lungs and bl­istered the skin. Many others suffered from diseases affecting men straight from the trenches, so the trains quickly became filthy, smelly and cramped.

Patients lay on stretchers on a British station platform, 

off the ambulance carriages and waiting to be taken to hospital.

As well as being physically wounded, many soldiers suffered post-traumatic stress disorder from the psychological effects of war. The eff­ective treatment of mental illness had not yet been developed, so patients had to be locked in secure padded cells.

By 1918, British Railway Companies had put 51 ambul­ance trains into service, 20 for use in Britain and 31 for the Cont­inent. A total of 2.7 million wounded soldiers had been taken from the front, many of whom lived!

Credit for all photos: Science Museum Group.