RAILWAY AMBULANCE TRANSPORT
According to statistics which have been compiled in relation to wars
alike in ancient and in modern times, for every ten men among the
armies in the field who have died from wounds received in battle there
have been from thirty-five to forty who died from sickness or disease.
Writing in the _Journal des Sciences Militaires_, Dr. Morache, a surgeon
in the French Army, has said that while the total number of deaths among
combatants taking part in the Crimean War was 95,000, no fewer than
70,000 were due to typhus, scurvy, cholera or other diseases. In the
Italian campaign of 1859 the French lost 5,498 men, of whom 2,500 died
from sickness. On the conclusion of the Russo-Turkish War the Russians
had 51,000 of their troops sick, the ravages of typhus having been
especially severe.
These conditions have been materially aggravated by the gathering
together of great numbers of sick and wounded into overcrowded hospitals
situate on or near to the theatre of war and destined inevitably to
become hot-beds of disease and pestilence far more dangerous to human
life, under these conditions, than even the most deadly weapons which
the art of war had invented for use on the battle-field itself.
Nor was it the armies alone that suffered. Returning troops spread the
seeds of disease among the civil population, causing epidemics that
lingered, in some instances, for several years and carried off many
thousands of non-combatants, in addition to the great number of victims
among the combatants themselves. In a volume of 866 pages, published by
Dr. E. Gurlt, under the title of "Zur Geschichte der Internationellen
und Freiwilligen Krankenpflege im Kriege" (Leipzig, 1873), will be found
many terrible details concerning the ravages in France, Germany and
Austria of the typhus which Napoleon's troops brought back with them on
the occasion of their disastrous retreat from Russia.
The most practicable means of mitigating, if not of avoiding, these
various evils is to be found in the prompt removal of the sick and
wounded from the theatre of war, and their distribution in smaller
units, not simply among a group of neighbouring towns, but over an
area extending to considerable distances inland. The adoption of this
remedy only became possible, however, with a provision of adequate rail
facilities, and even then many years were to elapse before an efficient
system of railway ambulance transport was finally evolved.
The objects which the use of the railway in these directions was to
attain were alike humanitarian and strategical.
To the sick and wounded among the troops, prompt removal and widespread
distribution among hospitals in the interior meant (1) that they avoided
the risks to which they would have been subjected in the aforesaid
overcrowded and pestilential hospitals near the fighting line, where
slight injuries might readily develop dangerous symptoms, and contagious
disease complete the conditions leading to a fatal issue; (2) that,
apart from these considerations, it would be possible to give them a
greater degree of individual attention if they were distributed among a
large number of hospitals away from the scene of the fighting; (3) that
more conservative methods of surgery became practicable when operations
of a kind not to be attempted either on the battle-field or in temporary
hospitals (from which the inmates might have to be suddenly removed,
owing to some change in the strategical position) could be delayed until
the sufferer's arrival at some hospital in the interior, where better
appliances and better facilities would be available, and where, after
the operation, the patient would be able to remain undisturbed until
he was cured; (4) that these improved conditions might more especially
permit of the avoidance of amputations otherwise imperatively necessary;
and (5) that, on the whole, the wounded soldier was afforded a better
chance of effecting a speedy recovery and of saving both life and limb
than would be possible if railways were not available.
To the army in the field the innovation meant that with the speedy
removal of the sick and wounded it would be relieved of the great
source of embarrassment caused by the presence and dependence upon it
of so many inefficients;[16] depôt and intermediate hospitals could
be reduced to the smallest proportions, and would thus occasion less
inconvenience if, owing to a retreat or a change in the strategical
position, they were brought within the sphere of military operations;
with the delegation of so many of the sick and wounded to the care of
civil practitioners in the interior, fewer of the divisional, brigade
and regimental medical officers would require to be detached from the
marching column; a smaller supplementary medical staff would suffice;
a considerable reduction could be effected in the stocks of ambulance
supplies kept on hand at the front; while important strategical
advantages would be gained through (1) the greater freedom of movement
which the army would secure; (2) the decreased risk of the number of
efficients being reduced through the outbreak of epidemics; and (3) the
prospect of a large proportion of the sick and wounded being enabled to
rejoin the fighting force on their making a speedy recovery from their
illness or their wounds.
The earliest occasion on which the railway was made use of for the
conveyance of sick and wounded from a scene of actual hostilities to the
rear was on the occasion of the _Crimean War_, when the little military
line between Balaklava and the camp before Sebastopol, of which an
account will be given in Chapter XV, was so employed. The facilities
afforded were, however, of the most primitive character. Only the
wagons used for the transport of supplies to the front--wagons, that is
to say, little better than those known as "contractors' trucks"--were
available, and there were no means of adapting them to the conveyance
of sufferers who could not be moved otherwise than in a recumbent
position. Sitting-up cases could, therefore, alone be carried; but what
was to develop into a revolution in the conditions of warfare was thus
introduced, all the same.
In the _Italian war of 1859_ both the French and the Austrians made use
of the railways for the withdrawal of their sick and wounded, and, in
his "Souvenir de Solferino," Jean Henri Dumant, the "Father" of the Red
Cross Movement, speaks of the transportation of wounded from Brescia to
Milan by train to the extent of about 1,000 a night. No arrangements for
their comfort on the journey had been made in advance, and the changes
in the military situation were so rapid, when hostilities broke out,
that no special facilities could be provided then. All that was done
was to lay down straw on the floor of the goods or cattle trucks used
for the conveyance of some of the more serious cases. The remainder
travelled in ordinary third-class carriages, and their sufferings on the
journey, before they reached the long and narrow sheds put up along the
railway lines at Milan or elsewhere to serve as temporary hospitals,
must often have been very great. They may, nevertheless, have escaped
the fate of those who died, not from their wounds, but from the fevers
quickly generated in the overcrowded hospitals at the front, where there
was, besides, a general deficiency of ambulance requirements of all
kinds. The good resulting from the removal by train is, indeed, said to
have been "immense."
These experiences in the campaign of 1859 led to a recommendation
being made in the following year by a _German_ medical authority, Dr.
E. Gurlt,[17] that railway vehicles should be specially prepared for
the conveyance of the sick and wounded in time of war. The plan which
he himself suggested for adoption was the placing of the sufferers in
hammocks suspended from hooks driven into the roof of the goods van or
carriage employed, mattresses being first put on the hammocks, when
necessary. By this means, he suggested, the sufferers would travel much
more comfortably than when seated in the ordinary passenger carriages,
or when lying on straw in the goods wagons or cattle trucks.
Dr. Gurlt's pamphlet served the good purpose of drawing much attention
to the subject, and his proposals were duly subjected to the test of
experiment. They failed, however, on two grounds,--(1) because the roofs
of the goods vans, designed for shelter only, were not sufficiently
strong to bear the weight of a number of men carried in the way
suggested; and (2) because the motion of the train caused the hammocks
to come into frequent contact with the sides of the wagon, to the
serious discomfort of the occupants.
In November of the same year (1860) the Prussian War Minister, von Roon,
appointed a Commission to enquire into the whole subject of the care
of the sick and wounded in time of war, and the question of transport
by rail was among the various matters considered. As a result of these
investigations, the Minister issued, on July 1, 1861, an order to the
effect that in future the less seriously wounded should travel in
ordinary first, second or third-class carriages, according to the degree
of comfort they required, care being taken to let them have corner
seats; while for those who were seriously ill, or badly wounded, there
were to be provided sacks of straw having three canvas loops on each
side for the insertion of poles by means of which the sacks and the
sufferers lying upon them could be readily lifted in or out of the goods
wagons set apart for their conveyance. In these wagons they were to be
placed on the floor in such a way that each wagon would accommodate
either seven or eight. In the event of a deficiency of sacks, loose
straw was to be used instead. The door on one side of the truck was to
be left open for ventilation. A doctor and attendants were to accompany
each train, and they were to have a supply of bandages, medicines and
appliances. Of the last-mentioned a list of five articles was appended
as obligatory. The medical officer was to visit the wagons during the
stoppages, and the attendants on duty in the wagons were to carry flags
so that, when necessary, they could signal both for the train to pull
up and for the doctor to come to the sufferers.
This was as far as Prussia had got by 1861, when the arrangements stated
were regarded as quite sufficient to meet the requirements of the
situation. Real progress was to come, rather, from the other side of the
Atlantic.
In the early days of the _War of Secession_ (1861-65) the arrangements
for the conveyance by rail of the sick and wounded from the
battle-fields of the Eastern States to the hospitals in the large
cities were still distinctly primitive. Those who could sit up in the
ordinary cars were conveyed in them. Those who could not sit up, or
would be injured by so doing, were carried to the railway, by hand, on
the mattresses or stretchers they had occupied in the hospitals to which
they had first been taken. At the station the mattresses were placed on
thick layers of straw or hay strewn over the floors of the freight cars
in which supplies had been brought to the front. Large window spaces
were cut in the sides or ends of the cars to provide for ventilation.
On some occasions, when hay or straw was not available, pine boughs or
leaves were used instead. As only the floor space was occupied no more
than about ten patients could be carried comfortably in each car, though
as many as twenty were occasionally crowded in. The wide doors of the
box cars readily permitted of the beds being lifted in or out. Medical
officers, with supplies, accompanied each train. On arrival at New
York, Washington, Philadelphia, Harrisburg, or other destination, the
sufferers were taken out and carried, still on the same mattresses or
stretchers, to the hospitals there.
Large numbers of sick or wounded were conveyed by rail under one or
other of these conditions, and the work was done with great expedition.
Between the morning of June 12 and the evening of June 14, 1863, over
9,000 wounded, victims of the Federal disaster at Chancellorsville,
were taken by the single-track Aquia Creek railroad from Aquia Creek to
Washington. Many even of the severely wounded declared they had suffered
no inconvenience from the journey. After the battle of Gettysburg, July
1-3, 1863, more than 15,000 wounded had been sent by rail from the
field hospitals to Baltimore, New York, Harrisburg or Philadelphia by
July 22. An even more rapid distribution was effected after the battles
of the Wilderness and Spottsylvania when, with a few exceptions, the
transfer to the hospitals in the cities mentioned was effected in the
course of a few days. Following on the battle of Olustree (February 20,
1864), the serious cases were removed on the Mobile Railway by freight
cars bedded with pine boughs, palmetto leaves and a small quantity of
straw, each patient having a blanket, in addition.
As an improvement on these methods of transport, the plan was adopted
of fixing rows of upright wooden posts, connecting floor and ceiling,
on each side of a car as supports for two or three tiers of rough
wooden bunks, a central gangway through the car being left. In this
way the available space in the car was much better utilised than
with the straw-on-floor system. Next, in place of the bunks, came an
arrangement by which the stretchers whereon the patients lay could be
securely lashed to the uprights; while this was followed, in turn, by
the insertion of wooden pegs into the uprights and the placing on them
of large and strong india-rubber rings into which the handles of the
stretchers could readily be slipped, and so suspended. The first car so
arranged came into use in March, 1863.
Meanwhile the Philadelphia Railroad Company had, at the end of 1862,
fitted up an ambulance car on the principle of a sleeping car, but so
planned that the stretchers on which the sufferers lay could be made to
slide in or out of the wooden supports. This particular car was capable
of accommodating fifty-one patients, in addition to a seat at each end
for an attendant. Other innovations introduced on the car were (1) a
stove at which soups could be warmed or tea made; (2) a water tank, and
(3) a locker.
What the introducers of these improvements mainly prided themselves
upon was the fact that the patient could remain, throughout the entire
journey from field hospital to destination, on the stretcher he had been
placed on at the start. The adoption of this principle necessitated,
however, uniformity in the dimensions of the stretchers in order that
these could always be accommodated on the ambulance-car fittings.
The next important development was reached when the ambulance _car_,
run in connection with ordinary trains, and used for exceptionally
severe cases, was succeeded by the ambulance _train_. Here came further
innovations, the nine or ten "ward-cars," of which such a train mainly
consisted in the Eastern States, being supplemented by others fitted
up as dispensary and store-room, kitchen, and quarters for surgeon,
attendants, and staff of train, besides carrying all necessary
appliances and provisions for the journey.
What was now specially aimed at was to make the train as close an
approach to an actual hospital on wheels as circumstances would
permit. "At present," wrote the Medical Director of the Department of
Washington, "the sick and wounded are transferred in cars ill-adapted
for the purpose and with difficulty spared from the other pressing
demands; and lives are lost on the route not infrequently which, in all
probability, might be saved by a more comfortable and easy method of
transportation." The train he caused to be constructed consisted of ten
ward-cars, one car for the surgeon and attendants, one as a dispensary
and store-room, and one as a kitchen, etc. The ward-cars, arranged on
an improved principle, each accommodated thirty recumbent and twenty or
thirty seated patients. The train was to run regularly on the Orange and
Alexandria Railroad between the theatre of war and the base hospitals at
Alexandria and Washington. It was either to supplement or to supersede
the freight cars with their bedding of straw, hay or leaves. If only
from the point of view of the inadequate supply of rolling stock, a car
fitted up to accommodate fifty or sixty patients offered an obvious
advantage, in the speedy removal and distribution of sick and wounded,
over a car, without fittings, in which the floor space alone could be
utilised.
Several complete trains of the type stated were soon running on the
Orange and Alexandria Railroad, within the Union lines, and the
hospital train thus became an established institution in modern warfare.
It was, however, in connection with the chief army in the West, the Army
of the Cumberland, operating under General George H. Thomas, that the
useful purposes which could be served by hospital trains became most
conspicuous.
The need for them in the West was even greater than in the East,
because the distances to be covered were greater and lay, also, to a
considerable extent, in enemy country.
In the fall of 1863 and the winter of 1864, as narrated in the "Medical
and Surgical History of the War of the Rebellion," the chief army of the
West was concentrated principally along the line of railroads leading
from Nashville, Tennessee, to the South-west, viâ Chattanooga, Tenn.,
and onwards towards Atlanta, Georgia. At the outset the sick and wounded
who could travel in ordinary passenger cars to points in the North were
so taken. Severe cases had to remain in the nearest available hospital
depôt. In addition to the discomfort suffered by the former in having
to travel in cars not suited to invalids, they were liable to frequent
and prolonged delays on the single-track lines by reason of the constant
passing of supply trains proceeding to the front; and not unfrequently
the detentions were at points where nothing could be obtained for
feeding the sufferers or making them comfortable, while even if rations
could be drawn the train afforded no means of cooking them. So it was
resolved to have a train which would be the equivalent of an ambulating,
self-contained hospital, capable of carrying both recumbent and
sitting-up patients and supplying all their wants on the journey.
On August 11, 1863, instructions were sent from the
Assistant-Surgeon-General's Office to the Medical Officer of the Army
of the Cumberland directing him "to take immediate measures to fit up a
special train for hospital purposes, with every possible comfort," to
run between Nashville, Ten., and Louisville, Ken. General Thomas, in
turn, accorded the fullest authority to the Medical Officer to select
for the purpose the best locomotives and the best cars to be found among
the railway rolling stock, and to have new cars fitted up whenever
necessary. He further directed that the most experienced drivers,
conductors and other necessary railway employés should be selected for
the conduct of the hospital-train service.
Three of these trains were ready by the spring of 1864, and they ran
regularly--each taking a section of the journey--between Atlanta and
Louisville, a distance of 472 miles. They consisted, apparently, in
part of specially-built and in part of adapted rolling stock, the
large open American passenger cars, with their greater freedom from
internal fittings than ordinary European railway carriages, lending
themselves specially to the purpose. In the converted passenger cars
the carrying of the stretchers through the end doors was avoided by
removing two windows and the panelling underneath them from the side of
the car, and making an opening 6 ft. in width which could be closed by
a sliding door. Each train provided five ward-cars (converted passenger
cars) for lying-down patients; a surgeon's car (a passenger car from
which the seats had been removed, with partitions and fittings for the
accommodation of the doctor and his helpers); a dispensary car (in which
an ample supply of medicines, instruments and appliances was carried);
an ordinary passenger car for sitting-up patients or convalescents; a
kitchen car (divided into kitchen, dining-room and store-room); and
a conductor's car. The kitchen car was supplied with a small cooking
range, boilers, and other requisites for the feeding of from 175 to
200 patients. The cars were warmed and lighted in winter, and special
attention was paid to ventilation, so that Dr. F. L. Town, of the
United States Army, was able to report of them:--"In visiting these
hospital trains, the air is found sweet and pure, the wards are neat
and inviting; and it may unhesitatingly be said that men on hospital
trains are often as comfortable and better fed and attended than in many
permanent hospitals." The trains had distinguishing signals which were
recognised by the Confederates, and none of them were ever fired on or
molested in any way.
One, at least, of the trains was despatched daily from the vicinity of
the field hospitals. The services rendered by them during the last
eighteen months of the war were of the greatest value. It has been said,
indeed, that the combined effect of all the provision made for the care
of the sick and wounded and their speedy recovery--including therein, as
one of the most important items, their prompt removal and distribution
by rail--was to ensure for the Federals the retention of a force equal
in itself to an army of 100,000 men. No single fact could show more
conclusively the _strategical_ as well as the humanitarian value of
railway ambulance transport.
These details as to what was accomplished in the American Civil War are
the more deserving of record because they show that the evolution of the
"hospital on wheels," from the initial conditions of a bedding of straw
on the floor of a railway goods wagon, was really carried out, step by
step, in all its essential details, in the United States. The hospital
train was thus _not_ an English invention, as is widely assumed to be
the case; though much was to be done here to improve its construction,
equipment and organisation.
Whilst America had been gaining all this very practical experience, the
_Danish War of 1864_ had given Prussia the opportunity of testing the
system approved by her in 1861 for the conveyance of the less severely
wounded in ordinary passenger carriages and of the seriously wounded on
sacks of straw laid on the floor of goods wagons. The results were found
so unsatisfactory that on the conclusion of hostilities a fresh series
of investigations and experiments was begun, and matters were still at
this stage when war broke out between Prussia and Austria.
The conditions in regard to the care of the sick and wounded in the
_campaign of 1866_ were deplorably defective. Not only, according to
Dr. T. W. Evans[18]--an American medical man, settled in Paris, who
visited the battle-field and assisted in the work of relief--was there
no advance on what had been done in the United States, but the American
example was in no way followed, the combatants having made no attempt
whatever to profit from her experience.
After the battle of Sadowa, thousands of wounded were left on the
battle-field, and many remained there three days and three nights before
they could be removed in the carts and wagons which were alone available
for the purpose. Within five days every village in a radius of four
leagues was crowded with wounded. Those taken to Dresden and Prague in
ordinary passenger carriages or goods vans were detained for days on
the journey owing to the congestion of traffic on the lines. Some of
them, also, were in the trains for two days before their wounds were
dressed. Then the use of straw, depended on by the Austrians, was found
to be unsatisfactory. It failed to afford the sufferers a sufficient
protection against the jolting of the wagons, especially when they
worked through it to the bare boards; and even then there was not always
sufficient straw available to meet requirements. Altogether, it is
declared, the wounded suffered "unheard-of tortures."
Shortly after the conclusion of the war there was appointed in _Prussia_
a further Commission of medical and military authorities to renew the
investigation into the care and transport of sick and wounded. The
Commission sat from March 18 to May 5, 1867. In the result it still
favoured the use of sacks of straw, with canvas loops, as the simplest
and most comfortable method to adopt for the rail transport of recumbent
sufferers, though it recommended that the sacks should be made with
side pieces, giving them the form of paillasses, as this would afford a
greater degree of support to those lying on them. The American system of
suspending stretchers in tiers by means of india-rubber rings depending
from pegs let into wooden uprights was disapproved of, partly because
of the continuous swinging of the stretchers so carried, and partly
because of the assumed discomfort to one set of patients of having
others just above them. The report also recommended the adoption of
the following principles:--(1) Through communication between all the
carriages employed in one and the same train for the conveyance of sick
and wounded; (2) provision, for the severely wounded, either of beds
with springs or of litters suspended from the roof or the sides of the
carriages; and (3) extra carriages for the accommodation of doctor,
nurses, surgical appliances, medical stores, cooking utensils, etc.
These principles were subjected to various tests, and it was found that
in Germany the existing carriages which could best be adapted to the
desired purpose were those belonging to the fourth-class, inasmuch as
they had no internal divisions or fittings, travellers by them being
expected either to stand during the journey or to sit on their luggage.
The only structural alteration necessary was the placing of the doors at
the end of the carriages instead of at the sides, so that, on opening
these end doors, and letting down a small bridge to be provided for the
purpose, access could readily be obtained from one carriage to another.
Instructions were accordingly given that all fourth-class carriages
on the Prussian railways should thenceforward have end doors--an
arrangement which had, in fact, already been adopted in South Germany.
Steps were also taken in Prussia to adapt goods vans and horse boxes
for the conveyance of sick and wounded in the event of the number of
fourth-class carriages not being sufficient to meet requirements.
The widespread interest which was being attracted throughout Europe to
the subject of the care of the sick and wounded in war led to a series
of experimental trials being carried out at the _Paris International
Exhibition of 1867_, when, with the help of a short line of railway laid
down in the exhibition grounds and of a goods wagon supplied by the
Western of France Railway Company, a number of different systems were
tested. On this occasion, also, a model of an American car fitted up
with india-rubber rings for the handles of stretchers was shown.
At this time, and for many years afterwards, the ideal arrangement was
considered, on the Continent of Europe, to be one under which railway
vehicles sent to the front with troops, supplies or munitions could be
readily adapted for bringing back the sick and wounded on the return
journey; and alike in Germany, Russia, France, Austria and Italy the
respective merits of a great variety of internal fittings designed to
adapt existing rolling stock, whether passenger coaches, luggage vans,
Post Office vans or goods wagons, to the serving of these dual purposes
formed the subject of much experiment and controversy. Rope cables
across the roof of a goods wagon, with dependent loops of rope for
the reception of the stretcher handles (as in the Zavodovski method);
stretchers laid on springs on the floor, suspended from the roof either
by strong springs or by rope, resting on brackets attached to the
sides, or partly resting and partly suspended; and collapsible frames
of various kinds, each had their respective advocates.[19] The use and
equipment of ambulance or hospital trains constituted, also, a regular
subject of discussion at all the international congresses of Red Cross
Societies which have been held since 1869.
The experimental trials at the Paris Exhibition of 1867 were followed
by the appointment in _Prussia_ of still another Commission of inquiry,
and, acting on the recommendations of this body, the Prussian Government
adopted the "Grund" system, under which the stretchers whereon the
recumbent sufferers lay in the goods wagons or fourth-class carriages
were placed on poles resting in slots over the convexity of laminated
springs having one end screwed into the floor while the other, and
free, end was provided with a roller designed to respond to the varying
conditions of weight by sliding to and fro. This was the system mainly
used in the "sanitary trains" of the Germans in the _Franco-Prussian
War of 1870-71_. It was criticised on the ground (1) that the sick
and wounded were still subject to the same jolts and concussions as
ordinary seated passengers; (2) that the number who could be carried per
carriage or wagon was very small, since it was still the case that only
the floor space was utilised; and (3) that it was inconvenient for the
doctor and the attendants to have to kneel down in order to attend to
the patients.[20] Apart from these disadvantages, the ambulance service
of the Germans was well organised during the war. Of ambulance trains,
fitted up more or less as complete travelling hospitals, twenty-one were
run, and the total number of sufferers removed by rail is said to have
been over 89,000.
Owing to traffic congestions, the transport to Berlin of wounded from
the army engaged in the investment of Paris occupied no less a period
than six days; but these journeys were made in the special ambulance
trains which, provided in the later stages of the war, ensured full
provision for the feeding, nursing and general comfort of the sufferers.
The fact that such journeys could be undertaken at all showed the great
advance which had been made since the battle of Sadowa, when most of the
wounded could be conveyed no further than to cottages and farm-houses in
neighbouring villages.
In the _South-African War of 1899-1902_ the system favoured was that
of having hospital trains either expressly built for the purpose or
adapted from ordinary rolling stock and devoted exclusively, for the
duration of the war, to the conveyance of the sick and wounded. The
"Princess Christian" hospital train, specially constructed for the
British Central Red Cross Committee by the Birmingham Railway Carriage
and Wagon Company Ltd., according to the plans of Sir John Furley and
Mr. W. J. Fieldhouse, and sent out to South Africa early in 1900,
consisted of seven carriages, each about 36 ft. in length, and 8 ft.
in width, for running on the Cape standard gauge of 3ft. 6in. The
carriages were arranged as follows:--I., divided into three compartments
for (_a_) linen and other stores, (_b_) two nurses and (_c_) two invalid
officers; II., also divided into three compartments, for (_a_) two
medical officers; (_b_) dining-room and (_c_) dispensary; III., IV.,
V., and VI., ward-cars for invalids, carried on beds arranged in three
tiers; VII., kitchen, pantry, and a compartment for the guard. The train
carried everything that was necessary for patients and staff even though
they might be cut off from other sources of supply for a period of two
or three weeks.
Seven other hospital trains, all adapted from existing rolling stock
in Cape Colony or Natal, were made available for the transport of sick
and wounded in the same war. One of these, No. 4, was arranged and
equipped at the cost of the British Central Red Cross Committee, under
the direction of Sir John Furley, then acting as the Society's Chief
Commissioner in South Africa. The arrangement of the other converted
trains was carried out by the Army Medical Service in South Africa,
with the co-operation of the Government Railway officials in Cape Town
and Natal. A number of specially-fitted carriages, placed at convenient
distances on the railways occupied by the British, were made use of to
pick up small parties of sick from the various posts along the lines,
such carriages being attached to passing trains for the conveyance
of the sufferers to the nearest hospital. Many of them had a regular
service up and down a particular stretch of railway. Some were provided
with iron frames for the support of service stretchers, and others were
fitted up similarly to the ward-carriages of the converted hospital
trains. Convalescents and "sitting-up" patients for whom no special
accommodation was necessary travelled in such ordinary trains as might
be available.
In effect, there are four classes of trains by which, under the
conditions of to-day, the sick and wounded may be despatched from the
seat of war:--(1) Permanent hospital trains, specially constructed for
the purpose; (2) temporary hospital trains, made up either entirely
of converted ordinary vehicles or partly of converted and partly of
specially-constructed rolling stock, their use for this purpose
continuing for the duration of the war; (3) ambulance trains improvised
at railhead out of rolling stock bringing troops, supplies and stores to
the front, the internal fittings for "lying-down" cases being of such
a kind that they can be readily fixed or dismantled; and (4) ordinary
passenger carriages for slightly wounded or convalescents.
The advantages conferred on armies from a strategical point of view,
under all these improved conditions, are no less beyond dispute than
the benefits conferred on the individual soldiers, and if railways had
done no more in regard to the conduct of warfare than ensure these dual
results, they would still have rendered a service of incalculable value.
While, also, their provision of an efficient ambulance transport system,
with its speedy removal of non-effectives, has served the purposes
of war, it has, in addition, by its regard for the sick and wounded
themselves, further served to relieve warfare of some, at least, of its
horrors.
FOOTNOTES:
[16] A saying attributed to Napoleon is that he preferred a dead soldier
to a wounded one.
[17] "Ueber den Transport Schwerverwundeter und Kranker im Kriege, nebst
Vorschlägen über die Benutzung der Eisenbahnen dabei." 33 pp. Berlin,
1860.
[18] "Les Institutions Sanitaires pendant le Conflit
Austro-Prussien-Italien." Par Thomas W. Evans. Paris, 1867.
[19] For "A short consideration and comparison of the regulations for
the transport of sick and wounded by rail, as laid down in four of the
leading Continental armies (the German, French, Austrian and Italian),"
see a paper on "Continental Regulations for the Transport of Sick and
Wounded by Rail," by Surg.-Capt. C. H. Melville, A.M.S., _Royal United
Service Institution Journal_, vol. 42 (1898), pp. 560-594.
[20] In an article on "Military Hospital Trains; their Origin and
Progress," in _The Railway Gazette_ of December 4, 1914, it is said:
"The comparatively small loss of the Germans by death from wounds in
1870 was due solely to the fact that they entered upon the war with what
were then considered wonderfully elaborate arrangements for removing the
wounded.... The trains were composed partly of first-class carriages,
for the less badly wounded, and partly of covered goods wagons.... In
these covered vans were placed beds formed of boards laid on springs.
Each van would hold four or five men, and a sister rode in the van." One
would not, however, consider to-day that there was anything wonderfully
elaborate in an arrangement under which no more than four or five
sufferers were accommodated in each goods van.