All About British Ambulance Trains

Ward Car, Ambulance Train #18

I remember the journey as a nightmare. My back was sagging, and I could not raise my knees to relieve the cramp, the bunk above me only a few inches away. 

Robert Graves, passenger

Railways played an essential part in the first truly industrialised war. As well as facilitating the horrors of mass conflict, they also enabled medical care of injured service personnel on a vast scale.

Evacuation of the wounded on this scale would have been unimaginable without the ambulance trains that ferried thousands of soldiers away from the front line toward safety.

During the First World War, huge numbers of injured soldiers had to be transported from the front line to casualty clearing stations, field hospitals, and beyond. The fastest way to do this was by train.

• Ambulance trains are essentially hospitals on wheels—trains converted to accommodate wards for injured soldiers, pharmacy and operating rooms, and medical staff quarters.
• First World War British ambulance trains could carry around 500 injured servicemen, along with 50 crew members including orderlies, nurses, and medical officers.
• 7 July 1916, during the Battle of the Somme, was the busiest day of ambulance train traffic during the war.
• By 1918, British railway companies had built 51 ambulance trains.

Ambulance trains had already been used in the 19th and early 20th centuries, in the Crimean War, American Civil War, and Boer War. But the possibilities of railways were fully exploited during the first truly industrial war. In the early days of the First World War, casualties arriving back in Britain were taken from hospital ships at Southampton to the nearby military hospital at Netley. However, as more and more casualties began to arrive, ambulance trains took passengers to newly opened hospitals across the country. These home ambulance trains carried the injured to hospitals as far-flung as Strathpeffer in the Scottish highlands. 

A 500-Patient Ambulance Train, August 1914

How did Britain’s railway companies prepare for war?

In the years leading up to 1914, the British government was secretly preparing for war. Anticipating the mass casualties of a Europe-wide war, they gathered the managers of Britain’s railways to design ambulance trains. Railway companies had to fit the facilities of a hospital into the confines of a train. Ambulance trains were up to a third of a mile long and included wards, pharmacies, emergency operating rooms, kitchens and staff accommodation. Secret drawings were sent out to companies across the country. When war was finally declared on 4 August 1914, the rail industry was ready.

Carriage builders were immediately recalled from their holidays and worked around the clock to prepare the ambulance trains. Companies worked day and night to build the trains and fittings—from ladders and latrine buckets to operating tables and ash trays. The first train arrived in Southampton just 20 days later. Companies and their workers were immensely proud of their hard work under pressure. The new ambulance trains were exhibited at railway stations across Britain. Thousands flocked to see the trains before they entered service.

Despite careful planning, when war broke out, the conflict put a huge strain on Britain’s railway industry. As well as building the ambulance trains, railway companies supplied stretchers, guns, shells and vehicles. At the same time, thousands of workers were leaving to join the army. Nonetheless, many rail workers were barred from joining up—it was essential work for the war effort. Overstretched and under attack, the French railways struggled to cope with evacuating injured soldiers. In December 1914, British companies were ordered to build continental ambulance trains to be used in France.

As war went on, the government demanded more and more from Britain’s railway companies. By 1918, the railway companies had built 20 ambulance trains for use in Britain and 31 for the continent. The continental trains were carefully designed to carry more passengers over longer distances.

A Crowd Awaits the Arrival of an Ambulance Train,
Liverpool Station, London

Life Aboard an Ambulance Train

For patients, a journey on an ambulance train could be a blessed relief or a nightmare. Patients were initially relieved to be on board and moving away from the front. Many hoped for a ‘Blighty wound’, which would mean a welcome return home.

However, travelling on an ambulance train could be an uncomfortable or even painful experience. The small bunks were claustrophobic, and men with broken bones felt every jolt of the train. Filled with men straight from the trenches, the trains quickly became filthy and smelly.

Kate Luard, Nurse, and Owen Willis, Orderly

The Workers

In 1915 I learned that it is possible to work for twenty-four hours or more at a stretch... and to use my strength in helping others rather than merely in playing games. 

Paul Cadbury, orderly

Each ambulance train could carry 500 passengers and was run by up to 50 staff: 47 orderlies, 3 medical officers, 3 nurses, 3 cooks.  The  orderlies, fetched water, changed dressings, fed the passengers, and cleaned the train. 

Working on an ambulance train was difficult, dirty and dangerous. For every new load of passengers, there was a long list of jobs to be done. Staff regularly worked through the night to make sure their patients were given the care they needed. They ran the constant risk of catching lice or infectious diseases, and of being bombed.

Arrival

The unloading of an ambulance train is always a sad sight... They crawl along, moving very slowly. They are bowed and listless . . . These men left England fine, alert, young soldiers.

The Times (25 January 1915)

The first ambulance trains were greeted with crowds, red carpets, brass bands and local dignitaries. But pomp and pride were quickly replaced by sorrow as battered and broken men were unloaded onto the platforms.

Ambulance trains didn’t just bring the injured home to Britain—they also brought the horror of the conflict home to the public. As the number of terribly wounded men arriving in Britain grew, railway stations became a place for the public to help in any way they could. 

Source: The National Railway Museum, York