The First World War saw casualties on an unprecedented scale. How were the railways used to get injured servicemen to safety—and treat them on the way?
What is an ambulance train?
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.
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.
A great responsibility rest[s] upon the Railway Companies.
Meeting of the Railway Executive Committee (August 1915)
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.
Imagine a hospital as big as King’s College Hospital all
packed into a train...
Kate Luard, nurse
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.
Ambulance trains at home and in Europe
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.
What was life like on board an ambulance train?
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
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.
EXPLORE THE TRAIN
Ambulance train design evolved through the war, and each train was better than the last.
Official photographs show immaculate carriages with pristine linen and even flowers—but this was a far cry from the reality once an ambulance train was in service.
Who worked on an ambulance train?
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. The majority of these were orderlies, who fetched water, changed dressings, fed the passengers, and cleaned the train.
There would also be three medical officers, who checked each soldier onto the train and decided their treatment, and two or three nurses, who gave patients skilled medical care. In addition to medical staff, each train had chefs working in the kitchen car to keep everybody fed.
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.
Meet the crew
War comes home
It was at railway stations that the British public got closest to the war. There they gathered to wave off sons, husbands and brothers who had joined the army—and went back to see them return on ambulance trains.
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.
[The] people... I felt... more sorry for were the Germans... when they got back to hospital... [t]hey wouldn’t have anyone to come and sympathise with them.
Alfred Pope Russell, orderly
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 towards safety.
The end of the First World War didn’t signal the end of ambulance trains—they were used during the Second World War and subsequent conflicts, right up to the end of the Cold War.
Header image courtesy of the Willis family.
Find out more about railways and the First World War
- National Railway Museum blog, Ambulance trains
- BBC iWonder, How WWI changed military medicine
- Network Rail, WWI and the railway
- The National Archives, Railways and the mobilisation for war in 1914
- Imperial War Museum, Transport and supply during the First World War
- British Library, Wounding and medicine in the First World War
- BBC Two, Railwaymen in front-line warfare