The Rise of Rail-Power in War and Conquest, 1833-1914

by Edwin A. Pratt

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.