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.