Kate Luard vividly describes her experiences on the ambulance trains of World War One in her first book ‘Diary of a Nursing Sister on the Western Front 1914-1915’. She arrived in Le Havre on 20 August 1914 and after a frustrating wait she received orders on 13 September to go by train to Le Mans where she arrived two days later.
Ambulance trains in WW1 were a crucial part of the medical evacuation. They transported the wounded from the casualty clearing stations in France and Belgium to base hospitals near one of the channel ports or directly to a port for transfer to a hospital ship.
In 1914 some trains were composed of old French trucks and often the wounded lay on straw without heating and conditions were primitive. Others were French passenger trains which were later fitted out as mobile hospitals with operating theatres, bunk beds and a full complement of QAIMNS [Queen Alexandra’s Imperial Military Nursing Service] nurses, RAMC [Royal Army Medical Corps] doctors and surgeons and RAMC medical orderlies. Emergency operations would be performed despite the movement of the train, the cramped conditions and poor lighting. Hospital carriages were also manufactured and fitted out in England to be shipped to France.
In the early trains there was often lack of passage between the coaches and it was necessary for a nursing sister to pass from coach to coach along the outside footboards, whether the train was in motion or not, carrying a load of dressings, medicines etc on her back in order to tend to the wounded.
Sunday, 20 September. The fighting for these concrete entrenched positions of the Germans behind Rheims has been so terrific since last Sunday that the number of casualties has been enormous. Three trains full of wounded, numbering altogether 1,175 cases, have been dressed at the station today. The train I was put to had 510 cases. You boarded a cattle-truck, armed with a tray of dressings and a pail; the men were lying on straw; had been in trains for several days; most had only been dressed once, and many were gangrenous. If you found one urgently needed amputation or operation, or was likely to die, you called an M.O. [Medical Officer] to have him taken off the train for Hospital. No one grumbled or made any fuss. The platform was soon packed with stretchers with all the bad cases waiting patiently to be taken to Hospital. The Blackwatch and Camerons were almost unrecognisable in their rags. The staple dressing is tincture of iodine; you don’t attempt anything but swabbing with lysol, and then gauze dipped in iodine. They were nearly all shrapnel shell wounds—more ghastly than anything I have ever seen or smelt; the Mauser wounds of the Boer War were pin pricks compared with them.
M. and I are now—9 p.m.—in charge of a train of 141 (with an M.O. and two orderlies) for St Nazaire; we jump out at the stations and see to them, and the orderlies and people on the station feed them: we have the worst cases next to us.
Thursday, 24 September 3pm—Taking 480 sick and wounded down to St Nazaire, with a junior staff nurse, one M.O., and two orderlies. The train is miles long—not corridor or ambulance; they have straw to lie on the floors and stretchers. The M.O. had been two nights in the train already on the way down from the front (four miles from the guns), and we joined on to him with a lot of hospital cases sent down to the base. I’ve been collecting the worst ones into carriages near ours all the way down when we stop. Got my haversack lined with jaconet and filled with cut-dressings, very convenient, as you have both hands free. We continually stop at little stations, so you can get to a good many of them, and we get quite expert at clawing along the footboards ….
On Sunday, September 27th Kate is told that she is for permanent duty on an ambulance train (equipped):
Tuesday, October 13th. At last I am on the train and have just unpacked. There is an army sister and two reserve, a Major, O.C. [Officer Commanding], and two junior officers.
We each have a bunk to ourselves, with a proper mattress, pillow, and blankets: a table and a seat at one end, lots of racks and hooks, and a lovely little washing-house leading out of the bunk, shared by the two Sisters.
The train is one-third mile long. The ward beds are lovely: broad and soft with lovely pillow-cases and soft thick blankets; any amount of dressings and surgical equipment, and a big kitchen, steward’s store, and three orderlies to each wagon.
Medical officers, nurses and orderlies cared for the wounded. The medical staff consisted of three RAMC medical officers including a Commanding Officer, usually a major, and two lieutenants, a nursing staff of three or four complemented by 40 RAMC other ranks and NCOs [non commissioned officers]. The ambulance trains were up to 1/3 mile long and included wards, pharmacies, operating ward, kitchens and staff accommodation.
An average load was 400-500 patients with a large number in critical condition. Often they were transferred to the train still in full uniform in shocking condition caked with mud and blood and owing to the cramped conditions their uniforms had to be cut away. Many journeys were long such as the one from Braisne to Rouen taking at least 2 ½ days. There were deaths on all journeys. The nurses’ workload was heavy and they worked under dangerous conditions with the barest necessities and no comforts.
Staff worked regularly through the night and came under constant risk of catching lice or infectious diseases and of being targets of enemy fire. They dealt with horrific wounds caused by shell and shrapnel—loss of limbs, abdominal wounds, severe head injuries and loss of sight, gangrene, frostbite, trench foot, rheumatism, pneumonia & bronchitis and the aftermath of gas attacks as well as infectious diseases such as enteritis, dysentery, typhoid fever, diphtheria, scarlet fever, measles, mumps and influenza; also the psychological effects of war and shell shock. Medical staff and soldiers were plagued with lice which caused much discomfort and which transmitted diseases such as trench fever. Without constant heating intense cold had to be endured.
Tuesday, 20 October, 6pm. Just leaving Rouen for Boulogne. We have been busy today getting the train ready, stocking dressings etc. All the 500 blankets are sent to be fumigated after each journey, and 500 others drawn instead. And well they may be; one of the difficulties is the lively conditions of the men’s shirts and trousers (with worse than fleas) [lice] when they come from the trenches in the same clothes they’ve worn for five weeks or more. You can’t wonder we made tracks for a bath at Rouen.
Sunday, 25 October (Ypres).—Couldn’t write last night: the only thing was to try and forget it all. It has been an absolute hell of a journey. … We had 368; a good 200 were dangerously and seriously wounded, perhaps more. The compound fractured femurs were put up with rifles and pick-handles for splints, padded with bits of kilts and straw; nearly all the men had more than one wound—some had ten..
They were bleeding faster than we could cope with; and the agony of getting them off the stretchers and on to the top bunks is something to forget. All night and without a break till we got back to Boulogne we grappled with them and some were not dressed when we got into Boulogne. The head cases were delirious, and trying to get out of the window, and we were giving strychnine and morphia all round. The outstanding shining thing that hit you in the eye all through was the universal silent pluck of all the men; they stuck it all without a whine or complaint or even a comment.
It took from 4 – 10pm to unload our bad cases and get them into hospitals on motor ambulances; they lay in rows on their stretchers on the platform waiting their turn without a grumble. There have been so many hundreds brought down this week that they had suddenly to clear four hotels for hospitals.
We are now in the filthiest of sidings, and the smell of the burning of our heaps of filthy débris off the train is enough to make you sick.
Sunday, 15 November. The cold on this train is going to be rather a problem. Our quarters are not heated, but we have “made” (i.e. acquired, looted) a very small oil-stove which faintly warms the corridor, but you can imagine how no amount of coats or clothes keeps you warm in a railway carriage in winter. A smart walk out of doors would do it – I did walk round the train for an hour in the dark and slime in the siding yesterday evening, but it is not a cheering form of exercise. Today it is pouring cats and dogs, awful for loading the sick.
Tuesday, 17 November. 7 A.M. Our load is a heavy and anxious one – 344; we shall be glad to get them safely somewhere. The amputations, fractures, and lung cases stand these journeys very badly.
Thursday, 19 November. Spent the day in a wilderness of railway lines at Sotteville—sharp frost; horizon bounded by fog. This afternoon raw, wet, snowing, slush outside. If it is so deadly cold on this unheated train, what do they do in the trenches with practically the same equipment they came out with in August?
Thursday, November 26th. Loaded up with Indians—full load—bad cases—quite a heavy day; back to Boulogne and unloaded by 9 p.m. and off again at 11.30 p.m. Three hospital ships were waiting this side to cross by daylight. They can’t cross now by night because of enemy torpedoes. So all the hospitals were full again, and the trains were taking their loads on to Rouen and Havre.
Thursday, December 10th. Left for Bailleul at 8 a.m. Arrived at 2 p.m. Loaded up in the rain, wounded and sick—full load. They were men wounded last night, very muddy and trenchy; said the train was like heaven! One showed us a fearsome piece of shell which killed his chum next to him. There is a good deal of dysentery about, and rheumatism.
Tuesday, December 15th. We were unloaded last night at 9.30, and reported ready to go up again at 11 p.m., but they didn’t move us till 5 a.m. Went to same place as yesterday, and cleared the Clearing Hospitals again; some badly wounded, with wounds exposed and splints padded with straw as in the Ypres days
The mud and floods are appalling. The Scotch regiments have lost their shoes and spats and wade barefoot in the water-logged trenches. This is a true fact.
Hospital siding in Etaples, France
Monday, December 21st.—got to Boulogne early this morning. Weather appallingly cold and no chauffage. On way up to Choques, where we will take up Indians again. How utterly miserable Indians must be in this eternal wet and cold.
Wednesday, 23rd.—we loaded up at Lillers late on Monday night with one of the worst loads we have ever taken, half Indians and half British. It was a dark wet night, and the loading people were half-way up to their knees in black mud, and we didn’t finish loading till 2 a.m., and we were hard at it trying to stop haemorrhage &c. ….
Xmas day, 11 a.m.—on way up again to Béthune. Sharp white frost, fog becoming denser as we get nearer Belgium. Everyone on the train has had a card from the King and Queen in a special envelope with the Royal Arms in red on it. And this is the message—“with our best wishes for Christmas, 1914. May God protect you and bring you home safe. MARY R. GEORGE R.I.”
12 Midnight.—still on the road. We had a very festive Xmas dinner, going to the wards which were in the charge of nursing orderlies between the courses.
Saturday, December 26th. The V.A.D. [Voluntary Aid Detachment] here brought a present to every man on the train this morning, and to the orderlies. They had 25,000 to distribute, cigarette cases, writing-cases, books, pouches, &c. The men were frightfully pleased, it was so unexpected.
January 3rd.—A sergeant we took down to Havre yesterday told me of his battalion’s very heavy losses. He said out of the 1400 of all ranks he came out with, there are now only 5 sergeants, 1 officer, and 72 men left.
Sunday, January 24th, 5 a.m., Versailles.—They’ve had a pretty good night most of them. If you see any compartment with men showing signs of being near the end of their tether, with bad feet and long hours on the train, you only have to say cheerfully, “How are you getting on in this dug-out?” for every man to brighten visibly and a burst of wit and merriment follows.
Sunday, January 31st. The French instruction books have come, and I am going to start the French class for the men on the train; they are very keen to learn, chiefly, I think, to make a little more running with the French girls at various stopping places.
Wednesday, February 3rd. Beyond Rouen, the honeysuckle is in leaf, the catkins are out, and the woods are full of buds. What a difference it will make when spring comes. On this side it is all canals, bogs, and pollards, and the eternal mud.
Tuesday, February 9th. …… we have had every kind of infectious disease to nurse in this war, except smallpox. The Infectious Ward is one of mine, and we’ve had enteric, scarlet fever, measles, mumps and diphtheria.
Monday, March 15th. 4.30 p.m.—Just time for a scrawl. The train is packed with wounded, most of whom are now dead asleep from exhaustion. The clearing hospitals get 800 in at a time, many with no dressings on. I have a boy of 22 with both legs off. He is dazed and white, and wants shifting very often. Forty of them were shelled in their billets.
Wednesday, March 31st. We actually acquired an engine [Sotteville] and got a move on at 4 o’clock this morning, and are now well on the way north. Just got out where we stopped by a fascinating winding river, and got some brave marsh-marigolds.
5 p.m.—Just getting into Boulogne.
In Boulogne on April 2nd Kate received movement orders “to proceed forthwith to report to the O.C. [Officer Commanding] of No. 4 Field Ambulance for duty”.
The ambulance trains not only transported the wounded to hospitals in the base area but from these to the evacuation ports where hospital ships conveyed them to Britain. Most hospital ships were requisitioned and converted passenger liners. Despite the excellent nursing and medical care many patients died because of their severe wounds. The risk of torpedoes and mines as the ships crossed the channel was very real.
Operating Theatre at 41st Casualty Clearing Station 1918 by J Hodgson Lobley 
Gommécourt trench 1917
