1. RAILWAY STATION UNITS
     Until the first week of September, 1914, no Sisters worked actually on Ambulance Trains, but where ever there were Hospitals, and Nursing Staff, Sisters were appointed for duty at the Railway Station. Their duties were to meet all trains bringing the wounded down from the Front, to do what dressings they could while the train was in the Station, and to take round hot drinks and light food. The very urgent cases were taken off the trains, and sent to the Hospitals. On all Stations, the French Red Cross usually had a unit of a similar kind, and they were very helpful. There was both a day staff and a night staff at all these Station units, so that no wounded should pass through without receiving some attention. Between the arrival of the trains, the Sisters were well occupied in making sufficient quantities of soup etc., and in the preparation of dressings.
     In August 1914, there was a unit at Rouen Station, in September there was one at Nantes, Le Mans, and Villeneuve St. Georges, and in October, one at Versailles and one for a little over 3 weeks at Angers.
     At Villeneuve St. Georges a depot was formed at which Sisters were collected for duty on Ambulance Trains. At the other Stations the work was carried out by the Nursing Staff from the nearest Hospital. At Versailles, there were three stations, and the Nurses from No.4 General Hospital were detailed in small groups to perform this duty. They were accommodated at the Hospital and relieved by others every few days. The heaviest station work was done in September at Le Mans, where Nurses were required for constant day and night duty, and where the trains, usually cattle trucks, some with and some without straw, arrived at all hours with wounded in an exhausted condition, and who had received little or no attention and for whom so much was needed to be done in so little time. Very valuable work was done by these Station units during September particularly, but with the advent of Sisters on Ambulance Trains, the character of the work altered, and Trained Nurses were no longer required. From early in 1915, the Station work was undertaken by the British Red Cross Society, and carried out almost exclusively by Voluntary Aid Detachment members, who had already in 1914, established a Station unit in a wagon on a siding at Boulogne.
     The work at this time consisted largely in the providing of smokes, refreshments, and extra supplies for the trains as they arrived, and particularly affected troop trains, and emergency Ambulance Trains.
     Though this report bears on the work of the Military Nursing Services and refers to the period of August to December 1914, it is fitting to place on record here, how much this particular branch of Red Cross Work, which rapidly developed, was appreciated by the Nursing Services. The Ambulance Train Sisters were, not only able to procure the clothing and smokes they so much required for the patients, but many other necessities, and in course of time, even luxuries. By these Station units, they themselves were provided with books to read, and games, and the V.A.D.’s most kindly undertook to look after the personal laundry of the staff of the trains, both Medical Officers and Sisters. As the trains passed through, they received the packages, sent or took them into the town, and when returned paid for them, ticketed them, and stored them until the train passed through again.

2. THE FIRST TRIAL JOURNEYS OF NURSING SISTERS ON AMBULANCE TRAINS
     Early in September, it was decided, that for the sake of the patients, Sisters should be placed on Ambulance Trains to see what could be done by them, in assisting to improve generally the conditions under which the wounded were carried to the Base. For various reasons, it had not previously been considered advisable or practical for Nurses to be detailed for this duty. Some of the trains on which the wounded travelled were composed of old French trucks with straw on the floor, others were French passenger trains, which were being converted by the British into Ambulance Trains. There were no supplies as regards nourishment for the wounded.
     On about September 7th, a nurse was detailed to join one of these trains at Le Mans, and on arrival at St. Nazaire to return by passenger train. There was a medical Officer in charge of the train, on which there were about 115 wounded British Officers and 100 other ranks. On this journey, at various points along the line, the Nurse was able to procure from the civilian people, fresh eggs, milk, and other necessities which enabled her to minister to the wants of the patients. On his return to Le Mans, the Medical Officer reported that the services of a Sister on the train were of inestimable value, and so it came about that on all trains arriving at Le Mans, 2 Sisters joined them for duty until its arrival at the Base when they returned by passenger trains. They were usually absent for about 42 hours, the journey to St. Nazaire taking about 24 hours. On September 16th 2 Nurses were sent on No.7 Ambulance Train to railhead for the first time.

3. THE APPOINTMENT OF A REGULAR NURSING STAFF ON THE 1ST 12 TRAINS
     From the Rest Station at Villeneuve St. Georges, Sisters were detailed during September 1914 for regular duty on the first 7 Ambulance Trains. For the first journey, 2 Sisters only were on each train, but as re-enforcements called up from Rouen, Versailles and other Bases arrived at Villeneuve, the Staff on each was made up to 4. In October No.8 and 9 Ambulance Trains were put into action and staffed with Sisters, and in December, both 11 and 12 Ambulance Trains were working. Nos.8 and 9 Trains were different from the preceding trains, insomuch as they were largely composed of vans, and not passenger coaches. No.11 Ambulance Train was one fitted up by the British Red Cross Society, and Order of St. John of Jerusalem. It was composed of 3rd Class carriages, which had been so adapted that it was able to carry a large number of stretcher cases. It also was a non-communicating train. The Nursing Staff of this train was composed of 11 British Red Cross trained Nurses, but the Sister-in-Charge was a member of the Regular Service. No.12 Train was the first ‘Khaki’ train to arrive from England. All coaches communicated and it was most beautifully fitted up. The Nursing Staff of 3 for this train was appointed from England.

4. DISPOSITION OF TRAINS
     The arrangements as regards disposition of coaches on all the first Ambulance Trains was the same. One half of the train was set apart for what was known as ‘Lying cases’, and each compartment of the coach had 4 couchettes. In the middle of the train was the Dispensary, the coach for the Staff and the kitchens. The remaining portion of the train was ordinary 2nd or 3rd Class accommodation, where the so-called ‘walking cases’ were taken in.
     The Sisters’ quarters on the first 10 Ambulance Trains were in the Staff coach differing a little in position on each train. The arrangements on one of the trains, and one which on the whole was the best as regards the Sisters, was as follows:-
At each end of the Staff coach was a separate compartment of 4 couchettes, divided off from the central compartments. These latter compartments were occupied by the 3 Medical Officers, and each of the end ones by two Sisters, so that they had the advantage of being quite private in their quarters. The one drawback was the lavatory accommodation which was in the middle of the coach.
     The Restaurant car attached to the Staff coach was so divided that a part was used for the Mess Room, and the other part for the Dispensary. No.7 Ambulance Train was a little different from the others in that part was reserved for French troops. 4 coaches were given up to them, and there was a French Major and 6 orderlies, who were assisted by the British Sisters when necessary.

5. DISTRIBUTION OF WORK
     The Medical Staff consisted of 3 officers – the C.O., usually a Major, and two Lieutenants. The Nursing Staff of 4 on the train was usually distributed as follows. the Sister-in-Charge took the supervision of the whole train, was responsible for the Officers’ coach, and as much as possible helped where it was most needed. Two of the other Sisters were responsible for the ‘lying cases’ of other ranks, and the fourth was responsible for all the ‘sitting cases’. Two of the staff always remained on duty throughout the night, and frequently the whole four did so.

6. CONDITIONS UNDER WHICH THE WORK WAS CARRIED OUT
     The insurmountable difficulty in connection with these early trains was the lack of any communication whatsoever between the coaches. Had it been possible to staff these trains with more Sisters the work would have been less difficult. As it was, it was necessary for the Sisters to pass from coach to coach whether the train was in motion or not, and usually carrying a load on their backs. The load was a bag, as aseptic as possible under the conditions, which contained dressings, medicaments etc. and in addition, during the night, when going from one coach to another, the Sisters had to carry hurricane lamps suspended from their arms. It is needless to say to what dangers they were exposed in the fulfilling of their duties; but it will be easily conceived by those who know the irregular speed at which Ambulance Trains travelled in 1914. Though it was known to be against the express wish of the Train Commanders that Sisters should change coaches while the train was in motion, under the circumstances, it was not possible for them to do otherwise, knowing as they did that men each coach might perhaps be dying for want of attention.

7. CONDITION OF PATIENTS
     The average load carried on a train was 400 to 500 patients, more than half of whom were quite helpless and a large number in a critical condition. The furthest railhead was Braisne. At Braisne there was British Casualty Clearing Station in the Church, and the Nurses from the trains, while waiting to load, would help at this C.C.S. The cases were exceedingly bad ones, brought there practically as they had been found on the field of battle. All that could be done for them at the C.C.S. was to dress their wounds and give them feeds. The patients taken on to the train were wearing full uniform in a shocking condition of filth. Owing to the cramped and difficult accommodation, it was almost impossible to undress the patients in the ordinary way, and consequently there was a great sacrifice of clothing. Where under normal conditions the clothes could have been removed and saved, for the sake of the patient they had to be cut away, and were of no further use.

8. SUPPLIES
     One of the first difficulties to be overcome was the question of supplies. The only issues were Blankets, Rations and Tinned Milk!! The want of comforts was doubly felt on account of the length of the journeys, the one from Braisne to Rouen taking at least 2½ days. This matter was very quickly taken in hand, and on arrival at Rouen even in the first journey, a certain amount of Red Cross Stores including pyjamas were obtained. By degrees, many comforts were procured and conveniences of every kind necessary for adequate nursing of the men. In those early days, in addition to the lack of commodities, the character of the cases made the work of the Sisters of an exceedingly trying nature. On all journeys there were six or more deaths.

9. TEMPORARY AMBULANCE TRAINS
     The Sisters not only attended to their own patients, but all along the line gave help where it was needed. It has been known that when they passed a Temporary Ambulance Train, the patients on it would call out to them, and if they were stationary for a short time, the Sisters would board the Train and do everything possible for them in the time.
The Temporary Ambulance Trains were formed of ordinary French rolling stock, and were staffed by Medical Officers and orderlies only. They were put into action only when the number of wounded was too great to be brought down by the normal trains. They were supposed to carry very minor cases only, but it frequently occurred during the journey that some cases, considered slight, developed grave symptoms. As far as possible these cases were taken off at the nearest Hospital centre.


10. IMPROVEMENT IN CONDITIONS OF PATIENTS AND REDUCTION OF STAFF
     One of the results of the presence of Sisters at Casualty Clearing Stations, which they joined in October and November 1914, was the very noticeable improvement in the condition of patients taken on to trains. In consequence, the work of the Ambulance Train Sisters was to some extent reduced. It was still further reduced by the gradual connection of some of these coaches, and this, of course, made the work of a less anxious nature. And again, the improvements in supplies and appliances, the replacement of couchettes by supported stretchers, did away with many difficulties which made it possible to reduce the Nursing Staff on all trains to the original war establishment i.e. a total of 3, a Sister and 2 Staff Nurses.

     Great work was accomplished by the Sisters on Ambulance Trains in 1914. They worked under enormous difficulties, and with, for themselves, the barest necessities, and no comforts. The loads carried were heavy, and the journeys long. They worked too under dangerous conditions and there is no doubt that there were many examples of brave conduct which passed unrecorded. The one example which was brought to the notice of the Commander-in-Chief was that of the conduct of the Nursing Staff of No.7 Ambulance Train under exceptional circumstances. The Commanding Officer reported that ‘on the night of November 1-2nd 1914, this train was entraining seriously wounded cases at Ypres, standing alongside an improvised train for the ‘lightly’ wounded in the Railway Station of this place. At 12.15 a.m. on November 2nd, the enemy commenced without warning to shell the station and town, using high explosive and shrapnel shell. This continued for an hour, one British soldier was killed in the Station square, and others wounded.’
The condition of the improvised train and No.7 Ambulance Train showed the accuracy of their fire. Although the 4 Nursing Sisters realised perfectly well that the next shell might mean the complete wrecking of the trains and station, they remained calm and collected, asking for orders, and continued attending to, and dressing the wounded already received on the train.

     The work of the Sisters on Ambulance Trains was brought to the notice of Her Majesty Queen Alexandra who in the first week of December, most graciously sent to all of them a gift of tea and sweets, which they truly appreciated, not only as an addition to their store cupboard but as a recognition of the services they were rendering to their country.

E. M. McCarthy
Matron-in-Chief
British Troops in France and Flanders
Headquarters – 13. 7. 1919