Life on an Ambulance Train in 1914

This is the first extract from 'Reminiscent Sketches' and is a brief, but vivid account of life on one of the early ambulance trains. All these extracts are written by trained nurses, most of them members of the 'Regular' Queen Alexandra's Imperial Military Nursing Service.

LIFE ON AN AMBULANCE TRAIN IN 1914 by M. Phillips

The ambulance trains in 1914 were not the trains of joy and beauty which they developed into later in the war, anything that ran on wheels and could be attached to an engine was utilized in the early days of 1914. They were chiefly trains composed of wagons bearing the legend “Hommes 40, Chevaux (en long) 8,” so that the staff of No.7 Ambulance train thought itself lucky. The front half of the train consisted of the 1^st class French “couchette” or carriages fitted with sleeping berths, so that at least the patients had a comfortable couch on which to lie; the rear half of the train simply consisted of ordinary third class railway carriages with their hard narrow wooden seats, but these were always reserved so far as possible for “sitting cases.”

All the coaches on the train were entirely unconnected, and those nurses who have only carried out nursing duties on trains whose entire length it was possible to walk without once going outside, can hardly realize the inconvenience, sometimes amusing but at most times vexatious, to which one was put in 1914. Quite a number of teapots and cups and saucers came to an untimely end from the habit which the batman had of placing those articles on the footboard of the train when bringing the early morning tea; then, leaving them while he went back for something which he had forgotten – the train would start with a jerk – and “goodbye-ee” to tea for that morning. The greatest inconvenience of all was the difficulty of attending to the patients, and the vexation of spirit occasioned when you had settled up one coachful of aching weary men, by the knowledge that there were still hundreds to be attended to. Climbing from coach to coach by way of the footboard was a practice absolutely forbidden, though, like more than one other rule, it was more honoured in the breach than in the observance. Frequently this means of passing from one coach to another was an absolute necessity in the interests of the patients. No doubt a French stationmaster in a little out of the way French village will probably remember to this day the sight that met his amazed gaze in the very early hours of a beautiful September morning in 1914. An ambulance train was flying through his station with an English sister clinging like a limpet to the side of the train. She had, I remember, a moment of horror when the train dashed into the station, wondering whether the platform would be higher than the footboard; but luckily all French country platforms are very low. After the Battle of the Aisne the train was garaged for a few days in a little village called Crepy-en-Valois; while the British armies moved north. Movement of troops took place only at night, and whether the whole British Army passed through this little town, we, of course, did not know; but at least one member of the staff of the train will never forget the continuous, apparently endless, procession of men, horses and guns. The men never spoke a word, either to us or among themselves. The only noise was the low, deep rumble of the procession itself, seeming to fill the autumn night with fear and foreboding.

On the night of October 31 to November 1, No.7 Ambulance train had the luck, or ill-luck, to be on Ypres station – the date that marks the beginning of the wonderful first Battle of Ypres. The train received its baptism of fire that night – poor train – it could not have run away had it wanted to; the engine had returned down the line for water. A neighbouring improvised train loaded with minor wounded had better luck and secured an engine from somewhere, and, as it pulled out of the station into safety, I expect poor old No.7 heaved a small sigh of envy, although I like to think that even had a second engine been handy, No.7 would have stuck to her post; but with what feelings of great thankfulness and relief she hooked herself on to her engine the next morning, and gave him a graphic description of those horrid shells which had made holes in her sides and broken her windows, while he was away at Hazebrouck imbibing water.

After the establishment of Casualty Clearing Stations the work on ambulance trains was not nearly so arduous. In the first days patients were entrained with all the dirt, mud, and blood of battle on them. All were fully dressed. Many had not had their boots off their feet for five or six weeks. Only those who have experienced it, know what it means to undress a heavy man, badly wounded and lying on the narrow seat of a railway carriage. Never before had it bee brought home to me what a quantity of clothes a man wears. On many an occasion it has seemed a task worthy of a Hercules, but when the deed was done, the man undressed and in soft dry pyjamas, even though maybe there had only been time to sponge his face, hands, and feet – then indeed labour had its reward – the gratitude, the patience, the infinite endurance of the men was a constant marvel to behold. One felt that the utmost one could do was but a drop in the ocean of their discomfort, and their gratitude for that drop was sometimes more than one could bear. When the Casualty Clearing Stations were established the men came on board washed, fed, and in pyjamas; so that we did not have to begin on the bedrock of things as it were, but had only to carry on the good work already commenced. It was with very mingled feelings that the writer gave up that particular kind of “good work” after three months’ service on the train; three very happy months where such minor personal discomforts as difficulties with one’s laundry, and even sometimes with one’s personal cleanliness, were all lost sight of in the feeling that one was doing real work.

Reminiscent Sketches

About a year ago, I managed to get hold of a copy of a book called 'Reminiscent Sketches, 1914 to 1919', published by John Bale, Sons and Danielsson in 1922. It's a small collection of personal accounts written by members of Queen Alexandra's Imperial Military Nursing Service, and gives great insight into day to day life during the war; in hospital, on trains and boats, and in many different locations. Over the next few weeks I'll include a selection of them here - they make a very enjoyable read for anyone with even a small interest in nursing during the Great War.

Back to Heilly again for a moment...

A recent comment on my previous post about Heilly Station Cemetery led me to return there for a moment. In the past, I've done some research on my local war memorials in Sussex, and about five years ago, long before my first visit to Heilly, I started a website to record the results - it's at:

Unchanged By Time

I added snippets of poetry to many of the pages, choosing each one to reflect some aspect of the man's life or service, and for the front page of the website I chose some lines which I had seen used in the 'In Memoriam' column of a local newspaper:

And now they are sleeping their long last sleep,
Their graves I may never see;
But some gentle hand in that distant land
May scatter some flowers for me.

I thought it summed up the feelings of families all over the world, particularly those who would never have the money or opportunity to visit the last resting place of their loved ones.
On my first visit to Heilly, a year or so later, the weather was stormy. The sky was ever-changing, with huge black clouds and heavy squalls accompanied by thunder and lightning. My daughter and I ran into the cemetery, and sat on the seat by the screen wall, sheltering until the current blast of rain had passed. Suddenly it stopped, and the sun broke through, shedding shards of light across the cemetery. I suppose my natural instinct was to follow the sun, and walked up to where it picked out vividly two or three headstones. As I stood in front of them I realised that I was looking at MY inscription [or a version of it] on the grave of Sapper David Simpson of the Australian Engineers:



in that distant land/will some kind hand/lay a flower/on his grave for me

I've visited a lot of cemeteries, but that day I did feel a very emotional attachment to Sapper Simpson, and hoped that for the sake of the family who left that message, I would remember on future visits to the cemetery to honour their wish.

Assistant Nurse

When I wrote last month about 'The Difference Between' the various grades of nurse, I put:

The grade of 'Assistant Nurse' became increasingly common, and these were women who had previously undertaken formal nurse training, but not to a standard sufficient to join Queen Alexandra's Imperial Nursing Service Reserve or the Territorial Force Nursing Service. They were women who had completed a set training as a fever nurse, a children's nurse, in a women's hospital, or as a midwife. Their pay fell half way between that of the VAD and the trained Staff Nurse, and they were likely to be given more responsibility in line with their training and experience.

While transcribing the war diary of the Matron-in-Chief with the British Expeditionary Force, I've now come across entries which show that this changed in 1918. The diary entry states:

V.A.D. Assistant Nurses: Received from Director General Medical Services copy of Army Council Instruction 214 of 1918 relating to the promotion of V.A.D. Members to the rank of
Assistant Nurses. Before being promoted they must have served two years, must be in possession of the Red Efficiency Stripe and must be recommended by the Officer Commanding and Matron. The letters "A.N." are to be worn on the apron in indoor uniform and on the shoulder straps on outdoor uniform.

The Red Efficiency Stripe was awarded to VAD members who had completed 13 months continuous service in a military hospital under the control of the War Office, and who had satisfactory confidential reports by their Matron and Commanding Officer. After another years' service they could qualify for a second stripe. These stripes should not be confused with the white stripes often seen on the sleeves of VADs, which signified length of service alone, not that they had necessarily reached a high standard in their work [although of course they might have done!].

Who has the truth?

I’ve got used to reading a fair amount of inaccuracy about nursing during the Great War. Well, that’s not quite true – I almost expect it now, although I’ve never got USED to it – and when I come across bits that are blatant rubbish, they really rankle, especially if they’re written by academics, as these are the accounts that may well be digested and then repeated as the absolute truth.

As a member of the Royal College of Nursing, the newsletter of the associated History of Nursing Society dropped through my letter box last week. Inside was a short article written by a prominent member of the nursing profession, titled ‘Who has the truth?’ In it she expresses regret that the health care professions are failing to keep much of their paperwork and written archive material, and also of the transient nature of electronic sources which are too easily deleted, a process that she describes as ‘throwing our “truth" away’. She makes a comparison with the diaries and letters retained by Vera Brittain, which allowed her, nearly two decades later, to ‘write an accurate testimony’ of her life as a VAD during the Great War.

How accurate those original diaries were, and whether we are throwing out history away now, any more than we did a hundred years ago, are both subjects which could be long debated, but I was interested in one paragraph, in which she writes:

A Testament of Youth kept us fixed to our TV screens in the 1970s as we followed this amazing woman through her Voluntary Aided Detachment (VAD) experiences in the First World War. Through her memory, supported by diaries, letters and “artefacts”, she gives subsequent generations insight into the experience of living through those times. She lost her fiancé, her brother, their friends and many, many patients. She nursed on the Western Front, in Malta and everywhere in between in field ambulances and hospital trains.

That last sentence made me sit up and take notice, and, very concerned that my memory might be failing me in advancing years, it had me running to grab my copies of “Testament of Youth” and “Chronicle of Youth.” Vera Brittain certainly served on the Western Front and in Malta, but where was this ‘everywhere in between’ that is mentioned. No VAD member working under the auspices of the War Office [as Brittain was] ever served in a casualty clearing station, let alone a field ambulance, their service being restricted to military hospitals only, and military ambulance trains carried a staff of three trained nurses, not VADs. So did VB make any claims in her writing to working in field ambulances or on ambulance trains? Did the filmed version of “Testament of Youth” use artistic licence to include scenes that could not be substantiated by original sources? Or has the writer included that sentence to make more interesting reading without having intimate knowledge of her subject? I’d be glad for any further insights into this.

‘Who has the truth?’

Marriage

I often see queries asking whether nurses serving with the British Army during the Great War could be married. The answer is, of course, rather a complicated one. Prior to the Great War, women training to be nurses were required to be either single, or widowed, although it was not too difficult for a married woman with no dependants and living apart from her husband to stretch the truth. But in general, nursing, like teaching, was a profession of single women, and they were required to resign their appointments on marriage.

At the outbreak of war, all the members Queen Alexandra’s Imperial Military Nursing Service, numbering just over 300, were single, and although there were a few members of the Territorial Force Nursing Service who were married, this had occurred during their civil employment, and on mobilisation many chose to resign, or were retained for home service only. The intention of the Matron-in-Chief at the War Office was to keep the services staffed by single women, but this proved to be impossible. By the middle of 1915 the shortage of trained nurses, both at home and abroad was acute, and it was obvious that it would be necessary to retain the services of women upon marriage, unless they wished to resign. At first they were sent home from France, for ‘Home Service only’, and Maud McCarthy, the Matron-in-Chief with the British Expeditionary Force thought that she would never get hard work and devotion to duty from women who had more than nursing on their minds. She was particularly opposed to married nurses and VADs who wished to work in France because their husbands were serving there, and described them as women with ‘their baggage at the Front.’ As the manpower shortage increased, marriage was looked upon rather more benevolently, and it was eventually agreed that as long as a woman informed the military authorities of her forthcoming marriage; observed all the correct formalities, and had good reports, she would be allowed to continue to serve, and remain overseas if she wished. Any woman who went on leave, and married in England without permission, would find herself looked on unfavourably, and probably refused permission to return to France, especially if she was a VAD, who were more easily recruited and not in such short supply.

Reading through the war diary of the Matron-in-Chief, it often seems as though there were many marriages happening at extremely short notice – the sort of ‘spur of the moment’ occurrences that wartime is famous for. I suspect that the phrase ‘marry in haste, repent at leisure’ haunted many a nurse throughout her life! And if the British military nursing authorities seemed very straight-laced about marriage, they could not compare with the Australians. Until the middle of 1917, a member of the Australian Army Nursing Service did not even have to bother to resign on marriage, as at that point her contract was automatically terminated, and she was returned to the UK, to continue her life as she chose – but of course, eventually the shortage of trained nurses changed that as well, and marriage became a necessary wartime evil for the AANS.

After the war, as the demobilization of nurses working on the QAIMNS Reserve was complete, the service returned to one of single women, a situation which lasted until the 1970s. Even married members of the Territorial Force Nursing Service, who returned to their civil employment, were not allowed to remain in the service – what was useful in wartime was found unacceptable in peacetime.

The Difference Between...

Having written about the WO399 run of files at The National Archives, it's worth mentioning that included among them are some records relating to untrained nurses; VADs, Special Probationers and Assistant Nurses who worked in military hospitals [rather than Red Cross hospitals] during the war. Why some files have been retained isn't clear, but all those that I've come across refer to women who were employed in Territorial General Hospitals in the United Kingdom - some of them later went on to work abroad, but most started off serving alongside the Territorial Force Nursing Service. So although a long shot, it's always worth checking for an untrained nurse in the WO399 index at The National Archives. The 'VAD' is familiar, but what were the differences between her, and the less common Special Military Probationer [SMP] and the 'Assistant Nurse'?

VADs were employed by the British Red Cross Society through their headquarters at Devonshire House, and the majority worked in Red Cross and auxiliary hospitals, but if employed in British military hospitals at home or abroad, they would work under the control of the War Office, and take their day to day orders from the Matron of their hospital or her deputies.

Special Military Probationers were also untrained, and the terms and conditions of their contracts were virtually identical to those of the VAD. But they were employed by the War Office specifically to work in military hospitals, and had no connection with the BRCS. There is some evidence to suggest that the War Office did some 'cherry picking' - during the 3 month initial training undertaken by VADs in civil hospitals from 1915 onwards, some of the most able were offered contracts as SMPs, and the result was the perception that these 'War Probationers' formed a more elite group than the VADs. In fact, except for the difference in employers, their contracts and conditions of service were identical, but there always remained the inference that those employed by the War Office were superior as nurses.

As the need for trained nurses grew during the war, shortages began to cause great difficulties, particularly overseas, where the need for skilled nurses in forward areas resulted in Base hospitals becoming top heavy with VADs, and seriously lacking in experienced women. The grade of 'Assistant Nurse' became increasingly common, and these were women who had previously undertaken formal nurse training, but not to a standard sufficient to join Queen Alexandra's Imperial Nursing Service Reserve or the Territorial Force Nursing Service. They were women who had completed a set training as a fever nurse, a children's nurse, in a women's hospital, or as a midwife. Their pay fell half way between that of the VAD and the trained Staff Nurse, and they were likely to be given more responsibility in line with their training and experience.

As the war progressed, there were certainly VADs who became very skilled nurses and took on great responsibility. Many had hopes that their wartime work would qualify them for a reduced training as a nurse after the war, and that was a question that caused great unrest and discussion within the nursing profession. And was definitely not to be...