Читать книгу The Rise of Rail-Power in War and Conquest, 1833-1914 - Edwin A. Pratt - Страница 15

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According to statistics which have been compiled in relation to wars alike in ancient and in modern times, for every ten men among the armies in the field who have died from wounds received in battle there have been from thirty-five to forty who died from sickness or disease. Writing in the Journal des Sciences Militaires, Dr. Morache, a surgeon in the French Army, has said that while the total number of deaths among combatants taking part in the Crimean War was 95,000, no fewer than 70,000 were due to typhus, scurvy, cholera or other diseases. In the Italian campaign of 1859 the French lost 5,498 men, of whom 2,500 died from sickness. On the conclusion of the Russo-Turkish War the Russians had 51,000 of their troops sick, the ravages of typhus having been especially severe.

These conditions have been materially aggravated by the gathering together of great numbers of sick and wounded into overcrowded hospitals situate on or near to the theatre of war and destined inevitably to become hot-beds of disease and pestilence far more dangerous to human life, under these conditions, than even the most deadly weapons which the art of war had invented for use on the battle-field itself.

Nor was it the armies alone that suffered. Returning troops spread the seeds of disease among the civil population, causing epidemics that lingered, in some instances, for several years and carried off many thousands of non-combatants, in addition to the great number of victims among the combatants themselves. In a volume of 866 pages, published by Dr. E. Gurlt, under the title of "Zur Geschichte der Internationellen und Freiwilligen Krankenpflege im Kriege" (Leipzig, 1873), will be found many terrible details concerning the ravages in France, Germany and Austria of the typhus which Napoleon's troops brought back with them on the occasion of their disastrous retreat from Russia.

The most practicable means of mitigating, if not of avoiding, these various evils is to be found in the prompt removal of the sick and wounded from the theatre of war, and their distribution in smaller units, not simply among a group of neighbouring towns, but over an area extending to considerable distances inland. The adoption of this remedy only became possible, however, with a provision of adequate rail facilities, and even then many years were to elapse before an efficient system of railway ambulance transport was finally evolved.

The objects which the use of the railway in these directions was to attain were alike humanitarian and strategical.

To the sick and wounded among the troops, prompt removal and widespread distribution among hospitals in the interior meant (1) that they avoided the risks to which they would have been subjected in the aforesaid overcrowded and pestilential hospitals near the fighting line, where slight injuries might readily develop dangerous symptoms, and contagious disease complete the conditions leading to a fatal issue; (2) that, apart from these considerations, it would be possible to give them a greater degree of individual attention if they were distributed among a large number of hospitals away from the scene of the fighting; (3) that more conservative methods of surgery became practicable when operations of a kind not to be attempted either on the battle-field or in temporary hospitals (from which the inmates might have to be suddenly removed, owing to some change in the strategical position) could be delayed until the sufferer's arrival at some hospital in the interior, where better appliances and better facilities would be available, and where, after the operation, the patient would be able to remain undisturbed until he was cured; (4) that these improved conditions might more especially permit of the avoidance of amputations otherwise imperatively necessary; and (5) that, on the whole, the wounded soldier was afforded a better chance of effecting a speedy recovery and of saving both life and limb than would be possible if railways were not available.

To the army in the field the innovation meant that with the speedy removal of the sick and wounded it would be relieved of the great source of embarrassment caused by the presence and dependence upon it of so many inefficients;[16] depôt and intermediate hospitals could be reduced to the smallest proportions, and would thus occasion less inconvenience if, owing to a retreat or a change in the strategical position, they were brought within the sphere of military operations; with the delegation of so many of the sick and wounded to the care of civil practitioners in the interior, fewer of the divisional, brigade and regimental medical officers would require to be detached from the marching column; a smaller supplementary medical staff would suffice; a considerable reduction could be effected in the stocks of ambulance supplies kept on hand at the front; while important strategical advantages would be gained through (1) the greater freedom of movement which the army would secure; (2) the decreased risk of the number of efficients being reduced through the outbreak of epidemics; and (3) the prospect of a large proportion of the sick and wounded being enabled to rejoin the fighting force on their making a speedy recovery from their illness or their wounds.

The earliest occasion on which the railway was made use of for the conveyance of sick and wounded from a scene of actual hostilities to the rear was on the occasion of the Crimean War, when the little military line between Balaklava and the camp before Sebastopol, of which an account will be given in Chapter XV, was so employed. The facilities afforded were, however, of the most primitive character. Only the wagons used for the transport of supplies to the front—wagons, that is to say, little better than those known as "contractors' trucks"—were available, and there were no means of adapting them to the conveyance of sufferers who could not be moved otherwise than in a recumbent position. Sitting-up cases could, therefore, alone be carried; but what was to develop into a revolution in the conditions of warfare was thus introduced, all the same.

In the Italian war of 1859 both the French and the Austrians made use of the railways for the withdrawal of their sick and wounded, and, in his "Souvenir de Solferino," Jean Henri Dumant, the "Father" of the Red Cross Movement, speaks of the transportation of wounded from Brescia to Milan by train to the extent of about 1,000 a night. No arrangements for their comfort on the journey had been made in advance, and the changes in the military situation were so rapid, when hostilities broke out, that no special facilities could be provided then. All that was done was to lay down straw on the floor of the goods or cattle trucks used for the conveyance of some of the more serious cases. The remainder travelled in ordinary third-class carriages, and their sufferings on the journey, before they reached the long and narrow sheds put up along the railway lines at Milan or elsewhere to serve as temporary hospitals, must often have been very great. They may, nevertheless, have escaped the fate of those who died, not from their wounds, but from the fevers quickly generated in the overcrowded hospitals at the front, where there was, besides, a general deficiency of ambulance requirements of all kinds. The good resulting from the removal by train is, indeed, said to have been "immense."

These experiences in the campaign of 1859 led to a recommendation being made in the following year by a German medical authority, Dr. E. Gurlt,[17] that railway vehicles should be specially prepared for the conveyance of the sick and wounded in time of war. The plan which he himself suggested for adoption was the placing of the sufferers in hammocks suspended from hooks driven into the roof of the goods van or carriage employed, mattresses being first put on the hammocks, when necessary. By this means, he suggested, the sufferers would travel much more comfortably than when seated in the ordinary passenger carriages, or when lying on straw in the goods wagons or cattle trucks.

Dr. Gurlt's pamphlet served the good purpose of drawing much attention to the subject, and his proposals were duly subjected to the test of experiment. They failed, however, on two grounds,—(1) because the roofs of the goods vans, designed for shelter only, were not sufficiently strong to bear the weight of a number of men carried in the way suggested; and (2) because the motion of the train caused the hammocks to come into frequent contact with the sides of the wagon, to the serious discomfort of the occupants.

In November of the same year (1860) the Prussian War Minister, von Roon, appointed a Commission to enquire into the whole subject of the care of the sick and wounded in time of war, and the question of transport by rail was among the various matters considered. As a result of these investigations, the Minister issued, on July 1, 1861, an order to the effect that in future the less seriously wounded should travel in ordinary first, second or third-class carriages, according to the degree of comfort they required, care being taken to let them have corner seats; while for those who were seriously ill, or badly wounded, there were to be provided sacks of straw having three canvas loops on each side for the insertion of poles by means of which the sacks and the sufferers lying upon them could be readily lifted in or out of the goods wagons set apart for their conveyance. In these wagons they were to be placed on the floor in such a way that each wagon would accommodate either seven or eight. In the event of a deficiency of sacks, loose straw was to be used instead. The door on one side of the truck was to be left open for ventilation. A doctor and attendants were to accompany each train, and they were to have a supply of bandages, medicines and appliances. Of the last-mentioned a list of five articles was appended as obligatory. The medical officer was to visit the wagons during the stoppages, and the attendants on duty in the wagons were to carry flags so that, when necessary, they could signal both for the train to pull up and for the doctor to come to the sufferers.

This was as far as Prussia had got by 1861, when the arrangements stated were regarded as quite sufficient to meet the requirements of the situation. Real progress was to come, rather, from the other side of the Atlantic.

In the early days of the War of Secession (1861-65) the arrangements for the conveyance by rail of the sick and wounded from the battle-fields of the Eastern States to the hospitals in the large cities were still distinctly primitive. Those who could sit up in the ordinary cars were conveyed in them. Those who could not sit up, or would be injured by so doing, were carried to the railway, by hand, on the mattresses or stretchers they had occupied in the hospitals to which they had first been taken. At the station the mattresses were placed on thick layers of straw or hay strewn over the floors of the freight cars in which supplies had been brought to the front. Large window spaces were cut in the sides or ends of the cars to provide for ventilation. On some occasions, when hay or straw was not available, pine boughs or leaves were used instead. As only the floor space was occupied no more than about ten patients could be carried comfortably in each car, though as many as twenty were occasionally crowded in. The wide doors of the box cars readily permitted of the beds being lifted in or out. Medical officers, with supplies, accompanied each train. On arrival at New York, Washington, Philadelphia, Harrisburg, or other destination, the sufferers were taken out and carried, still on the same mattresses or stretchers, to the hospitals there.

Large numbers of sick or wounded were conveyed by rail under one or other of these conditions, and the work was done with great expedition. Between the morning of June 12 and the evening of June 14, 1863, over 9,000 wounded, victims of the Federal disaster at Chancellorsville, were taken by the single-track Aquia Creek railroad from Aquia Creek to Washington. Many even of the severely wounded declared they had suffered no inconvenience from the journey. After the battle of Gettysburg, July 1-3, 1863, more than 15,000 wounded had been sent by rail from the field hospitals to Baltimore, New York, Harrisburg or Philadelphia by July 22. An even more rapid distribution was effected after the battles of the Wilderness and Spottsylvania when, with a few exceptions, the transfer to the hospitals in the cities mentioned was effected in the course of a few days. Following on the battle of Olustree (February 20, 1864), the serious cases were removed on the Mobile Railway by freight cars bedded with pine boughs, palmetto leaves and a small quantity of straw, each patient having a blanket, in addition.

As an improvement on these methods of transport, the plan was adopted of fixing rows of upright wooden posts, connecting floor and ceiling, on each side of a car as supports for two or three tiers of rough wooden bunks, a central gangway through the car being left. In this way the available space in the car was much better utilised than with the straw-on-floor system. Next, in place of the bunks, came an arrangement by which the stretchers whereon the patients lay could be securely lashed to the uprights; while this was followed, in turn, by the insertion of wooden pegs into the uprights and the placing on them of large and strong india-rubber rings into which the handles of the stretchers could readily be slipped, and so suspended. The first car so arranged came into use in March, 1863.

Meanwhile the Philadelphia Railroad Company had, at the end of 1862, fitted up an ambulance car on the principle of a sleeping car, but so planned that the stretchers on which the sufferers lay could be made to slide in or out of the wooden supports. This particular car was capable of accommodating fifty-one patients, in addition to a seat at each end for an attendant. Other innovations introduced on the car were (1) a stove at which soups could be warmed or tea made; (2) a water tank, and (3) a locker.

What the introducers of these improvements mainly prided themselves upon was the fact that the patient could remain, throughout the entire journey from field hospital to destination, on the stretcher he had been placed on at the start. The adoption of this principle necessitated, however, uniformity in the dimensions of the stretchers in order that these could always be accommodated on the ambulance-car fittings.

The next important development was reached when the ambulance car, run in connection with ordinary trains, and used for exceptionally severe cases, was succeeded by the ambulance train. Here came further innovations, the nine or ten "ward-cars," of which such a train mainly consisted in the Eastern States, being supplemented by others fitted up as dispensary and store-room, kitchen, and quarters for surgeon, attendants, and staff of train, besides carrying all necessary appliances and provisions for the journey.

What was now specially aimed at was to make the train as close an approach to an actual hospital on wheels as circumstances would permit. "At present," wrote the Medical Director of the Department of Washington, "the sick and wounded are transferred in cars ill-adapted for the purpose and with difficulty spared from the other pressing demands; and lives are lost on the route not infrequently which, in all probability, might be saved by a more comfortable and easy method of transportation." The train he caused to be constructed consisted of ten ward-cars, one car for the surgeon and attendants, one as a dispensary and store-room, and one as a kitchen, etc. The ward-cars, arranged on an improved principle, each accommodated thirty recumbent and twenty or thirty seated patients. The train was to run regularly on the Orange and Alexandria Railroad between the theatre of war and the base hospitals at Alexandria and Washington. It was either to supplement or to supersede the freight cars with their bedding of straw, hay or leaves. If only from the point of view of the inadequate supply of rolling stock, a car fitted up to accommodate fifty or sixty patients offered an obvious advantage, in the speedy removal and distribution of sick and wounded, over a car, without fittings, in which the floor space alone could be utilised.

Several complete trains of the type stated were soon running on the Orange and Alexandria Railroad, within the Union lines, and the hospital train thus became an established institution in modern warfare.

It was, however, in connection with the chief army in the West, the Army of the Cumberland, operating under General George H. Thomas, that the useful purposes which could be served by hospital trains became most conspicuous.

The need for them in the West was even greater than in the East, because the distances to be covered were greater and lay, also, to a considerable extent, in enemy country.

In the fall of 1863 and the winter of 1864, as narrated in the "Medical and Surgical History of the War of the Rebellion," the chief army of the West was concentrated principally along the line of railroads leading from Nashville, Tennessee, to the South-west, viâ Chattanooga, Tenn., and onwards towards Atlanta, Georgia. At the outset the sick and wounded who could travel in ordinary passenger cars to points in the North were so taken. Severe cases had to remain in the nearest available hospital depôt. In addition to the discomfort suffered by the former in having to travel in cars not suited to invalids, they were liable to frequent and prolonged delays on the single-track lines by reason of the constant passing of supply trains proceeding to the front; and not unfrequently the detentions were at points where nothing could be obtained for feeding the sufferers or making them comfortable, while even if rations could be drawn the train afforded no means of cooking them. So it was resolved to have a train which would be the equivalent of an ambulating, self-contained hospital, capable of carrying both recumbent and sitting-up patients and supplying all their wants on the journey.

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.

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.