During World War II, as the number of wounded soldiers needing transport back to the United States rose, the Army developed and managed a complex network of hospital trains that brought the injured from ports across the country to care facilities near their homes.
Now primarily a remnant of the past (at least in the U.S.), hospital trains were an essential element of American military operations for nearly a century. They were first used during the Civil War, then again during World War I. But during World War II, that familiarity didn’t save the Army and the Office of the Surgeon General from needing to undertake a laborious revamp of the system that nearly stretched to the end of the conflict in 1945.
During World War II, as the number of wounded soldiers needing transport back to the United States rose, the Army developed and managed a complex network of hospital trains that brought the injured from ports across the country to care facilities near their homes.
Now primarily a remnant of the past (at least in the U.S.), hospital trains were an essential element of American military operations for nearly a century. They were first used during the Civil War, then again during World War I. But during World War II, that familiarity didn’t save the Army and the Office of the Surgeon General from needing to undertake a laborious revamp of the system that nearly stretched to the end of the conflict in 1945.
In the aftermath of World War I, officials drafted plans for new hospital trains, suggesting the Army use converted commercial rail cars to move the wounded, according to an official 1956 history of the Army Medical Department’s domestic operations during World War II. Planning escalated in 1939, as fighting broke out in Europe and U.S. involvement in the conflict appeared likely. Work was still underway when the U.S. entered the war after the bombing of Pearl Harbor in December 1941. As the wounded began to return to the States in 1942, domestic transport was conducted almost entirely by commercial train; at the time, the Army had just six functioning hospital train cars, and aircraft were typically reserved for other essential wartime tasks.
"Seventy-eight years after the end of World War II, hospital trains are an oft-forgotten chapter in U.S. military history. America’s wounded soldiers have returned home by airplane for decades, with the popularity and speed of air travel for both military and civilian purposes ensuring the transportation method’s dominance. Trains, the mechanical advent that made it possible to settle the West, were once iconic American symbols. Now, as their role in popular culture shifts and the number of surviving World War II veterans dwindles, the fleeting years of domestic hospital trains are disappearing much like a train in the night.
Initially, military officers coordinated with commercial railroad companies to carry injured troops from America’s ports to hospitals around the country on Pullman sleeping cars. The arrangement was far from ideal. It could take as long as two weeks to secure space on commercial trains once requested, leading to delays in treatment and potential overcrowding in hospitals. Even when trains were available, staff struggled to load patients onto cars and navigate the narrow aisles.
The setup “presented some problems because obviously [the commercial cars] weren’t designed for that” purpose, says Robert S. Gillespie, a Houston-based nephrologist and amateur historian who runs RailwaySurgery.org, a website dedicated to the history of hospital trains. “Getting patients in and out was a problem. Sometimes they would bring them [in] through the windows.”"
 Interior view of a kitchen car in a U.S. Army Medical Department hospital train. |
These [diner cars] often failed to meet Army standards of sanitation, carried no foods for special diets, served meals that became monotonous, provided midmorning or midafternoon nourishment for patients only at high costs, were not open for meals for attendants on night duty, and were often uncoupled at junction points, leaving both patients and attendants without meals for the remainder of their journeys.
As these and other complications arose, the Army debated whether to convert existing Pullman cars or create purpose-built hospital cars from scratch. Eventually, officials settled on the latter, deploying four purpose-built cars: ward, ward dressing, kitchen, and unit cars. The unit car, which in 1944 replaced an earlier design of the same name, proved popular due its flexibility. These cars functioned as self-contained units, with berths for the wounded, a kitchen and a dressing room. They could be detached from military trains and attached to commercial trains without compromising the care of the patients on board.
Hospital trains had their work cut out for them. In January 1943, the number of wounded soldiers returning stateside for medical care was 2,475; in May 1945, that figure peaked at 57,030, according to Smith. By the end of World War II, writes Gillespie on his website, the U.S. Army owned 202 unit cars, 80 ward cars, 38 ward dressing cars and 60 kitchen cars—380 cars in total.
“How do you manage [so many] things moving across the system?” Marble asks. “You have to have some kind of management system to get the right people to the right place, and they did it without computers.”
"Staffing the trains proved to be almost as difficult as constructing and transporting them. The number of service members assigned to each train was based on the number of patients; directives specifying the exact ratios required changed throughout the war. This guidance was often considered misguided by the people charged with putting it into effect, and in some cases, it was outright ignored. Stark General Hospital in Charleston, South Carolina, provides a helpful frame of reference for staff size: The 17 hospital trains it sent out between March 1944 and May 1945 “each carried an average of 190 patients and had assigned as attendants an average of 6 doctors, 3 administrative officers, 5 nurses and 57 enlisted men,” Smith reported."
"The doctors in charge of medical care were relatively junior, because the patients on board were stable enough to travel by train, says Marble. Emergency procedures would have been few and far between. Performing surgery on a swaying, moving train could be done but was a last resort. Instead, officers managed supplies, medical paperwork and other logistics, while enlisted men served as medics, cooks and similarly essential personnel. Nurses managed the day-to-day care of patients and passed orders on to the medics.
Inside, quarters were tight. The unit car, for example, measured 84.5 feet long. It carried up to 36 patients in three-tiered bunks and contained a kitchen; a receiving room that functioned as a pharmacy, administrative office and emergency operating room; two bathrooms; and a storage area. As cramped as the trains might have been, they at least weren’t hot and stuffy. The Office of the Surgeon General mandated that they be built with air conditioning—a luxury at the time."
"While the experiences of those who worked on or were cared for on these trains have received little attention in the ample canon of World War II film and literature, contemporary newspaper accounts offer a sense of what their lives were like."
In August 1942, an Atlanta Journal writer traveling aboard what he hailed as the Army’s “first hospital train” described the debarkation at Lawson General Hospital in Georgia:
Stretcher cases were removed from the coaches through a double door, which opened wide enough to allow their exit. More than half the men were able to walk out. Several faces looked old with recent illness. One man glanced anxiously around, meanwhile whistling nervously under his breath. A paratrooper hobbled down with a bum ankle. As he stood at the top of the train steps, he glanced down the short flight with probably more apprehension than he showed as he made a jump.
“From midnight to dawn, the patients aboard the hospital cars slept little,” wrote the Pittsburgh Post-Gazette in March 1944, when its reporter traveled on a hospital train similarly bound for Lawson. “Most of them were from Georgia, and they knew they were nearing home.” One man dreamed of hunting for rabbits when he got home, while another envisioned his future girlfriend.
A year later, the Vermont-based Burlington Free Press profiled Marion Taggart, a local Red Cross worker assigned to a hospital train. She described the extent of the soldiers’ injuries and how some used humor to mask their pain and longing for home.
One young man Taggart encountered lost both of his legs while serving in France. When she passed his bunk, he playfully asked her, “How about going for a walk?”
Taggart recalled, “Every time I came through his car after that, I’d kid him, too. I’d say to him, ‘I wish you’d keep your feet out of the aisle. I’m falling all over them.’ Then he’d laugh.”
"Interior view of a hospital train car, 1944"
Hospital trains also transported soldiers suffering from post-traumatic stress disorder and other mental illnesses. In December 1943, a reporter for the Associated Press recounted his trip aboard “a swanky hospital train carrying the armless and legless, the blind, and the partially insane” from Staten Island to Ohio. Staff followed now-outdated protocol when treating psychiatric cases, installing heavy mesh wire screens on hospital car windows to stop patients from trying to escape and employing sedation and restraints, wrote Smith in the 1956 history.
“Doctors told us that about 30 percent of the returning cases are mental,” the AP reported. “Some are curable. … Some of the boys were bitter about the war and what it had done to them. Others felt lucky to be alive. Some of them wanted to recover and return to the Army. Many were mad at the Germans and at the atrocities Nazi soldiers committed.”
Though wartime newspaper accounts tended to focus on the wounded rather than the men and women working on hospital trains, Taggart’s profile offers a glimpse of the long hours and lack of personal space these individuals faced.
“There are no union hours on hospital trains,” the Free Press noted. “From 7 a.m. until the last patient is quieted down for the night, about 10, the Red Cross worker is busy. Trains shuttle all over the country. Her sleeping quarters are in a corner of a ward car, curtained off with a sheet. No fancy dressing rooms are provided.” Once, Taggart told the newspaper, she was so busy she didn’t bathe for nine days.
For soldiers and staff alike, the cramped conditions probably fostered both boredom and kinship. “There might have been a lot of camaraderie on board, because during the daytime, the beds could fold up and they could make tables out of them,” Gillespie says. “I imagine the people that weren’t too sick were sitting around talking [and] playing cards.”
While the patients were all generally considered stable enough to travel, the toll of their physical and emotional injuries would have cast a pall at times. “The amount of trauma they experienced must have been staggering and not really addressed in the way that we would look at it today,” Gillespie says.
My father’s recollections of his time in the Army suggested as much. Herbert J. Stern served on domestic hospital trains after graduating from Officer Candidate School in 1944. He occasionally shared some of his experiences with me before his death in 2002 at age 84.
On one of his trips, my father encountered a patient known to be a psychiatric concern. The man got ahold of a glass container—a Coke bottle, perhaps, or a glass vial for plasma—and broke it with the intent of harming others, himself or both. A tense standoff ensued, but staff managed to calm the soldier down before anyone got hurt.
Another story my father told centered on a burly, stoic patient who lost one of his legs in battle. When the man reached his destination, he made his way onto the platform on crutches and greeted his wife and young son. The child pushed his dad’s bathrobe aside to hug his legs, then looked up and asked where the other leg was. The man broke down, sobbing into his wife’s embrace. This was the tale my father recounted most often.
An Army hospital train during the Korean War
Hospital trains’ turbulent mixture of boredom, camaraderie, humor, and emotional trauma wouldn’t have been evident to the civilians who showed up to welcome them. Though trains’movements weren’t publicized ahead of time, the Post-Gazette noted that “the news always gets around,” perhaps via “a local train dispatcher’s gossip with a neighbor.”
The Pittsburgh newspaper recounted how a local resident “was stretching curtains in her frame cottage when she saw [a] hospital train pull into the station. She bustled out to a little shed adjoining her home and loaded a cart with old magazines, playing cards and apples. She wheeled the cart up to the train and handed the articles over to medical corpsmen for distribution among patients. … Officers who frequently make trips on the hospital trains always look forward to [her] visits. She’s as punctual as the trains themselves.”
A 1945 report in the Montana Standard detailed how members of the American Women'sVoluntary Services rushed into action on short notice when they knew a train was coming, noting, “Within 30 minutes, they filled 300 cardboard containers with ice cold milk, capped the bottles and delivered them to the depot as the train pulled in.”
A hospital train car on view at the U.S. Army Medical Department Museum in San Antonio
The Army continued to run hospital trains in the months immediately following the war’s end as the rest of the wounded returned home. When escalating tensions between the Soviet Union and the U.S. threatened to spark another global conflict, the Army kept these trains on hand, Marble says. Though hospital trains weren’t used domestically during the Korean War, the Army sent some abroad. By the time the U.S. entered the Vietnam War in 1965, however, wounded soldiers were transported chiefly by airplane.
The now-defunct hospital trains were sold to private parties, including museums and the Ringling Bros. and Barnum & Bailey circus, or destroyed as scrap. Today, a handful of World War II hospital cars are on display at such institutions as the U.S. Army Medical Department Museum in San Antonio and the Northwest Railway Museum in Snoqualmie, Washington.
Reflecting on the transportation method’s significance in August 1942, when the Army’s first hospital train delivered patients to a hospital in Georgia, the Atlanta Journal perhaps summarized it best. As reporter Frank Daniel wrote, “The … train moved on to Fort Bragg, mechanized mercy in a world of mechanized war.”
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