Ready to speed to any accessible port on telegraphic or telephonic orders from the Admiralty Medical Transport Department are Royal Naval Ambulance trains. They are always on the move, picking up wounded or sick officers and bluejackets at Scotch and English ports, bearing them to stations where there are great hospitals, to relieve the coast institutions likely to receive wounded in the event of a North Sea Fleet engagement. These grey-painted trains, with the Red Cross and the "R.N." on each coach, are the outcome of a great deal of study, and they are now run with remarkable efficiency. No millionaire could receive better care when wounded or ill than do John Bull's naval officers and seamen.

Sir James Porter, the head of this service, whose pen sends a train to all parts of England and Scotland, has a loyal staff, which devotes remarkable zeal to their share of the work. They take pride in making a time-record in disembarkation and entraining of patients. Naval surgeons at each railroad station watch the work of the stretcher-bearers to be sure that every cot has the gentlest possible handling when being carried from the train to the ambulance which is to take the patient to the local hospital.

The "stepping" of the stretcher-bearers seems a trifling thing, but it is surprising to note the attention given to this point in the first days of the war. Dr. A. V. Elder, staff surgeon of the Royal Naval Volunteer Reserve and the right bower of Sir James Porter, practised for weeks the carrying of patients, getting into cots to ascertain the most comfortable step for the wounded. Prizes were even given to the men who carried a pail of water on a cot and reached a fixed point with the most liquid in the receptacle. By this means the best method of "stepping off" was evolved. There are hundreds of these stretcher-bearers—volunteers without compensation—who now perform the task so well that it attracts even the attention of the casual observer. The cot-bearers are doing their "bit"; they get to the railroad stations at all times to meet the ambulance trains, and often have to wait hours and give up their usual business.

It may also be interesting to some that in those August days the Naval Ambulance trains were not much more than a series of box-cars. The present cot—an ingenious arrangement by naval surgeons—was used in the naval hospitals and aboard the warships. But the fixtures on the train for carrying this cot were far from perfection. The patient was tossed about by the movement of the train, and it was realised that in the event of hundreds of patients being carried something would have to be discovered to steady the beds. Dr. Elder invented a clip-spring to be attached to the cot and the side of the coach. It held the bed, and had sufficient "give" to make it steady. In lieu of the box-cars, there are now coaches of the American type, with windows and great sliding doors which permit of easy ingress or egress.

The railroad officials have listened to the bidding of the Medical Transport Officer of the Admiralty and have attached some of the best locomotives to these trains, usually of twelve coaches. Even when there has not been an action, and the trains are bearing mostly medical cases, all passenger and freight traffic gives way to the ambulance trains. If the surgeon in charge of the train decides that he has a case which should be hastened to a hospital he wires ahead, so that when he reaches that point the surgeon or the agent there is on hand with an ambulance to rush the patient to a local hospital.

Where it is possible, red tape has been eliminated. The cots in which the patients are carried are sent with the patient from a hospital or ship, and the patient is only taken out when he arrives at the hospital of his destination. For the cot bearing the patient, the train surgeon receives in exchange a clean cot. This cot has been laundered and fumigated, and is kept on the train so that when only patients are entrained the surgeon gives a cot for each case taken aboard. Hence the surgeon always has the same number of cots on his train, and through this means paper and pencil work is avoided. The patient's clothes are packed in a bag, and all the valuables of one batch of patients are sealed up in one envelope, which is receipted for by the surgeon of the hospital to which the patients are sent.

No patient is transferred from a hospital in a critical condition if it can be avoided. But sometimes this is necessary, as it was following the Jutland Battle. Then the most serious cases were held in the hospitals; while, where it was possible, hundreds of cases were despatched to institutions at other ports.

The route of these ambulance trains may differ every round trip. One ambulance train may go to the North of Scotland, while the next one will only go to Glasgow or Edinburgh if there is no call further north. The wonderful organisation not only undertakes to relieve hospitals, but also to ship the patients to institutions unlikely to be suddenly burdened with many cases; and consideration is also given as to where the patient can receive the best attention, such as in southern hospitals.

Fleet-Surgeon A. Stanley Nance is the Medical Transport Officer for Scotland. He is ever on the alert for what is going on in the hospitals in his territory. In the event of a great sea conflict, he receives orders from Sir James Porter and information concerning all the trains which are by that time racing to the ports nearest to the scene of the engagement.

In London, the Medical Transport Officer can place his finger on a railroad map at any time and tell within a mile or so where his trains are. If by any possible chance they are delayed he receives word from the train surgeons.

Knowing the probability of further engagements in the North Sea, quite a number of wealthy private individuals have interested themselves in the hospitals on the East Coast from north to south. And these persons take especial interest in the trains, many of them making it a point to be at the railroad station whenever a Royal Naval Ambulance train pulls in. What with sick men and accidents, the trains now and again may have a full quota of patients without there having been a fleet engagement. In war time no man who is not physically fit is kept aboard ship, for he may not take up another man's place without being able to perform his work.

Exigencies of war have caused the speedy transformation of buildings in many parts of England into hospitals. There also are institutions constructed in temporary form, architecturally not works of art, but wonderfully useful. The surgeons at these latter places have wrought marvels in obtaining good light in the wards and operating-rooms, and creating a comfortable atmosphere in the exteriorly dingy places.

The starting-point or headquarters of the ambulance trains is in the South, and when they plough their way North they carry no patients. The complement of these trains is from forty to fifty hands, and they all look upon the train as a ship, and use sailors' terms. It is the "Sick Bay Express."