The Whistlers' Room

by Alverdes, Paul; Creighton, Basil; Mayhew, Emily

  The Whistlers’ Room

  A Novel

  Paul Alverdes

  Translated by Basil Creighton

  Introduction by Emily Mayhew

  DEDICATED TO

  HANS CAROSSA

  INTRODUCTION

  Pointner, Kollin, Benjamin and Harry. The inhabitants of The Whistlers’ Room. Four young men who have been soldiers fighting in the Great War. Each wounded in the throat, saved, and sent back to Germany. As a group confined by their casualty to a single hospital ward, sharing a prolonged, painful and uncertain journey towards recovery. In Paul Alverdes’ remarkable novel of war and wounding, we will meet each of these souls individually, and hear their stories, and we will also come to understand the room—the world—that they inhabit, and the community they have made there. Alverdes will help us listen carefully to them, because the “Whistlers” speak in tones and a language that is so quiet and fragile, it is all too easily missed in the hubbub of war. But once we can hear it—hear them, we can never quite forget the sound.

  In a review from 1930, the year of the publication of The Whistlers’ Room in translation in Britain, The Spectator magazine said that it was “impossible to exaggerate the delicacy and originality of this piece of work.” Additionally, it has a very particular power that comes from the writing in the novel being deeply rooted in a precise medical reality. Alverdes was himself wounded in the throat, and it is clear that he paid very close attention to both his treatment and the treatment of others with a similar or more severe form of the same casualty. So the novel stands not just as an original and compelling artistic representation, it is also a valuable supplement to our understanding of the medical history of both the war and the period, both in Britain and in Germany. Weapons wounded just the same whichever side of the front they were fired from, and medics of all the combatant nations grew practised and expert at treating their consequences, as we shall see. In Britain, there were over sixty thousand soldiers who experienced damage to their face, jaw, throat and neck as a result of artillery shell fragments or high-velocity rifle bullets. Precise equivalent German casualty statistics are not easily determined but as all other forms of casualty were comparable with British figures or even higher, it is safe to assume that there were plenty of other patients for Alverdes to study alongside him on the ward.

  One significant reason why these kinds of wounds were so prevalent was the nature of the evolution of war itself by 1914. In trench warfare, only the combatants’ head and neck were exposed to the enemy, their bodies being protected by the trench itself. Metal helmets safeguarded the head (German helmets were considered to be the most effective at this) but the flesh of the face and the front of the neck was unprotected and therefore vulnerable, especially as troops charged forward into storms of shrapnel and artillery fragments. But they could also be inflicted at any time during a soldier’s forward service at the front, not just during times of actual fighting in battle, particularly by sniper fire. Snipers were expertly trained and well-equipped with the latest high-velocity rifles which enabled them to fire an accurate and powerful shot from great distances. One of the first surgeons working to repair facial injuries in a hospital on the French coast, Charles Valadier, asked his patients why so many of them came to him after being hit by sniper fire. Snipers, he was told, always targeted what they thought was human flesh, rather than helmets or movement, because flesh reflected light in a different way to any other material, even when camouflaged in mud. Snipers learned to look for this particular reflection and to set it as their target, hence the great number of injuries to the flesh of the face and throat. Both sides used snipers throughout the war, and they were feared and despised in equal measure. It is notable that in the novel that, even though his own throat wound was inflicted by artillery shell fragments, Pointner has an English sniper’s cap that he took from the battlefield where he was wounded, and that he refuses to give up no matter what (and that he keeps in the cupboard by his bed on the shelf where his chamber pot is stored).

  From the outset, Alverdes takes care to emphasise that the Whistlers have been in their room for “a long while”—at least a year since their original wounding. By any measure, this is a long time to remain in hospital and it is a revealing detail about the complex nature of these wounds. Although it was initially assumed that someone shot in the throat would die, the military medical system quickly learned that this was not the case. Provided blood and debris from the wound could be kept away from the windpipe during evacuation (usually achieved by keeping the casualty sitting up rather than lying down on the stretcher as he was borne away by the bearers), these wounds were not immediately life-threatening in the same way that abdominal, head or chest wounds were. By 1916, throat and facial casualties could find themselves in the “lightly wounded” category for evacuation priorities. It was only in the next stage of medical treatment, in hospitals such as the one in the novel, that medical staff came to understand that there was never anything light about wounds to the face and throat. These injuries could be every bit as lethal as a chest or abdominal wound but they took life in their own way, slowly but surely, over months or years.

  There were many factors at work in this process, but The Whistlers’ Room is centred around one in particular where, as Alverdes puts it with his gentle precision: “the process of healing overshot its mark.” The Whistlers are not just suffering from the same wound, but from the same physical complication that has confounded their recovery. Surgery has repaired the initial trauma but the repaired wound has had an abnormal healing response. Scar tissue, forming inside the windpipe itself, has grown larger than the original insult, narrowing the passage and thus changing the volume of air that they can inhale and exhale. Their ability to breathe normally is restricted to the point at which they are threatened with suffocation. The medical term for the condition is tracheal stricture (sometimes tracheal stenosis) and it is primarily seen today following radiation therapy or tracheostomy or prolonged intubation—where a breathing tube has been inserted in the windpipe to maintain respiration artificially. As part of the healing response, tracheal stricture takes some time to develop, with patients awakening from surgery able to breathe normally. Then the medical condition known as stridor (abnormal, high-pitched, guttering breath sounds) develops as the windpipe is gradually and unstoppably blocked by scar tissue. Finally, breathing becomes difficult and oxygen supply to the body via the lungs insufficient. The condition is aggravated because abnormal scar development produces tissue architecture that is tougher, thicker and less flexible than normal skin tissue. Alverdes’ description of this phenomenon is typically original, evocative, and medically precise: the internal scarring that deforms the Whistlers’ windpipes is “tough … hardened like the bones of young children.”

  Treatment of tracheal stricture is the same today as it was a century ago in the operating theatre adjoining the Whistlers’ ward. To provide immediate respiratory relief, a tracheotomy procedure is performed: surgically cutting a small hole in the neck below the level of the scarring and then inserting a tube with a vacuum fastening so that breathing air directly into the lungs can take place unimpeded. Instead of inhaling through the nose or mouth, the patient can now inhale through the tube and therefore receive sufficient oxygen. Only the material of the tube mechanism has changed. Today it is a medical-grade plastic but in the Whistlers’ ward, each of them has had a small silver pipe inserted into his throat so he can breathe. Tracheotomy patients find it difficult to speak, but Alverdes tells us that his subjects have learned to manipulate the open end of their silver pipes so they can communicate with one another in their own specially evolved
language of clicks and whistles to the extent that they can hold long, strange conversations with each other as the days and nights pass on their ward.

  As an initial repair, the installation of silver pipes was effective but it was also the reason for their new owners’ lengthy confinements. The pipe’s exit point was an open wound, leading directly from the outside environment to the lungs. Even simple daily management to keep it clean and functional was difficult and complicated, and could only be done in a hospital. This was the pre-antibiotic era, and the risk of infection with throat and facial wounds was very high. The story of Benjamin’s wounding gives insight into the filthy, chaotic environments that casualties were often left in before receiving hospital treatment. Gains made in treating wounds themselves were often confounded by the inability to master their accompanying or subsequent infections, which terrorised field hospital wards, as invisible and as deadly as snipers on the battlefield. Infections were just as hazardous to recovery in military hospitals at home. Every time the patient was fed or given liquids, the potential for food particles contaminating a wound so near the mouth or nose was significant. In the novel, Benjamin is given his first nutrition for days in the form of a drink—champagne, red wine, sugar and beaten egg. This was a standard mixture for such patients, and could also contain coffee and beef stock—protein, sugars in various forms, and alcohol for mood and as a muscle relaxants. The orderly who gave it to Benjamin would have been very skilled in administering the drink—any spillage would have been carefully cleaned up, so feeding could take hours. It was not just the risk of infection from foreign bodies. The feeding process was difficult and time-consuming, and every spoonful had to be ingested with great care. Patients who ended up coughing and spluttering could send food particles into their lungs. This risked causing pneumonia, which was almost always fatal in the case of wound-weakened physiologies. This condition is still feared today but, then as now, feeding of patients was essential if they were to regain strength not only for further treatment and resolution of their wounds, but also for the activities of daily living such as getting out of bed, walking and managing their own conditions as far as possible.

  By the time we are introduced to the residents of The Whistlers’ Room, we see the patients managing a certain amount of infection control themselves, without having to rely on nurses or orderlies unless they were bedridden. Alvardes’ description is particularly poignant of both the pipe technology that enabled them to breath and the means by which it was kept clean, using clean white muslin fabric shields and specially made little round brushes. His emphasis on the material of the pipes sets the description in a particular emotional context. Silver is a precious metal, it is crafted into things by a silversmith, not in a factory, so there is something special and precious about these medical implements that allow their owners to breathe. There were also specific technical medical reasons why silver was used in these pipes. It has been known for centuries that, in addition to being easy to work into intricate designs and shapes, silver has antibacterial properties. Non-toxic to humans, silver not only resists bacterial growth on its surface, it actually disrupts it by limiting bacterial cell reproduction. It is used today in an increasing range of medical products (silver-lined sticking plasters, for instance) because in certain compounds, it not only resists bacteria, it actually promotes healing. Silver-imbedded medical equipment is also used in hospitals as part of the on-going efforts to combat superbugs.

  Despite the Whistlers’ pride in keeping themselves and their pipes clean, Alvardes is discreetly honest about the reality of their condition. Infections were never really eradicated, only managed up to a point—“the low fever never really left the whistlers” and Pointner has a serious form of septic blood poisoning. Small but precise details, such as those of the colouration of Pointner’s nails and hands testify to the precarious nature of their survival. In the meantime, their reconstruction must continue. The silver pipes are only an intermediate treatment for their conditions. So the Whistlers receive regular surgical procedures to release their strictures and restore normal breathing. Their surgeon works “to widen by degrees their natural air channel … by insertions of sharp spoons and tongs” and rods “forced past the constricted passage of the throat.” Eventually the throat will be sufficiently widened so that the pipes can be removed, the external wound closed up, and normal breathing be resumed. This element of treatment has also not changed a great deal a century on. Surgeons perform dilation procedures which seek to stretch out the scar tissue and widen the trachea. They use surgical dilators (a type of surgical scissor with a rounded end) or small balloons which can be inserted down a tube and then gently inflated to stretch and smooth out the surrounding tissue. Whilst the technique may be the same across the century, there is one significant and especially brutal difference: today tracheal stricture relief is done under general anaesthetic, but for the Whistlers it was not.

  There were many fields of medical practice that were greatly advanced by their application and repeated practice in warfare, but anaesthetics was not among them. It was not really considered to be a medical procedure at all, but a non-professional trade that supported surgery. It would not become an “ology” until the interwar period, fully medicalised, with proper training and the beginnings of a research infrastructure. Throughout the Great War anaesthetics were dangerous and deeply unpleasant—the slightest whiff of chloroform or ether enough to make patients vomit or weep in terror as they waited outside operating theatres. Anaesthetic gases were administered via face masks in a bludgeoning dose of chemicals, and great care had to be taken as the patient’s breathing and blood pressure was depressed. Worst of all was the altered mental state of the patient which could result in extreme writhing or jerking movements, making delicate surgery all but impossible. Georges Duhamel, in his classic work of military medicine set in France during the Great War, The New Book of Martyrs wrote of the “disorderly intoxication, the muscular animal rebellion of those who are thrown into this artificial sleep.” If the injury or patient could not tolerate the gas mask, then default delivery method was ether in solution administered rectally. Some injuries complicated the delivery of anaesthetics beyond practicality or risk, tracheal stricture being one of them. It was next to impossible to operate on a patient’s face or throat if a gas mask was in use, and the surgeon performing the procedure would need to be able to hear the patient’s breathing at all times to know that he was not impeding it more than necessary. Additionally, aggravated movement of the kind Duhamel described could be fatal, so for all of these reasons, the Whistlers endured “the healing torture” of their surgical repairs awake and without pain medication of any kind.

  For them to do so, required a surgeon who inspired their confidence, and Alverdes describes Doctor Quint, who treats the Whistlers in strong characterising detail so that we understand why they trust him so. He is a physically imposing man who rarely shouts, but when he does, the Whistlers feel a certain pride in knowing that the voice resounding authoritatively through the hospital belongs to their surgeon. He generates a competitive but communal spirit amongst his patients, who he treats as a group, “three in a row on a long bench, wrapped in white sheets up to the chin.” Each of them understands better than anyone else in the world what the other is going through, so that whatever they are suffering, isolation is not one of its features. In the Second World War, surgeon Archibald McIndoe sought to generate the same kind of communal treatment ethos in his patients who had been badly burned in the Royal Air Force. They became known as “The Guinea Pig Club” and attended each other’s operations, giving each other support and advice on rehabilitation techniques and pain management—all of it prefigured by the story of the world of the Whistlers’ room.

  Alvardes gives Quint very particular features that tell us of another community beyond the war, struggling not to be changed by it. Quint wears “an English suit”—his style of dress with silk socks and patent leather shoes might be se
en to be that of a quintessential English gentleman in Saville Row tailoring. But this is not simply a question of personal style. By 1916 it was no longer acceptable in war-wracked Germany to demonstrate an affinity with anything English so Quint’s personal obstinacy is notable. Links between the British, German and Austrian medical professions at all levels were very strong. The generation of surgeons and clinicians who had graduated in the first decade of the twentieth century sought out fellowships in each other’s countries, spending a year in London or Vienna or Berlin as surgical or clinical residents. They spoke each other’s languages (something that would come in particularly useful when dealing with each other’s prisoners of war on the front). They read and wrote for each other’s journals. These connections were strongly maintained right up until the last weeks of peace in 1914 (they even went to each other’s conferences in the early months of the summer). Perhaps Quint’s insistence on his English tailoring is his attempt to signal that there is still life in the pan-European medical community above and beyond the war.

  There are other details in the novel that speak to the commonality of the experience of war and wounding across nations. We learn from Pointner’s treatment after he is wounded that German casualties were welcomed and “beflowered” by the civilian population. Dusseldorf Station, one of the primary processing points for German casualties, was decorated throughout with arrangements of flowers, kept watered and replaced when necessary by volunteers, just as they were in Charing Cross Station in London or Birmingham New Street. In the streets outside the stations, flowers were strewn in the paths of ambulances driving out to the hospitals, or handed in to the patients themselves through the windows. The medical staff who accompanied their patients found this behaviour inconvenient (cigarettes were much more welcome) but some patients had a few brief moments of enjoyment as the flowers were handed to them and patriotic songs rang out as they finally found themselves at home.