The ‘men with broken faces’ who survived First World War battlefields, the surgery that repaired their identity-sapping wounds, and their post-operative experiences have inspired histories of growing range and quality. Jason Bate, Suzannah Biernoff, Marjorie Gehrhardt, Beatriz Pichel and others have explored visual culture in and beyond the clinics where plastic surgery was improved. Historians and curators have highlighted the painters, photographers and sculptors who collaborated with the surgeons to recover the appearances of faces before trauma and to chart the progress of reconstruction. Their art then defined the horrors of disfigurement and the achievement of some semblance of normality. Plastic surgery in Britain during the Second World War has yet to yield similar studies, but Christine Slobogin has made a stimulating start.
Putting Plastic Surgery on Paper tackles the challenging archive of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) at the Royal College of Surgeons of England and the output and experiences of two artists represented within it: Diana (Dickie) Orpen and the drawings she made at Hill End Hospital in St Albans, and Percy Hennell and the photographs he took in several hospitals. Showing that visual culture helped to define plastic surgery, the book analyses how two artists and one archive have shaped the field. Although mainly addressing historians, Slobogin draws from affect studies and archive theory as well as histories of art and of emotions.
The first part is a ‘theory-heavy’ (p. 29) record of Slobogin’s struggle to turn the BAPRAS archive from obstacle into opportunity. This begins with the visceral impact of Hennell’s photographs, which left her reeling with ‘shock, pity, and empathy’ that ‘culminated in … nausea and dizziness’ (p. 41). Far more than sepia prints from the First World War, not to mention Orpen’s de-individualizing diagrams, these colour images, produced for surgeons, show the pulpy flesh of ravaged faces, shiny with blood and other liquids, before documenting stages of repair. Although Slobogin gives us a wealth of colour illustrations, she opted, for ethical reasons, to include only photographs previously reproduced and omitted the most disturbing of these. Her focus on the capacity of Hennell’s photographs to evoke empathy with their subjects today introduces the challenges of this material but leaves us several steps from historicized emotions.
The next two chapters of Part I continue to foreground patients by critiquing the explicit narratives of a collection created by and for members of BAPRAS in the 1980s and by proposing counternarratives. The surgeon–curators, Slobogin argues, celebrated heroic male innovators, promoted nationalist triumphalism and accepted progress in the speciality as a boon of war, while legitimizing their field as reconstructive, not cosmetic, surgery. One route to a different history would have run through case files, which allowed Bate to recover patients’ stories from the First World War and build relationships with their descendants (Photography in the Great War (2022)). This strategy gave him access to the limited circulation of the medical images and to family photography. Sadly, the BAPRAS archive does not hold files for the patients depicted by Orpen and Hennell and these are missing from the Hertfordshire Archives. (Could records for men Hennell photographed at hospitals other than Hill End be kept elsewhere?) Instead, Slobogin responds to the emphasis of the BAPRAS archive on physical repair. She suggests that, although surgeons headed teams that treated minds as well as bodies, this leaves psychological trauma to haunt the collection. She tries a loosely psychoanalytic investigation of repression and sublimation, intrusive memories and dissociation.
That ‘plastic surgery [is] an art and the plastic surgeon an artist’ has long been part of the surgeons’ self-presentation (Jerome Webster, quoted on p. 6). The four historical chapters in Slobogin’s second part shift the gaze to the professional artists who documented their work. Chapter 4 examines gender in the career of Dickie Orpen, daughter of the wealthy portraitist and official First World War artist William Orpen. Both studied with Henry Tonks, the Slade School professor known for his pastels of the patients of Harold Gillies, ‘father of modern plastic surgery’. Slobogin paints a rich picture of the artists’ triangular relationship and diagnoses a shared commitment to a medical gaze as the key to the truths of nature and the emotions. Chapter 5 probes Dickie Orpen’s humour, especially gender-bending cartoons that, in a wartime culture of gender anxieties and reversals, commented on the hospital hierarchy in an effort to create, among the staff, an atmosphere conducive to mental rehabilitation. Turning to Hennell, Chapter 6 opposes myths of innovation: this commercial photographer applied standard techniques of colour photography, as well as portraiture, to his extraordinary subjects. Here and in Chapter 7, on the photographs as propaganda for the surgeons, Slobogin reflects on the politics of British colour, as distinct from the perceived brashness of Technicolor. Comparing the surgical photographs with Hennell’s book illustrations brings out this visual nationalism. She speculates that the mental toll of photographing bodily damage, decay and death on a visit to Italy pushed him back to the business world after the war.
Slobogin offers ‘a novel affective and interdisciplinary approach to the visual culture and visual history of medicine’ (p. 35). Her eclectic selection of topics does make sense as a response to the lives and works of her artists as represented in this archive and as a critique of the surgeons’ own accounts. A conventional history might have provided more sense of continuity and change from the First World War to the Second. Nor does this one foreground the construction of ideally normal, masculine or white faces. But there is much here for historians of STM interested in visual culture and notably colour. I was prompted to think about a couple of points.
First, since the speciality presented itself as modelling bodies like clay, I wonder about relations between working in 2D and 3D, on paper and in plaster. I thought of Thomas Schnalke on moulage-making in dermatology, where artist and patient spent hours together to produce painted casts of individualized faces. In the First World War, Kathleen Scott, another student of Tonks, generated busts of heads before injury for Gillies. In the Second World War, at Valley Forge, Pennsylvania, Virginia McCall cast stages of facial reconstruction. Did sculpture, like prosthetics, come to play less of a role?
Second, Slobogin considers ‘before-and-after’ pictures, a topic that historians of medicine have touched on but that invites concerted investigation. Building on Kate Palmer Albers and Jordan Bear’s edited volume Before-and-After Photography (2017), Slobogin stresses that there is never a definitive ‘before’ or ‘after’, only choices to construct certain scenes from a continuum. That is as clear for plastic surgery as for diabetic children pre- and post-insulin (Arleen Marcia Tuchman, Diabetes: A History of Race and Disease (2020), pp. 45–6), but it would be worth teasing out the differences in visual rhetoric. I also wanted to know how it matters that Orpen’s diagrams and Hennell’s photographs show not just ‘before’ and ‘after’ but series of stages.
Carefully written, vividly illustrated and well produced, this brave book deserves to find readers in medical humanities and among historians of surgery, medicine and visual culture.
