Birth of the Photoessay — “Country Doctor” by W. Eugene Smith
“Photography is a small voice, at best, but sometimes one photograph, or a group of them, can lure our sense of awareness.” — W. Eugene Smith
Country Doctor begins with a brooding portrait of our local hero walking through a field, framed on one side by a white picket fence and on the other by a strand of trees. Dressed in a tie and jacket, and carrying a large leather bag, he is a respectable man with a purpose. His demeanour though, also suggests a man deep in thought, concern etched in his face.
The man in question is Dr. Ceriani, a doctor working in the town of Kremmling, Colorado, a rural community spread over an area of 400 square miles. Through the article we learn, “These 2,000 people are constantly falling ill, recovering or dying, having children, being kicked by horses and cutting themselves on broken bottles. A single country doctor, known in the profession as a “GP”, or general practitioner, takes care of them all.”
Dark and moody, and his subject portrayed in the most dignified manner — the photograph is a perfect example of the work its creator W. Eugene Smith became so well known for. Country Doctor, however, is iconic not because of this one image, but for its power to tell a story through the entirety of images that make it up. It is often credited as being not only one of the first examples of the editorial photoessay, but as one of the best ever created. A perfect blend of both imagery and text to tell the story of a small town doctor. Not only was it an instant success, but it cemented Smith’s reputation as being a master of his craft.
Today Country Doctor stands out not only as one of the best examples of the photoessay, but is also an enduring reminder of a more simple time in America we often look back on with nostalgia. An America where people still lived in small towns with a sense of community and healthcare was provided by a local doctor, who knew and treated everyone, rather than a stranger in a big city hospital.
The Photographer W. Eugene Smith
Born in Wichita, Kansas, in 1918 it seems that photojournalism wasn’t so much a choice for W. Eugene Smith, as it was his calling. Somewhat of a prodigy from a young age, Smith began taking photographs at the age of 14, encouraged by his mother who was an amateur photographer herself, and quickly became obsessed with the medium. Just a few years later he was already photographing for local newspapers.
While many of the 20th century’s most famous photographers are known for just one type of photography — W. Eugene Smith could seemingly do it all. He was a great war photographer, who could combine the grittiness of Capa with the compositions of a painter, he could take landscapes that evoked more emotion than the average photographer could with a human, and take portraits with his use of charuoscuro lighting that today remind us more of works of the great renaissance masters than any photographer.
While Smith may have been the complete photographer though, it came at the expense of being a complete human being. Whether this was a part of his DNA, or a result of childhood trauma, we don’t know. He was an alcoholic, mentally disturbed, and abandoned his first family. But he was also a perfectionist, an obsessive photographer, who could spend days in the darkroom amped up on amphetamines working on just one photograph, or years photographing a project that had supposed to of only taken three weeks. They were traits that made him both a brilliant photographer, but also almost impossible to work with.
Smith photographed Country Doctor in 1948, relatively early on in his career, and was one of his first forays back into photojournalism after getting injured by a piece of shrapnel on Okinawa in WWII — which at one point he thought would prevent him from every photographing again.
The Motivation for Country Doctor & Life Magazine
The impetus for Country Doctor came from the American Medical Association, who approached Life Magazine in 1948 about the story. The association was concerned about the shift in doctors away from rural areas and into the cities. Beginning in the 1940s with the rise of “third party” health insurance, doctors were no longer paid by their patients. The result was a shift towards specialization — as hospitals sought to make their healthcare more efficient and profitable by referring patients to specialists in urban hospitals instead of having them treated by cheaper GPs in rural areas.
While the shift was no doubt inevitable, the American Medical Association thought that perhaps an article highlighting the work of a general practitioner working in a rural area might stem the tide a little by showing how rewarding the work could be.
With the advent of the digital age and the decline of print media, its hard today to imagine the influence Life Magazine had in 1948. The magazine, and especially the photographs published within it, were massively influential though. In 1948 it was not only the most respected publication of the day, but had a readership of approximately 20 million or 30% of the American public.
If there was anywhere you wanted to advocate for a cause, it was surely within the pages of Life Magazine that you stood the best chance of being heard.
The Photoessay
Life Magazine chose to explore the issue of rural medicine by focusing on one Life — that of Dr. Ceriani. Young and photogenic, he was selected by the Colorado Medical Society because they thought he would be the perfect candidate for the story. W. Eugene Smith was given 23 days with the young Doctor, as he went about his daily life attending to his 2000 patients spread out over 400 square miles of rural Colorado.
Smith’s technique as a photojournalist was to cover every aspect of Dr. Ceriani’s life — whether it be visiting a patient, conducting surgery, or even taking one of his short lived breaks. His strategy was to portray what his life was really like, not just parts of it, and so in order to do this he immersed himself entirely into the story. As Dr. Ceriani later recalled, “I never made a move that Gene wasn’t sitting there. I’d go to the John and he’d be waiting outside the door, so it would seem. He insisted that I call him when anything happened, regardless of whether it was day or night. He would always be present. He would always be in the shadows.”
At first this created tension, not only between Dr. Ceriani and Smith, but also between his patients and the young photographer. Smith’s aim though, wasn’t to really start photographing immediately, but to get his subjects to not only get used to him, but even ignore him. At that point, Smith would be able to operate as a fly on the wall and being to photograph.
We can see the impact of such a strategy in his final photographs, especially those like the one in which Dr. Ceriani has just completed a surgery and stands exhausted with a cup of coffee and a cigarette in his mouth. He stands there, oblivious to Smith, staring into nothing. His posture betrays his exhaustion.
A writer once credited Smith with making heroes out of the ordinary, and while Smith always photographed his subjects with dignity throughout his career, it appears that he felt a particular affinity to Dr. Ceriani. For starters, both the Doctor and photographer were the same age — both 34 at the time of the story — but they also appeared to share a similar set of beliefs. Smith always hated bureaucracies and was drawn to individuals he saw fighting the system and working for the benefit of others. This indeed was the motivation behind much of Smith’s work and he saw Dr. Ceriani as a kindred spirit and a rebel. Someone who had moved in part to Kremmling, Coloardo, to escape the bureaucracies of large city hospitals and sacrifice a large paycheck in order to help those that needed it more.
W. Eugene Smith ultimately chose 200 photographs from Country Doctor to submit to Life Magazine for the story, of which they in turn chose 27 to publish. Life Magazine in turn combined these with text and laid them out for publication. However, as seemed to be a constant theme throughout his career Smith was not entirely satisfied with the layout for the photographs Life chose — something that would ultimately lead to him leaving the magazine several years later. A consumate perfectionist, Smith never seemed entirely satisfied with his work and would reflect later that he always questioned his photography afterwards — wondering why he hadn’t done something different.
The Impact of Country Doctor
For both the country doctor and photographer, Life’s article was a roaring success. Dr. Ceriani transfixed the nation and became an immediate celebrity, appearing on TV shows and the radio. America had just come out of WWII, as well as the Great Depression before that, and the times were still somewhat uncertain. People were looking for a hero they could cheer on, and Dr. Ceriani exemplified the best aspects of the human spirit and provided hope to so many of the readers who saw him selflessly helping those in his community each day.
The photoessay also rewarded W. Eugene Smith, solidifying his reputation as not only one of the most gifted photograhers of the day, but as a master of this new form of photojournalism called the photoessay. The photoessay would signal the golden age of photojournalism, which would go on to peak in the 1960s and 1970s, before slowly dying again with the advent television, the rise of the internet, and the decline of print media.
The only thing the photoessay perhaps wasn’t succesful at was actually stemming the tide of doctors moving away from rural areas and instead choosing to specialize in America’s bigger cities. Apparently the US public, after reading the article and admiring Smith’s photographs, decided they’d rather celebrate Dr. Ceriani for his tireless work- rather than judge the system that overworked him to the point of exhaustion each day. Its certainly possible the photoessay inspired some doctors to become GPs and move to rural towns like Dr. Ceriani, but ultimately the majority of doctors within the American healthcare system continued to down the road of ever increasing specialisation within cities.
Country Doctor’s Legacy
While Country Doctor was published in 1948 in order to highlight the pressing issue of the decline in rural doctors, the photoessay continues to be relevant today for a number of reasons.
For photographers it stands as a masterclass in storytelling — a near perfect arrangement of photographs and words, designed to bring a story to life and impart it onto the reader in the most impactful way possible. It continues to be taught to photography students and admired by photojournalists.
For others though, Country Doctor is perhaps relevant because it continues to remind us of some of the things we may have lost as we charged headfirst into modern healthcare — giving little thought to what we might be giving up in the process. Its hard to not look back on Country Doctor and feel a sense of nostalgia for the America depicted within its photographs. Whether this America ever actually existed or not — we see a simpler time, with small towns and communities that formed the backbone of rural life. We see an America that still had affordable healthcare, where everyone had equal access to their doctor, and where you knew your Doctor and they knew you.
Commissioned precisely to highlight a system already on the decline, healthcare in America has only accelerated down the road this photoessay warned it might. In 2004 a study found by the US Department of Health that although 20% of Americans still live in rural areas, only 9% of physicians practice there. Furthermore it seems we have lost that doctor-patient relationship that used to be at the very heart of medicine. While modern medicine is no doubt complicated, and requires the use of computers and other technology, to correctly diagnose patients — perhaps it has also slightly lost sight of the fact that good healthcare entails a trust relationship between a patient and doctor, which is something that can only be earned, not given. Such trusting relationships are something which radiates through every image of Eugene Smith’s and is perhaps the single greatest lesson we can learn from this photoessay today.
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