Medical Imagery and Public Discourse About War

Society member and Dutch military historian Leo van Bergen (et al) recently published the article From Goya to Afghanistan–an essay on the ratio and ethics of medical war pictures in which they explore the appropriate role(s) of medical imagery, particularly of combat injuries, in democratic societies.

First, van Bergen and his colleagues briefly review the history of war imagery, citing the use of paintings (Goya after the French counterinsurgency effort in Spain, 1810-1820; Otto Dix and Georg Grosz, during and after World War I) and later photographs (Dutch surgeon A van Teinhoven and Ernst Friedrich after World War I) as a means to encourage anti-war sentiment by depicting the horrors of war through the wounds suffered by combatants, or by those bystanders who become victims of war.

Van Bergen and his colleagues worry about what effect the images published in the U S, War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007 (2008) and intended, according to the book’s editors, for the education of military surgeons “on the plane before they get there”, might have upon a civilian populus not educated about the purpose of such imagery.  They note that these images portray the particularly horrific injuries wrought by modern IED-type weapons.  They also particularly note that this book was published “as a heavy coffee table book”, and wonder why the book’s editors selected this quite un-textbook format, in view of their educational intent.

The authors briefly describe that some in the U S military medical community sought to prevent the book’s publication or attempted significant censorship of the images specifically because of the concern that they could very well cause a popular backlash against the ongoing counterinsurgencies, and against war in general.  But in the end, Army officials permitted the publication of War Surgery with the full panoply of photographs selected by its editors.

After discussing 20th Century medical illustration of combat injuries, starting with physician-artist Henry Tonks’s renderings of the terrible facial wounds managed by British plastic surgeon Harold Gillies, to the more “sterilized” images of wounds as depicted in inter-war texts, van Bergen and his colleagues point out that the War Surgery is dedicated to the perspective of “immediate trauma care”, that is, an unvarnished rendition of the cold, hard truths of combat injuries in modern war, accompanied by textual narrative that adds clinical information not available from the photographs.

In the end, the authors decide, that while the book “is still in line with those of the old surgical textbooks–to medically prepare future colleagues”–they assert that “there have been significant changes”, namely that the book also contains images of medical facilities, combat action, and even “eight sober, black and white, non-clinical photographs in a military environment far away from war sites…sometimes poetic large photographs [that] register the pain, sorrow and grief associated with war…[and] poetically present compassion in regard to the fate of many soldiers who gave their lives, one way or another”.  On account of the added, non-medical images,  van Bergen and his associates offer the opinion that War Surgery “is not a pure medical instruction manual; it is a statement about the reality of modern war. It is a book to honour the people who gave their lives, and to the ones who try to save them.”   As for the book inciting a popular backlash, the authors offer this interesting insight:   “[w]ithin the public imagination this collection of visual extremes is probably unbearable. In this sense, [Susan] Sontag is right when commenting, in Regarding the Pain of Others on a picture of a First World War veteran with half his face blown away, that there are limits to respect:

Perhaps the only people with the right to look at images of suffering of this extreme order are those who could do something to alleviate it–say the surgeons at the military hospital where the photograph was taken–or those who could learn from it.  The rest of us are voyeurs, whether or not we mean to be.”

Just as we who have not experienced combat ourselves feel unworthy to ask friends and relatives who have “been there” to “tell us about it”, it is very possible that the average citizen feels similarly unworthy to view the injuries and the suffering portrayed in War Surgery, both because he didn’t experience combat, but also because he is unable to participate in repairing the damage he sees.

One wonders, in passing, if people may also be as horrified by the creators of the weapons that cause the wounds as they are by the wounds themselves.

Perhaps these are the reasons why we have seen virtually no popular reaction against the current military efforts based on the medical images in War Surgery.

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  • Matt Collier  On 27 Nov 2010 at 04:17

    Brilliantly written review. The Sontag quote (..The rest of us are voyeurs, whether or not we mean to be.’) sums up a large percentage of these images’ meaning to us, although not completely, as ignorance sometimes needs unexpected jolts to wake us up (by chance its the next book I’ve planned to read). I found this through surgery searches for an article on surgery art I will blog, such as on Henry Tonks who was recently featured on the Culture Show.

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