‘War, Art, and Surgery: The Work of Henry Tonks and Julia Midgley’ reviewed by Professor Duncan Geddes

‘War, Art and Surgery: The work of Henry Tonks & Julia Midgley’ edited by Samuel J.M.M Alberti (London: Royal College of Surgeons, 2014).

‘The only people with a right look are those who can do something […] the rest are voyeurs.’ 

previewTo mark the centenary of the outbreak of the First World War, the Hunterian Museum of the Royal College of Surgery staged, from October 2014- February 2015, an exhibition entitled War, Art and Surgery, which this book was designed to accompany. The work of two very different artists, separated by 100 years, were brought together: Henry Tonks’ 1916 pastels of facial injuries, with a few line drawings for surgical planning and Julia Midgely’s drawings and watercolours of medical trauma from simulation courses and real rehabilitation events from the recent coalition-led war in Afghanistan. Less than 10% of the pages are text, a structure that Tonks would no doubt approve of considering he detested ‘art boys’ debates.

Tonks initially trained as a surgeon, decided he was not any use as a doctor and instead taught drawing at the Slade School of Fine Art London, where he eventually became professor. In 1916 he obtained a temporary commission as Lieutenant at Aldershot Military Hospital assisting Harold Gillies, a pioneer of plastic surgery and facial reconstruction. One of Tonks’ roles was to draw line diagrams of operations – these look like dressmakers cutting plans – and were clearly useful. But he went on to do a large series of pastel sketches of the injured faces, many before and after surgery. He later wrote that these were ‘the only drawings I am not ashamed of’ and ‘a chamber of horrors, but I am quite content to draw them as it is excellent practice […] rather dreadful subjects and not fit for public view’. The drawings raise questions about the purpose and value of medical illustration and war art as well as their intended audience and impact.

Helping to explore these questions are Midgley’s sketches. Unlike the sometimes savage pastel works of Tonks, they are delicate and quiet. She ‘strives to make them beautiful […] to tell visually intense visceral stories with compassion’. They are clearly intended for the lay viewer, while Tonks’ were sketched more for clinical practice than display. Some have claimed to find Tonks’ faces beautiful but this is incidental; their main purpose was personal, archival, and perhaps functional.

Both sets of images hover between art and reportage, but we should be reminded that they were produced by people whose chief concerns and careers were art. The images do not work as medical illustrations and while they might interest a doctor in training they do not aim to educate.  Medical illustrations, like botanical art, must get the scientific detail right and have a purpose beyond aesthetics. This tension is very clearly discussed by the anatomical artist Sarah Simblet.  Tonks’ technicality and detail is superb; he captures skin tones and salivary drool better than any photograph and his before and after surgery studies must have made the surgeons proud. Although Tonks’ faces can be seen as portraits, there is one detail missing. The patients were presumably told, rather than invited, to sit and while some critics can see stoicism, heroism and even beauty, to me they share a distant unengaged look. There was probably little interaction between Tonks, the artist and Lieutenant, and the other ranks ordered to sit.

Midgely gives a sense of war zone drama – albeit simulated – and poignancy in rehabilitation; she certainly reports as well as illustrates, describing herself as a documentary artist. The sense of loss and determination that go with amputation are clear but universalised, even though the individual soldiers do not see it that way (see below). She claims her drawings can record moments and hours rather than photographic fractions of a second.

War art records action and can celebrate, but also challenge, heroism and nationalism as propaganda. Tonks wrote: ‘the wounds are horrible and I for one will be against wars in future, you have no right to ask men to endure such suffering’  but he did not intend his pastels to be used as anti-war propaganda. Interestingly, Ernst Friedrich in 1924 published photographs of German soldiers with facial injuries in an attempt to stem the rising tide of militarism in Germany. Picasso’s Guernica does not prevent military atrocities and nowadays we are overwhelmed by images of the horrors of war but the horrors go on.

Tonks images are striking but the necessary inhumanity of the clinical gaze is likely to draw the professional to the injury rather than the suffering it causes. Suffering is best seen in the eyes (nowadays blanked out in clinical photographs). In contrast, the lay viewer without the detached clinical gaze is likely to feel disgust at these facial distortions, and horror at the inhumanity of war. I showed the book to a range of non-medical people including artists and collectors. Very few wanted to go on turning the pages, and among those who did, I sensed they viewed the work as a pornography of violence. Interestingly, the artists, who saw the images were impressed by their technical facility and this, together with references to Francis Bacon’s distorted faces, seemed to overcome the disgust felt by others. Perhaps Tonks was right in thinking his pastel drawings of injured soldiers unfit for public view. The artists and collectors, that I showed the book to, saw Midgley’s work, as delicate, pleasant and often moving – just as she intended.

Much more fascinating is the impact of the creation of images on the patients themselves and the staff around them. We can only speculate how Tonks’ sitters felt. They did not volunteer to be sketched, the interaction was limited and Tonks was, by reputation, a forbidding figure. Their injuries were disfiguring and considered by some to be shameful. Mirrors were forbidden on their hospital wards, supposedly to protect the soldiers from the reality of their injuries. One consequence was that the soldiers had to imagine their disfigurement by comparison with their comrades. Tonks’ work may have confirmed their worst fears and it is unlikely that they were proud of their portraits. In contrast, Midgely’s soldiers were keen to be sketched and enjoyed it as an experience that in some way celebrated their injuries. This is a typical response to a hospital artist. Patients and staff alike find the process of being drawn, painted or photographed elevating and enobling. After all, for most people their medical problem occupies, for a while, the centre of their existence.

So, who should look at this book? Certainly, those treating trauma or interested in the history of plastic surgery should see Tonks sketches. Midgley’s work may appeal more widely but the book ensures that to reach her sunny uplands you have to pass through Tonks’ daunting corridors. Perhaps I agree with Susan Sontag’s Regarding the Pain of Others.

Reviewed by Duncan Geddes, a retired Professor of Respiratory Medicine at Imperial College and Royal Brompton Hospital. His main clinical work has been with Cystic Fibrosis, Lung Cancer and COPD, and he has published over 300 papers as well as co-editing the main UK textbook of respiratory medicine.

Correspondence to Professor Duncan Geddes.

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