Country Doctor

August 4, 2011

Case History of a Classic Profile Photo Essay

Magazine picture stories using photographs evolved during the 1930s, first in Europe, and then in the United States. Once editors understood that sequenced photographs on a double-page spread could tell a story in a different way from words alone, it became a particular way of communicating in its own right. It was Life magazine that gave it the name photo essay, and developed it to the full.

One of the classic early photo essays was Country Doctor, shot by W. Eugene Smith Smith on assignment for Life magazine in 1948. It took four weeks, longer than the editors anticipated, as was usual with this photographer. This is widely regarded as the first modern photo essay, and indeed, Smith is considered by most to have perfected the form, although of course this was in the context of Life magazine’s commitment to running picture stories. Considerable preparation went into the story, beginning with finding two things that the magazine thought important: a scenic setting and an attractive-looking person. Smith himself had no qualms about organising a story to ensure that the pictures would be strong. Smith wrote, “The majority of photographic stories require a certain amount of setting up, re-arranging and stage direction to bring pictorial and editorial coherency to pictures….it is done for the purpose of a better translation of the spirit of the actuality, it is completely ethical.”

Click on the corners to flick through the magazine spreads.

There is an excellent and detailed study of this photo essay, a book called W. Eugene Smith and the Photographic Essay by Glenn G. Willumsun, published in 1992, and I’ve drawn on it here for many of the facts and conclusions. It’s unfortunate that this book is now out of print and hard to find.

Ed Thompson, who joined the magazine in 1937, and who from 1949 to 1961 was it’s managing editor (arguably it’s most famous), controlled the story. “Somewhat like Gene,” he wrote, “the doctor was intense, worked grueling hours, and was compassionate. No one had to suggest what individual pictures Smith should take; he knew instinctively.” In fact, the editorial construction of the story is on two levels. The surface level, the most obvious, is a human interest story that works on the emotions. The readers are given a privileged insight into the life of a sympathetic and important member of a community. Life researched the location – it needed to be attractive – and the doctor, who was chosen partly for his looks. But there was another level, reflecting policy, and this is also a story about the modernisation of medicine at a local level. Thompson explained, “Art Director Charles Tudor and I laid out this story. Gene and I argued a bit about using the exhausted doctor with his cigarette and a cup of coffee as a full-page picture to end the essay, but I prevailed. I never heard a complaint thereafter. Dr. Ceriani became famous.” This last shot also was set up, and the out-takes show what an awkward position he is holding, with his feet splayed out uncomfortably, in order for Smith to get this precise angle.

The Theme

In early 1948, Life’s editors approved a human-interest story on the working life of a doctor in rural America. The idea was to show drama in people’s lives by focusing on one doctor in an attractively located community.

The Agenda

Behind what was on the face of it a straightforward profile of a young doctor’s life – essentially a likable human-interest feature – Life magazine had a political point to make. There was certainly an agenda, and because the editors used the images and layout to further it, it was partly hidden. This is one of the most interesting features of Country Doctor, and makes it a more subtle piece of photojournalism than most modern ones, as we’ll see in The Layout below. At national level there was a conflict brewing between President Truman’s administration and the American Medical Association. Health care was an important political issue, but while the government saw the problem as being too few doctors, the A.M.A. saw it as poor distribution of doctors. The government position meant compulsory federal health insurance in order to pay the wages of more doctors, but to many Americans this sounded like ‘socialized medicine’ and in a way left-wing politically. Life magazine sided with the A.M.A., and the agenda for this story was to show that people like Dr Ceriani and his community were perfectly capable of managing local health care independently.

The Preparation and Planning

Life had a large circulation, healthy advertising revenues, and could afford extensive research. The magazine had regional offices, and they were asked to suggest a location and a doctor. It was the Denver, Colorado office that ‘won’ the assignment, with a very attractively located town, Kremmling, and a good-looking, young and dedicated physician, Dr. Ceriani. Going for a young doctor was an interesting move at a time when the ‘family doctor’ tended to conjure up images of an avuncular, older man.

The Denver bureau chief of the magazine then set to and produced a shooting script, predicting as many things as he could think of – 45, in fact. As for the rest, that would be up to the assigned photographer – W.Eugene Smith. Smith was not compelled to follow the shooting script; it was there as a guide. But it appears that he did.

The Shooting

As is normal in this kind of assignment, considerable effort from many people went into setting up the shoot, but beyond a few obvious shots that could be set up (such as the opener of the doctor crossing a field to visit a patient, and a long shot of the town), the shooting scripts could only suggest. The bulk of the shooting was always going to be down to the unpredictable events while Smith was there, and on his ability to extract strong imagery from them.

The set-piece shots came mainly from the shooting script. These were planned set-ups, and while the term ‘set-up’ nowadays seems to have acquired bad associations, in a narrative photo essay it can be perfectly legitimate — providing, of course, that it doesn’t pretend to be wholly candid. Life magazine had few concerns about this kind of shot. In fact, it helped everyone understand and anticipate the story, because it could be, in a way, storyboarded before the photographer went out. A good deal of trust had to be placed in the photographer, as almost all of the results were unpredictable, but the set-piece gave (and still gives) a measure of comfort to the editors. The two main set-piece shots are the opener and the closer, and for very good reason, given the ‘agenda’ that Life had for this story, as explained below. The pair of images, first and last, are making a point. Smith shot 6 negatives of the opener, with a low camera angle to place the doctor against a threatening sky. He also shot 5 negatives of the closer, and this is a posed shot; two of them show that the doctor had been asked to slump down awkwardly, feet splayed, so that he rests his elbow on the worktop. While it looks natural in the chosen image, it is clearly an unnatural position to hold.

Most of Smith’s shooting was 35mm, the normal reportage choice of camera for its speed and unobtrusiveness. But he also used 2¹/₄ rollfilm for set-piece shots, and a 4×5 view camera for large static scenes such as the overview of the town. The larger negatives gave better image quality, and though they were slower to use than 35mm, this did not matter in a set-up situation. The opener was shot on 2¹/₄, but the closer on 35mm.

The Layout

The editors at Life had plenty of material to choose from, because Smith, as usual, had spent much more time than anticipated and had got himself, again as usual, deeply involved with his subject, whom he came to admire . There were over 2,000 negatives. This isn’t to say there were 2,000 different images, because there were often situations in which there was enough time for Smith to move around the subject trying for a better angle or a more telling moment. These were groups of pictures from which only one was intended to be chosen.

The magazine’s agenda with this story, as already mentioned, was to show that America didn’t need more doctors paid for by compulsory health insurance. It needed only doctors like Ceriani (the health insurance debate continues to this day, by the way). Stating this baldly in the text would have been too direct and challenging – therefore not so persuasive. Pictures, however, have a special power that Life came to exploit very well: with the right sequencing and juxtaposition they can make a point without anyone being able to make a legitimate complaint that they are doing that. The silence of photographs can be very effective indeed, and that happened here. In the body of the photo essay, the rat-a-tat of the first spread sets the fast pace, and the narrative flow of each of the following four ‘incidents’ keeps it going, so it’s little surprise that the message of a busy, demanding life gets across. The story ends with a spread that shows, small, the doctor with his family, and larger, pensive after a day’s work – in other words, he copes. He’s strong enough and capable.

The sequencing of pictures in the three narrative ‘event’ spreads

But less obvious is how this last picture, of him still dressed in white from the operating theatre, compares with the first picture of him crossing a field to make a house call. The opener and the closer (which of course are introduction and conclusion) are in a clever juxtaposition. The opener is rather old-fashioned and fits the imaginary ideal of what a country doctor might be. Ceriani is crossing a field, past a picket fence, and carrying a traditional doctor’s bag. By the end of the story we see him in a hospital (the caption reminds us), dressed as a surgeon. Without having to put it into words, the imagery shows us modernisation, with the lone doctor at the heart of it, thoroughly capable. In other words, communities like Kremmling are just fine if left to themselves, and America doesn’t need compulsory health insurance.

More subliminally, we go from an opener that is dark and brooding to a closer that is white and bright. This was deliberate. Smith’s printing notes for the opener of the doctor crossing the field read ‘keep darkest near the top gradually going lighter lower down’. This makes the dark clouds look even more brooding.

The Structure

The ‘argument’ that the picture selection makes goes as follows:

Establishing shot: what the audience expects a country doctor to look like and be doing
He has a very busy working life
So busy, in fact, that emergencies regularly intrude on his personal life
His work seems to be a succession of emergencies and other emotionally dramatic events
A very brief glimpse of the town and his place in it
Exhausted and thoughtful after another long day, and we see that he is more than just a family doctor – he is a modern surgeon as well.

…and this is the way in which it is laid out:

Opener: one page, one picture, a set-piece establishing shot showing Dr. Ceriani as a traditional doctor with bag making a house call.

Body: 8 pages organised as 4 individual double-page spreads, as follows:-

Spread 1: a medley titled He must specialize in a dozen fields, made to look like a day in the life.
Spread 2: the first of 4 narrative sequences each showing an emergency or otherwise emotionally powerful event. As the first emergency, this sequence is shown interrupting a fishing trip the doctor is on – a small but effective device for leading us into his work, and intimating that Ceriani’s work is a series of demanding call-outs.
Spread 3: two narrative sequences running in parallel – an emergency and an urgent amputation.
Spread 4: the final narrative sequence, occupying a full spread, of Ceriani attending a night-time death from a heart attack.
Spread 5 left page: a summation of Ceriani’s demanding work, his place in the community… Leading to the inevitable conclusion…

Closer: Spread 5 right page: full-page picture of Ceriani tired after a late-night operation, dressed as a surgeon.

Rhythm

As one spread follows the other, there needs to be a conscious sense of pacing. Here we can see this in action. Individual pictures have impact according to a) how large they are, b) how many other pictures they are with on a spread, c) their position on the spread, and d) their inherent power as photographs. Taking all this into account, this is, according to me at any rate, the relative attention-getting strength of each spread/page, arranged by height, like a bar-chart…

The rhythm becomes clear. Start strong, dip a little, rise even higher, dip a little, back up, and then, on the last spread a double effect of going down on the left-hand page and right up on the last. We can simplify this even more into an at-a-glance graph…