Letter to the Editor
Common Birthplace? Modern Plastic Surgery
and Surrealism
Aesthetic Surgery Journal
2016, Vol 36(6) NP202–NP205
© 2016 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
[email protected]
DOI: 10.1093/asj/sjw050
www.aestheticsurgeryjournal.com
Peter Niclas Broer, MD, PhD; and Paul Immanuel Heidekrueger, MD
Accepted for publication January 26, 2016; online publish-ahead-of-print April 5, 2016.
Modern plastic and reconstructive surgery certainly has a
well-documented history and evolution, with its roots,
thinking about the principles of nasal reconstruction by
Sushruta for instance, dating back several thousand years.1
However, World War I (WWI) can undoubtedly be considered a time of major importance to advances within our
specialty. Modern weaponry and trench warfare lead to
severe bodily trauma and a subsequent need for plastic and
reconstructive surgery. Not only medicine, but also art and
the societal and political mindsets were obviously strongly
influenced by the war. As such, several reports about art in
plastic surgery and respective exhibitions dating from the
time around WWI exist in the literature.2-5
While many illustrations and paintings were initially
very graphic in nature, the nihilistic view of the horrible
war also lead to the Dada movement and subsequently surrealism. These facts are well described in the literature.6
The fact that modern plastic and reconstructive surgery
and the surrealist movement are actually very closely interlinked and may as a matter of fact have common roots is
much less well described.
The surrealist movement, which commenced in the
1920s primarily in Paris and from there spread around the
world, was in part founded and consequently heavily promoted by Louis Aragon (1897-1939) and André Breton
(1896-1966), two French writers and poets. Surrealism profoundly influenced the evolution of modern art with representatives like Dalí, Picasso, and Miró, but also provided
the theoretical framework for surrealist philosophy, as well
as social theories and political concepts.
Breton defined surrealism in his 1924 manuscript
“Manifesto” as follows: “Pure psychic automatism, by which
one proposes to express, either verbally, in writing, or by
any other manner, the real functioning of thought. Dictation
of thought in the absence of all control exercised by reason,
outside of all aesthetic and moral preoccupation.”7 Little is
known about what exactly initiated Breton’s concept to
freely release and express all subconscious thoughts and
images, but the fact that is was so readily accepted by many
contemporary artists, writers, and poets, certainly shows
that it was the time during and post-WWI that let this movement fall on fruitful ground.
Interestingly, Aragon and Breton were physicians in
training when they first met sharing a room at the Parisian
military hospital Val-de-Grâce during WWI.8 What was it
that they saw and thought during that time, urging them to
express their sub consciousness, finally using it as a tactic
to imply societal changes? Lyford has researched the association between the hospital and its influence on Breton and
Aragon extensively in “The Aesthetics of Dismemberment:
Surrealism and the Musée du Val-de-Grâce in 1917.”9 Like
she and others described, the famous Val-de-Grâce hospital
was, during the time, a place like no other representing
bodily trauma in terms that were as visual as they were
physical or psychological.
Similarly, not only may this hospital to some extent be
considered as one of the birthplaces of surrealism, but also
as a birthplace of modern plastic surgery. Each of these
findings has been described previously, but we found it interesting how they apparently coincide. Also interesting
From the Department of Plastic, Reconstructive, Hand, and Burn
Surgery, Academic Teaching Hospital Technical University Munich,
Munich, Germany.
Corresponding Author:
Dr Paul Immanuel Heidekrueger, Department of Plastic and
Reconstructive Surgery, Klinkum Bogenhausen, Academic Teaching
Hospital Technical University Munich, Englschalkingerstr. 77, Munich
81925, Germany.
E-mail: [email protected]
Broer and Heidekrueger
appears the fact that the exact opposite of what is set as ultimate goal in daily reconstructive plastic surgery, namely
the repair of defects ideally to a degree as to camouflage all
previous deformity, is, in its exact contrary, being used as
one of the central themes by the surrealists: the persistence
of psychological and societal dismemberment even after the
external appearance may have undergone reconstruction.
Initially, the reason why these hospitals were set up
(as, for example, in the United Kingdom first at Aldershot
and then at Sidcup) was not because of any concern for
post-war outcomes. It was simply to make the soldiers as fit
for duty as soon as possible. In fact, in his speech “The
Problems of Facial Reconstruction” given by Major Gillies
to the Medical Society of London, he said, “I would have
you know that my first duty is to the Army, and that this
involves the sending back to duty as many soldiers as possible in the shortest time; my second obligation is to the
patient and to do the best for him that in me lies, whether
he is to be a spectacular success or merely a poor,
patched-up pensioner; and my third duty is to contribute as
freely as possible to science and to the knowledge of
surgery.” These three duties frequently clash, and the solution of a plastic problem is often complicated by the necessity to send a soldier back to duty, presentable but
unfinished. Likewise, my duty to surgery is greatly hampered by the stress of work.”10 Consequently the British,
French, and Germans set up unique hospitals to treat these
injuries, and the Americans, when joining the war 1917,
followed their example.
This became especially apparent in France, where
plastic surgery gained the interest of the public and the
media through the communication of the institution of the
above cited military hospital Val-de-Grâce.
Originally, this hospital was founded and run by
Benedictine nuns and, over time, it was regarded as the
cutting-edge teaching facility in France. Not very surprisingly it became a center of plastic and reconstructive
surgery during WWI.
One surgeon in particular, Hippolyte Morestin,11 is still
considered one of the founders of modern plastic surgery
by many. Working during a time where most of the surgeries were guided by ablational principles, Morestin was one
of the first to introduce the concept of reconstruction, a
principle that was of tremendous value during the years of
WWI with its technologic advances in warfare and consequently abundant deforming injuries. However, before the
days of war and his focus on plastic surgery, Morestin also
applied his natural sense of aesthetics and whenever possible he combined both, a good functional as well as a good
aesthetic result. As early as 1903 he proposed to make a
horizontal incision in the armpit to remove tumors of the
breast in order to avoid unsightly scars. The principle to
replace like with like and use skin grafts of the same color
and texture match were also proposed by him, just like he
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made many contributions to the development of facelift
techniques, later published by his pupil Raymond Passot in
“La Presse Médicale” in 1919.12
Besides Morestins’ impressive technical abilities, he also
held important positions within Val-de-Grâce’s administration, including being the intendant of the hospital’s war
museum. He thereby not only had tremendous influence
on the development of novel reconstructive procedures,
but also on the way human dismemberment and the subsequent reconstruction were displayed and perceived by the
public, mostly through the hospital’s own museum of
warship.
This museum of medical iconography documented the
military’s wartime medical activities. Morestin was responsible for the arrangement and display of the moulages in
the museum, which demonstrated impressively the novel
surgical procedures and reconstructive options of that time.
Morestin reorganized its collection in 1917 and the
museum opened its doors to a public that was widely concerned with the issue of injuries and mutilations created by
war in 1917.
What is interesting about this museum is that the
display of the exhibition and the way it was advertised was
a response to the pessimistic atmosphere in French society
in the 1920s, when fears about civilization, mankind in
general, and the uselessness of war were particularly pervasive. Being a state-owned institution, the museum played a
role in a more general public policy of keeping up the
spirits in a moment when war was lasting too long and
more and more people had become depressed.9
The museum opened amidst a blitz of publicity as the
war dragged on into 1916. By opening it to a larger public,
it was meant as an effort to show what the state was doing
to help the war’s most severely injured soldiers (mutilés de
guerre).
This policy of advertising health system had international impact and was noticed abroad. The New York Times
wrote in 1916: “The Ambulance takes these torn, mutilated
beings, without any faces, who would otherwise be unbearably repulsive and almost certainly economically dependent, and makes them over. It turns them into normal
men again, so that they can live normal lives, as individuals, and be of service to their country as well.”13
Consequently, plastic surgery and especially aesthetic
plastic surgery, evolved a lot during this time. Not only was
there was a new vast demand for reconstructive procedures, but European States were also facing a social
dilemma.
The many soldiers with severe facial injuries and no
good reconstructive surgical options became a concern for
public policies. These dismembered soldiers now were
unable to find a job, or a wife, depending solely on social
and state support requiring economically unfeasible levels
of government assistance and became not only a public
Aesthetic Surgery Journal 36(6)
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policy issue, but also a collective issue. Indeed, people saw
men and husbands coming back from the war, alive but
disfigured. This situation became a significant social
trauma, as many publications and works of art of the time
tended to indicate. Cultural artifacts translated this fear of
injury and dismemberment.
By 1917, then, Val-de-Grâce had become an institution
that played both a political and an aesthetic role in the
state’s public relations program to deflect criticism about
the huge numbers of casualties being incurred along the
western front in the same two years (1916-1917) in which
desertions were more numerous in the army.
The museum’s collection of moulages (wax and plaster
casts) demonstrated to its new audience how national reconstruction would be achieved: progress would occur
through the surgical repair of soldiers’ mutilated bodies.
Scientific intelligence, innovation, and therapeutic progress were symbolically represented through the tragic
displays of bodily injury and subsequent strategies of
repair. The explicitly visual character of the museum of
Val-de-Grâce was crucial to the military’s demonstration
of public support for the mutilés de guerre, for it delineated
the ways that French technology and scientific invention were being harnessed in the drive toward national
reconstruction.14
The facial casts and moulages were presented to the
viewer in chronological order of their repair, starting with
the dismembered faces and taking the novice through each
stage of the surgical repair.
André Breton and Luis Aragon, being among this evolution, found ample sources to establish and promote their
surrealists thoughts. The exact opposite of what the state
tried to convey with the help of the museum became the
central theme of the surrealist movement. Aragon and
Breton saw the advances that were made in regards to
plastic surgery. However, they symbolized how the trauma
persisted even through the most advanced reconstructive
techniques by expressing dismemberment trough their subconsciousness. It is a principle which still applies today; a
scalpel may sometimes, but not always, heal a mind.
During the times of war, this held true for both personal
trauma and societal trauma. It was to some degree a way to
criticize the state trying to camouflage the real damage and
to create a sense of hope and security.
Especially after the war when the state tried to make
things appear less dramatic then they were, the surrealists
continued to express their critique and openly displayed
the persistent trauma. Having lived through similar trauma,
the surrealist movement became accepted by many, and
became the foundation of what we perceive as modern art
today (Figure 1).
The hypothesis that surrealism and plastic surgery can
be traced back to a single hospital is certainly hard, if not
impossible, to prove and likely also not entirely correct; too
Figure 1. “The Three Dancers” (Les Trois Danseuses, 1925)
by Pablo Picasso (1881-1973). Type: Oil paint on canvas.
Reprinted with permission from Tate Modern, London,
United Kingdom.
many evolutions took place in a parallel fashion and in
several locations. Certainly this could have been coincidence. Also, if, when and where Morestin, Aragon, and
Breton met would be hard to prove. As such it was not the
aim to pinpoint either of the two to one location. More so,
we attempted to describe and illustrate the interesting overlaps of the phenomena which took place in Paris during the
time and which influenced both our specialty and the artistic movements profoundly.
Disclosures
The authors declared no potential conflicts of interest with
respect to the research, authorship, and publication of this
article.
Funding
The authors received no financial support for the research,
authorship, and publication of this article.
Broer and Heidekrueger
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