Dr. Ernest Ceriani looks towards the ground, his face is fraught with the tension of being the sole physician trying all that is humanly possible to do best by the 2000 or so inhabitants of Kremmling, Colorado, for which he is responsible. The sky is brooding as the wilds of the rural ranching community, located by the foot of the Rocky Mountains, spout up all around. Yet Dr. Ceriani, wearing a fedora hat and a jacket and tie, shows a tenacious professionality in the face of such overwhelming odds. W. Eugene Smith’s highly evocative, black and white, photograph was first published in Life Magazine as part of a photo essay called Country Doctor in 1948. Dr. Ceriani was a true unsung American hero and, after the photo essay was published, he was a national one, elevated to that level by the sheer power and breadth of Smith’s ability to embed himself so completely into a story and earnestly capture the most vital moments.

Smith spent 23 days with Dr. Ceriani, following him as he checked in on patients and tended to the needs of those who were sick and dying. He watched him treat infants, administer injections in the backseats of cars, even develop his own x-rays and phone a priest to give the last rites to a man who was succumbing to a fatal heart attack. Another photograph shows Dr. Ceriani in surgical gowns, leaning against a kitchen counter smoking a cigarette and holding a cup of coffee. He clutches them close to his body as if to assert a sense of control into an uncontrollable situation. The caption reads ‘Dr. Ceriani takes a coffee and a cigarette in the hospital kitchen, exhausted after a late night surgery’. Here, Smith highlights the humbleness and humility of Ceriani’s heroism intrinsic to his sense of duty and care, but never, as one would expect as the series unfolds, strays into an inflated, Hollywood-esq sense of heroism.

Yet throughout the series, Smith’s photographs also capture his angular features and distinctive black receding hairline, lending him a distinguished presence that radiates the captivating charisma and handsomeness of a film star that helped achieved becoming a nationally known American hero. This is most evident in the photograph captioned ‘The doctors makes a call to a priest from a patient’s home, letting them know his 82-year-old heart attack patient will not make it through the night’. Dr. Ceriani is perched on a desk in the living room of a modest house, his fedora next to him. He is looking down at the floor with his head cocked to the left, this time on the telephone. To his left, two women in patterned dresses, one with her arms crossed the other chewing the nail on her thumb, look towards him tensely. A light above him illuminates his face with the intensity of a Caravaggio, his face offering a strong and comforting respite to the events taking place, like a lighthouse in a storm, the patient in question and the two women are surely in the best care that they could be. But even here, Smith’s compositional skills and innate sense of timing means that this does not detract away from grave concerns of the moment.

But what does became clear throughout W. Eugene Smith: A Life in Photography, that was on display at the Tokyo Photographic Art Museum earlier this year, is, what else could have been, had certain circumstances within Smith’s life been handled differently. Primarily, this has to do with confrontations with editors which ended his relationship with Life Magazine, after a portrait of Albert Schweitzer was used against his wishes and was later found to be heavily edited, combined with late night parties and binges with amphetamines that, although initially used to stay awake in order to work, undoubtedly became a crutch in which his later life and career fell victim to. This is not to say that Smith’s output wasn’t to an exceptionally high standard; he clearly possessed a unique ability to express, so tenderly and so beautifully, suffering and elation and everything in between and to give voices to those who deserved it most yet never went in search of it. But he never seemed to be able to fully deliver that trait to himself, to take scope, with the clarity he captures his protagonists with, and allow his work to exist.

Take, for example, his first project for the Magnum Photo Agency in 1955. Having separated from Life, Smith was asked by Stefan Lorant to take photographs of Pittsburgh as it held its centenary celebrations. The brief was loose and wide stretching. At the time, Smith was said to be in debt, drinking heavily and while his wife, Carmen, was in Croton-on-Hudson, New York, caring for their four children, at the same time, in Philadelphia, Smith’s mistress, Margery Lewis, had recently given birth to the couple’s illicit son. It was scheduled to be a 3-week stint but by the end, it had mutated into a year-long slugging-match and, after receiving a further two Guggenheim grants, lasted until 1957, totalling over 21,000 photographs.

Throughout the series, Smith captures the city teetering on the precipice of its success, in the critical years of exponential growth after the Second World War as America anchored its position as the most powerful country in the world, in part, afforded by the enthusiasm and camaraderie within blue collar industrial cities such as Pittsburgh. Yet, as the second half of the century continued, America’s once great industrial towns started to become casualties in the shifting nature of commerce and globalization evidenced by glass skyscrapers beginning to appear in the cityscapes, looming like spectres over the smokestacks of the steel mills and factories. When looking at photographs from this series now, for instance, in one where the face of steel mill worker in protective goggles is streaked with sweat and dirt and hardened by the brutal physicality of his work, the feelings evoked are like looking at photograph of a recently departed loved one. It is a reminder that times have changed, irrevocably, but their impact is still ingrained within us as we begin to grow accustom to life beyond it. This is made more indelible by the physicality of Smith’s photographs, shot on film and handled and nurtured to their final state, they are a testament to his way of life as a photographer, to an artform that has now become all but eradicated in the digital era.

Smith saw the Pittsburgh project as his redemption, an epic masterpiece that would prove those who doubted him after he left Life wrong. He became even more obsessive over his work, spending days without sleeping and, when it came to how the project would eventually be shown, he settled for nothing less than complete control. To this day, it has yet to be displayed in full.

Although he would go on to produce one of his most acclaimed series showing how industrial mercury pollution had devastated the fishing village of Minamata, Japan, it seems as if the Pittsburgh series weighed heavily upon him. The photographs from Minamata are just as potent, visually, but they lack the indefinable presence – a fortitude of sorts – that is drawn from the series as a whole, the urgency, the pressure of the deadline, the fragility of human life and the drive to exist in the face of this. In re-examining his works and life, Smith comes across almost like a myth, like an underdog, an unsung hero that, if nothing else, will certainly be due his 15 minutes of critical acclaim, just as he had orchestrated for Dr. Ceriani, but that in reality this made impossible by his fallibility, his character overshadows the power of his works. “The main problem” he said of his Pittsburgh series, “is that there is no end to such a subject as Pittsburgh and no way to finish it”, begging the question, just how different things could have been.