- Email: [email protected]
Thomas Eakins’ Agnew Clinic
CURRENT COMMENTARY
Thomas Eakins’ Agnew Clinic: A Study of Medicine Through Art Michael M. Frumovitz, MD Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
In 1889, Thomas Eakins was commissioned to paint a portrait of Dr. David Hayes Agnew to commemorate his exemplary career as a physician and teacher at The University of Pennsylvania. What was originally proposed as a three-quarters portrait of the retiring professor quickly became an enormous painting depicting an operating theater with Dr. Agnew assuming his role as both surgeon and educator. When comparing this piece with an earlier Eakins’ painting, The Gross Clinic, one can trace the rapid evolution of surgical techniques that accompanied medicine’s advancement in the late 19th century. Eakins obviously embraced this progress, but was the public ready to do so too? (Obstet Gynecol 2002;100:1296 –300. © 2002 by The American College of Obstetricians and Gynecologists.) They call me a butcher, and all I was trying to do was to picture the soul of a great surgeon.1
With tears in his eyes, Thomas Eakins mumbled these words to a confidante in 1890. Unfortunately, it was only after his death in 1916 that critics came to realize that his Agnew Clinic of 1889 (Figure 1) successfully and powerfully captures “the soul of a great surgeon.” This work, which now hangs in The University of Pennsylvania Medical School, serves as a fit memorial to a dedicated faculty member and a nationally recognized physician. At age 70, Dr. David Hayes Agnew announced his retirement from teaching and practicing surgery. This would end a distinguished career as an eminent surgeon and anatomist. Born in 1819, the son of a doctor, Agnew received his medical degree from The University of Pennsylvania in 1838 and immediately began work alongside his father in a rural practice outside Philadelphia. An avid anatomist, Agnew taught at the Philadelphia School of Anatomy before becoming an attending Address reprint requests to: Michael M. Frumovitz, MD, The University of Texas M.D. Anderson Cancer Center, Department of Gynecologic Oncology, Box 440, 1515 Holcombe Boulevard, Houston, TX 77005; E-mail: [email protected]. The author thanks Dr. Julian Robinson and Dr. Elizabeth Johns for their help and support in writing this article.
1296
physician at the Pennsylvania Hospital. In May of 1871, he resigned from the staff after refusing to lecture at the Women’s Medical College. Agnew, a gentleman “first and foremost” did not want to expose young women to the “unpleasant sights and facts” of venereal disease.2 That same year, he accepted the position of professor of surgery at his alma mater, The University of Pennsylvania. There, he would become the first to hold the distinguished John Rhea Barton Chair in Surgery at its founding in 1878. During the Civil War, Agnew became a specialist in the treatment of gunshot wounds and was named the chief surgeon in care of President Garfield after he was shot in 1881. Dr. Agnew took his academic responsibilities quite seriously. He lectured three times a week and held surgery clinic every Wednesday at noon.3 He published prolifically, writing multiple journal articles, primarily on abdominal and renal surgeries as well as penning a three-volume, 3000-page treatise on surgery. He was adored by colleagues and students alike and was known to “make the boys yell with appreciation.”4 John MacIntosh referred to Agnew as “a gift, a glory, and a benediction.”4 And this was praise from a reverend, nonetheless. In 1889, after the announcement of his retirement, Agnew’s students from the three undergraduate classes decided to honor their professor with a portrait to be unveiled at May’s graduation. That ceremony would be notable not only for Dr. Agnew’s retirement but also for the famous speech, “Equamanious,” given by William Osler before his departure to a new medical center in Baltimore known as Johns Hopkins. The students approached Thomas Eakins in early February with their offer of $750 for a three-quarters portrait, which had been tradition at Penn for decades, and much like the ones that hang in hospitals all over the country today. Eakins, however, counteroffered. For the same sum and with the cooperation of the students who would come to his Chestnut Street studio to pose, Eakins would greatly expand the piece. The Agnew Clinic would be the largest of all his works, measuring 6 ⫻ 11 ft. The piece was too large to place on an easel, so Eakins placed the canvas on the floor, sitting cross-legged before it, painting 16 hours a day. (He had less than 3 months to complete the behemoth.) When he was tired, Eakins would simply lie down in front of his work and nap. Eakins was totally engrossed by the project. Set in the operating amphitheater, the obvious focal point of the painting is Agnew, even though he does not occupy the center of the piece. Agnew stands alone to the
VOL. 100, NO. 6, DECEMBER 2002 © 2002 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/02/$22.00 PII S0029-7844(02)02368-2
Figure 1. The Agnew Clinic, 1889. Thomas Eakins. Oil on canvas. 74.5 ⫻ 130.5 in. Courtesy of the University of Pennsylvania Art Collection, Philadelphia, Pennsylvania. Frumovitz. Thomas Eakins’ Agnew Clinic. Obstet Gynecol 2002.
left of center, scalpel in his left hand (he was ambidextrous), contemplating his next point in the lecture. He is dramatically set from the background by the lighting, illuminating the front of the painting, whereas shadowing the recesses. In addition, Eakins used two different palettes in his piece, lighter tones for the front and darker ones for the back. In addition to the aforementioned lack of a pyramidal structure, Eakins abandons other Renaissance shapes of unity, such as the square, rectangle, or circle, in favor of an oval foreground and a trapezoidal background. These factors contribute to a wholly ununified painting. Interestingly, every figure in the painting is easily recognized. As Agnew pauses to ponder, Nurse Clymer looks on as Dr. William White applies the final dressing to the wound. Dr. Joseph Leidy holds the patient’s legs, wiping away excess blood. Dr. Ellwood Kirby administers the anesthesia, keeping the patient in her etherinduced sleep. Having agreed to pose for Eakins while he painted, each student, dressed in his dark suit, is identi-
VOL. 100, NO. 6, DECEMBER 2002
fiable. For example, William Furness, III, slouches in the back row, asleep, probably to the chagrin of his wellknown socialite parents. On the far right, Dr. Fred Milliken whispers to an onlooker, Eakins himself. Artists have painted self-portraits into their works for centuries. Here, however, Eakins’ likeness was not brushed by himself, but by his wife, also an accomplished artist. This unorthodox twist was done for reasons unknown and continues to baffle art historians today. Why did Eakins bother to have himself put into his piece? Perhaps, it was to show he had more than a passing interest in anatomy and surgery. Eakins was known as a “scientific” painter. He was known to study medical dictionaries and took anatomy classes while studying in Paris. In fact, he taught some anatomy at the Philadelphia Academy of Fine Arts until his dismissal in 1886 for “his too great zeal in teaching anatomy to a woman’s class.”5 His teaching motto of “observe, ascertain, reproduce”6 is not a far cry from the more familiar “see one,
Frumovitz
Thomas Eakins’ Agnew Clinic
1297
Figure 2. The Gross Clinic, 1875. Thomas Eakins. Oil on canvas. 96 ⫻ 78 in. Courtesy of Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Frumovitz. Thomas Eakins’ Agnew Clinic. Obstet Gynecol 2002.
do one, teach one.” By making himself an observer, Eakins showed that he could (and did) most accurately portray the scene we look upon. And so, Eakins strove to realistically portray the surgical clinics of Philadelphia, overlooking no details. In fact, when Dr. Agnew viewed the painting near its completion, he noticed the blood that Eakins had painted on his right, free hand. These drops so offended Agnew that he insisted they be removed from the work. After heated discussion, Eakins yielded. This squabble stuck with Eakins who tried to show the strength of Agnew’s character in the piece. Eakins would later comment on the interaction saying “the criticism is made that surgeons grow brutal, but here was a surgeon who had been accustomed to working in blood for 50 years, who had not had his sense of propriety blunted in the very least.”1 Once completed, Eakins set to work on the frame, a common task for an artist to do for his painting. However, he went on to inscribe the frame, which was unusual for a commissioned piece. On the frame he wrote: D. HAYES AGNEW, M.D. CHIRURGUS PERTISSIMUS. SCRIPTOR ET DOCTOR CLARISSIMUS. VIR VENERATUS ET CARRISSIMUS. MDCCCLXXXIX
1298
Frumovitz
Thomas Eakins’ Agnew Clinic
(D. Hayes Agnew, M.D. The Most Experienced Surgeon, The Clearest Writer and Teacher, The Most Venerated and Beloved Man)
This adulation suggests more than a passing, commissioned artist’s interest in his subject. Eakins obviously held Agnew in the greatest respect and wrote a dedication by which any physician would strive to be remembered. There are many precedents for Eakins’ painting. Medical drawings and paintings date back to ancient times. Medical portraiture was a popular subject in the Middle Ages and became particularly fashionable in 17th-century Flemish art. However, the best precedent by which to compare The Agnew Clinic is a piece done 15 years earlier—The Gross Clinic by Thomas Eakins (Figure 2). This noncommissioned piece done in 1875 is one of the first-known paintings to serve as a tribute to a living physician performing surgery. It is interesting to compare these works not only artistically, but also historically. In his earlier painting, Eakins employs the classic composition by placing Gross, the painting’s subject, at the pinnacle of a pyramid, whereas Agnew stands alone, off-center. The Gross Clinic is subdued, almost colorless,
OBSTETRICS & GYNECOLOGY
except for the ample amounts of blood with subtle merging of foreground and background. The Agnew Clinic, in contrast, has a lighter tone, less blood, and an abrupt change from the dark background to the bright foreground. Eakins uses quick brushstrokes to render Gross’ onlookers unrecognizable, whereas Agnew’s gallery is carefully painted with each student identifiable (they did pay the commission). Both paintings are epic in size (The Gross Clinic, 6 1⁄2 ⫻ 8 ft; The Agnew Clinic, 6 1⁄2 ⫻ 11 ft), but their heroes are portrayed differently. Dr. Gross portrays calmness amid the motion of a recoiling onlooker and continued blood loss, whereas Dr. Agnew stands calm amid the stillness of reclining onlookers and bright white dressings. Their poses might represent more than just the stage of the operation or each surgeon’s demeanor. As some historians have noted, Eakins may have incorporated the general notion of late 19th-century Philadelphia that Jefferson was the medical center for the masses, whereas Pennsylvania served the city’s elite. Therefore, “Gross is [shown as being] of the people, whereas Agnew is the more patrician in appearance.”3 For practicing physicians, the historical differences in the two pieces will likely be more interesting. Commenting on the 15 years separating the two paintings, J. Collins Warren in his 1958 book, To Work in the Vineyard, noted that “no other generation of physicians in the history of medicine has seen such extraordinary changes in the practice of medicine and surgery.”7 Many of these important advances are visible in the works. For example, in the earlier piece, anesthesia is administered using a cloth, whereas the newer, safer cone technique is employed in the later work. One of the most obvious differences is the implementation of sterile techniques by 1889. Although Lister had published his treatise on antisepsis 10 years before completion of The Gross Clinic, it had yet to become universally accepted as either valid or necessary.8 Dr. Gross and his assistants wear “business” suits in the operating amphitheater. This dark dress allowed physicians to practice medicine without changing clothes, as bloodstains would not show on their attire. By Agnew’s era, sterile techniques had been embraced. Physicians now actually washed their hands before operating. Patients were prepped aseptically, instruments and towels were sterilized, and gowns to be worn only in the operating room were provided to surgeons. Interestingly, neither generation had begun to wear gloves. The introduction of artificial light into surgical practice marks one more advance. In The Gross Clinic, the surgeons work by natural light, limiting not only their view but also the time of day in which they could perform. The Agnew Clinic is awash in bright light. Some of today’s operating rooms are not as well lit as this one.
VOL. 100, NO. 6, DECEMBER 2002
One critic has attached a symbolic “enlightenment” to the Agnew piece.3 The piece not only shows actual advances in illumination but also “improved understanding and the optimism of the new surgery.”3 Whether this was a true intention of Eakins or a critic’s posthumous interpretation will never be known. The Agnew Clinic was unveiled at the medical school graduation in 1889. Eakins must have prayed its reception would be more positive than its predecessor, as critics had not been kind to The Gross Clinic. The Herald stated that it was “decidedly unpleasant and sickening,” whereas The Tribune “condemned its admission to a gallery where men and women of weak nerves must be compelled to look at it.”9 The newer work did not fare much better. The Agnew Clinic was rejected by The Committee of Selections for the 61st Annual Exhibit at Eakins’ alma mater, The Academy. In addition, it was not included in four successive exhibitions of the Society of American Artists between 1888 and 1891. The critics and curators were not alone as “the larger public [received the work] as hostile as [it had] The Gross Clinic had been.”2 Others noted “the picture was not cheerful for ladies to look at.”1 Why did Eakins risk another disaster after the “failure” of his earlier Gross Clinic? Some wonder why Eakins chose to present Agnew completing a mastectomy. Agnew was known for his expertise in the treatment of gunshot wounds and wrote extensively on the surgery of kidneys and abdomen. In fact, neither journal articles nor his 3000-page treatise on surgery even mentions breast surgery. Mastectomies were known as one of the simpler procedures of the day, and even Eakins’ earlier subject, Samuel Gross, was known to say it took “no skill.” One would think that a painting to commemorate a physician’s career would portray him performing his “bread-and-butter” procedures. Not here, though. Maybe Eakins wanted to intentionally shock the viewer. Still smarting from his earlier rejection, Eakins may have wanted to show the art world he was above their recourse. His portrayal of such a controversial subject matter, he must have known, would certainly be shunned by the viewing public. Or, maybe he thought just the opposite. Maybe Eakins believed that medicine and science had been transformed so drastically in the intervening 15 years that the art world must have done so too. Late 19thcentury surgery had evolved into a bloodless, sterile event. He even surrounded the amphitheater with bored students, echoing his own sentiment. Eakins’ world was rapidly changing, and he must have thought, along with the scientific community, that this painting simply portrayed modern medicine.
Frumovitz
Thomas Eakins’ Agnew Clinic
1299
Regardless of motivation, Eakins was once again disappointed in the reviews. Among social circles in the art world, the saying went “Eakins is a butcher.”1 A devastated Eakins would never paint another medical scene.
5. 6. 7.
REFERENCES 1. Goodrich L. Thomas Eakins. Cambridge, Massachusetts: Harvard University Press, 1982:41–5. 2. Schneider S. Eakins. Boston, Massachusetts: Little and Brown, 1967. 3. Brieger GH. A portrait of surgery: Surgery in America, 1875–1889. Surg Clin N Am 1987;67:1181–216. 4. Hall DL. Eakins’ Agnew Clinic: The medical world in
1300
Frumovitz
Thomas Eakins’ Agnew Clinic
8. 9.
transition. Transactions and Studies of the College of Physicians of Philadelphia 1985;7:26–32. Kessler C. The realism of Thomas Eakins. Arts 1962;36: 16–22. Johns E. Thomas Eakins: The heroism of modern life. Princeton, New Jersey: Princeton University Press, 1983. Churchill ED, ed. To work in the vineyard of surgery; the reminiscences of J. Collins Warren, 1842-1927. Cambridge, Massachusetts: Harvard University Press, 1958. Toledo-Pereyra LH. Founders of modern surgery. J Invest Surg 2001;14:301–2. Hendrick G. The life and work of Thomas Eakins. New York, New York: Grossman, 1974.
Received March 19, 2002. Received in revised form May 16, 2002. Accepted June 19, 2002.
OBSTETRICS & GYNECOLOGY
Thomas Eakins’ Agnew Clinic: A Study of Medicine Through Art Michael M. Frumovitz, MD Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
In 1889, Thomas Eakins was commissioned to paint a portrait of Dr. David Hayes Agnew to commemorate his exemplary career as a physician and teacher at The University of Pennsylvania. What was originally proposed as a three-quarters portrait of the retiring professor quickly became an enormous painting depicting an operating theater with Dr. Agnew assuming his role as both surgeon and educator. When comparing this piece with an earlier Eakins’ painting, The Gross Clinic, one can trace the rapid evolution of surgical techniques that accompanied medicine’s advancement in the late 19th century. Eakins obviously embraced this progress, but was the public ready to do so too? (Obstet Gynecol 2002;100:1296 –300. © 2002 by The American College of Obstetricians and Gynecologists.) They call me a butcher, and all I was trying to do was to picture the soul of a great surgeon.1
With tears in his eyes, Thomas Eakins mumbled these words to a confidante in 1890. Unfortunately, it was only after his death in 1916 that critics came to realize that his Agnew Clinic of 1889 (Figure 1) successfully and powerfully captures “the soul of a great surgeon.” This work, which now hangs in The University of Pennsylvania Medical School, serves as a fit memorial to a dedicated faculty member and a nationally recognized physician. At age 70, Dr. David Hayes Agnew announced his retirement from teaching and practicing surgery. This would end a distinguished career as an eminent surgeon and anatomist. Born in 1819, the son of a doctor, Agnew received his medical degree from The University of Pennsylvania in 1838 and immediately began work alongside his father in a rural practice outside Philadelphia. An avid anatomist, Agnew taught at the Philadelphia School of Anatomy before becoming an attending Address reprint requests to: Michael M. Frumovitz, MD, The University of Texas M.D. Anderson Cancer Center, Department of Gynecologic Oncology, Box 440, 1515 Holcombe Boulevard, Houston, TX 77005; E-mail: [email protected]. The author thanks Dr. Julian Robinson and Dr. Elizabeth Johns for their help and support in writing this article.
1296
physician at the Pennsylvania Hospital. In May of 1871, he resigned from the staff after refusing to lecture at the Women’s Medical College. Agnew, a gentleman “first and foremost” did not want to expose young women to the “unpleasant sights and facts” of venereal disease.2 That same year, he accepted the position of professor of surgery at his alma mater, The University of Pennsylvania. There, he would become the first to hold the distinguished John Rhea Barton Chair in Surgery at its founding in 1878. During the Civil War, Agnew became a specialist in the treatment of gunshot wounds and was named the chief surgeon in care of President Garfield after he was shot in 1881. Dr. Agnew took his academic responsibilities quite seriously. He lectured three times a week and held surgery clinic every Wednesday at noon.3 He published prolifically, writing multiple journal articles, primarily on abdominal and renal surgeries as well as penning a three-volume, 3000-page treatise on surgery. He was adored by colleagues and students alike and was known to “make the boys yell with appreciation.”4 John MacIntosh referred to Agnew as “a gift, a glory, and a benediction.”4 And this was praise from a reverend, nonetheless. In 1889, after the announcement of his retirement, Agnew’s students from the three undergraduate classes decided to honor their professor with a portrait to be unveiled at May’s graduation. That ceremony would be notable not only for Dr. Agnew’s retirement but also for the famous speech, “Equamanious,” given by William Osler before his departure to a new medical center in Baltimore known as Johns Hopkins. The students approached Thomas Eakins in early February with their offer of $750 for a three-quarters portrait, which had been tradition at Penn for decades, and much like the ones that hang in hospitals all over the country today. Eakins, however, counteroffered. For the same sum and with the cooperation of the students who would come to his Chestnut Street studio to pose, Eakins would greatly expand the piece. The Agnew Clinic would be the largest of all his works, measuring 6 ⫻ 11 ft. The piece was too large to place on an easel, so Eakins placed the canvas on the floor, sitting cross-legged before it, painting 16 hours a day. (He had less than 3 months to complete the behemoth.) When he was tired, Eakins would simply lie down in front of his work and nap. Eakins was totally engrossed by the project. Set in the operating amphitheater, the obvious focal point of the painting is Agnew, even though he does not occupy the center of the piece. Agnew stands alone to the
VOL. 100, NO. 6, DECEMBER 2002 © 2002 by The American College of Obstetricians and Gynecologists. Published by Elsevier Science Inc.
0029-7844/02/$22.00 PII S0029-7844(02)02368-2
Figure 1. The Agnew Clinic, 1889. Thomas Eakins. Oil on canvas. 74.5 ⫻ 130.5 in. Courtesy of the University of Pennsylvania Art Collection, Philadelphia, Pennsylvania. Frumovitz. Thomas Eakins’ Agnew Clinic. Obstet Gynecol 2002.
left of center, scalpel in his left hand (he was ambidextrous), contemplating his next point in the lecture. He is dramatically set from the background by the lighting, illuminating the front of the painting, whereas shadowing the recesses. In addition, Eakins used two different palettes in his piece, lighter tones for the front and darker ones for the back. In addition to the aforementioned lack of a pyramidal structure, Eakins abandons other Renaissance shapes of unity, such as the square, rectangle, or circle, in favor of an oval foreground and a trapezoidal background. These factors contribute to a wholly ununified painting. Interestingly, every figure in the painting is easily recognized. As Agnew pauses to ponder, Nurse Clymer looks on as Dr. William White applies the final dressing to the wound. Dr. Joseph Leidy holds the patient’s legs, wiping away excess blood. Dr. Ellwood Kirby administers the anesthesia, keeping the patient in her etherinduced sleep. Having agreed to pose for Eakins while he painted, each student, dressed in his dark suit, is identi-
VOL. 100, NO. 6, DECEMBER 2002
fiable. For example, William Furness, III, slouches in the back row, asleep, probably to the chagrin of his wellknown socialite parents. On the far right, Dr. Fred Milliken whispers to an onlooker, Eakins himself. Artists have painted self-portraits into their works for centuries. Here, however, Eakins’ likeness was not brushed by himself, but by his wife, also an accomplished artist. This unorthodox twist was done for reasons unknown and continues to baffle art historians today. Why did Eakins bother to have himself put into his piece? Perhaps, it was to show he had more than a passing interest in anatomy and surgery. Eakins was known as a “scientific” painter. He was known to study medical dictionaries and took anatomy classes while studying in Paris. In fact, he taught some anatomy at the Philadelphia Academy of Fine Arts until his dismissal in 1886 for “his too great zeal in teaching anatomy to a woman’s class.”5 His teaching motto of “observe, ascertain, reproduce”6 is not a far cry from the more familiar “see one,
Frumovitz
Thomas Eakins’ Agnew Clinic
1297
Figure 2. The Gross Clinic, 1875. Thomas Eakins. Oil on canvas. 96 ⫻ 78 in. Courtesy of Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Frumovitz. Thomas Eakins’ Agnew Clinic. Obstet Gynecol 2002.
do one, teach one.” By making himself an observer, Eakins showed that he could (and did) most accurately portray the scene we look upon. And so, Eakins strove to realistically portray the surgical clinics of Philadelphia, overlooking no details. In fact, when Dr. Agnew viewed the painting near its completion, he noticed the blood that Eakins had painted on his right, free hand. These drops so offended Agnew that he insisted they be removed from the work. After heated discussion, Eakins yielded. This squabble stuck with Eakins who tried to show the strength of Agnew’s character in the piece. Eakins would later comment on the interaction saying “the criticism is made that surgeons grow brutal, but here was a surgeon who had been accustomed to working in blood for 50 years, who had not had his sense of propriety blunted in the very least.”1 Once completed, Eakins set to work on the frame, a common task for an artist to do for his painting. However, he went on to inscribe the frame, which was unusual for a commissioned piece. On the frame he wrote: D. HAYES AGNEW, M.D. CHIRURGUS PERTISSIMUS. SCRIPTOR ET DOCTOR CLARISSIMUS. VIR VENERATUS ET CARRISSIMUS. MDCCCLXXXIX
1298
Frumovitz
Thomas Eakins’ Agnew Clinic
(D. Hayes Agnew, M.D. The Most Experienced Surgeon, The Clearest Writer and Teacher, The Most Venerated and Beloved Man)
This adulation suggests more than a passing, commissioned artist’s interest in his subject. Eakins obviously held Agnew in the greatest respect and wrote a dedication by which any physician would strive to be remembered. There are many precedents for Eakins’ painting. Medical drawings and paintings date back to ancient times. Medical portraiture was a popular subject in the Middle Ages and became particularly fashionable in 17th-century Flemish art. However, the best precedent by which to compare The Agnew Clinic is a piece done 15 years earlier—The Gross Clinic by Thomas Eakins (Figure 2). This noncommissioned piece done in 1875 is one of the first-known paintings to serve as a tribute to a living physician performing surgery. It is interesting to compare these works not only artistically, but also historically. In his earlier painting, Eakins employs the classic composition by placing Gross, the painting’s subject, at the pinnacle of a pyramid, whereas Agnew stands alone, off-center. The Gross Clinic is subdued, almost colorless,
OBSTETRICS & GYNECOLOGY
except for the ample amounts of blood with subtle merging of foreground and background. The Agnew Clinic, in contrast, has a lighter tone, less blood, and an abrupt change from the dark background to the bright foreground. Eakins uses quick brushstrokes to render Gross’ onlookers unrecognizable, whereas Agnew’s gallery is carefully painted with each student identifiable (they did pay the commission). Both paintings are epic in size (The Gross Clinic, 6 1⁄2 ⫻ 8 ft; The Agnew Clinic, 6 1⁄2 ⫻ 11 ft), but their heroes are portrayed differently. Dr. Gross portrays calmness amid the motion of a recoiling onlooker and continued blood loss, whereas Dr. Agnew stands calm amid the stillness of reclining onlookers and bright white dressings. Their poses might represent more than just the stage of the operation or each surgeon’s demeanor. As some historians have noted, Eakins may have incorporated the general notion of late 19th-century Philadelphia that Jefferson was the medical center for the masses, whereas Pennsylvania served the city’s elite. Therefore, “Gross is [shown as being] of the people, whereas Agnew is the more patrician in appearance.”3 For practicing physicians, the historical differences in the two pieces will likely be more interesting. Commenting on the 15 years separating the two paintings, J. Collins Warren in his 1958 book, To Work in the Vineyard, noted that “no other generation of physicians in the history of medicine has seen such extraordinary changes in the practice of medicine and surgery.”7 Many of these important advances are visible in the works. For example, in the earlier piece, anesthesia is administered using a cloth, whereas the newer, safer cone technique is employed in the later work. One of the most obvious differences is the implementation of sterile techniques by 1889. Although Lister had published his treatise on antisepsis 10 years before completion of The Gross Clinic, it had yet to become universally accepted as either valid or necessary.8 Dr. Gross and his assistants wear “business” suits in the operating amphitheater. This dark dress allowed physicians to practice medicine without changing clothes, as bloodstains would not show on their attire. By Agnew’s era, sterile techniques had been embraced. Physicians now actually washed their hands before operating. Patients were prepped aseptically, instruments and towels were sterilized, and gowns to be worn only in the operating room were provided to surgeons. Interestingly, neither generation had begun to wear gloves. The introduction of artificial light into surgical practice marks one more advance. In The Gross Clinic, the surgeons work by natural light, limiting not only their view but also the time of day in which they could perform. The Agnew Clinic is awash in bright light. Some of today’s operating rooms are not as well lit as this one.
VOL. 100, NO. 6, DECEMBER 2002
One critic has attached a symbolic “enlightenment” to the Agnew piece.3 The piece not only shows actual advances in illumination but also “improved understanding and the optimism of the new surgery.”3 Whether this was a true intention of Eakins or a critic’s posthumous interpretation will never be known. The Agnew Clinic was unveiled at the medical school graduation in 1889. Eakins must have prayed its reception would be more positive than its predecessor, as critics had not been kind to The Gross Clinic. The Herald stated that it was “decidedly unpleasant and sickening,” whereas The Tribune “condemned its admission to a gallery where men and women of weak nerves must be compelled to look at it.”9 The newer work did not fare much better. The Agnew Clinic was rejected by The Committee of Selections for the 61st Annual Exhibit at Eakins’ alma mater, The Academy. In addition, it was not included in four successive exhibitions of the Society of American Artists between 1888 and 1891. The critics and curators were not alone as “the larger public [received the work] as hostile as [it had] The Gross Clinic had been.”2 Others noted “the picture was not cheerful for ladies to look at.”1 Why did Eakins risk another disaster after the “failure” of his earlier Gross Clinic? Some wonder why Eakins chose to present Agnew completing a mastectomy. Agnew was known for his expertise in the treatment of gunshot wounds and wrote extensively on the surgery of kidneys and abdomen. In fact, neither journal articles nor his 3000-page treatise on surgery even mentions breast surgery. Mastectomies were known as one of the simpler procedures of the day, and even Eakins’ earlier subject, Samuel Gross, was known to say it took “no skill.” One would think that a painting to commemorate a physician’s career would portray him performing his “bread-and-butter” procedures. Not here, though. Maybe Eakins wanted to intentionally shock the viewer. Still smarting from his earlier rejection, Eakins may have wanted to show the art world he was above their recourse. His portrayal of such a controversial subject matter, he must have known, would certainly be shunned by the viewing public. Or, maybe he thought just the opposite. Maybe Eakins believed that medicine and science had been transformed so drastically in the intervening 15 years that the art world must have done so too. Late 19thcentury surgery had evolved into a bloodless, sterile event. He even surrounded the amphitheater with bored students, echoing his own sentiment. Eakins’ world was rapidly changing, and he must have thought, along with the scientific community, that this painting simply portrayed modern medicine.
Frumovitz
Thomas Eakins’ Agnew Clinic
1299
Regardless of motivation, Eakins was once again disappointed in the reviews. Among social circles in the art world, the saying went “Eakins is a butcher.”1 A devastated Eakins would never paint another medical scene.
5. 6. 7.
REFERENCES 1. Goodrich L. Thomas Eakins. Cambridge, Massachusetts: Harvard University Press, 1982:41–5. 2. Schneider S. Eakins. Boston, Massachusetts: Little and Brown, 1967. 3. Brieger GH. A portrait of surgery: Surgery in America, 1875–1889. Surg Clin N Am 1987;67:1181–216. 4. Hall DL. Eakins’ Agnew Clinic: The medical world in
1300
Frumovitz
Thomas Eakins’ Agnew Clinic
8. 9.
transition. Transactions and Studies of the College of Physicians of Philadelphia 1985;7:26–32. Kessler C. The realism of Thomas Eakins. Arts 1962;36: 16–22. Johns E. Thomas Eakins: The heroism of modern life. Princeton, New Jersey: Princeton University Press, 1983. Churchill ED, ed. To work in the vineyard of surgery; the reminiscences of J. Collins Warren, 1842-1927. Cambridge, Massachusetts: Harvard University Press, 1958. Toledo-Pereyra LH. Founders of modern surgery. J Invest Surg 2001;14:301–2. Hendrick G. The life and work of Thomas Eakins. New York, New York: Grossman, 1974.
Received March 19, 2002. Received in revised form May 16, 2002. Accepted June 19, 2002.
OBSTETRICS & GYNECOLOGY