One of the two most important paintings in the history of medicine and in the history of American art hangs in the John Morgan building at the University of Pennsylvania School of Medicine, yet very few students at the medical school realize the significance of this monumental piece of art. Thomas Eakins, an American realist, born in Philadelphia in 1844, rose to artistic maturity in the 1860's was known primarily for this portraiture and among his more famous pieces, his depiction of oarsmen along the Schuylkill River. He was interested in the human form and studied anatomy at the Jefferson Medical College from 1864 to 1865. He became a demonstrator of Anatomy at the Philadelphia Academy of the Fine Arts and had great respect for the field.

Eakins was exposed to the filed of surgery at a crucial transition point, at a time when surgery was gaining more respect as a branch of medicine and at a time when advances in sterilization and antisepsis were becoming more widespread. He was able to capture this exact transition through his two paintings The Gross Clinic and The Agnew Clinic (pictured right). His renderings of two surgical cases, separated by 15 years, provides a unique window into the advances that occurred within the field of surgery.

After graduating from the University of Pennsylvania School of Medicine in 1838, David Hayes Agnew moved to the country for several years to work with his father in a clinic. In 1848 he returned to Philadelphia School of Anatomy and became director of the school in 1852. During his tenure at the school he established himself as a practical surgeon. He served in the United States army as a surgeon during the Civil War. In 1863 he was invited to demonstrate anatomy at Penn, becoming a professor of surgery in 1871 and the first John Rhea Barton Chair of Surgery in 1878.

Thomas Eakins was commissioned to paint a portrait of Dr. D. Hayes Agnew, who was then an Anatomy Professor and Chair of Surgery at the University of Pennsylvania, for $750.00 by a group of medical students. Eakins was approached by these students who wanted a portrait of their professor who was to retire in May of that year. As a student of anatomy himself, Eakins had great respect and admiration for Dr. Agnew and accepted this new commission with great enthusiasm. And even though the students "asked only for the head" of their professor, Eakins delighted at the request, offered to paint a pictorial of the clinic including not only Agnew and his assistants, but the students as well. Eakins chose to depict Dr. Agnew in his primary role as a professor in action, as he had with Dr. Gross 14 years prior.

The Gross Clinic (pictured right) and The Agnew Clinic are similar compositionally and thematically, however much about these paintings is different. Eakins chose to portray two prominent Philadelphia surgeons in the act of surgery with their teams rather than as single contemplative figures standing in an operating room. In painting the surgeons in this manner, this allows us to view conditions as well as the techniques implemented in the operating room in the 1870's and the 1890's. In The Gross Clinic all of the surgeons are depicted wearing black suits without gowns, gloves, masks or drapes. It is clear from this painting that antisepsis and sterile techniques have not yet been accepted. The surgeons depicted in The Agnew Clinic, however, clearly show acceptance of Lister's theories on antisepsis that were published in 1867. All of the surgeons are wearing gowns, however gloves, masks and hats at this point were not implemented. It is also evident from this scene that drapes were also used in order to enforce the concept of sterile field. Advances were also made in lighting in the surgical amphitheater around this time which is evident based on how Eakins portrays lighting in both of his paintings. In The Gross Clinic natural light through a sky light provided the lighting source for the surgery, which was standard practice at the time. In The Agnew Clinic, however, artificial light was newly implemented. Artificial light clearly expanded the field of surgery, not only allowing the surgeons to operate at any time of day, but also allowing them to see more clearly with greater detail.

Thomas Eakins was not only a prominent accomplished artist, he clearly was also an historian. By depicting the surgical amphitheater at 2 different time periods during such an important time of change, he was able to document the advances that were made in the field of surgery with picture alone. The Agnew Clinic is not only important in the history of art and medicine, but also in the history of our medical school. The painting commemorates a professor that was the "most experiences surgeon, the clearest writer and teacher, the most venerated and beloved man" (Johns et al.) and appropriately serves as a model for our medical school. The painting is on tour in the Thomas Eakins American Realist retrospective currently at the Philadelphia Museum of Art, which will travel to Muse d'Orsay in Paris and then to the Metropolitan Museum of Art in New York.

Bibliography
Johns, E. et al. Thomas Eakins: Image of the Surgeon. Baltimore: Walters Art Gallery: The Johns Hopkins Medical Institution, 1989

Sewell, D. Thomas Eakins: Artist of Philadelphia. Philadelphia: Philadelphia Museum of Art, 1982.