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Art and Images in Psychiatry
March 2007

The Agnew Clinic

Arch Gen Psychiatry. 2007;64(3):270-271. doi:10.1001/archpsyc.64.3.270

I doubt whether [Eakins] is a prolific worker or works with an idea of making money. . . . He seemed to me much more like an inventor working [out] curious & interesting problems for himself than an average artist. . . . 

Art critic Marianna Griswold van Rensselaer to S. R. Kohler, June 12, 18811(p xi)

It seems to me that no one should work in a life class who thinks it is wrong to undress if needful. . . . I never in my life seduced a girl, nor tried to, but what else can people think of all this rage and insanity? . . . so much smoke for so little fire.

Thomas Eakins to Edward H. Coates, February 15, 18862(p214)

Thomas Eakins (1844-1916) was unique among 19th century artists for his scientific approach. As a student, Eakins excelled in science, mathematics, languages, and drawing.3,4 After high school graduation in 1862, he attended drawing classes at the Pennsylvania Academy of the Fine Arts and attended lectures in anatomy at Jefferson Medical College before leaving for Europe to study art. In Paris, he enrolled in the École des Beaux Arts, where he entered the studio of Jean-Léon Gérôme and drew from the nude for 5 months. Later he studied sculpture with Augustin-Alexandre Dumont and portraiture with Léon Bonnat. During his fourth and final year in Europe, his mother was diagnosed with a mental illness at 50 years of age. Shortly after his return to America in 1870, she was hospitalized. Following hospital discharge, she was confined to her room, dying 2 years later from “exhaustion from mania.” During his mother's illness, Eakins sought support from his 17-year-old sister, Margaret, who joined him in sporting activities and modeled for him. A stipend from his father's investments provided financial support that allowed him the freedom to choose his own subjects. Among those portrait subjects were the prominent surgeons Samuel David Gross and David Hayes Agnew, the poet Walt Whitman, physicist Henry A. Rowland, and President Rutherford Hayes.

Thomas Cowperthwait Eakins (1844-1916), American. Cover: The Agnew Clinic, 1889. Oil on canvas, 84⅜ × 118⅛ in. Courtesy of the University of Pennsylvania, Philadelphia.

Thomas Cowperthwait Eakins (1844-1916), American. Cover: The Agnew Clinic, 1889. Oil on canvas, 84⅜ × 118⅛ in. Courtesy of the University of Pennsylvania, Philadelphia.

In 1874, Eakins attended surgical demonstrations at Jefferson Medical College by Professor Gross, the leading surgeon of the time.4 Anticipating the upcoming US Centennial International Exhibition in Philadelphia (May 10, 1876), Eakins felt that a portrait of Professor Gross in his surgical amphitheater would provide an opportunity to show the world scientific advances in surgery. Gross was an innovative surgeon whose work encompassed pathological anatomy, orthopedics, thoracic surgery, abdominal surgery, and ophthalmology.5 President of the American Medical Association in 1868, Gross was the author of 6 surgical texts that passed through a combined total of 15 editions.

Rather than paint an individual portrait, Eakins realistically depicted Gross in the operating setting during a period after the introduction of anesthesia but before the introduction of asepsis, when surgeons wore street clothes. Surgery was conducted in an operating theater lit in midday by a skylight that illuminated the surgical team and the operative field while leaving the observers in the shadows. In The Gross Clinic (Figure), 70-year-old Gross, wearing a black frock coat, stands behind a tray of surgical instruments holding a bloody scalpel in his bloodstained right hand. He has moved away from the patient and surgical team to address the student observers. The young male patient, wearing only blue-gray socks to warm his feet, lies on his right side with his legs drawn up to expose the operative site, where a long incision has been placed in his left thigh.6 His head is at the far end of the table and is covered by chloroform-soaked gauze. The operation is conservative surgery championed by Gross to remove necrotic bone (sequestrum) from the femur and avoid amputation (the treatment before anesthesia was introduced) in cases of osteomyelitis. The anesthesiologist administers chloroform; one doctor holds a retractor while another holds the young man's legs in position. Obscured by Gross, a member of the team holds a second retractor. The patient's mother recoils from the operation and holds up her left arm to shield her eyes. In the center, Dr Frank West records the clinic proceedings. The college orderly and Gross's surgeon son, Samuel W. Gross, stand in the entryway. There are portraits of all of the 21 observers. Eakins himself looks on, pencil and pad in hand.6

The Gross Clinic, 1875. Oil on canvas, 96 × 78½ in. ©Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa/The Bridgeman Art Library (http://www.jefferson.edu/eakins/grosspic.cfm).

The Gross Clinic, 1875. Oil on canvas, 96 × 78½ in. ©Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa/The Bridgeman Art Library (http://www.jefferson.edu/eakins/grosspic.cfm).

To Eakins's deep disappointment, The Gross Clinic was not selected for exhibition in the painting gallery at the Centennial International Exhibition, although 3 of Eakins's oils and 2 watercolors were displayed. The Gross Clinic was placed in the US Army Post Hospital exhibit. Despite recognizing the quality of his work, the art world and the general public were not ready for a realistic portrayal of a surgeon with blood on his hands. Two years later, the Jefferson Medical Alumni purchased it for $200.

With the death of the professor of painting at the Pennsylvania Academy of the Fine Arts in 1879, Eakins was named professor of painting and drawing, assuming the directorship of the schools in 1882 at an annual salary of $1200. Eakins initiated an innovative, nationally recognized program that emphasized systematic study of mathematics, perspective, and life study. Male and female students dissected both humans and animals to learn anatomy and in life class practiced drawing nude models. Eakins taught the use of photography and participated in innovative research studies photographing humans and animals in motion.

Unlike art schools in other cities, the Pennsylvania Academy was run by local business leaders who had little understanding of art. Eakins was initially fortunate to have a strong supporter in Fairman Rogers, the chairman of the board. When Rogers retired in 1883 and was replaced by Edward H. Coates, Eakins was viewed more critically. In 1886, Eakins removed the loincloth from a male model to demonstrate pelvic muscle insertion in front of a class with female art students. He was admonished by the board of the school and asked to change his teaching practices. This episode served as an opportunity for male junior faculty, who disagreed with his exclusive focus on realism in art, to oppose his leadership to the board. Other board members thought that female students should paint genteel things, such as decorating teacups, and not be exposed to the rigors of anatomical dissection. When Eakins refused to change his teaching practices, he was asked to resign as director of the schools in February 1866. He wrote to the board in his defense (epigraph). Thirty-eight students resigned and established the Philadelphia Art Students League, where Eakins continued to teach.

Eakins's brother-in-law and former student, Frank Stephens, also pursued a vendetta against him and sought his expulsion from the Philadelphia Sketch Club for vague charges of “conduct unworthy of a gentleman.” When no specific written charges were forthcoming, a family hearing was held (without Eakins present) at his father's home. The accusation was that his favorite sister, Margaret, who had died several years earlier in 1882 of typhus, had posed for him nude and implied that he was sexually involved with her. There was no evidence for these charges, but the family turmoil that they caused resulted in his brother-in-law and sister Caroline being asked to leave the father's home and Eakins and his wife, Susan Macdowell, whom he had married in 1884, moving in. The members of the Philadelphia Sketch Club voted against proceedings to expel Eakins.

Disheartened and depressed by his termination and what he felt was a reckless and extravagant “organized movement to do me mischief,”1(p xxxiv) in 1887 Eakins took a “rest cure” at a Badlands Dakota Territory cattle ranch on the recommendation of neurologist S. Weir Mitchell. Afterwards, he sought out Walt Whitman, who agreed to a portrait, became his close friend, and spoke highly of his painting. Eakins may have agreed with Whitman's views when Whitman wrote in Specimen Days that nakedness is not indecent. “It is your thought, your sophistication, your fear, your respectability that is indecent.”7(p217)

In 1888, a former student of Eakins, Lillian Hammitt, whom he was painting, developed erotomania, stating publicly that Eakins would divorce his wife and marry her. Eakins terminated his portrait of her, writing her to say how much he loved his wife. Hammitt was hospitalized in a mental asylum, but after her discharge, her delusional beliefs about Eakins were published in the newspaper.4(p415) Several years later, family members ceased contact with him after a niece committed suicide; he was blamed for being a negative influence on her.4

Despite these controversies, Eakins was still sought out as an artist. In February 1889, 25 medical students from the 3 undergraduate classes at the University of Pennsylvania offered Eakins $750 to paint a three-quarter–length portrait of the retiring professor of surgery, David Hayes Agnew. Generously, Eakins told the students that for no additional charge he would expand the painting to include each of them in it. Totally engrossed in the project, Eakins worked continuously to complete it. Because it was too large (6 × 11 feet) for an easel, Eakins placed the canvas on the floor, sitting cross-legged before it and painting 16 hours a day, and he completed it in time for the May 1 graduation. William Osler gave a graduation farewell address, “Aequanimitas,” before he left the University of Pennsylvania for Johns Hopkins University. Osler emphasized clinging to an ideal of imperturbability and equanimity, qualities also attributed to Agnew. Osler mourned the loss that year of Gross's son, Samuel W. Gross (Figure, in entryway); in 1892, Osler married his widow.

In the painting, Agnew, the first John Rhea Barton Professor of Surgery, stands off center, holding a bloodless (as he insisted to Eakins) scalpel in his left hand (he was ambidextrous), and pauses for a moment from his surgery to teach. The viewer's eye is drawn successively to Agnew, the surgical team, and finally the spectators. Unlike The Gross Clinic, this operating area is artificially lit. Asepsis is more in evidence, and even though there are no gloves or masks, the patient is draped, instruments and towels are sterilized,7 Agnew and his staff are dressed in white gowns, and a nurse is in attendance. Instead of chloroform gauze, an ether cone is used with a Squibb ether container.

As Agnew instructs, Nurse Mary Clymer, who received the Nightingale Medal at the May 1 graduation, watches, and Dr William White, a future Barton Professor of Surgery, closes the wound of the patient. She is undergoing a partial mastectomy for breast cancer, probably a palliative procedure8 that predates the potentially curative radical mastectomy introduced by William Halsted. Dr Joseph Leidy holds the patient's legs, wiping away excess blood. Dr Ellwood Kirby administers the anesthesia. Each student, dressed in his dark suit, is identifiable. One, William Furness, III, is asleep in the back row. On the far right, Dr Fred Milliken whispers to Eakins himself, who was painted by his wife, Susan.6

Like The Gross Clinic, the Agnew painting was criticized for its subject matter.9 Eakins complained to friends that he was accused of being a butcher when what he simply sought to picture was the soul of a great surgeon3; for him Agnew was “the most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.”9(p1197) When The Agnew Clinic was rejected for exhibition 3 years in a row, Eakins resigned from the Society of American Artists. His three-quarters preparatory study for the portrait of Agnew standing alone was purchased in 1914 by Albert Barnes for $4000, the highest amount he received during his lifetime for a painting.

On November 10, 2006, the trustees of Thomas Jefferson University agreed to sell The Gross Clinic to Wal-Mart heiress Alice Walton and the National Gallery of Art for $68 million, a record for an early American portrait. On December 21, 2006, the philanthropic community in Philadelphia, whose elite had rejected Eakins during his lifetime but now claimed Eakins as their own, matched the $68 million offer after a major fund-raising effort. The Gross Clinic will rotate between the Philadelphia Museum of Art and Pennsylvania Academy of the Fine Arts. Thus, Eakins's The Gross Clinic and The Agnew Clinic, his tributes to surgical advances in alleviating human suffering, will remain in Philadelphia as monuments to Eakins's devotion to both art and science.

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