the department’s icon – 4/2/25

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Today's selection-- from Surgeons and Something More by Clyde F. Barker and Elizabeth Barker. D. Hayes Agnew’s legacy as an iconic surgeon

“D. Hayes Agnew is often referred to as our department's iconic figure. When Agnew retired in 1889, Penn's medical students commissioned a portrait of their beloved professor. They couldn't have realized that this would immortalize him. Chosen as the painter was a local artist, now famous but then failing. The $750 fee he got for the painting, The Agnew Clinic, helped salvage the career of Thomas Eakins, who at the time was in disrepute, having shortly before lost his job for exposing a nude male model to a class of female students. Ironically, it is now the painting rather than Agnew himself that has become the icon of our department, of the School of Medicine, and even to some extent, of modern surgery itself.

“Who knows what the iconic painting would be worth today? Its companion piece, The Gross Clinic, painted by Eakins thirteen years earlier, recently brought $68 million. This is a story for another day, but it called renewed attention to The Agnew Clinic. Before the hype over the value of these two paintings, they were most often discussed by medical historians as representing the transition to modern medicine through the acceptance of antisepsis. The subject of the later painting, D. Hayes Agnew, was our department chairman from 1871 to 1889. A surgical giant in his time, he is now a shadowy figure, mostly forgotten even at our medical school. Few if any students, residents, or faculty know anything about him, except as the subject of Eakins's portrait.

“Even in his day, Agnew modestly avoided notoriety. As a result, he lacked the international fame of the crosstown professor of surgery at Jefferson, the flamboyant Samuel Gross, who was called the ‘Emperor of Surgery.’ Agnew deserves better than this.

“Nowadays, most of what one hears about Agnew is from the dozens of volumes that art historians have written about him as the subject of the famous Eakins painting. Unfortunately, this considerably obscures the reputation Agnew deserves as a master surgeon, prolific author, and academic leader. The Agnew in the painting is an old man, ready to retire, worn down by a lifetime of long days, sleepless nights, and. illness. The other major source of information on him is hyperbole in the rather bland but loving biography written by his nephew, who was one of his students. Agnew's wife carefully supervised and edited this account, probably censoring some of the more interesting parts. Reading between the lines to reconstruct a younger, fully empowered Agnew brings into focus the image of a vigorous man easily capable of competing with the painting as our icon.

D. Hayes Agnew in 1858.

“Agnew was born and raised near Lancaster, Pennsylvania. His physician father's wealth allowed him to enjoy a carefree youth. His successor, Edward Martin, described him in his eulogy as powerful and athletic, over six feet tall, hard riding, hard reading, and hardworking. ‘He played the violin, followed the hounds, owned and rode a famous horse, was a lover and

trainer of dogs, and was known throughout the countryside as a judge of horses and a dead shot.’ The family's exalted status was typified by their exhibiting a coat of arms. This was probably responsible for the somewhat aloof, patrician image that Agnew maintained of

himself throughout his life. After two years of college, he obtained his MD from Penn in 1838. He then spent several unsatisfying years in general practice with his physician father. This experience was one reason he gave up medicine entirely to manage an iron foundry business that he inherited from his father-in-law.

“Three years later, when this venture ended in bankruptcy, Agnew decided to pursue a career in surgery. At that time, before there were residencies or formal training programs anywhere, the path to surgery was simply to acquire expertise in anatomy. To accomplish this, in 1852, Agnew purchased the once-famous but now defunct Philadelphia School of Anatomy. He began to dissect, study, and then teach the subject. After hours, since there was no legal way to obtain the cadavers needed for dissection by his students, Agnew became a ‘resurrectionist’ (body snatcher). As a result of hard work and this ghoulish, unlawful activity, Agnew became an expert anatomist. Before long, it was evident that he was also an exceptionally gifted teacher.

“During this time, Agnew became a murder suspect when he was found to have in his possession a skull that was perforated by a small round hole. Fortunately, Agnew was able to show that the hole had not been made by a bullet but by a trephine used to

treat its owner in life. Later, it became known that to prepare skeletons for student study, Agnew sank cadaver parts in a neighborhood pond where eels did a thorough job of cleaning off the soft tissue from the bones. The owner of the pond sold these eels to a local fish market. They were especially large and were said to have a special ‘snap’ that made them particularly tasty. However, learning this about their diet made the neighbors queasy, and Agnew was forced to abandon this method of preparing bones.

“As a teacher, Agnew had found at last his true bent. His style was absolutely plain, clear, and very effective. He had none of the eloquence or stagecraft of S. D. Gross. Although ten years older than Agnew, Gross was still at the peak of his fame as a teacher a few blocks away at Jefferson. Nevertheless, because of his effectiveness as a teacher, Agnew began to take students away from Jefferson. Students from Jefferson and other schools enrolled in Agnew's classes, which soon grew from 9 to 267 students. In fact, he eventually had students from all of the nation's states, thirty-four at that time. When he began to practice surgery, it was said that his extraordinary knowledge of anatomy had made him an absolutely confident and precise operator.

“His practice interrupted by the Civil War, Agnew acquired a wide reputation as a trauma surgeon. He served on the battlefield during the Battle of Gettysburg. Later, he was assigned to manage 50 percent of the casualties admitted to one of the war's largest Army hospitals, Mower (3,600 beds), which was in Chestnut Hill. He acquired a reputation as the country's foremost expert on gunshot wounds.

“After his Civil War service, Agnew was invited to join the faculty of the University of Pennsylvania. His appointment in 1863 was as a dissector and demonstrator for the chairman, Henry Hollingsworth Smith. Although this appointment was at the lowest level, Agnew was frequently asked to substitute for Smith as a lecturer. Before long, student demand resulted in his being assigned regularly scheduled lectures of his own twice a week. His practice of surgery soon became the largest in the city. It seems likely that Smith took advantage of Agnew's help while keeping him at minimal rank. After seven years with no promotions, Agnew apparently became disappointed and resentful. He submitted his resignation.

“The school could hardly afford to lose the faculty member who was its most popular teacher and its most active clinical surgeon. A special meeting of the faculty was called to elect Agnew directly from his entry level rank to full professor. This apparently did not sit well with Smith,

who resigned a year later. Agnew was then appointed to succeed him as chairman in 1871. During his tenure, the university built HUP, the country's first teaching hospital, in 187 4; and in 1877, appointed Agnew as John Rhea Barton Professor, the country's first endowed chair of surgery. Since then, the John Rhea Barton Professorship has been synonymous with the department chair.

“As an operating surgeon, Agnew was ambidextrous, deft, and swift in his manipulations without seeming to be. Students crowded to watch his demonstrations, especially if he was cutting for bladder stone. His colleague, Edward Martin, described the scene: ‘When a patient was prepared with the grooved staff passed into the bladder, Agnew would make one ample peroneal cut into the posterior urethra, drop his sharp pointed knife, take from his teeth his blunt pointed one, make with it one further ample cut through a lateral lobe of the prostate, insert his forceps, and remove the stone in less than six seconds, with a deceptive appearance of deliberation.’

“Agnew was not an experimentalist. His surgical innovations were limited to a few instruments, splints, and an operation for webbed fingers. His local reputation was based on his skill and judgment as a highly experienced clinical surgeon. His national and international reputation was secured by his very successful 3,000 page, three-volume, single-authored textbook of surgery. It replaced Gross' s earlier text as the standard for the United States and was translated into several languages, including Japanese. Agnew was a superb teacher with a style that was the opposite of Gross' s. As a lecturer, his delivery was simple and straightforward, well-organized, calm, and very effective. Unlike Gross, he was not a dramatist. His unassuming and, by comparison to Gross, somewhat colorless personality and his distaste for political ambition kept him in Gross' s shadow. Despite this, many honors came to him, including the presidencies of the College of Physicians of Philadelphia, the Philadelphia Academy of Surgery, and the American Surgical Association.”

author:	Clyde F. Barker, Elizabeth Barker
title:	Surgeons and Something More: The History of Surgery at the University of Pennsylvania
publisher:	The American Philosophical Society Press
pages:	73-77