There are two great paintings of surgical healing in Philadelphia, a city once at the center of medical education and practice in the world. But only one of those paintings, Thomas Eakins' The Gross Clinic (1875), depicts a more or less successful treatment — a thigh operation performed by celebrated Jefferson surgeon, Samuel Gross.
The other monumental Eakins work, The Agnew Clinic (1889), depicts Penn surgeon David Hayes Agnew presiding over a radical mastectomy, considered at the time a doomed, last-ditch amputation.
There are plenty of images of the sick and the lame in collections around the city, and even images of pestilential death, often allegorized. But treatments by larger-than-life doctors at the forefront of science are virtually nonexistent. Plagues — yellow fever or smallpox or cholera, or even AIDS — are collectively woeful, apparently not lending themselves to heroic imagery.
At a time of rampant, as-yet incurable spread of COVID-19, Eakins' unique work offers an opportunity to consider medical practice in the years following dissemination of Joseph Lister’s theories of germs and sterilization. Taken together, Gross and Agnew suggest a fundamental paradox: advances in medicine often expose medical limitations.
We have vaccines, but not the right vaccine. We have ventilators, but not in the right places. We have public health, but an inadequate political leadership to deliver it.
The coronavirus has put the extent of our limitations on display, opening the door to another paradoxical anomaly: therapeutic care, simply easing symptoms, can partially make up for technological deficiency. We find healing in attention and sympathy — from caregivers and from each other, if not from medical titans.
The art and humanity of caregiving
In this spirit, the Philadelphia Museum of Art has also mounted a small exhibition of prints, drawings, and photographs, “The Art of Care.”
The exhibition demonstrates the humanity of therapeutic health care, often undertaken by women (there is a striking Robert Riggs print of Florence Nightingale attending a patient), often depicting the loneliness and isolation of the seriously ill (Nicholas Nixon’s photo series, People With AIDS), and often undertaken without hope of lasting cure.
Drawn largely from the PMA’s Ars Medica Collection, these are images of deep empathy, sometimes poignant, sometimes angry.
“At the time of the Civil War, there were a certain number of paintings of nurses, you know, reading to a soldier in bed, that kind of a subject, or the veteran returning home, with an amputated leg and walking around with a crutch,” said Kathleen A. Foster, director of American art and senior curator at the Art Museum. “Basically, people were repelled by that kind of a bad news story. And so the subjects were not that common.
“It’s been a subject that people shied away from, that is frightening or melancholy,” she said. "So it’s really unusual to dive in, like Eakins did, and look so hard at medical treatment.”
Brutality and futility, face to face
Both the Gross and the Agnew currently hang across from each other in the main gallery of American art at the PMA, which owns Gross jointly with the Pennsylvania Academy of the Fine Arts; Agnew is on long-term loan from Penn.
When Eakins painted Gross, he sought to celebrate the great achievements of the city’s medical establishment. But the painting, which portrays a bloody-handed surgeon dressed in dark street clothes, bone-handled scalpel in his hand, remains brutal. On the operating table, bathed in natural light, is the patient, legs drawn up and foreshortened, surgical incision thrust forward for all to see. A woman, perhaps the mother of the patient, looks away in horror.
By contrast, his Agnew Clinic, painted 14 years later, is bathed in artificial light. Doctors and a female nurse are in white. Agnew holds a pristine metal scalpel. The patient lies anesthetized, with a breast exposed awaiting surgical removal. Germ theory and sterilization now rule in the surgical amphitheater. There is no blood.
“I think the painting itself is ironic,” said Robert Aronowitz, chair of Penn’s department of history and sociology of science. “Agnew said that … if it was truly an accurate diagnosis of cancer, he never cured it.”
“People did surgery,” Aronowitz said, “as a kind of Hail Mary,” although the application of anesthesia was “certainly a technological triumph” at the time.
“But, ironically, [anesthesia] allows more expensive futile operations rather than helping anybody,” Aronowitz said.
By contrast, The Gross Clinic may be gruesome, but the patient’s diseased bone was effectively removed and recovery followed.
The real advances in “Agnew”
“By 1889, Dr. Agnew has got lights over the surgical amphitheater,” said Foster. “Then really key to this story of infection is the sterile instruments. Dr. Agnew is holding a steel scalpel that’s dripping with water because he’s just picked it up out of the sterile bath … . His hands are wet with water, so it’s an image of cleanliness, which is subtle, but it’s nonetheless important.
"And a tiny observation of Eakins is that Dr. Agnew has a steel scalpel, Dr. Gross has an ivory-handled, delicate scalpel. You couldn’t have ivory on instruments after the day instruments were being boiled, because the ivory would deteriorate.”
Dr. Agnew also had at last agreed to allow women into the surgical amphitheater. Eakins recorded the presence at the operation of Mary Clymer, a prizewinning graduate of Penn’s just-established school of nursing.
“She is the one person who is very obviously looking at the incision. She’s really watching the surgery,” said Foster.
Women are prominent in “The Art of Care,” none more so than Maude Callen, a seemingly indefatigable nurse-midwife who served patients throughout rural South Carolina, which only had nine such practitioners. She is featured tending her patients in a remarkable series of W. Eugene Smith photographs that drew national attention in Life magazine in 1951.
“Her duties are extremely varied, and he really pictured her doing just about everything from assisting with a birth to setting up a makeshift clinic in a church. Sometimes those were sexual health clinics, sometimes they were general practitioner,” said Amanda Bock, PMA assistant curator of photographs, cocurator of the exhibition with Laurel Garber, assistant curator of prints and drawings.
“They were miles and miles and miles from the nearest hospital, so Maude Callen really served as not only a midwife, she assisted with every kind of medical ailment with walks to people’s homes in very rural areas for emergency medical intervention. She was a listener, a caregiver in the broadest sense, as well as almost a neighbor and caretaker. And yet, this was what many of her peers were also doing so it was a very ordinary world.”
No monumental and heroic surgeons attend the poor Black residents of rural South Carolina in the early 1950s. Yet caregiving is ultimately at the heart of medical treatment.
The art of plague and pestilence
This is particularly true of plague times, where disease may seem invincible, and may well be. That sense of deadly invincibility, in fact, underlies such works as Hugh Henry Breckenridge’s The Pestilence (formerly War) (1918) at the Pennsylvania Academy of the Fine Arts.
This extraordinary painting straddles the world of disease and warfare through the jarring use of colorful dead and decaying bodies. Death is, of course, the great common denominator.
“Well, I think that probably Eakins was more hopeful in his moments than Breckenridge was in his,” said Anna Marley, PAFA’s curator of historical American art. “Because, as you know, with Agnew and with Gross, these are great men who are going to use science to defeat pestilences. But I think Breckenridge, at the end of World War I and the epidemic, he’s not seeing that hope.”
Yet, in the wake of World War I and the subsequent pandemic, the United States built a remarkable public-health system that seems unimaginable in 2020. Along with therapeutic care, a public-health system aims to mitigate the inadequacies of medicine. It is best not to get sick at all — a truism generally acknowledged in Boccaccio’s Decameron in the 14th century and even in the United States not that long ago.
“In the first half of the 20th century, the U.S. developed not just a public-health system, but a way of knowing the world and approaching the world that really set the terms of the knowable and the doable,” said Morris J. Vogel, former professor of medical history at Temple University and president of New York City’s Tenement Museum.
“These were institutions without parallel. In 1946 or 1947, somebody got off a [bus] in New York. It was quickly determined he had an active case of smallpox. Within a week New York City managed to inoculate 6 million people. We created that system.”