David Hayes Agnew

American physician David Hayes Agnew (1818-1892) trained a generation of surgeons through his involvement in several medical schools in the Philadelphia area.

One of the best-known surgeons of his era, he gained a national reputation after he treated the assassinated United States president James A. Garfield (1831-1881) in 1881. Agnew's career spanned an important era in the history of Western medicine, for he entered the profession when operating on live human beings had not yet shed some of its macabre reputation among the general public.

Agnew was born on November 24, 1818, in Nobleville, Pennsylvania, which later became the town of Christiana. His father, Robert, was a physician in private practice and came from a family that had been among the first settlers to the area. An only child, Agnew was raised in the Presbyterian faith and as a teenager he enrolled at Jefferson College in Canonsburg, Pennsylvania, in the western part of the state. Founded by a Presbyterian minister in the late eighteenth century, the school was the one of the first institutes of higher learning west of the Allegheny Mountains. It later combined with the another Presbyterian school, Washington College, to become Washington & Jefferson College.

Earned Medical Degree

Agnew left after just a year, transferring to Delaware College in Newark, Delaware, where a cousin was a professor. Again, he spent just a year before returning home to begin the study of medicine under his father's tutelage. Such professional apprenticeships were not uncommon in the 1830s, although the University of Pennsylvania had established the first formal medical school in the United States in 1765 and had become a renowned training ground for doctors. Agnew entered Penn's Medical School in the fall of 1836, just before he turned 18, and earned his M.D. degree two years later with a thesis titled Medical Science and the Responsibility of Medical Character.

Agnew returned to Nobleville and joined his father's practice, taking over in 1840 when his father retired. Yet Agnew dreamed of a more exciting career than that of a country doctor who treated fevers and delivered infants: he wanted to become a surgeon. This was an ambitious goal at the time, for formal surgery had become a legitimate and esteemed profession only during the previous century. His ambition would be thwarted by further delay when, in 1841, he married Margaret Creighton Irwin, the daughter of an iron foundry owner in Chester County. When Irwin's father died a year later, Agnew entered into a business partnership with her brothers to take over the foundry, which bore the name Irwin & Agnew Iron Foundry after 1843. A depressed world market for iron forced the firm into bankruptcy in 1846.

Thrown from Carriage

Reluctantly, Agnew returned to practicing medicine, first in Cochranville in Chester County, then in nearby Lancaster County, for the next two years. One day in the summer of 1848, while out driving with his wife, their horses were unnerved by a flock of sheep and reared up; Agnew was thrown from the carriage. His wife was also injured, but remained on board for nearly a mile before she managed to jump off and return to her husband. Agnew spent several weeks recuperating from a bad hip injury, which gave him a lifelong limp, but the event also served as a catalyst; he decided to move to Philadelphia to study anatomy, and his wife agreed to the plan, though they had suffered severe financial losses because of the foundry's failure. In Philadelphia he set up a small private practice while training in his spare hours to become a surgeon.

A proficient surgeon needed to have a detailed knowledge of human anatomy, and this was only possible by human dissection. An almost primordial human taboo against tampering with the dead, bolstered by centuries of Christian religious and burial practices, made this training requirement quite difficult for surgeons during this era. Agnew began studying anatomy on his own, utilizing the private dissecting rooms available to medical students, some of which also offered lecture courses in anatomy during the medical school breaks. One of these was the Philadelphia School of Anatomy, founded in 1820 as a separate training facility for University of Pennsylvania medical students. It was extremely difficult to obtain bodies for the purposes of dissection, however. Agnew's biographer, Jedidiah Howe Adams, in the 1892 volume History of the Life of D. Hayes Agnew, explained that among some working class, immigrant, and African-American quarters, prejudices against the medical profession at the time included “a common belief … that the authorities of certain hospitals murder their patients in order that they may be dissected by medical students.”

Climbed into Mass Graves

Agnew began lecturing at the Philadelphia School of Anatomy, and would eventually take over the school outright in 1852. The availability of cadavers remained an issue, and as the school's director, “it was necessary for [Agnew] to be constantly on the outlook to obtain bodies for his students' use,” Adams wrote. He added, “he obtained them in a perfectly legitimate way; for example, during the terrible epidemic of Asiatic cholera in Philadelphia, in 1854, there were so many deaths daily, at the Philadelphia Hospital, that deep pits were dug in the neighboring fields, into which the bodies were rudely thrown. At that time, in order to render these bodies suitable for use, Dr. Agnew would descend into these pits, and, with the sun beating fiercely upon his head, he would inject a sufficient number of bodies for his purpose.” The injection referred to was probably a syringe of glutaraldehyde, a preservative used to forestall decay before formaldehyde became the prevalent embalming fluid.

Agnew gained a reputation as an expert on human anatomy and as a teacher who delivered riveting lectures, and his school flourished, with medical students from both the University of Pennsylvania and from another top Philadelphia training ground for physicians, the Jefferson Medical College of Thomas Jefferson University. In 1854 Agnew founded the Philadelphia School of Operative Surgery at the same location on Chant Street, and continued to educate future surgeons—a subject on which he had some firm opinions, as evidenced by his 1857 Valedictory Address at the Philadelphia School of Anatomy. In it, he provided the future doctors with several pieces of wisdom, including an injunction to have “a uniform, self-possessed, and cheerful manner.” He also reminded the new graduates that “the sick read in the face of their medical attendant lessons of hope or despair, and he who understands the powerful influence which the mind exerts on the recuperative powers of the material organism, will appreciate the value of cultivating every agency calculated to secure its co-operation.” Continuing on, he asserted that “a high moral tone should characterize professional intercourse. Such a deportment becomes the dignity of our calling, and secures a proper personal respect. Loose conversation and indelicate jests, aside from their being in themselves positively wrong, invite an unwarrantable degree of familiarity and freedom, and the assumption of eccentricities is altogether unbecoming an honorable practitioner, and, at best, only a charlatan trick to cover up the defects of education.”

Aided Union Army Wounded

In 1854 Agnew attained his career ambition when he was appointed surgeon at Philadelphia Hospital, which was commonly referred to in its day as “Blockley,” after the West Philadelphia neighborhood where it was located. It later became Philadelphia General Hospital, and when it closed in 1977 it had been the oldest continuously open medical care facility in the United States. There, he gained a reputation as a highly skilled surgeon who “was calm, never flurried in the face of emergencies,” according to Walter Lincoln Burrage in the Dictionary of American Biography. “He could handle the knife with either hand, ambidextrousness having been acquired early in life.”

Agnew found the Blockley hospital's pathological museum and served as its curator after 1860. During the American Civil War, Agnew was put in charge of the Hestonville Hospital, located on the outskirts of the city at the time, and also served as a consulting surgeon at the Mower Army Hospital in the Chestnut Hill section of Philadelphia. He gained a reputation as a specialist in gunshot wounds, one of the most pernicious causes of death and dismemberment during this particularly grisly military conflict.

In 1863 Agnew was elected surgeon at Wills Eye Hospital, was granted privileges at Pennsylvania Hospital two years later, and in 1867 became a surgeon at the Orthopaedic Hospital of Philadelphia as well. But it was with the prestigious University of Pennsylvania Medical School that he had the longest professional affiliation, serving on its faculty from 1863 to 1889. He became a professor of operative surgery in 1870, and a year later was named professor of the principles and practice of surgery. Within a decade his reputation had become a nationwide one, and when President James A. Garfield was assassinated on July 2, 1881, at the railway station in Washington, D.C., Agnew received a summons to Washington to serve as a medical consultant, along with prominent New York City physician Dr. Frank H. Hamilton (1813-1886). Like their predecessors on the case, Agnew and Hamilton were unable to pinpoint the exact location of the bullet, and agreed with their colleagues that the president was in no condition to undergo exploratory surgery. Over the next few weeks, Garfield's wound became infected, and the president died on September 19, after a period of great suffering. When government officials requested a bill from Agnew for his services, he refused to provide one.

Nevertheless, the intense newspaper coverage devoted to the president's wounds brought Agnew a degree of celebrity outside of Philadelphia and his professional circles, and those determined to obtain the best possible medical care— some from as far away as Europe—began flocking to his office, where he worked long hours to accommodate the increased demand for his expertise. In Philadelphia, Agnew and his wife spent the majority of their years in their home located at 1611 Chestnut Street; he also kept a country house in the Haverford area. He retired in 1889 as professor of surgery at the University of Pennsylvania, but continued to serve as an important influence on a generation of surgeons through his textbooks. These include Anatomy in Its Relations to Medicine and Surgery, published between 1859 and 1864, and The Principles and Practice of Surgery published in three volumes between 1878 and 1883.

Painted by Thomas Eakins

Agnew died on March 22, 1892, in Philadelphia. He was immortalized by the famous Philadelphia artist Thomas Eakins (1844-1916) in the 1889 painting Agnew Clinic, which hangs in the Medical School of the University of Pennsylvania. It was commissioned by the 1889 graduating class of the school and presented to him at that year's commencement ceremony. In art history scholarship, it is often compared to Eakins's earlier and better known painting, The Gross Clinic from 1875. Considered one of the most important paintings from this period of American art, The Gross Clinic depicts teacher-physician Dr. Samuel Gross (1805-1884) in the operating amphitheater at Jefferson Medical College in Philadelphia, with a surgery in progress. In comparing both paintings, the marked medical advances that occurred in the 1880s are apparent, with the operating attendants in Agnew's theater no longer wearing street clothes but more hygienic garments to guard against infection; a cone to administer anesthesia, rather than a rag soaked with ether, is another visible difference in the two tableaux. Eakins's earlier painting had provoked great controversy when it was exhibited back in 1875. “Well aware of the critical response to ‘The Gross Clinic,’ Dr. Agnew insisted that his hands and gown be free of blood,” wrote Howard Markel in the New York Times more than a century later. “In the background, a constant of medical education over the millennia is on display: snoozing medical students.”

Books

Adams, Jedidiah Howe, History of the Life of D. Hayes Agnew, The F.A. Davis Company, 1892.

Agnew, D. Hayes, Valedictory Address to the Anatomical Class of the Philadelphia School of Anatomy, Delivered on Thursday Evening, February 19, 1857, T. K. and P. G. Collins, 1857.

Burrage, Walter Lincoln, Dictionary of American Biography Base Set, American Council of Learned Societies, 1928-1936.

Simpson, Marc, “The 1880s,” Thomas Eakins, Philadelphia Museum of Art, 2001.

Periodicals

New York Times, August 13, 2002.

Online

“Penn Biographies: D. Hayes Agnew,” University Archives and Records Center (UARC), http://www.archives.upenn.edu/histy/people/1800s/agnew_d_hayes.html (January 3, 2008).