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Historical Profiles

The Listerian Revolution, the Gross Clinic & the Agnew Clinic

The Listerian Revolution

Joseph Listner, MDDr. Joseph Listner
  • Dr. Lister’s revolutionary ideas were presented in the mid-1860s.
  • Lister took Louis Pasteur’s theories of bacterial contamination and applied them to surgical infections.
  • Lister aimed to prevent microbial entrance into an injury and stressed an antiseptic system of surgery, one that included:
    • soaking surgical sponges and bandages in a solution of carbolic acid,
    • spraying a wound with an antiseptic solution during the operation,
    • washing all surgical instruments,
    • rinsing hands before beginning an operation,
    • and wearing appropriate surgical gowns.
  • Thomas Eakins' paintings of the Gross Clinic and Agnew Clinic illustrate the dramatic changes that took place in the surgical field during the 14 years between their creation.

Authors:
Caitlyn M. Johnson, BS
Charles J. Yeo, MD
Pinckney J. Maxwell IV, MD

Source:
The American Surgeon
(full text PDF)
Volume 77, Number 11, November 2011, pp. e229-e231(3)

The Gross Clinic

Gross Clinic
  • In 1875, with the anticipation of the upcoming U.S. Centennial International Exhibition, Thomas Eakins painted a portrait of Dr. Samuel D. Gross, arguably the most famous surgeon of the day.
  • Eakins painted Professor Gross in his surgical amphitheater performing a somewhat novel operation: removing necrotic bone in a case of osteomyelitis as opposed to lower extremity amputation.
  • Gross did not use Listerian antiseptic techniques.
  • Dr. Gross and colleagues are portrayed wearing ordinary dark street coats over their shirts and ties.
    • Dr. Gross holds a bloody scalpel in his hand while his assistant probes the wound of the patient with his bare, bloody hand. The patient is not draped and is instead wearing the same socks he wore in from the street.

The Agnew Clinic

Agnew Clinic

In 1889, 25 students from the University of Pennsylvania approached Eakins, offering him $750 to paint a portrait of their beloved, retiring professor, Dr. Hayes Agnew.

His largest piece yet, The Agnew Clinic, was a three-panel panorama of a surgical amphitheater picturing Dr. Agnew and his medical team performing a mastectomy surrounded by a theater full of vividly portrayed medical students.

Dr. Agnew was one of the first surgeons in the United States to pioneer antiseptic technique.

In The Agnew Clinic, Dr. Agnew is depicted holding a clean scalpel, and his staff are dressed in white, starched, aseptic gowns without a trace of blood. The patient is without street clothes and is draped in a sterile fashion. The surgical instruments are clean and arranged carefully on a surgical tray.

If Dr. Lister’s theories of antisepsis were presented before the periods of both Dr. Gross and Dr. Agnew, what prompted the acceptance of the Listerian theory between The Gross Clinic and The Agnew Clinic?

Perhaps the change was prompted by Dr. Agnew’s surgical assistant, J. William White, pictured closing the mastectomy incision in The Agnew Clinic.2 White had recently spent a year studying under Dr. Lister, who was traveling across America determined to convince American surgeons of the need for surgical cleanliness.

Slow Acceptance of New Ideas

On July 2, 1881, President James A. Garfield was shot in the back in a railroad station in Washington, DC

Sadly, the team of physicians called on to care for the President, one of whom was Dr. Agnew, did not subscribe to the theory of antisepsis at that time.

Two months after his injury, the President died, and an autopsy of his body revealed multiple abscesses along the trajectory of the bullet, yet not one vital organ was injured.

European surgeons criticized the American physicians, saying that his death was caused not by the bullet itself, but by the lack of adherence to Listerian principles.

Images courtesy of Archives & Special Collections, TJU.