HX64093956 
 R154.Ag6 W58 Memoir of D. Hayes A 
 
 RECAP 
 
 MEMOIR 
 
 OF 
 
 D. HAYES AGNEW, M.D., LL.D, 
 
 Prepared at the request of and read before the College of Physicians, 
 Philadelphia, January 4, 1893, 
 
 By J. WILLIAM WHITE, M.D., 
 
 PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, 
 
 (Reprinted from University Medical Magazine, February, /8g3.) 
 
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D., HA YES AGXEIV, AI.D., LL.D. 
 
MEMOIR 
 
 OF 
 
 D. HAYES AGNEW, M.D., LLD. 
 
 Prepared at the request of and read before the College of Physicians, 
 Philadelphia, January 4, 1893, 
 
 Bv J. WILLIAM WHITE, M.D., 
 
 PROFESSOR OF CLINICAL SURGERY IX THE UNIVERSITY OF PENNSYLVANIA. 
 
 (^Reprinted from Unh'eisity Medical MagaziTte, February, l8g3.) 
 
MSI 
 
MEMOIR OF D. HAYES AGNEW, M.D., LL.D. 
 
 In discharging the task which has been assigned to me by the 
 President of the college, and which I regard as at once a duty and an 
 honor, I do not propose to detain you with an account of the early life 
 and work of Dr. Agnew, nor with many biographical dates or details. 
 The excellent custom of embodying such information in the memoirs of 
 distinguished Fellows may well be disregarded in this instance, as a 
 biography of Dr. Agnew just published gives the main incidents of his 
 long and useful career. I shall, accordingly, content myself with the 
 briefest possible statement of the facts which seem essential in attempt- 
 ing to arrive at a just estimate of his position and rank in the profession 
 of this country and among the surgeons of the world, and with a few 
 reminiscences, in which I beg you to excuse occasional mention of my 
 own views or experiences, for the reason that everything relating to 
 him is of interest to hundreds, and is, therefore, worth recording. 
 
 He, himself, said not very long ago, in a sketch of his dear friend, 
 Dr. Beadle, that "to preserve, in some tangible or permanent form, a 
 record of the life-work of those who, after having achieved distinction 
 in some one or more of the various spheres of human pursuits, have 
 gone to swell the ranks of the great silent majorit}'- is a custom no less 
 commendable than beautiful." 
 
 Dr. Agnew was born in Lancaster County, November 24, 18 18, of 
 a family which, it is said, can be traced through many generations of 
 North of Ireland and Scotch ancestry to Norman progenitors. In this 
 country, for nearly two centuries, it has been prominent in the history 
 of Pennsylvania, and especially in that of the county of his birth. He 
 was educated at Moscow College, in Chester County, spent some 
 time (1833-34), 3.t Jefferson College, in Canonsburg, Pa., and a 
 year (1834-35), at Delaware College, Newark, Del. He graduated in 
 the medical department of the University of Pennsylvania in 1838, 
 before he was twenty- one years of age. The first few years of his pro- 
 fessional life were spent in practice in the vicinity of Nobleville and 
 Pleasant Garden, Chester County. During this time he married (1841), 
 and, being invited to enter the business which had been left b)^ his 
 wife's father, he joined his brothers-in-law in the formation (1843) of 
 
4 Memoir of D. Hayes Agnexv, M.D., LL.D. 
 
 the firm of Irwin & Agnew, iron founders. Fortunately this venture 
 was unsuccessful. The firm failed in three years (1846), from causes- 
 associated with a general depression of the iron industry, which 
 occurred at that time, and from the absence in the locality of their 
 works of sufficient facilities for the transportation of ore and fuel. Dr. 
 Agnew returned to the practice of medicine, and for two years (1846-48), 
 practiced in Chester and Lancaster Counties. He was not content, 
 however, with the future which opened up before him. His natural 
 bent was toward the study and teaching of anatomy and surgery. In 
 the country opportunities for dissection were obtained with the 
 greatest difficulty, and there were not only no classes to whom to 
 impart information, but no colleagues or co-workers with whom to 
 discuss it. For these reasons, and probably because he had a conscious- 
 ness, even though vague and unformulated, of the capacity for good 
 work which lay within him, he came to Philadelphia, in 1848, with the 
 purpose of making it his permanent home, and of prosecuting his 
 studies in his favorite subjects. 
 
 I have always regarded this step of Dr. Agnew's with unmixed 
 admiration. He was then thirty years of age. He had had seven 
 years of country practice and three years of business experience. His 
 life thus far had been a hard and laborious one; his disappointments 
 must have been bitter and, as regards his extra- professional essay, 
 almost overwhelming. He had not only failed to accumulate any 
 capital, but he had business debts which, to his sensitive and upright- 
 nature, seemed obligations which he was bound in honor to repay. 
 
 He left the region in which he had been born and reared, the 
 friends of his family and of his early manhood, the patients who had 
 learned to trust and depend upon him, and came to a city in which the 
 profession was overcrowded, the competition for place and practice 
 keen and unceasing, and the aspirants for both the honors and the 
 rewards of medicine many and able. The move is, perhaps, the earliest 
 traceable indication in his public life of the self-reliance and clear- 
 sightedness which came to be recognized as among his most marked 
 characteristics. 
 
 After some deliberation' he established himself in a large old- 
 fashioned house at 16 N. Eleventh Street, where I first saw him when, 
 as a boy of ten, I took a note to him from my father, asking him to see 
 a surgical case in a member of our family. This was in i860. For 
 twelve years he had been laying the foundations of his future success. 
 In 1852 he had begun his teaching of practical anatomy and operative 
 surgery at the Philadelphia School of Anatomy, and his name is still 
 the most distinguished in the long list of able men who have been con- 
 nected with that institution. In 1854 he had been elected a surgeon. 
 
Memoir of D. Hayes Agnew^ M.D., LL.D. 5 
 
 to the Philadelphia Hospital, and had thus been given not only his first 
 hospital wards, but also his first opportunity to perfect himself in the 
 teaching of clinical surgery. He always regarded this step as one of 
 the most important in his professional life, and once in speaking of it 
 to me, said he had already, at that time, decided that he "might as 
 well attempt to be a gardener without a garden as a surgeon without a 
 hospital." He had also, for two years, been occasionally substituting 
 lor Dr. Henry H. Smith, professor of surgery at the University, in 
 giving clinical instruction to the students. At the time of which I 
 speak (i860) his reputation as an able operator and a sound con- 
 sultant was firmly established and rapidly spreading, but his practice 
 was not yet, as he has told me, what would now be called a lucrative 
 one. He was, however, only forty-two years of age, in the enjoyment 
 of the fullest mental and physical vigor, and undoubtedly saw success 
 within his grasp. I remember well the kindly manner in which he 
 received me, and the promptness with which he left the fire, befv^re 
 which he had been reading, changed his slippers for shoes, and pre- 
 pared to answer the call which I had brought, although it was late on 
 a disagreeable evening. He had then, as always, an impressive per- 
 sonality and a magnetism felt by most persons who came within the 
 sphere of his influence. It was not of the sort that is exploited in the 
 journals as characterizing brilliant politicians and successful criminal 
 lawyers, nor yet of the variety, which historj^ teaches us, has been 
 possessed by many great statesmen and victorious generals. If I 
 attempted to epitomize or explain the secret of Dr. Agnew's attrac- 
 tiveness to so many and such different classes of people, I would say 
 that "kindliness" expressed it perhaps better than any other word. 
 There were strength and energy and determination back of it, with a 
 basis of broad knowledge and justifiable self-confidence; but, all the 
 same, the chief impression he made was of a tender benevolence which 
 always regarded the feelings and interests of others, and which pervaded 
 his whole atmosphere. It was noticeable then even to a child, and it 
 grew as he advanced in years, until the title of the " Dear Old Man," 
 which was given him by the younger Gross, was universally accepted 
 as in the highest degree applicable. 
 
 During the civil war Dr. Agnew had large opportunities — chiefly 
 at the Hestonville General Hospital — for operative work, and it is need- 
 less to say profited by them to the utmost. In 1863 he was elected 
 surgeon to Wills' Eye Hospital; in 1865, surgeon to the Pennsylvania 
 Hospital ; in 1867, surgeon to the Orthopedic Hospital; in 1870, pro- 
 fessor of Clinical Surgery, and in 187 1, professor of Surgery in the 
 University of Pennsylvania, retaining the latter positions until 1889, 
 when he resigned them to be created emeritus professor of Surgery, and 
 honorary professor of Clinical Surgery. 
 
6 Memoir of D. Hayes Agnezv, M.D., LL.D. 
 
 During all these years he grew steadily in professional strength, 
 his clinics were crowded, his office was filled, his services were in daily 
 demand in all parts of the Middle States, and the University of Penn- 
 sylvania was sending out, year after year, hundreds of young men who 
 regarded him, and justly, as the best possible adviser in all cases of 
 surgical disease or injury. 
 
 His election in 1889 to the Presidency of the College of Physicians 
 was a distinction which, like all the others, came to him unsought and 
 unsolicited but which he nevertheless highly appreciated. It resulted 
 from the very wide-spread feeling in the college that he should not be 
 permitted to end his days without adding his name to the list of those 
 gentlemen who, without exception, have for years reciprocally honored 
 and been honored by this organization, perhaps the most conservative 
 in America. 
 
 My personal remembrances of him begin again in the winter of 
 1868 when, twice a week, after supper, I used to hurry back to the 
 University to get a front seat at his half-past seven o'clock lectures on 
 surgical anatomy. He was then probably the most popular teacher at 
 the University, and deservedly so. I certainly have never heard 
 lectures on anatomy which, for clearness of description, actual teaching 
 force and living interest, could compare with those which he then gave. 
 On those two nights the room was crowded with the students of both 
 classes and, as he always spent the latter part of the evening in the 
 dissecting-room, every subject was surrounded by its full quota of dili- 
 gent workers who, if I may judge others by myself, found the chief 
 attraction in the chance of getting a pleasant word of advice or instruc- 
 tion from him. 
 
 He looked then very much as he did for the next twenty years of 
 his life. His hair was already thinning and beginning to turn white, 
 as was the moustache, which was prolonged on the cheeks in a military 
 fashion. His height, of more than six feet, and his fine muscular 
 development made his figure commanding in spite of the slight profes- 
 sional stoop which he always had, the result of hours spent over sick- 
 beds and operating tables. His blue eyes were keen but kind in their 
 expression. An old blue dress-coat with brass buttons, which he 
 wore to these lectures, gave him, I remember, to my imagination, a mili- 
 tary air, and this fancy came back to me in one of his last attacks of 
 illness, when I found him sitting up in bed with a handkerchief tied 
 around his forehead on account of a severe supra- orbital neuralgia. He 
 looked like a wounded grenadier. I told him of my boyish idea about 
 the blue coat, which he recalled, and said smilingly he would hardly 
 venture to wear it before a medical class of the present day, in spite of 
 their alleged improvement in manners. He has twice in my presence 
 
Memoir of D, Hayes Agyiew, M.D., LL.D. 7 
 
 alluded to himself, half laughingly, half seriously, as "homely." 
 Homely he was in the sense in which Chaucer and most English people 
 at the present day employ the word, that is, he was domestic in habits 
 and simple and affable in manners ; but homely in our perverted 
 American signification, which usually implies not only plainness of 
 feature but positive ugliness, he never was. A cold-blooded critical 
 analysis of his features might disclose some reason for such an opinion, 
 but no one who knew him looked at Dr. Agnew in that spirit. Good- 
 ness and kindness of character shine so clearly through some faces that 
 defects or irregularities are forgotten, and his was one of them. 
 
 The College of Physicians and the University are fortunate in pos- 
 sessing masterly portraits of him, which will help to bring before future 
 generations of Fellows and of students his striking personality. We 
 of the present day need no such reminders. We carry his likeness in 
 our hearts. 
 
 In reviewing his life one is struck with the fact that both hereditary 
 and personal influences were such as favored the growth and develop- 
 ment of that side of his character upon which, as fate willed it, the 
 greatest demand was to be made in years to come. The strain of 
 Scotch blood brought with it dogged perseverance, enduring patience, 
 disregard of luxury, even of personal comfort, ability to sustain uncom- 
 plainingly the reverses of fortune, and to submit contentedly to the 
 long- continued economies which they necessitated. But it must be 
 added that these virtues, so often associated with a sombre or stern dis- 
 position, were in his case tempered by geniality, cheerfulness and an 
 unvarying and all-embracing tolerance that was one of his chief char- 
 acteristics. 
 
 The wholesome out- door life which he led in the country for so 
 long a time was the best sort of ' ' physical culture, ' ' and doubtless those 
 years, which he sometimes thought had been in a sense wasted, came 
 back to him in the form of increased energy, endurance and good 
 health later in life. His very misfortunes supplied an additional 
 stimulus to a character which naturally was so domestic and affection- 
 ate that ambition alone might not have brought about its transplanta- 
 tion from the familiar soil in which it had been reared and nourished. 
 
 It is a trite observation that our apparent trials often prove to be 
 our greatest blessings. There can be little doubt that Dr. Agnew con- 
 tained within him the qualities which would have commanded success, 
 even under the unfavorable conditions associated with material pros- 
 perity, but neither is it doubtful that the years spent while waiting for 
 practice, when he went to the dissecting-room after his morning office 
 hours, went back after his midday dinner, spent most of the afternoon 
 there and returned after an early supper to leave only when the last 
 
8 Memoir of D. Hayes Agneii\ M.D., LL.D. 
 
 student had gone and the lights were extinguished, were the years 
 during which he laid broad and deep the foundations of his success. 
 They were years, also, the reward of which was not postponed to a 
 future period. Dr. Agnew has often told me that on the whole he 
 regarded the days spent in the rooms on Chant Street, the "Windmill 
 Street ' ' of Philadelphia, as the happiest days of his life, and he once at 
 least made the same statement in public. 
 
 When we come to estimate the true value, and the real and en- 
 during position of one of our profession who has left us, we can, 
 perhaps, adopt no better gauge than the opinion of his pupils. History 
 shows us that almost invariably the surgical contemporaries of a great 
 surgeon, with whatever affection they may have cherished him, were 
 still, in a sense, his rivals ; they learned, or failed to learn, at the same 
 time, or by the same stern experiences ; they often differed and, being 
 human, when they chanced to be right derived an increased pleasure 
 from the fact that he was wrong; their estimate, in other words, was 
 often unconsciously tinctured by personal prejudice, or influenced by 
 motives not apparent to themselves. Who would to-day be content to 
 accept Cline's opinion of Sir Astley Cooper, or Ferguson's of Syme, or 
 Syme's of Liston, or Pott's of John Hunter? 
 
 Dr. Agnew, more than any man of equal eminence in our pro- 
 fession with whose history I am familiar, was free from this sort of 
 belittling animosity toward others and, perhaps as a consequetice, 
 rarely if ever excited it. But when one dies at seventy- four, after more 
 than a half-century of professional work, few of his own years are left 
 to testify, and still fewer are apt to place on record their final and 
 deliberate judgment. 
 
 The laity, however sincere their admiration and however well- 
 founded it may sometimes prove, are essentially unfit to pronounce 
 upon the claims of medical men to either present or posthumous 
 honors. They are too apt to mistake show for brilliancy, self-assertion 
 for force of character and notoriety for fame. In Dr. Agnew' s case 
 they held him at his just value, but their verdict can never be regarded 
 as final or conclusive. 
 
 It is, after all, in the case of great surgeons at any rate, upon the 
 testimony of their pupils that their ultimate place in the history of our 
 profession depends. Nearly every surgeon who has made his name 
 immortal has been a teacher, and usually as great a teacher as he was 
 a surgeon. For one exception like John Hunter, a hundred illustrious 
 names could be adduced to emphasize the truth of this statement. 
 Their lives have been written, their merits described, their achieve- 
 ments recorded, their virtues extolled by those whom they have taught 
 and guided, and Dr. Agnew constitutes no exception. 
 
Memoir of D. Hayes Agnew, M.D., LL.D. 9 
 
 From the length and breadth of this land the pupils whom for ten 
 years (i 852-1 862) he instructed in the Philadelphia School of Anatomy, 
 and those who during the next thirty years had the paths of surgical 
 science made easy for them in the University of Pennsylvania by his 
 wise, clear, practical teachings have over and over again testified to 
 their respect for him living and their reverence for him dead. Their 
 estimate, their decision, will be those accepted by future generations, 
 and upon them Dr. Agnew's fame will rest justly and securely. 
 
 This professional reputation, thus testified to, will be found to 
 depend chiefly upon the following factors: (i) The clearness of his 
 teachings ; (2) the soundness of his judgment ; (3) the precision of his 
 operations; (4) the character of his writings. 
 
 Of course, some of his success was due to the personal qualities 
 which have already been mentioned. A man who cannot enter a 
 household or a sick-room without diffusing about him the almost 
 indescribable sense of repose and confidence that he inspired, the 
 feeling on the part of the anxious or grief-stricken relatives that 
 however the case is going everything humanly possible is being done 
 for the patient, and on that of the medical attendant that exhaustive 
 consideration has been given to every detail of the treatment, such a 
 man, I say, is certain of increasing practice as soon as he has made a 
 beginning, and has become known to the public and the profession. 
 Something of this quality is occasionally inherent in men whose 
 natural knowledge and capacity do not justify it. The public is then 
 deceived for a time, but the profession rarely or never. To the degree 
 in which it was possessed by Dr. Agnew, it may safely be said it is 
 never found except in association with wide experience, broad profes- 
 sional culture in the best sense of the word, and pre-eminent ability. 
 In its effect upon the acquiring of practice it is perhaps more important 
 than any of the factors above mentioned, but the reputation which it 
 brings is evanescent, and when years have elapsed it will be found, as 
 I have said, that the surgeon will be known to posterity, if known at 
 all, as a teacher or writer, a consultant or operator, not simply as a 
 successful practitioner. 
 
 fi) As a teacher he was remarkable for his simple, plain, straight- 
 forward methods, his entire disregard of oratorical effort, his faculty of 
 making clear and easily comprehensible even the abstruse and com- 
 plicated portions of his subject. He never spent time or labor upon 
 mere eloquence, but was alwaj^s so earnest and so obviously desirous 
 of conveying information as to hold the attention of his class, and so 
 concise and practical as to leave his teachings indelibly impressed upon 
 their memories. His views were so evidently the outcome of mature 
 experience, and so stamped with the seal of honest conviction, that his 
 
lo Memoir of D. Hayes Agneiv, M.D., LL.D. 
 
 enunciation of them gained added impressiveness and made his course 
 upon surgery not only one of the most useful, but also one of the most 
 pleasant, of their University experiences, to thousands of under- 
 graduates. Without apparent effort, and with a skill born of thorough 
 knowledge and perfect mastery of his theme, each subject was presented 
 to the student so clearly, simply and directly, that it remained a part 
 of his medical knowledge. His lectures were very uniform in quality, 
 but I recall with especial admiration those upon hernia, upon fractures, 
 and upon the ligation of arteries. To my mind they were models of 
 what surgical teaching should be. I have heard the same opinion 
 expressed many times by alumni who preceded and by those who 
 followed me at the University, and neither my reading nor my experi- 
 ence leads me to believe that those lectures would suffer by comparison 
 with the teachings of the greatest masters of our art in this or any 
 previous epoch. 
 
 His habit at his clinic was to precede his operation by a brief state- 
 ment of the history of the case, and by some remarks upon diagnosis and 
 prognosis, and upon his reasons for choosing the particular operative 
 method he was about to employ. During the operation itself he said 
 but little. Afterward he would usually leave some of the final details, 
 the arrest of hemorrhage, insertion of sutures, application of dressings, 
 etc., to his assistant, while he explained more fully what he had just 
 done, and described what he had observed.^ 
 
 He possessed to a remarkable degree the power of interweaving 
 with his admirable descriptions of surgical diseases and injuries the 
 underlying anatomical facts upon which accurate diagnosis and 
 successful treatment so commonly depend. Indeed, as a practical 
 surgical anatomist he was in this country without a peer, and much of 
 his success arose from his well-earned reputation in this department. 
 
 He was a natural teacher, always ready and pleased to impart 
 information even outside of his lectures to any one seeking it in the 
 proper spirit, and did so in the clearest and most agreeable manner 
 possible, making the dullest subject seem interesting, and investing it 
 with a more extended significance by some illustrative or cognate fact. 
 
 He never, however, forgot the interests of his patients in his desire 
 to convey instruction. I held the staff for him for some time and in a 
 great many lithotomies before I had much experience in cutting for 
 stone myself. He knew this, but as he did not believe in a multiplicity 
 of fingers in wounds, or in removing the finger in these cases until the 
 
 ' The cut on the opposite page is from a photograph taken by a member of the class. The 
 case was one of malignant growth of the foot, r ecessitating amputation of the leg. The period 
 was that during which we employed the carbolic spray at all operations, but before the use of 
 operating gowns had come into vogue here. Dr. Agnew had finished his preliminary remarks 
 and was about to begin the operation. 
 
Memoir of D. Hayes Agjtezv, M.D., LL.D. ii 
 
 forceps were in the bladder, he never but once asked me to explore 
 that organ prior to the removal of the calculus. On that occasion we 
 were operating in a little town in the southern part of Delaware. 
 After making the usual incision and putting his finger in the bladder, 
 he spent a long time in exploring the bas fond and the post- prostatic 
 pouch in search of the stone which we had both heard and touched 
 with the staff. Presently he asked me to slip my finger in as he with- 
 drew his, as the condition was so extraordinary that he would like me 
 to feel it. The stone was swinging like a pendulum from the summit 
 of the bladder, held there by a band of organized lymph quite firm and 
 resistant. 
 
 The case was unique in his experience. 
 
 (2) As a consultant and as a practitioner perhaps his most note- 
 worthy quality was the soundness of his judgment. Partly from his 
 natural clearness of mental vision and good common sense, partly from 
 his thorough preparatory training and his diligent and incessant study 
 of everything that bore upon the teaching and practice of all depart- 
 ments of surgery, and partly, no doubt, from the enormous experience 
 which in later years he could utilize for his guidance, he made singu- 
 larly few mistakes in either the diagnosis or the treatment of surgical 
 conditions. 
 
 It is given to none of us to be infallible ; error and humanity are 
 now, as always, inseparable ; perfect wisdom and complete knowledge 
 in even the narrowest of human occupations are unattainable. I desire 
 to make no exaggerated claim for the subject of this memoir, but I feel 
 sure that at least to this audience, which numbers so many who looked 
 ■upon him as the court of last appeal in all surgical matters, I may 
 venture to state my belief that few surgeons have ever lived who, in 
 the presence of an obscure case, were so uniformly correct in their 
 estimate of the precise diagnostic value of a surgical symptom, so 
 accurate in their application of the general principles bearing upon the 
 condition in question, and so conversant with all the varied possi- 
 bilities which such cases present. His ability to unravel the tangled 
 web of disease, to solve its intricate problems, seemed to me in the 
 earlier days of my association with him to be little short of inspiration ; 
 later I came to recognize it as the legitimate outcome of keen observa- 
 tion, wide experience and logical reasoning. 
 
 I have often thought that of all the great surgeons with whose lives 
 I was familiar I could trace the closest resemblance between both the 
 personal and the professional characteristics of Sir Astley Cooper and 
 those of Dr. Agnew. I once said this to him, and he replied that while 
 there was no surgeon whom he would rather be thought to resemble, he 
 feared that, like many other attempted parallels from the days of 
 
12 Memoir of D. Hayes Agnew, M.D., LL.D. 
 
 Plutarch until now, the facts would have to be made to conform to the 
 theory. 
 
 And yet I may ask those of you who knew him best if the follow- 
 ing description of the great English surgeon by his nephew might not 
 have been written verbatim et literatim of Dr. Agnew : 
 
 " His influence did not arise from his published works, nor from 
 his being a lecturer, nor, indeed, from any public situation which he 
 held, although each of these circumstances had its share in producing 
 the result ; but it seemed to originate more from his innate love of his- 
 profession, his extreme zeal in all that concerned it, and his honest 
 desire, as well as great power, to communicate his knowledge to 
 another, without at the same time exposing the ignorance of his 
 listener on the subject even to himself. This must be looked upon as 
 one great cause why his public character became so much diffused by 
 his professional brethren, for he owed little of his advancement in life 
 to patronage. Another peculiar quality which proved always a great 
 source of advantage to him was his thorough confidence in respect to 
 his professional knowledge, so that after he had once examined a case 
 he cared but little who was to give a farther surgical opinion upon it. 
 This must inevitably have instilled an equal degree of confidence in 
 those consulting him." 
 
 To the younger men, and especially to the younger operators in the 
 profession, he was more than a consultant. How many reputations he 
 has helped to make by the encouragement and guidance which he 
 never refused ; how many more he has saved from wreck by the 
 protection and support which his unassailable position permitted him tO' 
 give to those whose ignorance, rashness or ill-luck got them into 
 surgical difficulties, no one but himself ever knew. In suits for mal- 
 practice he was the bulwark and safeguard of dozens of unfortunate 
 medical defendants. He always saw clearly just what could be truth- 
 fully said in explanation or extenuation of a bad result ; and although 
 in his evidence in such cases he was never known to depart from the 
 strictest veracity, he would probably have himself pleaded guilty tO' 
 siippressio veri in more than one instance. What was said of Sir William 
 Fergusgon was true of him : 
 
 ' ' Full of experience himself, and able to wield his powers so 
 brilliantly, he was tender as to the failure of others, and nothing gave 
 him more pleasure than to have an opportunity of helping some one 
 out of difficulty, while the manner in which he gave this help was as 
 graceful as the assistance itself was valuable." 
 
 One source of Dr. Agnew' s power as a diagnostician was his very 
 retentive memory for even the details of cases which he had once seen. 
 No clinical observation, even of times long past, escaped him, and as- 
 
Memoir of D. Hayes Agnew, M.D., LL.D. 13 
 
 for many years he was the chief consultant of three States, with a 
 population of millions, his experience, almost without exception, 
 furnished a parallel to the rarest and most obscure conditions. I have 
 more than once begun to describe to him some recent experience or 
 observation of my own, which seemed to me unique, only to have him 
 interrupt me kindly and smilingly and finish the description as 
 accurately as if he had been present and had seen the case himself 
 Often, too, to my great profit, he would volunteer some words of 
 explanation that instantly made clear all that was previously doubtful. 
 
 His own powers of observation were so well trained that in many 
 surgical conditions a glance sufficed for a diagnosis, and although 
 usually cautious about expressing an opinion he would sometimes 
 venture upon a positive one the moment he saw the case. This was 
 notably so in patients with complete scrotal hernias or with large 
 hydroceles, the distinction between which he made by the relation of 
 the tumor to the anterior plane of the body ; in cases of shoulder 
 injury, where the position of the patient revealed the presence or 
 absence of luxation ; in deep abscesses, where a glance at the overlying 
 skin and a touch with his opposing fingers completed his examination ; 
 in fracture near joints and in un- united fracture, where he almost 
 seemed to have a special sense for determining preternatural mobility, 
 and in many other classes of cases. 
 
 The story which Vidal de Cassis tells of Dupuytren, that within a 
 few days of his death he was asked his opinion of a lesion of the elbow 
 in a patient who was brought to his bedside, and without touching him 
 diagnosed a luxation, which had been denied by an eminent colleague, 
 but was subsequently demonstrated and reduced, might well have been 
 told of Agnew. 
 
 (3) In speaking of his operative work I have purposely used the 
 word precision to characterize it, instead of the usual eulogistic term — 
 brilliancy. Dr. Agnew himself disliked the latter word, and with it 
 the kind of operating which it often described, in which everything is 
 sacrificed for the sake of what in athletics would be called a " record." 
 He has more than once told me interesting anecdotes of the difficulties 
 into which this habit of what he called ' ' slap-dash ' ' work had led some 
 of his contemporaries. He agreed with my friend Mr. Treves, him- 
 self an exceptionally able operator, who says that the days of the 
 so called "brilliant" surgeon are over, and that it is no longer a matter 
 of primary importance that a stone should be extracted or a vessel tied 
 -or a limb removed in a limited number of seconds. 
 
 Dr. Agnew was naturally a quick operator, and his training dated 
 back to the days when pre-anesthetic traditions kept alive the theory 
 that rapid surgery was good surgery, but he was above everything else 
 
14 Memoir of D. Hayes Ag7ieiv, 31. D., LL.D. 
 
 a safe operator, a precise operator. His knowledge of anatomy included 
 not only that of the dissecting room, which, important as it is, is but 
 the beginning for the surgeon, but that of the operating table, which is 
 often very different. He knew not only what the relations of parts and 
 structures ought to be, but what they were in any particular case. He 
 knew, in other words, not only the ordinary topographical anatomy of 
 books, of the cadaver, and of the lecture room, which is knowledge 
 common to many, but also the anatomy of the individual upon whom 
 he was operating, and of the disease which necessitated his interference. 
 He has often said to me that no two cases of hernia were precisely alike 
 in their anatomical appearances ; that each dissection of the neck for 
 the removal of a new growth had a certain individuality which enabled 
 him to remember it for years ; and that one might cut through the loin 
 twenty times to approach the colon or kidney and find no two of the 
 cases precisely identical in thickness of muscular layers, amount of 
 peri- renal fat, etc. 
 
 It was in this knowledge of the conditions and appearances to be 
 expected in a given case, the knowledge of these infinite variations, that 
 he was far superior to any operator with whom I have had a chance to 
 compare him. With the splendid foundation of practical anatomy 
 which his years of teaching and demonstration had given him, his con- 
 stant operating had developed in him this faculty of quick and certain 
 recognition of the structures exposed to view or to touch, which gave 
 his work the character of accuracy and precision that impressed every 
 one who saw it. 
 
 His use of all instruments was light but firm, devoid of flourishes 
 or attempts at show, but strikingly graceful. His hand was very steady 
 up to the last month of his life. His ability to work with either hand, 
 although he did not himself consider it of much practical value, was 
 certainly a great convenience, and was a peculiar and striking feature 
 in his operating. He acquired it as a consequence of a severe onychia 
 of the right index finger, which destroyed the matrix and which deprived 
 him for a long time of the use of that hand, during which period he 
 taught himself the use of the other.^ 
 
 The general level of his operative work was so high that it is dif- 
 ficult to select any particular cases or groups of cases for special men- 
 tion, but possibly his peculiar abilities were made most manifest during 
 the removal of a deep-seated growth of the neck or of a mammary 
 tumor, the ligation of a large bloodvessel, the extraction of a vesical 
 calculus, or the excision of a bone like the superior maxilla, or a joint 
 like the knee or elbow. 
 
 1 His hands had so much individuality, so much of what artists call " character," that I have 
 added to this memoir an illustration made from a plaster cast taken after his death by the sculp- 
 tor, Mr. Murray. 
 
DR. AG NEWS IIAXD, FROM A PLASTER CAST. 
 
Memoir of D. Hayes Agnew, M.D., LL.D. 15 
 
 One of his most marked characteristics was his imperturbability 
 described by his former colleague, Dr. Osier, with eloquent reference 
 to its applicability to Agnew as : " Coolness and presence of mind under 
 all circumstances, calmness amid the storm, clearness of judgment in 
 moments of grave peril; a quality which in its full development has 
 the nature of a divine gift, a blessing to the possessor, a comfort to all 
 who come in contact with him." This quality Dr. Agnew had to such 
 a degree that nothing that could happen during a operation, however 
 unexpected or undesirable, seemed greatly to disturb him. Terrific 
 and unlooked-for hemorrhage, profound shock, alarming collapse, 
 threatened asphyxia, all possible surgical accidents and emergencies, 
 were embraced within his experience, and I have seen him meet each 
 of them in the same prompt, quiet, masterful manner which assured and 
 gave confidence to every one who was working with him. Even death 
 on the operating table has come to him without disturbing his equa- 
 nimity. He had it occur once during tracheotomy in a desperate case, 
 but it was many. years ago. 
 
 The only other time I know of, and the only time I ever saw Dr. 
 Agnew lose a patient on the table, was during an operation for hemor- 
 rhoids in 1887 at the Bingham House in this city. The patient, who 
 was apparently well and strong, had taken less than four ounces of 
 ether and was breathing well when the first ligature was tightened. His 
 respiration immediately stopped, and although his heart continued to 
 beat for nearly half an hour he died without making even an attempt at 
 respiration. The autopsy showed an apoplexy into the floor of the fourth 
 ventricle. That half hour was one of the longest in my life. The 
 physical exertions employed in the efforts at resuscitation were in them- 
 selves exhausting, and in addition there was the mental distress inci- 
 dent to such a sudden and unexpected termination of a minor case. At 
 the end I was drenched with perspiration, unnerved from excitement 
 and disappointment, and felt ten years older. Dr. Agnew was as cool 
 and placid as if the occurrence was a common one in his experience. As 
 we walked down to our carriages on Eleventh Street he made a remark 
 which I have never forgotten ; he said : " I had hoped to escape the acci- 
 dent of an ether death, but it occurs once in a certain number of thou- 
 sands of cases in the best hands, and I've no doubt I passed my limit 
 long ago. We were not to blame." Then after he got in his carriage 
 he leaned out to say: " If you are asked about this just say it was my 
 case. I'll accept all the responsibility." 
 
 Philosophical and unchanged in the presence of calamity, tender 
 and thoughtful of the interests of others, he was then, as always, one 
 man in ten thousand. 
 
 Dr. Agnew was imperturbable not merely as an operator, but in all 
 
1 6 Memoir of D. Hayes Agnew, M.D., LL.D. 
 
 the ordinary relations of life. No surgeon ever lived and attained emi- 
 nence who was more careful to throw around his patients every safe- 
 guard, or who strove more earnestly after successful results ; and yet 
 no surgeon accepted untoward results with greater equanimity when it 
 became apparent that they were inevitable, or when the case had ended. 
 His mental attitude under these circumstances seemed to be that of a con- 
 sistent fatalist, and I have many times envied him the unruffled placidity 
 with which he finally learned of the unfavorable termination which 
 he had, perhaps, contested hour by hour for long and anxious days. 
 He used to explain it by saying that he felt that he had done his 
 best and could do no more, but he probably had the consolation denied 
 to most of us of knowing that his best was the best, although he was 
 too modest so to express it. 
 
 His patience as an operator was equally remarkable. I do not 
 remember, as his assistant, or indeed in any other capacity, ever to 
 have received a harsh or unkind word from him for faults of either 
 omission or commission, although I must often have deserved it. The 
 one thing that used to elicit from him an expression of impatience was 
 the breaking of an important stitch during a staphylorrhaphy or an 
 operation for vesico- vaginal fistula. He would then come as near to 
 swearing as his principles permitted. One of the first private operations 
 I ever saw him perform was for the relief of such a fistula in the wife of 
 a clergyman. The most troublesome stitch broke while he was tighten- 
 ing it, eliciting an ejaculation which led Dr. Elwood Wilson, who was 
 present, to say, "Agnew, I'll tell Beadle on you !" referring to the 
 Reverend Dr. Beadle, one of the most admirable and lovable of char- 
 acters and then, probably. Dr. Agnew' s dearest friend. This raised a 
 laugh in which Dr. Agnew joined, and the stitch was reinserted. The 
 incident represents the full extent to which he ever permitted himself 
 to show temper, and I must confess that it was a source of gratification 
 to me whenever a similar occurrence took place, as it momentarily 
 diminished my sense of inferiority. 
 
 (4) His collected writings embrace a number of miscellaneous arti- 
 cles — important contributions to the surgery of lacerated perineum and 
 vesico-vaginal fistula ; papers on general surgical diagnosis, etc. — but 
 the work of his life as a writer is his great " Treatise on the Principles 
 and Practice of Surgery," the three successive volumes of which bear 
 the dates 1878, 1881, 1883. 
 
 It is safe to say that this magnificent monument to the learning, 
 skill and industry of one man will remain unrivaled in surgical litera- 
 ture. It is not likely that there will ever again be any one who will 
 combine the enormous experience, embracing every department of 
 surgery, the clear judicial intellect, and the patient, untiring energy 
 
Memoir of D. Hayes Agnew^ M.D.^ LL.D. 17 
 
 'whicli enabled him in hours stolen from his family, from social pleas- 
 ures and from much-needed rest, to produce this remarkable exposition 
 of his work and views. 
 
 It was, as has been said, his child, the dearly- beloved offspring of 
 his brain, and while I regret that in the swift march of surgical science 
 it must, if left without revision, inevitably fall into disuse, I can under- 
 stand the sentiment which desires to keep it unaltered and unchanged 
 as the most eloquent of all records of his splendid achievements. 
 
 And yet there are portions, and large portions, of the book which 
 it seems to me can never grow surgically old or useless. Our succes- 
 sors may be too hurried to read the abstracts of the history of important 
 surgical procedures, which, with infinite labor and painstaking he had 
 ■conscientiously compiled ; his pathology may become antiquated, and 
 his therapeutic measures come to be looked upon as are those of Pare or 
 Wiseman, but his admirable clinical descriptions, his comprehensive and 
 well-balanced consideration of diagnostic points, his clear explanation 
 of the surgical anatomy of disease, injury and operation, must always 
 remain as at present, a mine of information for the busy practitioner. 
 
 After many years of what may be called intimate acquaintance 
 with the book I venture to assert, and I doubt not many of you will 
 ■corroborate me, that in the directions I have indicated one may turn to 
 it for help and guidance with more certainty of finding what he seeks 
 than to any other single treatise on surgery in his library. This state- 
 ment was made in some of the early reviews of the work, and I was 
 -once present when a surgeon of distinction from a neighboring city 
 expressed the same opinion to Dr. Agnew. I remember well the simple, 
 unaffected pleasure which it evidently gave him, and he afterward told 
 me that he hoped it was true, as he regarded it as a higher 
 compliment than any other that could be paid to a medical work. 
 
 The book went to a second edition in 1889, ^^^ is well deserving 
 -of many future editions. It is the property of the trustees of the Uni- 
 versity of Pennsylvania. 
 
 He was not a conspicuously original surgeon. He invented a 
 number of instruments and splints, notably that for use in transverse 
 fracture of the patella; introduced some new operations, such as that 
 for webbed fingers; modified others, as the musculo-cutaneous flap 
 method in amputation, and lateral lithotomy in children, and made many 
 minor improvements in both surgical apparatus and operative technique. 
 His claim to imperishable fame does not, however, rest upon any of his 
 inventions, nor upon any one great addition to surgical science. It is 
 not given to every one to be a discoverer. Dr. Agnew had not a mind 
 of the inventive, speculative, restless type which contributes the newest 
 l3ut not always the most useful ideas to our profession. Neither did 
 
1 8 ]\Iemoir of D. Hayes Agneza, M.D., LL.D. 
 
 his training uor his circumstances fit him for the plodding laboratory 
 work, experimental and microscopic, as a result of which a Pasteur or 
 a Lister or a Koch electrifies the world with some grand contribution to 
 its knowledge. Dr. Agnew had a judicial mind, wonderfully fitted to 
 weigh and decide upon the suggestions that came to it, and he had 
 extraordinary mechanical and physical ability to carry into effect in an 
 operative way whatever appealed to his deliberate judgment. As was 
 said of Abraham Colles, " He possessed the art of touching briefly on 
 the salient point of his cases, and was gifted with what Dove called 
 ' the incomprehensible talent ' of separating the essential from the imma- 
 terialin complicated phenomena." 
 
 He was eminently and above all others of his time — I am almost 
 tempted to say of all times — a sound surgeon, a safe surgeon. One 
 might be sure invariablj^ that his opinion in a given case, even if it 
 were not finally proven to be the right one, was well founded, and would 
 stand creditably the test of adverse criticism; and in every case and 
 under all circumstances it was equally certain that the opinion was given 
 with the single idea of being of use to the phj'sician or patient who had 
 consulted him. 
 
 In special departments of surgery he has probably been excelled 
 by not a few, but taking the whole round, including not only general 
 and operative surgery but gynecology, ophthalmology, genito urinary 
 surgery, syphilography, orthopedics, etc., he attained a degree of emi- 
 nence which has rarely, if ever, been equaled, and to which our own 
 times and generation furnish no parallel. 
 
 I have never seen or known of an instance in which he seemed in 
 the least degree influenced by the temptations which constantly beset 
 those of us who as teachers need clinical material, as operators desire 
 to attempt new or hitherto untried procedures, as practitioners feel the 
 universal need of money and of prestige. Since the death of Dr. Charles 
 Hunter, his previous assistant, which was a great loss to the profession, 
 to the University and to Dr. Agnew himself, I was intimately associated 
 with him in both his public and private work, and for the last few years 
 he did me the honor of referring to me those patients who required 
 operation. I may, therefore, claim to have had every possible oppor- 
 tunity of observing and criticizing the standard of his conduct in this 
 respect, and I cannot conceive of a loftier or more unswerving devotion 
 to the highest and best principles than that which he always displayed. 
 Certainly no one ever brought to any occupation a more profound sense 
 of its grandeur and nobility, a higher estimate of its relations to man- 
 kind, or a more steadfast purpose to consecrate his whole life to it than 
 did Dr. Agnew to the study and practice of surgery. 
 
 For a long time he had a medical practice which was among 
 
Memoir of D. Hayes Agnezv, M.D., LL.D. 19 
 
 the largest in Philadelphia. He retained ii at first because he 
 believed that while it was possible to be a good ph}'sician with no sur- 
 gical experience whatever, he did not think that the converse was true, 
 but always held that a surgeon was better and stronger in his own 
 department if he had had to watch and study and care for the medical 
 conditions which are liable at any time before, or after operation, to 
 complicate his purely surgical cases. I^ater, he had not the unusual 
 experience of finding it next to impossible to refuse to see such 
 cases in families who had for years been accustomed to depend upon 
 him. 
 
 His therapeutics,, both in medicine and surgery, were very simple, 
 and I have found, and still find, among the prescriptions brought to 
 me by his patients, astonishingly little variety.' Bransby Cooper 
 remarks of his distinguished uncle: " So simple were Mr. Cooper's pre- 
 scriptions that he had five or six formulae which, under ordinary cir- 
 cumstances, constituted his complete pharmacopia, and such medicines 
 he kept constantly made up, for the benefit of the poor." 
 
 Sir Joseph Lister once told me that during his very earliest days in 
 Kdinburgh, when he was still uncertain whether to remain there or to 
 begin his work elsewhere, he consulted Mr. Syme. The latter told him 
 that he would probably do well to stay there, but remarked that it really 
 seemed as though there were not much left to do in the way of advanc- 
 ing surgical science, little thinking at the time that the young man he 
 was talking to, his future son-in-law, would almost alone and unaided 
 effect the greatest revolution in surgery, and bring about the greatest 
 step in advance which has been made since Harvey discovered the 
 circulation of the blood. 
 
 Dr. Agnew never, to my knowledge, wavered in his profound and 
 unvarying faith in the future of surgery. He would have had far more 
 reason than Mr. Syme for believing that the limit of possible advance 
 had been reached, as he had seen the introduction not only of anesthesia, 
 but of antisepsis. It was contrary, however, to his buoyant and hopeful 
 disposition, and inconsistent with his own progressive spirit, to take 
 this view of the science which had shown such infinite capacity for 
 development. He believed, for example, that just as surgical tubercu- 
 losis is slowly but surely coming under the control of the surgeon, so 
 carcinoma, the present opprobrium of surgery, would in time yield to 
 methods of treatment yet to be discovered. He was always among the 
 first to test new surgical procedures and^to adopt them if they seemed 
 to him consistent with fundamental principles and common sense. 
 At a time when many of his juniors were skeptical as to the merits 
 of antisepsis, or were even openly antagonistic, he gave it a thorough 
 trial and at once discarded in its favor the methods which he had 
 
20 Memoir of D. Hayes Agnew, M.D., LL.D. 
 
 employed for forty years. He was among the first to advocate the 
 extension of the field of operative interference in fractures of the skull, 
 one of the innumerable advances which antisepsis made possible. He 
 performed nephrectomy and laryngectomy, supra-pubic lithotomy and 
 prostatectomy-, nerve grafting and other operations which were popular- 
 ized only after he had reached an age when, upon many minds, a new 
 idea has the effect of a foreign body upon the grosser tissues, and is 
 either encapsulated and disappears or sets up irritation and is extruded. 
 While Sir Henry Thompson was impeding the acceptance of litholapaxy 
 by the profession in Great Britain, Dr. Agnew, although one of the 
 most accomplished and successful of lithotomists, was employing it in 
 the majority of his cases of calculus. He attacked brain tumors, tried 
 the modern methods for the radical cure of hernia (though he had pre- 
 viousl}'' devised, employed and cast aside as useless a method of his 
 own), removed the appendix both during attacks of inflammation and 
 in the interval, employed the most recent technique in the treatment of 
 ununited fracture, and in every direction kept full)^ abreast of the times 
 up to the very week of his death. 
 
 On the other hand he could not be induced to attempt operations 
 which his judgment did not approve, and his last important paper, a 
 judicial review of the results obtained hy local surgeons in various 
 forms of cerebral disease and injury, was written partly with a view of 
 establishing the uselessness of certain procedures which he believed to 
 be unphilosophical and unjustifiable. He thought the evidence showed 
 that he was correct, but if future experience had demonstrated the con- 
 trary' to be true it is safe to say that he would have been one of the first 
 to admit it. I have alread}^ alluded to his behavior in reference to his 
 •own operation for the cure of hernia. A sLill more striking illustration, 
 however, of his fair-mindedness is to be found in his attitude toward a 
 question of public policy which, on account of the apparent conflict 
 between hygiene and morals involved has always excited the bitterest 
 contention. I allude to the so called " Contagious Diseases Acts," the 
 recognition and regulation of prostitution by the State. Everything in 
 Dr. Agnew's religious training and association, and many elements of 
 his personal character, tended to lead him into the ranks of the opposi- 
 tion, where are to be found in every country where the subject has been 
 discussed the large majority of the clergy and a small minority of our 
 profession. In 1882, however, when he was 64 years of age, he wrote : 
 "At one time I was disposed to take sides with the opponents of pros- 
 titution laws ; but on a more comprehensive and careful study of the 
 subject, and especially of the results which have been reached in those 
 countries where such legal regulations are in operation, I am forced to 
 believe that the evil is one which comes legitimately within the province 
 of civil law." 
 
Memoir of D. Hayes Agnew, M.D., LL.D. 2V 
 
 To my mind this statement is one of the most interesting examples- 
 of the many which might be adduced in evidence of Dr. Agnew's 
 broad-mindedness and absolute independence of thought and judg- 
 ment. 
 
 It is obvious that Dr. Agnew's physical endurance must have- 
 been extraordinar}" to enable him to carry on at one time the teaching,, 
 writing, operating and consulting, any one of which would have been 
 a heavy burden for an average man. He told me not more than five- 
 years ago that he did not know what it was to be tired. One of the 
 best illustrations of both his strength and his devotion to duty is- 
 afforded by an experience which he has more than once mentioned to- 
 me. He was called by telegram early one morning to an out- of- the- way 
 place in the northern part of the State. He ate a hurried breakfast, 
 caught his train, and by dint of close railway connections and a final 
 drive of eight miles over a rough road reached the house of his patient 
 late in the afternoon. An operation was required, and he performed it 
 at once, a meal being prepared for him in the meanwhile. On looking 
 at his watch and consulting a time- table he found, however, that hy 
 starting immediately he could make a connection at Harrisburg which 
 would enable him to reach Philadelphia in time for his office hours and 
 his lecture the next morning. He accordingly left at once and, as he 
 told me, reached home in time for breakfast the next day, without 
 having had anything whatever for twenty-four hours except a drink of 
 ice water on the cars. 
 
 Until a few years before his death he usually went up stairs at the 
 hospital at a gait which tried the legs and the wind of the assistants. 
 When operating in private houses heavy persons often had to be lifted 
 from the bed to operating table and back again. Dr. Agnew used to say 
 laughingly that there was no one we could not manage between us, and he 
 continued to do his share, and more than his share, of such work until 
 I positively refused to permit it. Physical labor never unsteadied his 
 hand or affected his operating in the slightest degree, and he was dis- 
 posed to speak rather disparagingly, so far as his kindly nature per- 
 mitted, of those who were thus affected. Among other minor peculiar- 
 ities of fellow-surgeons which he did not admire was the disposition to 
 invent and employ a multiplicity of instruments. He made some addi- 
 tions to the surgical armamentarium, as I have already mentioned, but 
 he never laid special stress upon them, and he habitually employed the 
 fewest and simplest instruments possible. 
 
 As an example of his extraordinary endurance, and also of his 
 physical courage, I may mention the fact that during a cholera epidemic 
 in Philadelphia he has. on a broiling summer night gone over to the pit 
 in which the unclaimed bodies were placed, and has himself injected as- 
 
22 
 
 Mevioir of D. Hayes Agneiv, M.D., LL.D. 
 
 many as fifteen at one time, an amount of labor and a degree of risk to 
 which few men would be willing to subject themselves. His expe- 
 riences in procuring dissecting material were many and peculiar. He 
 did not hesitate in the case of unknown vagrants or paupers, where 
 no feelings could be lacerated or shock inflicted upon surviving 
 relatives, to step slightly beyond the strict letter of the law in the 
 interests of science, and even has gone out to the Potter's Field at 
 midnight, resurrected a body, placed it in a sack in the seat of his 
 buggy alongside of him, and driven it in to his Chant Street dis- 
 secting room. 
 
 He had a keen sense of humor, which never failed to respond to a 
 good story or a jocular remark, and was always thoroughly appreciative 
 of innocent fun of any sort. He could on occasion be very amusing, 
 a quaint vein of harmless sarcasm running through his accounts of his 
 numerous experiences. I have heard him more than once tell of an 
 incident that occurred while he was living at 1611 Chestnut Street. A 
 man, residing in Williamsport, had half swallowed his artificial denture, 
 which became impacted in the esophagus. He was sent down to Dr. 
 Agnew, who met him at the Colonnade Hotel and extracted the plate. 
 An enterprising reporter who heard of it rang Dr. Agnew's bell at one 
 o'clock the following morning. Mrs. Agnew, who often interposed 
 between her husband and unnecessar}^ demands upon his time and 
 strength, spoke to the visitor from the window. He said that he had 
 learned that there was a man in town with a set of teeth in his throat, 
 and he wanted to get the particulars. She reported this to Dr. Agnew, 
 and asked what she should say. He said: " Tell him that if he doesn't 
 go away from here promptly there will be another man in town in a few 
 minutes with a set of teeth in his throat." 
 
 In his persistent cheerfulness he resembled most of the great sur- 
 geons of whose histories we have any accurate record. Larrey enlivened 
 even the retreat from Moscow with his pleasantries; Astley Cooper was 
 the life of his medical club ; Abernethy was famous for his dry witti- 
 cisms, and many other lesser lights were notably humorous. 
 
 Much of his success was undoubtedly due to his sympathetic tem- 
 perament, his native eloquence when discussing any subject on which 
 he felt deeply, and his remarkable self denial in the pursuit of that 
 science to which his life had been so thoroughly and completely devoted. 
 There are not many instances, apart from those of religious fanaticism, 
 of such utter abandonment of ordinary aims and ambitions, and of such 
 intense concentration of all mental and physical energies upon one idea, 
 as characterized Dr. Agnew during the years when the struggle was 
 hardest and the reward seemed doubtful or distant. While slow to go 
 beyond his self-appointed sphere of thought and action, he was prompt 
 
Memoir of D. Hayes Agncw, M.D., LL.D. 23 
 
 to resent interference from those whose knowledge and research he 
 knew to be superficial and limited ; and any suspicion of imposition or 
 falsehood was sufficient to excite in him the most profound contempt. 
 Thoroughly honest in all his convictions, making no effort to appear 
 what he was not, and never influenced by any but the most upright and 
 conscientious motives, he despised all hypocrisy in others, and above all 
 in those who prostituted our profession to what he considered their own 
 personal aggrandizement. He was not, however, quixotic in his ideas, 
 and his native shrewdness and common sense enabled him to appreciate 
 fully the merits of those men who, like himself, gained both profes- 
 sional and pecuniary success, and combined properly and deservedly 
 scientific with material progress. 
 
 He never asked and rarel}^ obtained in individual cases the fees to 
 which his rank in the profession entitled him, although the aggregate 
 of his earnings, on account of his enormous capacity for work, was very 
 large. His small charges arose partly from the habit formed during 
 his earlier days of practice, partly from a dislike for the drudgery of 
 bookkeeping which resulted, as in the case of the late Dr. Meigs, in 
 many visits being unrecorded and forgotten, but chiefly from his con- 
 scientious desire that no sick or ailing person who wanted or needed 
 his opinion should be prevented by lack of means from consulting him. 
 During the later years of his life it became absolutely necessary to limit 
 his practice by raising his fees somewhat, but he was always too modest 
 and had too little of the money-making instinct to place a proper valua- 
 tion upon his services. I am tempted again to call attention to the par- 
 allelism between his habits in this respect and those of Sir Astley 
 Cooper. The language employed by the biographer of the latter might 
 be applied without the change of a word to Dr. Agnew : " There were 
 two or three classes of persons from whom, if he knew their occupation, 
 he always, throughout life, made it a rule not to take a fee, even when 
 offered to him. When this desire not to receive any remuneration for 
 his advice arose out of a belief that the pecuniary resources of his patient 
 were very limited, he had the most happy manner of expressing it to 
 the patient, without wounding his pride, or otherwise offending his 
 feelings." 
 
 Both by character and training Dr. Agnew was law-abiding and 
 scrupulously, even rigidly, correct in all the details of his life, but on 
 the other hand, for those who, less fortunate in temperament or educa- 
 tion or surroundings, succumbed to temptations which to him were so 
 ineffective as to be practically non-existent, his sympathy and compas- 
 sion were never- failing. No one was farther than he from the Puri- 
 tanical morality which, negatively virtuous and technically Christian, 
 -finds the chief solace for its own discomforts in the contemplation of 
 
24 Memoir of D. Hayes Agnew, M.D., LL.D. 
 
 the failings of others, and its greatest pleasure in sour and sarcastic con- 
 demnation of their errors. 
 
 Not that he could not be tenacious to the last degree of his own 
 opinions when he considered that a principle was involved. He never 
 varied in his belief that the theatres, against which he once wrote a 
 vigorous philippic, were on the whole both a cause and a symptom of 
 moral deterioration in the community, an index of retrogressive civiliza- 
 tion. He never approved of the co-education of the sexes, nor of the 
 medical education of women under any circumstances, believing that 
 any possible advantages to them were far more than counterbalanced 
 by what he thought would be the inevitable loss of dignity and deli- 
 cacy resulting from the association of the sexes under such conditions 
 and from the character of their studies. In accord with the one opinion 
 he denied himself during his whole life the pleasure which he would 
 undoubtedly have derived from seeing the masterpieces of the drama, 
 many of which he was fond of quoting, enacted on the stage. In accord 
 with the other, he resigned a valuable hospital position, and, in spite 
 of strong pressure, refused many lucrative consultations. 
 
 He was never an advocate of what is now called the higher educa- 
 tion of women in any direction. He admired the domestic virtues, 
 and at one of the last dinners he ever gave, remarked that a woman 
 should be taught housekeeping, hygiene and belles-lettres. After that, 
 he said, the more she knew the worse off she was. 
 
 He valued highly the opinions of those whom he considered his- 
 peers in the surgical world, but, as a rule, entirely disregarded all 
 criticism of himself, or of his doings, whether favorable or the reverse. 
 
 In 1882, after the conclusion of Guiteau's trial, Dr. Hays, editor 
 of the Medical News, asked Dr. Agnew to prepare a statement of the 
 Garfield case, which should serve as an answer to the unfavorable 
 criticism of its conduct made by Dr. William Hammond and a few 
 notoriety seekers among the laity. Dr. Agnew at first consented, but 
 on reflection decided that it would not be dignified or proper for him 
 personally to notice such attacks, and asked me to write the paper 
 and state that it met with his approval. This I did, and this was the 
 only notice he took of the bitter public accusations which involved 
 him equally with the other consultants and the medical attendants. 
 A statement he had made to me, which I had previously published, 
 and a letter he had written to Dr. William Hunt, were evidence that he 
 knew from the beginning the surgical impossibility of locating or 
 extracting the missile, and recognized at the same time the probable 
 hopelessness of the case. But his cool judgment and calm superiority 
 to popular clamor and professional pressure prevented those facts from, 
 being made public at a time when their promulgation would have 
 
s 
 
Memoir of D. Hayes Agnew, M.D., LL.D. 25 
 
 wrought serious harm to great national interests. His high sense of 
 honor in all his relations as a consultant was never better illustrated 
 than in the same case. I cannot even now go into details with 
 propriety, but I may venture to say that had he. divorced his interests 
 from those of some of the gentlemen who saw the case earlier, he could 
 easily have avoided all responsibility for those portions of the treatment 
 most open to hostile criticism. This, however, he would not permit, 
 preferring to stand by his professional brethren even under fire, and in a 
 case which he know would be historical. 
 
 His refusal to make a charge for the many days and nights which 
 Tie had spent with the President during nearly three months, involving 
 a loss of weeks from his practice, then probably the largest and most 
 lucrative ever acquired by an American surgeon, and the niggardly 
 behavior of Congress in appropriating a sum which gave him only 
 ^5000, a sum less than he should have received, or could properly have 
 charged for one- tenth the service rendered, are also matters of history. 
 
 After his retirement from the chair of surgery he gave each year, 
 at my urgent solicitation, backed by that of the class, a clinic at the 
 University Hospital. It was always known in advance, and the amphi- 
 theatre was packed from floor to ceiling. At the first sight of his 
 stately figure and silvered head the applause began, as vociferous and 
 deafening as only a medical class can make it, and continued until by 
 a quiet motion of the hand he indicated his desire for silence. He 
 never lost his hold on the love and respect of the students, and until 
 the day of his death was the most popular member of the University 
 Faculty.^ 
 
 In 1888 the beginning of degenerative changes was manifested by a 
 violent attack of renal colic. He sent for me one morning about four 
 or five o'clock. I found him sitting in a chair in his bed-room, leaning 
 over the back, bathed in a cold perspiration, with a feeble pulse and in 
 an agony of pain. On inquiry, I learned that this had been his condition 
 for some hours, and on asking him why he had not sent for me sooner 
 found that he had not wanted to disturb me, as he knew I had been out 
 late to see a patient for him the evening before. I felt ashamed when I 
 thought how promptly I would have sent for him if I had had a tithe 
 of the pain from which he was suffering. 
 
 His first serious breakdown was in 1889, when he was confined to 
 his bed with influenza. I attended him in conjunction with Dr. 
 
 iThe cut on the opposite page is from the celebrated oil painting by the distinguished 
 Philadelphia artist, Mr. Thomas Eakens. Dr. Agnew is portrayed in his customary attitude at 
 the completion of an operation (in this case the removal of a carcinomatous breast), explaining 
 its details while the hemorrhage is being arrested. The faces of assistants, students and 
 onlookers are portraits. The picture was painted in 1888, the last year of Dr. Agnew's active 
 work as a teacher. 
 
26 Memoir of D. Hayes Agnew, M.D., LL.D. 
 
 William Pepper. He made a slow convalescence, interrupted and pro- 
 longed by supra-orbital neuralgia and lumbar myalgia. 
 
 In 1890 he fell on the marble floor of his hall and violently struck 
 the back of his head. I was never certain whether this was from a 
 sudden vertigo or not, and have thought that it might account for the 
 development of diabetes, which took place later in that year, when he 
 was again invalided under the care of Dr. James Tyson and myself for 
 a period of some weeks; but the autopsy disclosed no cerebral condition 
 which could have been associated with traumatism. 
 
 Soon after he began to develop distinct anginose symptoms. 
 
 lyast Spring, before entering the clinic room for his usual lecture, 
 he told me that he felt excessively nervous, and after the lecture he 
 said that the excitement had given him a great deal of precordial pain. 
 He spoke once more in public, at the University dinner at Musical Fund 
 Hall, and had the same experience. He said as we drove down there 
 that he had determined to give up public speaking, and regretted that 
 he had undertaken it on this occasion. If I may be forgiven for 
 pushing a favorite idea a little farther, I should like to note that after 
 describing Cooper's final address, his nephew says, ' ' This was the last 
 time he appeared as a public lecturer, for he found that the excitement 
 of the scene and the exertion of delivery increased his tendency to the 
 attacks to which he had lately been liable." 
 
 Those who were present at the dinner will remember Dr. Agnew' s 
 description of the members of the faculty under whom he had graduated 
 in 1838. His words were well chosen, and his account of their peculiari- 
 ties was most interesting ; but it was only too evident that he was no 
 longer fit for even the slight- strain which this imposed upon him. As 
 I went down stairs to see him into my carriage, which I had kept 
 waiting for him, he looked so badly that I suggested that I had better 
 go home with him, but with a touch of his old spirit he said : "No ; I 
 don't need a chaperon; I'm old enough to be trusted out alone at 
 night." 
 
 With the exception of a week or two, when he was laid up with a 
 mild recurrence of the influenza, he was at work all the spring, keeping 
 his office hours and attending the almost daily operations which I had 
 the honor of performing on his patients. His interest in surgery never 
 flagged, and not long before his death, after watching for an hour or 
 more a tedious and difficult dissection of the neck for the removal of a 
 growth, he looked at his watch, saw that it was far past his dinner 
 hour and said : "Well, I'd rather see that any day than eat dinner." 
 
 He never thought that he could be quite happy if he were alto- 
 gether without occupation. In 1879, when he was sixty-one years of 
 age, he expressed his views upon the question of the retirement of men 
 
Memoir of D. Hayes Agnezv, M.D., LL.D. 27 
 
 of advanced years from active work when as chairman of a dinner 
 given to Dr. S. D. Gross on the completion of his fifty-first year in the 
 profession, he said : " It is, I fear, too commonly thought in these days 
 of mad haste for preferment, place or power, that men when they have 
 passed three-score and ten years should gracefully retire to the shades 
 of private and inactive life, leaving the field to younger athletes. This 
 is a great mistake. . . . There is something in the grace and dignity of 
 age ; its serene complacency of mind which, when coupled with an 
 affluent wealth of knowledge and rich stores of observation and experi- 
 ence, renders the presence of old men in our midst pillars of strength 
 not only in a profession like our own, but to the community at large ; 
 indeed, to the world." 
 
 On the 8th of March last year I removed a recurrent sarcoma of 
 the abdominal wall from a lady, a patient of Dr. Agnew's and Dr. 
 Murray Cheston's, who had been originally operated on by Dr. Agnew 
 thirteen years previously. It is for me a memorable operation, as it 
 proved to be the last one at which I was to have the honor and the 
 comfort of Dr. Agnew's presence. The weather was cold and stormy. 
 Before leaving the house he told me that if he felt no better the 
 next day he would expect me to operate for him on an epithelioma 
 of the lip in a patient of Dr. E. W. Watson's. Early the following 
 morning I had a note, the last I ever received from him, saying 
 that as he was quite well, and as the operation was so trifling, he 
 would do it himself. I ventured to write him and advise against it, 
 but ineffectually. Dr. Watson tells me that it was only with the 
 greatest difficulty that Dr. Agnew succeeded in removing the little 
 growth, as immediately after his arrival at the patient's house the 
 anginose pains were so severe that he was unable to stand, and he 
 required full doses of brandy and some minutes' rest before and during 
 the operation, which was the last he ever performed. He saw another 
 patient later in the day in consultation, and climbed two flights of 
 stairs to do so. This brought on such a severe attack of cardiac pain 
 that it was with difficulty he reached home. He was then utterly 
 prostrated, and lay in the operating chair in his office for some hours. 
 During this time Dr. DaCosta, who came over at once from his office, 
 saw him, and tells me that he regarded his condition as extremely 
 critical. I visited him an hour or two later in response to an urgent 
 note from Mrs. Agnew, which I found awaiting me at my house late 
 in the afternoon. He was then cheerful and free from pain, and gave 
 me the above account of his day. With the help of Dr. Edward 
 Martin and Dr. George de Schweinitz I carried him up to his bed, 
 which he never left again. 
 
 I am sure I may say that in the days that followed he was well 
 
28 Memoir of D. Hayes Agnezv, M.D., LL.D: 
 
 and tenderly cared for. In addition to the loving and watchful atten- 
 tion which his devoted wife and niece bestowed upon him incessantly, 
 day and night, he was almost never without a physician in immediate 
 attendance. Dr. Alfred Wood and Dr. Judson Daland divided the 
 days with me ; I spent each night in the house and saw him at short 
 intervals; and the consultants, Drs. Da Costa and Pepper, were assidu- 
 ous and untiring in their efforts to bring about his recovery. There 
 were dozens of volunteers who would have considered it, as we did, a 
 privilege to evince their love and respect by similar services. 
 
 During this last illness he showed the same sweet, uncomplaining, 
 well-balanced disposition that had characterized him all his life. At 
 first, even in the thick of the grave paroxysms of angina pectoris that 
 gave him such distress, his professional judgment remained unimpaired, 
 and the most valuable and practical suggestions received by the attend- 
 ing physicians and consultants came from the patient himself. lyater, 
 when diabetes re-developed and the brain began to become clouded, 
 he dozed for most of the time, but he still retained his old interest in 
 everything relating to surgery. When, after an absence of an hour or 
 two, I would return to his bedside he would invariably ask as to what 
 had occurred surgically, and the formula, " What's new ? " on his lips 
 meant, ' ' What operation have you been doing ? what cases have you 
 been seeing ? ' ' An operation postponed on account of his illness was 
 remembered and inquired about the day before he died. At about the 
 same time in conversation with him mention was made of a mutual 
 friend who had recently undergone a severe operation upon the face. 
 Dr. Agnew was quiet for some minutes, and those about the bed spoke 
 of other matters, but he opened his eyes suddenly and said, " Is the 
 scar well placed ? " I at first thought he was wandering, and made 
 some remark about the effect of the morphia he had taken, but he 
 speedily made clear that he wanted accurate information as to an 
 important detail in the surgery of the case. " Did you take that breast 
 out?" was the greeting on another occasion, when the mind was 
 becoming feeble and when it was supposed that all outside interests had 
 departed, but the question referred to a specific operation upon a rela- 
 tive of one of his colleagues. 
 
 The attacks of angina which at first were brought on by even a 
 change of position in bed gradually diminished in frequency and 
 severity, and for some days the outlook was promising, but later 
 diabetes reappeared, he grew dull and drowsy, stupor deepened into 
 coma and he died on March 22, surrounded by loving friends and rela- 
 tives. The announcement of his death was followed by manifestations 
 of grief so widespread and so striking as to make it assume the propor- 
 tion of a public calamity, and no one who was present at his funeral and 
 
Memoir of D. Hayes Agneiv, M.D., LL.D. 29 
 
 saw the stream of persons of all ages and conditions who filed past his 
 coffin could have failed to be impressed by the hold which he had upon 
 the respect and affection of this community. 
 
 It is to be noted that the cardiac conditions found at the autopsy 
 were similar to those found in John Hunter and Sir Astley Cooper. 
 
 I have had the good fortune to number among my acquaintances, 
 and I think I may say my friends, four whose names could not be 
 omitted from the roll of the great men of this century. Two were devo- 
 tees of pure science, Agassiz and Leidy; two were surgeons, Agnew 
 and Lister. I have over and over again thought of the remarkable 
 similarity in their personal characteristics, which was so striking that a 
 descript'on of one applies equally to all. Simple and unaffected in 
 their manners, kind and courteous in their treatment of every one with- 
 out regard to social conditions; slow to take and even slower to give 
 offense; broad in all their views of life and its complex relations; 
 modest to the point of diffidence where their own merits were concerned; 
 ready to give freely and earnestly from their overflowing stores to the 
 humblest seeker after knowledge; earnest and sincere without being 
 quarrelsome; good with no shadow of self-righteousness, they seem to 
 me to hold up to poor human nature examples that should stimulate and 
 encourage even the worst or the weakest among us. 
 
 The words which my father, whose pride it was to count L,eidy and 
 Agnew among his personal friends, used in an obituary memoir of the 
 former would describe them all: " Appreciation of his rare intellectual 
 gifts was forgotten in admiration of his sincere, sweet-tempered, loving 
 nature. Retiring and unassuming ; genial and kindly in spirit and 
 manner, the friend of all, the enemy of none; as approachable as a 
 child, ready at all times and with evident pleasure to give the benefit 
 of his knowledge to all who sought it, his death will be mourned wher- 
 ever science is valued throughout the earth, but we especially will miss 
 his kindly face, his ready hand, his cordial greeting, and his noble 
 example of industry, integrity and manly character." 
 
 By the death of Dr. Agnew our profession suffered a loss of the 
 greatest magnitude, and one which is perhaps altogether irreparable. 
 There remain men equally eminent in some departments of surgery; 
 men of equal ability as public expounders of surgical principles; men 
 whose earnest and self-sacrificing devotion to medicine in its broadest 
 scope cannot for one moment be questioned ; but there is probably not 
 one who, combining in himself all these qualities, possesses in addi- 
 tion the skill in observation, the personal magnetism, the singleness of 
 soul, the ceaseless, untiring energy which made Dr. Agnew not only 
 one of the greatest surgeons but also one of the best citizens of this or 
 an}^ country. When I come to review finally his record in the many 
 
30 Memoir of D. Hayes Agnezv, M.D., LL.D, 
 
 important relations of his life, and remember his unswerving advocacy 
 of all that tended to raise the standard of teaching and of our profes- 
 sion; his resolute support of every progressive movement at the insti- 
 tutions with which he was connected; his unsurpassed ability as a 
 clinical and didactic lecturer, and his conscientious discharge of the 
 duties of those positions; his remarkable work as a practitioner, oper- 
 ator and consultant; his genuine love for that work, and his eager 
 desire to acquire any new fact that might benefit his patients; his respect 
 for every honest opinion, even if it differed from his own; his quick 
 and ready sympathy and his tender treatment of all who claimed his 
 help; his generous support of the feeble, the halting and the unfortu- 
 nate in the profession; his gentle courtesy, kindly bearing and warm 
 friendship which never failed in time of need, I can well believe not 
 only that our profession has suffered an irreparable loss, but that 
 there are many who, like myself, feel that they have sustained a per- 
 sonal bereavement which time may soften but cannot efface. 
 
 It is a consolation, gentlemen, to know that he lived to receive 
 and appreciate the highest rewards that the profession has it in its 
 power to offer. In the poem which our President read to him on the 
 occasion of his jubilee in 1888, he recalled the imaginative promise of 
 Minerva to the lad who a half century earlier had taken his degree in 
 medicine : 
 
 " But I will take you where the great have gone 
 
 And I will set your feet in honor's ways ; 
 Friends I will give and length of crowded years, 
 
 And crown your manhood with a Nation's praise." 
 
 When we mourn his departure from among us, and miss his strong 
 hand and friendly face and wise counsel, it is at least some comfort to 
 know that the honor and the friends and the praise came to him with- 
 out stint, and that he died in the knowledge that he was the well- 
 beloved, the "dear old man" of the profession. 
 1810 South Rittenhouse Square, Philadei<phia. 
 
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