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Bare fingers, a scalpel, blood, and a frock coat. Lister had published on antisepsis eight years earlier; Philadelphia had not read him yet.

Dr Samuel Gross was 70 and the most famous surgeon in America, and the operation Eakins painted him doing was a merciful one: cutting dead bone out of a young man's thigh rather than taking the leg off, which is what the previous generation would have done. The patient is under ether, which is the single modern thing in the room. Everything else in the picture is why the nineteenth century killed so many of the people it was trying to save. Gross is wearing his street clothes. So is every man cutting. There are no gloves, no masks, no gowns; the instruments lie in a velvet-lined case; the surgeons' bare fingers are in the wound, and Gross has stepped back mid-lecture with a scalpel in his hand and blood on his fingers to explain what he is doing to a hall full of students. Joseph Lister had published on antisepsis in 1867, eight years before this canvas, and Philadelphia had not adopted it. When Eakins painted the same subject again 14 years later, the surgeons in that picture wear white and the room is clean, and the difference between the two paintings is the most exact record anyone has of how long it took a good idea to cross an ocean and a profession. The woman recoiling in black at the left, hands clawed over her eyes, is understood to be the patient's mother, present because the rules for charity cases required a relative to attend. Eakins put himself in too, seated at the right of the entrance tunnel with a pencil. He submitted the picture to the art section of the Centennial Exhibition in 1876 and it was rejected; it ended up displayed among the medical exhibits in an army hospital pavilion. One reviewer wrote that people would come away sick. Jefferson Medical College bought it for 200 dollars. In 2006 the college agreed to sell it to a new museum in Arkansas for 68 million, and Philadelphia raised the money to keep it in about 45 days. It now belongs jointly to two of the city's museums, and the argument about whether it is beautiful has been over for a century. Gross's face is lit like a portrait; the thing that draws every eye first is the hand holding the knife.