It was commissioned to honor anatomist and surgeon David Hayes Agnew, on his retirement from teaching at the University of Pennsylvania.

In the background, the operating room nurse, Mary V. Clymer, and University of Pennsylvania medical school students observe.

[3] It was commissioned for $750 (equivalent to $25,433 today) in 1889 by three undergraduate classes at the University of Pennsylvania, to honor Dr. Agnew on the occasion of his retirement.

The painting echoes the subject and treatment of Rembrandt's famous Anatomy Lesson of Dr. Nicolaes Tulp (1632; in the Mauritshuis museum in The Hague, Netherlands), and other earlier depictions of public surgery such as the frontispiece of Andreas Vesalius's De humani corporis fabrica (1543), the Quack Physicians' Hall (c. 1730) by the Dutch artist Egbert van Heemskerck, and the fourth scene in William Hogarth's The Four Stages of Cruelty (1751).

[6] His decision to portray a partially nude woman observed by a roomful of men (even though they were doctors, and in an undeniably medical setting) was controversial.