Unlike most of the countless medical procedurals on the air, director Steven Soderbergh’s new Cinemax series, The Knick, does not pussyfoot around hospital gore. Set in a poor New York immigrant neighborhood in 1900, the first episode opens with a spurting, hectic emergency cesarean section operation. A few prominent critics have ripped into the show, slamming it for skimping on historical fidelity, and hiding a routine anti-hero story about Clive Owen’s cocaine-addled, genius surgeon underneath the shock value of well-produced blood and guts. But The Knick’s surgeries aren’t just fluff. Soderbergh has stated that he wants at least one scene in every episode to make our heads snap back because he wants the audience to viscerally understand the harsh realities of medicine 114 years ago. The show is a teaching tool, drawing upon thousands of early 20th century medical photos to bring an abstract age of promise and progress to life, and, in doing so, force us to consider the raw physicality and continual evolution of modern medicine.
Dr. William Halsted, the inspiration for Soderbergh’s Dr. John Thackery, Photo by John H. Stocksdale/WIkimedia Commons
In its first three episodes this past August, The Knick has already offered a great overview of major trends in American medicine at the dawn of the 20th century. We’ve been introduced to medical self-experimentation with “patent medicines,” laden with cocaine, heroin, morphine, and opium; major killers like tuberculosis; and early developments in surgical sterilization and stabilization, slowly mitigating the era’s nearly 50-50 operating room kill ratio. The real-life inspiration for Owen’s character, Dr. John Thackery, was pioneering surgeon and Johns Hopkins founding professor William Halsted (1852-1922), who fell so deep into addiction that he eventually started running out mid-surgery, vanishing for months on end. While Halsted’s dark muse serves as prime fodder for a tantalizing TV drama, there are a host of other fascinating innovations from this era of touch-and-go, experimental medicine, which could make their way into the show’s narrative.
Dr. Louis T Wright, an inspiration for the character of Algernon Edwards
Investigating medical developments from 1900 to get a sense of the show’s pool of potential material, it’s easy to understand why The Knick’s showrunners might be willing to fudge historical fidelity. Medicine evolved in gradual revelations, rather than sudden ‘Eureka!’ moment snips and hacks on the operating table. And though 1900 carried with it the expected, symbolic feel of a new era, most of the major developments of that year were tweaks on their way to or building off of medical breakthroughs. We’re likely to see Knick doctors experimenting with newly isolated epinephrine and emergency medicine, or picking up the first Bayer Aspirin to thin patients’ blood and aid with heart attacks. The year also bore witness to plague in San Francisco, which might prompt plot points around quarantines. Hopefully the show will find a way to engage with 1900’s revolutions in medical ethics, when doctors began experimenting with diseases on consenting healthy subjects rather than, as in the past, injecting poor people with the plague just to see what would happen. It’d be a hard storyline to craft, but it could be rewarding to see doctors on The Knick stumble their way through ethical experimentation on the physically sound, not just the terminally desperate.
Top: A skin grafting technique for treating syphilis injuries, used on The Knick Bottom: Pre-1904 Ad for Bayer products, including Heroin
Chances are that Soderbergh and company won’t rely on the developments of 1900 alone to inform the show’s arc, but will cherry-pick from the real-life innovations of the doctors who inspired the characters. In Thackery’s case, that means emergency blood transfusions performed on family members, skin grafts and brutal cauterizations on syphilitic faces, gallbladder operations at 2 AM on the kitchen table, and radical mastectomies. We’re also likely to see advances in eye-popping surgeries on arteries in aneurysm patients, goiters, ruptured intestines, thyroids, and tuberculosis-ridden lungs. But if the show is true to Halsted’s obsession with sterility, then the show will also progress beyond blood and gore as Thackery develops mattress sutures and hemostats to control bleeding and pushes surgical gloves on the hospital. Beyond Halsted, the influences behind the other doctors on the show, like Louis T. Wright (1891-1952), the pioneering black surgeon and civil rights advocate upon whom Andre Holland’s character of Algernon Edwards was modeled, can bring the drama beyond surgical innovation and into the development of cancer drugs, vaccinations, and antibiotics. If that sounds a bit duller, consider potential scenes showing pre-Wright treatments, involving acids and arsenic paste used on growths, and patients on proto-chemo.
The early 20th century was awash in experiments with peg legs, toxic radium cure-alls, and intentional malarial infections and mercury poisoning to fight STDs. But while The Knick wants us to acknowledge the insanity of some these older cures, and question our own confidence in modern medicine’s certitude and civility, it’s also fundamentally a tale of determined progress and inspired good. So it’s far more likely that we’ll see, through the gore and confusion, lessening body counts and blood spills, growing awareness, and honest, if bumbling and misinformed, efforts to inch towards the ethical and effective, hopefully lending a tinge of optimism to a bloody, yet illuminating show.
1906 Collier's Cover, Decrying the use of patent medicines