Andre Holland as Dr. Algernon Edwards, Michael Angarano as Dr. Bertram "Bertie" Chickering, Clive Owen as Dr. John Thackery, Eve Hewson as Nurse Lucy Elkins and Eric Johnson as Dr. Everett Gallinger in Cinemax's The Knick
One technique used by most demagogues is to paint a picture of simpler times in the past with a folksy world where life was easier and generations of yore exhibited tradition and virtue. Instead of offering a vision of the future, or dealing with the realities of the present, they appeal to restore the past. The problem with this is there's usually a reason why times and things change. When someone can't provide a logical argument for why we need to keep doing things the same dumb ways we've always done them, they appeal to an imagined era and values of forefathers. Demagogues finish this off by wrapping themselves in the flag (or some other authority) and position themselves as defenders of all that is good and wholesome being threatened by modernity and change.
Of course, that's all bullshit, but it can be comforting to believe a lie. And the reality is that sometimes the past wasn't as good as we remember it, and a lot of times the present is not as bad as we think it is.
Just like how Mad Men, Masters of Sex and Downton Abbey allow viewers to think about the culture of a different time period beyond the fake nostalgia, Cinemax's The Knick dissects distinctions of class, race, and sex that surround a hospital in New York City of the year 1900. Created and written by Jack Amiel and Michael Begler, with each episode directed, shot and edited by Steven Soderbergh, the series depicts an era with some of the first steps of "progress" that is not quaint or idyllic, and in many ways seems horribly backwards.
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From Daniel Fienberg at HitFix:
Steven Soderbergh: I'm always a little unnerved when I see a show that's set in the past that implies in any way that things were nicer then, because my first reaction is, "Yeah if you were white." But this just had none of that. This was the opposite.
The first 11 minutes of
The Knick begin with Dr. John Thackery (Clive Owen) shooting up cocaine after leaving a Chinatown opium den to take part in an emergency Caesarean section at the Knickerbocker Hospital. The surgery is depicted graphically and ends disastrously, resulting in the lead surgeon, Dr. J. M. Christiansen (Matt Frewer), committing suicide. For any modern obstetrician/gynecologist viewing it, the surgery is a clusterfuck and will seem completely foreign to modern procedure and technique.
"It seems we are still lacking."
But in many ways that's one of the themes of the show. Not only are we watching the first error-filled steps toward modern medicine, but the series transports us to a time when American society inside and outside the walls of the Knickerbocker Hospital seems authentic, foreign, full of possibilities, and as much a clusterfuck as the surgery that starts the series. The setting of
The Knick is an interesting time in post-Civil War America. Immigrants from around the world are coming to America, men with names of Rockefeller and Carnegie have built financial empires, and the first steps in various scientific, medical, and social changes are beginning to take place. But those advances are only small steps in the backdrop of a United States that's still adjusting to the
germ theory of disease and won't see black doctors and female administrators as commonplace for decades.
Most of the action of The Knick is centered around a very Dickensian setting. Dr. Algernon Edwards (Andre Holland) is a Harvard-educated, highly accomplished surgeon who's studied with some of the most renowned surgeons in the world. But he has no respect in his new position as deputy chief of surgery, either from his colleagues or (white) patients because of the color of his skin. Edwards decides to take matters into his own hands by establishing a surgical clinic for black patients. The rest of the surgical staff consists of Dr. Everett Gallinger (Eric Johnson), who feels slighted for not getting the deputy chief position, and is outwardly racist; and Dr. Bertram "Bertie" Chickering (Michael Angarano) is young, admires Thackery, and has a father who doesn't like his son working at the Knick. Edwards was hired by the hospital because of the influence of the wealthy Robertson family, with shipping tycoon Captain August Robertson (Grainger Hines) having installed his daughter Cornelia (Juliet Rylance) as a hospital administrator. The situation at the Knickerbocker Hospital is reminiscent of St. Eligius in St. Elsewhere, with an underfunded institution treating those in poverty while everyone else is moving uptown to chase money. The hospital is also mismanaged by Herman Barrow (Jeremy Bobb), who's skimming money from the budget, selling patient bodies, and in debt to organized crime. Ambulance driver Tom Cleary (Chris Sullivan) and Sister Harriet (Cara Seymour) provide working class, immigrant perspectives on the situation as they deal with orphans, unwanted pregnancies, and a world that's not always fair.
Owen's Dr. Thackery has been compared to Hugh Laurie's Dr. Gregory House, and some have nicknamed the series House 1900. Both Thackery and House are abrasive, intelligent, find purpose in innovation and solving puzzles, and both are addicts. However, beyond those surface similarities, Thackery and the situation are much more complicated by both personal flaws and the societal flaws of the time. For example, Laurie's House hated making personal connections, whereas Thackery seems to like having Bertie's admiration and a developing relationship with Nurse Elkins (Eve Hewson).
“I don’t think anyone could have done it faster. We did everything right.”
Your god always wins. It is the longest unbeaten streak in the history of the world. Yet J.M. Christiansen fearlessly took up arms in that battle to oppose the inevitable. Throwing himself at an enemy that has never known defeat and, as sure as I'm standing here, never will. One could not be blamed for wondering if J.M. came to see his life's work as a fool's errand. A rube finally realizing that the game he's been playing will be forever rigged against him. But my dear friend J.M. was a fine man and certainly was no fool or rube. He and I spent our lives tilting at the very same windmills. So why have I not lost hope like he did? Because those windmills at which we tilted were created by men to turn grindstones that transformed the Earth's bounty into flour. From such humble beginnings grew the astonishing modern world in which we now live. We cannot conquer the mountains, but our railroads now run through them with ease. We cannot defeat the river, but we can bend it to our will and dam it for our own purposes. We now live in a time of endless possibility. More has been learned about the treatment of the human body in the last five years than was learned in the previous 500. Twenty-years ago, 39 was the number of years a man could expect from his life. Today, it is more than 47. Eventually the train tunnels will crumble. The dams will be overrun. Our patients' hearts will all stop their beating. But we humans can get in a few good licks in battle before we surrender.
—Dr. John Thackery
In the end,
The Knick is a show set in the past about the future. We know the New York City that will come into being over the next 114 years. And we know how society will change as it gets there. But we also get to see how ignorant the world once was while contemplating how far we still have to go.
- Genius on the edge: Thackery is based on Dr. William Stewart Halsted, an extremely influential medical practitioner who developed revolutionary techniques (e.g., performed one of the first blood transfusions, introduced procedures for sterility and cleanliness during surgery, developed radical mastectomy for breast cancer, etc.) and one of the founding physicians of Johns Hopkins Hospital. In The Knick, surgery is performed without masks and using bare hands. However, Halsted and his colleagues began using rubber gloves ordered from the Goodyear Rubber Company in the 1890s. Unlike Thackery, Halsted was said to have been reclusive, somber and extremely shy in personal dealings. Like Thackery, Halsted became addicted to cocaine (and morphine) while researching its medical properties and practiced medicine while high. In his defense, neither substance was illegal at the time. In fact, cocaine was used in Coca-Cola until 1929, seven years after Halsted's death.
Dr. William Halsted, Dr. Harvey Cushing and Dr. Hugh Young in the Johns Hopkins operating theater, circa 1903
- Placenta previa: Thackery and Christiansen's search for a solution is based on a very morbid stat for pregnant women at the turn of the 20th century. Placenta previa is a condition in which the placenta covers the mother's cervix, causing vaginal bleeding. According to researchers for The Knick, surgery to deal with this complication had a near 100 percent failure rate in 1900. This isn't all that surprising given that doctors were still working out the kinks of Caesarean section, and for that matter surgery itself. According to at least one source, not a single woman in Paris, France survived attempted C-sections between 1787 and 1876. In some American cities, up to 30 percent of infants died before reaching their first birthday in 1900. The U.S. infant mortality rate that year was approximately 100 infant deaths per 1,000. Today that number is 6 per 1,000.
- An anachronistic soundtrack: Soderbergh made the choice not to use period music as part of the score, since he found it "boring and not interesting." Instead composer Cliff Martinez went in the direction of an electronic soundtrack that has an energy and fits the theme of modernity clashing with older ways.
- Thackery's racism: I've seen the racism of Thackery debated in some reviews of the show, to the point of questioning whether or not he is a racist. The pilot has him objecting to Dr. Edwards' employment on the basis that it's a detriment to the hospital and treating him like shit. The sixth and seventh episodes showed some of the distinctions between him and Dr. Gallinger. Thackery seems to care about what you can do for him and the bottom line. If segregation allows the hospital to operate more efficiently, he's willing to go along to get along. And if Dr. Edwards is productive and can provide innovations, he's willing to co-author papers and bring Algernon into the operating theater. But I've always felt there was a grudging, underlying respect by Thackery for Edwards. And in the seventh episode, based around the 1900 New York City race riot, I think for Thackery and Cleary you see a base decency. Gallinger and Barrow were ready to throw the black patients to the wolves. But even with their faults, Thackery and Cleary couldn't let helpless people be butchered in the streets because of the color of their skin.
Cara Seymour as Sister Harriet and Chris Sullivan as Tom Cleary
- My kind of Nun: A few days ago, Emily Nussbaum of The New Yorker changed her mind about The Knick. She originally panned the series but came around because she thinks she misjudged the series and thinks it's "legitimately nihilistic about the circumstances surrounding scientific and social progress." However, I'm not sure I agree with her reasoning. For example, the situation with Cleary and Harry shows how people are able to move some in their views when they get the whole story. Cleary at first treats Sister Harriet like she's a child murderer to be blackmailed and used after he learns that she helps perform abortions. But she's a woman that's seen the unwanted, the abused, and the abandoned. And after he sees what happens when young women self-perform abortions, he understands why Harry is doing what she's doing. And even before that, Cleary wouldn't let Barrow defile the woman's cadaver for profit and made sure she received a proper burial. And that smidgen of hope for better things can even be seen in Thackery. In his actions, Thackery really does want to help people. If he didn't give a shit about medicine, beyond his ability to go to opium dens and shoot up cocaine, I don't think he would have reacted so harshly to the tonic salesman. He told him to go fuck himself because he cares about the advancement of medicine and that the cures are legitimate. And it's that same aspect that brings him around to accepting Algernon as an equal.
- Rat-bite fever and post-mortem photography: According to the writers and producers, it was a real thing in turn of the century New York for people to go stomp on rats for entertainment. Or to watch dogs kill rats. Sadly for Dr. Gallinger he didn't wash his hands after treating a patient bitten by said rats because he was too busy being racist towards Dr. Edwards. He then handles his baby, which dies from meningitis after being infected. The picture Gallinger and his wife take with their dead child was a common practice of the time period, when people would stage their dead loved ones in family portraits.
- Two characters in search of something more: Edwards and Cornelia hooking up feels like it's been telegraphed since the first episode, but I bought the moment they decided to give in to their attraction. Both are characters who are smart, accomplished, and talented, but are constrained by the expectations of either their sex or race. They're expected to either stay on their side of town, mind their place or be barefoot and pregnant. For Edwards, he faces it with a dignity that belies a boiling rage just under the surface that he has to let out in bar fights. And with both Edwards and Cornelia, they had just been through a horrible event and want to "blow off some steam" in a way. And I don't think the symbolism of it was an accident that she has sex with Edwards on his makeshift operating table.
- Barbers and surgeons: In the fifth episode, crime boss/pimp Bunky Collier (Danny Hoch) takes one of his injured men to a barber shop to treat a leg wound. From the 11th to 19th centuries, barbers served as surgeon, dentist and chopper of hair. So if you needed someone to perform an amputation, bloodletting, pull a tooth or get a shave and trim, your local barber could maybe help you out, since he was the guy in town that had a pretty good set of knives and tools. Of course, the quality of service would have varied greatly. In the 19th century, some smarter people decided that it would be better if we separated medical care and hair care. However, the barber's pole still used today is a reference to this past, with the white representing bandages, the blue is for veins and the end cap being the vessel used to catch red blood. A few years ago, licensed barbers in Minnesota objected to cosmetologists and hair salons putting barber poles outside their shops and cited this history as why.
- Progressive for his time: The interesting thing about Cornelia's father is that he seems to think of himself as very progressive, and given the time period he probably would be considered "liberal" by his counterparts for putting a woman in a position of power at a hospital with a black doctor. But he's also the type of person that thinks he's enlightened but doesn't recognize his own shortcomings. When he introduces Dr. Edwards to Cornelia's future father-in-law, he does it in the most condescending, racist way possible. And he also has an inferiority complex when it comes to comparisons to the Rockefellers, Carnegies, and Vanderbilts. So if Cornelia were to tell her father about the rape-y threats of her future father-in law, would he believe her? Would he let her get out of the engagement? The future father-in-law implied that Cornelia's father took a good chunk of money for an investment. Would he let that walk out the door to save his daughter from a horrible marriage?
Algernon’s 3 Layer Hernia Repair technique is based on a real medical breakthrough credited to Italian doctor
Edoardo Bassini.
- Not until 1920 in the real world: In The Knick, Holland's Dr. Edwards is the first African-American surgeon to be on staff at a New York City hospital. In reality, this didn't happen until 1920 when Louis T. Wright was appointed to clinical assistant in the Out-patient Department at Harlem Hospital.
Four doctors resigned from Harlem Hospital in protest and Dr. Casmo D. O'Neil, the superintendent and person directly responsible for Dr. Wright's appointment, was promptly demoted to the information booth at Bellevue Hospital.
- None were spared: The incident that caused the 1900 New York City race riot is depicted true to history (i.e., a plainclothes New York City officer, Robert Thorpe, accused a black woman of being a prostitute; the woman's boyfriend, Arthur Harris, intervened, got into a scuffle, and stabbed the cop). According to news reports from the time, the riot began after a drunk Irish woman came out and screamed at a crowd that "the black bastes ought to be kilt." The crowd became a mob and attacked a 17-year-old black kid who happened to be passing by. However, unlike the depiction in The Knick, the riot started not at the hospital where the officer died but during a wake at his home the next day. For two days, white mobs attacked African-Americans in the city. And according to some of the victims, not only did the NYPD officers do nothing to stop the mobs, they actively participated in the riot.
- Tenderloin to Harlem: The Tenderloin was the red-light district of Manhattan during the late 19th and early 20th century. It comprised parts of what are now the Flatiron District, Madison Square North, Chelsea, Hell's Kitchen, the Garment District, and the Theater District. After the 1900 race riot, African Americans began migrating from areas like the Tenderloin to what was then the primarily white neighborhood of Harlem. In 1910, Central Harlem was about 10 percent black. By 1930, it had reached 70 percent. Incidentally, the real Knickerbocker Hospital was located on Convent Avenue and 131st Street in Harlem. The fictional version in the series seems to be on the Lower East Side.
- Typhoid Mary: Part of Cornelia's storyline is her hunt for the cause of a typhoid outbreak in the city. The source is Mary Mallon (aka Typhoid Mary). Mallon was the first known asymptomatic carrier of typhoid and she is thought to have infected at least 53 people while working as a cook. However, the show's version of events doesn't fit the actual history. Mallon didn't come to the attention of authorities until 1906. She was actually quarantined until 1910 before being released by a sympathetic health official. Mallon then changed her name and returned to working in kitchens. After new outbreaks of typhoid were detected and investigated, Mallon was caught and returned to quarantine, where she would live out the final 23 years of her life.
"In the blackest darkness, even a dim light is better than no light at all."
- The other Halsted reference: The relationship between Thackery, and Lucy is based on Dr. Halsted getting involved and eventually marrying one of his nurses. Like Lucy, Caroline Hampton Halsted came from a Southern family that disapproved of her attending nursing school in New York. Dr. Halsted appointed her chief nurse of the operating room at Johns Hopkins Hospital and insisted she wear medical gloves just like the surgeons. The look on Lucy's face after her night with Thackery was great, since Eve Hewson does an amazing job of selling the entire mix of shame, regret, joy, and feeling good about a night of cocaine and sex.
- Saddle nose: The affliction and treatment of Thackery's former flame, Mrs. Abby Alford (Jennifer Ferrin), is truth in television. Abby caught syphilis from her philandering husband. Untreated congenital syphilis can cause the bridge of the nose to collapse and the flesh around it to rot away in what's called a saddle nose deformity. Since Alexander Fleming won't discover an effective treatment, penicillin, until 1928, having saddle nose became a mark of shame that marked its victims as morally corrupted. Also keep in mind that at this point in American history the Comstock laws made contraception and safe sex a bit difficult. Today saddle nose deformity is treated with grafting and rhinoplasty. However, the only option in 1900 was an arm-flap technique developed in the 16th century by Italian surgeon Gaspare Tagliacozzi. The living skin of the arm is attached to the living skin on the nose until blood vessels from the nose start irrigating it. Then the amount of flesh need for reconstruction is cut. Assuming everything is kept clean and doesn't get infected, the flesh is irrigated by the nose vessels and can remain alive without contact from the rest of the arm flesh. It can then be molded onto the face. However, the patient has to keep his or her arm in a position next to the face for weeks.
The skin flap restoration procedure was invented during the Renaissance.