Written by: Jack Bennett.
Having recently watched the period medical drama The Knick, from Academy Award winning director Steven Soderbergh, set during the Gilded Age of American history, the series encompasses the medical advancements, contemporary racial tensions found in both medical treatment and wider society, and the tumultuous political climate of America. Providing a window through which the harsh reality of illness and incurability on the wards of The Knick is revealed, mirroring the trichotomous nature of corruption, consumption and capitalism in the tension ridden socio-political environment of New York City and the United States at the turn of the twentieth century. This article will explore the historical depiction of medicine and the socio-political landscape of the USA in 1900 through a synthesis of historical criticism.
Set within a fictionalised Knickerbocker Hospital in Lower Manhattan in 1900, Dr John Thackery (Clive Owen), the main protagonist of the show, becomes a tragic hero, plagued by his own cocaine addiction and amidst the noble pursuit of developing medical practices to save lives across society is loosely inspired by the drug-addict, medical pioneer Dr William Stewart Halstead. While, Dr Algernon Edwards (André Holland) is another fictional character who is possibly an amalgam of two notable doctors – Daniel Hale Williams and Louis T. Wright. Williams set up Chicago’s first non-segregated hospital and was the first African American to be admitted to the American College of Surgeons. Wright, a Harvard graduate, was the first African American doctor to work as a surgeon in a non-segregated hospital, at Harlem Hospital in New York City. Critically, the show conveys the sense of immediacy and rapidity of medical development at this time. For example, between 1880 and 1890, approximately 100 new types of operations were conceived, made possible by progress in anaesthetics and antisepsis, discovered in the latter part of the nineteenth century. Meanwhile, through the shows creation of 1900 Manhattan, combining the narratives of corrupt political officials, criminals, academics, and exploited immigrants, women and African Americans, The Knick assumes greater intentions through the creation of a rich tapestry of cultural characters, placing agency in the individuals and communities ordinarily subjugated during this period.
The dimly lit interiors provide the backdrop to the domestic tensions and relations which reflect the wider developments within New York at the dawn of a new century. Foremost amongst these central themes is the shows depiction of racial injustices and relations at the nadir of racial policies in America at this time. Like its television counterpart, the Knickerbocker hospital had a policy of refusing to treat African Americans at the beginning of the twentieth century. revealing both implicit and explicit forms of discrimination, along with the dichotomy between the boundaries and limitations to African American social mobility as well as increasing degrees of interracial communication, collaboration and acceptance throughout society. Moreover, the position of multivariate immigrant populations in the United States during this period is expertly handled by Soderbergh throughout the two seasons of the show. Major shifts in the sources of immigration during the 1890s occurred, with 3.5 million newcomers entered the USA during this decade despite the onset of economic depression from 1892. Over 50% of which were from new immigration sources in Southern and Eastern Europe, such as Catholics from Italy and Jewish populations from Poland, residing alongside nativist communities with Irish, German and British decent. This produced an inherently global nation and melting pot of culture, along with resulting conflicts. With this influx, The Knick illuminates the reality of fin de siècle New York, as one in which immigrants come believing the promises but far too many do not survive the realities long. Constructing this reality was a political machine system beset by corruption and challenges for authority between established sources of wealth and power and the emergence of a Progressive era, with greater Democratic Political support and an increase in the pace of social development. For example, The Knick constructs a range of female characters, such as the hospital’s reform-minded patron, Cornelia Robertson (Juliet Rylance), illustrating the increasing socio-political mobility of women at the turn of the century, assuming roles as medical practitioners, nurses and socio-political reformers within New York City.
Medical historians, however, such as Howard Markel and Peter Kernahan have raised the issue of historical inaccuracies in The Knick. Markel, for instance, argues that the series conflated the medical historical developments which took place from the 1870s and into the early decades of the twentieth century, akin to ‘conflating the Middle Ages to colonial America to the Civil War’. While Kernahan determined a multitude of historical inaccuracies, in particular, the trade of cadavers for medical experimentation within the hospital, which would have unlikely taken place in New York in 1900. Anatomy Acts were passed in the mid-eighteenth century, preventing the practice of grave robbing for dissection. Despite these historical flaws, The Knick achieves an intricately written narrative of historical change through Soderberg’s uniquely active and engaging cinematographic form.
Nevertheless, The Knick reveals the perils of progress, straddling both medical modernity and static tradition. Whilst also depicting the vices and iniquities of early twentieth century society, it demonstrates a sense of unforgiving anti-romanticism. It creates a graphic, vividly detailed depiction of a shocking house of horror in the pursuit of modern ascendancy, despite the obvious side effects and creation of inequalities along this journey. Particularly, the elevation within the period drama of the surgeons as almost deified figures, balancing innocent with the suspenseful and graphically portrayed progressive and experimental medical procedures. But these individuals must experience their peripeteia, whether through hubris or dualism, pursuing the unsustainable double lives and moral compromises. This relates to Charles Rosenberg’s 1971 call for a “new emphasis” in the history of medicine, moving beyond the focus on the intellectual life of physicians to their activities as healers and as members of a profession. Medical historians, Rosenberg attested, were required to place medicine in its socio-cultural context and to explore the ways in which socio-economic factors might have influenced medical developments. This brought into the historical framework the increased authoritative roles of both African Americans and women at the time of widespread disenfranchisement, segregation and the propagation of second-class citizenship across the United States. By delving into an often-overlooked period of history, the medical drama experiences a fresh revitalisation. Arguably, however, the show is instilled with a historically revisionist approach and agenda, by exploring a field shaped and dominated by white men, adding contributions by African-Americans and women.
The Knick, by blending both seemingly gothic elements and unflinching medical realism, attempts to achieve dramatic historical accuracy, but is best appreciated and viewed as a pastiche of fact and fiction. Therefore, it allows for the reality of progressiveness and the sense of a new age dawning to be explored through the character developments of intriguing and complicated individuals and communities. Revealing the direct and intimate interplay between medical science and its social environment, becoming co-dependent of one another consequently during this transformative period. What The Knick fundamentally captures in its exquisite visual form, aesthetic and historical context is the fraught, unequal and transformative birth of modern medicine in the United States at the turn of the twentieth century.
Stanley B. Burns, MD/Burns Archive, found in ‘The Cocaine, the Blood, the Body Count’, The New York Times, August 1, 2014, https://www.nytimes.com/2014/08/03/arts/television/modern-medicine-circa-1900-in-soderberghs-the-knick.html?auth=login-google. Accessed on 11 January 2020.
The Knick (Series 1 and 2). Directed by Steven Soderbergh. 2014–15. HBO Cinemax
Adams, Peter. ‘Modern Medicine Had to Start Somewhere’. Health and History 18, no. 1 (2016): 174-79.
Deng, Boer. ‘How Accurate Is The Knick’s Take on Medical History?’, Slate, August 08, 2014, https://slate.com/culture/2014/08/the-knick-true-story-fact-checking-medical-history-on-the-cinemax-show-from-steven-soderbergh.html. Accessed on 11 January 2020.
James, Nick. ‘Further notes on The Knick’, Sight and Sound Magazine, 29 January 2015, https://www.bfi.org.uk/news-opinion/sight-sound-magazine/reviews-recommendations/further-notes-knick. Accessed on 14 January 2020
Kernahan, Peter J. ‘“A Condition of Development”: Muckrakers, Surgeons, and Hospitals, 1890−1920’, Journal of the American College of Surgeons, 206, 2, (2008): 376 – 384
Labuza, Peter. ‘Shock treatment: The Knick’, Sight and Sound Magazine, 29 January 2015, https://www.bfi.org.uk/news-opinion/sight-sound-magazine/features/shock-treatment-knick. Accessed on 14 January 2020
Schuessler, Jennifer. ‘The Cocaine, the Blood, the Body Count’, The New York Times, August 1, 2014
https://www.nytimes.com/2014/08/03/arts/television/modern-medicine-circa-1900-in-soderberghs-the-knick.html. Accessed on 11 January 2020.
Stanley, Alessandra. ‘No Leeches, No Rusty Saw, But Hell Nonetheless’, The New York Times, August 7, 2014, https://www.nytimes.com/2014/08/08/arts/television/the-knick-a-cinemax-medical-drama-set-in-1900.html. Accessed on 11 January 2020.