The Knick’s Gory History Is Super Real

I have just finished a second viewing of the 2 seasons of The Knick…I saw it originally when it was first released. It is, despite the gore aspect, addictive viewing even the second time around. My only complaint is that it had no further seasons.

With cocaine-addled doctors, botched C-sections, a suicide before its first 15 minutes are up: The Knick , Cinemax’s new series from Steven Soderbergh, is only one episode old, but the 1900-set drama about the invention of modern medicine has already proved to be nearly as mesmerizing as it is gruesome. This summer has been full of ambitious scary-gross new dramas, like The Strain and The Leftovers, of which The Knick is only the latest. The Knick, however, is made all the more fascinating by the fact that its depictions of disease, gore, and immorality are all inspired by real events.

According to The Bowery Boys blog, The Knickerbocker, the hospital from which The Knick derives its name, was a real New York hospital that operated from 1862 to 1979 in Harlem. The institution went through several names throughout its existence. It started as a hospital for northern Civil War veterans known as the Manhattan Dispensary. By 1895 the building had been rechristened J. Hood Wright Memorial Hospital, and in 1913, its name was finally changed to the Knickerbocker, a moniker that stuck until a few years before its closing, when it was renamed the Arthur C. Logan Memorial Hospital.

Hello, Name & Location Change

So the Knick actually existed during the time of the Cinemax show, but it didn’t get that name until 13 years later. Beyond that, there are other differences between the fictional hospital and the actual Knick. For one, the show is set way downtown in the Village, whereas the historical hospital is located at Covent Avenue and 131st Street, at the opposite end of Manhattan. Today, the Knickerbocker building is an apartment complex for senior citizens, according to Bowery Boogie.

But There’s Plenty of Truth

But despite these editorial changes, much of The Knick is based in fact. As in the show, the Knickerbocker was a hospital serving primarily poor and immigrant patients, the Bowery Boys report. And Clive Owen’s character, Dr. John Thackery, is based in part on an actual person, Dr. William Stewart Halsted, who invented many new surgical instruments and techniques in the early 20th century and, like Thackery, was known to be addicted to cocaine and morphine, according to the Johns Hopkins Institute. Of course, these substances were not illegal at the time, but that doesn’t exactly mean they were safe to use while operating on other people.

All About Algernon Edwards

Another aspect of the show that is historically accurate is its portrayal of racism among the hospital’s staff. It is established from the first episode that Thackery opposes integration, and he refuses to work with a new black doctor, Algernon Edwards. The Bowery Boys report that the real Knickerbocker had a similar policy regarding African-Americans, often refusing to treat them, despite the hospital’s mission to serve those who could not afford to pay for medical care.

In coming episodes of The Knick we’ll see André Holland’s character, Dr. Edwards — the only black doctor at the hospital — attempt to treat African-American patients in secret. The first African-American to ever earn a medical license was James McCune Smith in 1837 — but Smith was trained at the University of Glasgow, Scotland, because no American college would admit him, according to PBS. In The Knick (which is set 63 years after Smith became a doctor) Edwards went to Harvard (which graduated its first black student, Richard T. Greener, in 1870). But before starting at the Knick, the fictional Edwards had only previously practiced medicine in Europe, because American hospitals refused to hire him, which lines up with his onscreen incarnation.

The Bottom Line

It’s still too early to tell if The Knick is worth watching all the way through, or if it doesn’t deliver the quality to justify its graphic content. But having such an extensive history behind the show’s concept does make me more interested in seeing where this season goes. And the fact that Soderbergh is at the helm can only mean good things for the show. Maybe he can even get his old pal Channing Tatumto drop by for a scene — in one of Thackery’s opium-fueled hallucinations, perhaps?

How Accurate Is The Knick’s Take on Medical History?

Here’s what’s fact and what’s fiction in The Knick’s take on medical history.André Holland and Clive Owen inThe Knick. Photo by Mary Cybulski.

Steven Soderbergh’s new cable series The Knickwhich premieres Friday on Cinemax, aims not so much to be a medical drama as to be a social panorama of New York in 1900. A fictional hospital, the Knickerbocker, led by its chief surgeon, John Thackery (Clive Owen), feels like both a beacon of turn-of-the-century progress and a shocking house of horror. There are three deaths within the first 10 minutes, yet it is an age of “endless possibilities,” Thackery informs us early on. “More has been learned about the treatment of the human body in the last five years than in the last five hundred.”

The show’s producers have emphasized their desire for historical authenticity and the great lengths taken to replicate surgical procedures with accuracy. Much of their staging came from consulting records in the Burns Archive, an impressive historical collection of photographs and medical history materials curated by Dr. Stanley Burns, a doctor who also served as medical adviser for the show. But the world of The Knick is better seen as an image of history refracted in a funhouse mirror than as an accurate snapshot of medical progress and society in 1900. What is accurate, and what is exaggerated on The Knick? I consulted several medical historians and papers to find out.

John Thackery (Clive Owen) and William Halsted

Left: Clive Owen in The Knick. Right: William Stewart Halsted.Photo (left) by Mary Cybulski/Anonymous Content (right) courtesy of Wikimedia Commons

Owen has said that the show’s writers based the drug-guzzling John Thackery on William Halsted, one of the most important figures in modern surgery. Halsted is credited with performing the first emergency blood transfusion in the United States, and with revolutionizing the way surgery is taught and practiced as a meticulous, scientific discipline.* In 1889, he was a founding professor, along with three colleagues, of Johns Hopkins Hospital, where he headed the department of surgery. He did struggle, as Thackery does, with cocaine addiction—the result of experimenting with the drug as an anesthetic for surgery. Still, it’s unlikely he would have been impressed with the cavalier demeanor his fictional counterpart exhibits in the operating theatre. A reclusive, somber man, “Halsted subordinated technical brilliance and speed of dissection to a meticulous and safe, albeit sometimes slow, performance,” in surgery, says the Sabiston Textbook of SurgeryHalsted’s principles for surgery—which insist on gentle, careful technique—were developed in the 1890s and are still followed today.

Surgery at the turn of the century

Photo courtesy Mary Cybulski/Cinemax\

By 1900, surgery had become more commonplace and acceptable than The Knick implies. In the first episode Thackery, reflecting on his beginning at the hospital, tells his predecessor: “You are legitimizing surgery, taking it out of the barbershops and into the future, and I want to be part of it.” In real-life 1900 New York, on the other hand, surgery in a top-flight hospital would probably have lost much of its old unsavory image as a practice of crude butchery. Between 1880 and 1890, approximately 100 new types of operations were conceived, made possible by progress in anesthetics and antisepsis discovered in the latter part of the 19th century. A later episode in which a man is taken to a drunken barber for an amputation seems implausibly anachronistic. Other small anachronisms seem to be included for dramatic effect. For example, the show depicts surgeons performing operations barehanded, rather than with rubber gloves, which Halsted and his colleagues began using in the late 1890s.

Hospitals at the turn of the century

The late 19th and early 20th century saw an incredible rise in the number of hospitals in the United States. Quality varied greatly, says Peter Kernahan, a medical historian at the University of Minnesota, as all that would be required was a house with some beds and funds to start one. A 1910 book written by a surgeon who had spent time at New York and Washington Heights hospitals, Medical Chaos and Crime, caused a sensation by purporting to document gross misconduct in hospitals—drunken night nurses, greedy superintendents, and incompetently trained surgeons. The money pinching and bribery depicted on The Knick might have occurred even at reputable hospitals.

The body trade

As greedy as some hospital workers may have been, a lurid black market cadaver trade could not have existed as it does on The Knick. (Not least because an early scene has a doctor declaring that “Other hospitals may frown on studying the dead, but I believe it is the only way to advance our knowledge of the living”: Human anatomical dissections date back to ancient Greece; doctors in 1900 would certainly have been doing them.) It’s true that cadavers would have been a commodity in demand, says Michel Anteby of Harvard Business School, and fresh ones were better for study than older, decaying ones. So one might think that an ambulance driver on the lookout for a business opportunity would be in a prime position to deliver (for a good fee) luckless patients who did not survive the journey to a hospital.

But Kernahan notes that it’s unlikely this happened in 1900 New York City: New York was one of the first states to pass “anatomical acts” in the mid-19thcentury, to discourage body snatching and the inappropriate sale of cadavers. Under such laws, only bodies left unclaimed by friends and loved ones could be used for medical studies. Beginning in the 1830s, these acts also helped provide anatomists with “a steady supply of free cadavers, … rescuing the profession from the taint of association with unsavory lower-class body snatchers,” writes Michael Sappol in A Traffic of Dead Bodies: Anatomy and Social Identity in Nineteenth Century AmericaFor ambulance drivers in 1900, brokering a trade in cadavers would have been a dubious way to get rich (though, interestingly enough, there is a cadaver shortage today).

Black surgeons

Algernon Edwards (André Holland) in The Knick.

For a hospital that is supposed to be on the cutting edge of surgical history, the Knick is a strangely conservative one with respect to many medical practices and attitudes. What’s truly (but anachronistically) progressive about the hospital is that it’s the first in New York to hire a black doctor. In real-life New York, this didn’t happen until 1920, with the appointment of Louis Wright at Harlem Hospital, on which occasion several hospital surgeons resigned in protest.

If Edwards has a historical model, it is likely Daniel Hale Williams, a pioneering cardiac surgeon, and founder of the first hospital with an integrated staff—Provident Hospital in Chicago—in 1891. In the real-life history of integration, it was a black doctor, not white benefactors, who led the charge.


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