There are three things that hit you fast when you watch The Knick, a new Cinemax miniseries directed by Steven Soderbergh. First, Clive Owen has an era-appropriate but annoying mustache. Second, the electronic, intermittently pulsing music is anachronistic – and yet it works (and is arguably the most memorable TV soundtrack since Game of Thrones). And finally, surgeries without gloves are really gross to watch even when fictional. While it would have been dangerous to be a patient at the Knickerbocker (more familiarly known as the Knick in the show), it’s entertaining and informative to watch the shenanigans of early 20^th century medicine.

I’m a sucker for period pieces so when I heard about The Knick, I immediately put it on my to-watch list. It has not disappointed so far, but beware, this is not your stereotypical fluffy drama (I don’t think anybody will be emerging from a lake anytime soon). The Knick is a downtown hospital whose patients are increasingly drawn from the poor surrounding community. As such, the hospital has fallen on hard times as richer clients have moved uptown. Clive Owen plays Dr. Thackeray, a talented surgeon facing internal demons and external pressures. Single and generally morose, Thack (as he’s known to his intermittently fawning and frustrated colleagues and underlings) injects himself with cocaine before performing surgeries at the Knick. Without cocaine, Thack can’t function. If this sounds like retro House, don’t worry, it’s not – it’s better. Thack doesn’t talk nearly as much and comes across as far more intimidating than House ever did. The supporting cast of characters is also compelling. At the top of this list is Dr. Edwards, who is arguably the second lead of the show. Thack is forced to hire Edwards, a young black doctor with impressive credentials, as the new deputy surgeon due to pressure from the Knick’s wealthy benefactor. The relationship between the racist Thack and the confident Edwards is the central dynamic of the show. Thack is a brilliant surgeon, but Edwards has a vast amount of knowledge through his training abroad that proves difficult to ignore. Meanwhile, the hospital administrator is trying to line his own pockets, but in doing so has run afoul of some in the city’s underworld and one of the rough-and-tumble ambulance drivers – whose salary is based on the number of patients he brings to the Knick – doesn’t see eye-to-eye with a nun, who helps deliver babies at the hospital but also provides abortions on the side. The characters are sufficiently numerous to cover a wide cross-section of the workers at the hospital and illustrate the range of experiences in New York itself but the story lines never become unwieldy.

Aside from the character drama, there is also the drama in the surgical theater. The absence of medical technologies that we now consider mainstream (such as the X-ray machine) and the use of treatments – for example, mercuric chloride – that we now know to be extremely toxic have spurred both shock and discussion about the show’s accuracy. Was surgery really THIS bad just over one hundred years ago? While watching the pilot episode, I was both horrified and confused by the lack of gloves in the surgical theater. My history is a little rusty, so I went back to check the timeline of major advances in sanitation. Joseph Lister – an English doctor who practiced medicine in the second half of the 19^th century – introduced the antiseptic carbolic acid to surgery about thirty years before The Knick takes place. In the show, surgical instruments are sterilized and the doctors do wash their hands in carbolic acid before and after surgeries but they never wear gloves. Gloves were introduced into surgical practice at various times around the globe. Lister – an advocate for wearing gloves – gave talks in the United States in 1876 and one of the attendees was William Halsted, the cocaine-addicted Baltimore doctor who Thack is based on. Halsted adopted many of the practices that Lister advocated for and did ultimately wear gloves but interestingly, he was not the first to do so in his surgical theater. In 1889, his scrub nurse Caroline Hampton – who later became his wife – developed contact dermatitis from repeated hand washing with the disinfectants carbolic acid and mercuric chloride (mercuric chloride was commonly used in medicine both as a disinfectant and as a treatment for syphilis – yikes!). To potentially alleviate Hampton’s discomfort, Halsted requested some rubber gloves from the Goodyear Rubber Company. Hampton’s hands were less irritated and more gloves were ordered for other surgical assistants. Somewhat surprisingly, the doctors themselves – Halsted included – did not wear gloves as frequently but over the course of the 1890s, it appears to be a practice that was increasingly adopted. Other doctors at the Johns Hopkins Hospital where Halsted worked began to recognize the value of gloves in reducing infection rates during operations. Based on this information, as well as the portrayal of Thack as a man who is progressive when it comes to medical technologies and treatments, Soderbergh has taken some cinematic license with the introduction of certain key features of modern medical practice. I have no doubt that at some point in the show’s run (it has already been renewed for a second season), gloves will be introduced by the young nurse who currently serves as Thack’s assistant and shares some distinct similarities with Caroline Hampton…

If you’re interested in Clive Owen, period pieces and/or the history of science and medicine, The Knick will probably appeal to you – and renew your appreciation for living in the 21^st century (it may also drive you to wash your hands immediately after watching the show). In spite of some anachronisms – the show seems to be running about ten years behind actual reality – The Knick provides valuable insights into the development and modernization of medical care. We’ve come a long way.

Sources:

Lathan SR. Caroline Hampton Halsted: the first to use rubber gloves in the operating room. Proc (Bayl Univ Med Cent). 2010 Oct;23(4):389–92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943454/

For more information:

http://nyamcenterforhistory.org/tag/the-knick/

http://www.cinemax.com/the-knick/

http://www.slate.com/blogs/browbeat/2014/08/08/the_knick_true_story_fact_checking_medical_history_on_the_cinemax_show_from.html