“The Knick” Great medical review

  • Posted by Dr. Jay Gordon

 

Surgery
The Politics of Early Surgery: Review of ‘The Knick’

Published: Aug 8, 2014

By Karen Kruse Thomas , Johns Hopkins University

Cinemax is presenting Steven Soderbergh’s “The Knick,” a medical drama about the origins of modern surgery — the blood, gore, and the thrill of those early days. MedPage Today asked Karen Kruse Thomas, a medical historian at Johns Hopkins University, to review the premier episode.

Steven Soderbergh dramatized medical and public health issues in his films (“Contagion,” “Side Effects”), and, now that he’s renounced movies for TV, he’s doing it again with a historical twist — “The Knick,” set in New York City’s Knickerbocker Hospital in 1900.

For this venture, Soderbergh teamed up with English actor Clive Owen, who both stars in the series and co-produced the series, which premiers tonight.

The Halsted Model

Owen plays Dr. John Thackeray, a character loosely based on William S. Halsted, the first chief of surgery at Johns Hopkins Hospital, who introduced many surgical techniques still used today. Like Halsted, Thackeray pushes the envelope of surgical science; he is cast in the mold of the “heroic” surgeon who was quick to intervene in an age of mass mortality, but often killed the patient sooner than the malady would have.

The first episode is populated with characters who could have walked out of a U.S. history textbook essay on the Progressive Era: an immigrant girl laborer like those portrayed in Lewis Hine’s iconic photographs of the “kindergarten factories”; the benefactress of the Knick, whose humanitarian zeal could be modeled on either Jane Addams or D. H. Lawrence’s Lady Chatterley, depending on the plot’s trajectory; a New York public health officer who enforces the quarantine laws requiring hospitalization of tuberculosis victims while employing shameless pocket-lining tactics that embody the graft rampant in the heyday of Tammany Hall.

This is an age when prostitution and narcotics were legal, Southern migrants as well as Eastern European immigrants were seeking new lives in the metropolises, and rapid medical and scientific advances cause Thackeray to proclaim, “We live in a time of endless possibility. More has been learned about the treatment of the human body in the last 5 years than in the previous 500.”

The hospital building, like the staff who inhabit it, evolves even in the course of the pilot episode. In one of the opening scenes in the operating theater, the camera lingers on the gaslight chandelier’s feeble glow amidst the natural light streaming through cathedral-like windows. The episode’s closing image is of newly installed electric lights glowing fiercely against the darkness.

Whereas Halsted was somewhat mousy with a bushy moustache, Owen’s Thackeray has dark, dramatic forelocks and a trim, somewhat villainous moustache.

And the Wright Model

Halsted studied surgical techniques in Europe, but the show grants this cachet not to Thackeray, but to his colleague and foil, Dr. Algernon Edwards, a character played by Andre Holland, who strikingly resembles a young W.E.B. DuBois, down to the Van Dyke beard and winged white collar. Holland is 31 and Owen is 49, roughly the same ages as DuBois and Halsted in 1900.

If Dr. Edwards looks like DuBois, his character has a great deal in common with Louis T. Wright, another brilliant surgeon of the era. Among the several plot lines launched in the first episode, one thread is a counter factual meditation on what might have happened if Halsted had practiced in the same hospital with Wright, a prominent clinical researcher and fellow of the American Medical Association and American College of Surgeons.

Just before graduating at the top of his class at Harvard Medical School, Wright had participated in protests against D.W. Griffith’s 1915 film “Birth of a Nation”, which glorified Ku Klux Klan violence against blacks during Reconstruction. To escape the intense racism of his native Georgia, Wright migrated to New York, where his ties with the Democratic machine eased his path to becoming the first black police surgeon on the city’s force and the first black chief surgeon of Harlem Hospital. (Wright’s inspiring career is detailed in my book, “Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954″).

The site where the Knickerbocker once stood, in the center of Harlem, is less than a mile west of Harlem Hospital, still operating today. Although Harlem Hospital was a large municipal facility that admitted mainly black patients, it was, like the Knick, also run by an all-white staff that, slowly and contentiously, became integrated. After a long fight, Wright and the New York NAACP opened Harlem’s staff to black physicians in 1921.

Wright would go on to lead a national campaign to integrate healthcare and medical education while chairing the NAACP Board of Directors from 1931 to 1952. Wright declared to the 1938 National Health Conference, “There is no such thing as Negro health… the health of the American Negro is not a separate racial problem to be met by special segregated setups or dealt with on a dual standard basis, but is an American problem which should be adequately and equitably handled by the identical agencies and met with the identical methods that deal with the health of the remainder of the population.”

It remains to be seen whether Algernon Edwards will live up to this high standard, but he is certainly imbued with what DuBois called “double-consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels his two-ness, — an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.”

Cultural Commentary

In addition to its rich commentary on race, “The Knick” is concerned with class, which means it is as much about public health as it is about medicine.

Thackeray’s initial carriage ride through the New York streets, which sets the scene for the entire series, is a tutorial on urbanization’s toll on the health of American cities, replete with the droppings and dead bodies of horses, smoke-belching factories, and grim, crowded streets ripe for spreading contagious disease.

The Knick, a private, Catholic-affiliated hospital, is struggling financially and eager to attract paying patients to offset not only its technological improvements but its obligatory care for indigents, like the tuberculous mother of the above-mentioned Polish girl, whose family languishes in a Dickensian tenement apartment without light, ventilation, or indoor plumbing.

One cannot help but wonder if at least some who view the premiere of “The Knick” tonight will place the show in the context of the horrific outbreak of Ebola virus that is now decimating West Africa. After all, the absence or fragility of health systems in the region is fomenting the spread of the epidemic, just as the once-primitive state of health systems in the U.S. a century ago drove tuberculosis to become the leading killer.

“The Knick” makes thrilling entertainment of the blood and gore that accompanied turn-of-the-twentieth-century surgery to address life-threatening maternal complications like placenta previa; maternal bleeding remains the leading cause of maternal mortality in the developing world. In the mourning words of one of the Knick’s surgeons, “It seems we are still lacking.”