A Doctor Explains Why All the Crazy Experiments on The Knick Probably Could Have Happened

Lurid, muscular and unafraid to look at turn-of-the-century Manhattan’s rotting guts, The Knick has distinguished itself in the crowded antihero-drama landscape through its mosaic portrait of a city on the verge of implosion and epidemic — detailed with an extraordinary visual expressiveness (courtesy of Steven Soderbergh, who directs every episode). As the cocaine- and power-addicted super-surgeon Dr. John Thackery, Clive Owen leads a first-rate ensemble cast with which showrunners Jack Amiel and Michael Begler explore issues of gender, race, class and xenophobia in a teeming metropolis.

And yet what's most fascinating about the Cinemax drama might be its scenes of medical history being made. Among the many TV shows about doctors, The Knick is perhaps the only one to treat medicine as science. This historically faithful series examines what’s changed in the last century — thank god scientists are over that whole eugenics fad — and what hasn’t, especially the way hospitals continue to reflect both the altruism and the status-jockeying of the wealthy.

I spoke with Sydnee McElroy, a family-medicine physician and co-host (with her husband Justin McElroy) of the exceptional and hilarious medical-science podcast Sawbones, about hospital life during the age of The Knick, when doctors were rock stars, surgeries were an alternative to the movies and operating on your own mom seemed totally fine.

What makes the turn of the century, when The Knick takes place, a particularly significant medical era?

It’s when you start seeing people being a lot more rigorous in medicine. You start seeing the scientific method. We’re learning from what we’re doing, instead of just trying something and doing it forever [even] if it doesn’t work. And the FDA gets created, so we start putting drugs through a trial process.

[What came before was] the Heroic Era of Medicine, when the scientific method was nowhere to be found. We just gave whatever we had to whoever was sick; it was really just, “I’ve got some mercury and they seem sick. Let’s just keep giving it to them, and they’ll either die or they won’t!” The thought process then was: Anything you’re doing is okay, because even if you end up killing the patient, you’re trying to do good, and they’re probably going to die anyway. Doctors were thought of as heroes, so if they won, great. And if they didn’t? Well, at least they went down swinging.

Right. In the series’ second episode, Thackery says of a procedure he’s about to perform, “It’s never been proven to work, but we’re going to do it anyway.” Watching, you’re just like, where’s the Hippocratic Oath in this?

“First do no harm” is really just not there. The U.S. was a fledgling nation without a lot of doctors, and [medical] training was just spending a year with a doctor and then going out and trying to make it on your own, learning from people around you. It wasn’t until the 1900s that you see people doing things in a more rigorous fashion, saying to themselves, “Okay, let’s use scientific ethics to guide what we’re doing.”

Thackery and the other surgeons’ operations have heightened stakes because there is an audience for each procedure. Who do you suppose those onlookers to be?

At that time, it could be several different groups. They certainly could be medical students. But you could also just pay to go and watch surgeries if you were a wealthy person. If you were respected enough in the community and perhaps had donated money, you might be allowed to come without paying. [Surgeries] were a form of entertainment, especially if you were well-educated. You wanted to be “in the know.” It was something that you could share at a dinner party.

So you’re saying that medicine used to be the Kardashians of its time?

Absolutely. You see that showmanship in [the seventh episode of the current season] when Thackery enters the operating theater and he’s about to separate conjoined twins. He announces to the spectators what he is about to do, and it would have been very exciting to have contact with a doctor who could do something amazing like that. Everyone would be writing about it and talking about it for years to come. They were rock stars.

There’s a pretty surprising moment when one of the surgeons, Bertie (Michael Angarano), performs throat surgery on his own mother. Is that really something that could have happened back then?

I certainly don’t think it would have been strange at the time. Today, you are not supposed to treat your own relatives [because of] ethical guidelines from the American Medical Association. But at that time, you wouldn’t have been bound by those guidelines. Maybe a really smart person would’ve said, “Hey, that’s not a good idea; you might get too emotional.” But there wouldn’t have been any ethical guidelines or rules against it then.
Thackery also boasts in the show’s second episode that he’s bringing surgery from the barbershop, where invasive procedures used to take place, to the hospital. Were there any lingering stigmas against surgeons by the turn of the century?

Well, no. We’re still moving toward a time when doctors and hospitals were accepted as good things, though we’re not completely there yet. There was a time, especially during the Heroic Era of Medicine, when the last place you wanted to be if you were sick was the hospital, and the last person you wanted near you was a doctor. Those were often perceived as increasing your chances of dying — and that wasn't always wrong. So it would be another few decades before the idea of hospitals was completely embraced.

What do you think changed people’s minds?

We started to understand how to keep hospitals a little cleaner as we got better at antiseptic techniques in the antibiotic era [of the '40s]. At the same time, we knew that when we saw a doctor, that title would mean a certain thing: They had a certain schooling, they had earned a certain degree.

This is the more cynical side, [even though] I try not to be cynical: It also has to do with the advent of insurance companies. There was a big push around the early 1900s by the insurance companies to get you to go to hospitals for births [instead of calling a midwife], and that changed people’s perceptions of hospitals, too, as they started seeing ads for hospitals. And then there’s all sorts of things that have to do with money, but I hate talking about that.

Did the insurance companies want women to go to a hospital because it was easier for them to get paid?

Yes. At the time, yes. The hospitals and insurance companies were working in tandem to get women to come to hospitals to give birth because it was more lucrative.

You've brought up on your podcast a (real-life) procedure on The Knick, where a woman in the advanced stages of syphilis has skin from her arm sewed on to her nose-less nasal cavity to cover up the hole in the middle of her face. To facilitate the arm-to-face skin graft, her upper arm is attached to her face via a sling for six weeks. Is that your favorite among the treatments illustrated on the show?

It probably is, because I had read about how they had tried to repair syphilis-damaged noses, and just reading about it (as you can imagine) does not do the procedure justice. Thinking about keeping your arm above your head in one position for weeks on end? It’s just wild.

Do you find The Knick to be historically accurate?

Yeah. Generally they’re very accurate for the time period: what we would’ve known, what we would’ve tried. It’s also realistic in that the doctors fail often. The one thing I still wonder about is using the malaria therapy for the syphilis, inducing the really high fever. There are some studies that say that did work, but obviously we wouldn’t do that now because we have antibiotics. That was the only time when I was like, “Eh, I don’t know about that.”

Do you have any suggestions for someone who wants to watch The Knick but can’t take the realistic medical scenes?

The show makes it pretty clear when they’re going to do an operating-room scene. So when the slow music starts playing and you see Thackery donning his white surgical gown, maybe just tune out. The other thing that might be helpful is watching the director’s commentary that they sometimes show after the episode is over, when they show how they faked the special effects. Those are well done.

What always takes me out of a scene is when someone plunges their bare hands into someone’s abdominal cavity. Every time I see that, I’m just like, “Where are your gloves?”
Do you know when gloves came into use for surgery?

Actually, yes. I looked it up because of the show, and it’s kind of a cool story. Around 1898 to '99, there was a Dr. Halsted who was a famous physician. One of his chief scrub nurses was allergic to the stuff they used to scrub their hands with, and she got this really vicious dermatitis from it. And because she was one of his favorite nurses and he wanted to keep her (I think later on they fell in love and got married), he had a pair of gloves made for her by Goodyear. Everyone wanted a pair of gloves after that. You didn’t have to keep scrubbing your hands, and they started seeing a lower infection rate.

A lot of the medical challenges that we see on the show, like meningitis and C-sections, are either diseases we’ve cured or practices we can now do safely. That makes Thackery's second-season search for an addiction treatment really fascinating, since we’re still looking for a cure today. What was the medical treatment to addiction in that era?

It’s interesting, because this is the first time when we would’ve talked about addiction within medicine. Prior to that, it would have been thought of as a moral failing.

So the show’s doing a really good job of depicting what addiction treatment would’ve been like at that time: telling people to go to church more, or drying them by locking them up somewhere so they can’t use. Once they got through the physical part of addiction, they [were expected to] just willpower their way to sobriety and not use again, which wasn’t a good plan. Thackery starts to experiment with hypnosis and figure out which part of the brain controls addiction. But we don’t see medicines for addiction for quite a while.

As a doctor, what’s your reaction to seeing jerk doctors like Thackery and House depicted on TV?

It doesn’t bother me. I think it’s actually pretty realistic. Just like in any profession, there are nice people and not-so-nice people. With surgeons, you have to have a certain amount of confidence to cut into the human body, and sometimes that spills over into a certain amount of ego or arrogance. But I don’t mind it if alternately the characters are redeemable in their quest to do better for people.

The Knick will air its Season 2 finale on Friday, December 18, on Cinemax.

Sydnee and Justin McElroy’s delightfully gross and always educational Sawbones podcast debuts a new episode every week. They recommend you start with the episodes “Tuberculosis,” “Medical Cannibalism” or “Mr. Reich’s Sexbox.”