Medicine and surgery in 1900. Should you watch TV’s latest medical drama?

Someone recently stopped you and said, “I can’t believe you are not watching [Breaking Bad, Mad Men, OITNB, Downton Abbey, House of Cards].” You made some reference about the lead character, but know you don’t have the time to watch one episode, let alone 4 seasons on Netflix to catch up.  I did indulge in HBO’s True Detective. Completely worth it. Largely to simply understand these hilarious memes.

When the latest buzz surrounded a medical drama during the turn of the 20th century, New York City, and cable television’s ability to hold nothing back, I had to tune in. In the first episode of Cinemax’s new adventure in highbrow cable television, The Knick, the lead surgeon announces, “Let’s give them a show.” Does the show deliver?

Before the opening credits, the superstar surgeon of the Knickerbocker Hospital visited a brothel and found the remaining vessel to help propel the cocaine. Added to the growing list of drug addled TV health care providers in the same vein as Nurse Jackie and Gregory House we now have The Knick’s surgeon, Dr. Thackery.

In the inaugural episode, Clive Owen’s Dr. Thackery finds himself being promoted to chief of surgery of the Knickerbocker Hospital, after the sudden death of his mentor. The word mentor loosely applies, as his lesson in achieving better surgical innovations is unleashing the power of narcotic addiction. However, he also taught Thackery the cutting edge thinking to elevate surgery in the modern world.

William Stewart Halsted in 1922. From NLM online

Image source: http://ihm.nlm.nih.gov/luna/servlet/view/search?q=B014034

While watching, I couldn’t help thinking of Dr. William Halsted, the father of modern surgery, and an inspiration for the show. Halsted, largely known for his illustrious career at The Johns Hopkins Hospital, trained at Bellevue, forged his friendship with William Henry Welch as junior professors, and laid the groundwork for his strict antiseptic techniques and methodical surgeries there. In 1883, Halsted had his own clean operating theater built at Bellevue, outside in a large tent.

Halsted innovated at an unparalleled pace. He was the first to do inguinal hernia repairs, radical mastectomies, new treatments for thyroid cancers, and new vascular surgical techniques. His work was revolutionary, and that is the essence Thackery embodies. He also provides the biography for the drug addiction. Halsted was one of the first to use cocaine as local anesthetics, and became addicted himself after self experimentation – an addiction he battled his entire life.

One minor omission in this great period piece is the lack of gloves used in operations. Halsted was one of the first to use gloves in the operating theater, after calling on friends at Goodyear, having special rubber ones initially made for his nurse and future wife, Caroline Hampton. He popularized their usage in the OR, in the 1890s, ten years before The Knick takes place. Perhaps the blood splattered hands made for a more powerful television image.

This was the era that the hospital came into being. Instead of assured death, surgeons could now offer a way out. And the surgeons were the show, the thespians on the stage, and the spectacle that you came to watch. The younger surgeons can’t dare to look away despite the radical methods Thackeray takes, and neither will you.

The recreation of early 20th century operating theaters is fascinating to behold. The vivid recreation of surgical techniques is one of the main draws of the show. Soderbergh, the director, puts you in the stands of the theater, with the medical students, to see in full gory the operations occurring at the hands of a madman.

During one operation, Thackery states, “I tried that once on a Labrador.”

“What happened?”

“Not a day goes back that I don’t miss that dog.”

The first episode unfolds in racial struggle, class battles, battles for patients, the inner workings of an inner city hospital, board meetings, and drug use. And a health inspector who provides some villainy. Public Health officials providing the Cinemax healthcare version of Nucky Thompson.

I will come back for all this, to see the battles waged, to hopefully see patients no longer treated as dogs, but most certainly for the surgeries. Bring on the blood and guts. Early 1900 cutting edge. It’s good television.

So, yes, take in The Knick. It delivers. In bloody goodness. Friday nights on Cinemax. You can also catch it on HBO TO GO.

Enjoy the madness!

Jordan Messler

Jordan is a hospitalist at Morton Plant Hospitalists in Clearwater, Florida. He currently chairs SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University.

He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality (Anti-UpToDate reading material). But inevitably will get a five year old dumping sand on him, and then has to explain why she is buried up to her neck.

Leave a Comment