The Knick and the Harrowing Realities of 1900s Medicine: Blood, Cocaine, and Hubris
- Nov 25
- 6 min read
The Knick (two seasons, 2014-2015), directed and produced by Steven Soderbergh and starring Clive Owen, stands out as one of the "best and most influential shows of the prestige TV era". Set in New York City in 1900, the series centers on the Knickerbocker Hospital, a real historical institution that the show uses as a dramatic, albeit not entirely literal, model. While initially dismissed or hesitantly embraced by some critics, the show gains profound relevance today as a visceral exploration of the immense suffering and trial-and-error that laid the foundation for modern medicine. The hospital environment, dominated by brilliant but volatile individuals like the surgeon Dr. John Thackery, provides a stage for the dramatic and often harrowing acceleration of medical practice during this pivotal period. The sources confirm the series’ deep investigation into the historical and medical accuracy of early 20th-century practices, making it both entertaining and educational.
The Brutal Dawn of 1900s Medicine
The central conflict of The Knick is the constant race for innovation amidst pervasive ignorance, a theme vividly rooted in the historical reality of 1900s medicine. The setting is the Knickerbocker Hospital, which struggles financially because it primarily serves the working poor of the Lower East Side tenements. This was a time when medical knowledge was expanding exponentially, yet key modern safeguards were nonexistent.
The era shown on screen is defined by its dangers: antibiotics were unknown until 1928, electricity had yet to dawn in hospitals, and even pregnancy carried a risk that was "a coin-toss away from certain death". Surgery was often a spectacle, unfolding in open semi-circles of medical arenas where physicians operated without modern essentials like face masks, scrubs, or surgical gloves. In these early operating theaters, blood was often administered using hand cranks, and sutures were improvised using materials like silk or silver wire. Physicians frequently reacted with shock when patients died, responding often to a blow to their egos and their aspirations for glory as healers.
The sources compare the experience of watching The Knick to observing the shift captured in the paintings of American realist Thomas Eakins, specifically The Gross Clinic (1875) and The Agnew Clinic (1889). Painted less than 15 years apart, Eakins’ works visually demonstrate the significant changes occurring in medicine, especially the adoption of sterile practice and the pervasive use of anesthesia. The Knick puts this comparison into motion, illustrating how far medicine had come in a short time, while simultaneously highlighting the dangers of early, experimental procedures. One stark example of this ignorance is the sleazeball hospital administrator, excited to try the Knick’s first x-ray machine, who trains its radioactive material three inches from his skull for over an hour.
Visceral Realism: Soderbergh's Immersive Vision
What elevates The Knick beyond a typical period drama is the immersive sense of motion and the "visceral" visual style managed by Steven Soderbergh. The show is decidedly not for the faint of heart or light of stomach. Soderbergh aimed to create at least one moment in every episode where a viewer might have to cover their face. The gore, however, is not gratuitous; it is unavoidable, contributing to the historical atmosphere and sense of realism for a series covering this subject matter and time period. To achieve this shocking reality, the series relied on practical special effects, which impacted the viewer in ways that current CGI technology simply cannot. To ensure a sense of immediacy—a feeling of "now"—the camera work is often handheld, and natural lighting is used whenever possible. The entire effect, which includes an unexpected score, conveys an energy that makes the viewer feel part of the scene, much like Eakins inserted himself into his paintings.
Dr. Thackery: Genius, Addiction, and the Price of Progress
Central to the series is Dr. John Thackery (Clive Owen), described as a volatile and brilliant surgeon. Thackery personifies the shift in 1900s medicine—a man racing to perfect understanding of the human body and create new treatments. His surgical innovations are often riveting, but his approach is highly experimental, sometimes at the expense of his patients.
Thackery is presented as a functional addict par excellence. Counterbalancing his brilliant surgical work is his less-than-judicious choice of self-medication: cocaine, opium, and later, heroin. These substances were entirely legal and unregulated at the time. The character is loosely based on William Stewart Halstead, a pioneering surgeon known for aseptic surgery and his own serious drug dependency involving morphine and cocaine. Thackery is also a conflation of other medical men, such as Thomas Dent Mütter, evoked when Thackery pursues skin grafting.
Thackery's zeal drives several critical plot points focusing on difficult medical challenges, such as finding a viable treatment for placenta praevia, a condition that was often fatal for mother and child. His innovations include procedures like inguinal hernia treatment, which he shares with his colleagues. In the second season, even while reduced by his addiction, Thackery's medical mind clings to its purpose. He begins working to find the "seat" of addiction and advances the "unheard-of theory" to a shocked hospital board that addiction is a "disease" that can be treated, rather than a moral failing. This duality—a man whose medical genius pushes the boundaries of life-saving surgery while his personal hubris and addiction lead him toward devolution—is a key thematic element.
Confronting Social Inequity at The Knick
Beyond the advancements in 1900s medicine, The Knick meticulously highlights the social stratification and rampant bigotry of the era. The constant fear and derision expressed by characters toward the oncoming wave of Irish and East European immigration reveals the social tensions gripping New York City.
The most powerful social critique unfolds through the character of Dr. Algernon Edwards (André Holland), a black physician. The show takes pains to highlight the Knickerbocker’s policy of refusing to treat black patients. Edwards, who possesses sterling competence and a keen mind, faces discrimination at nearly every turn. He owes his position solely to his benefactor, August Robertson, a wealthy shipping magnate who forces Thackery to take him on. Edwards' presence illustrates how deadly racism was, potentially harming White patients who refused to benefit from his talents simply due to bigotry. Historically, this aspect was even more problematic: the real Knickerbocker Hospital was located in the heart of Harlem, making its refusal to treat "colored people" especially troubling as time went on.
A Microcosm of Turn-of-the-Century New York
The series functions as a microcosm of early 20th-century New York, occasionally attempting to "shoehorn every notable element of the period" into the hospital’s confines. The hospital’s administrator introduces elements of Tammany Hall corruption and gangster dealings. Other characters illustrate different dynamics of the time, such as Robertson’s daughter fighting for feminine independence, while historical figures like Thomas Edison and Mary Mallon (Typhoid Mary) make appearances. This dense integration of historical elements led one critic to note the show had "a crammed feeling of tremendously high ambition and not a little potential hubris".
The Knick’s Lasting Impact and Modern Portent
Though The Knick originally struggled for visibility—it was "subsumed by the never-ending tsunami of new content" after airing on Cinemax as an experiment to break the channel into prestige television—it has survived its initial obscurity. Its availability on HBO Max has revived interest.
Watching the series today, during a period where modern medicine and scientific consensus are sometimes marginalized, the show feels like a "barrage of road flares". It powerfully reminds contemporary viewers of the steep price paid by millions before us so that we might enjoy longer, better lives. The foundation of modern medicine was built on "trial, error, and incredible suffering and loss of life". The Knick acts as a potent warning about the fragility of this inheritance and what stands to be lost if we refuse to defend and preserve it.
The original plan for the series included six seasons occurring in varying time periods. Although Soderbergh is no longer at the helm, there are strong rumors that HBO is slated to resurrect the series, with André Holland and Barry Jenkins currently developing material for a third season. Given that the real Knickerbocker Hospital continued operating well into the 1970s, the possibilities for future storylines remain vast.
🔖 Key Takeaways
🗝️ Visceral Historical Accuracy: The Knick provides a brutal and immersive look at 1900s medicine, showcasing rapid innovation (like aseptic surgery and early X-rays) alongside the chaotic reality of operating without antibiotics, reflecting the visual historical shift seen in works like the Eakins paintings.
🗝️ The Duality of Genius: Dr. John Thackery embodies the hubris and brilliance of medical pioneers, driving essential research (e.g., placenta praevia, blood groups) while simultaneously battling a severe, yet legal and unregulated, addiction to cocaine and opium.
🗝️ Social Commentary: The show uses the setting of the Knickerbocker to expose severe societal inequities of the time, particularly the intense racism faced by Dr. Algernon Edwards and the discrimination against the working poor and immigrants.
🗝️ Modern Relevance: Despite its initial obscurity, The Knick has found renewed relevance as a potent reminder of the incredible human cost and suffering required to establish modern healthcare, serving as a warning against dismissing medical history and scientific progress.
🌐 External sources
Keywords: The Knick Realities
The Knick Realities
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