This review contains no specific spoilers, and is written as a Forward to viewership of the show, but with particular insight into some of the science behind the surgeries featured.
The Knick is about the exciting advent of medical discovery at the dawn of the 20th century.
Actually, The Knick is about the social forces that shape the spread and effects of the new and exciting innovations in science and technology in medicine in America.
Actually, The Knick is about how man’s hubris and amoral penchants pervert the social forces that surround and direct the tide of progress, and undermine the glory of achievement.
Actually, The Knick is about the fragility of human life and civilization.
Actually, it’s about all of the above. Think of it as a show about how the sausage of scientific and social advancement is made. Director Steven Soderbergh and writers/producers Jack Amiel and Michael Begler have brought us cerebral television, the likes of which haven’t been attempted since Deadwood. The story arrives in layers, each showcased through the conflicts and placement of characters – oftentimes moving simultaneously in the same frame.
The Knick begins and ends in the operating room that is also a theater. Surgeries and human experiments more gruesome than anything you’ve ever witnessed are on full display for the medical journals and newspapers. Even with the new inventions like electricity, vacuums, and wiring, they fail as often as they succeed. This show occurs at a time of great change and progress in medicine, but also at a time when the fruits of that progress are untested, uncontrolled, and full of both scientific and ethical pitfalls. It features the intersection of technology and medicine as medicine moves away from the anecdotal and the barber-surgeon into the scientific and the professional through pathological research and controlled experimentation. There are five major scientific themes throughout: Anesthesia, Syphilis, Skin grafting, Addiction, and Eugenics.
The use of ether as a general anesthetic is The Knick’s first development, and one that runs throughout the entire show. While it revolutionized the field of surgery, ether is not without its risks: It is easily flammable, incompatible with patients with lung diseases, and it interacts badly with common narcotics. Watching Clive Owen’s Dr. John “Thack” Thackery wrestle with its use and deal with these issues is one of the highlights in the medical theater. Too bad the advent of safe and effective general anesthesia had to wait a few decades.
Then there’s the development of a cure for syphilis. The fever bed was a revolutionary, but extremely risky, treatment, especially before the age of antibiotics. For a disease that leads to disfigurement, societal shunning, and, eventually, mental instability and death, a method that might be even mildly effective was a game-changer. It took Germ Theory into practice for a chronic bacterial infection and paved the way for the introduction of antibiotics later in the 20th century. The storyline here is fraught with issues of sexuality, shame, and even romance, but it doesn’t end in the medical ward. In the age of prostitution, and where abortion is not only outlawed but also condemned with sneers and hisses, characters struggle to mitigate harm everywhere–not just medically.
Intertwined with that is the issue of skin grafting to correct some of the deformities caused by syphilis. In this day of plastic surgery, artificial bio-materials, and lab-grown tissue it seems quaint to think about how cosmetic surgery has developed. Still, think about this question: how do you take a piece of skin from one part of the body and put it on another without it dying due to lack of blood, and without being able to kickstart blood vessel growth like we’re able to do today? You do it by keeping the skin attached to its original place while the graft takes. Then you wait a few weeks before removing it from its original site so it can be useful where it’s needed. As you might imagine, this is a bit awkward, and the risk for infection is extremely high. But it works, and it’s progress.
Then there are the issues medicine still hasn’t figured out today. Addiction was just starting to become recognized as a true disease in the early 20th century, and The Knick’s depiction of the cavalier use of addictive substances is spot on. Cocaine was developed as the first local anesthetic. Heroin was a cough suppressant. Few knew that these substances were so addictive that they would destroy lives. And even when people did know about it, they clung to the belief that addiction was due to the moral failings of the addicted instead of some intrinsic effect of the substances. Thack’s work into finding a cure for addiction is a rare moment in the show where a modern medical professional can conclude that time has effectively frozen since. We’ve advanced in nearly everything else – general anesthesia is safe and effective, syphilis is easily cured with a dose of antibiotics, skin grafts are routinely done – but our knowledge of how to battle the demons of addiction remains at an early 20th century level. The Knick does not hesitate to show us the lack of progress too.
To our characters, of course, these are just problems to solve, and each chooses their passion.
These experiments, of course, are all for naught if the Knickerbocker hospital can’t even keep its fancy new electric lightbulbs on. Funding and debts remain a constant problem for the hospital’s board of administration, whether it’s the Robertson family’s investments or Herman Barrow (Jeremy Bob)’s corruption and coitus with social predators in an effort to ascend to the elite club.
In essence, the featured treatment of medical discovery is not about securing the well-being of the patient or healing the sick for a high-society living, but to be seen making magic. Self-publicity and mobility is the name of the game, not just for our doctors but the entire hospital that has its hired ambulance goon squad race through the streets to retrieve the sick and the dead as prizes, taking bats to agents from rival hospitals, and touts its competitive reputation on the prowess of such achievers. And doctors evangelize their practice. The first time a surgery goes wrong, Thack attempts to comfort his mentor: “The procedure failed; you didn’t.” But when Thack steps into his mentor’s shoes, the pressure of success and his personal investments in his patients further set loose his self-destructive habits.
A fate similar to Thack’s awaits Dr. Algernon Edwards (André Holland), a good man and brilliant scholar of medicine cursed with being born black. His arc is in how his great contributions and skills are beset by his pugnacity and irrational expressions of righteous anger at how he is continuously undermined by his aberrant place in a racist institution and helplessness in the face of the greater moral failings that define the era. Patients are turned away on the basis of their skin color, as it would be poor form for a hospital of class and sophistication to be seen tending to the “dregs” of society, a list which also includes drug addicts and non-white immigrants that are arriving to America’s shores at unprecedented numbers.
Speaking of the “dregs,” if Season Two is better for any reason, it’s for its treatment of the Eugenics Movement. In a show about modernizing medicine by bringing it into the light, sterilization of the “unworthy,” like the dissection of pigs and the autopsies of cadavers, is kept in the lonely dark. The Knick frames eugenics as the opportunity for those insecure of and left behind by the rapid advance of medicine to play ball with the big boys. Its champions are akin to poor whites in the Antebellum South who worked on plantations as overseers and self-anointed enforcers of oppression. Eugenics began in 20th century America under the belief of social responsibility that comes with the power and prestige of the practice. It became systemic for that same reason along with its academic intrigue. Then it spread elsewhere and beyond like an insidious virus, and the medical community continues to deal with it even today. American society has an issue with getting black people into medicine as a profession, and determining the roots of that is beyond the point of this article. Yet so as long as medicine remains a lily-white field, the issue of eugenics, and preserving that field will remain. Eugenics is a largely forgotten horror chapter that both Hollywood and modern education have been skittish about addressing, but The Knick stands as a tall reminder that history repeats itself, and that we must remain vigilant.
That’s where the fragility of civilization theme comes in. The show is too immediate for us to see the long-term effects of any particular development, but The Knick shows how sparks of amorality turn to fires. The first season’s best episode involves a rampant race riot stemming from a street incident that happens entirely because of one character’s prostitution arrangements with the mob. Like the lighting in the eugenics sequences, the cinematography there is some of the best that has ever been put to television.
Other critics have mentioned the weighted presence of Soderbergh’s artistic signature in the blocking and camerawork. It’s artsy but never without function for the material defies convention. This is a heavy show with a slow start, but loaded with enriching detail just beyond the frame and actors doing real drama in their allegorical roles. The only weak link there is Juliet Rylance’s Cornelia Robertson. Her character has an appropriately feminist setup, but she comes across like the wrong person to be doing what the show has her do, especially in Season Two.
The strength of The Knick’s poignant indictments of post-Victorian evil, utilitarian amorality, and unhealthy competition over the public good of medical care lies in not actually making the shallow political points, but merely assuming the truth of them. It’s an incredible look into a world where scientific progress begins to bloom in some places and stagnates in others. But it doesn’t take the easy preachy high road either. At no point is it stated or even implied that the patients or study of medicine would be better off if the hospital was run by agency bureaucrats (they’re as duplicitous as anyone else), or that the insurance incentives compel doctors and staff against their ethics to turn up their nose. The Knick is elevated for its drive to play straight the sensations of Progressive mythology before subverting them entirely, and to do the same with the clichés of serious-minded television.
Whether it gets a third season or not, The Knick is a new bar for ambitious modern television, and you absolutely should not miss it.
Vivek’s Score: 9.5/10
Linus’s Score: 9.7/10