Under the Knife: The Knick’s Medical Consultant Tells All (Part Two)

Shortly before the August 8 debut of Steven Soderbergh’s new Cinemax period drama, The Knick, we talked with Dr. Stanley B. Burns about the show’s time period and authenticity. Dr. Burns serves as technical advisor for The Knick, which is set in 1900 New York City and stars Clive Owen as Dr. John Thackery, the brilliant head physician of the fictional Knickerbocker Hospital, who is also addicted to cocaine and opium. Dr. Burns created and runs The Burns Archive, a collection of more than one million medical photographs dating back to 1840. In part one of our visit with Dr. Burns, he described how he trained Owen to perform like a real surgeon. Here, in part two, he contrasts early 20^th century medicine with today, and reveals what he told Soderbergh to change in a major scene to ensure accuracy of the period.

One of the chief plot points in the series involves the arrival of a Black surgeon, Dr. Algernon Edwards, who trained at Harvard and in Europe. How did medical training in the United States compare with Europe at that time?

Oh, no comparison. Europe was decades ahead. It was a clinical system with laboratory methods. In the United States, you didn’t have to go to medical school—you were apprenticed to someone. You took a few classes and had anatomy. A lot of doctors went to school here and then went to Europe to train. They would develop theories and methods abroad, which is what you see in the show. In 1893 Johns Hopkins University was established and adapted the European system that specified that you had to have a university degree to go to medical school. Put it this way—I just came back from the Royal Society of Surgeons in Edinburgh, which was established in 1505. The American Society of Surgeons was established in 1913.

So almost anyone could become a doctor in the U.S.?

That was the whole purpose of the Jacksonian Laws [of the 1820s]—anyone could become a doctor or a lawyer. You could just apprentice with someone and that was it. So when you went to a doctor at the time you didn’t know what their education was. But think about the therapy then—the biggest medication of all was alcohol and opium. It made you feel better.

Dr. Thackery and the other surgeons do not wear gloves while operating. Wasn’t that risky?

In the days when patients were infected some of the doctors died, yes. [Dr. William] Halsted [the inspiration for the Thackery character] developed gloves because Caroline, his girlfriend and nurse, was allergic to all the solutions they sterilized their hands in—the permanganates, the mercuries, the salicylic acids. Halsted finally came down to a thin enough glove that they could operate with.

When was that?

Around 1897 or ’98. But gloves did not really become established until about 1910 or so.

Why does Thackery perform surgery in an operating theater in front of an audience?

That was about teaching—and about creating an image of the hospital as a place to live. People got sick with typhoid and yellow fever and they wouldn’t want to go to the hospital because they didn’t know what caused it. So surgery was the place you could have success in the operating room, with a team of doctors, and nurses. Hospitals grew as a result of a surgery. If it weren’t for surgery, hospitals wouldn’t have a need to grow. I have photos of surgeons turned away from the patient in the operating theater to talk to the audience just the way Thackery turned away to explain what was going on.

Who typically attended the “performance” in the operating room?

The first row were the professors, then came the associate professors, then the assistant professors, then the students, and then onlookers would be on top. When they set up that scene in the first episode they put all the young good-looking people in the front row and I had them change it. That would have been an error of the time period. The old guys would have been up front. I said to Steven [Soderbergh], ‘If you invited Spielberg or Scorsese to a screening would you put them in the back row?’

How much dramatic license does the show take, in your opinion?

The thing that thrilled me the most is that the writers in their brilliance were able to take some un-dramatic things and make them dramatic. As far as the license, there were only a few things I thought were wrong. But I recall Steven saying something to me like, ‘Well, there’s going to be a thousand medical historians who are going to write to me and tell me that’s wrong. But 10 million other people are going to love it.’

You’ve consulted on more than 27 movies. What do you hope comes across for viewers watching The Knick?

This is the most important [film] of my lifetime. Because what I’ve tried to do during my lifetime is show that the doctors’ promise of 1900 came true—that medicine has allowed you to live a life without worrying about getting a disease and dying. As a matter of fact, [Thackery] says that life expectancy was about 47. Now it’s 80. It was 80 within 60 or 70 years. Now people have the opposite effect from the era—they do not expect to get disease, they do not live with death. ‘He’s only 97, we can do the heart transplant and then do the liver afterwards!’ So doctors have not only given you perpetual life, but you expect it.

Read part one

Read more here: Under the Knife: The Knick’s Medical Consultant Tells All (Part Two)