Fodder for Progress: Caesarean Patients in "The Knick"

By Leila A. McNeill

Set in the surgical hospital The Knickerbocker in 1900 New York, The Knick features many of the developments in modern medicine and surgery and follows the doctors and nurses who work at the hospital. The time period in which this show is set was a rather exciting time in the history of medicine and surgery. Due to the 19th century’s discoveries of anesthesia and antiseptic techniques, surgeons at The Knick could experiment with new methods and implement life saving operations with less pain and risk to the patient. Yet, with all the excitement and promise of these discoveries, there was a darker side to this era, marked by unethical experiments* of trial and error and significant disappointment and loss of life. This dark side is illustrated by Dr. JM Christiansen’s suicide and Dr. John Thackery’s insidious cocaine addiction, habit of frequenting brothels, and experimenting on a dead woman’s corpse without prior consent. When the creators of The Knick chose to depict this period of medical history of concurrent excitement and desperation on screen, they chose well--it makes great TV.

I really like The Knick because it has fantastic direction and film making but mostly because I can finally see the research that I love integrated into popular culture with some first-rate production value and major financial backing. However, as much as I like this show, I still have to ask the annoying question: where all the ladies at?

Sure, The Knick has women in it, but it is never about them-- even episodes or individual story lines that have an OB/GYN focus. The experiences and voices of women, especially women of the middle and lower classes and women of color, is startlingly absent from them. Instead, the show revolves around the educated men of science, the brilliant men to whom we owe modern Western medicine. The tagline for The Knick perhaps says it all: “MODERN MEDICINE HAD TO START SOMEWHERE.”

For the most part, women in The Knick serve merely as objects in a male-dominated narrative of progress. Consider the progressive development of the caesarean operation from the first episode to the sixth.

The first episode “Method and Madness” opens with a failed caesarean section. Head surgeon Dr. Christiansen gives himself and his team 100 seconds to complete the operation and stem the hemorrhaging of a mother suffering from placenta previa. With Christiansen unable to stop the hemorrhaging, the mother bleeds out, resulting in the death of both the mother and fetus. Upon the death of his patients, Christiansen turns to the onlooking students in the surgical theater and solemnly says, “It seems...it seems we are still lacking. I hope, if nothing else...this has been instructive for you all.” That was his twelfth failed caesarean operation. When Dr. Christiansen is later alone in his office, he quietly and methodically covers his couch with a white sheet, lies down, and shoots and kills himself.

In episode five “They Capture the Heat,” Clive Owen’s character, Dr. Thackery, who takes over as head of surgery at The Knick, attempts an emergency caesarean, again due to placenta previa. Like his predecessor, he fails, losing both mother and fetus. The scene of the aftermath shows pooling blood at the legs of the operating table, surgical instruments sticking out of the woman’s abdomen, and a despondent Thackery sitting on the floor, his bloody palms turned up in defeat. Dr. Chickering (aka Bertie), however, reminds Thackery that he did actually accomplish some progress compared to Christiansen who intended to take 100 seconds to complete the operation, whereas Thackery only took 72.

Finally, in episode six “Start Calling Me Dad,” Thackery and Bertie develop a new technique to solve such a problem. In a cocaine and prostitute fueled stroke of genius, Thackery invents a balloon/bladder catheter. Once inserted into the womb through the vaginal cavity, the surgeon inflates the bladder with water to put pressure on the hemorrhaging tear from inside the womb. This would slow the bleed long enough for them to complete the operation. To practice the technology before an actual operation, Thackery and Bertie experiment on two of Thackery’s (not even pregnant) prostitutes. During the caesarean operation later in the episode, Thackery and Bertie successfully implement the new technique saving both mother and baby. Upon completion of the operation, Thackery officially presents to the onlookers “The Christiansen, Thackery, and Chickering Placenta Repair.”

Gentlemen, to progress!

It’s not that these episodes represent women in an explicitly negative light; it’s that they don’t represent them at all. Obstetrics and gynecology is exclusively a matter of female health, but this storyline revolves around the men, Christiansen, Thackery, and Chickering and their struggles. Though obstetrics and gynecology had improved considerably by the 1900s, women and babies were still brutalized again and again by invasive and debilitating obstetric methods. Pregnant women felt a very real terror of entering a hospital without knowing if they would come out. Yet, in each one of these episodes, the writers give the women only one to two lines before their operation, and afterward, we don’t even see their faces or see the tragedy of their deaths reflected in the response of their families that survive them. They have no agency, experiences, or stories of their own.Instead, our sympathies are entirely directed at the male doctors. In each case, the woman serves solely as the object of male progress. “Modern medicine had to start somewhere,” and apparently, it started on a heap of dead women.

The problem with the progress narrative here is the same problem with the progress narrative in the study of history-- the voices and experiences of those who lost to progress are silenced, in this case, the voices of women. Their experiences are lessened or completely absent in light of forward-marching progress. Instead, we get a hearty dose of Great Man History to further perpetuate the incorrect notion that white men are the sole agents of history, constantly moving the whole of humanity forward.

Rather than challenge the audience with powerful history that shows the rich and varied experiences of this moment in time, the writers, as New Yorker TV critic Emily Nussbaum points out, opt for something “far simpler: a Great Man Tale, studded with lurid thrills.”**

*Unethical by today’s standards. In 1900, our current understanding and collective cultural value of consent and informed consent did not yet exist.

**Nussbaum issued a ‘change of mind’ from the article cited above.

Further Reading: 

CR King, “The New York Maternal Mortality Study: A Conflict of Professionalization,” Bulletin of the History of Medicine 65, no. 4 (1991): 476–502.

Deborah A. Hooker, "The Arguments of Labor: Twentieth-century American Women's Autobiographical Childbirth Narratives" (PhD diss., University of Florida, 1997).

Jane Eliot Sewell, “Cesarean Section: A Brief History,” National Library of Medicine, A Brochure to Accompany an Exhibition on the History of Cesarean Section At the National Library of Medicine, 1993.