Inside an Operating Theatre of the 1900s: A Review of Cinemax’s “The Knick”

This post includes a review of Cinemax’s The Knick and contains minor spoilers.

On arriving to Bellevue Hospital in New York in the 1880s, American surgeon Robert Morris (1857-1945) commented on the new surgical operating rooms at the institution:

[T]he operating room was similar to that of other large general hospitals. The set-up consisted of a plain wooden table to carry instruments, lint or oakum dressing, unbleached muslin bandages (we had no absorbent gauze or cotton), and a large tin basin of tap water. Sometimes plaster of paris and other splint outfit was added.[1]

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Dr. William Williams Keen conducts a surgical clinic in the Jefferson Medical College Hospital amphitheater, c.1890s.
Archives & Special Collections, Thomas Jefferson University, Philadelphia.

I’m utterly fascinated with the surgical operating theater and how it evolved from a simple room with minor equipment to a packed theatre stage, and eventually to the sterile and spacious environment of modern operating rooms. The transformation of the operating theatre mirrors many tremendous advancements in the surgery during the twentieth century, as surgeons became more skilled and innovative as they mastered complicated and dangerous procedures. It’s no surprise then that I was completely riveted by Cinemax’s new television series, The Knick, directed by Steven Soderbergh, written  by Jack Amiel and Michael Begler, and starting Clive Owen.

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The show takes place in turn-of-the-century New York City, with Owen playing the anti-hero Dr. John Thackray, surgeon at the Knickerbocker Hospital. The pilot episode, “Method and Madness” brilliantly captures the dual nature of medicine: we see Thackray begging his nurse (Eve Hewson) to inject him with 22cc of cocaine, and a short time later, watch him order her to prepare a 2% solution as an innovative spinal anaesthetic to inject a patient on the operating table.

The show’s opening scene in the operating room is, in a word, gory, illustrating the difficulty of procedures that are considered as routine today. Bareknuckle surgery. 100 seconds to perform a caesarean section on a patient with haemorrhage in the womb. Brass hand cranks for suction. White aprons and rolled-up sleeves of street clothes. The rubber apron of Dr. Jules Christiansen (Matt Frewer), which could barely camouflage the surgeon’s hopelessness and despair over 12 unsuccessful caesarean operations. When the patient and baby die on the operating table, Christiansen turns to his audience and reminds them that surgery is about advancement: “It seems…it seems we are still lacking. I hope, if nothing else…this has been instructive for you all.”

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During the early 19th century, operative surgery was limited to breakages, fractures, and amputations. Experimental operations to save the life of a patient were incredibly painful, gruesome, and, in many instances, unsuccessful. Two major advances during the mid-19th century would establish a foundation for surgeons to innovate new life-saving operations with greater confidence: the discovery of anaesthetics and the introduction of antiseptics. Analgesics were always made use of in medicine, as medical practitioners were aware of certain natural substances contained properties for relieving pain, such as opium or alcohol. During the 1790s, experiments of the effects of inhaling various gases and vapours first initiated the possibility pain relief could be achieved by inhalation of some suitable vapour or gas. Humphrey Davy (1778-1829) experimented with nitrous oxide (laughing gas), but other medical practitioners did not pay attention to his developments. The 1840s introduced ether as a more satisfactory anaesthetic, though chloroform anaesthesia became widespread as well after 1847 when James Young Simpson (1811-1870) first used it to relieve a patient’s difficult childbirth pains.

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Dr. William Halstead is the inspiration for Clive Owen's character.

However, post-operative sepsis infection accounted for the majority patient deaths after major surgery. Antiseptics and antiseptic surgical methods became widespread with Joseph Lister’s (1828-1912) introduction of carbolic acid (phenol) as a method for eliminating bacteria on skin and on surface objects. The development of anaesthetics and antiseptics spearheaded the notion of a painless surgical operation. In the 1870s, towns with 10,000 residents had only 100 hospitals within their limits or nearby; by 1910, the number of hospitals increased to over 4,000, as new, innovative surgical procedures were became more successful.[2]

Even with anaesthetics and antiseptics, surgery was an incredible gruesome practice. Operations were performed either in patient wards, a small operating room, or in front of hundreds of students in the ordinary lecture theatre. We see this in The Knick, which surely benefited from the medical, historical and technical advice of Dr. Stanley Burns and the Burns Archive.

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The scenes in the operating theatre appear to jump out of the incredible photographic collections housed at the Burns Archives. I found it difficult to get emotionally connected to characters, though the pilot episode did set up a solid foundation to explore their developments as well as the broader cultural strokes of America in the 1900s. Midwifery and “Stretcher Men;” divisions of the rich and poor; hospital administration; and of course, new technological developments like electricity being fitted in the Knick as it undergoes renovation. Dr. Algernon Edwards (Andre Holland) the “Negro” surgeon, gives us an interesting insight into America racial tensions, but I was more captivated with the scenes of the squalor and poverty of immigrants. The New York Public Health Board’s inspections of tuberculosis cases and their forced removal of sick persons, for instance, shows us how medicine was enforced in the legislative level, as laws outlined demands to enforce structural changes in housing to eradicate breeding grounds for disease. These scenes are a reminder of the terrifying cloud of disease and death.

You can watch the first episode here: http://youtu.be/ItBAXOEE8Vk

 

NOTES

[1] Quoted in Roy Porter, Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton & Company, 1997), 374.

[2] Morris J. Vogel, “Managing Medicine: Creating a Profession of Hospital Administration in the United States, 1895-1915,” in Lindsay Granshaw and Roy Porter (Eds.), The Hospital in History (New York: Routledge, 1989).

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Elephant Clocks & Sultans of Science

“How many centuries did the Islamic Golden Age last?” a student asked me, thrusting his worksheet in front of me, anxious for me to answer his question. “6, 8, 9, or 10?”

“Uh…9? No. . Wait…” I answered, flustered because I can’t calculate in my head—I knew it lasted from the 8th to 13th centuries, but basic arithmetic slipped my mind at the moment. Our tour guide told the boy to go do the worksheet himself.

That was our introduction to the wonderful Sultans of Science: 1000 Years of Knowledge Rediscovered, a featured exhibit at the Ontario Science Centre.

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I became enthralled by the exhibit after seeing a photo of a replica elephant clock on Twitter, especially since I began learning about Islamic history of medicine and science a few years ago in order to add the topic as a module for my course on the History of Medicine. So I invited fellow historian Samantha Sandassie to visit the exhibit with me, to explore the history of Islamic medicine and chat about all things related to medicine, history, and random things of life.

Behold, the Elephant Clock!

Photo by Jai Virdi-Dhesi
Photo by Jai Virdi-Dhesi
Photo by Jai Virdi-Dhesi
Photo by Jai Virdi-Dhesi
Photo by Jai Virdi-Dhesi
Photo by Jai Virdi-Dhesi

This remarkable machine is the work of al-Shaykh Ra’is al-Amal  Badi’ al-Zaman abu-‘Izz Isma’il ibn al-Razzaz al-Jazari (1136-1206), a Muslim engineer who lived north of Baghdad under the Ayyubid Dynasty.[1] He was named after his birthplace, Al-Jazari, a region in northern Syria and Iraq between the rivers Tigris and Euphrates in Mesopotamia; he lived most of his life in Diya Bikr in Upper Mesopotamia (now Southern Turkey). Approximately between 1174 and 1200, al-Jazari severed as the mechanical engineer to the Artuqid kings of Diya Bakir.

Around 1198, al-Jazari began writing his extraordinary book, Al-Jami’ bayn al-‘ilm wa-‘l-‘amal al-nafi’ fi sinat’at al-hiyal (Knowledge of Ingenious Mechanical Devices), after spending twenty-five years at the Artuqid court. The book was written in response to the request of the Artuqid king Nasir al-Din Mahmud ibn Muhamma; al-Jazari completed the book shortly before his death.

The book is an outstanding contribution to mechanical engineering, a compendium of both theoretical and practical mechanic, and beautifully illustrated. Al-Jazari describes fifty different types of machines in varying complexity, including: 10 water clocks; 10 designs of automata vessels for dispensing water and wine; 10 designs of water dispensers for bloodletting devices; 10 fountains and musical automata; 5 designs of water raising machines; and 5 machines or instruments for measuring spheres and locks. The book is not a theoretical compendium, but a practical guide—al-Jazari even includes how his water designs can be used for irrigation and domestic purposes.

The Elephant Clock is an intricate testimonial to the cosmopolitan nature of Islamic science and is a reflection of al-Jazari’s many travels. The elephant represents both Indian and African cultures; the dragon, Chinese; the phoenix, the ancient Egyptians; the water flow a representation of ancient Greek architecture; the Persian carpet; and the turbaned man on top of the elephant, Islamic culture.

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A page from a dispersed copy of a manuscript, dated 1315, of al-Jazari’s “Kitab fi macrifat al-hiyal al-handasiyya.” The Metropolitan Museum of Art

The earliest water clocks were simple devices used mostly for astronomy and astrology. By the 12th century, water clocks became complex marvels of engineering skill and craftsmanship, as the accuracy of clocks and time-keeping were improved by the addition of automated control systems used for regulating prayer times.[2] The Elephant Clock’s timing mechanism is based upon a water-filled bucket that is hidden inside the elephant, taking half an hour to fill. The pulley system releases a ball that tips the water sound each half-hour. You can see the actual mechanics of the clock in this video.

Special thanks to Anita Lennon and Sebastian Assenza for their generous hospitality and to Samantha for putting up with my constant photography.

NOTES

[1] His full name indicates his titles: Ra’is al-A’mal means he was a chief engineer; Badi’al-Zaman means  he was unique and unrivalled; and al-shaykh indicated he was a learned and dignified scholar.

[2] For instance, see: Gerhard Dohrn van Rossum, History of the Hour: Clocks and Modern Temporal Orders (Chicago: University of Chicago Press, 1996).

A Report on Disability & the Victorians: Confronting Legacies Conference

From July 30 to August 1, 2012, I had the pleasure to participate in the Disability & the Victorians: Confronting LegaciesConference, hosted at the Leeds Center for Victorian Studies at Leeds-Trinity University College. Over the course of three days, the conference brought together delegates from Canada, the United States, Great Britain, Uganda, Belgium, Australia, and many more, in hopes of integrating the disciplines of Victorian Studies and Disabilities Studies together. With three keynotes and sixteen sessions, as well as a visit to the Thackray Museum, the conference presented an abundance of energetic discourse on the topic of disability—as many of you already know from my Tweets on the conference!

As disability studies has emerged as a significant aspect for revealing key histories in Victorian culture (see: Martha Stoddard-Holmes, Fictions of Affliction (2006), Julia Miele Rodas, “Mainstreaming Disability Studies,” Victorian Literature and Culture 36.1 (2006), and the Special issue on “Victorian Disability” in the Victorian Review (2009)), one of the agenda of the conference was to uncover new avenues for a revisionist approach to disability studies, outside of the social construction model. Various speakers at the conference challenged traditional histories of disability that pinpointed the Industrial Revolution and nineteenth century social reforms as a period in which disability was conceptualized, classified, and marginalized; rather, as some of the presentations have revealed, disability has a rich history, and new creative disability narratives are revealed by seeking out non-traditional sources (e.g. police reports). In particular, the Plenary Roundtable session held on the last day and led by Iain Hutchison (University of Glasgow), Fred Reid and Nancy Hansen, focused on how to offer new directions for scholarly discourse on disability studies, especially directions addressing the testimonies of the disabled themselves. Hutchison acknowledged the fact disability is important for understanding the landscape of nineteenth social history, for it overlaps important historical areas—economics, medicine, politics, society, etc—and a focus on cultural approaches can possibly challenge the (perhaps outdated?) social model of disability.

A key issue discussed during the Roundtable, which sought to integrate the dominant themes of the conference, was how to create an interdisciplinary perspective from multiple sources, an issue reflected in the three keynote presentations, which stressed the importance of looking at sensitive and neglected histories. Martha Stoddard-Holmes (California State University), the first keynote, presented “Desiring Cognitive Difference in the Victorian Novel: The Case of Anne Catherick,” discussing the eroticization of madness as presented in Wilkie Collin’s The Woman in White (1860). Can intellectual deficiency be sexually desirable? Stoddard-Holmes made a strong case for confronting critical discomfort, pushing towards challenging approaches for conceptualizing disability in relation to the history of mentality and moral management—particularly in the Victorian novel.

David Wright (McGill University), also spoke of Victorians and mental disability, in his keynote “Did the Victorians Invent Disability? A Case Study of ‘Mongolism.’” Examining the emergence of “Mongolism” (taxonomy of mental illness grouping individuals with Down’s Syndrome), Wright argues that the Victorian preoccupation of taxonomy was not about the perseverance of the dominant cultural motif, but rather a devotion to the Enlightenment ideals of betterment of mankind. As certification of “idiots” were largely undertaken by non-medical persons, the presentation challenged the “invention” of disability by medical experts in the nineteenth century—showing that disability in fact, needs to be historically re-evaluated for its roots are far more diffusive and complex.

The third keynote was presented by Vanessa Toulmin (University of Sheffield) , founder & director of National Fairground Archives, Sheffield, which holds over 6000 images relating to the history of the freak show—records, as Toulmin contends, that can be either “interpreted as both a history of exploitation, or a record of performance genres.” In the keynote, “’To Show or Not to Show’ the Victorian Freak Show: Issues of Contextualization, Cataloguing and Interpreting for Modern Researchers,” which contained controversial material that was actually approved by an ethics committee, Toulmin discussed how forms of illegitimate entertainment actually became institutionalized over time—including exhibitions, museums, circuses, world fairs, and side-show traditions. The display of disability as entertainment was actually quite widespread, and far from being displayed in the margins of society, it was actually assimilated into culture and society. As suggested in the keynote, we can clearly draw parallels between the culture of curiosities that emerged in the 16-17th centuries, and the “freaks of nature” exhibits; moreover, Toulmin argues that these entertainment environments forces us to rethink traditional histories about the “freak show,” in light of histories of performance and display—as evident with Toulmin’s narrative about learning lessons about curating and displaying these exhibitions following media controversy and outraged response. Modern media representation is something that needs to be considered when dealing with sensitive materials, for media misrepresentation actually can undo careful historical contextualization.

Even though there were some amazing papers being presented at the conference, due to my own research interests, I stuck to the sessions on d/Deafness. Traditional histories on the deaf argue that until the 1860s, deafness was often described as an affliction that isolated the individual from the Christian community, the tragedy being that the affliction denied the deaf the reach of the gospel. After the 1860s, deafness was redefined as a condition that isolated the deaf from the national community; being cut off from communicating with others was a tragedy. The papers in the first session argued that contextualization and deaf narratives actually revise this history; different perceptions on deaf history concentrating on race/ethnicity, policies, or religion, speak towards a performance of disability, emphasizing the cultural construction of disability? Esme Cleall (University of Liverpool) spoke of disability as defined within cultural contexts of colonialism of nineteenth century British empire, as narrated through John Kitto, the “Deaf Traveller,” whose privileged status as a white, British male contradicted with his marginalized position as a deaf man. Martin Atherton (University of Central Lancashire) discussed how the 1834 Poor Law categorized the deaf as part of the “deserving poor,” allowing them to be seen, for the first time, as disabled; and yet, these restrictions also gave the deaf, for the first time, something to rebel against. Toni Morgan (Leeds-Trinity University College) finished off the session by questioning n whether the deaf had “true personhood” as defined by religion, focusing on William Sleight’s voice from the Dumb (1849): promotion of sympathy and benevolence as an aspect of Christianizing deaf to hear the world of god, at the same time, deafness also portrayed as innocence or as messiahs.

The second session on deafness continued with recurring themes of charitable benevolence humanitarianism, and performance all wrapped with social controls and institutionalization. Mike Mantin (Swansea University) presented on the letters children at the Cambrian Institution for the Deaf and Dumb in Swansea sent home; these letters were printed in the annual reports of the institution to showcase its success as well as to solicit donations from subscribers. However, the letters are also another instance of display and performance, praising the marvels of education, while at the same time, speaking volumes about the perceptions of deaf children, who are usually silenced in history sources. Mantin also raised an important point about being wary of the kinds of motives behind these letters. Sofie de Veriman (University of Ghent) also spoke of motives, criticizing the “golden age” of deaf employment that coincided with education, with an economical case study of deaf employment in eighteenth and nineteenth century Flanders. Literacy and education may have helped the deaf obtain jobs before 1830, but after that, education did not guarantee employment. Nicola Gauld also discussed charity and institutions with an exploration to the archives of the Birmingham Institution for the Deaf and Dumb.

The last session on d/Deafness (other than my own) carried multiple themes relating to my own work: assistance and technology. Jennifer Esmail (Wilfred Laurier University) presented on the prosthetic companion of the blind man: companionship raising issues of dividing line of human and non-human animals—obviously ties to Aristotelianism—speaking on how perspectives on companion dogs as bodily extensions further enhances dividing barrier of human/non human beings. Graeme Gooday (University of Leeds) and Karen Sayer (Leeds-Trinity University College) presented on the “(dis)appearing hearing aid,” covering themes of the invisibility of hearing loss, stigmatization and conflicting authorities—the “culturally hearing”. Oralism, telephony, national efficiency concerns, and advertising all played a role in constructing the hearing aid. As Sayer explained, “When people think of hearing loss, they may or may not be resisting the kinds of visual association of technology.” Their presentation posed important questions of social history of technology and disability, questions which in part overlap identity narratives and taxonomies. Caroline Lieffers’(University of Alberta) paper on the making and marketing of B.F. Palmer’s artificial leg nicely rounded up the session, with discussions on authenticity and authority, and display and performance. This session raised questions of how versatile technology aimed to normalized disabilities, but yet contributed to stigmatization (e.g. concealing devises to hide disability and increase social participation), which suggests that the problem of disability is not so much about infirmity per se, but about ready access to technology.

Delegates were also invited to visit the Thackray Museum, which was one of my favourite parts of the conference. Below are some photos I managed to take with my iPad (with absolutely poor resolution!):

Thackray Museum
19th Century Auricles
Various Hearing Aid Instruments & Devices
Various hearing aid devices
Delegates inspecting various artifacts

This conference was simply wonderful. I truly enjoyed the many conversations with a wonderful group of scholars—particularly Graeme Gooday, John Hay, and Jill Jones, who offered me indispensable advise for my own work. I look forward to hearing more from the delegates as we take away some of the lessons of the conference. I would like to finish off my report with gratitude. Thank you to the organizers of Disability and the Victorians, especially Karen Sayer, for all their hard work in putting together a fantastic event, and for inviting me to participate. Thank you to the Review Committee and the Board of Disability History Association for selecting me for the 2012 DHA Graduate Student Award and to the Institution for the History and Philosophy of Science and Technology at University of Toronto, for funding that made this trip possible.

My presentation, all set up!