114 years ago, the average life expectancy was just 47, and with good reason. Diseases like tuberculosis were rampant and mothers regularly died in childbirth. But there were medical advancements being made that were groundbreaking and controversial for the time, and this scientific backdrop sets the intriguing scene for a fictional drama, Cinemax's series "The Knick," which premieres on Aug. 8.

Set in a New York hospital, the Knickerbocker, at the turn of the previous century, the show stars Clive Owen as Dr. John Thackery, a brilliant, difficult, drug-addicted surgeon. The show was shot on location in Brooklyn and lower Manhattan. "There was a Knickerbocker Hospital, but it was uptown. This is a fictional hospital that we created, and the surgeries that you see, almost all of them are based on actual surgeries, actual procedures," says co-creator/writer/executive producer Michael Begler, who shares that title with Jack Amiel. "We wanted to make it as true and real as possible, keep all of the medical stuff as true to the times as we could, and just fictionalize the characters."

"This was a time of massive discovery, blasting forward into the future. You could see a moving picture for the first time. You could see an automobile. Doctors were the new pioneers, the new heroes in America," adds Amiel. "It was very important to show things like how they prepared for surgery, but have it be integral to the story."

Both did extensive research into the subject and the era. "We spent four or five months just reading before we ever started writing or outlining, because we wanted to immerse ourselves, and we wanted to become experts in this era so that we understood what was possible, what was real, what was not," Amiel says. "We've been pretty careful to make sure that we've followed the guidelines of history pretty closely."

Jack Amiel and Michael Begler on the set of The Knick

Jack Amiel (left) and Michael Begler going over a script on the set of their show "The Knick."

Sources like "Genius on the Edge," a biography of surgeon William Halsted, Luc Sante's "Low Life: Lures and Snares of Old New York," and medical textbooks and journals of the time that they found on eBay proved to be valuable tools. “Everything that we were reading, our eyes were just wide open. We couldn't believe some of the facts that we were coming up with. There were things that we couldn't even fit in because there was so much material," notes Begler, adding that medical consultant Dr. Stanley Burns "showed us things that even all the books and all the research we had didn't."

Medical equipment was also extensively researched and sourced. "My hat's off to the prop department. They were about to find a lot of real stuff," says Begler. "Some things they had to build. The device that Thackery makes in the first episode is based on an actual device, but the prop guys had to make it."

Executive producer Steven Soderbergh, who directed all 10 episodes, aimed for an authentically dim tone. "The sets were all designed to be lit practically by the kinds of instruments that existed during that period. The good news is that cameras are now sensitive enough to shoot in literally any circumstance that you can see. I wanted the show to be dark enough for you to understand what it was like to walk around during that period."

As far as the societal aspects the series portrays, "This is an era when white Protestant American men were in the forefront of everything. They owned everything. Women could not even vote in this era," Amiel sets the scene. "Into this mix, you had African‑Americans coming up from the South looking for a new life. You had Catholic Irishmen coming from Europe. You had Eastern Europeans, Jews, and Italians coming in, and they all wanted their piece of the pie, and they were challenging the status quo. At the same time, women wanted a voice and a role. Just because they didn't have one, doesn't mean they didn't want one."

Thackery's cocaine habit is also true to life. In the course of their research, says Begler, they learned that "a lot of doctors were using drugs like cocaine, and some of them, William Halsted being the best example, was one of the founders of Johns Hopkins. He was taking cocaine to do his job and to progress medicine, but he also needed to come down and needed to balance that, and his drug of choice was morphine."

"Thackery is a guy who is forcing himself into the future," adds Amiel.  "He's the bow of every boat he's ever been on. And I think, for him, cocaine allows him to not look back. How do you forget the body count and cut into the next patient, who you know may have 100 percent mortality rate in this particular procedure? Cocaine, I think, helps him to concentrate and to work inordinately wild hours, but the other part of it is it's a good drug for forgetting and having the courage to go forward."

For his part, Owen admits that he hesitated to commit to the series until he read the script. "I started to read, and 40 minutes later there was no way I was not going to do it. It was clear that these guys had done a phenomenal amount of research and knew an awful lot about that period and the ideas that they were throwing out, of where to take the thing were hugely exciting," says the actor, who calls Thackery "a very complex, difficult character. He's redeemed by the fact that he's brilliant and he's passionate. He's trying to forward the whole world of medicine and trying to save people's lives but he's a very difficult, complicated, functioning addict at the same time. As an actor, I love the challenge of taking that on."

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