There could be no “Mercy” without Reed Bontecou.
He was a Union Army surgeon in charge of Harewood General Hospital in Washington, D.C., during the Civil War, so his work would be a natural subject for exploration on the new PBS series “Mercy Street,” a period drama set during the war at a hotel turned hospital in Alexandria.
But his skill with a surgical knife is less relevant to the series than was his photography. For Bontecou chronicled care to the wounded in his charge with a camera. That work was a factor in setting standards that were crucial in the development of modern medicine, according to Dr. Stanley B. Burns of the Burns Archive in New York, and a consultant to “Mercy Street.” His photos also were a key in providing the production with an exceptional level of accuracy in its portrayal of how medicine was practiced back in the day.
What set Bontecou's photos apart was that he was unafraid to get up close, providing extraordinary detail. “Bontecou was able to capture with his lens the true state of the wounded or wounds,” says Burns.
Burns describes his work as “extraordinarily artistic,” and notes that the surgeon-turned-photographer was prolific: Bontecou took the greatest number of medical-related photos of anyone during the war. It was an incredible contribution to the advancement of medicine. The detail, the close-ups, were used to train generations of doctors who followed.
Accuracy is a must for Burns, and he is the go-to source for period medical practices (he’s also advisor to the Cinemax series “The Knick,” the exceptional Steven Soderbergh drama starring Clive Owen as a brilliant, but cocaine-addicted physician in a New York City hospital in the early 20th century).
Burns is a surgeon with a passion for history and for preserving the past. In 1977, he started the Burns Archives, an astounding collection of more than 1 million photographs and images “from the birth of photography through the atomic age.”
Burns acquired Bontecou’s photos and in 2011 issued a compilation, “Shooting Soldiers: Civil War Medical Photography by Reed Bontecou.” That book was part of the prepping for “Mercy Street.” Each page was copied and placed on a bulletin board for all to see accurately what Civil War medicine was about, according to Burns.
Burns served on the set during filming here in Richmond (Laburnum House is a stand-in for the Alexandria hotel) for the series. He showed them how to properly hold and wield the medical instruments, which are from an original period set owned by Burns.
Burns on Set
PBS
“Mercy Street” debuts at 10 p.m. Sunday on PBS station WCVE. It focuses on the Union Medical Department during the first year of the war, and its problems in gearing up for the conflict. The department was led by an old school surgeon general basically opposed to any changes and closed to scientific innovations, says Shauna Devine, an advisor to the production and author of the 2014 book “Learning From the Wounded: The Civil War and the Rise of American Medical Science.” That changes in 1862 with William Hammond assuming the post.
History is as integral to “Mercy Street” as the drama. The series goes beyond the sweep of a hospital filled with the wounded and dying as portrayed in “Gone With the Wind” and instead strives for accuracy in its detail. Actual case histories are the subjects of some episodes.
“They wanted to step back and look more broadly at Civil War medicine and life," Devine says. “It’s been so interesting, to see Civil War medicine come to life in this interesting way.”
The educational component is prominent on the series website, where you’ll find entertaining, thorough essays and photos from Burns. Delve into the essays and you’ll soon learn that everything you thought you knew about Civil War era medicine is wrong. There’s a quiz to prove the point, too.
Start with the perception that Civil War surgeons were butchers who chopped off limbs of wounded soldiers without benefit of anesthesia.
Yes, amputations were common, but done out of necessity. The mangled remains of limbs shot through with the massive munitions of the day could not be saved and had to be removed quickly and cleanly. These surgeons would cut off a limb in one fell swoop, says Burns.
The myth persists that anesthesia was rarely used in these operations, but the historic records prove otherwise, says Burns. In the aftermath of the bloodbath at the battle of Antietam in Maryland, Union surgeons wrote of a shortage of anesthesia and that caused a delay in treatments that may have cost lives, but not that the amputations were done without the sedation of the soldiers.
“Doctors were doing the best they could under the most trying circumstances, ever,” he says. “These doctors were working feverishly to save their patients. These doctors were just as smart, just as interested in healing and they worked with inferior knowledge and technology.”
A crucial deficit was the lack of understanding of germ theory. In her book, Devine writes that diseases accounted for 66 percent of Civil War soldier deaths, not war wounds.
Health care providers knew smallpox and typhoid were contagious, but they didn’t know why. Medical personnel, by their actions, would inadvertently spread diseases. Microscopes were in use, and cells were seen, but the doctors just didn’t make the connection, says Devine.
“Mercy Street” explores this pre-germ theory world in an episode that deals with gangrene. The staff is puzzled, and trying to understand what’s going on," says Devine, a history professor at the University of Western Ontario in London, Ontario. Is it something from the sponges? Is it contagious?
Another misconception is that wards and hospital were unclean, but it was common practice after the start of the war to use bromide and carbolic acids to keep the wards clean. They didn’t know they were killing germs, but of course they were, says Devine.
The operating theater was not a private space; surgery was a public event. Wounded soldiers awaiting their turn under the knife could see the surgery being performed with the knowledge that they were next, says Burns.
As with so much in life, many improvements came through trial and error. Doctors initially tried to conserve the limbs, but infection would set in and after a week, they would amputate anyway, through infected tissues, says Devine, making matters far worse than if an amputation had been done promptly.
That led to the establishment of a system in which doctors would assess and consult pre-surgery. Surgeons learned that if an amputation was performed within 48 hours, there was less likelihood of infection. That was crucial to survival in a time before germ theory and well before development of antibiotics. There was a 40 percent chance of gangrene occurring even if amputations were done promptly, Burns said. That sound horrendous, but even today there is a 20 percent chance of gangrene following such surgery, even with antibiotics, he says.
You can thank the Civil War medical practitioners for establishing medical and surgical standards. Post-war, doctors had to know anatomy and prove their competence in the practice of medicine and the use of standard medicines of the time, says Burns. The war also led to setting standards in medical education and record keeping.
On the Union side, there was the creation of the Army Medical Museum and the standardization of records. After the war, all surgeries and interesting cases were compiled into six massive volumes, the “Medical and Surgical History of the War of the Rebellion.”
Their work was a key step toward establishment of modern medicinal practices.
“In retrospect, they didn’t do a bad job, they did a great job,” says Burns.
Give Blood
The American Red Cross wants you to start the new year with a donation of the gift of life. Blood donations were down nationally over the holidays and the Red Cross is seeking donations of blood and blood platelets. Schedule an appointment or find a blood drive at redcrossblood.org, or call 800-733-2767.
Open Circle
Healing Circle Counseling will hold an open house from 4 to 7 p.m. on Saturday, Feb. 20, at its office at 8401 C Mayland Drive in western Henrico County.
Healing Circle is owned by Linda Zaffram. She’s a licensed clinical social worker who also provides birth doula services, breastfeeding support and photography services. Partners include midwife Adrianna Ross of Community Birth Services, Joy Kraynak of Joyful Birth Services, and Kate Noon of breastfeed.love, a licensed clinical social worker.
Ross offers well woman care and home births. She’s also an herbalist.
Kraynak is a birth doula and photographer who also teaches hypnobirthing and does placenta encapsulation.
Noon is also a certified lactation counselor and will lead classes on breastfeeding and provide lactation support to women who are breastfeeding.
The open house will feature works by local artists and crafters that will be available for sale, with 10 percent of proceeds to benefit the MISS Foundation, a Richmond nonprofit that provides support groups to bereaved parents.
RSVP on Facebook.
Growing Practices
‘Change has come with the new year to two Richmond-based practices.
Chippenham Pediatrics is now Commonwealth Pediatrics, according to a news release. The name change, effective Jan. 4, reflects its expansion and the opening on Jan. 4 of a branch at Westchester Commons Shopping Center, 15400 W.C. Commons Way in Midlothian.
Also, two of Virginia’s larger orthopedic practices, OrthoVirginia of Richmond, and the Lynchburg-based Orthopaedic Center of Central Virginia, have merged. The OrthoVirginia name will be retained for the merged business, according to a Jan. 7 release. It now has 105 physicians, 22 offices and 14 physical therapy locations across Virginia.
