Gallons of blood, surgical specimens, and the real-life doctor who prescribes The Knick’s medicine

In the event of an extremely specific emergency, actors Clive Owen or André Holland might be able to stitch up your wounds and send you on your way. The technique would likely resemble that of the Victorian-era Knickerbocker Hospital—the eponymous setting of Cinemax’s Emmy-winning drama The Knick—but they could do it. That’s thanks in part to Dr. Stanley Burns, the show’s eagle-eyed and exacting technical consultant. A New York-based ophthalmologist and historian, Burns’ duties on The Knick extend from overseeing the proper tying-off of sutures to suggesting intriguing diseases as possible plot points.

Widely regarded as one of the world’s premier collectors of antique photographs, material from his archives (along with his own personal expertise) has been seen in The Others, The Civil War, and exhibits at The Metropolitan Museum Of Art and the Musée D’Orsay. Burns became interested in collecting photographs after he used his training to discern a discrepancy between the description of a medical daguerreotype and what was actually depicted in the image. Struck by the possibility of photographs as historical documents, he began collecting with abandon. Since then, his archive has amassed “about a million” images. Explaining his love of photographic history, he tells The A.V. Club, “If you have a photograph then you have the truth of the event”—without photographic evidence, everything is subjective and accounts can be misleading. To wit, he jokes, “I don’t want you to write that, when interviewed, Dr. Burns was wearing a clown suit.” A photograph would instead depict him in a crisply ironed, pinstriped button-down.

Since 1975, the Burns Archive—which the doctor runs with the help of his equally thorough daughter, Elizabeth A. Burns—has preserved and categorized images that mainly focus on history, rather than images of pop-cultural or artistic significance. The collection covers the Civil War, medicine, crime, Victorian memorial images, African Americans, and Judaica. Of his esoteric tastes, Burns explains, “The purpose in collecting was to collect what you haven’t seen and to collect unknown history and unknown photography.” After gathering the materials, Burns began to arrange exhibits, write articles, and publish books—44 to date, including the groundbreaking Sleeping Beauty, which reintroduced Americans to the concept of postmortem memorial photos, particularly those of children. (The photograph of a child who dies in season one of The Knick is a direct recreation of a piece from the Burns Archive.) “It’s become the norm of culture again. I was part of that,” he says of memorial photography, adding that there are now charities devoted to helping mourning parents with the arrangements.

Burns was involved with the creation of The Knick before the first frame was even shot. At their initial meeting, “[producers] Steven Soderbergh, Michael Begler, and Jack Amiel came here and they had a pilot and they wanted to see what we had.” The meeting went longer than planned, and the impressed creators came away with more ideas for plot twists based on the doctor’s anecdotes and images. “From the first meeting, they had enough for 10 episodes for season one, and, of course, we’ve just been feeding them ideas since.”

There was also the issue of building the world of the Knickerbocker Hospital and educating its staff. Set in the operating rooms and opium dens of 1900 New York, The Knick centers around that era’s struggles for advances in medicine and social justice. The character-driven ensemble drama joins the ranks of period shows like Mad Men and Downton Abbey that similarly went to extraordinary pains to make sure everything from the characters’ shoes to the day’s weather were accurately reflected and visually accounted for. There, too, the Burns’ intimate knowledge of the material has been pressed into service. “We work with the art department, we work with the props department, we work with the effects department,” describes Elizabeth A. Burns of their roles as consultants. “We work with all of these different departments to help create the historic accuracy.”

Instruments from the doctor’s own collection have been used to create the scalpels used in The Knick’s OR, and labels from his bottles mark the medications that are doled out in the wards (and by Clive Owen’s self-medicating Dr. Thackery). It was important to the showrunners that the actors learned how to wield those tools of the trade, so each of the principal actors was given a crash course by the veteran surgeon in the basic procedures. “I taught them medical school, and it wasn’t just like one day or two days,” Burns describes. “I taught them until they knew how to tie, how to suture, how to do all the things that they had to do. If you watch it on screen, you can see how great they are.” This is no minor detail, considering that surgery—and the operating room itself—are at the heart of the show’s story arcs, so it’s critical that every drop of blood and every incision be lifelike. “The models—the medical material—[that] is really where we did our most work. Our biggest job was to recreate surgical specimens that were realistic.”

During shooting days, Burns has been on set for all surgery- and medical-related scenes: “Sometimes I would change the scene or add something to it to make it more realistic.” The working relationship the doctor has forged with Oscar-winning director Soderbergh even allows Burns to occasionally interrupt a scene when he spies something historically inaccurate. On Burns’ first day, Soderbergh let him stop the filming to rearrange the audience in the operating theater’s gallery, a change intended to display the correct pecking order—senior staff in the front and younger residents in the back.

Burns is attuned to the finest of details, even going so far as to lay out the surgical trays to make sure they have the right instruments in the right order for the operation being filmed—a detail that probably goes unnoticed by the lay viewer, but has earned him praise in medical and historical circles. Like most behind-the-scenes showbiz veterans, he worried most about his own critics. He was relieved by their response to the show: “After the first few shows, I got great reviews from the surgical historians about how accurate it was.”

The Knick isn’t Burns’ only ongoing TV project: Centering on his “first love,” the Civil War, the Ridley Scott-produced public-television drama Mercy Street has also engaged the doctor’s technical-advisor services. The first American drama to air on PBS in more than a decade, Mercy Street concerns the “socialization of nursing” inside a Virginia hospital circa 1862. Unable to offer any plot details ahead of the show’s winter 2016 debut, Burns still reports the following: “It’s accurate and I loved it.” But not so accurate that it will bother viewers disturbed by The Knick’s anatomical fidelity: “[It] is PBS, so there won’t be five gallons of blood like there was on the first day of The Knick.”