PROFILES: MAYO ET AL.
By John W. Klooster
Delivered to the Chicago Literary Club
October 15, 2001
Today, the Mayo Clinic of Rochester, Minnesota is perhaps the world's largest private
medical clinic, reportedly averaging over 1,000 new outpatients a day and performing over
70,000 surgical procedures are annually. The Clinic utilizes about 1,000 doctors, has about
18,000 employees, maintains practice groups outside of Rochester, and conducts extensive
education programs.
How did the Mayo Clinic ever get started, situated as it is in a small town in the midst
of Minnesota prairie land? Who were the founders and what sort of people were they?
Well, the founders were William W. Mayo and his two sons, William and Charles.
Their lives spanned the period when medicine and surgery advanced from primitive levels.
When glimpsed across time through a small window, we can see what sort of people they
were and how the Clinic got started.
William W. Mayo
In 1850, an immigrant from England named William W. Mayo, who had served as a
medical apprentice in the Manchester infirmary, and had worked as a preceptor to an Indiana
physician, received a doctor of medicine degree from Indiana Medical College in La Porte.
Few procedures and instruments were yet available for diagnosis. The stethoscope was still
novel, the clinical thermometer had not yet been invented, but the College did have a
microscope. Few diseases had been sufficiently differentiated and identified to be recognized.
For a sick patient, a doctor was to prescribe a remedy that had seemed to work in some
previous case. The course covering anatomy and dissection had the usual problem of
obtaining fresh cadavers, so a midnight excursion with sack and shovel to a new grave could
satisfy a medical student's need.
A year later, Dr. Mayo married Louise Wright, began a partnership with his former
preceptor, and became a doctor on horseback making daily rounds and answering calls from
the country. There was plenty of sickness, but malaria was the great scourge in the bottom
lands of the Wabash valley.
Dr. Mayo contracted cholera and malaria, and the subsequent, post-malarial,
debilitating, summer-time spells of the "shakes" (alternating chills) and fever were too much
for him. One day in the summer of 1854, in the midst of a chill, he hitched up horse and
buggy, and shouted to his startled wife as he drove off westward, "Good-bye, Louise. I'm
going to keep on driving until I get well or die."
He traveled to St. Paul, Minnesota and in a few months went back to Indiana for his
wife and daughter. Apparently, his "shakes" ceased, but he made no attempt to establish a
practice in St. Paul which already had 20 to 30 resident physicians. He wandered north and
south but decided to live near Le Sueur, where he took over an abandoned farm in 1856. A
few months later, Mrs. Mayo and their daughter Gertrude arrived from St. Paul. Here, Dr.
Mayo endeavored to practice medicine, but calls for his services were few. There was plenty
of sickness, but no malaria. The competition was great and involved established doctors,
midwives, herbalists, bonesetters, and experienced mothers.
His living was lean, and to supplement his income, he farmed, practiced veterinary
medicine, served as a justice of the peace, and operated a ferry boat to and from Le Sueur.
Mrs. Mayo was not suited for the life of a pioneer and her life was hard. Second and
third daughters arrived, but the third lived only about a year.
In the spring of 1859, a flood of the Minnesota River and its tributaries caused Dr.
Mayo to move across the river into La Sueur where a house and barn were built. There, on
June 28, 1861, his son William was born.
To augment his income and also to extend his acquaintances throughout the area, Dr.
Mayo became active in local politics, and such activities helped substantially to spread his
name and presence through the Minnesota Valley. The people found him to be professionally
able when they became his patients. In a few years, he emerged as one of the outstanding
citizens of the Valley and his practice covered most of three counties.
After Fort Sumter fell on April 12, 1861, and volunteering had slackened, President
Lincoln in August proclaimed a draft of 300,000 men. Dr. Mayo was appointed to act as
examining surgeon in Le Sueur County, but then the Minnesota Sioux revolted. They were
angry over the refusal of the local Indian Agent to distribute their annuity payments of food
and cash.
Catching the settlers unaware, they shot all the men they could find, moved from farm
to farm, made captives of the women and children, gorged on food, and set fire to barns and
haystacks. To aid the threatened town of New Ulm, men from St. Peter and Le Sueur,
including Dr. Mayo, went to New Ulm.
Barricades about the town were set up. Dr. Mayo was installed in one of two small,
improvised hospitals and kept busy ministering to casualties. On the morning of the second
day, the guards yelled: "The Indians are coming!" The women and children were hurried
into cellars, and companies of men marched out to appointed positions. When the Indians
advanced with terrific yells, the men quickly fell back to the barricades.
Dr. Mayo saw some men seeking refuge in the cellars with the women. He went after
them, thrust pitchforks into their hands, and stationed them behind the barricades. When the
frightened fellows asked what they should do if the Indians came, Dr. Mayo swore and said:
"Run your pitchforks through them, of course."
In the first hour and a half, ten men were killed and 50 wounded. The latter were
carried to the hospitals on doors serving as stretchers. As he worked, Dr. Mayo kept an eye
on outside events. Once, looking up, while amputating a man's leg, he saw two men
sneaking away from their guard duties at the barricades and moving past the window.
Immediately, he was at the door shouting and waving his bloody knife. The men returned to
their posts in a hurry.
People in New Ulm were subsequently evacuated to Mankato, and the Indians were
routed by a force from St. Paul. About 2000 were taken captive, and their white prisoners
recovered. Although a trial before a military commission resulted in a death sentence on 307
warriors, President Lincoln postponed execution of the sentence, but finally ordered hanging
for 39 Indians who had committed rape and murder. These were strung up at Mankato,
December 26, 1862, and buried in a trench, but they did not rest there long. Among the
spectators were many medical men, including Dr. Mayo, and, under cover of darkness, the
grave was opened and the bodies removed and distributed.
To Dr. Mayo went the body of Cut Nose, a large, ugly brave whom the little doctor
had once bested in a struggle for his horse during a lonely ride to a patient's bedside. Carted
to Le Sueur, his body was dissected by Dr. Mayo in the presence of other doctors. The
skeleton was cleaned and articulated for the Doctor's permanent use.
After the Sioux Outbreak, Dr. Mayo was named examining surgeon of the Board for
the First Minnesota district which comprised the entire southern half of the state. For its
headquarters, the board chose Rochester, the seat of Olmsted County. In May, 1863, Dr.
Mayo said good bye once again to his wife and children and traveled to Rochester to take up
his new duties.
For about a year and a half, Dr. Mayo worked long hours every day. He examined
volunteers, draftees after each drawing, and "droves" who hoped to have their names removed
from conscription rolls. During office hours, Dr, Mayo faced the task of making a case
examination and decision at the rate of five to six hundred men a day, or about one per
minute.
The press discovered that Dr. Mayo was giving private examinations in his rooms after
hours for a $5 fee, and then was exempting most of the men so examined when they appeared
for review. Suspicion of possible scandal was aroused. The War Department at once
dismissed Dr. Mayo from army service "for receiving fees for private examinations." A new
board was appointed along with a new examining surgeon. As the Mankato Union observed:
"No one who is acquainted with Dr. Mayo will for a moment question his honesty and good
intentions. He supposed from a reading of the law that he had a perfect right to give a
private examination and charge a fee of five dollars. The authorities at Washington construed
the law differently, and his official head has paid the forfeit."
Dr. Mayo had a cottage built in Rochester and moved his family there. Here, on July
19, 1865, his second son, Charles Horace, was born.
Dr. Mayo also had a little office constructed in central Rochester which he decorated
with a plaster bust of President Lincoln, and he invited private patients with a newspaper
advertisement. In his practice, he used the only precision instruments then available, the
clinical thermometer and a crude wooden stethoscope. He tested urine for sugar and albumen
using reagents he carried with him and heat from a bedside lamp or candle. He depended
upon his five senses to make or complete a diagnosis. Practice and experience trained his
senses to recognize and sharpened his mind to interpret.
Rochester was then only ten years old with fewer than 3,000 residents. Energetically,
Dr. Mayo involved himself in community life.
Though nominally an Episcopalian, Dr. Mayo was a free thinker and confessed
unbeliever, a follower of Darwin, Haeckel, Thomas Huxley, and Herbert Spencer. He got
along as well with Catholics as Protestants and had many Catholic patients. His attitude
towards social mores was that of a liberal. In politics, he tended to side with the underdog
and to agitate for municipal improvements and expansions.
In 1882, he was elected mayor of Rochester, and in 1890 he was elected to the state
senate from the local Farmers' Alliance, having bought a farm near Rochester in 1885. His
tenure in elected public offices was generally uneventful because of his poor patience and
poor capacity to compromise. He frequently made speeches, and many were published.
Everybody knew Dr. Mayo and what he stood for.
There were enough patients in the Rochester area to keep Dr. Mayo and several other
doctors busy. Perhaps it was his tendency to accept radical ideas that led Dr. Mayo to react
against contemporary medicine's bloodletting and dosing with emetics and purgatives.
He seldom appeared in public except in a long tailed, double-breasted coat and tall top
hat. Thus dressed, he always went somewhere in a hurry. In town, he made his calls on
foot; for county calls, he always drove his horses very hard. He earnestly sought to help
people who needed a doctor, and was casual or indifferent about his fee and payment for
services. He quickly sized up a patient's symptoms and made his diagnosis, and, having
made his diagnosis, he typically acted quickly and decisively. He thought a detailed patient
record was unnecessary and a potential cause of missed diagnosis.
One time, while rendering professional services at the Granger farm, he saw little
George among the grown-ups, and asked him a question. When the youngster answered, Dr.
Mayo exclaimed: "Why that child is tongue-tied! Come here, George." George climbed
unsuspectingly into his lap and, responding to Dr. Mayo, opened his mouth. Immediately, Dr.
Mayo extended a small pair of scissors from his pocket case into the boy's mouth and
snipped the membrane under the tongue. After the tongue healed, George could speak
normally. When George grew up, he became a lawyer, a judge, and legal advisor to the
Mayos.
Dr. Mayo liked to do surgery, but, up until the 1870s, he did not do an unusual
amount. However, in Rochester, injuries from farm machinery and disorders of female
reproductive organs presented opportunities for surgery. Dr. Mayo kept current on
developments in these fields through reading of medical journals, and making trips to St.
Paul, east coast cities, and Europe.
In Rochester, his surgical practice continued to expand and he performed some
audacious and radical surgeries when the need arose. A woman doctor, Harriet Preston,
trained at the Philadelphia Women's Medical College, began practicing in Rochester. She
built up a large practice, and she referred her major and surgical cases to Dr. Mayo which
helped develop his practice in gynecology.
Though amputations were a particularly common surgical procedure, Dr. Mayo
thought that, where possible, it was better to excise a piece of diseased bone than to cut off
an entire limb.
The local newspapers published stories about doctors, especially those involving Dr.
Mayo's surgical cases. These stories continued to appear well beyond 1900. Although
sometimes cited as evidence that the Mayos indulged in unethical advertising, in those days,
such stories were considered customary and newsworthy.
Dr. Mayo is considered today to have performed "kitchen surgery" on an informal and
makeshift basis. The theater was usually the patient's home, the operating table one from the
kitchen, or the parlor sofa, or even a door removed from its hinges and supported by
sawhorses. Friends and neighbors, though not allowed by the doctor in the room, milled
about the doorway or in the yard outside, curious and excited. Dr. Mayo's instruments were
not sterile and were carried either in a little case or loose in his pocket. Like his fellows, Dr.
Mayo expected infection to develop in the incision or stump.
To his own practice was added an extensive referral and consultation practice. Dozens
of southern Minnesota doctors sent him their surgical cases and also consulted him in difficult
or puzzling cases. Sometimes he acted as preceptor for medical students.
Dr. Mayo's best assistant for many years was his wife. She acquired a knowledge of
medicine from her husband and from his books and journals. He was known to seek her
opinion on a puzzling case, and she frequently went with him to see a patient and often
assisted in reducing fractures and applying splints. She had a good business brain. Her
judgment may have been more balanced than his. Both had forceful personalities.
Boyhood of Will and Charles
Dr. Mayo sought to imbrue Will and Charlie not only with good medical training, but
also with high standards.
As they were growing up, Will and Charlie were always together. Will was tall and
athletic; Charlie was short and studious. The boys always had home chores to do. Charlie
came to love farming, but Will would have no part of it. Both were fun loving.
Neither was a brilliant student. They attended a public school, and also were sent to private
schools and individual instructors. They gained substantial education from their parents. Dr.
Mayo had a large library in the home and encouraged his children to explore and read among
these books. Mrs. Mayo taught the boys botany and astronomy, the latter being a subject in
which she remained interested over many years. She had a four-foot telescope mounted in an
observatory tower that she had built at the Mayo farmhouse.
From casual chats with their father, the boys picked up chemistry and physics, and he
also talked to them about his early teacher, John Dalton. The bones of the Sioux, Cut Nose,
that were kept in their father's office, were the center for early lessons in anatomy and
osteology.
First Will, then Charlie, drove the horse that transported the father on his calls. In
cold weather, the father would take one or the other into a house to see the patient. Then, on
the way to the next call, they would review the case.
The boys participated in autopsies when they were so small that the father had to lift
one or the other up to the table where the boy would lean forward and hang onto the hair of
the corpse to steady himself as he watched his father. He taught the boys technical
procedures for fixing, cutting and mounting of tissues he had surgically removed, so the boys
were introduced to both microscopic and gross pathology.
At early ages, Will and Charlie became able to assist their father in his operations.
One time, the little Doctor was operating to remove an ovarian tumor with Will acting as his
first assistant. In accord with the custom of having an established physician give the
anesthetic, the anesthetist was a doctor well known in Rochester. He was a surgeon and had
served as county coroner, but was not familiar with operations on a breathing body. Dr.
Mayo made a small incision and drained the fluid contents of the tumor into a tub. Then,
using clamps adjusted by thumbscrews, he began to pull the growth out through the incision,
producing a sucking noise like that of "a cows foot in the mud," whereupon, the anesthetist
fainted. After quickly surveying the possibilities, Dr, Mayo kicked over a cracker box that
happened to lie adjacent the end of the sofa supporting the patient and said, "Here, Charlie,
you stand on this and give the anesthetic." "He did it well, with perfect composure," said
Will afterwards.
When they were ready for medical school, the only question was: To what school
should each boy go? The family decided that Will should attend the University of Michigan
at Ann Arbor, where he began in 1880 and graduated in 1883, and that Charlie should enter
Chicago Medical School, which was then nominally affiliated with Northwestern University,
which he did in 1885 and graduated in 1888.
Perhaps the most important thing that Will and Charlie learned in medical school was that
septic infection from surgery could be eliminated or avoided by using sanitary procedures.
Old Dr. Mayo, along with many other doctors, was reluctant to use the new antiseptic
procedures of Lister that were introduced in the 1880s.
By 1883, Dr, Mayo's practice was one of the three largest, maybe even the largest, in
southern Minnesota. For Dr. Mayo, his two sons were successors to whom he could transfer
his large practice while he was still active. This continuity from father to sons was a basic
reason for the continuing and the rapid growth of the Mayo practice.
Until Will entered the practice, the W. W. Mayos always had to practice strict
economy in their daily living, but accounts of his expenditures indicate ample availability of
funds. Not until he was himself being pressed would Dr. Mayo send out bills, and for poor
folks he made little or no charge.
Dr. Will After Medical School
At first, Will, like his father before him, made country rounds in all weather
conditions, but, initially, the patients wanted only the old doctor, not the young stripling.
After medical school, Will soon ended the stringent financial condition of his folks.
Will was methodical about charges and collections. As the double practice grew, income
increased. Office improvements were made.
Diseases of the eye in the Rochester area at that time needed a specialist. To develop
his capacity to perform eye surgery, Dr. Will collected from a slaughterhouse at Rochester's
outskirts eyes of slaughtered pigs and sheep and spent many hours practicing dissections and
operations. Though not yet in medical school yet, Charlie participated. Two months after his
graduation, in August, 1883, Dr. Will with Charlie had gone in a buggy to the slaughterhouse
for specimens. As the two were returning, a tornado struck Rochester in the early evening.
They experienced a series of very close calls, but were unharmed. North Rochester, though,
was a shambles. The rescue work began at once, and men with lanterns sought the dead and
wounded and carried them into hotels, homes, offices, and a convent. Dr. Mayo took charge
of those brought to the Buck Hotel adjacent north Rochester, and Dr. Will and Charlie took
care of those brought to the Mayo office. The work went on all night. In the morning, an
improvised hospital was arranged to which 34 were admitted.
One local doctor thought an emetic should be given first thing in treating every
accident case and insisted on this treatment for all the injured. Dr. Mayo angrily told the city
council: "Either he gets out or I do." The council placed the little doctor in charge.
His first task was to solve the nursing problem. The volunteers were not adequate.
He thought of the teaching Sisters of St. Francis who were at home in their Rochester mother
house for summer vacation. When he approached the mother superior, Mother Alfred, she
agreed at once, and, from then on until it closed, the hospital's nursing was carried out by the
Sisters of St. Francis.
In 1884, after returning from a course in surgery in New York City, Will married his
best girl, Hattie Damon, whom he had known since boyhood school days. Hattie was the
daughter of Rochester's jeweler and a graduate of Carleton College in Northfield, Minnesota.
The next year, one of Will's two sisters, Phoebe, died, and the couple's joy in the birth of
their first child, a son, in 1887 was ended by the death of the infant three months later. The
couple had four more children and celebrated their 50th wedding anniversary in 1934.
In 1888, Will delivered a paper on appendicitis cases which surprised his listeners at
the Minnesota State Medical Society because it indicated that, surprisingly, the young surgeon
had treated at least of score of such cases involving the relatively new procedure.
Later in 1888, Dr. Will was called to a neighboring town to examine a woman for
what was found to be an unusually large ovarian tumor. When he heard his son's report, old
Dr. Mayo scheduled the removal operation for the following Sunday morning. Subsequently,
though, he received a note asking for a consultation on a case in St. Paul from Dr. A. J.
Stone, and he left Rochester saying he would be back Saturday night. But he did not then
return and was not on the first train Sunday morning. By the time set for the operation at
Mrs. Carpenter's, about 15 doctor spectators had gathered.. The patient was waiting along
with relatives some of whom had left small children alone at home. Dr Will told the patient
that, if she were willing, he would perform the operation. She was, and Dr. Will proceeded
to remove the tumor which was huge, completely filling the washtub they put it in. The
watching doctors were much impressed.
Dr, Will was very much concerned what his father would say. The senior doctor
returned on the evening train bringing with him Dr. Stone. Dr. Mayo had stayed over in St
Paul to assist Dr. Stone in an operation and had brought Dr. Stone home with him to watch
him perform his own fine case. Hesitantly, Dr. Will explained that he had done the operation
that morning and that all had gone well. His father was speechless. Dr. Stone sat down on
the station stairs, beat his hat against the adjacent platform edge, and laughed till tears came.
The boy had stolen his father's big case. Dr. Will thereafter maintained that it was then that
his father understood that his son had become a competent surgeon.
Hospitals in Rochester
In those days, before the general use of antiseptic procedures, a hospital was where
one went, not to get well, but to die. Hospitals did not have public favor, were ranked with
jails, insane asylums, and poor houses, were mainly for sick indigents, and were typically
grim and lonely places where nursing was inferior to home care. There was no hospital in
Rochester.
The Mayos typically took rooms for their patients at the old Norton Hotel, but it was a
problem to provide aftercare there. An alternative was to direct their patients to a private
home where a practical nurse was available. A few women in town served as practical
nurses, and a good one of these was Mrs. Carpenter who could accommodate eight or nine
patients in her house in north Rochester. There was no operating room there, so the Mayos
used a small, portable table and an operating kit that they moved from room to room.
Often other doctors would come to watch a major operation, and to accommodate their
attendance, the Mayos liked to schedule important operations for Sunday mornings at Mrs.
Carpenters. Old Dr. Mayo talked as he worked, explaining and answering questions. Within
a year after medical school, Dr. Will was sharing in this work.
Though life in Rochester returned to normal after the Tornado, Mother Alfred had
gotten it into her head that the Sisters would found a hospital in Rochester. Old Doctor Mayo
initially opposed the idea. But the sisters worked very hard for the next four years to put
enough money together for the project. Old Dr. Mayo agreed to choose the site and to plan
the hospital. He and Dr. Will toured eastern hospitals to study plans and organization.
Finally, a three story building was constructed in 1886 and 87 that had an operating room
and accommodations for 45 patients. The place was named St. Mary's Hospital and was and
is about a mile away from Clinic offices.
St. Mary's was open to all sick persons, regardless of circumstances, religion, race, etc., and
was not a nursing asylum or nursing home for the wealthy.
In 1887, however, there was substantial animosity between Catholics and Protestants
in Minnesota. The Protestants would have nothing to do with an institution managed by
black robed nuns who practiced popery in an associated chapel, and the Catholics did not like
protestant doctors to work with catholic nurses in a catholic hospital. Even the full support of
the Sisters of St. Francis was lacking.
Old Dr. Mayo at first found it impossible to organize a staff for the hospital, but to the
Mayos fell responsibility for success of St. Mary's. Mother Alfred was arbitrarily retired by
the Church, but then took charge of St. Mary's Hospital where she remained until 1892. She
was succeeded first by Sister Hyacinth and then by Sister Joseph who was an outstanding
performer and administrator and exerted a great influence on subsequent development of the
Hospital and the Clinic.
Dr. Charlie After Medical School
Will had accomplished much before his brother Charlie returned to Rochester after
medical school, but Charlie fit readily and immediately into the family partnership. Will
recognized Charlie's surgical ability, but Charlie's youthful appearance made patients
skeptical. Very soon, Charlie took over eye surgery from Will.
One day before St, Mary's Hospital officially opened on October 1, 1887, the Mayos
began using the operating room. A patient needed surgery. That first operation was
performed by Dr. Charlie and was for removal of a cancer of the eye. Dr. Will assisted, and
old Dr. W. W. Mayo administered the anesthetic.
Within a week of its opening, four Sisters were assigned by St. Francis to duty in St
Mary's, and Edith Graham, an employee of the Mayos, was placed in temporary charge of the
nursing staff.
Edith was a Rochester girl who had graduated from the school of nursing of Women's
Hospital in Chicago was the first trained nurse in town. She was a small, lively, attractive
woman who had been hired by the Mayos as office nurse, anesthetist, and general bookkeeper
and secretary. Previously, on her first case in Chicago, she had been rejected because the
doctor thought her to be too attractive to be a nurse.
Unfortunately, Charlie soon contracted whooping cough and could not get rid of it.
After six months, it was decided that he needed to get away and change his environment. So
Charlie went to Europe in 1889. In Paris, Charlie attended a lecture in French by Pasteur, but
Charlie did not understand French. In Germany, Charlie came into contact with the types of
antisepsis and asepsis then in use. He returned to Rochester well.
In Rochester, Dr. Charlie also found Edith to be attractive and in 1893 married her. On their
honeymoon, they traveled to several eastern medical centers. When they returned, they built
their "Red House" next door to Dr. Will and Hattie, and began their family of eight children.
The Boom in Surgery
The Mayo practice continued to increase after Will and Charlie began. One helpful
factor continued to be the frequent occurrence of news stories of successful Mayo surgeries.
Another helpful factor was the large immigration into Dakota Territory from Rochester
and southern Minnesota during the 1880s. Even after the admission of the Dakotas as States
in 1889, former residents of southern Minnesota wanted, when possible, to travel back to the
doctor who had previously taken care of them, and they also recommended him to their new
neighbors.
The Mayos got patients in increasing numbers who needed surgery. At first, their
operating concerned mostly repair work after accidental injury, but their surgery for more
radical procedures gradually increased.
At this time, modern surgery was dawning, and the Mayos tried to stay current. With
zeal to bring the best to relatively remote Rochester, once a year, each brother spent at least a
month away from Rochester observing the work of other surgeons. Usually one brother
remained in Rochester so that incoming patients would always find a Mayo.
The more the sick folk who sought them, the more the brothers gained experience and
skill. They achieved unprecedented case numbers to add to unusual results. Their reports to
professional colleagues were frequently startling and involved many areas.
Rapid advances in surgery led to a boom in surgery in the 1890 -- 1910 period.
Improving operative techniques steadily lowered the death rate and increased the certainty of
beneficial results. The advances enabled the brothers to treat a vast reservoir of uncured
illness in a wide area around Rochester. As Dr. Will commented to his biographer: "stress
the unusual opportunity that existed at the time, the place, the general setup, not to be
duplicated now."
Chicago men contributed to the Mayos' surgical education. For several years, Dr. Will
and Dr. Charlie alternately journeyed to Chicago on Wednesday night to attend Dr. Christian
Fenger's clinic on Thursday, and afterward join a smaller group in his autopsy room. Fenger
had an operating table at Passavant Memorial Hospital and a postmortem table at Cook
County Hospital. Around Fenger were Doctors Nicholas Senn, Albert Ochsner, and John
Murphy from whom the Mayos learned much. Ochsner became Will's closest personal friend.
John Murphy invented the so-called "Murphy button" for end-to-end union of severed gut
which the Mayos often used in intestinal, gallbladder, and stomach surgery.
The young Mayos made a favorable impression on their fellow doctors. In accord
with medical ethics, they did not personally report their achievements publicly, but rather
made them known to the profession. Beginning in 1896, Dr. Will gave a paper each year
before the surgical section of the American Medical Association.
At St. Mary's, there were no inflexible seniors and no board of lay trustees to protest
or forbid new and improved methods utilized by the Mayos. Dr. Will and Dr. Charlie used
wet antisepsis methods for years, but adopted aseptic methods as fast as they came in.
Dr. Charlie sometimes invented surgical instruments, and he introduced various
procedures some of which came to be called "Mayo operations." He worked in an amazing
variety of body repair tasks.
Coping with Growth
Needing help to serve their increasing numbers of patients, in 1892, the brothers asked
Dr. Stinchfield of Eyota to become their partner. Dr, Graham, a brother of Mrs. Charles
Mayo, soon joined them.
During the first decade of their joint practice, the brothers operated as a team, each
serving his turn as the other's first assistant. As their work increased, Dr. will specialized in
pelvic and abdominal surgery, while Dr. Charlie performed most other surgical procedures.
When, because of the press for their services, the brothers began operating separately, they
arranged their schedule so that they operated on alternate days, including Saturday.
Others were hired, including Dr. Henry Plummer in 1901 and Dr. Judd in 1902.
Professional persons, either partners or employees, were paid well. In 1904 the brothers
initiated a policy of periodically making gifts to Rochester.
Doctors continued to refer cases to the Mayo brothers, and, even after neighboring
towns got their own hospitals, many patients still wanted to go to Rochester and to the
surgeons they had heard so much about. The Mayos never offered a referring physician a
commission of any sort. When many physicians themselves needed surgery, they went to
Rochester and to the brothers to have their own work done.
Dr. Will became a district surgeon for the Chicago and Northwestern Railroad. He, or
his brother as substitute, would respond to a call for help in treating injured and travel to an
emergency on a special train.
Calls to individual patient residences practically ceased, under time limits and patient
numbers, and the brothers became experts at differential diagnosis.
By 1900, the hard times of the 1890s had passed, and Rochester prospered. Since
medicine seemed to be failing to cure most chronic ulcer cases, many sufferers sought
surgery. From 54 abdominal operations in St. Mary's during its first three and a quarter
years, the number rose to 2,157 in 1905.
To accommodate the growth, the Sisters of St Francis kept expanding St. Mary's.
In 1905, nearly 4000 operations were performed at St. Mary's Hospital which
represented the surgical culmination of 10,000 to 11,000 office examinations. Obviously, the
brothers did not handle all this alone.
Dr. Charlie knew as many facts as Dr. Will, but was not as good in presenting them.
After his wife had gone over his speeches, pruned them, and delivery had been practiced
before her, they would attend a meeting where she would sit in the rear and use pre-arranged
signals to inform him about his delivery. But Charlie would always think of something extra
to say, or some story to tell, and he would wind up just talking with a rich humor. Since
only the prepared speeches were published, his humor is lost.
Sometimes the work of the brothers in a town of less than 6000 inhabitants seemed
unbelievable to professionals. Yet a visit to Rochester and a day or so of watching the
brothers work convinced doubters that the brothers were doing what they said they were
doing.
First they received state recognition, then national recognition. When noted European
physicians and surgeons visited the U.S. and headed from the east coast to Rochester,
American medical men were astonished. It was irritating and humiliating for a St. Paul
surgeon to be asked by a European doctor: "St Paul, Minnesota. Is that anywhere near
Rochester?"
In July, 1905, Dr Will was elected president of the American Medical Association.
By then, he was the foremost American authority on stomach surgery. Visiting Rochester was
then a sort of status symbol in the profession.
However, Charlie was credited with greater surgical versatility and ingenuity than
Will. In 1917, Charlie was elected President of the American Medical Association.
Like their father, while they operated, the brothers encouraged visits, as a teaching
experience, by physicians and surgeons without regard to skill or training. Dr. Charlie
designed, and the brothers had built, special wheel-mounted platforms each holding and
positioning a number of men so that visitors were enabled to look non-obtrusively over an
operating surgeon's shoulder and view an operation. Also, slanting mirrors were installed
over the operating tables for good visibility of work in progress. That this was a sizable
effort is shown by some illustrative figures. In 1906, for example, between them, the brothers
were doing about 4,000 operations per year. One visitor recorded in this period that he had
seen 104 operations in one week with every operation usually having from 20 to 30
spectators. Many visitors wondered how the brothers could stand the strain.
One time, Dr. Will was removing a large kidney tumor that had pushed all the local
anatomical landmarks out of place and that had attached itself to adjoining tissues. As he
was separating and lifting the tumor out, the largest vein in the body, the vena cava ruptured.
He quickly found and plugged the opening guided only his trained touch, since the blood hid
everything from sight. He said calmly to the tense audience: "Gentlemen, I have torn the
vena cava and it will be necessary to make another incision to repair the vein." He did so,
stitched up the vein, checked that the stitches were tight, and went back to cutting the tumor
away. The tumor came loose suddenly, causing a long tear in the bowel. As he continued
talking, he said: "This, gentlemen, is a much more serious accident than the injury to the
vein. I have torn a long rent in the duodenum." Then, he slowly and carefully sutured the
torn bowel before he returned to complete the work on the kidney. The operation took 3 ½
hours, and while the spectators were exhausted by the strain, Dr. Will was unperturbed.
Then, later, following the postoperative course, no signs of shock, no complications, occurred,
and the patient progressed smoothly to full recovery.
Newcomers to the gallery were likely to be invited for lunch or dinner at the home of
one of the brothers. Mrs. Will and Mrs. Charlie had to keep their larders stocked. One time,
Dr. Will arrived with two unexpected dinner guests. Fortunately, Mrs. Will had been given
two wild ducks that the cook was preparing for dinner. At the table, as Mrs. Will did the
carving to relieve her husband, one of the ducks slid to the floor. Calmly, she rang for the
maid, and with a slight lowering of one eyelid said: "Bring in another duck, Bessie!" So,
Bessie took the grounded duck to the kitchen, wiped it off, and returned it to the table.
Mrs. Mayo had to carry the conversation with the guests at lunches for this was the
time that Dr. Will dealt with his substantial correspondence. His secretary sat at a nearby
table and he dictated the responses to his letters as he ate.
There was no opportunity for such an activity in Dr. Charlie's house for his adoring
and clamoring children struggled noisily for a position on his knee. Watching this
competition one noon, Dr. Haggard commented to Mrs. Mayo: "Charlie has done a day's
work this morning and will do another this afternoon. He ought to be resting now, but how
can he?" Mrs. Mayo suggested that he take another look, and he saw that Dr. Charlie with the
active children about him was napping as he did for 15 or 20 minutes each day.
Charlie liked automobiles. Since there was no dealers yet, Charlie took agencies for
several makes to be sure of getting the new models. They were shipped to him disassembled,
and it was relaxation for him after a day in surgery to unpack the crates and assemble the
cars.
With both his sons in practice, life became easier for the old Doctor. He began what
became frequent and many travels, and kept involved with political and civic activities. By
1910, he no longer participated in the work, but remained in good health. He began
experimenting with a process for extracting alcohol from vegetable and animal wastes. One
day the mechanism jammed, and he stuck his hand in to see what was wrong. The
mechanism started, and his hand and lower forearm were crushed. Amputation was
necessary. The strain and pain caused his health to fail and he died in 1911 shortly before
his 92 birthday and shortly after his 60th wedding anniversary.
Unlike their father, neither brother ever became involved in political activity.
However, in 1912, a scarlet fever epidemic struck Rochester, and Dr. Charlie accepted the job
of health officer, a post which he subsequently held many years. Working with a deputy and
enforcing strict quarantine measures, the epidemic was soon ended. To reduce the numbers
of humped backs, crippled limbs, and scarred necks that he believed were caused by drinking
infected milk, Charlie got the city council to enact a dairy inspection ordinance. Later, when
he had observed from experience with a herd at his own farm, that inspection could not
guarantee a herd free from tuberculosis, he got an ordinance passed requiring all milk to be
pasteurized. This ordinance was revolutionary at the time. There being no central systematic
collection of garbage in Rochester, Dr. Charlie instituted a program where garbage was
collected three times a week. The stuff was then treated to eliminate any source of infection,
and finally fed to a herd of purebred hogs. After seeing the operation, some meat packers
refused to buy from anywhere else. In a few years, Dr. Charlie turned the profitable hog
enterprise over to the city.
The press always found the activities of the brothers newsworthy, causing negative
comments from others in the profession. The brothers generally shunned attention, but, in
one 1911 incident, the brothers themselves were primary participants. Charlie became
suddenly and acutely ill in New York City. He diagnosed his trouble as gallstones, but the
attending physicians said it was appendicitis and operated accordingly. After a few days, a
relapse occurred and the papers announced that Dr. Charlie was dying. Dr. Will started out
from Rochester at 4:30 in the morning with a nurse, rode a locomotive engine to Winona,
boarded a special train that went to Chicago, then New York. The press made much of this
event and frequent bulletins not only told of Dr. Charlie's recovery, but also reviewed the
Mayo record.
The spread of their reputation and their attraction among laymen was aided by the
concurrent period of national prosperity and by the increasing mobility of the population with
the developing automobile and advances in rail travel. Rochester continued to expand.
When, in 1907, John Kahler opened the Kahler House, which was a combined hotel,
convalescent center, and hospital complete with operating room, Sister Joseph appreciated the
significance, and immediately began the process of building a new wing for St. Mary's.
Improvements in patient record keeping and patient business records began in 1907.
In about 1911, with training of assistants, the term "Fellows of the Mayo Clinic" came into
usage.
Registrations at Mayo offices rose from 15,000 in 1912 to more than double that two
years later. The large increase in patients resulted in a large expansion of personnel in all
phases of the practice. Specialization developed. With increasing numbers came increasing
experience and increasing expertness. Since additions to staff were always behind the rate of
growth in patients, the staff members had to work hard.
Office hours were from 7:30 am to 7 or 8 pm six days a week without pause, and the
offices were open on Sunday afternoon also.
Advent of the Mayo Clinic
The rate of growth kept the problem of additional space needs continuously acute.
About 1912, special guides had to be provided to get patients around in the maze.
Finally, responsive mainly to Henry Plummer's urgings, the brothers consented to construction
of a single innovative building with a plan of organization that facilitated and integrated the
functions of the various groups, but the building was not completed until 1914. This building
marked the beginning of the Mayo Clinic as a distinct institution independent of any hospital
which was a new kind of private medical practice.
Initially, the Mayo brothers included each partner's name in the firm's title. However,
in accounts by physician visitors, the term "the Mayo brothers' clinic" began appearing. The
railroads and the patients soon brought this reference into popuar usage. In 1914, the
partnership name was changed to "Mayo Clinic."
Dr. Will assumed the role of Clinic manager. Although he considered present efforts
to relieve pain and suffering to be more significant than research, he nevertheless gradually
came to accept the advice of Drs. Plummer and Wilson that a research program was
necessary. So, in 1908, the brothers contributed $500 towards a laboratory aimed at
experimental pathology and surgery inaugurated by Dr. Wilson. In 1914, Dr. Plummer and
Dr. Charlie persuaded Dr. Will to support work by Dr. Kendall at Rochester to isolate the
active product of the thyroid gland, and, by the following Christmas, Dr. Kendall succeeded
in isolating what proved to be the active thyroid hormone, thyroxin.
Just prior to America's entry into World War I, the General Medical Board of the
Counsel for National Defense was organized. The Clinic provided the Board with about
one-third of the medical personnel of Base Hospital no. 26 which served at Allerey,
Saone-et-Loire commencing in early 1918 and received hundreds of wounded a day.
Dr. Will was made a member of Board's executive committee with Dr. Charlie as his
alternate. Although they had thought they would be serving in France, Washington thought
otherwise, and assigned the brothers to work as general advisors to Surgeon General Gorgas,
each serving three weeks at a time. The strain of their war service combined with keeping
the Clinic operating deteriorated the health of both brothers. Charlie contracted pneumonia
during one of his turns in Washington, and Will in 1918 came down with a severe case of
jaundice.
At the Clinic, registrations continued to grow and went from 30,000 in 1914 to 60,000
in 1919, fed by the setting up of the Foundation and the prosperous "silk shirt era" of the
war. In addition, the Clinic was involved with draftee examination and war training for
incoming medical corps members. Charlie and Will provided short courses covering
developments in medicine and surgery.
The flu epidemic arrived in September, 1918 and taxed an already overburdened Clinic
staff. The signing of the armistice went almost unheeded in the circumstances.
After the war, medical practice continued to advance. Stories about the Clinic and its
patients continued, and made the Clinic a household word.
In the postwar agricultural depression, Clinic registrations dropped from the 60,000 in
1919 to just over 49,000 in 1922, and the proportion of nonpaying patients rose sharply. By
the mid-1920s, conditions had improved, and registrations rose.
The first Clinic building became inadequate so a new and larger second Clinic
building was needed and was constructed. In 1928, the new Clinic building, 15 stories,
costing $3,000,000, was dedicated. Like the first, this second building was designed mainly
by Dr. Henry Plummer.
Business Structure and Organization
At first, the brothers had one bank account between them. They tried to adjust their
fees in accordance with ability to pay. Thus, money might be given to a poor patient from
one of the brothers, usual fees would be paid by those who could pay such, and others paid
fees in accord with their ability to pay. The fees paid were independent of the quality of
medicine and surgery provided.
Eventually, the brothers hired a business manager, Burt Eaton, who soon got the
partners to enter into their first written contract of partnership.
Under the contract, partnership participation was limited to income without any share
of property or assets. Will and Charlie quickly signed, but the partners at that time,
Stinchfield and Graham, at first refused and then reluctantly signed because they had
understood that their share included not only income but property and assets. After the
signing by all partners, only a stipulated share of income went to each partner annually.
Later, the Mayos decided the partnership needed a business manager and a brother of
Charlie's wife, Mr. William Graham, was hired. He collected at the end of each day the fees
paid to each doctor that day. From 1885 to 1907, case ledgers were kept for each doctor.
By the time of the first World War, the brothers had achieved personal savings under
Burt Eaton's management of seven figures. After setting up a trust fund for their respective
families, they donated the remainder of $1,500,000 in 1915 to their newly incorporated Mayo
Foundation for Medical Education and Research. The terms of an affiliation with the
University of Minnesota Medical School were developed. However, intense opposition to this
affiliation promptly erupted. In response, the Mayos altered the terms. Articles making the
affiliation permanent were signed in 1917. The controversy and the Foundation generated
much publicity for the Mayos and the Clinic. However, this educational program in 1964
became known as the Mayo Graduate School of Medicine and in 1983 became independent of
the University when the affiliation ended.
While endowing the Foundation had taken the brothers savings, they still retained
ownership of the properties and partnership capital. These they wished to turn over as an
endowment to the Clinic. After much thought and advice, in 1919, they incorporated the
Mayo Properties Association, a self-perpetuating charitable organization having nine trustees,
and to it they transferred all property of the Clinic. The Association's name was later
changed first to Mayo Association, and., then, in 1964, to its present title, Mayo Foundation.
By 1925, the Clinic properties were valued at $5,000,000 and Clinic securities at $5,500,000.
In 1923, the brothers reorganized the Clinic itself to guide it in the future. The
partnership was replaced by a "voluntary association," a cross between a partnership and a
corporation. All proprietary and participating interests ceased. Will and Charlie, like the rest
of the staff, received a fixed salary. Administration and operation of the Clinic was vested in
a Board of Governors which was originally made up of the former partners, plus Mr. Harry
Harwick, and some members of the Clinic staff. All matters of Rochester Mayo Clinic policy
were determined by a council comprised of the Board of Governors, the executive committee,
and the president of the staff. In addition, various phases of the administration were entrusted
to a group of standing committees whose members are appointed from the staff and which
report to the Board.
Under a written contract, The Mayo Properties Association (now renamed, as indicated
above) leased back to the Clinic all equipment and buildings at an annual rental equal to the
total net income of the Clinic which money was added to the endowment funds of the
Association. In addition, the contract provided that all Clinic salaries had to be approved by
the Association.
Thus, the brothers provided, long before their retirement, a self-governing,
self-perpetuating organization and structure for the Clinic. Dr. Will explained that he and
Charlie wanted the Clinic staff people to receive a good living, but they did not want anyone
to receive enough wealth "to keep his children on the beach in Miami when they should be
working."
Retirement
Dr. Will was 67 in 1928, and in July of that year he suddenly announced that he had
"done his last operation." Dr. Charlie's retirement came a year and a half later when he
suddenly experienced a retinal hemorrhage while operating. A series of strokes then sapped
his strength and some of his mental powers. Now they could travel together. They bought
homes in Tucson for spending the winter months.
In November, 1932, Dr. Will advised a staff meeting that he, Dr, Charlie, and Dr.
Plummer would withdraw from the Board of Governors of the Clinic at the end of the year.
The system of standing committees for administration, installed a decade earlier, was working
well.
In 1934, President Roosevelt came to Rochester to join in honoring the brothers.
In 1939, the Mayos returned early from Tucson. Dr. Will was not feeling well and
wanted a check-up at the Clinic. He was found to have stomach cancer, was operated on at
once. After he was recovering well, Dr. Charlie decided he could travel to Chicago for a
fitting on some suits he had ordered. While there, he contracted pneumonia and soon died.
Two months later, Dr. Will died.
Retrospect
The little doctor and his two sons were all needed to evolve the Clinic. W.W. Mayo
gave his practice to his sons, and, though they were each hard working and productive,
neither alone could have built the Clinic from structure they took over.
Dr. Will frequently used the phrase: "my brother and I." Dr. Will was usually the
one who spoke and acted and who served as the administrator. They were not alike. Charlie
had a gift for human contacts, Will was inclined to be reserved, dignified, austere, perhaps a
little aloof, and sometimes autocratic. Charlie tended to live in the present, Will in the future.
Will relaxed while river cruising; Charlie while farming. Both were simple, kindly, direct,
unpretentious. Dr. Will enjoyed greater attention and recognition, but Dr. Charlie appears
never to have felt resentment. No wedge was ever driven between the two. If they did not
agree on a plan, it was laid aside or compromised until they did. Will declared: "When
Charlie says no, it means no for me." Both endeavored to keep the Clinic from being an
impersonal machine. The affection between them was real and strong.