The Mayo Brothers
July 1999
By Annie Feidt

RealAudio 3.0

The Mayo clinic is Minnesota's most famous medical institution. But just over 100 years ago, at a time when many people still called hospitals "death houses", Doctors Will and Charles Mayo were building a successful surgical practice out of a three-room office in an unlikely location: a frontier town called Rochester, Minnesota.

In this month's Minnesota Century series, the story of two brothers who helped transform surgery from a risky option of last resort to a mainstay of modern medicine and made Minnesota an international destination for medical treatment.

WILL AND CHARLIE MAYO liked to say they grew up with medicine like a farm boy grows up with farming. Their father, Dr. William Mayo, was one of the most well-respected doctors in the community surrounding Rochester. The boys went with Dr. Mayo on his horse and buggy trips to visit patients and were invited to watch their father in his operating room. Years later, Charlie described the first time Dr. Mayo needed his help during a surgery.

Charlie: When I was 10 years old, Father had another doctor here to help him remove an ovarian tumor. Will was giving the anesthetic , chloroform, and this Doctor was helping Father but he got sick and fainted. At the time I was peeking through the door, Father called me in and I stood on a box and gave the chloroform, while Will, who was just 14 years old, helped with the operation.

	Dr. C.H. Mayo in the scrub room at Mayo Clinic in Rochester, ca. 1924. Photo courtesy of Mayo Clinic R2.1

Dr. Mayo had successfully removed a number of ovarian tumors and was gaining a reputation as a skilled gynecological surgeon. But in the early 1880's, even a skilled surgeon could not offer his patients a very good chance they would survive. Abdominal surgery, especially, was extremely risky. Many doctors had the technical skill to perform surgery, but very few understood how to prevent post-operation infection.

Gunn: When people began doing more abdominal and gynecological surgery failure rates were pretty high.

Jennifer Gunn is an assistant professor at the University of Minnesota's history of Medicine program.

Gunn: Ovariotomies and the removal of ovarian tumors had about a 60% fatality rate. But when you realize that some of these tumors weighed as much as 60 pounds, and were basically pressing the life out of these women anyway, surgery seems like an acceptable option.

British Dr. Joseph Lister had carefully laid out directions for avoiding such a high fatality rate decades earlier, in 1867. But his theory of how a steam spray of carbolic acid, could erase bacteria from the air and reduce infection was only slowly gaining acceptance. Doctors didn't want to believe that their own hands, which looked clean, could be passing deadly bacteria to their patients.

	Dr. W.J. Mayo in the scrub room at Mayo Clinic in Rochester, ca. 1924. Photo courtesy of the Mayo Clinic. R2.1.

In 1880, the Minnesota state committee on surgery flatly rejected Lister's theory of antiseptics.

Lister: In this pure and bracing air and comparatively thinly settled country, there does not seem to be the need for that strict and methodical attention to the Listerian details that may have been found necessary in some crowded hospitals, whose very walls reek with the odor of generations of patients.

Dr. Mayo followed the state's lead and continued to perform surgery in unsanitary conditions. The doctor's earlier surgical notes hint he even took a certain amount of pride in every successful surgery he completed without the help of antiseptics.

In 1885, Will Mayo, who had just graduated from medical school, went to New York to take a short internship with a famous eastern surgeon. The man had adopted Lister's methods and had results to prove its effectiveness.

Will returned to Rochester a month later and, over time, was able to convince his father that antisepsis could push his surgical success rate even higher.

	The operating room at St. Mary's Hospital in Rochester. 1893. Photo courtesy of the Minnesota Historical Society. mo5.9 RC7.15/r15.

In the fall of 1888, after years of assisting in his father's operating room, Will had his first big test as a surgeon. While his father was in St. Paul consulting on a surgical case, Will was called to the home of a patient who was suffering from a massive ovarian tumor.

Will: She had a tumor that weighed 107 pounds. They had a narrow sofa in the living room, and she laid down on that. Normally thin, she was now a very large woman and she had a bad burn on her abdomen, due to the fact that something on the stove was burning and she had reached for it and burned herself. I asked her to move a little on the sofa and she started to roll and went onto the floor. I had a terrible time getting her up onto the sofa again.

Father was in the twin cities and could not operate until the following day. The whole family of this woman was gathered and a group of doctors had come from the surrounding country. Her family insisted that she have surgery to remove the tumor and asked if I could not do it. I said, "Yes, I think I can."

The doctors crowded around and I took out the biggest thing you ever saw. Her tumor filled an entire washtub. The woman recovered well.

From that time on father let me do any operation I wanted.

At the time, all three Mayo doctors were practicing out of a three-room office in downtown Rochester. But one year later, they were able to move their growing practice into Rochester's new St. Mary's hospital. Their new quarters were the direct result of a tornado that had devastated the town five years earlier.

The tornado hit the town on a muggy day in August, 1883. Will and Charlie were out at a slaughterhouse to get pigs heads for practice eye operations that night. In a 1932 interview, Charlie described what happened when the brothers started home in their single-horse buggy.

Charlie: We had to cross a bridge at the north end of town and before we had gone two blocks after crossing the bridge it went down and was smashed to pieces. A streak of wind came by. I looked up the railroad tracks and saw a big grain elevator tip over. When we got to town, lots of people came running up to us saying a great many people were killed. We opened up the roof on the old Dance Hall, and converted it into a place to care for the injured.

	The operating room at St. Mary's Hospital in Rochester. 1893. Photo courtesy of the Minnesota Historical Society. mo5.9 RC7.15/r14.

The city council asked the elder Dr. Mayo to take charge of the make-shift hospital. Mother Alfred, the mother superior at St. Francis convent organized the nuns to help. Mother Alfred's work at Rochester's temporary hospital convinced her the town needed something more permanent. But Dr. Mayo was not convinced. At the time, hospitals were little more than state run institutions where contagious patients could be kept from the general public. Dr. Mayo and his sons did agree to staff the hospital if she pulled together enough money to build it. It took five years, but she did raise the money, and in 1899, St. Mary's hospital opened up on nine acres of wooded land just west of the city limits.

St. Mary's location very near the geographic center of the country was, in many ways, the Mayo's ticket to surgical expertise. Many Midwesterners had "goiters", a disfiguring growth of the thyroid gland. Doctors later learned that enlarged thyroids were caused by a lack of iodine, which is mainly found in fresh seafood. Today, salt is iodized and the problem has virtually disappeared. But before the turn of the century, Minnesota was positioned at the heart of the national goiter belt. Again, Professor Jennifer Gunn.

Gunn: One of the cases of where the Mayos got a lot of specialized practice was goiter surgery which was very dangerous and much to be dreaded and avoided if at all possible, it was a last resort kind of surgery. But because they lived in the Midwest and because they saw many more cases of goiter than even surgeons on the east coast, they developed a lot of skill in that particular operation. And it is an operation that, because of the location of the goiter on the neck, that requires very fine motor skills.

The three Mayo doctors worked together on the first goiter operation performed in the new hospital's operating room. Will said the goiter was the largest he'd ever seen.

Will: The huge tumor was a degenerating thyroid, and the man had great difficulty in breathing and was in a very serious condition. The patient's condition was precarious, and I knew, that whatever happened, the tumor must come out. We put him on the table, using a small amount of the old anaesthetic mixture, one part alcohol, two parts chloroform and three parts ether.

We incised the skin and superficial tissues covering the mass and quickly removed the tumor with our hands. The bleeding was profuse but I had prepared some turpentine in a bowl and placed a large sponge in it to become saturated. The minute the tumor was out, the sponge soaked with turpentine was placed in the cavity from which the goiter had been removed, and the wound was sutured tightly over it with a hand needle to compress the sponge in the bleeding cavity. A large dressing was bandaged in place as tightly as the patient's breathing capacity would permit. After some days the incision was opened and the sponge removed.

Their reputation as goiter surgeons grew and by 1904, the Mayos reported a total of 68 operations with a failure rate of only three percent.

But the Mayos practice wasn't limited to just one kind of surgery. The brothers treated patients with eye, throat and abdominal tumors, gall stones, hernias, appendicitis and gastric ulcers and were soon receiving referrals from all over the state.

Gunn: They really tried to develop their surgical practice and their expertise and their ability to draw patients to them for surgery. And it is the case of the more practice you get, the better you get. So somebody who's doing a general practice and seeing cases of infectious disease as often as they are of injuries and accidents or tumors doesn't get the same kind of surgical practice as the Mayos.

Doctors from around the country were beginning to take notice. But they were skeptical too. In 1899, William Mayo wrote an article describing the brothers experience with over 100 gall stone operations and he submitted the paper to American Journal of Medical Sciences. The editor of the journal couldn't believe that two brothers from a small Midwestern town could have possibly seen so many gall bladder cases and sent the article back with regrets.

But slowly, the Mayos did gain a national reputation. They often traveled east to watch skilled surgeons at some of the country's best hospitals and gradually convinced these doctors to visit their small hospital in Rochester. When surgeons came to St. Mary's, they were almost always impressed with what they saw. One English surgeon who was a fellow at the hospital summed up the sentiment.

The most amazing thing of all about the hospital is the fact that five hundred members of the most highly individualistic profession in the world could be induced to live and work together in a small town on the edge of nowhere and like it!

In 1912, Will and Charlie realized they had outgrown St. Mary's hospital and began building what would soon be called the Mayo Clinic. The year the clinic opened in 1914, more than 30,000 patients were treated, an impressive statistic for a town with a permanent population of less than 8,000.

The Mayo brothers continued to see patients and perform surgery until the late 1930s, when Will and Charlie finally retired. In 1939, the brothers died within two months of each other.

Some sixty years later, the brothers might not recognize their clinic. It's grown to include three sites where doctors treat more than 400,000 patients a year from every state in the U.S. and 150 foreign countries.