In a skylit room about twenty men in white coats crane to observe surgeons and nurses working.

The Origins and Evolution of the Mayo Clinic

Bruce Fye will give the annual James H. Cassedy Memorial Lecture on June 22, 2016 at the National Library of Medicine on “The Origins and Evolution of the Mayo Clinic from 1864 to 1939: A Minnesota Family Practice Becomes an International ‘Medical Mecca.’” Dr. Fye is an emeritus professor of medicine and the history of medicine at Mayo Clinic. He is also a past president of the American College of Cardiology, the American Association for the History of Medicine, and the American Osler Society.  Dr. Fye has authored more than 100 historical or biographical articles and three books. The Development of American Physiology: Scientific Medicine in the 19th Century was published in 1987. His 1996 book American Cardiology: The History of a Specialty and Its College won the prestigious Welch Medal of the American Association for the History of Medicine. Oxford University Press published Caring for the Heart: Mayo Clinic and the Rise of Specialization in 2015. Circulating Now interviewed him about his work.

Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

A formal business portrait.Bruce Fye:  I was born and raised in Pennsylvania and received my BA and MD degrees from Johns Hopkins. I completed a medical residency at New York Hospital-Cornell Medical Center in Manhattan before returning to Hopkins for a cardiology fellowship. I chaired the Cardiology Department at Marshfield Clinic in Wisconsin from 1981 to 1999 and joined the Mayo Clinic in 2000. In addition to being a cardiologist at Mayo Clinic, I was the founding director of the institution’s Center for the History of Medicine.

Having retired in 2014, I am now an emeritus professor of medicine and the history of medicine at Mayo Clinic. In retirement, I am sorting through several large personal collections relating to the history of medicine. These medical collections include about 20,000 books, 10,000 prints and engravings, 10,000 pieces of ephemera, and several hundred pre-1900 letters. I met my wife Lois in high school and we have two daughters, and three grandsons, and have just welcomed a granddaughter to the world. My wife and I have donated more than 9,000 books to Mayo Clinic since 2010 and have established an endowment for the W. Bruce Fye Center for the History of Medicine at the institution.

CN: On June 22, 2016 you’ll be at NLM to talk about “The Origins and Evolution of the Mayo Clinic from 1864 to 1939: A Minnesota Family Practice Becomes an International ‘Medical Mecca.’” Could you give us a little preview of your lecture?

A man in a suit stands by a horse and buggy.
William Worrall Mayo (1819–1911) in Rochester, Minnesota ca. 1900
Courtesy Mayo Clinic Archives

BF: In my talk I will explain how America’s first, largest, and most influential group practice grew up in Rochester, a small town in rural Minnesota. I begin with the birth of William Worrall Mayo in 1819 and end with the death of his two sons in 1939. Many things contributed to the creation of the Mayo Clinic, but three were essential: a family of ambitious doctors, an order of Catholic sisters, and the advent of hospital-based aseptic surgery.

The clinic has its origins in the 1880s, when William and Charles Mayo joined their father’s general practice in Rochester. The Mayo brothers, known as Dr. Will and Dr. Charlie, wanted to become specialists in surgery. They benefited from a unique set of circumstances that catapulted them from a small Minnesota town into an international orbit in two decades. Their success as surgeons owed much to the Franciscan Sisters who opened and staffed St. Mary’s Hospital in Rochester in 1889. After a trip to the town in 1905, Johns Hopkins surgeon Harvey Cushing told his physician-father that the Mayo brothers “have built up a wonderful operative clinic and are well protected by an able staff of internists, specialists, etc. and are little likely to make mistakes. They do as good and as much surgery in their own particular lines as any other two men in the world. It has become worthily quite a Mecca for medical men.”

The growing outpatient practice moved into a custom-designed five-story building named “Mayo Clinic” in 1914. This physical structure embodied a novel concept—a group practice that united patients with several types of specialists who were supported by a large staff. As specialization grew in popularity during the early decades of the twentieth century, residency training began to shape a physician’s professional identity more than his or her medical school experiences. Despite this, historians have devoted very little attention to this critical part of a doctor’s career path. I describe some of the major contributions the Mayo Clinic made to the development of postgraduate specialty training. By the time Will and Charlie Mayo died in 1939, their institution had trained about 1500 residents, far more than any other medical center in the United States. Although the Mayo Clinic is recognized internationally as a leading academic medical center, its main mission remains highly coordinated patient care. The talk will emphasize this aspect of the institution’s history.

CN: Your focus in the lecture is on the period during which the founding Mayo brothers were alive, would you tell us about them?

Two men in scrubs stand in a room full of medical equipment.
Charlie and Will Mayo in an operating room at St. Mary’s Hospital, ca. 1895
Courtesy Mayo Clinic Archives

BF: Will Mayo (1861–1939) and Charlie Mayo (1865–1939) were the central figures in the creation of the Mayo Clinic. Patients, visiting physicians, and almost everyone else who interacted with the brothers noticed how different the surgeons were in many respects. Will Mayo was the dominant figure in their family and in the group practice they established. Harry Harwick, their long-time business manager, characterized him as the group’s mastermind and visionary leader. Harwick, like others who knew Will and Charlie very well, was impressed by the brothers’ devotion to one another. Charlie’s son Charles W. (Chuck) Mayo, who would join the practice as a surgeon, described his uncle as a man with “an aristocratic face and the bearing of a general.” He explained that Will spoke distinctly and dressed impeccably, whereas his father “mumbled and drawled his words” and “could look disheveled in a freshly-pressed suit.” Will’s demeanor and attitudes influenced the clinic’s atmosphere. Harwick explained: “Professional dignity was a religion with Dr. Will. If he saw a young man without clean linen, or unshaved, without his shoes shined, or in any sort of unconventional clothing, or showing facetiousness toward a patient he would call him in and talk to him.” William Braasch, a surgeon who joined the Mayo practice in 1907, recalled that all staff members were expected to conduct themselves in ways that “conformed to his ideas of decency, decorum, and dignity.”

CN: In researching this subject, were you drawn to any particular document or resource?

BF: My search for material about the Mayo Clinic’s history was especially exciting because I had access to a treasure trove of minutes, memos, reports, and letters from the Mayo Clinic’s Archives that other historians have not seen. Two other sources deserve mention. Several dozen visiting physicians and surgeons published their impressions of the Mayo Clinic during the first four decades of the twentieth century. Turning from physicians to patients, I found many fascinating personal perspectives about the clinic and the care delivered there in postcards that patients and their family members mailed from Rochester.

CN: How did you originally become interested in the History of Medicine? What sparked your interest in the history of the Mayo Clinic?

BF: My interest in the history of medicine grew out of a passion for book collecting. Growing up in the 1950s, I collected all sorts of things. During the 1960s my collecting began to focus almost exclusively on old books. As a first year medical student at Johns Hopkins, I spent an elective quarter in the Institute for the History of Medicine. But the real catalyst for my career as a clinician-historian was an opportunity that arose during my cardiology fellowship at Hopkins. I was accepted into the Robert Wood Johnson Clinical Scholars Program, which allowed me to dovetail my cardiology training with an MA program in the history of medicine.

I’m very pleased to be giving this year’s James H. Cassedy Memorial Lecture in light of a service he rendered me thirty-three years ago. Among others, Jim wrote a letter on my behalf in support of my historical research during my time at the Marshfield Clinic. Happily, it worked.

My interest in the history of the Mayo Clinic arose in 2000, when I joined the staff of the institution. The chair of the Cardiovascular Division encouraged me to write a history of cardiology at Mayo. I agreed because it seemed to be a logical extension of my previous research and writing and to be a good way to learn about the institution I was joining. It soon became obvious that I needed to research the origins and growth of the institution before focusing on the evolution of heart care.

Bruce Fye’s presentation is part of our ongoing history of medicine lecture series, which promotes awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All lectures are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.

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