THE AUTHOR AND COTTAGE ON BIG STONE LAKE 
WHERE THE STORY WAS WRITTEN. Rochester and the Mayo Clinic 
A Fair and Unbiased Story Calculated to 
Aid Physicians to Greater Cures 
and Larger Incomes 
BY 
GEORGE WILEY BROOME, M. D. 
THE SHAKESPEARE PRESS 
114-116 E. 28th St. 
New York. 
1914 Copyright, 1914, 
by GEORGE WILEY BROOME FOREWORD. 
Why I Have Written Up "The Lourdes of the 
Press." 
For the last several years the question, "What is the 
matter with the medical profession?'' has been discussed 
most extensively both in the medical press and by the 
physicians of this-country .in. .general. Every now and 
again, the medical -journals, publish an editorial or an 
article by some tbntributor in. which this question is 
asked. The question may vary slightly in form, but the 
persistence of its recurrence and the attempts made to 
answer it, indicate clearly enough that there is some- 
thing radically wrong in the ranks of the medical pro- 
fession. 
The literary pages of most of the medical journals 
seem to be growing lean in contributions from the great 
mass of the profession. There is likewise a dearth of 
advertisers, perhaps not so apparent in the "Journal of 
the Association" because of its peculiar relations to the 
general profession. But the subscription lists of many 
of the medical magazines are dwindling away, and the 
great majority of doctors over the country are complain- 
ing over present conditions. There is a perceptible lack 
of enthusiasm in all of the medical society meetings, held 
in the different states and districts. The societies no 
longer flourish as in former years. The "Journal" is 
now and has been for some time preaching the gospel 
of ethical reform, but still the life of the average doctor 
3 4 
Rochester and the Mayo Clinic 
seems to be growing harder and harder, until prosperity 
has almost faded from his ken. 
The motives of the "Journal" are no doubt of the very 
highest character, but have the reforms instituted and 
carried into effect benefited the great mass of the pro- 
fession? Whether true or not, it has been alleged that 
these reforms have resulted advantageously only to a 
few. Others have alleged that there seems to prevail too 
much paternalism over the physicians, their literary con- 
tributions, and policies of the state meetings, by the 
national official organ. If true, this may tend to dampen 
the ardor of the average medical enthusiast. This pa- 
ternalism over the profession no doubt helps to exercise 
a persuading influence over the advertiser as well. In- 
deed, the "Journal" seems to enjoy something of a 
monopoly in medical advertising. At all events, the 
publication is able to maintain a commercial status that 
makes the medical publications not enjoying the same 
privilege and authority look cheap by comparison. The 
pages of the copy of the "Journal" I have before me 
are divided about as follows: 
Twenty pages to clippings and the like; io pages to 
items and the like; 6 pages to editorial matter; 78 pages 
are devoted to the exploitation of advertising matter, 
and only 20 pages remain for the 56,000 members of 
the Association and subscribers to the "Journal," on 
which to express American medical thought. 22 pages 
more are given up to advertising than to all of the 
other matter combined going to make up the issue. 
That there is manifest assumption of autocratic power 
over the profession to be seen in the editorial columns 
of the "Journal," may be too true. Anyway, it is more 
than true that the editor's literary discrimination is 
limited to contributions from certain sources. I guess it Rochester and the Mayo Clinic 
5 
is difficult at times for the editor to distinguish impar- 
tially the ethical from the unethical. Even in this 
instance it seems a hard task to find merit in others when 
judgment is to be based wholly upon the inspiring ideals 
of his own splendid career. 
Current reports appear to approve the judgment that 
most doctors have neither the time nor the means to 
emulate examples set for them by the medical editor, 
but are toiling desperately to make both ends meet. 
Briefly summed up, the viewpoint of the great mass 
of doctors throughout this country remains decidedly 
pessimistic. However, this does not prevail in all 
quarters of this country, i. e., not all doctors are in the 
slough of despond. For example, take the country vil- 
lage of Rochester, up in Minnesota, where the Doctors 
Mayo practice their profession. Here there is not a sign 
of the pessimism that is pervading the ranks of the 
general profession. There, indeed, optimism is rampant! 
So it seems to me that those in the profession who 
are experiencing the stings of adversity should first aim 
to answer the question why it is that a certain few medi- 
cal men, living in a remote country district, can enjoy 
extraordinary prosperity, while the great mass of doc- 
tors, distributed in cities and larger places, cannot do so. 
What is a possible explanation? The doctors at 
Rochester have not only become widely celebrated, but 
they are very popular with the people everywhere, a 
popularity which is approved by the medical press and 
carefully and solicitously fostered by the daily press. 
Posted upon the desk of one of the Rochester surgeons 
may be seen the following quotation: 
"Have something the world wants, and tho you dwell 
in the midst of a forest, it will wear a beaten pathway to 
your door." 6 
Rochester and the Mayo Clinic 
Surely a well-chosen slogan. 
It is told that, while Rochester is only of village size, 
the publicity given its surgeons has made its name 
familiar to persons in all parts of the world. The early 
history of Rochester and its doctors, from the profes- 
sional viewpoint, appears most anomalous. It is almost 
startling to learn that from simple and infertile sur- 
roundings, with only the crude advantages of pioneer 
schools, the surgeons of Rochester succeeded in attain- 
ing a most flattering position in the profession very early 
in their career. The further the inquiry is extended 
into the history and circumstances surrounding the rise 
of these doctors, the conviction grows correspondingly 
strong that, very early in their professional lives, they 
must have learned the lesson of how real progress is 
hurriedly accomplished; that is, one is led to believe that 
"to learn to labor and to wait" is a maxim that fails to 
appeal to some because lacking in quick results-that a 
still shorter cut to fame and fortune may be pursued 
to the coveted goal without the vexatious trials that are 
usually encountered in the first stages of professional 
life. It is found that shortly following the introduction 
of the Doctors Mayo to the practice of medicine, the 
professional writers made use of the following phrases: 
"The Mayo brothers early in their career became 
enamored of the marvelous handiwork of the Creator," 
and "the marvelous skill with which the Mayos handle 
their instruments has amazed the world." Again, "from 
every state in the Union, from almost every country in 
the world, sufferers journey to this place to feel the 
magic of the four hands that perform the surgical 
operations," "America's Greatest Surgeons; the fame of 
these doctors is world-wide. They are noted for the 
cleanest work in surgery on record, and altho they have Rochester and the Mayo Clinic 
7 
made no discovery of new methods, or of any new surg- 
ical cures for malignant diseases, they have 'covered' all 
modem methods, and reduced them to their ultimate ac- 
curacy." "It was not that the Mayo boys were so bril- 
liant but that they were ambitious in the right way, eager 
to learn and able to take and make chances. By the 
time they had been at work for ten years, their names 
had become familiar to everyone doing serious surgical 
work in America. It is no wonder then, that one of the 
trains that comes into Rochester from the West is called 
the Hospital Train because so many ailing persons 
travel by it." 
In an interview between Dr. Wm. J. Mayo and a 
public press writer, the former stated: "Some men 
at 35 reach the summit of their mental development 
while other men are receptive at 70. It isn't the age that 
counts." This may have some bearing upon precocity. 
St. Louis, Jan. 1, 1914. INTROD UCTION-OB JECT. 
I have a two-fold object in writing these pages. One 
is to satisfy a desire to be occupied while resting physi- 
cally, and mentally recreating away from home and 
work; the other is to make a careful record of my per- 
sonal observations of professional conditions at Ro- 
chester. It has been my habit for many years to take 
a vacation during midsummer and midwinter, and on 
each occasion I have assiduously cultivated the habit of 
filling out the vacations with some special mental em- 
ployment. 
My recollection in regard to this goes back about sev- 
enteen years, to a trip which I made in company with 
the late Dr. Senn, when I became a witness of his mar- 
velously industrious habits. It was the summer of 1896, 
and was passed for the most part on the coasts of Maine 
and Nova Scotia. On this trip he wrote the first edition 
of the text-book, "Pathology and Surgical Treatment of 
Tumors." This work proved to be a comprehensive, 
scientific study of tumor formation, rare in originality. 
He wrote this great book in most part offhand and 
without extensive references. When leaving home to 
join Senn at Chicago, I placed in my suit-case a small 
hand-book I had just purchased, on "Histology and Em- 
bryology," by Dr. Geo. A. Piersol, of Philadelphia. This 
little work I handed to Senn after reaching Scarboro 
Beach. He had not seen the book before, but found it 
of sufficient importance to incorporate some of its text, 
9 10 
Rochester and the Mayo Clinic 
and at the same time marked points in his manuscript 
for the insertion of some of the illustrations. In pass- 
ing, it may not be out of place to add that this small 
book from Dr. Piersol's pen formed the nucleus of what 
is now the most expensive single volume on "Human 
Anatomy" published in any language. So far as I know, 
aside from this short reference work, Senn wrote all 
of the matter forming the text of the "Pathology and 
Surgical Treatment of Tumors" from memory. He had 
had, however, the composition of this work in mind for 
several years, and when he commenced writing the chap- 
ters, his brain was so well stored with knowledge of his 
subject, that he was able to write rapidly and without 
hesitation. 
While writing this great book, he worked all day and, 
for aught I know, all night. At all events, I was led to 
believe that he slept but little, for about every day, an- 
other chapter had passed through his hands to comple- 
tion. There were thirty chapters of this first edition 
of about 4,000 words each, nearly all of which were 
written offhand and as rapidly as he was able to use his 
pen. So it may be imagined how much of the day and 
night his brain was at work, and he himself occupied, 
in order to complete the tremendous task before him, 
and in such a short period of time. 
There is a little story about the MS. for Senn's book, 
that I shall briefly relate here. On reaching home, Senn 
notified the Saunders Publishing House at Philadelphia 
that he had completed the preparation of MS. for a book 
on the "Pathology and Surgical Treatment of Tumors"; 
that he found many important surgical cases awaiting 
him at Chicago and that he doubted his ability in conse- 
quence to find time to look after the proof-reading. 
Would the publisher take the MS. and make the best 
of it? Mr. Saunders replied that he would send his Rochester and the Mayo Clinic 
11 
check for $5,000.00 in payment of the manuscript and at 
the same time promised to bother Senn but little in its 
publication. Senn accepted the proposition. 
When Senn finished the first chapter, he suggested 
that I write an abstract of each chapter of the book as 
it was completed. This I did, and later made an ab- 
stract of what I had written, and read the same before 
the St. Louis Medical Society. I must mention here 
what I found to be a most remarkable fact-that is, the 
absence of any evidence to show that Senn ever found 
it necessary to make a single change of any word or 
sentence in the original draft of each chapter. Few 
noted scholars were able to do this. 
After leaving Chicago on this trip, Dr. Senn told me 
about a speech that Professor Chaplin, Chancellor of 
Washington University, St. Louis, had delivered at Bos- 
ton on the subject of "The Wild and Wooly West." Dr. 
Senn thought the speech was particularly severe on medi- 
cal college methods in St. Louis, and expressed himself 
in a manner that led me to think that some one loyal 
to the educational institutions of St. Louis should write 
a defense against the Chancellor's charges. Being at 
this time away from St. Louis and St. Louis people, I 
took it upon myself to make a reply. I then sent what 
I had written to Mr. Stephen A. Martin, who was then 
on the editorial staff of the St. Louis Post Dispatch, a 
newspaper always to be found on the firing line in the 
defence of St. Louis and its rights. My story was 
promptly published, and created quite a stir among the 
leading people of St. Louis, and particularly among the 
members of the various college faculties. Chancellor 
Chaplin no longer resides in St. Louis, having given up 
his connection with Washington University several 
years ago, but I understand that he has not yet entirely 12 
Rochester and the Mayo Clinic 
recovered from the fusillade of criticism directed against 
him by the Post Dispatch and citizens of St. Louis. 
The trip previously referred to up to St. John's, New 
Brunswick, from Scarboro Beach, proved exceedingly 
interesting to Senn. The stay at the former place gave 
him quite a respite from his work. The wonderful tide 
coming in from the Bay of Fundy greatly excited his 
curiosity. Here the tide rises nearly to seventy-five feet, 
and conies in with such a rush that one finds it necessary 
to hurry away from the low water level in order to 
save oneself from being swallowed up and carried out 
into the madding depths. Senn immensely enjoyed the 
mad rush of the waters dashing high up against the 
rocky cliffs. After a few days, we embarked on a boat 
plying between St. John's and Digby, Nova Scotia. At 
the latter place, Senn got down to writing again in earn- 
est. We intended to extend this trip abroad, but finding 
the weather conditions here much to our liking, we re- 
mained most of the time in the Canadian country. 
On each vacation since, I have found a way to employ 
my time. The last several have been passed in writing 
a biographical sketch of the life of Dr. Senn, who died 
January 2, 1908. Of course the inspiration that led me 
to turn these periods of time into something worth while 
came to me thru witnessing the industrious habits of 
Senn, for the spirit of industry overpowered every hour 
of his career, and even in the quietude of his own home, 
he could nearly always be found among the books of 
his immense library or at his writing desk. He knew 
nothing personally about physical or mental fatigue. 
The results of my own work on these vacations are 
mighty small in comparison with those of Senn, it is 
very true. But, at all events, I succeeded in accomplish- 
ing my chief aim, that of keeping myself observantly 
occupied while going about and witnessing scenes in the Rochester and the Mayo Clinic 
13 
outside world. I experienced much profit in many ways 
by these employments, even tho of a modest character. 
The work afforded me not only pleasant and profitable 
pastime, but relieved my mind of the idea of spending 
these vacations wholly in idleness. 
"Give me life in fullest measure: 
Duty done, my greatest pleasure: 
Work achieved, my heart's best treasure." 
-Writer's Magazine. 
I have worked laboriously on the before-mentioned 
biography, and for a much longer period of time than I 
would have were I a ready and rapid writer. So much 
time has been consumed, perhaps, in consequence of the 
fact that my thoughts usually come slowly, and that I 
am slow to phrase them satisfactorily when they do 
come into my mind. The expert surgeon becomes so 
by constant practice, and the same may be said of a 
good writer. He must be constantly writing in order 
to achieve excellence. 
My observations lead me to think that there are other 
essentials necessary to be acquired in order to make 
one either a good writer or a good surgeon, other than 
mere practice. The surgeon must bring into his prac- 
tice honest, faithful, and intelligent work, and a good 
writer should not find it necessary to hesitate for a 
word. The subject of my biography never did; he also 
brought intelligence and honesty to bear upon his prac- 
tice. Some writers have a much larger vocabulary than 
others. There are now about 450,000 words in the Eng- 
lish language. Many professional men and many writers 
do not use more than 15,000, but I judged that Senn had 
at his command about 40,000 words. I have great ad- 
miration for the following two lines from the pen of 
the Duke of Buckinghamshire: 14 
Rochester and the Mayo Clinic 
"Of all the arts in which the wise excel, 
Nature's chief masterpiece is writing well." 
Under the inspiring influence of my association with 
Senn, together with the advice of Dr. Samuel Johnson, 
the author of Rasselas, that "the use of traveling is to 
regulate the imagination by reality and instead of think- 
ing how things may be, to see them as they are," I was 
led to make Rochester the objective point of my sum- 
mer's vacation. 
The ensuing pages are a record of my impressions and 
observations. 
The Author. ROCHESTER AND THE MAYO CLINIC 
THE LOURDES OF THE PRESS 
"If any man is able to convince me that I do not think or 
act right, I will gladly change, for I seek the truth by which no 
man was ever injured; but he is injured who abides in his 
error and ignorance."-Marcus Aurelius. 
The scope of these pages is based upon personal ob- 
servation and study. Tho some seemingly extraneous 
matter has intruded itself in the chapters of my story, 
it is purposefully intended to accentuate my impressions 
of the more important surgical aspects of St. Mary's 
Hospital, its clinic, and the surgeons. The whole deals 
only and entirely with facts-evidential facts, without 
the use of adulatory language, expressions of exagger- 
ated compliment or ornate divertisement. 
There have been a great many articles written in a 
most fulsome and complimentary style about the Doc- 
tors Mayo, but I have not seen any confined strictly to 
plain, hard facts. I am led to venture the belief that 
medical men everywhere, and especially those who have 
not had the opportunity of personal contact, and the 
privilege of witnessing the busy scenes at his far-famed 
place, and studying them from their own personal view- 
point, might find a narrative of simple truths of some 
interest. 
Actual contact would more than likely color the view- 
point of any disinterested observer, and would have the 
effect of impressing the mind against the ornate methods 
15 16 
Rochester and the Mayo Clinic 
of the professional writer. It is admitted at the outset 
that there have been few doctors known to medical his- 
tory who have gained such swift and wide popularity 
and have retained it so securely; and, I ask myself, 
what is the real secret of it all ? 
I was quickly informed after reaching Rochester 
that these doctors have grown big as surgeons-big in 
the voice of the medical world-big as authors; big in 
the counsels of the American Medical Association and 
its prosperous "Journal," and also big as financiers. 
I might as well confess here and now that the senti- 
ment that I find myself forced to express will neces- 
sarily convey a meaning somewhat converse to that 
which would have followed had I written before I visited 
Rochester and came into personal contact with the 
various things of general medical interest. That is to 
say, had I written a story about Rochester and its famous 
doctors, basing its text wholly upon impressions that 
came to me second-hand, the story would have been 
written in a style somewhat more compatible with the 
sonorous roll of praise sounded forth in so many of 
the articles about the Mayos. Hence this narrative will 
no doubt prove enharmonic with most of the Parnassian 
praise heretofore printed and said about Rochester and 
its celebrated surgeons. But I must here emphasize the 
fact that what I shall say is not influenced by bias in 
any form. If in any particular this recital is found to 
be faulty, the error must be charged to error of sight 
and not to prejudice of mental vision. The extracts 
taken from the various stories published in the several 
lay magazines about the Rochester surgeons are given 
later on for the reason that they constitute a part of my 
search for the helpful influences that seemed to guaran- 
tee the rapid rise of these men and their widely recog- 
nized popularity. The particular problem I wanted to Rochester and the Mayo Clinic 
17 
solve was, "What were the actual potentialities that aided 
them in achieving the great fame they have enjoyed 
almost from the beginning of their professional career?" 
I wondered if the early molding of this lofty destiny was 
alone the handiwork of innate genius and perspicacious 
inheritance. Certainly, it is a truism that genius and 
wisdom, like destiny, know no local habitation. 
"For genius is a deathless light 
That still burns on thru darkest night; 
It fires a steady lamp, whose rays 
Descend thru time as stars thru space; 
Tho twice a thousand years be fled, 
We still repeat what TEsop said." 
No one would think that spectacular practices alone 
could ever bring fame into any field of scientific activity. 
Whatever the chief factors, I was curious to know 
something about them. I was curious to know 
how it was that these young country boys became 
"enamored of the marvelous handiwork of the Creator" 
at such an early age as has been said. Early writers 
have told us that "the marvelous skill with which the 
Mayos handle their instruments has amazed the world." 
Again, it is said and many times repeated that "from 
every state in the Union, from almost every country in 
the world, sufferers journey to this place to feel the 
magic of the four hands that perform the surgical opera- 
tions. The Mayos have given their lives to relieving 
the physical sufferings of humanity, and the door of 
hope has never closed upon a man because he could not 
pay." The intenseness of this curiosity was all the more 
increased by reading the following: 
"No other Mecca of physical suffering in the world 
is so unique as St. Mary's Hospital in the little city of 
Rochester, Minnesota, where the Doctors Mayo pursue 
their marvelous work. There is real and sincere mod- 18 
Rochester and the Mayo Clinic 
esty among the Mayos, so much so, that they will be 
genuinely distressed when this little article is brought to 
their attention. They do not understand that in their 
case publicity is simply the gratitude of the world trying 
to express itself." 
Rochester history shows that its now celebrated surg- 
eons did not have to wait or undergo years of struggling 
effort in order to establish themselves in practice and 
achieve reputation. Prosperity came without special 
training, equipment or many years of waiting, and while 
in the midst of infertile literary surroundings, rose to 
the flattering position of "the greatest surgeons in the 
world," and at the same time "maintained a characteris- 
tic and unique modesty that has surprised the world." 
As generally accepted, this word "modesty" is some- 
thing of an Americanism, but unique modesty is some- 
thing even more extraordinary. In the press notices the 
word "modesty" is used frequently, and I was led to 
wonder how it is possible for any single staff of doc- 
tors to handle during one year, say, twenty-five thousand 
patients, and during all that time maintain not only a 
characteristic modesty but a unique modesty. One writer 
said: "A glimpse into the Mayo offices reveals a motley 
crowd, millionaire and pauper, plebeian and prince have 
left differences of rank without to join the army of 
human sufferers in search of health within." It is but 
natural for one to believe that this motley crowd, re- 
ferred to by the writer, has moods; temperamentally 
some of them may manifest at times a stinging negative 
to all the charms of modesty, and in a manner excite the 
positive pole of resentment. Hence it is hard to under- 
stand how these hundreds of solicitous and moody 
patients can be handled, and at the same time the doc- 
tors remain able to maintain a modest bearing. There 
are necessarily many trying situations between the rcla- Rochester and the Mayo Clinic 
19 
tions of doctor and patient. A large part, of course, is 
purely business, and the very busy man cannot always 
remain modest; and to maintain, while handling a large 
number of patients annually, both a characteristic and 
unique modesty, I am sure is beyond the ordinary doc- 
tor. Perhaps many times when the term modesty is 
used, the writer meant to convey the impression that 
these popular doctors were able to suppress all evidences 
of the vanity of fame. 
Still there is an atmosphere about the place pointing 
to a mild infection of the vanity of fame. An instance 
of this was apparent in the publicity quarters of the 
Mayo firm. I asked one in charge of this department, 
"In what estimation does the Mayo firm hold the works 
of the late Dr. Senn?" The reply was to the effect that 
"our doctors here" had gotten so far in advance of Senn's 
teachings and his day that they did not now take time 
to think about him. 
Until well along in the eighties, these two brothers 
were plain farmer boys, and had only the early simple 
life experiences of all farm boys, and now at the end 
of a few years, their reputation as surgeons has ex- 
tended to nearly all quarters of the world. At the time 
they took up the study of medicine, they were living 
with their father in the country, with only the educa- 
tional advantages afforded by the common schools of the 
simple, pioneer days. These common public schools, as 
every one knows, in their early organization are not usual- 
ly able to impart more than the crudest preliminary edu- 
cation, for these hurried and imperfect country schools 
are mainly due to the circumstances of rapid pioneer de- 
velopment of their respective sections and are, in conse- 
quence, only fitted to teach elementary studies. 
Hence, it is not strange that one is led to marvel much 
over the remarkable history of these "greatest surgeons 20 
Rochester and the Mayo Clinic 
of the world/ reaching this position in the professional 
world so soon after leaving the plow. There, are, how- 
ever, many striking examples in history tending to show' 
great achievements in after life by the farm boy; but 
rather by slower progressions. Carl Gerhart Haupt- 
mann turned his two acres a day on the farm until he 
was eighteen years of age. In 1912, the Nobel prize of 
$40,000 was awarded to Hauptmann for literature. But 
after attaining the age of eighteen, he had the advan- 
tages of studying in several of the universities of the 
old world, yet he hardly rose to distinction until fifty 
years of age. But studying literature as Hauptmann did 
before he was able to win his prize, on the one hand, and 
bringing the masses of afflicted people and the public 
press under a seeming spell, are entirely different pro- 
cesses. 
It is more than a twice-told tale that most people are 
likely to think a man who has much intellect possesses 
it to the detriment and at the expense of his other hu- 
man qualities, and possibly that is measurably true. But 
there have been instances when a man has been intel- 
lectual, and reasonably, even if not effusively, human; 
doubtless there are many of these instances in the pro- 
fession. 
Great achievements from crude beginnings might be 
used as an argument against the customary series of long 
years of university training, such as are required abroad, 
and as is the modern trend in our country. Nowadays 
everyone who makes any pretension to a higher educa- 
tion, and who is ambitious to join the cultured classes, 
must submit to the university custom. We know that 
no man has for many decades had the opportunity or 
the hope of occupying positions of distinction and at- 
taining to greatness in a profession abroad, especially as 
a teacher in medicine, without first having served the Rochester and the Mayo Clinic 
21 
required number of years. Qualifications fitting one 
for these positions are not based upon the results of 
examinations but upon the time spent in preparation 
and study. The sentiment at Rochester, I think, is some- 
what complex, but apparently opposed to what was 
formerly prevalent as purely an Americanism: "machine- 
made" methods of education. I gather this information 
from the following quotation taken from one of their 
reprints: 
"In comparing the Italian and American plan of 
education, Italy is not the loser. In the United States, 
from the time the child enters the first grade, he is 
harnessed up to a system which ends in the university, 
and always with the direct intention of fitting him to be 
President of the United States. The mere fact that 
only a small percentage of these students ever reach the 
University, or have an opportunity to become the Presi- 
dent, counts for nothing. Everything in America must 
be 'machine-made,' without any possibility of develop- 
ing individuality in our country schools; nothing is taught 
concerning farm life, the growth of grain, or anything 
in the way of agricultural pursuit; neither in the manu- 
facturing districts is there any educational variation 
with the view to the future employment of the indi- 
vidual." 
Possibly we might find justification in here dismissing 
the whole problem of education so far as it had to do 
with the embarkation upon their career of the Doctors 
Mayo, with the following quotation from the article, 
"A Medical Pilgrimage Westward," printed in the In- 
dependent Magazine. Speaking of St. Mary's Hospital, 
and the Mayo boys, the writer says: 
"The history of this little hospital at Rochester is 
worth while tracing. At first it was placed in charge 
of a country practitioner who did all sorts of medical 22 
Rochester and the Mayo Clinic 
work. This was Dr. W. W. Mayo, then quite an old 
man. His two boys raised on the farm-there are some 
great things raised on the farm besides ordinary farm 
products-got an introduction to medicine in their 
father's office and then went off to medical school." So, 
from this, it would seem that to the soil of this farm 
there is due a large share of credit for what the doctors 
are today. 
WITHIN SIGHT OF ROCHESTER-FIRST IM- 
PRESSIONS. 
The railway train approached Rochester from the east, 
winding down into the Zumbro valley from the hills. 
It was just before twilight, when the brilliant sun had 
almost reached the serried summits of the distant domes 
in the west, and the lengthening shadows silhouetted 
the rugged bluffs beyond, lending a charm to the scene, 
as well as joy that we were now ending our tedious pil- 
grimage. At first sight, the station and surroundings 
reminded one of the railway station and usual scenes 
witnessed on arriving at St. Augustine, Florida. The 
picture was perfectly true, especially to the varied sorts 
of vehicles awaiting and in readiness to drive one away. 
They were of the same antiquated type. I found a dif- 
ference, however, in the color of the drivers. Heie, 
they are all white; down in Florida, they are all black. 
The crowd of people present at the little Rochester 
station on the arrival of the Chicago & Northwestern 
train, on which I was a passenger, gave to the place a 
real holiday and festive appearance. Possibly, I thought, 
a circus might be in town. I discovered later that such 
was really the case, for, in company with Dr. Sanderson 
of Detroit, I walked to the circus grounds on the fol- 
lowing evening, and the line of people headed in the Rochester and the Mayo Clinic 
23 
same direction seemed to be almost endless. "Later we 
took a ramble together to see the great curiosities of this 
great town." (Addison.) But I found that during my 
entire stay at Rochester, every day seemed much like a 
holiday; that is, the spirit of a day like the Fourth of 
July remained perennially in evidence. The crowded 
sidewalks, the people in holiday attire, the hurrying 
vehicles, made up a picture of real holiday charm in a 
delightful old country village. It was much the same 
every day. The automobiles I judged were for private 
use, but it was the horse vehicles that gave picturesque- 
ness and life to the streets. These conveyances were 
for hire. Much of their business was done with patients 
wanting to go to the surgeons' offices, St. Mary's Hos- 
pital, and between . there and the various rooming 
houses in and about the town and railway station. Now 
and again, one might see strangers driving about for 
pleasure and sight-seeing. Such a trip would always be 
made to take in "Mayo Park," an attractive and inter- 
esting playground, the pride of Rochester because it was 
a gift from the Surgeons Mayo to its people. The 
people of Rochester are proud of the gift too because it 
came from the now famous men who had passed their 
boyhood days among them-from these two of their 
number who, by a life of diligent endeavor, had at- 
tained a distinction among the people of the country 
seldom achieved in the span of human life. Because, too, 
of the eminent reputation of these brothers and citizens, 
the name of their home town, Rochester, had become 
known all over the world, and over this fact, there is 
deep-felt gratitude in the heart of every man, woman 
and child. But to walk up and down the main street, 
particularly in the vicinity of the Mayo offices any 
afternoon, to look into the faces of the people slowly 
passing to and fro or gathered about in the offices, one 24 
Rochester and the Mayo Clinic 
is inclined to realize that a vast majority of the strangers 
at Rochester belong to the ailing class, and are there 
for the purpose of seeking relief. The Mayo offices 
are the magnet that attracts the afflicted from every 
point of the compass. Here it is that the patients 
gather, scores of them, every afternoon. A certain 
anxiety is pictured on each face, and the countenances 
depict the results of suffering from some mental or 
physical derangement. Some of them, enfeebled by age 
and other infirmities, are seen tottering toward the of- 
fices leaning heavily upon the arm of a son, a daughter 
or attendant. Some are unable to arise from the roller 
chairs in which they are being wheeled along to their 
last hope. There go several with immense tumor 
growths from the thyroid gland; many of these with 
large protruding eyeballs. Here come the pitiful vic- 
tims of cancer, with the faces of some and the necks of 
others half destroyed by that relentless disease that 
never ceases its destructive work until its host succumbs. 
All of these people, it is natural to presume, have under- 
gone treatment elsewhere, but were turned away as 
hopeless, and now the lure of Rochester gives them re- 
newed courage. Among others drawn thither, I seemed 
to recognize the purely psychological type lured by 
imaginary ills perhaps but all with a new light of hope 
in their eyes. 
With these before one, an entirely different train 
of thought follows. Every ailment to which human 
flesh is heir might be found, I dare say, among this 
mass of people awaiting turns to see the far-famed 
doctors or members of their general staff. But while 
evidences of long suffering are plainly noticeable among 
these people, they still appear hopeful, for now their 
faith is strengthened in the belief that they have reached 
the Mecca of their pilgrimage-the Lourdes of hope! Rochester and the Mayo Clinic 
25 
After viewing these local scenes for a day or two, I 
seemed to find a strong resemblance between them and 
the one I witnessed on an occasion when I visited 
Kirksville, Missouri, at a time when the late Dr. Still 
was in the zenith of his glory. The more I saw of 
Rochester, its people, its homes and patients, particularly 
the latter, the more strikingly vivid the replica appeared. 
The psychological fetishism of Kirksville seemed to 
stare at me from every direction, and I thought I could 
detect subjects ailing from the same causes as those at 
Kirksville. Surgeons thruout the world are well aware 
of one dominating idiosyncrasy among a certain type of 
patient-a certain desire to seek sources of relief from 
which come the greatest mystery. It is only this excep- 
tional type that looks upon the hospital without mis- 
givings. 
It may be noted that I often refer to Rochester as 
"The Lourdes of the Press," but there is no sacrilege 
intended in this reference. I cannot explain just how it 
happened that I first associated Lourdes with Rochester. 
Possibly the fact that one of the most pretentious build- 
ings in Rochester is named "The Academy of Our Lady 
of Lourdes" brought to mind the accounts printed about 
the annual pilgrimages of variously afflicted persons to 
the little Pyrennian town near which is located the grotto 
of Lourdes. There have been many press notices pub- 
lished about the wonderful healing properties in this 
grotto. Only the other day, the Congregation of Rites 
at Rome issued a decree announcing the beatification 
of Bernadette Gouborous, the peasant girl to whom ap- 
peared the apparitions of the Virgin Mary at Lourdes, 
which were followed by the first of the extraordinary 
cures which made that place so famous. Not unlike the 
hopeful promises held out to the afflicted by the public 
press of Rochester's healing power, there too seems to 26 
Rochester and the Mayo Clinic 
be no limitations to the kind of disease cured at Lourdes. 
The same diseases, such as cancer of the stomach and 
of the heart, hernia, cirrhosis, bronchitis, Bright's dis- 
ease, nephritis, caries, necrosis, arthritis, elephantiasis, 
lupus, tumors, morphinomania, deaf-mutism, wounds and 
sores and broken bones, are all permanently cured by 
immersion in the waters of the grotto, and these are not 
a tithe of the diseases that have been cured. The walls 
of the grotto are now covered with crutches and vari- 
ous kinds of braces left by pilgrims after being cured. 
The character of the pilgrims to both places seems to 
sustain a striking resemblance. One cannot help but as- 
sociate comparisons in the mind. 
With Rome's approval, pilgrimages to the Grotto at 
Lourdes will at once become even more popular as a 
Mecca for the sick. Recently, George Bernard Shaw de- 
clared that America is the "classic land of Christian 
Science." This rapidly growing church is also in the 
healing industry. Indeed, the future seems to possess 
but scant comfort for the doctor who is struggling along 
without the lure of a fetish to attract to him valetudinar- 
ianism. 
Among the other phases of Rochester, I found much 
that is in common with other frontier settlements that 
I had visited up in the great northwestern part of our 
country. The pioneers of those earlier days were men 
and women, who had emigrated into this Eldorado 
from the same communities in older states. Their early 
lives were passed in much the same way with similar 
home ideals. Hence it was natural for them to fashion 
these pioneer settlements much alike. So that indeed all 
the towns that grew up in the early days bear a striking 
resemblance one to the other. There are the court- 
houses, all of the same architectural pattern, situated 
usually upon a plot of ground by themselves, and near Rochester and the Mayo Clinic 
27 
by various stores, on the opposite sides of the streets. 
There is the post office, and the various denominational 
church buildings, all constructed upon much the same 
plan. The little homes mostly built of wood looked to 
be fashioned by the same hands. All over Minnesota, 
however, it is very noticeable that the Catholic denomi- 
nation is represented by the more imposing church edi- 
fices. These have a dominant number of worshippers 
in every town. The same may be said of the public 
school buildings and the parochial schools. The latter 
are more pretentious and equally (if not more) prosper- 
ous. As I have intimated, the early settlers of the 
country are people coming largely from the same stock, 
and among the present generation there is a striking re- 
semblance. Indeed, I often thought that I could see a 
typical double of the big banker of the town among 
the farmers on the street. Nor will one find it a diffi- 
cult task to pick out the double of any member of the 
Mayo firm from among these same people. 
Rochester is hardly beyond village size, but it has a 
metropolitan air. Indeed its life is cosmopolitan. It 
has been brought up to date largely in consequence of 
the modernizing influences of its learned and busy 
medical men and their vast clientele made up largely of 
fashionable patients from all parts of the world. Yet 
the general make-up of the place is easily seen to be 
along lines of other towns in the state. The older resi- 
dential districts of Rochester are identically the same 
as one may see among any of the early settlements thru- 
out the state. 
Rochester, however, has gone far towards the front 
in providing educational facilities for its rising genera- 
tion. A magnificent high school was erected a few 
years ago, that now stands a towering monument to the 
progressive spirit of the people. The building and play- 28 
Rochester and the Mayo Clinic 
grounds occupy an entire block. These splendid provi- 
sions for the children of Rochester would be a credit 
to a city several times its size. 
I extended my travels over Minnesota to Big Stone 
Lake, some three hundred miles northwest of Rochester, 
hence I had a view of Minnesota's rich farming lands, 
and at my several stops became acquainted with many 
of its people. The fertility of its soil is unexcelled. 
The agricultural districts of the state reflect a splendid 
citizenship. There are no idlers here. When harvest 
time comes, a helping hand is hard to secure, for the 
reason that every citizen in these districts is employed. 
I was much taken with the character of the citizenship 
in Minnesota. Those residing in the towns, as well as 
those living in the outlying rural districts, all seem to 
be regular church-goers. I must say that I never saw 
gathered together at one time a happier or more whole- 
some-looking lot of people than I saw on a Sunday 
among the country folk emerging from the churches. 
It seems as tho the whole community attends, and that 
none remain away from the services. The spirit of the 
church seems to pervade the social life of these smaller 
communities. Here it is, too, where perfect robust 
health is seen, indicated by the rosy cheeks of the young 
girls in their modest, maidenly attire, and the sturdy 
figures and manly faces of the boys in their comfortable 
garb; scenes strikingly different from those coming be- 
fore one in the streets of a big city, where the young 
girls go about dressed more after the fashion of the 
women of the streets. Here in the country, among 
these well-reared young folks, one sees nothing sugges- 
tive in the style of dress. The appearances are only 
such as would naturally indicate maidenly modesty. 
Much praise is no doubt due the church influences. But, Rochester and the Mayo Clinic 
29 
"So many Gods, so many creeds, 
So many paths that wind and wind, 
When just the art of being kind 
Is all this sad world needs." 
-Ella Wheeler Wilcox. 
I cannot resist the temptation of quoting from the 
same author the following beautiful lines, relating some- 
what to the above thought and which have so often found 
themselves uppermost in my own mind: 
"It is hardly worth while to be anything else but kind, 
It may be that some of us sin but 'tis easy to find 
That more, far more of us sin just because we are blind. 
It is hardly worth while to be anything else but just 
For today or tomorrow we die and our bodies are dust, 
And the millionaire's head is as low' as the man with 
the crust. 
It is hardly worth while to be anything else but good- 
We may as well serve the Master the way that we 
should, 
We may as well love Him and serve Him the way that 
He would. 
To be honest and pure, to be faithful and brave and 
resigned, 
Ah, this is the standard He sets for a heart and a mind, 
And day after day, till the end, to be kind, to be kind." 
Rochester, itself, is nestled down upon the banks of a 
body of water natively called the Zumbro River, and 
lying in a little valley just off the western prairie. But 
the river looked to me as though it were misnamed, for 
one day while standing upon one of its bridges, I failed 
to detect any motion in the water. I asked a passer-by, 
who seemed to be a native, if the river had any current. 
His reply was to the effect that the waters did not move 
over one inch in twenty-four hours, so I concluded that if 30 
Rochester and the Mayo Clinic 
the Zumbro were located in the state of Louisiana, the 
people down there would call it a bayou. The bluffs of 
the Mississippi are not far distant from Rochester. In- 
deed their outlines were pointed out to me from the 
fifth floor of the Zumbro Hotel, on the north side. 
SIDE LIGHTS ROCHESTER HOMES. 
The little homes sitting in behind their hardy lawn 
shrubbery and continuous green masses of foliage, all 
enclosed by picket fences, add picturesqueness and lend 
to the scene quite a charm of repose and contentment. 
Four-fifths of these homes have posted at the side of 
the front-door the sign, "Rooms and Board." Upon the 
porches, which look to be comparatively spacious, one 
may see a long row of deep-seated, high-backed, com- 
fortable-looking rocking chairs, invitingly arranged, and 
which seem to say to the passer-by, "Come in; you will 
find the hospitality within of even a more pleasing kind." 
In one of the Mayo reprints, "Notes on Italian 
Surgery," I find the following references to the weather 
conditions in Minnesota: "From the first of June to the 
first of March, at least nine months, the weather condi- 
tions in Minnesota bear a favorable comparison with 
any part of the world it has been my privilege to visit. 
A popular and fallacious idea, at least so far as Minne- 
sota is concerned, is that the summer months, especially 
July and August, are not favorable months in which to 
perform operations. We have found the contrary to be 
true. No other months in the year furnish a lower mor- 
tality or a smaller morbidity, and as a rule patients do 
not suffer particularly from the heat." 
On a Saturday afternoon, while walking down from St. 
Mary's Hospital to the Zumbro Hotel, and passing a 
Protestant Episcopal Church building, I saw a notice 
posted on the lawn which announced that the Rector Rochester and the Mayo Clinic 
31 
would, on the next evening (Sunday) deliver a lecture 
on the Roman Catholic Church. This struck me as an 
odd undertaking for an Episcopal Minister, in a 
community largely dominated by the Catholic influ- 
ences. The religious balance of Minnesota weighs 
heavily in favor of the Roman faith. Its communicants 
all over the state outnumber all other denominations. 
Indeed, while in Graceville, I was informed that a trial 
had been made to establish a Protestant Episcopal 
Church in that community, but the effect proved a 
failure in consequence of the inability to muster a suf- 
ficient membership to support it. On the other hand, I 
witnessed the attendance of hundreds of the best people 
in this community among the Catholic congregation. 
So that in the face of these facts, I wondered at the 
Rector's temerity. I made up my mind to hear what 
he had to say. 
On the following evening, in company with Dr. W. B. 
Thompson of New York, whom I had invited to go 
along, I heard the lecture. There were few people in 
attendance, owing, I suppose, to the sultry atmosphere. 
I did notice, however, the presence of two Catholic 
priests dressed in heavy black suits. It was a cruelly 
hot, close evening, but Dr. Thompson and I sat it out. 
The fact that the perspiration was constantly dripping 
from my head and face made it necessary to keep my 
hands in constant motion in order to use my hand- 
kerchief, and I was led to wonder if the lecturer fully 
appreciated the compliment we were paying him by our 
presence under these sweltering circumstances. Pres- 
ently the vestrymen came down the aisle, passing the 
plate for the offertory. Dr. Thompson immediately 
pointed out Dr. Graham, of the firm of Mayo, Graham. 
Plummer & Judd, as one of them. This was the first time 
I had seen Dr. Graham, so that under these circurn- 32 
Rochester and the Mayo Clinic 
stances, and on this particular occasion, I became ac- 
quainted with the general appearance of the doctor, and 
the fact that he was a churchman and an officer in the 
church. 
Dr. Graham is stockily built and I should judge him 
to be over sixty years of age, with hair wavy and white 
like cotton. Dr. Graham did not graduate in medicine 
until 1894, ten years after Wm. J. Mayo had graduated, 
and six years after Dr. Charlie Mayo. Dr. Graham was 
occupied as a farmer, I understand, before 1894, and 
after Charlie Mayo became his brother-in-law, perhaps, 
it was deemed best to make a doctor out of him and 
take him into the firm. Anyway, the integral function 
of the firm would now find itself decidedly incomplete 
without him. 
I must add that all during the lecture, my companion, 
Dr. Thompson, was kept busy mopping the sweat from 
his brow, but at the close of the lecture declared he had 
enjoyed it. I make this little diversion to show how in- 
considerate the temperature is up at Rochester. 
I was told at Rochester that the thermometer often 
dropped to and remained for days at forty degrees be- 
low zero during the winter months, and as to the heat 
in summer, the mercury in the Rochester thermometer 
had St. Louis beaten to a standstill. During the last of 
August and the first part of September, for a number 
of days while I was staying there, the thermometer stood 
above ninety, and on one of the Sundays, the druggist in 
the Mayo's drug store told me that the thermometer 
remained at 106 nearly all day. I left my room to make 
this inquiry because the heat seemed to be so intense. 
Dr. G. E. Lyon of St. Louis declined to join me on a 
drive, declaring it was too hot and dusty. Dr. Lyon 
had stopped over on his return trip from California. So 
it is very likely that they get two very wide extremes of Rochester and the Mayo Clinic 
33 
temperature in winter and summer. I found the dining 
room at Zumbro Hotel so very warm that many times 
I was unable to enjoy my meals. On one ocacsion, I 
asked the man in charge of the dining room if he could 
not furnish a few electric fans in order to relieve the 
oppressive heat. He informed me that I would have 
to see Mr. Kahler, who, I learned later, acted in the 
capacity of manager of the three Mayo Hotels, and was 
also a relative of some of the families constituting the 
medical corporation. (Still it is nothing unusual in these 
days of concentration of forces for hotel companies to 
have several different hostelries under one management. 
Mr. Lyman Hay of St. Louis has all of the hotels worth 
while in St. Louis under his management besides finding 
time to run one or two at Hot Springs, Arkansas.) 
A day or so later, Mr. Kahler was pointed out to me 
while he was passing the hotel in his automobile. The 
same informant reminded me that the machine cost 
$7,000. The speed of the machine forbade my speaking 
to him. 
The dining room of the hotel, like many of its rooms, 
is constructed for use in cold weather, and without 
provision for ventilation. Otherwise, the hotel is com- 
fortable and conducted in a very satisfactory manner. 
The rates charged might be considered too high by 
some, for a country town where the tables may be sup- 
plied almost entirely by the adjacent gardens and farm. 
Of course, the coffee is shipped a long distance, so far, 
indeed, as to lose much of its strength in transit. I was 
fortunate enough to be able to supply my own from 
several small cans I carried with me. Hence, I ex- 
perienced no disappointment in the matter of securing 
a good cup of coffee whenever I wanted it. It is a good 
thing for anyone traveling about among the small cities 
scattered in the northwest to include in his grip a supply 34 
Rochester and the Mayo Clinic 
of choice coffee. Three-fourths of the hotels of this 
country are weak on coffee and to my taste the Pull- 
man supply is abominable. While the hotel rates at 
Rochester suggest cosmopolitan distinction, at the same 
time, Mr. Kahler would more than likely find his hotels 
well patronized even if he were to raise the rates to 
twice their present figure. This I believe to be true for 
the reason that during my stay there, the hotels, like 
St. Mary's Hospital, most of the time have a waiting 
list. There is genuine optimism and an air of in- 
dependence all about the hotels just as is apparent 
about the offices of the celebrated surgeons of Rochester. 
Everybody, patient and visitor, is forced to think that if 
they should feel disposed to make a "kick" about any- 
thing, they would have to get out of Rochester to do it. 
Hence, the patients submit most cheerfully (?) to 
Brother Graham's demands, and the visitors to Cousin 
Kahler's hotel rates. In these and other things, Ro- 
chester is absolutely without competition. Its one pow- 
erful, nepotic corporation controls everything worth 
while in the place, including "the four magic hands of 
the two greatest surgeons in the world." It all teaches 
a lesson of the advantages to be gained by medical com- 
bination, and leads me to believe that a "reasonable" 
medical trust might enjoy the same ethical privileges as 
those that are flourishing in the other fields of world 
activity. Success would more than prove a certainty 
in the event that a central, illuminating figure would 
be provided each medical combination. This is where 
Rockefeller, Carnegie, Armour and Swift shine, and 
where Harriman and Morgan shone. 
HISTORICAL IMPRESSIONS. 
"Except wind stands as never it stood, 
It is an ill wind that turns none to good." 
-Thos. Tusser, 1523-1580. Rochester and the Mayo Clinic 
35 
The story has been repeatedly told and many times 
printed that the present reputation of the surgeons at 
Rochester had its beginning following an ill wind which 
swept over the little town and the adjacent prairie 
farms, thirty years ago. 
Upon inquiry of Mrs. M. H. Mellish, the editor of the 
Mayo clinic publications, I was enabled to make some 
notes in regard to this story. Later, when I returned 
home, I found these data somewhat incomplete, and in 
reply to a letter to Mrs. Mellish for further information, 
she very kindly sent me a copy of the history of Olm- 
stead County, the county in which Rochester is situated. 
Anyone wishing to read the story in regard to this ill 
wind that did turn good into the professional pathway 
of the Rochester family of physicians, may find the 
recital detailed in the published history of Olmstead 
County-altho the ill wind was in reality a cyclone of 
devastating proportions, and caused serious casualties 
to many people living there and in the surrounding 
neighborhood. 
Another item of medical interest printed in this his- 
tory relates to the organization of the first medical so- 
ciety of Olmstead County. This took place in December, 
188'5, and its first officers were, President, Dr. W. W. 
Mayo; Vice-Presidents, A. W. Stinchfield of Eyota and 
E. A. Holmes of Oronoco; Secretary and Treasurer, Ida 
Clark of Rochester. The charter members were: Drs. 
W. W. and W. J. Mayo, E. C. and E. W. Cross and P. N. 
Kelly of Rochester; J. E. Bowers, Dr. Collins and Dr. 
Phelps of the State Hospital; C. Lane, Dr. Trow, Chat- 
field; W. T. Adams, Elgin; E. Stoddard, High Forest; 
C. L. Keys, Byron; C. Hill, Pleasant Grove. 
The first president, it may be noted, was the father of 
Dr. Wm. J. and Chas. H. Mayo. The elder doctor was 
at that time 66 years of age. It is said that he remained 36 
Rochester and the Mayo Clinic 
in full physical and mental vigor until he was 90 years 
old, when he received an injury to his left hand and arm. 
The bones and soft parts were mangled and crushed. 
The injuries were sustained while engaged in repairing 
some machinery. During the year that followed, three 
operations were performed, the last one being amputa- 
tion of the hand and a part of the forearm. Had it not 
been for this accident, he might have lived many years 
longer. It may be interesting to the local members of 
the profession to note in passing that Dr. Mayo, Sr., 
completed his studies in St. Louis, acting in the capacity, 
a part of this period of time, of assistant to the late Dr. 
John T. Hodgen, and graduated here in 1854. The 
mother is still living and past ninety. She, too, became 
the victim of a serious accident only recently that re- 
sulted in a fractured hip, which has caused an unfortu- 
nate invalidism and confines her to her home. 
At the time of the cyclone, and during several preced- 
ing years, the Sisters of St. Francis, a charitable order 
of the Catholic church, had been successfully conducting 
a convent and the Academy of Our Lady of Lourdes in 
Rochester, and it was through the efforts of the Sisters 
of this organization, together with the aid of the elder 
Dr. Mayo, that St. Mary's Hospital was founded. It was 
on the second day after the cyclone that the Sister Su- 
perior, Mary Alford, and Dr. Mayo, Sr., inaugurated the 
movement. The hospital was opened October 1st, 1889, 
with a capacity of forty-five beds and about a dozen pa- 
tients. These were the particular circumstances attend- 
ant upon the organization and beginning of what is now 
said to be one of the busiest hospitals in the world. Its 
present capacity of two hundred beds is found insufficient 
to accommodate the number of patients seeking admis- 
sion. There is always a waiting list. Rochester and the Mayo Clinic 
37 
PERSONAL EQUATION. 
Nearly every doctor in the country is able and willing 
to advance a theory in explanation of how the Mayos 
were made to flourish so early, and how they remained 
able to maintain a degree of prosperity never before 
reached by any organization of regular physicians. I 
myself am led to venture the conclusion that the personal 
equation will have to be taken into account in order to 
learn something more definite in regard to the resource- 
fulness of the constituent elements of that organization, 
and along these lines it may be possible to reach a better 
understanding of how the crude beginnings of these doc- 
tors out in that little prairie town, grew so rapidly that, 
in a period of only a few years, Rochester and its sur- 
geons have been and are now publicly spoken of every- 
where, a circumstance that has never before happened 
to any doctor or set of regular doctors. 
It is a common comment at Rochester that Dr. Wm. 
J. Mayo is the dominating figure of the firm, and I have 
read the statement that those who know him best are 
inclined to rank him with such men as E. H. Harriman, 
J. Pierpont Morgan, J. J. Hill, Theodore Roosevelt and 
other towering intellects who have so marvelously in- 
fluenced their respective fields of activity. It has been 
said of Harriman that his name might have gone down 
in history as a great general had he chosen the profession 
of arms, and that Pierpont Morgan might have been 
another Disraeli had he devoted himself to statesmanship. 
So it seems that in every pursuit in the affairs of human 
activities if a man is aptitudinally a genius, he will get 
the money. No one will pretend that these men over- 
looked any chance to further personal possibilities of 
gain, for reports have been in the air for a long while 
until there is now clinging about them an odor of offen- 
sive notoriety in this direction. The opinion is pretty 38 
Rochester and the Mayo Clinic 
generally established that these men have allowed the sel- 
fish instinct to dominate their whole lives. As before in- 
timated, every doctor speaking about the matter, has his 
own explanation for the development and growth of the 
Rochester medical organization. Yet, most of them are 
willing to concede that there is something of a mystery 
surrounding it all. The belief is general that by some 
way and by some means, there has been built up a myth 
around this firm as the "greatest surgeons in the world." 
Curiously inclined myself, I wanted to go there, and if 
possible to brush the veil of mystery' aside for the pur- 
pose of learning something about the secret of their suc- 
cess, and what the nature of the peculiar professional at- 
mosphere investing Rochester really was. The world at 
large has always been led to think that the road to fame 
is rough and rocky, the struggles for achievement often 
checked by the rude tortures of disappointment. I had 
not heard that disappointment had ever fallen in the path- 
way of the Rochester doctors. 
The story of the medical career of the Mayo brothers 
properly begins with the history of the early struggles 
of their father. Since it forms the basis of their future 
medical life, it may not be amiss to sketch briefly the life 
of that father. 
"Back in the pioneer days, the father settled with his 
wife in St. Peter, Minnesota. Finding there but a very 
limited amount of practice, he joined his wife's uncle in 
a farming enterprise at LeSueur. Here he built a house, 
cutting his own logs. Farming, however, proved un- 
profitable so he hung out his M. D. shingle on the out- 
side of his log house. Before he had his first patient, he 
received a visit from the only other physician in that sec- 
tion. 'There is not enough practice here for two of us- 
you will have to get out.' The elder Mayo laid down the 
tools with which he was finishing his house, and straight- Rochester and the Mayo Clinic 
39 
ening himself up, replied, 'I have come to stay. If either 
of us leaves, I will not be the one.' A short time later 
while the doctor was shingling his bam, an Easterner 
called asking him to go visit a sick cow. Dr. Mayo ac- 
cepted this first call and brought his patient through 
safely. The next patient was a horse; the horse died. 
Dr. Mayo here gave an exhibition of that scientific 
thoroness and interest which he left as an inheritance to 
his sons. He performed an autopsy on the horse to find 
out the cause of its death. This was the first autopsy that 
any of the Mayo family performed in Minnesota. The 
practice of medicine continued unprofitable. The posi- 
tion of Captain on a boat which ran from St. Paul to 
Fort Ridgely on the Mississippi being offered him, Dr. 
Mayo accepted. For two years he held the job, continu- 
ing the practice of his profession during the intervals 
when on land. It was not until he received an appoint- 
ment as army surgeon that he was able to confine his 
attention wholly to the practice of his profession. A 
short time after his appointment, he was transferred from 
his first post at New Ulm to Rochester, a small village 
of 2,000 inhabitants, to establish an enrolling post for 
volunteers of the Civil War. He here branched out into 
private practice and at the close of the war, he found him- 
self well-established for a country doctor." 
I hope I may not incur adverse judgment and be 
charged (by the paragraphs that immediately follow) of 
work of supererogation, or be charged with attempts of 
carrying coals to New Castle, for I want to remain 
within bounds of plain duty in regard to this record. 
SENIOR SURGEON AND ST. MARY'S HOSPITAL. 
The now senior surgeon of the Mayo firm has advised 
in speaking of veiled problems that "occult inspection 
has been necessary to dispel mystery and develop the 
truth." Now, it is indeed human nature to want to pry' 40 
Rochester and the Mayo Clinic 
into enviable and attractive situations which are covered 
by the veil of mystery. And again, I have often won- 
dered if it were not this human frailty that has led many 
others to Rochester. I herewith subjoin in a paragraph, 
from a reprint over the signature of one of the firm 
members, printed in September, 1910. This reference is 
included here because I believe that from it I may secure 
sufficient authority to justify the comments that follow, 
altho I must explain beforehand that they are not in- 
tended in any respect to convey the meaning of a criti- 
cism. Speaking of Italian Hospitals, he says: "If one 
goes abroad to criticize, there are plenty of opportunities. 
But why go abroad for that purpose? There are plenty 
of opportunities at home." 
Yet in the face of this reflection on Italian Hospitals, 
there are many ideas utilized in the Mayo Clinic that 
originated in the hospitals of Italy, so it is easily clear 
that if one should criticize St. Mary's Hospital even after 
deriving valuable information therefrom, he could hardly 
be accused of lese majesty, for he would only be trying 
to emulate the example set by its most noted surgeon. 
"And this is the Mayo Clinic." This was the first 
thought that came into my mind upon entering one of the 
little rooms in which the operating is done. After pass- 
ing in and out of the other three operating rooms, two of 
them busily occupied by Drs. Beckman and Judd, the 
thought again came to me, tho in a different form, "And 
this is what is emphasized as the Mayo Clinic." The im- 
pression that one gets from the publications coming from 
the editorial rooms of the surgeons, and the contributions 
found published in the lay press is wholly different from 
what one gets on visiting the place in person. Indeed, 
from this personal viewpoint, I could only see a mirage. 
My impressions led me to believe that it was purely a 
Mayo clinic-a clinic coming within the scope of modern Rochester and the Mayo Clinic 
41 
clinical ideals with lectures describing the diseases, opera- 
tive procedures, pathological processes, and so forth, as 
is the custom in all modern clinics. I naturally believed 
these things for the reason that it had been given more 
publicity than any other in the world, and believed that 
it would more than favorably compare with a clinic like 
Murphy conducts at Chicago, or that Senn used to carry 
on at Rush, or that Crile conducts at Lakeside Hospital. 
But to my mind it was only a mirage of these. 
If one wishes to compare the talks given at this clinic 
with those of Murphy at Mercy Hospital, the lecture fea- 
ture of the former will show to a very decided disadvan- 
tage. For example, take the goiter operation, one that 
is made so often at Rochester. It may be found that 
Murphy in one clinical lecture on this subject used over 
7,000 words in describing the disease and its surgical 
treatment. At St. Mary's, I saw a number of these opera- 
tions without a half dozen words being spoken. Going 
further, take the cases of appendicitis. The surgeons of 
St. Mary's Hospital are familiar with this type of case 
and the operation. They do many, especially of the quies- 
cent type, and ought to have much to say about these 
cases. One seldom ever hears but a few under-toned 
remarks. On the other hand, Murphy found 3,3°° words 
to use in one clinical lecture covering the more interesting 
phases, and the surgical technic instituted for the removal 
of the appendix, so that I cannot help believing that the 
phrase, "Mayo Clinic" is more of an ambitious term than 
otherwise. Perhaps the title might not meet with the 
approval of the Rochester doctors not being sufficiently 
pretentious, but I should say that the words "private 
clinic of St. Mary's Hospital" would be more appro- 
priately descriptive. This would at least eliminate the 
misleading feature of the name "Mayo Clinic," for some 
believe that it is neither a clinic within the meaning of 42 
Rochester and the Mayo Clinic 
that term, nor is it exclusively a Mayo clinic, for the 
Mayo brothers do only a fraction of the work. 
As previously mentioned, the phrase "Mayo Clinic" 
is featured in all of the pamphlets by the firm, Mayo. 
Graham, Plummer & Judd; whether the authorship be- 
longs to any one of the forty or fifty members of the 
general staff or one of the other surgeons, it is given the 
same name. Founding my conception of this clinic 
wholly upon the publicity given it, I was naturally led 
to believe that the Mayo clinic must be one of the most 
wonderfully organized institutions in the world, and oc- 
cupying a position far in advance of any other of its 
kind. One of the chief disappointments I found, had to 
do with the almost lack of anything that could be digni- 
fied by the term "lecture." Indeed the silence is so pro- 
found that even the visitors become scientifically ob- 
mutescent. 
The lack of the instructive feature of teaching by lec- 
ture makes it almost wholly wanting in the essentials of 
a clinic. There is a total absence of anything coming 
within the scope of the term "lecture." What little they 
say is not even followed in colloquial order. Hence, from 
my own viewpoint, I could hardly contemplate it in the 
light of a clinic of modern or even remote times. For 
the reason I have mentioned, it does not in many essen- 
tials fulfil the acquirements of a clinic. Indeed I venture 
the conviction that any one familiar with the literary out- 
put of the firm, after witnessing the conduct of the clinic, 
will more than likely become disappointed, and more- 
over, conclude that it falls short of the published esti- 
mate placed upon it by the writers themselves. The talks 
they give behind the mufflers, in the presence of some lis- 
teners crowding around the operating table, or disadvan- 
tageously stationed at a distance, remind one of the odd 
ideas introduced by Pythagoras when lecturing before Rochester and the Mayo Clinic 
43 
his esoterics and his exoterics. The surgeons make a 
remark or two at intervals during an operation, but 
usually with their faces down on their work. This muf- 
fled voice makes it difficult to catch or understand what 
they say at a distance. The mufflers really seem to be a 
two-fold handicap to these operators. Even the young 
man who reads the history of the cases does so in a voice 
so uncertain and indistinct that one is wholly unable to 
catch in a connected way any of the information intended 
to be conveyed. Some of this is certainly due to infertile 
voices. Much of the difficulty or inability to carry their 
voices to those listening may be charged to the mufflers 
alone. Nowadays, the objects which the surgical clinic 
is designed to subserve are these: Teaching, studying dis- 
eases, and healing. Teaching clinical surgery without 
words is like sending a vessel out to sea without a man 
at the helm to set its course. Contrary to what is so often 
said complimentary to the personality of the surgeons in 
the clinic, they struck me as just plain men exactly after 
the order of all their fellows. 
"Where Nature's end of language is declined, 
And men talk only to conceal the mind."-Young. 
To my mind the make-up of all of the surgeons and 
assistants for the operating rooms present certain phases 
of incongruity. For example, they make no change of 
their street-shoes when coming into the operating room. 
The surgeous, assistants and nurses all come in to per- 
form the day's work in shoes they wear upon the streets 
and country places. The women, however, wear white 
shoes, but to all appearances the same style that are worn 
out of doors. They all wear gauze caps, but these 
scarcely cover two-thirds of the hair of their heads. They 
also wear mufflers over the nose and the mouth, but with 
eyebrows and locks of hair exposed. These mufflers are 44 
Rochester and the Mayo Clinic 
composed of several layers of gauze. Now and again, 
the mufflers may be seen to have dropped below the nose 
of an assistant, but he goes about his duties just as tho 
nothing had happened to his fixing. Speaking of the 
muffler, and now and then dealing in light persiflage, Dr. 
Will Mayo explained that the mufflers were not worn for 
the purpose of preventing the surgeon's breathing into 
the wound, for he believed that there was absolutely no 
danger to the patient from that source; but that the muf- 
flers were placed over the mouth and nose of the young 
men in the clinic for the particular purpose of covering 
up "their looks," and that he himself used the muffler 
to protect the patient in the event that he might perchance 
sputter. He said he didn't think he was a "sputterer," 
but such a thing was a possibility. He then attempted to 
illustrate what he meant by "sputtering" by describing 
certain paroxysms unexpectedly developed by the dog. 
But I failed to catch his words, and therefore the illus- 
tration was lost to me. 
A further incongruity, to my mind, lies in the fact that 
the muffler considered by the head of the clinic just 
quoted, practically harmless as far as the patient is con- 
cerned, is permitted to leave the eyebrows exposed as a 
standing menace to the welfare of the wound. The two 
leading surgeons in the clinic have long, outstanding, 
shaggy eyebrows, some hairs pointing up and some down, 
indicating that the eyebrows are not well groomed. It 
would seem to me that here is a real danger, a danger, 
too, that is entirely ignored. Also, if it is deemed neces- 
sary to wear caps at all, why not cover the entire head as 
is Crile's practice, and not as they do, covering about 
two-thirds of the hair. Crile uses something in the form 
of a mask or helmet, which, when placed over the head 
and face, covers these completely, including the neck. 
The eyes alone are left without protective covering. Rochester and the Mayo Clinic 
45 
SKETCH ILLUSTRATING THE NECESSARY PROTECTIVE 
DRESSINGS OF THE OPERATOR'S FACE. 46 
Rochester and the Mayo Clinic 
As has been stated, the Mayo clinic is a clinic without 
words, or at least audible words. I was forced to believe 
that all the surgeons seemed to lack (in no small degree) 
the ability to express themselves clearly and distinctly. 
I mean by this that they do not seem to have the gift of 
clearly enunciating their thoughts in distinctly articulated 
speech. 
The mastery of the clinic seems to go to Dr. Will 
Mayo by a force inherent in his dominating character. 
It is believed that he reflects the business as well as the 
medical spirit of the entire organization. He is inclined 
to be stout, but of remarkable nervosity and pervading 
command. He gets for operation the most attractive 
case, according to the opinions of the visiting physicians, 
and the thirty or more doctors there in quest of orthodox 
surgery crowd into his room at the tap of two bells. I 
was, however, led to think that some of the popularity 
of his room with the visiting contingent was more than 
likely due to the fact that he is a better talker, and his 
words are more distinctly articulated than are those 
voiced by the other surgeons. Also, he is not so timid 
in the use of his voice and language. Now and again he 
deals somewhat in levity and this alone affords at least 
some amusement to his hearers. 
"I believe in smiles and laughter, 
I believe in gentle ways, 
I believe in making merry 
When I have my merry days. 
But when obstacles beset me 
And the clouds above are gray 
I do not believe in thinking. 
I can laugh them all away." Rochester and the Mayo Clinic 
47 
GOITER WORK. 
At this clinic, there is a pronounced trend toward the 
operation of a preliminary ligation of one or both thyroid 
arteries, in serious cases of goiter, before the more for- 
midable operation of thyroidectomy is undertaken. The 
surgeons seem to want to emphasize the importance of 
this preliminary procedure, and insist that great benefit 
to the patient invariably follows. At least, for four 
months the patient's arteries remain ligated, at the end 
of which time, if his condition so warrants, a thyroid- 
ectomy is carried out. They say that in several hundred 
patients, the average gain in those who were below 
weight at the time of ligation was 22 pounds within the 
four months. But I saw at least two cases brought into 
the clinic after the lapse of four months from the date 
of ligation of their thyroid arteries, in which there was 
failure to make any gain. Hence it cannot be said that a 
gain in weight follows the ligation of the thyroid in every 
case. I noticed in other cases having recently undergone 
the ligation procedure, in which this preliminary work 
had a decidedly prejudicial psychical effect on the pa- 
tient's ever-present state of trepidation, over the fact of 
having impatiently to await the operation they had in 
mind day and night during the four months of nervous 
waiting. It did more harm than good. 
While it is very true that the thyroid work in this clinic 
is unsurpassed as to number, I am certain the actual 
work does not come up to the standard set by Crile. 
Indeed it is a debatable question in my mind as to whether 
the cases passing through St. Mary's Hospital receive a 
higher or even the same studiously intelligent skilful care 
as that which Kocher gave his cases of goiter twenty-five 
years ago. In order to make a practical comparison, I 
shall quote Senn's graphic description of one of Kocher's 
clinics, showing in particular how he handled one of the 48 
Rochester and the Mayo Clinic 
more desperate type of cases. This report may be found 
printed in the form of letters from Senn to C. Fenger, 
dated Berne, July, 1887. 
"I remained in Berne four days, and had an excellent 
opportunity to become familiar with the work in the 
surgical ward, but will only describe the operations of 
one forenoon, to show what a man like Kocher can do in 
three or four hours. The operations began at 7 a. m. 
and a little after 11 o'clock, the whole work was done. 
The world knows that Kocher's great specialty is 
strumectomy. He astonished us all a few years ago 
when he reported 101 cases of strumectomy at the time 
he first called attention to the danger which follows com- 
plete extirpation of the thyroid gland, as in quite a num- 
ber of his cases in which the whole organ was removed; 
a condition allied to cretinism followed which he de- 
scribed under the term cachexiastrumipriva. He has now 
performed the operation more than 300 times, and his 
results have been so good that in a hundred consecutive 
cases, he has not had a single death. He looks upon 
excision of struma as one of the safe operations in sur- 
gery. I was very anxious to see the master of this opera- 
tion confronted with a difficult case. Two cases were in 
the hospital awaiting strumectomy, and he selected for 
my special benefit the one which was expected to present 
the greatest difficulty. The patient was a woman about 
40 years old, who had a large neck since childhood, which 
was now giving a great deal of difficulty in breathing, 
especially when undergoing unusual exertion. She was 
very anemic. The tumor was located almost centrally 
over the neck, but did not dip behind the sternum. No 
fluctation. Chloroform was the anesthetic used, and was 
continued throughout the operation. 
"The external incision was made over the center of 
the tumor and across the neck. Even before the tumor Rochester and the Mayo Clinic 
49 
was reached a number of vessels had to be divided be- 
tween two forceps. The veins all around and beneath 
the tumor had walls as thin as paper, so attempts to 
ligate them failed, and venous hemorrhage had to be 
guarded against by compression. Another difficulty from 
these thin-walled veins was that many times large trunks 
were accidentally injured in the blunt separation of the 
tumor from its surrounding tissues. The extirpation 
lasted over an hour, and all the forceps which the insti- 
tution possessed, some 60 or 70, were brought into use, 
and at least another dozen would have been used had 
they been accessible. The patient, already senemic lost 
considerable blood during the operation, and after all 
vessels were ligated and the wound sutured, and as the 
dressings were being applied, she passed into a condition 
of collapse with rapid, almost imperceptible pulse, dilated 
pupils and extremely pallid countenance. The operator 
at once had the patient's head lowered and the lower ex- 
tremities elevated, and at the same time, injected ether 
hypodermatically. As the heart did not respond, he at 
once prepared for saline intravenous transfusion. A 
saline solution at the temperature of the blood was used. 
The median basillic vein was exposed, opened, and a 
glass tube connected with a rubber tube and an ordinary 
glass funnel was introduced into the vein and tied firmly 
with a ligature. The fluid was allowed to flow very 
slowly, and a little more than a litre was introduced 
before the contraction of the heart became firmer and 
the pulse fuller. When this was done, the pupils con- 
tracted, the patient became conscious and the operation 
was suspended. The dressing was now applied, and the 
patient put to bed with the head low, and artificial heat 
applied about the periphery of the body. An hour later 
the patient was conscious, pulse still rapid but with a 
fair volume. Under such circumstances a man's courage 50 
Rochester and the Mayo Clinic 
is put to the severest test, but Kocher did not show the 
least excitement, and performed the transfusion very 
deliberately. The day after the operation, I examined 
the case with Kocher, and tho the pulse still remained 
rapid, all other indications were favorable, and it is more 
than likely that this patient, snatched from almost cer- 
tain death by prompt treatment, will ultimately recover." 
MAYO CLINIC-GOITER LITERATURE. 
In two recent near-jejune productions accredited to 
Dr. Charlie Mayo, the first on "Factors of Safety in 
Operating for Exopthalmic Goiter," and the other 
"Observations on the Thyroid Gland and Its Diseases," 
he takes occasion to say in the first paper in concluding 
the article, that ether preceded by atropin and morphin 
is the anesthetic of choice for a double ligation and 
thyroidectomy. If there be extreme nervousness, 
scopolamin is used, and the worst type of cases with af- 
fections of the heart and kidneys are operated on by local 
anesthesia or receive the benefit of Crile's "Anoscia"- 
injecting local anesthesia into the field of operation in 
addition to the other preparation before ether is admin- 
istered. "The operation for hyper-thyroidism is not an 
emergency one nor is to be called life-saving in the ex- 
treme condition as the surgeon's secure judgment as to 
the stages and conditions of the disease and its compli- 
cations, he is enabled to select a form of operation or 
treatment for certain conditions and he may then with 
impunity develop his fad in the line of preparation, anes- 
thesia, operation and after-care, all minor details to which 
undue importance is attributed." 
The inference is natural that the above was provoked 
by jealous pique or at least written from a biased point 
of view, and he is evidently trying to throw "hooks" 
into somebody. The conclusion of the second paper is Rochester and the Mayo Clinic 
51 
in these words: "In general, operations for goiter are 
becoming very common, not because of an increase of 
the disease, but because the laity are becoming to appre- 
ciate the benefit and the safety of operation, and sur- 
geons are operating on goiters of long standing. Since 
the first of the present year, a little over ten months, 
nine hundred operations for goiter have been performed 
at St. Mary's Hospital with a mortality of one per cent." 
This quotation is not couched in particularly modest 
language but it has a dash of this clinic's imperturb- 
ability. Both, to me, sounded decidedly humoresque. 
Perhaps naivete is the word that best fits. I should say 
this writer may not be of the potential type. Dr. Charlie 
Mayo has a doleful, inexpressive face, and a personality 
not distinctly impressive. Naturally, I take it, he is a 
quiet man with a reserved demeanor and not actively 
aggressive, tho it may be his wont to keep himself well 
within his own reserved dignity. He is, however, a tire- 
less worker, but demonstrates little originality. 
A mere glance at the goiter work of this clinic and 
that of Crile's will secure a valuable comparative view- 
point. 
THE PRINCIPLES OF ANOCI-ASSOCIATION. 
By special management of the patient prior to the 
operation by an anesthesia, without an emotional disturb- 
ance, and the use of the pleasant nitrous-oxide-oxygen 
anesthesia, and by local anesthesia, the whole operation 
is so managed that the principles of anoci-association 
taught by Crile extends well into the environment of the 
subject of this disease. Indeed, Crile gives his patients 
the benefit of the results of ecologic studies. I mean by 
that he extends his knowledge, studies and service in 
behalf of the patient to the actual science of environ- 
ment. This forms a part of the essential detail of his 52 
Rochester and the Mayo Clinic 
operative technic. The fruits of this new ecologic study 
simply means the prevention of harmful association, such 
as fear or dread of the operation on the part of the pa- 
tient. This exclusion of harmful association and stimuli 
is obtained by Dr. Crile, first by putting all the brain 
cells to sleep that are capable of being affected by a 
general anesthetic. He then blocks off sensation from 
the areas in the field of operation by the use of local 
anesthesia. He uses for preference novacain, quinine 
and ureahydroclorate, and has achieved brilliant results 
by this method. Crile has performed hundreds of ex- 
periments on animals under ether with the operation field 
cocainized in addition, and found that the cocain pre- 
vented the transmission of injurious impulses and so pre- 
vented shock. The application of the principle to the 
human subject showed that no patient died of the dis- 
ease after leaving the hospital, no patient was made worse 
by the operation, in fact every patient was either bene- 
fited or cured. Here, and indeed in all of his masterful 
work, we can see how Crile is exerting notable influ- 
ences not only over American surgery, but over the en- 
tire surgery of the world. 
Crile tells us that "In grave cases, therefore, I so plan 
the operation that the psychic factor is wholly eliminated. 
Full consent to operate is obtained from the patient be- 
fore ever entering the hospital. Then in the morning 
while in bed the patient is given daily, by the anesthetist, 
under the guise of inhalation treatment, a complete form 
of anesthesia. In some instances, a 'prior pretend' dress- 
ing was applied to the neck. On the arrival of the day 
of operation, a hypodermic of morphin and atropin is 
administered, half an hour prior to the anesthetic, which 
is given in bed in the early morning, and without a word 
of information, precisely as the inhalation treatment has 
been given. As soon as the second stage of anesthesia is Rochester and the Mayo Clinic 
53 
reached, the patient is taken to the operating room where 
all is in readiness. Performed in this manner, I have 
rarely observed any change in the pulse rate during the 
entire operation. In some cases, the patients were dis- 
charged from the hospital without knowing the gland had 
been removed. In more than 90 per cent, of my patients, 
in the routine operation, there are no unpleasant memories 
of the operating room. The post-operative discomforts 
are greatly minimized, and the mortality rate is reduced 
in proportion. In a number of the cases, the operation 
was done with a complete exclusion of fear; the brain 
being completely isolated from operative influences, is not 
more affected than if the operation were performed on 
the clothing. This is the ideal surgical state." 
A study of the post-operative course of his patients 
showed that the recovery proceeds along a course 
analogous to that which follows a nervous breakdown to a 
major sorrow and a crushing disappointment. "Re-edu- 
cation in the philosophy of life," he advises, "would be.a 
part of the after care." 
In a paper by R. C< Coffey, M. D., of Portland, Ore- 
gon, recently printed under the title of "Impressions 
Gathered on a Recent Trip to Some of the Surgical 
Clinics of Europe and America," he adds corroborative 
proof of Crile's unique work, in the Lakeside Hospital at 
Cleveland, in the following words: 
"In going thru the hospital, I found his patients all 
looking well, bright and cheerful. I think I am safe in 
saying I have never seen a more hopeful-looking and bet- 
ter pleased lot of patients. I was clearly impressed with 
the fact that I had never seen a more tender, more skilful 
and more knowing surgeon operate than Geo. W. Crile." 
MAYO CLINIC SIDELIGHTS-BECKMAN. 
Beckman is a spare-made man, statuesquely angular 
and bald, but I should say under middle age. His is a 54 
Rochester and the Mayo Clinic 
long slender neck, and when he speaks it seems to have 
great freedom of movement, and its mobility is intensified 
by the additional effort required in breathing through the 
thick muffler placed over his nose and mouth, making the 
picture as a whole not attractably pulchrious, but then 
there seems to be no special cause for vanity over the 
pulchritude of any of these otherwise noted men. But 
Beckman, I am sure, is imbued with much earnestness, 
and is a diligent worker, and gets as much good surgery 
behind him during the morning hours as any of the 
others. He dissects rapidly and cleverly. I did not see 
him do any stomach or intestinal surgery. His work ap- 
peared to be limited to the head and neck. I was told 
that Beckman served as one of the earlier assistants to 
Dr. Charlie Mayo over a period of several years. I ven- 
ture to say that while Beckman does much of the neck 
work in the Mayo clinic, pointing out that he follows 
Crile's original work, to my mind, his conception of the 
Crile plan of block dissection in surgical procedures of 
the neck, especially for cancer, is somewhat vague. His 
work, oral explanations and writings emphasize this be- 
lief. What he has written on the subject seems to have 
been liberally reinforced from Crile's contributions. 
Crile writes: "In 61 cases I have temporarily closed 
the common or external carotid without immediate or 
remote complications. Proper closure of the vessel 
should be attended with little more risk of thrombosis or 
embolism than closure by tourniquet or by pressure ap- 
plied on the skin." 
Beckman: "One or both external carotid arteries can 
be ligated but the only risk being that from embolism." 
Crile: "In one case, both external and internal jugu- 
lars of one side were excised their whole length from the 
bottom to the top of the neck, when, several months later, 
metastases appeared on the opposite side of the neck. Rochester and the Mayo Clinic 
55 
A similar excision of both veins was made on this side 
also but only after it was discovered what the compensa- 
tion for the return circulation was. Following the ex- 
cision of the internal and external jugulars of the op- 
posite side of the neck, there was not the slightest cir- 
culatory disturbance, congestion or hint of insufficient 
return of circulation." 
Beckman: "The external and internal jugular veins on 
one or both sides may be removed the entire length of 
the neck with safety. The collateral venous circulation 
is abundant and easily compensates for their loss. 
Since Crile advocated his block dissection, it has been 
learned that many muscles, nerves and blood vessels of 
the neck, formerly considered of importance, may be re- 
moved with comparative safety to the patient and with 
but little deformity. One or both sterno mastoid muscles 
can be removed with safety and very little inconvenience 
to the patient. The diagastic, omohyoid, the sternohyoid, 
and the sternothyroid are all compensated for by other 
muscles and can be removed when necessary," thus treat- 
ing the matter in a vague manner, and then abruptly dis- 
missing it. 
Crile explains his block dissections, after detailing the 
direction of the lymph streams in the neck, as follows: 
"Judged by analogy and experience, the logical technic 
is that a block dissection of the regional lymphatic system, 
as well as the primary focus, are exactly on the same 
line as the Halstead operation for cancer of the breast. 
Such a dissection is indicated whether the glands are or 
are not palpable. Palpable glands may be inflammatory 
and impalpable glands may be carcinomatous. A strict 
rule of excision should be therefore followed. A hyper- 
dermic injection of stropin is given an hour before be- 
ginning the operation, for the purpose of paralyzing the 
nerve ending of the vagus in the heart, thereby wholly 56 
Rochester and the Mayo Clinic 
preventing an inhibitory collapse from direct reflex inhi- 
bition, thru the vagus or its branches and controlling 
bronchial secretion. Morphin favors quiet anesthesia and 
partially supplements the general anesthetic. By taking 
advantage of the distribution of the sensory nerve, the 
supply of which is rich in the skin and superficial fascia, 
while scanty in the deeper planes of the neck, but little 
ether in addition to the morphin is required during the 
latter dissection. This is analogous to the ether morphin 
anesthesia in certain abdominal technics. The practical 
application of the foregoing data may be illustrated in 
the technic for the excision of carcinoma of the floor of 
the mouth, invading the lower jaw with extensive meta- 
stases in the submaxillary lymphatic gland. The patient 
is then placed in the inclined posture, head up, and the 
skin incision over the common carotid artery just above 
the clavicle is made. The artery is exposed by an inter- 
muscular separation of the sternomastoid, its outer sheath 
nicked, the vessel exposed and temporary closure made. 
The complete skin incisions are then made, and the skin 
reflected back over the entire area of the field. The 
sternomastoid is divided, the internal and external jugu- 
lars are secured, tied double and divided at the base of 
the neck. The dissection is then carried from below 
upward into the deep plane of the neck. Behind the lym- 
phatic glands, working first at the side then posteriorly, 
carrying upward all the fascia, muscles, veins, fat and 
connective tissue until the floor of the mouth is reached. 
The lower jaw is then divided at a safe distance on each 
side of the growth. The floor of the mouth and the 
border of the tongue are then similarly divided, thus com- 
pleting the block." 
JUDD. 
Judd is a smallish, insignificant-looking man, and like 
Beckman finds himself destitute of hair on the top of Rochester and the Mayo Clinic 
57 
his head. He is a youngish looking man, and I should 
say a junior in regard to age in the quartet of surgeons. 
It is he who looks after most of the prostatic work in 
patients coming to this clinic. In this work he is by no 
means a routinist. It is clear to my mind that he has 
learned the lesson of making the operation fit the case. 
In his bladder and prostatic surgical methods, he adopts 
the surgical procedure that is best adapted to the indi- 
vidual case. He has read several papers on the surgi- 
cal treatment of prostatics and allied topics. The only 
fault I have to find with his work lies in the emphasis 
placed upon the remaining puissance following prostatec- 
tomy and in the promises made to patients that the 
seminal ducts as they pass through the prostate will not 
be molested by the surgical procedure carried out by him 
for the complete relief of the patient. Especially, it is 
promised that the patient will remain puissantly a happy 
man. My observation convinces me that this is going too 
far in regard to the future possibilities of these patients. 
When Young began publishing the same thing, I pro- 
tested and ventured the opinion, then, that such promises 
might prove an easy way to add to one's clientele but not 
prove so easy to fulfil. I am still of the same opinion, and 
strengthened all the more by an extensive investigation 
of the subject. I conclude that the real conditions within 
the hypertrophied prostate were never as seriously studied 
as were various individual methods of surgical procedure 
for its removal, particularly by the men who specialized 
in this field of operative work. 
APPENDIX-SIDELIGHTS. 
Many comments were made on the fact that in nearly 
every one of the abdominal cases at the Mayo clinic, the 
surgeons remove the appendix whether apparently patho- 
logical or not. After opening the belly, when the diag- 58 
Rochester and the Mayo Clinic 
nosis is found unverified or undiscoverable in a case 
with symptoms, they at least remove the appendix. This 
is done by eliminating the appendix, lifting it up on the 
stretch and making a short stump by dividing between 
two forceps. A double purse string sulture is applied and 
the stump is invaginated. The invagination is re-enforced 
by catgut sutures. The practice of invariably removing 
the appendix in the presence of symptoms without any 
discoverable cause for symptoms, is, I am satisfied, be- 
yond doubt a most commendable routine. 
This statement needs a qualifying explanation. In the 
first place, I want to add that my information is clearly 
conclusive in regard to the fact that unjustifiable appen- 
dectomies have been made and are being made daily. 
Some of these perhaps for no other reason than a mone- 
tary consideration; some again are made by ambitious 
surgeons merely to gratify this ambition. Again, symp- 
toms are deliberately misinterpreted for the purpose of 
obtaining the consent of the patient to submit to the op- 
eration merely to increase the surgeon's numerical list. 
There should be a ban put upon this kind of work, which 
is more or less of a criminal practice. Perhaps it was the 
result of personal experience or something akin thereto 
that led a member of the Colorado Legislature to intro- 
duce a bill for the purpose of reaching this class of 
rara aves. My item about this bill reads: "Surgeons 
operating for appendicitis in this state will have to pro- 
duce the defective appendices afterward or suffer im- 
prisonment or fine. Those included by the bill imposes 
from one to ten years' imprisonment or a fine of from 
$500 to $10,000 for operations on healthy organs." 
But now, since practical experience and clinical obser- 
vation teach that a perfectly healthy appendix, so far as 
appearances go, may give rise to certain serious pains and Rochester and the Mayo Clinic 
59 
remain a menace to the patient's health until removed, 
it is hard to see just how a law may be so framed as to 
convict the real criminal practitioner and set free the 
surgeon who, to all intents and purposes, violates the 
same law. The apparent serious defect of the proposed 
law lies in the fact that conclusive incriminating evidence 
is to be founded wholly upon the macroscopic appearance 
of the appendix. From the viewpoint of the honest sur- 
geon, only baneful consequences can be seen from the 
enforcement of such a law. Indeed, imagine if such a 
law were effective, up in Minnesota, for example, all the 
surgeons at Rochester would be subject to criminal prose- 
cution. Perhaps some of us might be in jail were the law 
likewise effective elsewhere. The law in my judgment 
should be made to fit the specific crime, but the crime is 
in the motive rather than in the mere act of removing an 
apparently sound appendix. Present-day scientific thought 
about the appendix makes it necessary often to remove 
an apparently healthy appendix. This fact may prove a 
stumbling block to the lawmakers in the matter of dis- 
criminating between the work of the conscientious sur- 
geons and the really unscrupulous doctors. 
I witnessed Judd do an appendectomy, and at the same 
time short-circuiting the colon. Judd and others over- 
look the advantages of the muscle-splitting technic in ap- 
pendiceal surgical procedure. In this operation which I 
was now witnessing, Judd stated that, so far as appear- 
ances go, the appendix was not pathological, but he re- 
moved it. He found an ampullated cecum with adhesions. 
These he liberated and then short-circuited the lower end 
of the colon for the purpose of reducing its size and 
lumen. The abraded surfaces following the denudation 
were quite extensive, including the separation of the 
colon well up out of its bed. He made no attempt to 
cover the abrasions, simply contenting himself with vasel- 60 
Rochester and the Mayo Clinic 
izing these raw surfaces, then replacing the whole in the 
flank. This is contrary to the practice of many surgeons 
at the present time. For example, Crile, Murphy and 
others teach and follow the practice of enclosing every 
raw surface in the belly, and Murphy says that every ab- 
rasion in the peritoneal cavity should be covered. 
On one occasion when operating on similar cases in 
his clinic, Murphy announced, "I bring all the raw sur- 
faces into submission and turn the edge over so as to keep 
it as near as I can free from subsequent adhesions. We 
will make as much of an ectropion of the cut edges of the 
peritoneum as we can under the circumstances, as in all 
the surface that is here to get the line of approximation 
and lessening as much as possible future fixation." We 
all realize, ever since the time Senn introduced the prac- 
tice, the great value of covering raw surfaces in the 
abdominal cavity with a patch of omentum. The omen- 
tum, when properly applied, will perfectly seal all such 
surfaces, and is always accessible and is always pro- 
phylactic against future troubles. Dr. N. Senn is the man 
who worked out that patch idea originally, and all the 
patch-work is based on Senn's original experiment. His 
wide experience and intelligent observation long since 
taught him the dangers of allowing abrasions in the 
belly to go unprotected. In Judd's case, in view of this 
doctrine, what he temporarily accomplished may have 
terminated in a worse condition. I was curious to know 
how the case was progressing but was unable to learn 
anything about it. What I saw Judd do in his work of 
short-circuiting the colon, set my mind to thinking in 
regard to this work of enteroptotic conditions of the 
abdominal viscera and the limitations of surgical pos- 
sibilities in this field. Thoughts crowded into my mind 
in regard to the fate of the sutured raw surfaces within 
the belly cavity, after having been returned after a sort 
of haphazard manner. I recollect vividly the impres- Rochester and the Mayo Clinic 
61 
sion made upon me by Senn in this matter. It was al- 
ways his custom to drive home the idea that one must 
imitate nature as nearly as possible, in order to secure 
early and uninterrupted restitution and integrum in the 
surgery of any part, especially within the cavity of the 
abdomen. 
The views of the men who are actively working out 
the problems of enteroptotic surgery and its study are 
somewhat at variance, as would be natural at this stage 
in the study of the evolution of this trouble. There is, 
however, a general unanimity of opinion on the funda- 
mental principle underlying the condition itself. Dr. 
Clark of Philadelphia has done an immense amount of 
work in this direction, studying the conditions of en- 
teroptosis from childhood, following the cases as well as 
studying them in the adult. He has made many opera- 
tions, but of late has grown somewhat conservative in 
regard to surgical intervention. He has called attention 
to the severity of surgical operation, and the danger to 
life, and thinks such cases should be selected with the 
greatest care, and the operations performed only when 
other means have failed to relieve an otherwise thor- 
oughly deplorable state of health. 
Mr. Lane of London, on the other hand, has some 
radical ideas on the subject. Mr. Lane believes that 
much of the ill-health of enteroptotic women is due to 
auto-intoxication, the result of a tardiness of the stomach 
and small and large intestines to empty themselves. He 
has performed many operations on these women with 
the idea of removing obstruction in the intestines which 
he believes exists in many of these cases and can often 
be clearly demonstrated. Mr. Lane believes that a large 
variety of body ailments can be ascribed to this intes- 
tinal statis, including such remote diseases as cancer, 
trifacial neuralgia, aside from the malnutrition and 
muddy skin commonly met with. He has obtained ex- 62 
Rochester and the Mayo Clinic 
cellent results by short-circuiting the bowel in such a 
way as to remove the obstruction and cut out a large 
amount of the absorbing surface, thus preventing auto- 
intoxication to a large extent. 
Anatomical knowledge of the vermiform appendix 
leads one to look upon it as something of a progressive 
organ, during the early and adolescent period of life, 
and very much regressive during the later period of 
existence, and sympathetically during all of one's life- 
time sustains a close relationship to the other viscera 
of the belly cavity, thru its nerves, arteries and lym- 
phatics. From a pathological viewpoint, MacCarty of the 
Mayo staff has about made it convincingly clear that the 
appendix may become very much wrought up over the 
simple presence of an ulcer up in the stomach or duo- 
denum; from stones in the gall bladder; diseases of the 
pancreas or liver and lesions in general in the intestines, 
elsewhere than in the cecum. The cecum, being orig- 
inally an outgrowth from the convex side of the prim- 
itive intestinal loop, is completely covered by peritoneum 
and has no mesentary, since the mesentary of the ileum 
passes directly to the colon. The appendix being the 
original end of the cecal pouch is consequently also 
completely invested with peritoneum. The late Jesse 
Myer came close to a description of the foregoing in a 
paper which he wrote some time before I had seen any- 
thing written upon the subject. 
When the ascending colon has come to life in the 
right flank, after descending from its position higher up 
in the belly in early life, the posterior layer of its mes- 
entary degenerates into areolar tissue, fusing with that 
resulting from the degeneration of the parietal periton- 
eum behind it and by the same process, the back of the 
colon is attached by areolar tissue to the abdominal wall 
behind. This anatomical arrangement I think is a wise 
provision of nature in mechanics. The motor mechanism Rochester and the Mayo Clinic 
63 
or energy, whatever it may be termed, that renders the 
cecum and colon capable of emptying themselves, starts 
in the appendix and the mechanical power of the muscles 
is immensely more efficient in accomplishing this work, 
because of this mechanical arrangement by which the ce- 
cum is anchored under this peritoneal covering. The 
lesson that this anatomical arrangement teaches is im- 
portant to the operating surgeon. After an appendec- 
tomy, nature should be imitated as closely as possible in 
the matter of the re-fixation of the cecum. Otherwise, 
its motor mechanism will remain almost nil, at least until 
nature forms re-attachments, if this is ever possible. 
From my own experience, most, if not all of the distress 
caused by the accumulation of gas in the cecum follow- 
ing surgical procedures that destroy its mechanical ad- 
justment, is due to the loss of power to force the gas up 
and out of the ascending colon. The nerves supplying 
the cecum and appendix are derived from the superior 
mesentary plexus. The artery comes from the superior 
mesenteric artery. This artery forms all of the meso- 
appendix that it has. And the cecum and the appendix 
are richly supplied with lymphatics. The appendix, 
alone, contains a large lymph sinus at the base of the 
follicles, all factors of great importance in the study and 
surgical treatment of appendiceal cases. These parts, 
and indeed the entire intestinal tube, should never be 
handled roughly. The indications never justify it. Any- 
one commiting the error only demonstrates one of his 
mistakes and lack of knowledge of the possible serious- 
ness of the consequences. Then, as I have already in- 
timated, the unvulnerability of the belly wall secured by 
the muscle-splitting route to the appendix is too often 
lost sight of and neglected. In the event a hernia does 
not follow upon the careless technic, the liberated roam- 
ing cecum remains a constant source of annoyance, and 
in many instances a real discomfort to the person who 64 
Rochester and the Mayo Clinic 
has been exposed to this kind of surgery, i. e., a condi- 
tion results not unlike a Hirschsprung dilatation, or in 
other words Hirschsprung's disease follows. Indeed, I 
have seen several cases in which the appendix was re- 
moved and the position of the cecum found lying trans- 
versely, which I have tried to illustrate in the accom- 
panying rough sketch. 
The detrimental constitutional effects of this unfor- 
tunate surgical sequel are intestinal stasis and constipa- 
tion; then follows the absorption of the toxic products 
of pernicious decomposition in the large intestine. It 
was Ely Metchnikoff who advanced the theory that such 
auto-intoxication was responsible not only for certain 
toxic neuroses, rheumatoid arthritis, and possibly dia- 
betes, exophthalmic goiter, pernicious anemia, hepatic 
cirrhosis, and the like, but for premature senility, and 
for various local senile degenerations. It was perhaps 
upon this theory that Arbuthnot Lane of London has 
called attention in a systematic way, not only to these Rochester and the Mayo Clinic 
65 
defects but to the secondary adhesions which form and 
bind the intestine into kinks and limit the activity of its 
peristaltic movements. He has also proposed to cure this 
stasis and its resultant auto-intoxication by severing the 
ilium near the ilio-cecal valve and transplanting it into 
the upper part of the rectum. But why not practice 
prophylaxis in these surgical cases and avoid this un- 
fortunate condition? Of course, I must have it under- 
stood that Lane's work has been limited to cases not 
due to surgical operations. 
THE MOUTH IN HEALTH AND DISEASE. 
In health, the tongue and mouth should be moist, the 
color should be pink and the shape of the papillae visible, 
the filliform papillae being surmounted by a delicate 
tipping of fur faintly colored, and a sweet, pure breath. 
As a general rule, one tries to keep the mouth and tongue 
the cleanest part of one's person. This is ordinarily 
observed in life, and yet doctors who make post- 
mortems know from observation that after death 
the mouth is about as nasty as any part of the human 
body. In ill-health, the mouth is forever wanting to be 
foul, and so it seems that at dissolution much of the 
nastiness of the garbage of the body is poured into the 
mouth. In the conditions of the cecum, I have described, 
and which result from careless surgery and entailing 
disability upon the cecum and impairment of its function, 
the mouth of the patient remains forever foul. Auto- 
intoxication has a special predilection for contaminating 
the mouth with pernicious influences of decomposition 
in the intestine. So that, aside from the now vicious 
mechanism about the cecum, the victims of a good many 
surgical operations must always experience the repul- 
siveness of a foul breath and mouth. 66 
Rochester and the Mayo Clinic 
MAYO CLINIC-DIAGNOSTIC ERRORS. 
I saw in the clinic, in one day, I think it was, all of 
the following described errors in diagnosis and surgical 
disappointments disclosed by operations. First case was 
noted on the slip placed in the waiting room provided 
for the visiting physicians and for their information. 
The slip read: 
"Diagnosis-A fibroid in the uterus. 
"Proposed operation-Exploration of gall bladder, re- 
moval if necessary." 
This case turned out to be not a fibroid of the uterus, 
nor one with the disease of the gall bladder after the 
belly cavity wras exposed, but to the utter amazement 
of those present and the operator, the uterus was found 
to contain a pregnancy of some months standing. After 
deliberation and a hurried consultation, the incision was 
promptly closed and the woman returned to bed. - 
Second Case-Diagnosis: Enlarged Spleen. Upon 
exposing the belly cavity, this case turned out to be one 
of cancer of the pancreas, and after a few moments' 
hesitation on the part of the operator, it was thought 
nothing could be done. Patient sewed up and returned 
to bed. 
Third Case-Diagnosis: Empyema. A rib was re- 
sected in this case, the tissues of the thoracic cavity were 
then thoroughly explored by means of the trocar, but 
no pus could be found. After a few moments' hesita- 
tion, the incision wound was dressed and the patient 
returned to bed. (In passing, I may add that the case 
was from Oklahoma, and a doctor friend of the family 
was present, and told me that he was positive it was not 
empyema, but alT&r examination by members of the 
Mayo staff, it was thought different and the operation 
advised and undertaken.) Rochester and the Mayo Clinic 
67 
Fourth Case-Nasty fistula leading to a gall bladder 
on which cholocystotomy had been performed in this clinic, 
some months before. Adhesions most extensive requir- 
ing prolonged dissection. 
The next case was a hernia in the tract of a gall blad- 
der incision made here some time ago. 
The concluding case proved to be anurism. The belly 
was opened in the case of anurism at the bifurcation of 
the aorta. The tumor rested upon the promintory of 
the sacrum, and after the surgeon introduced his hand 
to explore, announced that the outlines of the tumor 
in connection with the iliac arteries resembled to the 
touch the head of an infant with its arms extended. 
Nothing further was done in the case save sewing him 
up and returning him to his room. 
While the assistants were dressing the incision wound 
in this case, the operating surgeon called the attention 
of the visitors to the man's physical makeup. He said 
the man was about seven feet tall with unusually long 
slender legs and arms, but with big heavy feet and hands. 
He said the feet were about twelve inches long. 
The patient was a young man and came from some 
remote country district. It was plainly evident to me, 
and to the gentleman standing next, that the attending 
surgeon wanted to convey the impression that this pa- 
tient was really more of an object of curiosity than of 
scientific interest. This person, and perhaps many of 
the other pitiable people who go to Rochester and expect 
to pass through the "Magic Hands" of the surgeons of 
St. Mary's Hospital, entertain implicit faith in the be- 
lief that here their chances for a speedy restoration to 
health is better than anywhere else in the world. The 
patients seem to be imbued with an unshakable faith in 
the belief that there are surgical miracles performed 
here. x j 68 
Rochester and the Mayo Clinic 
POTENTIAL ENERGY. 
The introduction of the hands following the incision 
of the abdominal wall for the purpose of exploration is 
done with a degree of ease that is worthy of note. The 
left hand is introduced in the belly cavity and used to 
explore the lower abdomen. The body of the examiner 
at the time of introducing the hand is turned half-way 
to the right. This position affords the easy movement 
of the arm and hand, and the exploration is made most 
thoroughly while the body and arm remain in an easy 
position. The examiner turns about facing the opposite 
direction and introduces the right hand for the purpose 
of examining conditions of the upper abdominal cavity. 
This struck me as a very clever part of the technic of 
this work because especially of the easy way in which 
it is executed by them. Really, I thought, a clever dem- 
onstration of the availability of potential energy. 
KRASKE-MAYO OPERATION FOR CANCER. 
The bulletin of one morning's list of operations in- 
cluded a Mayo-Kraske operation for cancer in the lower 
sigmoid. After witnessing the procedure, I was unable 
to segregate it as a distinct new method from a com- 
bination of those already known and practiced. Altho 
one writer tells us that some of the surgical operations 
are called distinctly "Mayo Processes." To my mind 
this does not seem to be one of them. They show a 
preference in their literature for the combined abdomino- 
sacral operation in two stages in extensive malignant 
infiltration of the rectum. 
GASTRIC AND INTESTINAL CASES. 
It is reported that there are more of this variety of 
cases operated upon in St. Mary's Hospital than any one 
institution in the world. The work is done day after Rochester and the Mayo Clinic 
69 
day by routine methods. The opinion is entertained 
among the staff of Rochester doctors that there is al- 
ways present an actual irritant prior to the development 
of gastric cancer, and upon this opinion the clinical lab- 
oratory men place the greatest emphasis, and cling to 
the belief that even a gastric ulcer should be excised, 
whether healed or merely scar tissue. In covering this 
point, the senior surgeon of the clinic, in one of his re- 
prints, advises that gastric ulcer should be excised and 
duodenal ulcers infolded with sutures. In some cases, 
he adds, it is impossible to inclose the gastric ulcer with- 
out great risk, and in the occasional case in which the 
duodenal ulcer is already roofed in by adhesions, it may 
not be advisable to infold it. In regard to the disposi- 
tion of the pyloric outlet following gastro-jejunostomy, 
he writes: "Clinically and experimentally nothing short 
of complete division of the pylorus, turning in the end 
of the stomach on the one hand and of the duodenum 
on the other can be expected to give permanent results.'' 
When the posterior wall of the stomach is accessible, 
they adopt, as a routine, the posterior no loop gastro- 
jejunostomy as the technic with a Moynihan holding 
clamp always brought into service over which the anas- 
tomosis is completed by means of the Hartman suture; 
i. e., holding the jejunum by a mattress suture to the 
stomach one inch proximal and one inch distal to the 
suture line of the gastrojejunostomy. 
In order to prevent hemorrhage, an experience they 
frequently encountered in former cases, they now use 
a third row of catgut sutures uniting the mucous mem- 
brane along the posterior suture line. "The accident is 
not so likely to happen on the anterior wall and since 
applying this muco-mucous stitch to the posterior line, 
there has been no bleeding following gastro-jejunostomy 
in any of our cases." The above information is gathered 
in whole from the writings of the surgeons at Rochester. 70 
Rochester and the Mayo Clinic 
For, as I stated in the earlier pages of this narrative, 
there is nothing to be learned in the clinic from anything 
they say. As I promised a while back I would discuss 
some of the more important phases of the Mayo clinic 
from a comparative point of view, I shall at this point 
refer to notes that I made at other clinics, reciting espe- 
cially medical history of some of the cases and remarks 
bearing upon the surgical and other instructive features. 
MERCY HOSPITAL CLINIC MEDICAL HISTORY. 
The following is given as a striking illustration of 
the difference in the conduct of this and the Mayo Clinic. 
Dr. Mix: "Attention is called to this fact that twelve 
years ago when the patient was 18 years of age he 
had an attack of appendicitis, and his appendix was 
removed. He says that no drainage tube was inserted 
but the scar is a ragged one. This attack of appendicitis 
eliminates from our consideration any possible conse- 
quence of appendix disease except possibly the post- 
operative adhesions. The first salient point in this his- 
tory is its duration, the onset occurring eight years ago. 
Its course has been intermittent with periods of freedom 
from suffering alternating with attacks of epigastric 
pain sometimes excruciating and sometimes consisting 
only of an annoying sensation. We found by cross-ex- 
amination last evening when I examined him that he 
had more trouble in the spring and fall of the year than 
he did during the summer or winter. Another import- 
ant point in the history of this case is the relationship 
of the pain to the taking of food. The majority of cases 
of duodenal ulcer have pain coming on some time after 
eating and the pain is relieved by the further ingestion 
of food. It is a probable fact that the hyper-chlorhydria 
which is almost always associated with duodenal ulcer, 
is responsible for the acid stream of hydrochloric acid 
bathing the ulcer as it flows from the pylorus thus caus- Rochester and the Mayo Clinic 
71 
ing pain. It is a fact further, that, by the ingestion of 
food the pylorus is temporarily closed and duodenal alka- 
line secretion temporarily increased with the result that 
such acid as there is in the duodenal is neutralized at once 
and so the pain is obviated. I asked the patient if he was 
not one of those who gets up in the night to eat and 
learned that he was a night feeder. Night feeding is a 
very common symptom in these cases, many of the pa- 
tients going to bed with some cracker or a glass of milk 
by their bedside. A negative point of some importance is 
the absence of vomiting during the eight years of his ill- 
ness. It is true that he vomited on one occasion recently 
during an acute exacerbation of his distress but during 
the eight years he did not vomit at all during the history. 
About ten days ago, at the height of one of his attacks, 
he vomited for about three days. This is the only at- 
tack of vomiting we have a record of in his history. 
Such vomiting raises a strong presumption of peritoneal 
involvement. Also important is the question of the 
presence of blood in the feces. During his stay in the 
hospital we have not found blood, but about two weeks 
ago, as I learned by careful cross-examination for two 
days, he had very dark stools. He had not been taking 
either bismuth or iron. The stools were not formed 
but were mushy and pasty. There is no history of the 
vomiting of blood. Important also are the negative 
symptoms, the absence of the attacks of colic, jaundice, 
fever and chills. Physical examination shows very little. 
The only finding of importance is the tenderness over the 
duodenal area near the epigastrium. This marks the 
location of the duodenal ulcer. It is near the pylorus 
and evidently on the duodenal side. He has no icterus, 
therefore it does not lie near the duodenal pappili, or if 
it does, does not involve it and so produce an icterus. 
The ulcer is not on the gastric side because the period 72 
Rochester and the Mayo Clinic 
of time (two hours) elapsing between the ingestion of 
food and onset of the pain is too great. And also be- 
cause of the absence of the vomiting of blood and ab- 
sence of blood in the Ewald test-meal. We are forced 
to the conclusion that he has a duodenal ulcer lying 
near the pylorus and of eight years' duration. We do not 
find on examination any signs of perchlechystitis. There 
is no tenderness on pressure over the gall bladder, and 
no gall bladder disease as far as I can make out, either 
from the surgical signs or from the history of the case." 
Clinical comments are what counts when one is seeking 
valuable, practical information. 
SURGERY AND COMMENTS. 
Dr. Murphy: "This man had an attack of pain last 
night which is exceptional for duodenal ulcer. The pain 
was so severe that he had to have a hypodermic of 
morphine. We will make the usual incision, going in 
thru the right rectus muscle between the umbilicus and 
the ensiform cartilage. Just as soon as the peritoneum 
is pinched he begins to stiffen. We will draw the stom- 
ach out into the wound. There is no evidence of ulcer- 
ation here. Running over the lesser curvature with my 
finger, I find no induration. Now we will pass around 
to the pyloric zone. The pylorus does not come up as 
easily as usual. I can feel an ulcer on the posterior sur- 
face of the pylorus. It appears to be active. There is 
a mass here that feels firm and hard as tho the ulcer 
might have perforated on to the head of the pancreas. 
The thickening is very pronounced. The mass is as large 
as a butternut and as hard as wood. If this mass were 
in the stomach I would say at once that it is a carcinoma. 
Being in the duodenum, I can say that it is not a car- 
cinoma ; that it is an active ulcer which accounts for the 
pain he had last night. It is you see a big hard and Rochester and the Mayo Clinic 
73 
woody mass on the posterior wall of the duodenum. It 
is a condition which is very rare with duodenal ulcer. 
It looks more as if the ulcer had perforated clear thru 
the wall of the bowel and into the head of the pancreas. 
The pain last night went right straight thru to the back, 
it seems as tho there were a mass in the pancreas, but on 
careful palpitation, I can feel only a general infiltration. 
In this case, we must do a posterior gastrointerostomy 
with the button. The chances are that this condition is 
not malignant because it is in the duodenum. A malig- 
nant ulcer in that position is rare. The typical button 
anastomosis side to side was done. The patient has 
evidently had some bleeding, recent bleeding, probably 
last night. On opening the abdomen, we found the in- 
testine full of blood. That is very interesting because 
the acuteness of the pain last night resembled in its 
severity the type of pain that one has in a tuberculous 
ulcer just preceding the bleeding. The evidence of bleed- 
ing is an instructive point. I rarely talk about the but- 
ton now because I think that every one has found out 
for himself whether or not he wants to use it. A recent 
writer went through not only the recent literature but 
all of the literature in the clinic at Heidelberg. He men- 
tioned a large number of cases, including those of Stein- 
thal. The point that concerned me was how many fail- 
ures with the suture and the button were due to hem- 
orrhage. There were 547 posterior gastroenterostomes 
by Daniell suture operations with 14 vicious circles. In 
458 cases done with the button, he had 5 cases of vicious 
circles. In Heidelberg, out of 333 cases with the button, 
there were only 2 cases of vicious circles. In 447 suture 
operations, there were 10 leakages, while in 397 button 
operations there were only 5 leakages or perforations. 
That is, about 1.2 per cent." 
This author's conclusions may be summed up in this 74 
Kochester and the Mayo Clinic 
expression: "If you want to do a gastroenterostomy and 
free from the danger of subsequent complications as 
regard leakage and hemorrhage, the thing to do is the 
posterior operation with the button. He says that the 
anastomoses done with the button is the ideal anasto- 
moses. Zcerny has been using the button ever since it 
came out, first for his desperate cases demanding hur- 
ried operation, mostly malignant cases and now for all 
his gastroenterostomes. We do the suture operation in 
a small percentage of the cases but we never feel quite 
secure as far as hemorrhages are concerned. One point 
in using the button must be emphasized. In tying the 
puckering string around the neck of a button, always 
have the knot on the end of the cylinder, never on the 
side." 
Murphy used nearly 300 more instructive words be- 
fore concluding his talk on this case. That is, duodenal 
ulcer and surgical technic. In this clinic, Mr. Robt. 
Milne, F. R. C. S., of the London Hospital, gave the 
following offhand talk, and its scientific and technical 
character made it all the more interesting because of the 
fact that it was offhand. I am giving a liberal abstract 
of his remarks to show the value of the lecture feature 
in a surgical clinic. 
"If you will look at that list of 19 operations on the 
board ranging from cerebral tumor down to tuberculosis 
of the metatarsus, you will appreciate my difficulty in 
choosing a subject, seeing that Dr. Murphy himself does 
work from the crown of the head to the sole of the 
foot. Since Dr. Murphy has mentioned septic ulcers, 
I may put before you some points on these in connection 
with some infections. I believe the great essential in 
the treatment of any pathologic condition is to remedy 
the cause, if these be still active. Can we determine the 
cause of gastric ulcer? We know in the mucous mem- Rochester and the Mayo Clinic 
75 
brane of the stomach, and even partially in the submu- 
cous coat, there are small collections of lymphoid tissue. 
These are in greatest number along the lesser curvature 
and in the pre-pyloric portion of the stomach; rare in 
the cardiac portion. Altho small in a healthy stomach, 
when inflamed they swell up, push the mucous glands to 
each side, and reach the surface. Various terminations 
are possible in such a swollen follicle. First, it may 
simply resolve. Second, it may break down in the center 
and a minute bead of pus be discharged in the stomach. 
Third, in the submucous coat there are the large blood- 
vessels. The follicular inflammation, if in contact with 
a vessel, may erode its wall, give rise to a miliary aneur- 
ism, or finally lead to rupture of the vessel. Fourth, the 
burst follicle, giving vent to the bead of pus, may allow 
the gastric juice to enter, to digest the coat of the stom- 
ach, and lead to the funnel-shaped, acute perforating 
ulcer to which, unfortunately, we have become accus- 
tomed. I shall enlarge on this later. Fifth, the entry 
of gastric juice may lead to a chronic ulcer, and so later 
to carcinoma. Terminations one and two would be called 
acute gastritis. Number three accounts for those cases 
of hematemesis in which gastrotomy revealed simply 
points oozing blood. Termination four may seem too 
radical, for you will remember several observers endeav- 
ored to produce ulcers by lacerating the gastro-mucous 
membrane in animals. They were only rarely successful. 
So in the human stomach, we believe that normally the 
edges of the mucous membrane fall together and gastric 
juice does not enter the wall of the stomach. If, how- 
ever, from any cause, e. g., fibrosis due to repeated in- 
flammatory attacks, the mucous membrane is altered so 
that the edges do not fall into contact, then the sub- 
mucous coat is unprotected, and an ulcer follows from 
the penetration of the gastric juice. Other experimenters 76 
Rochester and the Mayo Clinic 
injected lycopodium into the circulation to produce gas- 
tric ulcer. They were successful rarely. One pathologic 
condition seemed to support the theory upon which they 
were working. I refer to the contact ulcer. The small 
ulcer which we may find on the wall of the stomach or 
duodenum opposite a chronic ulcer. The theory would 
be that these may be terminal necroses due to embolism 
of a vessel on the lesser curve, just as blocking of the 
abdominal aorta might lead to gangrene of both legs, 
but not thighs. Pathologists started to look for these 
emboli. They could not distinguish them with the naked 
eye or with the microscope, and saw them only with the 
eye of faith. I believe these paired ulcers are not em- 
bolic, but that the second ulcer has been started by the 
infection of lymphoid follicles there from the septic 
surface of the primary ulcer. We know how a patho- 
logic appendix or gall bladder will lead to pyloric spasm 
and gastric pain. We can go no further. If you have 
in that gall bladder or in that appendix an infected pro- 
cess you have a possible source of infection of these 
lymphoid follicles in the stomach, and so a source of ulcer, 
and we have not done our duty to the patient in remedy- 
ing the gastric ulcer unless, in addition to the operative 
treatment on the stomach, we remove that appendix, and 
deal with that gall bladder." etc. (Italics mine.) 
"Mr. Bond of Leicester did some experiments. In 
patients with colostomes, we found indigo blue traveled 
from the rectum to the opening. He found in patients 
with vestical fistula that it traveled up the urethra and 
appeared in the fistula. The indigo blue particles ap- 
peared in the bile from a gall bladder fistula when ad- 
ministered by mouth. It reached the pelvic peritoneum 
as shown in laparotomies for pelvic trouble when placed 
inside the cervix twenty-four hours before. These 
phenomena were not due to capillary action, for they Rochester and the Mayo Clinic 
77 
did not occur in the cadaver, therefore were vital. They 
were not due to reverse peristalsis, for a cathartic has- 
tened their appearance in a colostomy. They were not 
due to ciliary action, for there are not cilia in the bile 
ducts or urethra. Indigo blue is a bit soluble in bile, 
but it is deposited in the bile ducts in crystals. While 
in these experiments it was deposited as amorphous 
granules on the wall of the gall bladder. He explained 
the phenomena by ascending mucoid currents on the 
walls of the ducts or tubes, notice. All these experiments 
were on pathologic subjects and are not proof as to what 
would happen in a healthy subject. We know if a man 
has an infection in the bladder, there is little risk of 
that affection going up the urethra to the kidney unless 
there is some obstruction to the ureter. We believe that 
infection in the gall bladder comes not thru the common 
bile duct, but thru the circulation, the organism having 
escaped the destructive ability of the liver cells, being, 
however, as a rule, greatly attentuated and virulent. I 
had to operate on a woman aged 73 about a year ago 
for acute cocholesystitis, and her case illustrates the long 
time the organism may live in the gall bladder. She had 
suffered from typhoid 45 years before; her gall bladder 
gave her pure culture of typhoid bacilli. She gave a 
positive Widal, with a dilution of .132, and one of the 
nurses in charge of her developed typhoid, the patient 
being the only source we could discover. A third com- 
plication of interest to surgeons is in the kidneys. After 
speaking of gall stones, one would naturally think of 
the relation between infection and renal calculus. We 
have all unfortunately had to deal with patients coming 
with both kidneys packed with large dirt calculi and 
perhaps removed them. What was the result? That 
man will come back to us for certain within two or 
three years with re-formation as big as the former cal- 78 
Rochester and the Mayo Clinic 
culi. Why ? Because those stones were due to infection 
of the pelvis. They were what we call secondary renal 
calculi, and unless we get rid of the infection, in those 
pelves, those stones will reform again and again. We 
used to think infection of those pelves occurred by way 
of the ureter, but have now given that up. We know 
on the contrary that the kidney can excrete organisms 
from the circulation without any apparent damage to the 
organ. We know that tubercle bacilli in the urine do 
not prove tuberculosis of genito-urinary tract. We know' 
that the bacillus coli is found in the urine of one in 
twenty women and kidneys suffer no harm. If, however, 
a kidney be weakened by trauma, the right kidney may 
be mobile unduly, or by pressure on the right ureter by 
a pregnant uterus. The organisms can then produce 
definite lesions demonstrable clinically. I have said to 
you that in order to cure this type of secondary stone, 
the infection must be cured. Of course, infection does 
not play so great a part in renal calculi as it does 
in gall bladder calculi. Shade has done pioneer work 
in the elucidation of the primary renal calculi; the 
stone unassociated w'ith infection thru this may occur 
later. To follow' Shade's explanation of primary stone 
formation, we must comprehend what he means by the 
term 'colloids/ 'reversible' and 'absorption' as applied 
to this problem. Colloids are substances w'hich appear 
to dissolve in water; (e. g., mucin or fibrinogen) but are 
probably in a condition of suspension since osmotic 
pressure is not affected by their presence. A reversible 
substance is one which can be redissolved after being de- 
posited from solution, e. g., a crystal of magnesium sul- 
phate. Mucin is a reversible colloid, fibrin is an irre- 
versible colloid. Absorption is the property colloids have 
of holding in solution inorganic substances to an extent 
greater than could be resolved in an equal quantity of Rochester and the Mayo Clinic 
79 
water. He would suggest that, for example, uric acid 
in urine is held in there in excess by absorption, on 
urochrome and other reversible colloids. Should the uric 
acid be in excess of the amount which the colloid can 
hold by absorption, we can picture the uric acid being 
deposited on the colloid. Should the colloid be a re- 
versible one, both colloid and deposit can be removed by 
more water. If the colloid be irreversible, e. g., if that 
uric acid be deposited on the surface of fibrin, then no 
amount of water will redissolve that irreversible colloid. 
The patient is forming a primary renal calculus, which 
no mineral water or drug ever cured. The colloid is 
the source of the small amount of organic matter found 
in every primary aseptic calculus. The tendency of 
fibrin to form laminae is the reason of the laminations of 
these primary renal calculi, and lastly, to cure that pa- 
tient we have not only to diet him in future to prevent 
excess of the substance which forms the stone; we have 
not only to tell him to prevent relative excess by drink- 
ing an abundance of water, but we have to discover the 
cause of fibrin uria, or fibrin in the urine which occurs 
apart from hemorrhage. This problem has still to be 
solved." 
MAYO CLINIC-GALL BLADDER. 
They are not especially radical in gall bladder work. 
That is, not so much so, as for instance is Deaver in 
his work, for Deaver in many of the cases upon which 
I saw these surgeons operate would have made a cho- 
lecystecomy instead of a simple drainage operation. In 
a majority of the Mayo cases, the gall bladder is cleaned 
out by means of a spoon and the bladder temporarily 
anchored for drainage. 
In an apparent effort to justify this conservatism, one 
of the women members of the staff lectured upon the 80 
Rochester and the Mayo Clinic 
subject before a number of medical guests in one of the 
larger rooms of the Mayo office building. She said their 
work was not nearly so radical as that of other surgeons, 
but that she was sure that their statistics would make a 
better showing than those who were inclined to taboo 
conservatism in gall bladder surgery. The earnestness 
of her remarks led me to think that she had been coached 
in order to be able to criticise the gall bladder surgery 
of one or two eastern surgeons before her audience. 
During my three weeks of observation at Rochester, 
the daily cases bore a striking resemblance in similarity. 
The average visiting doctor seemed to be surfeited with 
the same type. This similarity is corroborated by their 
publications. Dr. Wm. J. Mayo commenced writing on 
the surgery of the stomach in 1894, not a great while 
after he graduated and emerged into the surgical lime- 
light, and since that time, he has had published about 
100 papers on the subject of gastric surgery or on topics 
correlative thereto. Charlie Mayo has read many, many 
papers on the surgery of goiter. This he began early 
in his career, but I take it that he intends to speak the 
last word on the subject at Chicago at the coming meet- 
ing of the Congress of Surgeons of North America, for 
the title of the paper which he intends to read there is: 
"A Summing-Up of the Goiter Question." 
I did not see or hear anything about the newer things 
in surgery; such, for example, as congenital pyloric sten- 
osis, bone transplantation, carbon-dioxid snow, bone de- 
compression, the DeKeating-Hart fulguration, W. L. 
Clark's desiccation, pituitary surgery, nitrous oxide, intra 
tracheal and intravenous anesthesia, Murphy's formalin- 
glycerin injections, Lane's kink, subphrenic abcess, 
therapeutic immunization, Gerraghty test for renal im- 
pairment, specific cytatoxic serum for thyrotoxicoses, the 
newer technic in coecal operations, ecologic measures, Rochester and the Mayo Clinic 
81 
anoci-association, and the like. I saw no emergency work 
of any kind. 
ASSISTANTS MAYO CLINIC. 
The men assistants at St. Mary's Hospital act as 
tho they were efficient and familiar with the work in 
hand. One of these, however, acted as if he were shin- 
ing brightly in reflected glory and evidently proud of the 
semblance of authority given him at times. While I was 
sitting with another visiting doctor on the back railing 
in Judd's operating room, discussing the case that had 
just been operated upon, the particular assistant waived 
us both to the door, saying that they did not want the 
presence of strangers in the room while preparing pa- 
tients for operation. I learned later that the particular 
person on account of whom we were asked to vacate, 
was a young man upon whose neck a trivial operation 
was to be performed. Upon learning this fact, the 
thought passed through my mind that the exercise of a 
little discriminating indulgence might have given us a 
better opinion of this fellow. Further deliberation over 
our own autopsy led us to think that the exciting cause 
of our enforced exit came as a consequence of the sur- 
plusage of reflected glory. 
Dr. Balfour, the first assistant to Dr. Charlie Mayo, 
struck me as a different type of man than the assistant 
to whom I have just referred. He is pleasing in manner, 
cordial in voice, and painstaking in his work. It was 
Balfour who suggested the combination retractor that is 
now used exclusively for exposing the upper and lower 
abdomen in surgical work at the clinic. This device, 
formed by the union of the full merits of the Doyen and 
Goset retractors, makes it a most invaluable instrument. 
When placed in position with the intestines padded off, 
the pelvic organs are brought plainly in view of the opera- 82 
Rochester and the Mayo Clinic 
tor, making it unnecessary to explore further by means of 
the hands for the purpose of gaining more light and in- 
formation in regard to the condition within the pelvis. 
Everything can be plainly seen by the proper adjustment 
of the retractor alone. With this exposure, pelvic work 
may be accomplished easily with every step of the pro- 
cedure plainly in sight. If anyone should use the instru- 
ment devised by Dr. Balfour, he will forever after find 
his surgical armamentarium incomplete without it. Bal- 
four is a young Canadian and graduated from the Cana- 
dian schools. He is a son-in-law of Dr. Wm. J. Mayo, 
and hence is very worthily in line for future advance- 
ment. 
I personally congratulated Dr. Balfour on the mechani- 
cal genius he displayed in giving to us such a useful 
instrument and added: "Now if you could devise an in- 
strument that would expose the gall bladder region like 
the retractor does the pelvic organs, we would remain 
still more deeply your debtor." Tapping the top of my 
shoulder with his finger, he said: "I shall have just such 
an instrument working very soon." 
Balfour graduated from Toronto University in 1906. 
Besides the reprint describing the combination of the 
abdominal retractor I have one copy each of two other 
papers written by Balfour: "Polycystic Diseases of the 
Kidney and Tuberculosis of the Kidney." These excel- 
lent literary contributions to these studies, T have no 
doubt, came directly from Balfour's own mind and were 
purely holographic. His early, excellent training ac- 
counts for the marked difference in the surgical litera- 
ture. 
This good fortune does not seem to surround the future 
prospects of all the assistants, for I heard one of them 
bemoaning the certain fate that was early awaiting him 
unless he succeeded in marrying into one of the families Rochester and the Mayo Clinic 
83 
of the firm. But this young man was finding much con- 
solation in keeping the fact in mind that Dr. Wm. J. 
Mayo has other unmarried daughters and Dr. Charlie has 
six. The Mayo firm is an incorporated organization and 
I take it that the firm name is styled "Mayo, Graham, 
Plummer and Judd." At all events this is the name I 
noticed on some of the medical journals received by mail. 
Dr. Charley Mayo married Dr. Graham's sister, and Drs. 
Judd and Plummer married nieces, so you can under- 
stand how it is that Judd is working in the clinic and 
Plummer became a member of the firm and is given prom- 
inence otherwise. Dr. Graham is the factotum at the 
office. The whole is strictly a family affair. Edward 
Starr Judd, that is his full name, graduated in 1902 from 
the College of Medicine and Surgery of Minnesota. E. 
H. Beckman graduated at the same institution in 1901. 
The antecedents of both are somewhat obscure. 
In each operating room, there is always one sister 
noiselessly but busily occupied. One of the visiting doc- 
tors whom I found to be engaged making observations 
on the appearance, movements and dress of the female 
assistants at the clinic, laconically expressed the opinion 
that the sisters act as tho they were "ninety-nine per cent, 
impersonal and the Protestant nurses as ninety-nine per 
cent, personal." Why shouldn't they be? The sister is 
content in her present sphere but there are stirring in the 
mind of the nurse other aspirations. The sister in each 
room is in charge of the surgical instruments. She seems 
to know the nature of the next proposed operation and 
the necessary instruments are always found arranged in 
readiness for the surgeon before he begins the surgical 
procedure planned, before the patient is placed upon the 
operating table. She is neatly and modestly attired in 
the regulation dress of the Order of the Sisterhood of 
St. Francis, but in pure white. St. Mary's Hospital is 84 
Rochester and the Mayo Clinic 
under the control of the Sisters of St. Francis. While 
pondering over the early history of St. Mary's Hospital, 
I seemed to be able to see the self-sacrificing devotion of 
Sister Mary Alvord and I thought the name "Mary Al- 
vord" ought to be enshrined with emblems of love and 
placed high upon the hospital made possible by her noble 
work. The same sisterhood controls St. Anthony's Hos- 
pital in this city, St. Louis, and anyone passing Chippewa 
Street and Grand Avenue, South St. Louis, will be at- 
tracted by the towering building and its beautiful grounds. 
Here it is that Dr. Bartlett performs many surgical 
operations. It is only natural, I imagine, for one to ex- 
perience giowings of uncommon gratitude for the doctor 
and the hospital under whose care he successfully passes 
thru a serious surgical ordeal. Perhaps this is true with 
me, for I underwent the operation for appendicitis in St. 
Anthony's Hospital, and there was not a moment follow- 
ing the operation that I was not progressing toward the 
complete restoration of my former self. Dr. Bartlett did 
the surgical work, and the faithful kindness of the Sisters 
added much to my comfort, as well as to the certainty of 
a speedy convalescence. During my stay at the hospital, 
I had the opportunity of seeing a variety of Dr. Bartlett's 
cases, and I can say that every one of his operations 
shows the hand of a skilful surgeon. 
ANESTHETISTS AND ASSISTANTS, MAYO CLINIC. 
The anesthetists are all women of mature years. Ac- 
cording to my information, at least two of them have 
served in this capacity for a number of years and no 
doubt have become experts in the administration of ether 
anesthesia, but after all these years of experience might 
find themselves greatly puzzled if called upon to secure 
nitrous-oxide anesthesia. They and the other women in 
the operating rooms wear caps, but with that irrepressible Rochester and the Mayo Clinic 
85 
vanity so characteristic of all of our sisters old and young, 
a few locks of hair may be seen playing coquettishly from 
beneath each one's cap. I pondered over this, and won- 
dered that the senior surgeon tolerated even this womanly 
bit of ornamentation in his clinic. In speaking of the 
London hospitals, he embraced the opportunity to anim- 
advert on the subject in this wise: "I was glad to see in 
many of the hospitals that the nurses were compelled to 
wear a head covering in the operating room instead of 
allowing the hair, some of it their own, to fly about their 
heads in the barbaric manner prescribed by modern style. 
It is incongruous that an operating room nurse should be 
covered by gown, rubber gloves and sleeves and yet allow 
her hair to fly in every direction like shaking a hair duster 
on things she should protect." 
NURSING STAFF, MAYO CLINIC. 
The nurses at St. Mary's Hospital are neat in appear- 
ance and have pretty, fresh faces, and in their nicely 
fitting uniforms and white shoes make up an attractive 
picture. Some, or at least most of them, seem to have 
been reared with plenty of outdoor life. They have the 
bloom of the country upon their cheeks, and each has a 
personality that might be envied by any city belle. It must 
be noted here that there are many handsome, well-dressed 
young doctors, some from far away cities, constantly in 
attendance at the clinic and passing thru the hospital 
halls. Hence, one would think it perfectly natural for 
these daughters of the northwestern prairie to want to 
show their natural charms to the very best advantage. 
There may be method, perhaps, but 'tis of a coy variety. 
But it is nevertheless true that the trained nurse is a 
potent factor in hospital activities in general. She it is 
who becomes supreme in authority in matters relating to 
the patient's care in the surgeon's absence. She, indeed, 86 
Rochester and the Mayo Clinic 
remains the surgical mentor, and the patient must obey 
her orders. Oftentimes, she must assume critical re- 
sponsibilities. She acts a part of the hospital life of the 
surgeon, and is always able to handle the more serious 
cases in a way that results in great relief from the burden 
of anxiety and worry. By her efficient and kindly offices, 
the hospital'life of the patient is relieved of much of its 
depressing monotony. Here follows the sentiment of a 
hospital patient expressed in verse, whose nurse he found 
not any more attractive than she was dutiful. 
MY UNIFORMED NURSE. 
A sweetly winsome face, 
Ripe lips and merry eyes 
Where tender pity lies; 
Brown hair beneath a cap of lace 
To keep the wayward locks in place. 
A fichu neat and plain 
Crossed on her bosom white; 
Her heart beneath is light, 
But throbs in sympathy with pain 
And other's sorrows feels again. 
Her very presence heals, 
Her quiet footfalls soothe, 
Her hand is soft and smooth, 
And as my fevered pulse she feels 
A glad thrill thru my being steals. 
And when, grown bold, I say, 
"I love you, gentle nurseI" 
She says, "I'm sure you're worse! 
You must not talk, you're worse today." 
And so she flings my heart away. Rochester and the Mayo Clinic 
87 
MAYO CLINIC-DR. MAC CARTY. 
The clinical laboratory presided over by Dr. Wm. Car- 
penter MacCarty, St. Mary's Hospital, I found to be 
a place full of interest. Dr. MacCarty is a genial cor- 
dial gentleman and does not require fomalities when one 
wishes to enter his workshop for information. There are 
four or five engaged with him in his laboratory, and he 
and his assistants are at all times very busy. He is widely 
cultured, and stands very high in his field of w'ork. He 
has ideas of his own too about the possibilities and limita- 
tions of surgical procedures, and he has offered many 
valuable suggestions to surgeons with respect to the 
interdependent relations existing between certain organs 
of the body. He is working out pathological problems 
that will no doubt eventually throw much light on the 
causes of the extension of symptoms into a group of or- 
gans from the primary focus in one. His summary cover- 
ing this new field of study is as follows: "First, what are 
the pathological conditions which arise in the gall blad- 
der?" 
"Second: What pathological conditions are frequently 
associated with lesions in the gall bladder ?" 
"Third: What evidence is there for common disturb- 
ance in the activity of the duodenum, stomach, liver and 
bile passages?" 
"Fourth: What is the relationship between the condi- 
tions of the stomach and the conditions in the duodenum 
and the function of the liver, gall bladder and pancreas?" 
"Fifth: Is there any relationship between the frequency 
of pathological conditions of the appendix and disturb- 
ance in the stomach, duodenum, liver, gall bladder and 
pancreas ?" 
Dr. MacCarty is a tireless worker and his laboratory 
is full of zealous activities. I read in one of the pamph- 88 
Rochester and the Mayo Clinic 
lets from a member of the Mayo medical staff this sen- 
tence : 
"And I think we have shown with a considerable de- 
gree of accuracy that 70 per cent, of our cases of cancer 
of the stomach have developed upon previous ulcer of the 
stomach." I handed Dr. MacCarty this pamphlet with 
the above quoted sentence marked and after he read it, 
I asked him the following question: "What is the per- 
centage of healed ulcers of the stomach that later develop 
cancer?" He did not know definitely but suggested that 
whether healed or open should be excised. A radical 
practice perhaps, but I am sure full of wisdom. 
Dr. MacCarty has suggested another method of oblit- 
erating the gastric ulcer. It is a method he described 
under the terms "autolitic excision by a pentagonal com- 
pression suture." In these experiments, John Wm. 
Draper was associated with him, and in their reprint, it 
is stated that the authors wish it understood that they 
are not advocating this method for the treatment of gas- 
tric ulcer or any other special lesion. They leave to the 
ingenuity of others its possible adaptation to occasional 
and varied uses. "Interrupted compression sutures," they 
further admonish, "which have occasionally been used 
in the past are not more quickly introduced nor as certain 
of constricting all the blood supply as a continuous stitch. 
We have found that a continuous suture in the form of 
a superimposed double pentagon is satisfactory." Dr. 
MacCarty has also devised a very useful apparatus for 
the quick examination of specimens. He describes it as 
"a simple photographic apparatus for immediate record 
of fresh and fixed macroscopic and microscopic sections." 
Dr. MacCarty is an inspiration to his associates. Rochester and the Mayo Clinic 
89 
SIMPLE METHOD OF PREPARING THE SKIN FOR SURGICAL 
OPERATIONS, MAYO CLINIC. 
For over a year they have not been using the old 
method, which included a cumbersome pack on the pa- 
tient's abdomen over night, in preparing abdominal cases 
for operation, a thing I have long contended should have 
been abandoned because of its terrorizing effects upon 
the patient's mind. They now use the same method of 
preparing the skin for surgical operations as was insti- 
tuted and practiced in the clinic of Dr. Bastianelli in 
Rome. This method eliminates the old scrubbing pro- 
cess, followed by the application of numerous liquid solu- 
tions and the pack. The Bastianelli method consists sim- 
ply of the application of two solutions to the dry skin; 
the first solution is composed of one part of iodin crystals 
to one thousand parts of benzin. Solution No. 2 consists 
of 3.5 per cent, tincture of iodin made by diluting the 
ordinary tincture one-half with alcohol. If it is thought 
advisable to shave the field of operation before preparing 
the skin, this should be done either dry or by using ben- 
zin so that no water is absorbed by the cells of the tissue; 
or, if desired, the field of operation may be shaved some 
hours before. Solution No. 1 is painted over the field 
of operation with a piece of gauze, simply rubbing enough 
to remove all dirt and scales from the skin. All the ben- 
zin should be allowed to evaporate, leaving the skin abso- 
lutely dry before solution No. 2 is applied. Solution No. 
2 is then applied by painting over the field of operation 
with a pledget of cotton or a piece of gauze saturated with 
the tincture of iodin. One coat of each solution is 
enough. 
Prof. Bastianelli of Rome recently visited Rochester, 
and as I write this is in New York on his return voyage. 
While in New York, he was interviewed by a New York 90 
Rochester and the Mayo Clinic 
Times reporter. Among other questions, the reporter 
asked him the following: 
"Which country do you think is the foremost in sur- 
gery ?" The Doctor replied: "That I would not care to 
answer. It is difficult to measure progress in surgery 
by countries. So much in surgery is individual. But if 
you ask me where the best ideas come from, I may tell 
you I think that, while I have the greatest admiration for 
American surgeons, the best ideas come from Europe. 
Over here, you have the means of developing them. Such 
is not to be had in Europe." 
This is the opinion of one abundantly capable of pass- 
ing judgment as to the preeminence of any doctor or set 
of doctors. How differently these opinions are ex- 
pressed in the American press, and the various magazines 
I have quoted. And yet, Prof. Bastianelli took in Roches- 
ter on his recent trip thru the West. 
In reply to one question, he did refer to the surgical 
institutions of America in general. "I cannot single out 
any of your surgical institutions as better than the rest." 
This article is printed in the Times, headed "Dr. Bas- 
tianelli of Rome Finds Our Surgeons Only Develop 
Ideas." 
Dr. Bastianelli, who has an zYmerican wife, speaks 
English fluently, and much of his splendid work is well 
known to American surgeons. Like Crile, he has made 
many experiments in efforts to improve methods of anes- 
thesia. He has used spinal anesthesia in his clinic in more 
than two thousand cases without a death and more re- 
cently tried chloroform solution in the veins as an anes- 
thetic. 
Dr. Bastianelli's parting words were: "I have enjoyed 
my trip. I may say I have learned a lot. I visited the 
Rockefeller Institute. That institution has been devel- 
oped by men of great talent who have already given to Rochester and the Mayo Clinic 
91 
the world proof of the work that the Rockefeller Insti- 
tute can do for the community and for the common good. 
The work of Dr. Flexner and Dr. Carrel is of the highest 
order. We have men who are doing a great deal in re- 
search work in respect to tumor. Of course, we have 
men who are working hard in the study of cancer. That 
is a subject on which little should be said until something 
is actually demonstrated, as it is cruel to raise false 
hopes." 
No doubt Dr. Bastianelli had the clinic at Rochester in 
mind when he replied to the reporter who asked him 
which country was the foremost in surgery, for it was 
the Bastianelli clinic at Rome to which one of the stall 
had been sent the year before to get the iodin-benzin 
method of preparing patients for surgical operations. In 
fact, others of the staff had previously visited this clinic 
looking for new ideas. In this connection, I may add 
that one or another member of the Mayo staff is kept 
upon the road most of the time visiting different hos- 
pitals and institutions over the Continent and this country 
in quest of innovations upon older methods. 
MAYO STAFF. 
In going about the staff, it was easy to note signs of 
friction among its members. This might be expected 
and, I take it, is a very natural thing to follow in the 
wake of the employment of so many different types of 
specialism. On one occasion, a member of the staff to 
whom I showed a paragraph in an article written by 
another member of the staff, characterized it as "mere 
rot." Pretty strong criticism of the scientific literary 
efforts of a colleague, but I took it to mean that the feel- 
ing between them was not of the most harmonious kind. 
I heard that a like feeling existed between some of the 
other members of the general staff, most of them dis- 92 
Rochester and the Mayo Clinic 
playing the habit of watching one another jealously. Ab- 
sence of harmonious team-work may be the cause of some 
of the faulty diagnosis that occur now and again. It is 
well known that in any association of men brought to- 
gether for a single purpose, if its members are allowed 
to distrust each other, they will never pull together. A 
quarrelsome household will be a divided family. 
"Jealous in honor, sudden and quick in quarrel." 
-As You Like It. 
Perhaps much of this personal strife is due to the fact 
that by the practice of constantly adding new men to 
the staff, it cannot readily be determined "Who's Who 
and Why." Hence the little prejudices and big preju- 
dices. Little fights and big fights cause a ceaseless strug- 
gle for who is to win recognition as the "survival of the 
fittest," and so certain gentlemen engage in the gentle 
art of "throwing hooks" into certain other gentlemen 
until the conquest is won. Then, too, there are several 
women members of the general staff who more than 
likely often find themselves obsessed by a spirit of rivalry 
with the great and the near-great. But then there is no 
difference here in this respect to what may be found else- 
where under like circumstances. It is simply human na- 
ture and "Everybody's doin' it." 
I found one of the members of the staff to be so busily 
occupied with his work in the Mayo offices as to forbid 
the possibility of sparing a bit of his time with any out- 
sider. To this member I had a letter from a person who 
at one time served him in the capacity of a benefactor. 
The letter had been read to me and I was acquainted with 
its contents. Its sentiment was friendly, including the 
expression of many good wishes. The next day after 
reaching Rochester, I passed the letter to one of the 
young ladies in the general office of the firm, requesting Rochester and the Mayo Clinic 
93 
that she hand it to the doctor when he arrived at the 
office. I had written the name of the hotel at which 1 
was stopping and the number of the room on the en- 
velope, but I never heard from the letter. 
The benefaction consisted, I understand, of the neces- 
sary means to enable the young man to go to a medical 
school. He was at that time living in a sparsely settled 
section of northwest Minnesota with only the little school- 
house of one room situated far back on the prairie to 
look to for his mental uplift. He soon won the coveted 
medical diploma-perhaps after two years of study-and 
later joined the staff of doctors at Rochester. He gradu- 
ated from a medical school in Minneapolis. The party 
giving me the letter stated at the time that this doctor 
had just closed another contract with the medical firm at 
Rochester for three years' service at an annual salary of 
$6,000. 
IN DEFENCE OF DR. NICHOLAS SENN. 
It was my intention at the outset of this paper to gather 
from my notes all of the items relating to the things that 
especially attracted attention at Rochester. Therefore, 1 
must make mention of an article I chanced to see in a 
medical magazine, published I think in Seattle, Washing- 
ton. On this particular occasion, I was sitting in the 
Mayo Public Library when my eyes happened to fall 
upon this medical journal. Out of curiosity 1 picked it 
up, as I had never seen this particular publication before, 
intending only to look over its general makeup. In glanc- 
ing over its pages, I saw in one of the columns, the name 
of Dr. Nicholas Senn. In connection with this name. 
I read that Senn was charged with having been egotisti- 
cal, bombastic, and inordinately jealous, and therefore, 
did not stand close personal contact; that he had never 
made a single good surgeon during his professional ca- 94 
Rochester and the Mayo Clinic 
reer, but by his inspiring example on the one side and 
stinging jealousy on the other, he had awakened emula- 
tion on the one, and envy on the other, hand. This inter- 
view was held between Dr. Wm. J. Mayo and Dr. R. C. 
Coffey, Portland, Oregon. The strictures about Senn 
were made by the former to the latter, who wrote them 
in the article I had just read. 
The connection between this article and the matter I 
am bringing to notice lies in the fact that the article indi- 
cated that this criticism was made to the writer of the 
story by one of the now famous members of the Mayo 
surgical staff. This article made a most grievous and 
lasting impression upon my mind. Therefore, in accord- 
ance with my early intention of recording all facts, I 
must speak of it, altho not entirely a pleasant theme. 
In regard as to whether Senn ever made a good sur- 
geon, it may be found in print that, by his own acknowl- 
edgement, this particular member of the Mayo surgical 
staff had an imperfect knowledge of how7 to tie sutures 
even after many years of practice, until taught how to 
do so by a surgeon that w7as made by Dr. Senn. I refer 
to Dr. A. J. Ochsner, who w7as made a surgeon by Senn. 
It is useless, I must say, for anyone to undertake to ex- 
plain how and from whom Ochsner received his surgical 
training, if not from Senn, for it is widely known that, 
soon after Ochsner graduated, he became Senn's first 
assistant, and remained in that position for five years. 
Now, as to the occasion on which the proper applica- 
tion of the suture wras suggested, here follows the ex- 
planation of Dr. Wm. J. Mayo, given in his own words: 
"About ten years ago, A. J. Ochsner was visiting our 
clinic and while making a myomecotomy, I remarked 
that it was an operation that I feared. Ochsner said very 
promptly, 'You will not fear it, if you don't tie your 
sutures so tight,' referring to the catgut suture I had used Rochester and the Mayo Clinic 
95 
in drawing the cavity in the uterus wall together from 
which I had removed the myoma. Ochsner said: 'If 
you will put in the sutures just tight enough to coapt the 
tissues and stop hemorrhage and not tight enough to 
bleach the tissues, you will have no trouble.' We have 
followed Dr. Ochsner's advice ever since, and I consider 
his teaching in regard to the danger of suture tension not 
only in myomecotomies but in all operations one of the 
many valuable contributions he has made to surgery." 
To my mind, Dr. Mayo's criticism in Dr. Coffey's ar- 
ticle carried with it a suggestion of ingratitude. 
At the testimonial banquet given to Dr. Senn in No- 
vember, 1905, Dr. Mayo was present, and read a speech 
on American surgery, and in the presence of Senn, em- 
braced the opportunity to refer to him thus: 
"The mass of the profession in this country did not 
know the position they occupied until Senn's 'Principles 
of Surgery' was published. (Applause.) This book was 
popular. It had its effect in diffusing knowledge, and 
surgery in this country became instantaneous. This book 
did more to teach the profession how little they knew and 
how much was being accomplished than any one thing 
that had happened. There appeared at this time, too, a 
series of letters from abroad published in the Journal of 
the American Medical Association, and written by Senn, 
describing in clear-cut and forcible language, the condi- 
tions as they actually existed in German clinics. These 
letters told the profession what they did, what they 
thought and how they did it. Dr. Senn had written up 
the work of these men in such an absorbing and fascinat- 
ing style that every man felt as tho he himself had 
visited these clinics and had seen these men at work. 
These letters were a stimulus for every medical student 
who desired to do surgery to go to Germany, or to be 
drawn there as by a magnet. Every man who did sur- 96 
Rochester and the Mayo Clinic 
gery felt he could not do justice to his patients if he had 
not been abroad, and consequently he slaved and slaved 
for the purpose. Multitudes of American students went 
to Germany, so that there were more medical students in 
Germany than in all the other foreign countries combined. 
American surgery was soon Germanized in the United 
States under the leadership of Dr. Senn. At a time when 
American surgery was relatively held in contempt, Senn, 
by a series of brilliant articles on practical subjects, such 
as pancreatic disease, branchial cysts, etc., made the sur- 
geons of the world respect America. It is therefore 
fitting that the profession should acknowledge their in- 
debtedness to this man, whose work has been an inspira- 
tion to ambitious Americans. For this and many things 
more, the profession owes a lasting debt to Senn." 
(Applause.) 
If one cares to review the "Collection of Papers" pub- 
lished in the first two volumes, printed by Saunders in 
the year 1912, it may be found that Senn was quoted 
twenty-eight times by the Mayo writers, examples of 
which follow: 
"In regard to the breaking down of a syphilitic guma, 
Senn says: 'Syphilis may cause a fibrous stricture of any 
portion of the alimentary canal,' and adds 'it is not ulcer- 
ative in character.' " 
Discussing surgery of the stomach: "By forcing air 
into the colon per rectum as practiced by Senn, the rela- 
tion of the stomach to the transversed colon may be 
mapped out." 
In writing about the great omentum in abdominal and 
pelvic surgery, he mentions Senn's work twice. "Follow- 
ing Senn's lead, many operators have utilized the omen- 
tum to cover defects in the peritoneum or by proper appli- 
cation of suture to form a channel between an irrepar- 
able damage of a deep-seated viscus and the surface of Rochester and the Mayo Clinic 
97 
the body. To Senn is due the credit of the practical ap- 
plication of this method. He recommends the total re- 
moval of the graft rather than its partial disconnection 
with the omentum, and after the end to end method of 
the approximation of the intestine by suture, completely 
surrounding the line by an omental graft two inches in 
width, and holding in place by loose catgut sutures thru 
the mesentary in the lines of the vessels." 
"Popularization of correct views on the pathology of 
surgical tuberculosis in English speaking countries has 
been slow and due largely to such men as Bland-Sutton 
and Treves in England, Roswell Park, Gerster and Senn 
in the United States." 
"In a most exhaustive paper on intestinal tuberculosis 
published in the Journal of the American Medical Asso- 
ciation in May and June, 1898, Senn says: 'That the 
disease may occur as a primary infection, can no longer 
be doubted. The results of an enormous clinical experi- 
ence and thousands of knee cropsies furnish a substan- 
tial verification of this fact.' " 
"Senn describes two forms of disease, one fibrous with 
marked hypertrophy resembling carcinoma and an ulcera- 
tive variety more apt to cause stricture. The two phases 
of disease are often present in the same case. Senn points 
out the fact that in many cases supposed to be primary, 
there are other infected localities which may not be 
recognized; localized tuberculosis of the intestines. In 
Senn's monograph previously referred to will be found 
a differential diagnosis worthy of the most careful study." 
"Removal of the cecum and ileo-coecal coil or ascend- 
ing colon has been practiced with good results and many 
cases are now recorded by Senn, Pilcher, Ochsner, Corte, 
Sachs, and others. Senn notes in connection with this 
that even a short length of remaining large bowel is suffi- 
cient to drive the stool and this was our experience in case 
number four." 98 
Rochester and the Mayo Clinic 
Referring to extra-uterine pregnancy, he says: "True 
abdominal gestation is rare (extra-uterine pregnancy.) 
The digestive power of the healthy peritoneum is well 
known and the possibility of its occurrence implies a 
previous disease of this membrane. Senn is now conduct- 
ing experiments in regard to the possibility of its produc- 
tion in the lower animals. We shall await his conclu- 
sions with interest." 
Skin-grafting-"Senn recently recorded the successful 
transplantation by the Wolfe method of skin from the 
inside of an arm to form the upper eyelid and brow." 
Surgery of the neck: "The extensive incision so fre- 
quently required for the removal of tuberculosis and 
other forms of diseased glands involving the various tri- 
angles of the neck is best made after the S plan which is 
frequently used in Senn's clinic, being preferable to the 
Z incision of Fenger as the points of flap in the latter 
incision are more difficult of co-aptation." 
Again, surgery of the stomach: 
"This admirable operation has been performed by Senn 
and many other surgeons with good results. It was first 
performed by Wolfler in 1881 with suture and up to the 
time of Senn's innovation in the use of bone plates for 
anastomosis, the mortality was great, about 50 per cent. 
Anastomosis by means of bone plates inaugurated by 
Senn first popularized this operation." 
Writing of cicatrical stenosis and malformation, a 
cause for pyloric obstruction: "Now and then cases oper- 
ated upon by masters in the art of surgery, e. g., Senn, 
Lange, Weir, and others, have been reported in Ameri- 
can Medical Literature." 
"In his monumental work on tumors, Senn says that 
the histologic structure of cancer in this organ mimics the 
tuberler glands, while the character of the tumor is deter- 
mined by the relative amount of epithelia cells to the 
stroma." Rochester and the Mayo Clinic 
99 
Under heading of malignant obstruction of pylorus: 
"Senn has taught us that when the fundus lies below the 
level of the umbilicus, there is pathologic dilation, unless 
gastroptosis is present." 
At present there are but two methods of gastro-enteros- 
tomy which have a considerable following: the suture 
operation and the one with the Murphy button. I had 
the privilege recently of witnessing Senn do the suture 
operation. Tn his hands, it seemed easy, and was cer- 
tainly rapid and satisfactory. 
Pyloric obstruction: "The advocates are rather equally 
divided, for example Kocher, Doyen and Senn use the 
suture; Czerny, Kummell and a large share of German 
surgeons hold to the button." 
Malignant disease of stomach and pylorus: "Senn 
warns against the rough handling of a malignant tumor 
for the purpose of making a diagnosis and says that such 
diagnostic massage may result in increased activity." 
"The suture operation of Wolfert brings the lateral 
wall of the jejunum to the side of the stomach, and Senn 
fixes the bowel at several points each side of the opening 
to prevent angulation, and favors a long visceral incision 
to prevent contraction." 
Surgery of stomach and associated viscera: "In orig- 
inal races," says Senn, "many diseases of civilization, 
such as appendicitis, gall stones, ulcer and cancer seem 
to be rare." 
Pancreatic cyst: "The pathology of this rare affection 
has advanced but little since 1885, when Senn wrote his 
classic paper upon the surgery of the pancreas." 
Pathology and diagnosis of oblique fractures: "The in- 
fluence of chronic inflammation of the bone especially 
near the epithyseal line upon bone growths is noted by 
Senn." 
Treatment of tuberculosis of bones and joints: "This 100 
Rochester and the Mayo Clinic 
treatment (io per cent, iodoform emulsion in glycerine) 
was advanced by Billroth and Mikulioz in 1882, and has 
been advocated and practiced extensively in this coun- 
try by Senn." 
Cancer and its surgical treatment: "The late diagno- 
sis in rectal disease like that of the uterus does not often 
permit of radical operation even after the method of 
Kraske. In palliation of cancer of the stomach and in- 
testines, Senn advocates anastomosis by means of bone 
plates." 
Surgical treatment of suppuration: "For unmixed 
tuberculous suppuration, the iodoform emulsion treat- 
ment, advocated by Senn, is an important aid, and the 
resulting reactive swelling when absorbed contains some 
chemical compound which acts favorably upon the body 
as a whole in a remarkable degree." 
It will be seen from the foregoing that the ideas and 
teachings of Senn were appropriated most extensively in 
forming the ground-work upon which this critic built 
his own reputation. I was therefore more than surprised 
that one for whom the profession has done so much 
should find it necessary to pass a criticism of such se- 
verity, or any kind of criticism at all, upon any member, 
however great the grievance may have been, real or 
imaginary. 
But the voice of Senn, the martyr master surgeon, is 
stilled in death and those who knew him best will not 
likely take serious offense at the umbrageous reflection 
on Senn's career, for the remarks embracing the crit- 
icism, it will be believed, are as empty of the truth as 
they are reprehensible in character. 
I think I can truthfully say that I knew Dr. Senn 
well. Indeed, I believe I was considered by him as one 
of his most intimate friends. We kept up a regular 
letter correspondence for many years, besides I passed Rochester and the Mayo Clinic 
101 
many weeks in his company, much of the time alone 
with him. We made many hunting trips together, and 
oftentimes found ourselves by the camp fire miles away 
from anybody. His conversation on these occasions 
often would lead him to speak of his acquaintances, 
medical friends, and others whom he had not met, but 
whose work, literary and otherwise he held in high es- 
teem. During all my association with him, I never 
heard him speak boastingly of his own work nor dis- 
paragingly of the work of others. He never brought 
himself to the level of a personal critic. He was by 
nature a refined man, with an exalted sentiment, and 
his heart and mind and mouth were as clean as a little 
girl's. 
Magna est veritas et prsevalebit. 
MEDICAL OPINIONS ON THE MAYO CLINIC. 
Little proofs came to me daily of the fact that the 
professional perspective as well as the clinical features 
at St. Mary's Hospital were disappointing to many of 
the visiting physicians with whom I talked, registered 
at the Mayo clinic. Personal contact seemed to change 
opinion, i. e., I frequently heard it remarked that the 
Mayo clinic did not measure up to expectations. In 
order to obtain general expressions covering the opin- 
ions of a greater number in regard to how others were 
impressed with the situation at Rochester and the work 
in general, and, in order to fully satisfy myself about 
these points, to obtain sound and intelligent judgment 
of a wider circle of surgeons whom I knew had visited 
Rochester since my return home, I have written several 
letters to surgeons with whom I had not discussed the 
subject. A number of replies have been received and 
I feel that I must quote the substance of at least one 
of them, and typical of all. It is as follows: 102 
Rochester and the Mayo Clinic 
"Was much taken with W. J. Mayo and Dr. Judd's 
work. Both were clever, quick workers, but in many 
ways they are not painstaking enough. Closing of 
wounds crude, and repair of hernia imperfect in many 
details, especially the use of kangaroo tendon being 
wanted. I think, altogether, they are much overrated, 
and Judd promises to be much better man than either. 
Dr. Charles Mayo very ordinary. However, I got many 
points of great interest, especially in technic, and had 
a very pleasant time in Rochester." 
I, too, noted that there was little evidence of the more 
delicate and gentle technic displayed in closing the in- 
cision wound in the belly. For example, the Michel 
skin clips find no place in their suture technic in any 
case and the wounded tissues and instruments are 
handled rather roughly. 
SURGICAL LITERATURE OF THE MAYO CLINIC. 
For a fair perspective of the events of my stay in 
regard to their writings, it is necessary first to get a view 
of how they are looked upon by others as authors. "The 
surgeons of the Mayo clinic write much in the style they 
talk, and therefore many of the literary productions 
emanating from the clinic are not written by the person 
to whom is assigned the credit of authorship. The sur- 
geons simply furnish the data. The editorial functions 
are performed vicariously." That is, from the informa- 
tion that came to me, and the information must be re- 
liable for it came from the editorial department of the 
Mayo firm, I am forced to believe that the surgical 
literature from the Mayo clinic is never holographic. 
One may always see many busy stenographers and type- 
writers at work in the offices, library building, and the 
various working rooms in St. Mary's Hospital. The 
editor, Mrs. M. H. Mellish, occupies room in the li- Rochester and the Mayo Clinic 
103 
brary, with the assistance of several typewriters. During 
the early part of the year of 1912, some three hundred 
papers were edited or re-edited, including the publica- 
tion of four large volumes, aside from many papers 
read before medical bodies, one large volume came from 
the Mayo Clinic this year, 1913. Basing judgment upon 
this amount of literary output within this short period 
of time, I should think the people at the library would 
be kept as busy as the surgeons at St. Mary's Hospital. 
If anyone should find it hard to convince himself that 
Rochester does not lie in the literary belt of the nation, 
he should at least easily convince himself that that vil- 
lage would lose nothing by comparison with any other 
literary center in regard to the sum total of the printed 
output. 
surgeons" club. 
The organization of a surgeons' club took place some 
years ago at Rochester. Its membership, I understand, 
is made up wholly from the visiting contingent of doctors. 
It holds its meetings in the Y. M. C. A. building, which 
is located directly across Zumbro Street from the Mayo 
offices. A meeting is held every afternoon at three 
o'clock, and usually continues in session until about five. 
Its presiding officer and secretary are selected from 
among the membership by nominations and vote. They 
usually serve three days to one week. At each meeting, 
four reporters are appointed by the chairman to attend 
the surgical operations at St. Mary's Hospital, one re- 
porter in each of the four operating rooms. The re- 
porters are given the privilege of standing room by the 
respective operator. With pencil in hand while the 
surgical work is in progress there, they jot down notes 
of the work and the various important things that may 
transpire. On the same or following day, at the meeting 104 
Rochester and the Mayo Clinic 
of the surgeons' club, these reports are read, followed 
by discussions in which many of the visiting doctors take 
part. I attended several of these meetings but did not 
apply for membership. The talks in the main proved 
very interesting, some of the speakers showing them- 
selves to be quite familiar with the various pathologic 
conditions and surgical procedures under discussion. 
These deliberations were wholly confined to the member- 
ship circle of doctors. Now and again, a woman physi- 
cian would not only take part in the discussion but was 
also appointed reporter. No surgeon from the Mayo 
clinic ever attended any of the meetings at which I was 
present. One member of the general staff, however, de- 
livered a lecture and made some demonstrations on one 
occasion. Frequently, a visiting doctor high in some 
particular specialty would deliver a lecture which in 
some instances consumed one hour's time or more. 
I listened to a number of these lectures and became 
greatly interested in them. One lecture on bone-grafting 
including demonstrations by a doctor from Washington, 
D. C., proved especially instructive. Once in a while, a 
member of the general staff would give a talk before the 
medical guests at Rochester on some special subject, in 
a large room adjoining the Mayo offices. I heard but 
one of these lectures, and that was by a woman member 
of the general staff. Her subject was gallstone disease, 
and the thing that she said that impressed me most was 
in regard to her explanation of the conservative methods 
of practice on the gall bladder at the Mayo clinic. She 
seemed to want to emphasize a fact to which I have al- 
ready referred that they were not nearly so radical in 
their surgical treatment and methods at St. Marv's Hos- 
pital as some other surgeons are known to be who write 
a great deal upon the subject. She said she thought 
their statistics at St. Mary's would reveal a better show- Rochester and the Mayo Clinic 
105 
ing than those of the more radical surgeons. I took her 
earnestness to mean, as I have explained, that she had 
been coached in this matter to rap one or two surgeons, 
perhaps in Philadelphia, for some of their gall bladder 
temerity. 
The expenses of the surgeons' club are defrayed from 
a fund that results from a contribution of two dollars 
from each member. Besides the privilege of member- 
ship of the club, the two dollars initiation fee entitles 
each member to a copy of all of the Mayo clinic papers, 
which, as fast as they are printed, are subsequently 
mailed to each member. 
I must not neglect to mention the fact that some of 
the men who take part in the discussion before the club 
members on the subjects reported by the four reporters 
appointed to make notes of the work at the clinic, were 
physicians, pathologists, or laboratory workers and not 
always surgeons. But I take it that they were all lec- 
turers in medical colleges. I formed this opinion of 
them after hearing their talks. They impressed me as 
being fine speakers. When speaking before the audience, 
they seemed composed, deliberate, and unhesitating in 
speech. I heard several of them disclaim any preten- 
sion to a surgical practice but wanted the privilege of 
discussing the pathological aspects of the cases. Others 
wanted to speak from the viewpoint of the physician. 
One of these men had made over a hundred diagnoses 
of stomach, duodenal and pyloric ulcer without a miss. 
The methods he employed to establish the diagnoses 
were exceedingly clever and interesting. These men 
proved themselves to be exceptionally well-informed and 
I should judge them to be popular teachers, if such they 
be. 
One afternoon the chairman called upon me to take 
part in the discussion, but I rose to my feet and thanked 106 
Rochester and the Mayo Clinic 
him, stating at the same time that I was not a member 
of the club, that I came there with the single purpose of 
listening to others talk. 
Each Wednesday evening at eight o'clock, a meeting 
of the members of the general staff of the Corporation 
(Mayo firm) is held in the Mayo Public Library. Us- 
ually some member has returned from a trip made for 
the purpose of obtaining new ideas, or of seeing the 
work of others, or from the meeting of some medical 
society. At this meeting of the general staff, the "scout" 
makes a report. I learned that now and again, one or 
the other of the more conspicuously distinguished of the 
Mayo clinic would present himself before the meeting. 
I did not attend any of these, but Dr. Silver of New 
York, always did, and from him I learned about the 
things that were brought up for the scientific scrutiny 
and judgment of this medical body. 
Usually I spent the evenings in my room elaborating 
the notes I had taken of the day's events. Hence this 
employment kept me away from these noted meetings. 
BUSINESS OFFICE OF THE MAYO FIRM. 
Dr. Graham's brother is manager of the business of- 
fice, and all patients going to Rochester for the purpose 
of reaching the staff of doctors must first pass thru the 
business office. From here, he is passed along until the 
treatment of his case is completed, when he is again 
directed to this office, where he receives the first inti- 
mation as to the cost and expense of the treatment of 
his case. Money is never mentioned to him except by 
Brother Graham, who is in charge of the business office 
of the firm, and then only on his return trip when he is 
ready to leave Rochester. I venture the opinion that 
there is much agitation of the mind up to the time he 
gets back to this office and hears for the first time the 
fee be must pay. Rochester and the Mayo Clinic 
107 
Dr. Graham's brother is looked upon by the patient 
as the highbrow of finance in the business office. It is 
he to whom all new patients are first introduced and be- 
fore any doctor of the firm can be seen. Here in this 
office, the patient must unfold his identity and disclose 
his worldly possessions. Here about the office there is 
forever present an air of optimism. Unlike most of 
those of us who must remain in doubt as to the size of 
the fee we may be able to collect at the conclusion of 
our services, or indeed whether we shall be able to col- 
lect a cent, it is a trepidary circumstance they never ex- 
perience. It is known beforehand just what amount 
the fee shall be and that the man has the money to pay 
it. There is never any occasion, therefore, to worry 
over this matter. 
A story was related to me by a doctor who had been 
a frequenter of this office, which seems to illustrate the 
application of business methods at the office of this en- 
terprising firm. 
A Jew presented himself to the business manager, on 
his return from the hospital, for the settlement of his 
bill, and characteristicaliy wanted to get off cheaply. This 
old Jew, arrayed in garments not indicative of wealth 
by any means, laid down one hundred dollars on the 
counter in front of Mr. Graham, saying, after elevating 
both hands to the side of his head and shrugging his 
shoulders, that he was a poor man and could pay no 
more. The office manager immediately raked the hun- 
dred dollars into a drawer and while doing so said to 
the Jew, "Nine hundred dollars more, if you please." 
The Jew protested, saying he had but railroad fare left. 
The manager wrote out a check for nine hundred dol- 
lars, turned the check around, handed the Jew a pen and 
told him to sign it. 
The Mayo representative remarked to the bystander 108 
Rochester and the Mayo Clinic 
after the departure of the Jew that "That untidy old 
Jew" had lots of money. So it seems there is no way 
of escaping the payment of the fee charged, for the firm 
fortifies itself beforehand. It is believed that a patient's 
rating-financial and social standing at his home, are 
fully ascertained while he is undergoing treatment in the 
hospital, or perhaps before he is allowed to enter the 
hospital at all. 
VISITING DOCTORS. 
The custom prevails at the Mayo clinic for the more 
distinguished visiting physicians to be invited upon the 
floor with the operator during the morning work. In 
my judgment, this is a courtesy that should be extended 
to no one, and when extended by any one of the sur- 
geons, should not be accepted by the visiting doctors. 
The rooms are small, and with six or seven assistants 
busily engaged in the operating rooms, and frequently 
passing around the operating table from one part of the 
room to another, the field of vision of the spectator 
hanging upon the railing above, is already well obstructed 
before the bodies of the favored guests assume positions 
about the operator. When this favored guest appears in 
the field, it becomes necessary to put upon the stretch 
every fiber of rubber in one's neck to see anything at 
all. These guests by distinction usually take vantage 
position, and one is able to catch a glimpse of what is 
being done by the operator only at long intervals. One 
from Nashville, Tennessee, so favored, was seen upon 
the floor at all times during my stay there. I am sure 
that he found particular pleasure in remaining promin- 
ently before the less favored spectators, who would much 
of the time see nothing but his broad, self-complacent 
back. More consideration should be accorded those who 
are there to see instead of to be seen. The custom tends Rochester and the Mayo Clinic 
109 
to cheapen the dignity of any clinic, real or otherwise. 
At this particular clinic, if one fails to see the work, he 
perhaps fails to profit by it. None of the bigger clinics 
tolerate the practice at all. I take it, however, that in 
many instances, the much talked about men at Rochester 
are compelled to show special consideration for certain 
men eminently distinguished, or the foreign visitors, but 
I am sure the privilege here is much abused. A number 
of the visitors on the back seats were much inclined to 
think with Burns, 
"Oh, wad some power the giftie gie us 
To see oursels as ithers see us," 
tho they all knew that Burns had reference to a very 
different sort of pest. 
NEW ACQUAINTANCES RENEWING OLD ACQUAINTANCES. 
One of the chief pleasures one may enjoy on a vaca- 
tion passed at Rochester results from the new acquaint- 
ances one is certain to make, and the renewing of old 
friendships. If one is cordially and sociably inclined, 
that is, without hesitation speaks to anyone who may 
appear to be a visiting doctor when opportunity offers, 
the new acquaintances thus made are more than likely to 
prove an interesting feature of the stay. 
I met for the first time, Dr. D. E. Mundell, of Kings- 
ton, Ontario, a delightful gentleman, full of infectious 
enthusiasm in surgical conversation; Dr. H. M. Silver, 
of New York, surgeon to Governeur Hospital; Dr. W. B. 
Thompson, member of the staff of the Polyclinic, New 
York; Dr. H. L. Pendergast, Memphis, Tenn., Dr. San- 
derson of Detroit; Dr. Spence of Florida, and Dr. Leigh 
Buckner of Roanoke, Va., and many others. 
Dr. Mundell is a typical Englishman, and one of the 
most charming type. Dr. Thompson proved a most in- 110 
Rochester and the Mayo Clinic 
teresting companion, and one whose company I frequent- 
ly sought. Dr. Pendergast carried away the palm for 
long conversational seances. He was romantic at times, 
for he seemed to be especially fascinated with the dark- 
ness of the Rochester evenings and their melancholy 
twilights. These, among other things, lent charm to his 
conversational powers. 
Dr. Spence and Dr. Pendergast were both patients 
at Rochester. Dr. Spence before entering the hospital 
was much about the hotel. I found him full of the 
nobleness of character that is so characteristic of the 
southern born. He entered the hospital later, where has 
right kidney was removed for sarcoma. His actual 
condition before being operated upon was held in much 
doubt by the diagnosticians of the Mayo firm. The 
opinion pretty generally prevailed among them that the 
case was one of cancer of the gall bladder and the sur- 
geons at first refused to operate, telling him that he 
would more than likely die on the table. They only 
consented to operate after Dr. Spence threatened to take 
the next train for Johns Hopkins. He insisted upon an 
immediate operation, saying that his life was not worth 
while in his present condition. He informed them that 
he had made his will and was prepared for the worst. 
It was found at the operation that instead of being can- 
cer of the gall bladder, perhaps involving the liver, the 
disease was confined entirely to the right kidney. After 
a short convalescence, he was able to return to his home 
in Florida. I have not, however, heard from him since 
going back home. 
Dr. Pendergast was undergoing treatment for intes- 
tinal amoebae. He was not otherwise restricted as a pa- 
tient beyond that of entertaining the intestinal guests with 
big meals of ipecac followed by large doses of Red 
Raven Splits. Rochester and the Mayo Clinic 
111 
The visiting doctors, as a rule, are about middle age 
and full of ambitious energy, constantly on the go, fol- 
lowing the work and things of professional interest about 
Rochester. While in conversation with most every one 
of the visitors, names of some of the more distinguished 
members of our craft would always come up for dis- 
cussion. It is somewhat shocking to think how few men 
in our profession are really considered truly eminent and 
become the subject of frequent conversation. Indeed, 
I marveled at the thought that out of about one hun- 
dred and forty thousand men actively engaged in the 
practice of medicine in the United States, there are 
scarcely half a dozen of these whose work is often 
spoken of. I heard the names of Crile of Cleveland, 
Cushing of Baltimore, Deaver of Philadelphia, Ochsner 
and Murphy of Chicago, Mattas of New Orleans, Blake 
of New York, mentioned often, but Crile's work was 
talked about more than that of any surgeon in the coun- 
try. Since the following matter was suggested at Ro- 
chester, and, too, since it sustained a certain relation to 
the foregoing, I must give it space in this narrative, and 
shall do so now. 
I was asked by different physicians the question: 
"What is the matter with St. Louis?" "Never hear from 
your doctors. What brand of modesty is it that keeps 
them perennially out of the limelight?" 
Some people, it seems, do not appear to appreciate the 
worth of certain brands of modesty. Some think it's 
foolish to believe that winning modesty means that you 
shall hide your talents, but I guess the St. Louis doctors 
are influenced by that old brand of Puritanism that pre- 
vailed before the days of publicity and yellow journalism. 
I was willing to concede, however, from a literary 
point of view, that my colleagues at St. Louis do not 
manifest an over amount of public enthusiasm. Per- 112 
Rochester and the Mayo Clinic 
haps, I stated, the reason for this poverty of inspiration 
may be due to the fact that St. Louis fails to furnish 
the kind of literary atmosphere that prevails on the 
Minnesota prairies. It is easy to see that there is a high- 
tensioned sort of enthusiasm in evidence at every view- 
point at Rochester. This is intensely accentuated in all 
its medical aspects, especially at the Mayo clinic. All 
of the magazine writers take particular pains to empha- 
size the fact of the presence of unbounded enthusiasm 
in the work of the Rochester surgeons. But then one 
must note that there are varieties of enthusiasm. In a 
discussion on enthusiasm by Dr. H. More, he interprets 
the word to mean: "Enthusiasm is nothing but miscon- 
ceit of being inspired," and again, that "Enthusiasm is 
sometimes that state of the mind in which the imagina- 
tion has got the better of the judgment." 
I did hear two surgeons of St. Louis spoken of while 
in Rochester, but not by members of the visiting con- 
tingent. Since this was the only occasion on which I 
heard the name of a St. Louis doctor mentioned, it 
seems the importance of it is sufficient to justify me in 
relating the circumstances. 
One morning I went down to the barber shop to get 
a shave. After settling down in the chair, the barber 
opened up the following conversation: 
"You are a doctor, I suppose?" 
"Yes." 
"Here for a long stay?" 
"Perhaps." 
"Here to learn something, I suppose?" 
"I certainly have that in view." 
"Where are you from?" 
"St. Louis," said I. 
"Oh, St. Louis. There were two big doctors up here 
from St. Louis not long ago." Rochester and the Mayo Clinic 
113 
"Ah," said I, "and what is your method for estimating 
the size of a doctor?" 
"Oh, they told me themselves, they were big doctors 
down in St. Louis." 
"Well, that being so, doubtless they are well known 
in St. Louis. I may know them if you give me their 
names." 
"L. Maclandlen and Armstrong." 
MEDICAL PROFESSION OF ST. LOUIS. 
A short time ago, while discussing the subject of the 
work at Rochester with Dr. W. G. Moore, he said, 
"Broome, I believe there are many surgeons in St. Louis 
who are as well qualified in training, education, skill and 
experience to do just as good work if not better than 
that done at Rochester." I want to emphasize the af- 
firmative of Dr. Moore's judgment. I am sure it is 
quite possible for all of us to agree with Dr. Moore, 
especially in regard to the younger generation of sur- 
geons, about the qualifications in education, training and 
experience. But the question remains to be answered 
whether or not they fulfil the full measure of the duty 
they owe the profession in a literary way. 
I do not know how many scientific papers have been 
contributed in recent times by the local surgeons, but 
I am very sure not nearly so many as they should have. 
Perhaps I have not had easy access to the papers com- 
ing from the local surgeons, but it is very easy to know 
the number that Rochester has contributed. They are 
made easily accessible by wide distribution. The num- 
ber coming from Chicago and from Cleveland, Balti- 
more and Philadelphia, much of which is included in 
current surgical literature, we also have ready access to. 
There have been edited and printed about 300 papers, 
some originals and some reproductions by the Mayo 114 
Rochester and the Mayo Clinic 
clinic within the last year. Take Murphy's work alone 
at Chicago and touch only upon the subscription list of 
his published clinics. You will find that there are 12,000 
doctors taking this publication in the first year of its 
issue. This is all independent of a great amount of 
other literary work he is doing constantly. I was told 
by the publishers of the Murphy Clinics that it was ex- 
pected that the subscription list would reach 25,000 in 
1913. He, alone, I am sure it will be acknowledged, has 
outstripped us in this work, but then you must recollect 
that Ochsner is not far behind him in literary output. 
These constitute only a small portion of the surgical 
literary work coming from the hands of the surgeons in 
Chicago. Crile is busy with his pen during the greater 
part of his leisure from hospital duties, his splendid 
essays always teeming with originality. The work of 
the genius may be found at all times in current surgical 
literature. The same may be said of others whose names 
have become well established and whose cities are made 
equally well known by these labors to the medical world, 
and of course add strength, distinction, influence and 
fame to the authors as well as renown to the home cities. 
Now, what shall the answer be to the query of the doc- 
tor at Rochester: "What is the matter with St. Louis?" 
The profession of our city, with its acknowledged 
ability, ought at least to be able to compete successfully 
in this matter with our friends in the country districts. 
I am sure that an excuse for this alleged apathetic at- 
titude based wholly upon the ground of being too busy, 
is hardly sufficient. With respect to this, take, for ex- 
ample, the professional career of the late Nicholas Senn. 
Perhaps no surgeon ever found his time more wholly 
consumed with work in the clinic, hospital and private 
surgical practice than did he. Yet in twenty-five years, 
he wrote 300 publications, some of them large volumes. Rochester and the Mayo Clinic 
115 
on scientific surgery, that remain standards in the li- 
braries of today. He also wrote several text-books of 
the highest type of classical merit. It may be seen that 
he was able to send a contribution to the printer every 
month during these twenty-five years. Then, too, Senn 
never availed himself of the helpful advantages of the 
stenographer and typewriting machine. Now, we have 
easily available the dictaphone, into which one can al- 
most think his scientific and practical thoughts with no 
physical exertion whatever, and the irksomeness of 
handwriting may be wholly eliminated. Senn wrote out 
in long hand every line of which he was the author. 
That is, his entire literary output, covering these three 
hundred volumes, was entirely holographic. Think of 
the hours, whole nights, that this marvelous amount of 
literary work consumed, and yet he never seemed to 
grow tired of it, or too busy to find time to do it. 
"He worked as if he were to live forever; 
He lived as if he were to die tomorrow." 
The foregoing is not all that might be added in reply 
to the question, "What is the matter with St. Louis?" 
I have thought the inquiry over quite seriously, and, 
since returning home, have put the question to others. 
There is an opinion, which seems to be held by a num- 
ber of our doctors, that the profession of St. Louis is 
handicapped considerably by too much Machiavellianism. 
Cunning and unscrupulous methods may win high places 
in the profession, yet the doctor exercising such influ- 
ences may be able to put a gangrenous blotch upon the 
esprit de corps of the entire profession. 
NEW ACQUAINTANCES AT ROCHESTER. 
Some of the medical men whom I met here on va- 
cation were passing a part of the summer here in order 116 
Rochester and the Mayo Clinic 
to witness the work, and see the men so much talked 
about. Many came, of course, for the sole purpose of 
seeing and studying the surgery at the Mayo clinic. All 
now free from the more or less exacting cares and re- 
sponsibilities of the medical life at home, enjoy the 
greatest reward of all in the life of a busy doctor-rest 
and recreation. Time is not wholly passed in idleness, 
for the daily program is filled with interest. The new 
acquaintances one makes, interchange of opinion, and 
the discussions that are forever coming up on various, 
living medical thought, and of prominent men in the 
profession, always afford zest to the hours spent in this 
little town; and really constitute no small part of the 
intellectual profit as well as the pleasure in the mutual 
instruction gathered and gained by personal contact with 
these aggressive fellow members of our craft. 
I became exceedingly interested in every new acquaint- 
ance made at Rochester, but many of the names I do 
not recall. I met one or two from New Orleans, San- 
tiago, Los Angeles, Seattle, Galveston, Toledo, besides 
those mentioned on another page. Among old friend- 
ships renewed, was one with Stuart Maguire of Rich- 
mond, the son of a doctor. Stuart Maguire now has his 
own private hospital in Richmond, containing seventy 
rooms, and his fame as a skilled surgeon enables him to 
keep all of them constantly occupied. Physically he 
bears a striking resemblance to one of St. Louis' most 
distinguished young surgeons, Willard Bartlett. Neither 
appears to be robust in health, but both are mighty in 
surgical output. Neither neglects the duty he owes to 
the profession in literary work. 
Stuart Maguire's apparent weakened physical condi- 
tion suggested to my mind that he was greatly in need 
of this recreation, and while I was meditating upon this 
thought, mentally comparing the physical makeup of Dr. Rochester and the Mayo Clinic 
117 
Bartlett and Dr. Maguire, the latter asked about the 
health of Dr. Bartlett. I thought this a strange mental 
coincidence. Dr. Buckner accompanied Dr. Maguire on 
this vacation trip. He and his companion remained at 
Rochester but a day or two, leaving there at the end of 
this time to join Dr. Wm. J. Mayo for a cruise in the 
latter's yacht on the Mississippi River, up to St. Paul, 
I think. During the summer season it is frequently the 
habit of Dr. Mayo to pass much of the time in the pleas- 
ant pursuit of cruising the Upper Mississippi in his 
handsome yacht-no doubt a delightful recreation spent 
away from his busy hospital work. Stuart Maguire is 
a descendant of Virginia's aristocracy. His father be- 
came distinguished rather early in life as the young 
surgeon of Stonewall Jackson, Confederate Army Corps. 
After treating his general for severe and fatal gunshot 
wounds, he witnessed the death of that mighty soldier. 
I first saw Dr. Stuart Maguire's father at a meeting 
of the International Medical Congress, and I see his face 
at this moment as vividly as tho it were reflected upon 
a screen. He was addressing the meeting of the In- 
ternational Medical Congress at the time, in reply to 
demonstrations Lord Lister had just made in regard to 
the prevention of wound infection. Sitting in the audi- 
ence facing the speaker were three hundred and sixty- 
six of the world's most distinguished representative 
medical men. Every medical center and every civilized 
country was included in the membership. The vener- 
able Samuel D. Gross presided. Dr. Maguire's speech 
was characterized by earnest, fiery eloquence, convey- 
ing the conviction to my young mind that if he had 
served as a combatant instead of a surgeon in the serivce 
of the Confederate Army, he would have been always 
found on the firing line. I was then a mere boy, scarce- 
ly without medical initiative, but I had unrequited as- 118 
Rochester and the Mayo Clinic 
pirations for a medical career, and I wanted to hear the 
deliberations of these noted medical men. Knowing, 
however, that I could understand but little that they 
might say, I nevertheless was resolved to go to the con- 
vention. I had only recently reached the North from 
the state of Georgia, and after dressing myself in my 
best clothes, I walked into the presence of this learned 
and venerable body. 
I recollect my coat was of the long, frock variety with 
velvet collar. My waistcoat was cut low, showing a 
white unplaited shirt front. My collar was widely 
turned down, with a flowing white silk bow at my neck. 
My trousers were cut on full lines. I wore kid gloves 
and a high silk hat and carried a gold-headed cane. My 
hair reached the top of my shoulders, and my moustache 
had just begun to put in an appearance. Thus attired, 
I walked into the main hall of the Pennsylvania Univer- 
sity, Philadelphia, where the meetings were being held. 
This was my first introduction to the society known as 
"medical." 
Minnesota had only two representatives, one from 
Winona and the other from St. Paul. The two Minne- 
sotians, who were soon to become the "greatest surgeons 
in the world," were not present, and Rochester was not 
represented. Its medical history was held open until 
these men could give to it its present luster and his- 
torical fame. 
AN IMPORTANT LESSON THAT THE MAYO CLINIC TEACHES. 
In order to emphasize a point, I shall have to make 
some reference to the large number of patients handled 
by the Drs. Mayo and staff, and, incidentally, refer to 
some of the ailments of these patients. The astonish- 
ingly large number of about 2,000 persons passed thru 
the Mayo offices in the one month of August. Now Rochester and the Mayo Clinic 
119 
bear in mind that they had operated upon over 700 
goiter cases alone since the first of January of the year. 
That is, between January 1st and September 1st of this 
year, they had made over 700 goiter operations. The 
gall bladder, appendix and gastro-intestinal operations 
constituted a large majority of the other cases. Many 
of the cases, both goiter and those previously spoken of 
had been long sufferers. Not a few, in fact a great 
number, of the patients had been either medically treated 
or operated upon elsewhere. Yet invalidism remained 
a dominating factor in their lives, and they now came 
to Rochester for relief. Some, possibly most of these 
heretofore hopeless and unhappy people, return home 
after receiving treatment at St. Mary's Hospital in much 
better health than they were when they went to Roches- 
ter. Herein lies the most important phase of the lesson 
that the Mayo clinic teaches. For it is a fact we must 
bear in mind that a considerable number of the Mayo 
clientele belongs to that class of patients who have had 
little or perhaps much surgery done upon them before 
the surgeons at Rochester see them. Hence, the reader 
will more than likely take it for granted that the former 
surgery was bad or at all events it must be conceded 
that the Mayo surgery was better, because, as I have al- 
ready said, these patients were forced into a hopeless 
state of mind before they went from under the care of 
the home surgeon to St. Mary's Hospital, at which in- 
stitution they were made to feel that their condition was 
no longer so seriously hopeless as before. So, the les- 
son I have indicated, points the moral that better work 
ought to be done at home. In other words, a large 
number of medical men and surgeons throughout the 
country are allowing themselves to be out-skilled by their 
colleagues at Rochester. This is the crux of the situa- 
tion. The volume of business at Rochester is constant- 120 
Rochester and the Mayo Clinic 
ly increasing. The Mayo staff is constantly growing in 
strength and numbers and, at this stage of my narration, 
I take it that the inference is clear as to some of the 
contributing sources of this increasing business. From 
this also it is easy to understand why patients who have 
been benefited at Rochester after exhausting trials at 
home, are able to cast reflections upon the skill and in- 
telligence of the home surgeon. 
Another important lesson that the Mayo clinic teaches 
concerns the attitude the Mayo firm maintains in regard 
to the future treatment of the cases sent to them by other 
physicians. Many physicians throughout the country 
think they have a grievance against the respective local 
surgeons who operate and take about all the money the 
patient has, and then hold onto the patient after the 
operation. The Mayo firm never is guilty of trying to 
withhold the patient from the physician who referred 
the case to them. The patients, as a rule, are returned 
to the doctor at the earliest possible date, with instruc- 
tions to apply to his home physician for any further 
necessary treatment. I have my own peculiar views 
about this whole matter, and without going into a detailed 
explanation, I shall simply say that my idea is that every 
doctor concerned, that is, the physician or specialist who 
has to do with the diagnosis and the reference of the 
case to the surgeon, should be held in consultation and 
paid for any service during the entire time the case is 
undergoing surgical treatment. At the conclusion of 
this, the case should be promptly turned over to those 
doctors who had the patient in charge before a surgical 
operation was decided upon. 
Some figuring was done by the visiting doctors, in 
regard to the number of operations performed daily, 
and the number of beds in St. Mary's Hospital to which 
they were sent, with a view of developing the period of Rochester and the Mayo Clinic 
121 
time given to each patient for preparation for operation, 
and number of days subsequently kept under treatment 
at the hospital. It was found that a room is vacated dur- 
ing the morning hours. On the preceding day a pa- 
tient is given a card for the room and cot for 2 P. M., 
the day on which the discharged patient leaves. The 
new patient is then purged and about all the time for 
preparation for the operation that he gets, is given him 
between 2 P. M. and 8 o'clock the next morning, at 
which hour he is taken to the operating room. They 
seldom vary this rule. The strenuous indications to be 
met have to do with the necessity of hurrying him thru 
the hospital within the period of eight days, at the end 
of which time, he is to make way for another. So, to 
recapitulate and emphasize, the facts show that there are 
200 beds in St. Mary's Hospital, and let it be borne in 
mind that an average of 25 patients are operated on 
daily at the hospital. One may figure for himself what 
it all means. It really means 200 new patients every 
eight days. In fact, it means more. It means that every 
one of the two hundred beds in this hospital is kept busy 
and rapidly makes new acquaintances. Indeed, every 
eighth day, each bed receives a new patient. This means 
that each patient, it matters not as to the nature of the 
surgical procedure to which he has been exposed, must 
vacate his room and cot for another at the end of eight 
days. To judge by my own opportunities, I should say 
no one of the visiting doctors had much chance to see 
or observe the progress or condition of these post-oper- 
ative cases during the eight days confinement at the 
hospital. Usually it seems the patient is sent to a board- 
ing house from the hospital at the end of eight days. 
Many Rochester families are fortunately constantly 
profiting by this rapid shifting of the scenes, and one 
would think, after looking over the ground, that two- 122 
Rochester and the Mayo Clinic 
thirds of the homes of Rochester are open to this busi- 
ness. Some of the outgoing patients go to one or the 
other of the three big hotels. These all belong to the 
one medical firm. The question was often discussed in 
regard to the expediency of the routine that forced the 
cases out of the hospital at the end of eight days. But 
as long as the patient remains at Rochester, whether in 
the hospital or not, the firm realizes a certain profit di- 
rectly or indirectly. At the end of each month, there 
are perhaps several hundred convalescent patients at the 
hotels, paying pecuniary tribute into the treasury of this 
great enterprise. These convalescents, while remaining 
at Rochester, are no doubt constantly taking medicines, 
and the only one big drug store in the town, easily ac- 
cessible to the patients, is owned and controlled by the 
Mayo firm. The whole scheme, it is evident, teaches a 
lesson in business methods, and indeed, brings home to 
all how any business doctor may add to his income by 
the judicious application of business rules, joined with 
business cleverness together with professional work. 
These patients are hurried into the hospital and operat- 
ing rooms, and hurried out of the hospital to make room 
for others. The hustling spirit that appears so irresistible 
at Rochester seems necessary, yet one cannot help think- 
ing of the commercial advantages of it. This spirit, so 
characteristic of the place, does now and again result, 
however, in scenes most pathetic. There is no time for 
the patient to receive the benefit of ecologic treatment, 
either before undergoing surgical operation or after 
leaving the hospital. 
It is acknowledged by the practical business doctors, 
and many physicians, that there is a serious lack of real 
business qualifications in the ranks of our profession. 
It is a matter that is often discussed, this inattention to 
business requirements; it is equally often suggested that Rochester and the Mayo Clinic 
123 
if we were more aggressive in business methods, pros- 
perity would be less of a stranger to some of us. It is 
certainly no reflection on the worth of any doctor who 
joins business principles with his professional work. 
Herein lies at least a plausible explanation of the secret 
for much of the unsurpassed business prosperity of the 
medical corporation at Rochester. I am sure it would 
seem quite impossible for any one familiar with the fin- 
ancial, social and professional standing of these men 
at Rochester to believe for a moment that the members 
of that firm would openly countenance, let alone author- 
ize, public write-ups for the purpose of increasing their 
professional popularity, business or social standing, for 
they do not have to resort to anything of the kind. I 
have heard it said that they have all the money they can 
perhaps ever use. Certainly, they could not be more 
favorably or widely known. Hence, one could not con- 
ceive of any other object in seeking further public notice 
save for mere self-adulation, and that to many, I am 
sure, w'ill sound preposterous. In order, however, to 
complete these notes, I shall have to refer briefly to 
some certain magazines in which articles appeared from 
time to time about the eminent surgeons and their work. 
These monthly publications are intended for the lay 
reader. Those to which I shall refer came to my notice 
by accident. It seems necessary to include these quota- 
tions in order to account fully for at least some of the 
attraction for Rochester. This matter will prove suf- 
ficient to acquaint anyone with the character and style 
of the contributions. While these publications were in- 
tended especially for lay readers, the medical mind will 
likely construe them to mean excessive praise with much 
fulsome flattery and exaggerated compliment. After 
reading them myself, I wondered if these notices did not 
sometimes grate harshly upon the sensibilities of those 124 
Rochester and the Mayo Clinic 
for whom the adulation was intended. But coming be- 
fore them at such regular intervals, they may have be- 
come immovably accustomed to them. Dr. Bitting, a 
prominent clergyman of St. Louis, recently commenting 
publicly on articles somewhat similar, characterized them 
as being "fat with mendacity and lean with truth.'' 
In each article published in the public prints, mention 
is invariably made of the extreme modesty of the doc- 
tors at Rochester. These frequent repetitions might 
lead one to think that the modesty displayed there pos- 
sesses real commercial value and is an asset well worth 
while. But then, it may not be unnatural for one pos- 
sessing extreme modesty, without even a suggestion of 
commercialism, to manifest under great provocation a 
real fighting spirit. However, it is a trait characteristic 
of men of affairs to frown contemptuously upon some of 
the weaknesses of mankind. Perhaps the doctors at Ro- 
chester are not exceptions. In all history there may be 
found ample precedent for this. The gentle Hamlet was 
willing to have his players treat the conduct of his 
mother and stepfather in the most disdainful manner 
possible, for his instructions were, "Be not too tame 
neither, but let your own discretion be your tutor; suit 
the action to the word, the word to the action, with this 
special observance that you o'erstep not the modesty of 
nature." 
PARTHIAN ARROW. 
Here follows a paragraph, taken from one of the 
Mayo reprints, that might strike one as rather odd 
language to be used by one of extreme reserve; but, in 
this instance, the exciting causes were sufficiently brazen 
to justify the use of a trenchant and militant pen in the 
defence of righteousness. 
"A great number of supposititious diseases in the ab- 
domen have been shown by operative inspection to be Rochester and the Mayo Clinic 
125 
the result of appendiceal infections and gall stones have 
been shown not 'innocent.' In the same way, the ac- 
cumulated rubbish of supposititious diseases of the 
stomach have gone to the scientific garbage can as sur- 
gical examinations have worked from the lower to the 
upper abdomen." 
Comment and phrases like the following may be found 
now and again in the Mayo publications: 
"Then surgery entered the field with enthusiasm. Some 
of these poor patients had gastro-jejunostomy and other 
stomach operations performed for supposititious ulcers 
much to the discontent of the patient, physician and the 
surgeon and in the records of these cases, failure of 
operation to cure the ulcer was put down when it should 
have been recorded unnecessary surgical interference." 
The phrase "surgical interference" is the choice of ex- 
pression with all of the surgeons. 
After reading the above, one is more than likely to 
rise from its perusal with the impression that the writer 
is really gifted rather as a doer than as a thinker; that 
the practical side of his nature-his ability to deal with 
men and affairs is more highly developed than his powers 
of analysis. The literary significance rather conveys the 
idea that the special purpose was to give a sting to his 
Parthian arrow. I wondered how unique modesty could 
permit it. 
One naturally wonders, after reading the many ornate 
comments printed in the magazines, why it is that the 
other four surgical hands are not spoken of by these 
writers, as also possessing magic. Letters that I have 
received from surgeons who have witnessed the work, 
express the opinion that the younger surgeons show 
equal skill. It was believed that the object in keeping 
the names of the other surgeons in the background was 
more than likely due to the fact that any attempt to 126 
Rochester and the Mayo Clinic 
feature these might in some way detract from the charm 
of the phrase, "Mayo Clinic." According to my way of 
thinking, this is a queer form of modesty. 
ARMAGEDDON STRIFE. 
It cannot be considered immodest, I know, for one 
intensely interested to try to segregate the good from the 
bad, the virtuous from the vicious, in medicine, yet I 
find in one of the Mayo clinic papers a challenge in this 
direction, uttered much in the same spirit as those of Sir 
Andrew in "Twelfth Night" when he handed his chal- 
lenge to Fabian: 
"Here's the challenge, read it; 
I warrant there's vinegar and pepper in't." 
The particular matter in the paper to which I refer, 
is in regard to and following the discussion of the "Three 
Closely Associated Conditions"-a tonic dilation of the 
stomach-gastroptosis-and gastric-neurosis. This writer 
adds, "Among the protean manifestations of neurasthenia, 
stomach complaint is the most common. This group of 
cases has given rise to many fads in medicine. Eminent 
gentlemen have asserted that no case of gastric ulcer 
should be operated upon until the patient has had his 
eye-strain corrected. Authorities stated that gastric 
ulcer was more common in women than in men, and that 
distree in ulcer followed at once upon eating. Osteo- 
pathy, Christian Science, walking barefoot thru the 
grass, Lydia Pinkham's remedies, and Pierce's, as well 
as our own favorite prescriptions, and that time-honored 
fake, that loaded dice and shell game of the medical pro- 
fession, 'electricity,' all achieve about the same results in 
the treatment of these conditions." 
For cloudy thinking and unction, the above might be 
considered by the average critic beyond praise! Rochester and the Mayo Clinic 
127 
MAGAZINE ARTICLES. 
(From Munsey s Magazine, June, 1910.) 
"Two Famous American Surgeons-The Mayo 
Brothers of Rochester and their remarkable work.-By 
Geo. W. Sackett. 
"The following quotation was found by Mr. Sackett 
posted on the desk of one of the surgeons: 'If a man 
build a better mousetrap, or preach a better sermon than 
his neighbor, even tho he build his home in the woods, 
the world will find him out and wear a beaten path to 
his door.' 
"Dr. Wm. Mayo graduated in medicine, 1883; Dr. 
Charlie, in 1888. St. Mary's opened in 1889. Under the 
guidance of their more experienced father, they became 
enamored of the marvelous handiwork of the Creator. 
Hand in hand they worked, studied and reasoned. Soon 
they were undertaking more complicated operations, and 
the skill with which they handled the knife, and the mar- 
velous success of their work, became the talk of their 
friends. Patients began to come from a distance, and the 
modest hospital was soon too small to meet the demands. 
The Mayo brothers were born in Minnesota. Their 
father, a country physician, was not well endowed with 
worldly possessions and, before graduating in medicine, 
they worked in a drug store and mixed their father's 
prescriptions." The article goes on to say that "In twenty 
years more than 33,000 people afflicted with disease have 
sought these men, have submitted to operations, and in 
the vast majority of cases, have returned to their homes 
with a new lease of life. It is doubtful if any other sur- 
geons in the world can show an equal record. The per- 
centage of cures at St. Mary's Hospital is probably larger 
than that of any other institution. The marvelous skill 
with which the Mayos handled their instruments has 128 
Rochester and the Mayo Clinic 
amazed the world. From every state in the Union, from 
almost every country in the world, sufferers journey to 
this place to see the magic of the four hands that perform 
the surgical operations. One of their specialties is the 
treatment of goiter, the study of the disease having re- 
sulted in reducing the death rate by one-half. Today the 
Mayos are called the surgeons' surgeons. A glimpse 
into the Mayo offices reveals a motley crowd; millionaire 
and pauper; plebeian and prince, have left differences of 
rank without, and join the army of human sufferers in 
search of health. Wealth, fame, social position make no 
difference here. The man without a dollar receives the 
same helping hand as the one with the big bank account. 
The Mayos have given their lives to relieving the physical 
sufferings of humanity, and the door of hope has never 
closed upon a man because he could not pay." 
(From The Independent Magazine of July 27, 1911, a 
weekly published 130 Fulton St., N. Y.) 
"A Medical Pilgrimage Westward, by Jas. J. Walsh, 
M. D., New York City. 
"(The following article is about the Mayo Brothers, 
perhaps the two greatest American surgeons. Dr. Jas. J. 
Walsh especially undertook a trip to Rochester, Minne- 
sota, to get this article for the Independent, which we are 
sure will interest all our readers.-Editor.) 
"From the earliest times, medical pilgrimages have 
been the rule. Those who wanted to learn more about 
medicine than was possible at home, traveled, usually with 
some definite place as their objective point. Always this 
point has been eastward. In modern times, our first great 
American pilgrim was Constantine Africanus, who trav- 
eled in the near East and taught and wrote at Solemo. Rochester and the Mayo Clinic 
129 
After his time, Solerno and many other cities in Italy 
became the sites of medical pilgrimages. Gradually, the 
course of empire and of culture and of scientific training 
took its way westward. Alway, however, the westerly 
peoples went eastward for a touch of what was most ad- 
vanced and progressive in science. Our American physi- 
cians have gone to Europe. It is an anomaly then to talk 
of a medical pilgrimage westward. At the present time, 
however, there is a pilgrimage place well to the west that 
is probably attracting more attention from physicians and 
surgeons than any other. The story of how it came to 
occupy this unusual position is rather interesting. Just 
twenty years ago a cyclone struck the little town of 
Rochester, Minnesota. More than two score people were 
killed, and a large number were injured. There was no 
hospital in the town, so that the injured, of whom there 
were a great many, had to be housed in various public 
buildings, to be cared for by the devotion of the charit- 
ably inclined. Many of the injured children were taken 
into the Academy of the Franciscan Sisters, founded only 
a few years before. The Sisters volunteered as nurses in 
certain of the public buildings, where the injured were 
being cared for. When Rochester recovered from the 
cyclone, it was realized that a hospital was needed, and 
St. Mary's Hospital, in charge of the Franciscan Sisters, 
was founded the following year. The history of this little 
hospital at Rochester is worth while tracing. At first it 
was placed in charge of a county practitioner who did 
all sorts of medical work. This was Dr. W. W. Mayo, 
then quite an old man. His two boys raised on the farm 
-there are some great things raised on the farm besides 
ordinary farm products-got an introduction to medicine 
in their father's office and then went off to medical school. 
"They came back to Rochester and were engaged in 
practice with their father some few years before the cy- 130 
Rochester and the Mayo Clinic 
clone which entailed such disaster to the little community 
and gave them the opportunity to treat a great number 
of injured persons. 
"It was not that the Mayo boys were so brilliant, but 
that they were ambitious in the right way, eager to learn 
and able to take and make chances, and one of them, at 
least, possessed a genius for organization. By the time 
they had been at work for ten years, their names had 
become familiar to everyone doing serious surgical work 
in America, and it gradually became the custom for a 
certain number of younger, ambitious surgeons at least 
to take their vacations at Rochester, and see the Mayos 
do their work. It is no wonder then that one of the 
trains that come into Rochester from the West is called 
the Hospital train, because so many seriously ailing per- 
sons travel by it. 
"After one has had a good look around at Rochester, 
has seen the hospital crowded in spite of its 200 beds, 
with its daily average of at least fifteen serious operations 
a day, has had a view close up of the crowded offices 
downtown, where some 25,000 patients apply for treat- 
ment every year, has realized the cosmopolitan character 
of this crowd of patients, from the farmer from the sur- 
rounding country and the Northwest (who is in the ma- 
jority because he lives nearby) to the better dressed 
classes who have evidently come from long distances, ap- 
preciating besides that there are many physicians from 
all over the country, wealthy patients who are seen in 
private, it is easy to understand the appropriateness of 
the quotation from Emerson in an illuminated print which 
hangs just over the desk of one of the Drs. Mayo. 'Have 
something the world wants, and tho you dwell in the 
midst of a forest, it will make a pathway to your door.' " 
I made inquiry about the contribution to the Independ- 
ent by asking Dr. H. M. Silver of New York about Dr. Rochester and the Mayo Clinic 
131 
Walsh, the author. The question was put to him in the 
following words: "What manner of man is this Dr. 
James J. Walsh?" Dr. Silver's reply was to the effect 
that he could easily see why it was that Dr. Walsh had 
been selected from among the members of the New York 
profession to perform such a mission. Dr. Walsh is a 
good'public speaker and ready writer and is frequently 
seen and heard from in these capacities in New York. 
Dr. Walsh served for some time with Fordham Univer- 
sity, one of the Jesuit Colleges of the city. 
Dr. Walsh's contribution is made more attractive by 
illustrations showing the hospital, operating rooms and 
the Kahler Hostelry, which is said to be especially con- 
ducted for the friends of patients and convalescents. 
(From Hampton's Magazine, May, 1910.) 
"America's Most Noted Surgeons," by Rheta Childe 
Door. 
"No other Mecca of physical sufferers in the world is 
so unique as St. Mary's Hospital, in the little city of 
Rochester, Minnesota, where the Doctors Mayo pursue 
their marvelous work. The fame of these doctors is world- 
wide. They are noted for the cleanest work in surgery 
on record, and altho they have made no discovery of new 
methods, or of any new surgical cures for malignant dis- 
eases, they have covered all modern methods and re- 
duced them to their ultimate accuracy. There is real and 
sincere modesty among the Mayos, so much so, that they 
will be genuinely distressed when this little article is 
brought to their attention. They do not understand that 
in their case publicity is simply the gratitude of the world 
trying to express itself." 
The article is illustrated with two pictures of the 
famous surgeons, and an engraved illustration by the 132 
Rochester and the Mayo Clinic 
artist, Wm. Oberhardt, showing a scene where a sur- 
geon and nurse are leaning over a patient in the act of 
administering a cure. 
The contribution to a magazine under the title "The 
Surgeons' Surgeons," I have not seen, but such an article 
has been printed for I have noticed from time to time 
references to it. The annual magazine article about these 
famous doctors for the year 1912 appeared, so I am told, 
in the Cosmopolitan Magazine. I take it for granted that 
it was gotten up much after the same style as the other 
public contributions, but I have not seen it. All of the 
articles, however, about these distinguished medical men, 
found their way into the columns of the best publicity 
mediums. 
The writers of the contributions to the lay magazines 
about the Mayos, it is very evident, receive pay for the 
work, including no doubt expenses of the trip to and from 
Rochester, from somebody. This belief is based upon 
the statement of the editor of the Independent that Dr. 
Walsh especially undertook the trip to Rochester to get 
the article for the Independent. We know the readers 
of the Independent are not all doctors. Wherefor this 
liberality in expenditure? 
In regard to the article about the surgeons which ap- 
peared in The Munsey Magazine, I must add that I 
wrote the Frank A. Munsey Company, asking whether 
or not the edition containing this article was unusually 
large. The reply is as follows: 
"The Munsey containing article about the Drs. Mayo 
of Rochester, Minnesota, cannot be supplied. Our entire 
stock of this issue was exhausted some time since. We 
had a large edition of the number containing this article, 
but it was exhausted very quickly. 
"Very truly yours, 
"(Signed) The Frank A. Munsey Company." Rochester and the Mayo Clinic 
133 
After receiving this reply from The Munsey Company, 
the question came inquisitively into my mind as to the 
identity of the probable persons who ordered this extra 
large edition and who bought it up so quickly. The 
copy I had was found lying on the seat of a boat in 
which I was traveling; the officer of the vessel told me 
that it had been placed there for anyone who might wish 
to take it. Query: Who had it placed there, that the 
copy might be picked up and carried away by some un- 
known traveler? What was the motive? What feature 
of the magazine was it desirable to exploit? I, myself, 
found nothing especially attractive or interesting in its 
pages except the article, "Two Famous American Sur- 
geons." 
PRESS NOTICES SYNDICATED SUNDAY NEWSPAPERS 
STORY ABOUT THE MAYOS. 
The manager of the advertising department of the 
Associated Sunday Magazines will guarantee that the 
syndicated papers carrying these iadvertisements will 
go into nearly one and one-half million homes each week, 
and will be read by that many families. Thru this med- 
ium, so long ago as 1907, a story was published about the 
Mayos which was made up almost entirely of laudatory 
comment and exaggerated compliment. These, together 
with the illustrations, covered almost one full page and 
a half of the Associated Sunday papers. Most of the 
information printed in this article was based upon points 
given to the writer, Mr. Lee Mitchell Hodges, by some 
one close to the firm. Photographs of both brothers, the 
father, and a scene in an operating room, follow under- 
neath the illuminated headlines of these Sunday papers. 
Following are a few extracts taken from the article, the 
title of which was: "The World's Surgical Center, an 134 
Rochester and the Mayo Clinic 
American Country Town-Mayo Brothers Have Made 
Rochester Famous." 
"Tho only a quiet country town, Rochester, Minnesota, 
which is 105 miles south of St. Paul by slow train, is the 
abiding place of the two greatest surgeons in the world. 
It makes very little difference where you may happen to 
be when the doubt teases you-Japan, Germany, Egypt, 
Norway, or any part of our own country-the answer is 
the same. It consists of four letters, Mayo. But there 
are two. Yes and they bear the same name for the best 
of reasons-they are young brothers. They are perhaps 
the most remarkable pair of brothers now alive, and the 
story of their lives from mischievous country beys to 
undisputed masters of a difficult profession has a flavor 
of fairy-tale, tho it is all solid fact. 
"When you are in Rochester, you are in a town way 
off from what we are pleased to call the 'main traveled 
roads,' but to which nearly two thousand of the most 
skilled surgeons in Christendom annually come just to sit 
and watch one or both of these surgeons handle slim, 
sharp knives, long-curved needles and all manner of 
curious shaped, shiny instruments. 
"Like most country doctors, the father was poor, so 
when these boys were thru with the common schooling 
provided by the town, they were put to work in a local 
drug store. They learned to mix the doses their father 
prescribed. After they had worked a while in the drug 
store, they went off to medical school. Then along in 
the eighties, they came back to Rochester, ordered a tin 
sign and each was hailed as "Doc" by his friends. Soon 
they became serious of mien and speech. They went 
ahead in that dead earnest way that cannot help giving 
birth to big things any more than the unclouded sun 
can help giving light. 
"From every State in the Union, from every country Rochester and the Mayo Clinic 
135 
in the world, come sufferers to this place to feel the 
magic of the four hands, that daily perform from fifteen 
to thirty operations in the hospital. From its two operat- 
ing tables, come a larger percentage of cures than from 
any other in existence. On them, not one patient has 
ever died. You may be the president of some vast rail- 
road system, but with something wrong inside for all 
that, and you may have come down the cold molasses 
route in a private car, or you may be a poor wretch with 
nothing to carry around in the world beyond the pain 
that sometimes seems too great to bear. What you wear 
before you reach this place means nothing. The door 
that swings to behind you shuts out all differences of 
rank, station or condition, except one: are you a sufferer 
come to buy relief? You belong to the democracy of 
pain, and you have come to the most democratic place 
imaginable. You take your place in the line, and when 
you reach the desk in the center of the room, you get a 
card. That card is numbered and bears your name. The 
chances are that you will have to wait some time before 
your turn. 
"Appendicitis-that is one of the commonest causes 
of a trip to Rochester of course. 'Appendicitis,' the doc- 
tor announces after the examination, and adds: 'You 
have come at the right time. No, there is scarcely any 
danger as far as I can see. The operation will take about 
seven minutes. You should be up and around in two 
weeks. Good afternoon.' 
On the way to Rochester, I fell in 
with a man of the place who had the nerves of his tongue 
taken out by one of the Drs. Mayo a few years ago. In 
the town, I saw a woman from whom the same one 
(doctor) had removed a yard of intestine, and connected 
with this latter case, is an incident which should bring 
joy to the hearts of those thousands who have collided 136 
Rochester and the Mayo Clinic 
with the ethics of the medical profession as most every 
one has at some time or other. These brothers believe 
in ethics, but not to the extent of letting this belief inter 
fere with their honesty and square dealing. 
"This woman's trouble had been diagnosed by one of 
them as something not even akin to tuberculosis. The 
first stroke of the keen blade revealed tuberculosis. 
Decide for yourself what the average surgeon would do 
under this circumstances. Dr. Mayo stopped the opera- 
tion at once, and went into the waiting room to the 
woman's husband. He acknowledged the mistake in the 
diagnosis, explained the conditions as found, said the 
matter was a very serious one, and asked what he 
should do. 'Go ahead,' said the husband. I told you I 
saw the woman on the street, yes, but no more mistakes 
were to be made in her case. 
"Their hands are as sure as tho they had been born 
to that very brand and that is why they are Mayo pro- 
cesses. 
"The one thing neither of them will do is to talk 
about himself or their work. You might as well hope 
for a syllable from the stone lips of the Sphinx. With 
them, silence is a hobby.'' 
And yet in the next paragraph, the writer of this 
article asked Dr. Chas. Mayo, as they were walking to- 
gether from the doctor's home to his office, the following 
question: "How much further can you go in surgery?" 
The syllables from the stone lips of the Sphinx were as 
follows: 
"How much further we can go in surgery, it is hard 
to tell. Great advances have been made in this branch 
of the healing art, but medicine is far behind. The next 
great task is the uplifting of medicine to the present 
high plane of surgery. Old fogyism will have to go. 
We must learn more about diagnosis. When we have Rochester and the Mayo Clinic 
137 
conquered thia most difficult of all the phases of medical 
work, disease will be easier to deal with." 
The stilted style which characterizes the foregoing 
contribution about the Mayos would no doubt make the 
average doctor feel, in the language of the street, some- 
what "chesty," but it seems the modest equilibrium of 
Rochester remains unmoved through it all. 
It is natural to infer that the writer of the above was 
entertained at the surgeon's home, and perhaps many 
of the things above recited were gathered from the 
doctors about whom the article was written. 
I am sure that it will have been noticed that much of 
the foregoing matter embraces about the same points 
in regard to the Rochester doctors. This is so strikingly 
true that one is compelled to believe that most, if not 
all of the information came from one and the same per- 
son. That is to say, there stands out a certain charac- 
teristic individuality in all of the compositions of these 
writers that one cannot help believing but that all the 
verbal matter is either based upon one original story or 
else the substance of each succeeding article was given 
these writers by the same person. 
THE PUBLIC PRESS. 
I may state, what is known to all, that, with a persever- 
ing consistency, the public press in general keeps the 
names of the members of the regular profession out of 
public notice with painful regularity. The newspapers 
have a certain dope on our altruistic conventionalities, 
and know among other things that we never use their 
advertising pages. Look over the advertising columns 
of almost every one of them, and the tale will unfold 
itself to you as to the character of the doctor who 
patronizes them, the doctors themselves, and the things 
that they now and again voluntarily notice. Every 138 
Rochester and the Mayo Clinic 
member of the regular profession knows that a knock 
against us is apparently gratifying to the newspapers, 
for the reason that it is against the rules of the regular 
organization to advertise. This has characterized their 
conduct towards us throughout our history as a regular 
organized profession. You know how the public press, 
including the magazines, with one or two exceptions, 
have treated the regular profession in all of its public 
spirited undertakings. You may recall the bitterness 
of the fight they have put up against efforts to instal a 
secretary of public health, especially against the Gore 
bill in the U. S. Congress. The antagonism is usually 
strengthened thru the influence of the Interests. It 
seems that the papers are easily subsidized, and directly 
aided by a lobby which is maintained at Washington, 
and is ostensibly doing business under the firm name of 
The National Manufacturers Association of America. 
But in truth, this federation is supported, partly I am 
told, by the osteopaths, Christian Scientists and a number 
of representative "isms," together with a host of chem- 
ical and pharmaceutical manufacturers. That is to say, 
the osteopaths, Mrs. Eddy's followers, together with a 
number of manufacturers of spurious things, have joined 
hands against us in legislative matter. Mr. Marion 
Reedy, of the Mirror, explains in his splendid article on 
"The Myth of the Free Press": "It may be true, and is 
perfectly evident to me after a whole life spent in the 
atmosphere of newspaper work, that 90 out of a hundred 
editorial writers on the press today are men who are in 
intellectual and sympathetic revolt against present-day 
conditions. The men who make the newspapers are be- 
hind the scenes, and it is these men who are wholly 
responsible for the money-making policy of the press." 
We can never hope, I venture to believe, to expect 
any good word from the press unless we pay for it or Rochester and the Mayo Clinic 
139 
abandon our rules against advertising. You will recall, 
no doubt, the fight put up by these interests, newspapers 
and lobby against Dr. Harvey W. Wiley. It is well 
known what happened to him. 
No disinterested estimate of the retiring administration 
can fail to recognize the treatment of Dr. Wiley, one 
of the most deplorable of Taft's delinquencies. A Con- 
gressional inquiry gave a triumphant vindication of Dr. 
Wiley. It had no effect in improving his helpless status 
in the department. Dr. Wiley has computed that more 
than 6,200 complaints, in which the evidence of mis- 
branding and adulteration was clear, were obstructed 
by the department and cabal and never brought to trial. 
After fighting for three years and eleven days, Dr. 
Wiley resigned. 
For nine years Collier's Weekly waged a most re- 
lentless war against quackish nostrums, and the secrecy of 
the manufacturer of dope and proprietary medicines, and 
what has happened? The man who penned the edi- 
torials, Mr. Norman Hapgood, one of the most stirring 
figures in the early movements of American publicity 
against the manufacturers of the patent medicine nos- 
trums, has been forced to resign, and before leaving the 
editorial columns of Collier's Weekly, he charged that 
the appointment of his successor meant that the editorial 
columns of that publication would be controlled hence- 
forth from its advertising department. Mr. Hapgood 
has long been classed among the best independent and 
wholly original thinkers in the country. While he gave 
that publication its great popularity, his trenchant pen 
was wielded against the Interests, hence his downfall. 
The combinations against him, including the antis of the 
regular profession, have won, and we shall no more 
receive aid and comfort from that source. 
Now' it is in connection with these things, and with 140 
Rochester and the Mayo Clinic 
this brief matter before us, that we may wonder why it 
is that so many nice things have been said about the 
Drs. Mayo, in the public press and magazines, without 
pay. 
Mr. Reedy styles the double-acting feats of the news- 
papers "Laodiceanism." He says. ''Great newspapers 
play to the masses for circulation, and then go around 
and coddle the classes for advertising. The manner in 
which the newspapers have rallied to the support of 
crooks, and at the same time using their powers to 
create a force among honest business and professional 
men that has the effect of operating as a shield for the 
protection of thieves, to me, (Mr. Reedy) is damnable 
doctrine, and is sufficient confirmation of my idea that 
daily journalism of the United States is only in sympathy 
with the interests that play upon the public. Everything 
passing to the columns of the paper, from the lowliest 
reporter to the chief of the editorial staff, is interwoven 
with mendacity. Reporters seem to think that a truthful 
story, especially when it relates to personal character, is 
not what the editor wants, and as Madame Sarah Bern- 
hardt says 'The newspapers only see harm or the ridicu- 
lous in everything. Nothing is sacred to them. This is 
about the depth of degradation to which they are going.' 
"Everything in this country has been regulated more 
or less except the press. The daily press has participated 
more or less in the regulation, but there are reasons for 
believing that one of the greatest evils in the United States 
is the same daily press itself. The owners of newspapers 
are business men of a certain type. They want dividends, 
they want the business, the commercial ideal held up at 
all hazards. They must get the money from the men 
who have it. They must cater to please the men who 
run the community. 
This is also true of the representative medical press. Rochester and the Mayo Clinic 
141 
While it is regulating the profession, as a mass, it is 
catering, at the same time, to a few. "Such men are out 
for their own pockets, first, last, and all the time. All 
the rest is leather and prunella. The great intellectual 
personality no longer dominates the great paper. The 
supreme headship of a great newspaper is not the man 
who may be turned out in a school of journalism but a 
money-maker. The journalist proper can never be more 
than a hired man on a great paper. All of us admit all 
the good that may be claimed for the press and publicity 
-and Lord knows the press can toot its own horn with 
all sufficient plangency-but no person capable of obser- 
vation or of thought can nowadays cling to the supersti- 
tion that the great daily press is free or independent, 
or in any sense an organ of public opinion. 
"Furthermore, when we look at the great newspapers 
we observe another laughable feature in the manner in 
which they work upon the general public the most elabor- 
ate confidence game known in the history of America. 
There is not a man in the United States today who has 
tried honestly to do anything to change the fundamental 
conditions that make for poverty, disease, vice and crime 
in our cites, in our courts, and in our legislatures, who, at 
the very time at which his efforts seemed most likely 
to succeed, has not been suddenly turned upon and rent 
by the great newspaper publications. If this occurred 
but once in a while, we might regard such matters as 
mere coincidences, but in view of the fact that it occurs 
all of the time, there must be a cause for it, and, search- 
ing for the cause, we must look for the motive. By the 
process of exclusion and elimination, we come finally 
to the last motive, which is self-interest, and we find, 
from what we know of the people who own and control 
great newspapers, that every one of them is identified 
thru sympathy, thru investment, thru revenue, thru asso- 142 
Rochester and the Mayo Clinic 
ciation with the corporations and organized money-mak- 
ing schemers who milk the community by means of the 
powers which they have filched from the body politic." 
The following appeared in a Sunday edition of the 
St. Louis Republic: 
"How Fee Graft Affects the Public. 
"The family doctor is given a portion of the fee, and 
the patient unknowingly pays the amount without re- 
ceiving any aid in return. It leads patients to being 
kept in their beds for days and weeks longer than is 
necessary. Unnecessary operations, the mutilation of 
men and women, months of human agony, and in some 
cases, death itself, are direct results of the commercialism 
and greed that grow out of the secret division of fees." 
This and much other like comment is what we get 
for our pains. 
It is easy, to note, however, in most of the newspapers, 
that there is a general ethical activity in spreading scur- 
rilous insinuations and subtle invective against the con- 
scientious and regular doctor. This controlling principle 
puts them all in an attitude which is antagonistic to the 
growth of scientific medicine. But the ads, and some- 
times, notices exploiting quackery, printed in the press, 
are usually written in glaringly vulgar phrases, so grossly 
disgusting indeed as to violate all forms of decency. Even 
the most sober-minded physician might in many instances 
find these vulgarisms so ludicrously stated as to excite his 
risibilities. For example, in one column, an ad appears 
calling upon the man who is shy on manhood to call and 
have it restored. Close to this, may appear the ad call- 
ing upon the lady to purchase the wonderful, marvelous 
whirling spray, "It cleanses instantly." Then we may 
read with the inference that, this failing, the lady is Rochester and the Mayo Clinic 
143 
advised to supply herself with Chichester pills, diamond 
brand, "Best, safest, always reliable." Then in glaring 
headlines, "Big 'G' cures in one to five days unnatural 
discharges; contains no poison, and may be used full 
strength absolutely without fear. Guaranteed not to 
stricture. Why not cure yourself?" ad nauseam. 
So it may be inferred by the above that there is even 
a comity existing between the quacks, and made more 
plausible by the public press. Each specialty is for a 
purpose and prepared to meet any emergency. Our pro- 
fessional attitude against the quacks, and the attitude of 
the newspapers toward the regular profession, brings 
the righteous doctor to confess that, when we shun 
Scylla, the evils of quackery, we fall into Charybdis, the 
stenchy whirlpool of the public press. 
THE LURE OF MYSTICISM. 
The real clinging and fascinating heritage of the heal- 
ing art is mysticism. Its position seems to be secure 
and permanent among the peoples of the earth. When 
one of this psychological type is ailing, either from a 
curable or incurable disease, he wants a doctor who at 
least will promise to cure him. To the mystics of the 
healing art, belongs much of the superstition of the ages. 
About everything known to fakism has found willing 
victims and continued to prosper right along with the 
evolution of scientific medicine since the days of 2Es- 
culapius. Many persons in all parts of the world are 
controlled by inherited beliefs and impulses, and rely 
upon incantation and the mystery of the fetishisms, and 
charms, to guard them against malignant disease. "Many 
a shrine has more followers than Pasteur; many a saint 
more believers than Lister. Mentally, the race is still 
in leading strings." In primitive times, priests, philo- 
sophers and physicians grew up together, and there was 144 
Rochester and the Mayo Clinic 
much mystery surrounding their doings, just as today, to 
a large number of laymen, there is much mystery about 
sickness. Religion and medicine had their beginning 
in the practice of magic, and the working of hocus-pocus 
and the hoodoo. Perhaps licking of wounds and sores 
by the charmed serpent has been eliminated from the 
category of the older methods employed, but many of the 
other hallucinatory remedies remain in practice among 
the victims of superstition, more especially because their 
promises are involved in so much mystery. We shall 
never cease to wonder at the amazing credulity .of the 
public, and still more amazing that it learns nothing by 
experience, but prefers to chase the phantom of mystery 
instead of heeding the dictates of science and common- 
sense. It is, therefore, not strange that in this condition 
of the public mind we have the quack, the faker, and the 
impostor. These succeed because their promises are 
unlimited, and the more they mystify, the more popular 
they grow. Some part of the exploitation of these things 
must be charged to the public press. The yellow press 
particularly continues to flourish and profit thru the pre- 
tenses and promises spread before the mentally-weak 
victims of disease. The press consoling itself, the while, 
with the belief that it is giving the people what they want, 
thus fattens out the "iniquities of mystery." 
We experience, however, the deepest chagrin when we 
come to know that there is a disposition, on the part of 
some of the regular members of the profession, to an- 
nounce now and again in the public press, prematurely, 
so-called cancer cures and sure-cures for other like dis- 
eases. In many instances, these premature announce- 
ments are unfortunate. Not only do they redound to 
the discredit of the profession, but they raise false hopes 
that are calculated to mislead, and hence, they are often 
interpreted as attempts at deception. This is especially Rochester and the Mayo Clinic 
145 
the case when the alleged new discovery is proven by 
more mature trial to be a failure in fulfilling its promises. 
We have had twelve or more sure cures for cancer and 
tuberculosis exploited within the last several months. 
One of these sure-cures emanated from the Cancer Hos- 
pital in St. Louis, and from the recent meeting of the 
American Medical Association, held at Minneapolis, 
there came flaring headlines in the newspapers to the 
effect that "cancer of the stomach is curable." This 
announcement came from one of the Rochester surgeons, 
I understand. The public at the time of this widely cir- 
culated promise was entitled to certain exploitations 
covering limitation of conditions, but these they did not 
get, at least, not from the newspapers. But, perhaps, a 
great influx of this class of cases was in evidence at 
Rochester soon after the announcement appeared in print. 
ATTITUDE OF THE MINNESOTA PROFESSION. 
Adverse criticism may be heard now and again from 
the Minnesota doctors against the Rochester firm. This 
is not a noisy opposition, but still there are many doctors 
who seem to have a grievance against the ethical inter- 
pretation at Rochester. Indeed, it is hard to find in their 
home State, the same degree of admiration as that ex- 
pressed by the New York magazine writers. I have some 
letters from these up-State doctors based upon the fore- 
going. The mildest of these is from Dr. Randall of 
Graceville, Minnesota, whom I found to stand very high 
in his profession. He is also a splendid example of the 
straightforward, honest doctor, and a man of liberal 
views and broad culture. I herewith give his letter in 
full: 146 
Rochester and the Mayo Clinic 
"Office of B. M. Randall, M. D. 
"Graceville, Min., Sept. 5th, 1912. 
"Dear Dr. Broome: 
"The attitude of the profession in Minnesota is not 
entirely friendly towards the Mayo corporation, and I 
believe the main reason is the same as that which pre- 
judices the general merchants against the big department 
stores. Prices are cut in a way that is annoying to the 
surgeons of the Minnesota cities, but they have a grad- 
uated scale of fees and no doubt make adequate charges 
to the rich. Personally, I cannot complain of lack of 
ethical treatment, tho I have heard charges of this 
character. 
"My principal hesitation in sending patients to Roches- 
ter is due to the unsatisfactory after-treatment in 
operative cases, but I believe many hospitals are equally 
inadequate in capacity and remiss in attention. 
"The amount of money accruing to this medical firm 
must be very large; the statement that they take in more 
than a million a year might easily be true, and their 
donations are also large; that they have contributed to 
the building of St. Mary's Hospital is not unlikely, and 
this would be a contribution to the sisterhood; but this 
would have no relation whatever to the church or its 
treasury. While you can see how impossible it is for me 
to know where or how the Mayos choose to place their 
benefactions, I can state with the greatest positiveness 
that the church does not and cannot make return by 
advertising or promoting the business of anybody. Since 
you have done me the honor to say that you would accept 
the reliability of my statements, I would like to insist, 
Doctor, upon the fact that both clerical and laity in 
this country have no other spiritual relation with the 
church (except of course the necessity of supporting 
the officials) and neither priests nor people would think Rochester and the Mayo Clinic 
147 
of tolerating interference with political or business 
affairs, notwithstanding many reports to the contrary. 
"In light of these facts, I cannot conceive of any 
method by which a reciprocal arrangement could be 
attempted. The orders of the sisters are entirely distinct 
in their business arrangements from any church author- 
ities, and whatever business arrangements a nursing order 
makes with a medical faculty is confined to themselves 
and has nothing to do with the church, even indirectly. 
I have never heard of priests recommending the Mayos 
to their parishioners. If they do so, it is a matter of 
individual judgment. You will find that they very rarely 
take the responsibility of making recommendations in 
such matters and are wise in this attitude. 
"I do not ask that anything I say be held confidential 
for I approve of open understanding in all such matters. 
"With kindest regards from myself and family, I 
remain, 
"Sincerely yours, 
"(Signed) B. M. Randall." 
Before bringing this narrative to a close, I wish again 
to refer to the comment on American surgery, made by 
Dr. Raffaele Bastianelli, chief surgeon of the Policlinic 
at Rome, Italy, on his recent visit to the various medical 
centers of this country. Among other things, he seemed 
to want to emphasize the fact that the surgeons of Amer- 
ica only develop ideas. The comments in regard to his 
medical observations here follow: 
"I cannot single out any of your surgical institutions 
as better than the rest. You have beautiful establish- 
ments everywhere, the best in the world, in fact. Then 
the technique of your surgeons is first rate; some of them 
are brilliant both in theory and in operating. You are 148 
Rochester and the Mayo Clinic 
very keen for new things over here, and as soon as a new 
idea comes out, you go ahead and develop it with charac- 
teristic energy and, I may add, the means you have. 
It is wonderful the money there is to be had over here 
for the development of surgical ideas. With respect to 
what our best Italian surgeons are now investigating, 
this is a large order. They are working along every line, 
but little is being said about it until something is actually 
accomplished. We have men who are doing a great deal 
in research work in respect to tumors. Of course, we 
have men who are working hard in the study of cancer, 
but that is a subject on which little should be said until 
something is actually demonstrated as it is cruel to raise 
false hopes." 
Then in reply to the question, "Which country do you 
think is foremost in surgery?" he said: "That I would 
not care to answer. It is difficult to measure progress 
in surgery by countries. So much in surgery is individ- 
ual, but if you asked me where the best ideas come from, 
I may tell you I think that, while I have the greatest 
admiration for American surgeons, the best ideas come 
from Europe. Over here, you have the means of de- 
veloping them such as is not to be had in Europe." 
From my personal viewpoint, I seem to see that these 
remarks apply with more force to the surgeons at Roches- 
ter than any other of the leading men of this country. 
There are few clinics in the world where there are 25 
surgical operations made every day. None in this coun- 
try, except the Mayo clinic. This of course means that 
more work is done, more surgical cases handled at St. 
Mary's Hospital than any other hospital in this country. 
This brings me to the point I had in view when I un- 
dertook to write this conclusion. 
This clinic, as I have already intimated, is the busiest 
in this country. That it is able to demonstrate the largest Rochester and the Mayo Clinic 
149 
amount of surgical work in this country, but to my mind 
shows the least originality, and can perhaps make a 
better showing than any other clinic in demonstrating the 
truth of Prof. Bastianelli's remark, "That American 
surgeons only develop ideas." 
The widespread popularity of the Drs. Mayo must be 
held to be due to the publicity freely accorded them. 
They must not be judged altogether by this publicity, 
for they do not fill the standard of high scientific measure- 
ment that is accredited them. I can say that they are 
eminently practical in professional work, and just as 
practical in business methods. The organization is such 
that the business of achieving wealth is as cogent as the 
business of performing surgical operations. It is con- 
ceded, I may suggest, that the reputations of the doctors 
at Rochester is founded altogether upon practical surgical 
work furthered mightily by the publicity given them so 
freely by the public press. They became popular as 
surgeons from the beginning: that is, they are never 
spoken of as physicians, only as famed surgeons. When 
they were first heard of, it was as "surgeons." Following 
the cyclone, when they were young doctors, their reputa- 
tions as surgeons began to take root. Their chief asset 
is practicability, both as practical doctors and as practical 
business men. They have developed no new ideas in 
surgical processes. They have not been able to accom- 
plish originality in the science of healing. They have 
hewn strictly along mechanical lines, using the ideas of 
others when their availability could be brought into the 
field of their practical vision. It is true they have de- 
veloped a skilful technic in many surgical operations, 
but their daily work is largely routine. Every case going 
to Rochester, however, is taken care of, whether surgical 
or not. A general staff has been provided to meet any 
exigencies that may arise. 150 
Rochester and the Mayo Clinic 
Aside from any other consideration, the chief result 
of thus extending its practice to cover all cases, is the 
earning of more money. The thought has come into my 
mind time and again since visiting Rochester that if the 
medical firm there could see its future from purely the 
scientific viewpoint, it would assume a better position. 
I concluded too that greater things might be expected 
and realized following a change in their professional 
attitude. It seems that the thoughts of other visiting 
doctors were running along this same channel. Standing 
with a group of them, on one occasion, a spokesman, who 
was an elderly physician and who had been at Rochester 
some time, said that he had looked into everything about 
the place of professional interest, and he was now of the 
opinion "that if the medical firm, with its large and varied 
clientele and its big body of specialists on its staff, could 
separate its line of cleavage between work and dollars and 
cents, and turn the minds of its scientific members to 
conquests in discovery, the world would see the place 
in a different light." It is a common habit to await the 
results of the scientific labors of men in other countries. 
But I believe that the resources of the Rochester firm 
could be made as available for research work as any 
institution in foreign lands. It has been said that mere 
operative surgery is based upon handicraft, and the sphere 
of the handicraftsman is limited to the operative technic 
in surgical procedure. 
THE CANCER PROBLEM. 
The cancerous process is animated by movements so 
mighty and so furious that the cause behind it all cannot 
lie hidden much longer. 
When the real cause is positively disclosed, its scientific 
treatment will follow, and in that scientific treatment. Rochester and the Mayo Clinic 
151 
surgery may have no place. At Rochester, so far as I 
was informed, the only treatment for cancer ever insti- 
tuted was surgery, and so far as I could see, there is none 
other desired or sought. We must turn elsewhere to see 
the busy surgeon employing means other than the mere 
routine of surgery. In Crile's clinic, an immense amount 
of patient effort is exhausted on the cancer cases inde- 
pendently of surgical procedures, and one need only to 
read the splendid address of Dr. Robert Abbe of New 
York, delivered at London before the International Con- 
gress of Medicine on the subject "The Astonishing Dis- 
appearance of both Benign and Malignant Growth Under 
the Influence of Radium," to learn what busy surgeons 
are doing in the non-operative field. 
Following is an extract, taken from the New York 
Tinies, on the splendid work Dr. Abbe has been doing 
along lines non-operative in the cure of cancer: 
"Dr. Robert Abbe, senior surgeon to St. Luke's Hos- 
pital, whose eminence in the medical profession is recog- 
nized abroad, as it is here, has been using radium in his 
practice almost since its discovery. His results have been 
just as astonishing as those announced by the secretary of 
the Middlesex Hospital. And strangely enough, he made 
known those results in London to the greatest gathering 
of medical men the world has ever seen just prior to the 
Middlesex Hospital announcement. He was invited to 
read a paper in the Section of Radiology at the seven- 
teenth International Congress of Medicine, held in Lon- 
don in August, and took for his subject, 'The Use of 
Radium in Malignant Disease.' It has since been 
brought to the attention of the medical men of Great 
Britain and elsewhere, thru the medium of The Lancet, 
the authoritative medical publication of the British em- 
pire. 152 
Rochester and the Mayo Clinic 
"It is safe to say that surgery is entering upon a new 
era of hope and attainment in the treatment of malignant 
disease. Whatever the primary cause of cancer, in its 
broadest sense, is for the hour a question of less im- 
portance than the more practical one-as to what de- 
terrent effect can be produced on disordered cells by new 
physical agents. It is a trite saying that there has been 
no known cure for cancer. Surgery has expended its 
utmost force in cutting out every vestige of disease, or 
to destroying by cautery, caustics, or freezing. These 
occasionally cure the patient; they never cure the disease, 
they only remove it. We must look to forces like organic 
chemistry, or biochemistry, or agents like Roentgen rays 
or radium." 
IDEAS PURELY AMERICAN. 
If one cares to open the ledger of American surgical 
history and examine its accounts to see how it stands 
with itself and the world at large, he will find that 
originality and genius were in the minds of even the 
pioneer American surgeons. The same has characterized 
the personnel of its ranks since. If one goes back to a 
period of time when America was yet young, he will find 
that the surgery of the entire world was greatly en- 
riched by the new ideas springing from the minds of 
the surgeons of these early days. Indeed, America at no 
time in its history has experienced a dearth in new 
surgical ideas. 
"Have something the world wants, and though you 
dwell in the midst of a forest, it will make a pathway to 
your door." 
In closing, I wish to express the hope that I have, in 
these pages, given the doctor inclined to pessimism, an 
idea of how others have made it possible to have some- 
thing the world wants. 
FINIS.