A Rochester without Mayo Clinic? It could have happened

Jan. 25—ROCHESTER — If you live here, it has always been there. A veritable mountain of granite and marble, steel and glass that commands the city skyline.

Perennially the No. 1 hospital in the U.S.,

Mayo Clinic is the lifeblood of the region's economy — if it doesn't put food on your table, it does a friend's — and a ray of hope for patients the world over.

But, if not for a few critical moments in Rochester's history, we all might live in a city without Mayo Clinic.

As Mayo Clinic marks its 160th anniversary this month, we look back at the moments where things stood in doubt, and where, but for epiphany, foresight, guesswork or, in at least one case, sheer, dumb luck, things could have gone another way.

In most histories of Mayo Clinic, the story begins this way: William Worrell "W.W." Mayo, a 27-year-old Englishman with some medical training, comes to the U.S., practices as a pharmacist for a time in New York City, then completes his education in Indiana and Missouri before setting off Minnesota and new opportunities there. That was 1854.

He finds work here and there — St. Paul, Le Sueur, New Ulm, and even the Duluth area — before, in 1863, Abraham Lincoln appoints him examining surgeon for Union Army draftees in Rochester. On Jan. 27, 1864 — 160 years ago from this day — he opens a practice in downtown Rochester, though he eventually set down professional roots in St. Paul. And there W.W. Mayo planned to stay. After all, Rochester was too small for his ambitions. But Mayo's wife, Louise Wright Mayo, had other plans.

Already the mother of a daughter and a son, Louise was tired of the frequent moves her husband's profession seemed to demand, and besides, she had taken a liking to Rochester and refused to move from here.

"She was someone who was very tough," said Dr. Christopher Boes, a neurologist and medical director of the W. Bruce Fye Center for the History of Medicine at Mayo Clinic.

So this became Plan B: Louise and the family would remain in Rochester. Dr. Mayo would work in St. Paul and return to Rochester every month or two to see his family.

That plan seemed to work except for one implacable force: the Minnesota winter. One train trip home, in March 1874, was delayed by a blizzard, and W.W. Mayo, showing his own stubbornness, walked home from where he was stranded, in Kasson, 18 miles to home, hearth and Louise. It signaled a turning point.

"I think he basically realized, well, I guess this is where my wife and family are. I guess I've got to come back," Boes said. "And he finally settled down."

W.W. Mayo's acquiescence to Louise signaled a broader sense of egalitarianism. More than most of his contemporaries, W.W. Mayo took women seriously, a fact that showed up in his working partnership with the Franciscan sisterhood, his championing of Dr. Harriet Preston for inclusion in the Minnesota State Medical Society in the 1870s, and his welcoming of female doctors onto his staff and into positions of prominence and leadership.

"The senior Mayo's inclusive attitude toward women was not missed by the Mayo brothers," wrote

Dr. Paul Scanlon,

a retired Mayo Clinic physician and Rochester native who has published two local histories on the city.

Even with W.W. Mayo's settling down in Rochester and his progressive attitude toward women, it took a cataclysmic event to truly change the fate of Rochester and kickstart the Mayo Clinic. In the summer of 1883, not one, but two major cyclones swept our region. The second one, which struck Rochester "with a roar like ten thousand demons," according to a history of the region published by Charles Eaton, remains to this day possibly the most significant natural disaster to strike the city. The Aug. 21, 1883, storm leveled the Lowertown neighborhood just north of downtown, injured more than 200 people and killed as many as 39 people.

The death toll could have been higher — two higher, in fact. Had it been, the repercussions would have completely changed the trajectory of the still-fledgling Mayo Clinic.

Escaping with their lives in the storm were none other than William J. Mayo and Charles H. Mayo, the sons of W.W. Mayo.

The brothers, who would go on to take the clinic from a local practice to a world institution, cheated death not once, but twice on that day.

Will, 22 at the time, and Charlie, 18, were newly trained doctors. The brothers had headed north of the city, largely undeveloped beyond today's Silver Lake, to a slaughterhouse to pick up a sheep's head they planned to use for surgical practice.

As Helen Clapesattle described in her book "The Doctors Mayo," the brothers were warned of the approaching storm and turned their carriage quickly for home.

"Turning around to start back, the brothers saw the huge whirling cloud, funnel-shaped now, moving toward them, saw buildings sucked into its maw like wheat into a thresher and the pieces blown out in all directions like chaff," she wrote.

They galloped across the Zumbro River bridge — around the site of today's North Broadway bridge — moments before "it was torn from its moorings by the wind and smashed to bits." First escape.

Reaching the city center, as they passed the intersection of today's Broadway and Second Street Southwest, part of the cornice from the top of the Cook House, a hotel, was ripped free and smashed down onto their buggy. The impact from the boulder-sized chunk of masonry freed the horse and threw the young doctors into a panic.

"I think it just barely missed the boys," Scanlon said. They ran, or were blown, to hide out in a blacksmith's shop — at one point the roof was ripped free and carried away — and they came out from the rubble to find they had cheated death a second time.

"It's amazing they survived," Scanlon said.

The death toll and devastation from the tornado is commonly cited as the catalyst of the modern Mayo Clinic. But had that same storm claimed the lives of its future leaders — what then?

"I don't think there's a Mayo Clinic," Boes said.

Unlike their father, Will and Charlie had received modern training at a critical time when medicine was moving into the antiseptic era. Will's stated ambition was to become the best surgeon in the world.

So, given the times in which they lived and their ambition, their loss would have been unimaginable, and it is considerably less likely that Mayo Clinic would have come to represent the leading edge of medicine as it did. Chances are, it would exist now only as a historical footnote. Their father, by then 54 years old, could have carried things only so far.

"W.W. was a very good doctor and all that," Boes said, "but I don't think he would have gone on."

The brothers had survived a deadly storm, but they still realized that death comes for us all in the end. Will and Charlie knew that if the institution they had founded was to outlive them — to say nothing of how it could thrive during their lifetimes — it would need more than them.

The brothers sought to attract top-flight talent. But the same problem existed then as it does today: How do you get high-achieving students and young doctors to come to (and, ideally, remain in) Rochester?

The brothers' growing reputations helped. The opportunity to work with them — and learn from them — was a powerful lure, and already by the first few years of the 20th century Mayo Clinic had attracted such leading practitioners as Dr. Christopher Graham, the clinic's first internist; Dr. Henry Plummer, who led development of Mayo's clinical laboratories; and Dr. Edward Starr Judd, a master in general surgery. (Each of them, and others, are described in Clark Nelson's book "Mayo Roots.")

But the growing clinic required still more talent. Will and Charlie spotted a wealth of it just 70 miles to the north, at the University of Minnesota Graduate School of Medicine.

Mayo Clinic having its own medical school was still decades away, so in 1915 the brothers offered $1.5 million from their own savings to seed a partnership with the "U" to train young physicians, called "fellows," in a three-year program that offered exposure to various medical specialties in Rochester, and a medical degree at the end of it. (Mayo Clinic had already begun educating fellows, but could not offer an accredited academic degree.)

The university's Board of Regents promptly approved the partnership with the newly created Mayo Foundation for Medical Education and Research, and right away the program had 250 applications for 60 spots.

However, voices were rising against the partnership, some of them perhaps springing from professional jealousy. Seventy-eight doctors from around the state signed a petition against it. Still others were suspicious there were hidden financial motives, and some simply thought the plan was a bad idea.

Those concerns were taken to the Minnesota Legislature, which convened in the spring of 1917 to vote on a bill that would have killed the partnership before it could get started. William J. Mayo was called to speak at a hearing. His words — delivered off the cuff and from the heart — were taken down by newspaper reporters and published as what would become known as "The Lost Oration."

"I can't understand why all this opposition should have been aroused over the affiliation with the University," Mayo said. "It seems to be the idea of some persons that no one can want to do anything for anybody without having some sinister motive back of it.

"If we wanted money, we have it," Mayo continued. "That can't be the reason for our offer. We want the money to go back to the people who gave it to us. ... We want to serve the state that has given us so much and we think the best way we can serve it is through medical education."

Mayo's words, delivered in something like desperation, inspired legislators to squelch the bill and allow the partnership to continue, setting the conditions which led to Mayo's role as a leading educational institution to this day. "And without that, you wouldn't have an ongoing Mayo Clinic that would last beyond the lives of the founders," Boes said.

Like the rest of the country, Mayo Clinic faced severe tests during the Great Depression. Patient traffic slowed to a trickle — so much so, that William J. Mayo ordered a number of chairs removed from each waiting room so they wouldn't look so empty, and the clinic cut staff and implemented a hiring freeze, wrote Mayo medical professor and cardiologist — and author —

W. Bruce Fye

in his book, "Caring for the Heart."

But death would also come for the brothers during this time period. 1939 was a dark year.

"It is known as the year of greatest crisis for Mayo Clinic," said Matthew Dacy, director of Mayo's Heritage Hall, the museum of Mayo Clinic.

First, Sister Mary Joseph, the longtime head nurse at Saint Marys Hospital and surgical assistant to William J. Mayo, died on March 29.

Charlie Mayo died of pneumonia on May 26 while on a trip to Chicago. William was too sick to attend his brother's funeral, according to Clapesattle, and he died two months and two days later, on July 28, from stomach cancer.

By then, the brothers had been retired for years. Even so, the crisis that could have followed the passing of the founders was averted, thanks to foresight.

"A key principle that they had committed to was succession planning, so well before the brothers' lifetime ended, they had people in place who were able to pick up and carry on. They had been mentored and groomed for that," Dacy said.

The restless dreams that produced the growth and innovation of Mayo Clinic's first century-plus were incredible. But the story really takes flight over the last 40 years or so, when an updraft of growth across the U.S. health care industry carried Mayo to heights even its founders could not have imagined.

From a financial perspective, the world of health care in the early 1980s bore more resemblance to the Mayo brothers' time than it does today's.

Consider that today, according to the Centers for Medicare and Medicaid Services, the nationwide cost of health care has topped $4.5 trillion per year. That's more than a ten-fold surge of growth over just four decades.

Also today, the share of U.S. spending on health care amounts to about 17.3% of the U.S. gross domestic product. In 1980s, health care's share of GDP was only about half as much — 8.9%.

As grows the U.S. health care industry, so grows Mayo Clinic. In its most recent financial report, for 2022, Mayo Clinic tallied $16.3 billion in revenues. That is a full $10 billion higher than the revenues reported as recently as 2006.

Fye chronicled the origins of this period of expansion in "Caring for the Heart." Fye finds the roots of today's galloping growth in the early 1980s, when under the leadership of

Eugene Mayberry,

then-chairman of the Board of Governors, Mayo Clinic recognized the trends of its industry and took important strategic steps to secure its future as a leading destination.

An important early step was to bring Rochester's health houses together, and in 1986, leaders of the Mayo Foundation, Saint Marys Hospital and Methodist Hospital agreed to merge under a common governance and management structure.

A for-profit arm, Mayo Medical Ventures, was formed. Mayo extended its reach across the Upper Midwest with Mayo Clinic Health System. New practices were opened in Florida and Arizona. All of this happened in the 1980s. Mayo has since gone on to

establish a presence worldwide

in places ranging from central London to the United Arab Emirates and China.

From this perspective, it's not hard to see the current Destination Medical Center initiative and the recently announced "Bold. Forward. Unbound." initiative, a $5 billion project set to begin this year, as further steps to cement Mayo Clinic's position as an important world center for health care, innovation, education and research.

"The place has gotten so big," Scanlon said. "It once was called 'Mother Mayo' by employees. Now it's 'Mayo Inc.' That's inevitable with growth. You can't operate the same way."

Yet, thanks to the integrity of the workforce, the quality of care and a "culture of integrity, professionalism, dignity and patient welfare" remained intact, said John La Forgia, Mayo's longtime chief marketing officer in his book "Brand Aid," in which he recalls his arrival at Mayo Clinic in the early 1990s.

"What I soon learned," he said, "was that everyone who worked there — and I mean everyone — was completely obsessed with maintaining the institution's reputation. ... Even before I started at Mayo Clinic, when I read some of the pre-employment material, I read over and over again the rubric 'The needs of the patient come first.'"

Initially skeptical, La Forgia became a believer. "The sentence ... was on everyone's lips: in memos, in speeches, in board minutes. It was the touchstone for every decision anyone made. In twenty-three years, I never met anyone at any level of the institution who didn't know those words and what they meant, even now when Mayo Clinic employs roughly 65,000 (today, topping 70,000) people around the world."

So, why Rochester? And would Mayo Clinic have been the same if, in an alternate reality, it had laid roots first in Mankato, Le Sueur, St. Paul or Duluth — or someplace beyond Minnesota?

Scanlon tackles that question in his first book, "Rochester Stories," and attributes Mayo's history of success and growth in Rochester to 11 main factors that include the genius and drive of Dr. W.W. Mayo and his sons, the time of Mayo Clinic's establishment during a revolutionary period that gave rise to modern surgical practice, and the "Midwest work ethic" of its "extraordinarily productive workforce."

Dacy considers Rochester to be "key to Mayo's success."

"If the Mayo brothers and their dad had been living in a large, urban area, you would have had other leading health care centers, you would have had a kind of medical hierarchy saying, 'Oh, we don't do that, that's too risky, don't go there, that's not how it's done.'"

Away from such influences, the Mayos' leadership was powered by the work of the Franciscan sisters and the community around them — a "little engine that could," Dacy said — powered by the realization that, without each other, all of it would fail.

In fact, you might even say that, while little Rochester seems like an unlikely place for a world-famous medical center such as Mayo Clinic to be sited, it is arguably one of very few places, if not the only place, where this story could have unfolded as it did. In other words, there could be a Rochester without Mayo Clinic, but a Mayo Clinic without Rochester? Highly doubtful.