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OBITUARY

CHARLES H. MAYOM.D., D.SC., M.CH., LL.D., F.A.C.S., F.R.C.S., D.P.H.

THE Mayo Clinic is the most characteristicexpression of American medicine. Beginning as asmall hospital in an insignificant country town ithas developed into an immense institution for

diagnosis, treatment, and research, established firmlyon the principle that every patient shall have the fullbenefit of modern knowledge. To this end has beendirected the same rational planning and the samecollective effort that build efficient factories andmachines. But though the clinic is thus a productof its age it is also a work of genius. Of its two

creators, the youngerbrother, CharlesHorace Mayo, died inChicago on May 26 atthe age of 73.

Their father, WilliamWorrell Mayo, came

from Eccles in Lanca-shire and learnt

chemistry at Owens

College. After an

adventurous career hefinally settled at

Rochester, Minnesota,in 1863. Two yearspreviously he hadmarried a woman ofScottish parentage,Louise Wright, of NewYork state, who hadsoon afterwards dis-

played great couragein the Sioux rising and massacre of 1862. Of theirfive children the two boys, William and Charles,very early assisted their father in his practice ;and afterwards they would often recount how Charleshad to stand on an upturned biscuit box in orderto help at operations. When in 1885 his time camefor a more formal education he entered ChicagoMedical College, returning to his father’s surgeryin the vacations, and in 1888 he graduated at theNorthwestern University.

It was in the following year that the father, then70, and the two sons opened their new hospital,St. Mary’s, with thirteen patients and five nursesfrom the Roman Catholic sisterhood of St. Francis.Neither William nor Charles had worked as hospitalinterns ; but that, they said, made them more

careful. Despite opposition in the town they wonincreasing success, and soon St. Mary’s was ableto offer much better surgical facilities than wasusual in western towns. At first all three Mayosstill worked as general practitioners, but the twosons early showed a surgical bent. They were readyto tackle all sorts of surgery, and as early as 1895Charles was doing most of the operations on the eye,ear, nose, throat, bones and joints. When thetime came to find associates who could take over

part of the work they followed at once the policyof training their own associates-a policy which,it has been said, " has resulted in a surgical corps witha perhaps unparalleled unity of ideals and standards,but in which personal initiative has been fosteredto a remarkable degree."

Prof. Grev Turner recalls that at the time of hisfirst visit, now 33 years ago, Charlie and Will, asthey were always affectionately called, with E. Starr

Judd as assistant, did almost all the operative work." But then the place was little more than a big village,and on arrival at the station the cabmen called out’Clinic, Hospital, or Cooks Hotel ? ’ as representingthe sum of the activities of the place. Now it is a

hospital city and the largest single medical centrein the world. In all this remarkable developmentCharles Mayo played a notable part. He was four

years younger than William, but throughout life

they worked together as one, and there was singulardevotion between them. Throughout all their greatsuccesses, as I have often heard them declare, they’always shared the same pocket-book’ (i.e., note-case)."The history of the Mayo Clinic and Hospital has

been written elsewhere and will be written again.From a small local and private venture it has becomea national and almost public institution ; for in1919 its properties, already of enormous value,were made over to an appropriate association, whiletwo years previously the University of Minnesotahad benefited by the establishment of the MayoFoundation fund for medical education and research.From their father’s day the brothers had acceptedpatients regardless of their ability to pay ; in 1926about 30 per cent. were paying nothing to the clinic,and 25 per cent. paid only enough to cover the costof examination. But large sums were neverthelessearned and after salaries had been paid to the staff,including the two chiefs, and provision for upkeepand expansion had been made, the rest went toendowment of research, education, and welfare.The Mayos held, as they said, that the success ofthe clinic, past, present and future, " must bemeasured largely by its contributions to the generalgood of humanity." The extent of these contri-butions cannot yet be judged, but the existence ofthe clinic and the fame of its methods have had a

profound effect on American medicine, and thus onmedicine throughout the world.The influence has not come so much through

outstanding surgical or medical discoveries. Ithas flowed directly from the conception of Williamand Charles Mayo that modern medicine demands,not an alteration in the individualistic approachof the patient to the doctor, or the doctor to thepatient, but an organisation of medical men that

brings to the service of the patient all known facilitiesfor efficient diagnosis and treatment. In the MayoClinic the doctor still consults with his patient withinthe quiet walls of his examining-room, just as everydoctor does the world over; but he does so with allthe diagnostic aid of the clinic within his easy grasp.Immediate answers to doubtful points are available.He can utilise the experience of hundreds of specialistsin a moment. He lives in a medical world whereevery human fallible factor has been as far as possibleeliminated. The system is as fool-proof as humaningenuity can make it. Nevertheless, it is claimed,the essential patient-doctor relationship remains

undisturbed ; there still must exist confidence, trustand faith between them. There are few hospitalstoday in any civilised country which have not beenin some way influenced by the experiences of thisgreat institution.

It would be easy for a machine of this type tobecome sterile and lifeless. The Mayo Clinic wasnever that. Charles Mayo was its soul. He was the

humanising element in the organisation. More thananyone he was responsible for the fact that 500members of the most highly individualistic profession

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could be induced to live and work together in a smalltown on the edge of nowhere-and like it ! He itwas who established that tradition which enablesso many men distinguished in their own particularfields to work in peace and harmony for commonideals. Moreover, this same integrative qualityfound expression in an even wider sphere. He had aflair for the interpretation of medical knowledge to thelay public. Though he was perfectly at home withthe great he never lost that common touch whichenabled him to talk to the most humble in termswhich could be understood and appreciated. As aresult he had a deep interest in public health andin the welfare of the community. He battled fiercelyfor anything which made his country a better placeto live in. In this usually dangerous field for medicalmen, in which the press must play a part, he wasequally successful. His " news value " was enormousbut he never offended his colleagues nor antagonisedthe press. He was honoured by countless universitiesand scientific bodies but these distinctions he acceptedmerely in so far as they honoured his colleagues andthe clinic as a whole. He regarded himself simplyas another member of the institution which byaccident bore his name. This was typical of hisunselfish life.As a surgeon he had remarkable versatility and

was responsible for innovations over a wide field." It is characteristic," writes Prof. J. R. Learmonth,"that his first six contributions to medical journalsdealt with such varied subjects as glandular tuber-culosis, cerebral surgery, nasal sinusitis, injuriesof nerves, skin-grafting, and obstruction of thecommon bile-duct. In all he wrote or shared in413 papers of professional interest ; although in hislater life he narrowed the field of his technical interest,he maintained the same broad outlook on surgeryin general, and his contributions were alwayscharacterised by clarity and proper perspective.The amount of successful surgical work which heaccomplished could have been overtaken only byone gifted with great intellectual and physical powers,as well as single-minded devotion to his craft ; inaddition he had an uncanny knack of inventingprocedures which were simple yet entirely efficacious,perhaps the most valuable of which was his brilliantwork on transplantation of the ureters to the colon.That he was intrigued by this aspect of surgery isclear from his paper, published six years ago, on’ wrinkles and recipes in intestinal surgery.’As a clinician he had a unique position. At once atease with any patient, he had the faculty of gettingimmediately to the root of the matter, and of enlistinghis patient’s absolute confidence by his ability toput the problem clearly in lay language, and by histransparent sincerity. His patients became andremained his friends.... Few men of his positioncan have commanded the same mixture of deeprespect and genuine affection."Another former assistant, Mr. A. H. McIndoe,

to whom we are indebted for many of the more intimatedetails of this notice, speaks of him as the perfectsurgical chief. " Few there were who after fiveminutes’ conversation did not fall beneath the spellof those twinkling eyes set in a half-serious, half-humorous face, of the quiet voice with its charac-teristic dry twang and the head cocked a little on oneside. His method of expression was unforgettable.He presented facts and figures in forthright mannerwith apt allusions and illustrations drawn fromnatural history and comparative anatomy, sometimesgermane to the point under discussion, sometimesnot. He illuminated his picture with flashes of

dry humour which kept his audience in a bubbleof anticipation. During the morning’s work of

anything from ten to fifteen major cases he mightdiscuss the number of nails and match-heads, theweight of charcoal and gunpowder which couldbe made from the constituents of the human body ;he might philosophise about the gall-bladder of thepocket gopher, the pineal eye of the tuatara lizard,the galls on his oak trees, the tuberculous lesionsof turkeys’ livers or a hundred other odd subjects,and between these divagations introduce soundclinical teaching drawn from the accumulated wisdomof his vast experience. Those who listened year byyear fascinated by his extraordinary discourse neverknew what new and curious information his wide

reading and shrewd observation would bring to light." As an operator he was rapid, dexterous and

direct, bold when necessary, conservative when

possible, always gentle. He was difficult to assist,for, contrary to the usual practice of the clinic, hedid not try to standardise his technique. He wasforever trying new methods, unexpected approachesto difficult problems, variations in routine which werenot easy to anticipate. Dr. Will thought thatDr. Charlie would have made a brilliant plasticsurgeon, and indeed he loved anything of a con-structive nature. He never ragged his assistantsand was as unfailingly kind to them at the operating-table as he was outside the theatre. I can vividlyremember my first nervous clumsiness as his assistantwhen he suddenly interrupted the curious mixture ofhalf-scientific jargon and half-popular medical lorewith which he delighted his crowded theatre to

whisper in my ear—’ You’re doing fine; so long as youdon’t drop the bit’s on the floor I don’t mind.’ Equallywell can I remember the last sad day in 1929 on whichhe operated-a gastric resection interrupted by hishaving a retinal hoemorrhage. The day had a particularsignificance, for in the adjoining theatre the nextoperation was to witness his own son’s initiation asassistant to his famous father. This was a ceremonyto be watched with interest and appreciation by thewhole clinic and keenly anticipated by father andson. It never took place. How well the son is

following in the father’s footsteps is evident to

anyone who visits the clinic today."Charles Mayo was a great traveller and was

personally known to very many of the surgeons ofEurope. In Great Britain he received honoraryfellowships from the surgical colleges of England andIreland and from the Association of Surgeons. Inhis own country he held the presidency of the AmericanCollege of Surgeons, the American Medical Association,the American Surgical Association, and innumerableother bodies. During the late war, alternatingwith his brother, he was chief consultant for all

surgical services of the United States army. From1912 onwards he was medical officer of health forRochester, Minnesota, where his life was spent.

CHARLES RALPH COOKE-TAYLORO.B.E., B.A. OXFD, M.R.C.S., D.P.M.

Dr. Cooke-Taylor, who has died in London at theage of 55, did not qualify in medicine until 1927 rwhen he was already 43. He came of a family ofsocial reformers and after a brilliant career at OxfordUniversity, where he took his degree in 1906 withhonours in jurisprudence, he was called to the barin 1910, and in the same year stood.for Parliamentin the Holborn division. After that he contestedDulwich unsuccessfully on eight occasions, the lastat the general election of 1935 ; at this time be was

president of the Monmouth Liberal Federation an d

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hon. treasurer of the University of London LiberalAssociation. His interest in medicine began whenduring the late war he joined a medical unit forservice in Serbia and after capture by the Bulgarshe began to work for refugees and obtained an insightinto shell-shock. Soon after qualifying in medicinehe took a psychological diploma and became visitingphysician to the British Hospital for Nervous andMental Disorders and psychologist to the Ex-ServiceWelfare Society. His name appeared in the Corona-tion honours list. He was unmarried.

DONALD ROSE PATERSONM.D. EDIN., F.R.C.P.

Dr. D. R. Paterson, who died at his home in Cardiffon May 23, had been a general physician before hespecialised in diseases of the ear, nose and throat.After qualifying with honours in Edinburgh in 1883he was house-surgeon at the Northern Infirmary,Inverness, and then at the Cardiff Infirmary withwhich he remained associated for the rest of his life.In those early days he was lecturer on materia medicaat the South Wales University College, pathologist tothe Glamorgan and Monmouthshire Infirmary andhon. secretary to the Cardiff Medical Society. Anumber of short papers which he then wrote covered awide range of clinical subjects. Having becomeassistant physician to the infirmary he resigned thisappointment to take charge of the ear, nose and throatdepartment, with the teaching of laryngology in theWelsh National School. On one of his many visitsto continental clinics he met Killian and becameinterested in the direct examination of the oesophagusand upper air-passages, being one of the first to use

the bronchoscope in this country. He became acorresponding member of several foreign laryngologicalsocieties and was elected F.R.C.P. in 1926. An oldfriend and confrere writes : " Paterson had qualitieswhich placed him among the most trusted and

respected figures in his professional circle, whetheras a physician or as a specialist. Apart from profes-sional excellence his richly endowed and highlycultured intellect made him a choice companion.It was a stimulating experience to be in hiscompany. He was a fine companion, an earnestworker and a cultured gentleman." In later yearsDr. Paterson found time to develop his taste for

archaeology and became hon. curator of the Cardiffmunicipal museum, being later elected a member ofthe council of the National Museum of Wales. In1897 he married Constance Mary, elder daughter ofRichard Baker-Gabb of Abergavenny. They had adaughter and three sons, of whom the eldest waskilled in 1917 while on active service in Belgium.

Dr. JOSEPH THOMPSON, who died in Nottinghamon May 22, was the son of a local practitioner andwas born there in 1844. He was educated at

University College, London, and qualified in 1865,going at once into partnership with his father. Hewas appointed surgeon to the Nottingham GeneralHospital and the Nottingham Hospital for Womenand was an active member of the staff of both untilhis retirement in 1910. He was a prominent free-mason. The eldest of Dr. Thompson’s family offive-four sons and one daughter-is Dr. J. B.Thompson, who is in practice in Nottingham. Hiswife died two years ago.

MEDICAL NEWSUniversity of OxfordDr. Freda Pratt has been appointed first assistant in

the Nuffield department of anaesthetics in the university.

University of CambridgeOn May 27 the degrees of M.B., B.Chir. were conferred

by proxy on R. D. S. Jack.

University of LondonDr. G. W. Pickering has been appointed to the university

chair of medicine at St. Mary’s Hospital medical school.Dr. Pickering, who is 34 years of age, was educated at the

Royal Grammar School, Newcastle-on-Tyne. at Dulwich College,and at Pembroke College, Cambridge, where he was a scholar.He obtained a first-class in both parts of the natural sciencestripos and in 1926 went to St. Thomas’s Hospital. Whileworking as a student he taught biology at Westminster school.2n 192 8 he qualified, and in the following year he was awardedthe Mead medal and Wainwright prize for medicine at thehospital. He was resident anaesthetist and house-physician, andin 1930 graduated M.B. Camb. and became M.R.C.P. FromSt. Thomas’s he went to University College Hospital as assistantin the department of clinical research under Sir Thomas Lewis,F.R.S. In 1931 he was appointed to the permanent scientificstaff of the Medical Research Council and in 1932 he presented,with W. Hess, a preliminary account of his work on the experi-mental production of headache. This has been followed bymany other reports, especially on experimental hypertensionand allied problems, and since 1936 he has been lecturer incardiovascular pathology. Last year he was appointedHerzstein lecturer to the University of California and StanfordUniversity, San Francisco, and spent two months visiting theseand other schools in the United States. He was elected F.R.C.P.in 1938.

University of LeedsThe university court decided on May 24 to confer

the hon. degree ofD.Sc. on Dr. L. A. Rowden, hon. directorof the electrotherapy and X-ray departments of LeedsGeneral Infirmary.

’

Harveian Society of LondonOn Thursday, June 8, at 7.30 P.M., the annual Buckston

Browne banquet of this society will be held at theConnaught Rooms, Great Queen Street, W.C.2.

Society of Apothecaries of LondonAt recent examinations the following candidates were

successful :-Surgery.-R. M. Coplans, S. K. Krishnan, J. Lieber, and

S. A. Schuyler.Medicine.-S. K. Das, ‘V. D. Jenkins, E. L. Moll, J. R. Rose,

E. Smith, and W. E. Swanston.Forensic AfgfZtCtme.—S. K. Das, W. D. Jenkins, E. L. Moll,

J. R. Rose, E. Smith, and W. E. Swanston.Midwijery.-E. F. Gleadow, A. N. Kalra, and E. C. G. Miller.

The following candidates, having completed the finalexamination, are granted the diploma of the societyentitling them to practise medicine, surgery and midwifery:

S. K. Das, Bengal and St. George’s ; E. L. Moll, Guy’s ; J. R.Rose, Charing Cross ; and W. E. Swanston, St. George’s.

Royal College of Surgeons of EnglandOn June 2 Miss Dorothy Collier will deliver a Hunterian

lecture on facial paralysis and its operative treatment.Other Hunterian lectures will be given on June 12, whenDr. D. W. Gordon Murray will speak on heparin inthrombosis, and on June 14, when Mr. George Armitagewill describe gastroseopic observations on the healing ofchronic gastric ulcer. On June 5, 7, and 9 Mr. John Beattiewill deliver three Arris and Gale lectures on experimentalsurgery. His subjects will be hyperthermia, arterial

hypertension, and blood conservation methods. All theselectures will be held at the college, Lincoln’s Inn Fields,London, W.C.2, at 5 P.M.Medicine Stamp ActThe Socialist Medical Association circulate a statement

objecting to the proposed repeal of the Medicine StampAct which is, they consider, a retrograde step because(a) every committee which has discussed this subjecthas reported in favour of publishing formulae on everydrug package ; (b) it will remove even the presentsemblance of control over these preparations ; (c) it mustlead to more extensive self-medication; and (d) it is

unlikely to mean any saving to the consumer, but ratherincreased profits for the manufacturers.