Caring for the Heart: Mayo Clinic and the Rise of Specialization

705 Pages·2015·13.424 MB·English

by  W Bruce Fye

Advance Praise for Caring for the Heart:
Mayo Clinic and the Rise of Specialization
“This book describes the intersection of two of the greatest success stories in twentieth
century medicine: the evolution of the subspecialty of cardiology, responsible for the
greatest prolongation of life in industrialized nations, and the development and growth
of the Mayo Clinic, the largest and arguably the finest high quality health care system
in the United States. Fye is a highly respected consultant cardiologist at Mayo and an
equally distinguished medical historian who has risen to the top of both of these fields.
He has produced a lively, insightful book that should be of interest to health care pro-
fessionals, cardiac patients, their families and all who are interested in the evolution of
medical care in the United States.”
—Eugene Braunwald, MD, Distinguished Hersey Professor of Medicine,
Harvard Medical School
“In his latest book Bruce Fye tells the story of how the Mayo Clinic has, through the
years, been a valuable contributor in the fight against heart disease and stroke. The
American Heart Association is devoted to building healthier lives, free of cardiovas-
cular disease and stroke, and allies like the Mayo Clinic are essential to achieving this
mission.”
—Nancy Brown, CEO, American Heart Association
“The Mayo Clinic has long epitomized the development of cardiovascular care, cardi-
ology practice, and medical technology in the United States. Dr. W. Bruce Fye vividly
recounts the history of this world-renowned, yet uniquely American, medical center. As
a cardiologist and historian, he provides unique insights into the Mayo model of care,
the growth of medical specialization, and the evolution of diagnostic and therapeutic
techniques. He also presents fascinating glimpses into American society and culture.
The personal stories about patients and physicians are particularly compelling. This
scholarly yet engaging book deserves a broad audience of both medical and lay readers.”
—Denton A. Cooley, MD, founder and president emeritus,
Texas Heart Institute
“Millions of people owe their lives and health to the rise of cardiac specialization and
the remarkable personalities who made it happen. Bruce Fye, MD, has written a frank,
fast-moving, and thoroughly readable account of this scientific revolution as it occurred
at Mayo Clinic, Cleveland Clinic, and elsewhere. Those of us who played some small
role in the events described can only thank Dr. Fye for his honest and generous history.”
—Delos M. Cosgrove, MD, CEO and President,
Cleveland Clinic
“American health care is so often portrayed as a problem that it’s easy to overlook the
pioneers and visionaries whose remarkable advances have saved and improved millions
of lives. With a focus on heart care, the rise of specialization, and the application of
new technologies and protocols pioneered by the Mayo Clinic, Dr. Bruce Fye brings
these remarkable achievements to life. He has written a scrupulously researched yet
thoroughly readable book for experts and non-experts alike. Caring for the Heart is a
compelling story and readers will be in awe of how far we have come in so short a time.”
—Thomas J. Donohue, President and CEO,
US Chamber of Commerce
“Bruce Fye’s Caring for the Heart: Mayo Clinic and the Rise of Specialization is a unique
and brilliant platform to understand the complex interplay of medical, scientific, tech-
nological, social and economic forces that over a century have shaped the practice of
medicine and cardiology. The author is a cardiologist and historian of international
reputation who has produced a highly stimulating, pragmatic, didactic and easy to read
book for the general public, health care professionals and policy makers. It portrays
beautifully more than a century of cardiovascular science, sophisticated technology,
and humanistic medicine. Mayo Clinic has been an American phenomenon for over 100
years. Whether the reader is concerned about the development and future of medicine in
general, or heart disease in particular, or about integration of the best care on a techno-
logical or human basis, he or she must read this unique and brilliant book.
—Valentin Fuster, MD, PhD, Physician-in-Chief, The Mount Sinai Medical Center,
and Editor-in-Chief, Journal of the American College of Cardiology
“There are many scholarly books about cardiology. This volume is unique as its focus
is on the emergence and development of an institution whose goal is to do the very best
that cardiology offers, and to apply this knowledge to patient care. Reading through the
chapters, one becomes quickly aware that the Mayo Clinic has successfully implemented
a partnership between the management of the institution, the clinical and scientific fac-
ulty, and the patients—including both their physical and emotional care and well-being.
The best illustration of this is shown by the development of open-heart surgery begin-
ning in the 1950s. The story of this advance of cardiology at the Mayo Clinic is unique
and fascinating, but so is what it has done to extend or improve the lives of thousands of
patients. Reading about this is an experience that no one should miss.”
—Claude Lenfant, MD, former Director, National Heart,
Lung and Blood Institute
“This well-written and thoroughly researched book is very timely and deserves wide
readership. The chapter on Franklin Roosevelt’s hypertensive heart disease is outstand-
ing. Bruce Fye provides convincing evidence to support his argument that a few White
House insiders conspired to mislead the press and the public about the president’s health.
While this precise and clear history recounts events occurring over seventy years ago,
its lessons should be carefully studied by our leaders in the medical and public arenas;
indeed by all Americans concerned about the need for honest politics.”
—Walter F. Mondale, former Vice President
of the United States
“Who other than the uniquely talented Bruce Fye could have written such a magnifi-
cent narrative of the development of cardiology and its growth at the pioneering Mayo
Clinic? This beautifully researched volume is panoramic while meticulously informa-
tive; scholarly while engrossingly literate; historic while of the moment—it is vintage
Fye at his very best. Here he has created the template on which subsequent such treatises
should be based.”
—Sherwin Nuland, MD, emeritus clinical professor
of surgery, Yale University
“Bruce Fye is a magnificent storyteller. I had a hard time putting this book down.”
—William C. Roberts, MD, executive director, Baylor Heart and Vascular Institute
and Editor-in-Chief of the American Journal of Cardiology
“It is impossible to think of anyone else with the experience and passion to write this
extraordinary book. Bruce Fye is a cardiologist who has lived through many of the
changes he describes, and a historian who is well recognized in both careers.”
—Rosemary A. Stevens, PhD, emeritus professor, History
and Sociology of Science, University of Pennsylvania
“W. Bruce Fye uses his unique background as a cardiologist and historian-writer to
charm and educate a broad audience. He weaves the history of the Mayo Clinic and
its world class surgical and cardiovascular programs with the worldwide historical
advances in heart disease diagnosis and treatment. The pages seem to turn themselves,
as the text is readable, entertaining, and educational.”
—Myron L. Weisfeldt, MD, professor of medicine and former Director,
Department of Medicine, Johns Hopkins Medical Institutions
Caring for the Heart
MAYO CLINIC AND THE RISE OF SPECIALIZATION
W. Bruce Fye
1
1
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Library of Congress Cataloging-in-Publication Data
Fye, Bruce, author.
Caring for the heart : Mayo Clinic and the rise of specialization / W. Bruce Fye.
p.; cm.
Includes bibliographical references and index.
ISBN 978–0–19–998235–6 (alk. paper)
I. Title.
[DNLM: 1. Mayo Clinic. 2. Cardiology—history—Minnesota. 3. Academic Medical
Centers—history—Minnesota. 4. Cardiovascular Diseases—history—Minnesota.
5. Coronary Care Units—history—Minnesota. 6. Diagnostic Techniques,
Cardiovascular—history—Minnesota. 7. History, 19th Century—
Minnesota. 8. History, 20th Century— Minnesota.
9. History, 21st Century—Minnesota. 10. Specialization—history—Minnesota.
WG 11 AM6]
RC681
616.′2—dc23
2014016050
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
Dedication
For Lois Baker Fye

{ CONTENTS }
List of Figures and Tables ix
Foreword by Rosemary A. Stevens xiii
Preface and Acknowledgments xvii
Introduction xxi
Abbreviations and Acronyms xxv
SECTION I Inventing the Mayo Clinic and Cardiology
1. The Nineteenth-Century Origins of the Mayo Practice 3
2. The Mayos’ Invention of Multispecialty Group Practice 22
3. The Development of an Academic Medical Center in Rochester 42
4. Patient Care and Clinical Research in the 1920s 63
5. The Electrocardiograph and the Birth of Cardiology 81
6. Challenges and Changes During the Depression 101
SECTION II Developments in the Diagnosis and Treatment
of Heart Disease
7. President Roosevelt’s Secret Hypertensive Heart Disease 127
8. The Reinvention of the American Heart Association
and the Invention of Cardiac Catheterization 158
9. Surgeons Begin Trying to Treat Heart Disease 181
10. Pioneering Open-Heart Surgery at the University of Minnesota
and the Mayo Clinic 204
11. The Expansion of Open-Heart Surgery
and Cardiac Catheterization 228
12. Beyond Mid-Century: Two Decades of Growth and Change 255
viii Contents
SECTION III Technologies Transform Heart Care
and Stimulate Subspecialization
13. Creating Coronary Care Units and Empowering Nurses 285
14. Coronary Angiography: The Cleveland Clinic Leads the Way 315
15. Coronary Artery Bypass Surgery Stimulates the Growth
of Angiography 340
16. Transforming Cardiac Catheters into Treatment Tools 363
17. Analyzing and Managing Abnormal Heart Rhythms 396
18. Seeing the Heart: Echocardiography and Other Imaging
Technologies 427
19. Treating Heart Failure and Preventing Cardiovascular Disease 450
20. Challenges and Opportunities Around the New Millennium 480
Appendix: Interviews 505
Notes 511
Index 645
{ LIST OF FIGURES AND TABLES }
Figures
1.1 William Worrall Mayo (1819–1911) in Rochester, Minnesota,
ca. 1900 6
1.2 St. Mary’s Hospital, Rochester, Minnesota, 1889 11
1.3 Ten-bed ward at St. Mary’s Hospital, Rochester, Minnesota,
ca. 1890 14
1.4 Charles H. (Charlie) Mayo and William J. (Will) Mayo
in an operating room at St. Mary’s Hospital, Rochester,
Minnesota, ca. 1895 17
2.1 Charles H. Mayo, William W. Mayo, and William J. Mayo,
ca. 1900 24
2.2 Mayo Clinic Building, Rochester, Minnesota, ca. 1925 35
2.3 Visiting doctors watching Charles H. Mayo operate at St. Mary’s
Hospital, ca. 1920 40
3.1 Seal of the Mayo Foundation for Medical Education
and Research, 1915 52
3.2 Charles H. Mayo and William J. Mayo in World War I military
uniforms, 1918 59
4.1 The Kahler and Mayo Clinic buildings, ca. 1925 67
4.2 The 1914 and 1928 Mayo Clinic buildings 79
5.1 Three-lead electrocardiogram recorded with Cambridge
Electrocardiograph Apparatus, 1915 82
5.2 Cambridge Electrocardiograph Apparatus, 1915 83
6.1 Dorothea Lange, “Migrant Mother,” 1936 103
6.2 Franklin D. Roosevelt, Charles H. Mayo, and William J. Mayo
riding through Rochester, Minnesota, August 8, 1934 105
7.1 Stephen (Steve) Early with President Franklin Roosevelt,
August 25, 1939 130
7.2 President Roosevelt delivering Democratic nomination
acceptance speech over the radio from a railroad car
on the West Coast, July 20, 1944 135
7.3 J. Edgar Hoover in his office in Washington, D.C., July 1941 150
7.4 Norman Rockwell, “Undecided,” Saturday Evening Post,
November 4, 1944 153