The Mayo Clinic at Rochester, Minnesota

Kai Tiaki : the journal of the nurses of New Zealand, Volume IV, Issue 4, 1 October 1911, Page 168

The Mayo Clinic at Rochester, Minnesota

A Talk with the Nurses of the Dunedin Association, May, 1911, by 1,, E. Barnktt

I have been three times to the United States, and hope to go again. It is a wonderful country, and from the surgeon's point of view there is at the present time, I think, no more interesting country m the world! Of course, one has to know the ropes a little, and get m touch with the right people, for I must admit that the wrong people are more numerous than the other kind. I mean the smart, selfish, mercenary, dollarworshipping class. The general average of surgery m America is by no means high, and this is owing to the large number of commercially-run medical schools which grant the M.D. degree (which is the only medical degree m U.S.A.), without due regard to the scientific training of the students. They have to pass a State examination, but this is often made too easy, and the consequence is that the general status of the medical profession m America is far below that of Great Britain. There are many exceptions : Some of the American medical schools are famous for the excellence of their equipments and teaching, for example, John Hopkins at Baltimore, Harvard at Boston, Cornell at New York, and Rush at Chicago, and at least a score of others could be mentioned that are quite on a par with good schools m the Old World. But at least a hundred others, bogus, semibogus, and inefficient/ -.carry on a more or less, discreditable existence as dollar-making, degree-selling concerns. Urged on by exPresident Roosevelt, the better class Americans are doing all they can to fight fraud and corruption m the States, and these bad medical schools are receiving their share of public ■ attention. Some of them have already received their quietus, and a general process of cleaning up is m progress. The leading surgeons m America develop huge practices, the population being so vast, and the competition of the general practitioner of little significance. The Mayo Clinic at Rochester represents the most extraordinary development of .private surgical practice to be found anywhere. I first visited their cliiic m the winter of 1904, and they v ere then doing from twelve to fifteen rru.jor

operations every morning between 9 and 1 o'clock. At my recent visit m September of last year I found that the operations had jumped up to about twenty every morning between the hours of 8 and 1, and a third surgeon (Dr. Judd) had been taken into partnership to help the brothers W. J., and £ H. Mayo. Rochester, Minnesota, the little town where one sees all this surgical activity, is situated m the north of the central part of the United States ; the nearest large cities are St. Paul and Minneapolis, about 100 miles to the north, and Chicago about 400 miles to the south. To get to Rochester by way of San Francisco 3 r ou branch off at Chicago, and to get there via Vancouver you branch off the Canadian Pacific line at Moosejaw, and change trains at Minneapolis. The City of Rochester has a population of about 10,000 inhabitants, comparable therefore to Timaru, and yet is the site of the largest private surgical clinic m the world. The little city is beautifully laid out with boulevards of maple and oak, walnut, and lime and the houses and gardens are very picturesque indeed. There are two large hotels, which cater for the visiting doctors, patients, friends, convalescent cases ; and a host of smaller hotels and boardinghouses, all dependent for their support on the Ma}'o Clinic. At one of the large hotels a staff of nurses is employed for the benefit of patients before or after operative treatment at the Hospital. The consulting rooms, or officer as they are called m America, are situated m the middle of the town, and are very extensive and splendidly equipped. Here the cases are all thoroughly investigated by physicians, radiologists, urologists, etc., before deciding the question of operation. Specially trained nurses are employed m making blood examinations, urine testing, etc. Beautiful drawings of specimens are made by Miss Dorothy Peters m her studio. During the afternoon hours, when the Mayos themselves were m attendance, the consulting rooms are a veritable hive of industry. The hospital is just a nice little walk from the centre of the town, and by 8 a.m. operations are already m progress. There

are four operating rooms. In No. 2 Dr. W. J. Mayo, the elder brother, of middle height and handsome features, the strongest personality on the staff, operates and specialises m abdominal work, such as stomach cases, gall-bladders, kidneys, sigmoids, hysterectomies, etc. He is a brilliant operator and a witty and instructive talker. In No. 1 Charles H. Mayo, the younger brother ; short, swarthy, mechanical, original, humorous, and altogether loveable, does his morning's work — just now mostly goitres. He did ten on one morning as a record not long ago. In Nos. 3 and 4 Dr. Starr Judd wields the scalpel. He is short m stature, but remarkably active, and gets through a vast amount of work each morning. His cases include such things as breast tumours, hernias, appendix cases, excisions of joints, tubercular glands, etc.

To give an idea of the magnitude of the operative work at this Clinic, I may mention that during the year 1910 there were 336 stomach and duodenum operations, 1174 appendix cases, 654 liver, gall-bladder, and pancreas operations, 594 hernias, 445 operations on uterus, ovaries and tubes, and 702 goitre cases. The visiting surgeons are given every facility for seeing the work, not only m the operating rooms, but also m the pathological laboratories, X-ray, and cystoscope departments, etc. There are usually about 40 visitors present.

Now for some details of more special interest to nurses. To begin with, there is a notice m the hospital to the effect that visiting nurses are accorded similar privileges to doctors, and I noticed from time to time nurses present as visitors m the operation rooms. Preparation of Patients for Operation. At about 3 o'clock on the day before, the patients receive as an aperient what is usually and jestingly referred to as the " Rochester cocktail," which consists of two ounces of castor oil, hidden under the foam of half a glass of frothy beer. Then the usual warm bath, and skin preparation of the operation area is made. Some of the cases have the skin washed over with ordinary antiseptic lotions, of which Harrington's is the favourite, but for the most part the simple iodine preparation is displacing the older-fashioned methods ; the skin being first cleaned with benzine and then painted with a three per cent, solution of iodine m

rectified spirit. While the patient is going under the anaesthetic a second painting with iodine is given. The operator and assistants and theatre nurses all wear the usual overalls, caps, and masks, long sleeves and rubber gloves, the latter are put on wet from a mercurial lotion. The long sleeves are removable, and with the gloves are changed for each operation, and a fresh towel is pinned over the front of the overall, unless it is soiled so badly as to necessitate complete change. The patient is brought into the operating room and anaesthetised there, and is, at once placed m the position required for the operation. The anaesthetists are all nurses who have received special instruction m this work, and capital anaesthetists they are. The senior at present is Miss Henderson, and she has administered

ether m over ten thousand cases. They have had at St. Mary's Hospital, Rochester, more than forty thousand ether operations without a death. Kther is the anaesthetic almost invariably employed, and it is given by the open method.

Dr. Crile, of Cleveland, another very distinguished American surgeon, also employs nurses to administer the anaesthetic, and some of the Chicago surgeons likewise, and they all express a decided preference for a nurse as anaesthetist as compared with a medical practitioner.

Apropos of patients coming straight into the theatre for anaesthesia, Dr. Beckman, one of the assistant surgeons at Rochester, writes as follows : — " There seems to be, a prevalent idea that the patients should not be permitted to see the operating room at the time of his operation, although the great majority of patients express a desire to see it and are allowed to do so at some time during their stay m the hospital. The modern operating room is attractive and clean, and it cannot do any harm to let the patient see this for himself. It is certainly more reasonable to let your patient see a clean, well-appointed operating room than to surround it with such an air of mystery that he is led to believe it is such a horrible sight that he cannot be taken there until he is asleep."

When the patient comes to the operating room and lies down on the operating table, a hesvy blanket is ::olded over the legs and exterded half-way up the thighs. A wide web >trap (surcingh) is buckled about the table over the thighs of the patient just

above the knees. The patient's hands are clasped together over the chest (not the ordinary folding of the arms) and tied with gauze attached jto the head of the table. The tying is done m such a way that the hands cannot be moved towards the feet, but: can be moved, slightly from side to side and towards the head. Where there is an}^ risk of infection from the mouth of patient or anaesthetists, as m goitre cases or other operations about the neck, etc., a goitre screen is used. Dr. Crille's anaesthetist envelops herself and the head of her patient m a complete covering of butter muslin.

PREPARATION; OF OPERATOR AND ASSISTANTS.

The hands and arms are scrubbed m running water with gauze and " Jumbo " soap (an alkaline pumice soap similar, I should say, to Eureka). No brush is ordinarily used ; if one is used it is only about the

nails. The nails are carefully cleaned with a nail .file, and the hands again scrubbed. Harrington's solution — -mercuric chloride 0.8; hydrochloride acid, c.p. 60 ; alchohol, 700 ; water, 240 — is then applied for about 30 seconds, followed by a wash with 70 per cent, alcohol. Gloves are sterilised by boiling m plain water for a few minutes. They are then placed m a 1 m 5,000 mercuric chloride solution and put on wet.

All the other nursing details m connection with operations and after treatment are of the ordinary character,, and simple methods are preferred to elaborate ones.

The hospital charges are very much the same as rule m New Zealand — ward rates about £3 3s. Od per week, and private rooms £i 4s. od., £b ss. Od. and upwards. Wealthy patients can occupy a suite of rooms : bedroom, sitting-room, bathroom, and lavatory with special nursing, at about £8 Bs. Od. to £10 10s. Od. per week and upwards.