427 6th Avenue Southwest
Rochester, MN, USA

National Register of Historic Places - Dr. Donald C. Balfour House (Civic League Day Nursery)

Statement of Significance:

The Dr. Donald C. Balfour House in Rochester, Minnesota, is where Dr. Balfour and his family lived from 1910, when he married Carrie Mayo, until 1960, when the couple gave the property to the Mayo Foundation. The property had a national significance from 1910 to 1947, the period when Dr. Balfour worked for the Mayo system. It is eligible for the National Register under Criterion B for its association with Dr. Balfour, a nationally recognized surgeon, partner in the Mayo Clinic, and founder and director of the Mayo Foundation for Medical Education and Research. It is also reflecting the historical patterns identified by the Minnesota Historic Context, “Urban Centers, 1870-1940.”

Dr. Balfour: A Cornerstone of the Mayo Empire
The histories of Rochester and the Mayo Clinic go hand in hand. The town was begun in 1854 and had grown sufficiently by 1858 to be incorporated as a city. As the seat of Olmsted County, the city thrived and attracted the business of local farmers and small industry. It was the development and growth of Dr. William Worrell Mayo’s family medical practice, however, that put Rochester on the map.

Dr. Mayo came to Rochester from Le Sueur in 1863. He had a small medical practice typical of a country doctor, sometimes taking on a partner but often working alone. As his two sons. Will and Charlie, grew up, they assisted in basic tasks while attending local schools. Both went on to medical school. Will graduating from the University of Michigan in 1883 and Charlie from the Chicago Medical College (affiliated with Northwestern University) in 1888. They then returned home to join their father’s practice. Rochester had been hit by a tornado in August 1883 and the disaster led to the construction of the city’s first hospital. Saint Mary’s. The enterprise was owned and operated by the sisters of Saint Francis of the Congregation of Our Lady of Lourdes, whose convent and girls’ academy were in Rochester. The Mayos used the hospital’s operating rooms but did not share in the hospital’s ownership. Dr. Will and Dr. Charlie, as the Mayo boys were known, had received surgical training in medical school and continued their education by attending conferences and visiting state-of-the-art hospitals. Their advanced knowledge soon earned them the reputation as the top surgeons in the state outside of the Twin Cities and among the best in the Midwest. They added partners to their practice as the number of patients increased. By the turn of the century, the Mayos had become famous in medical circles, and doctors from across the country came to Rochester to see them perform surgery.

It was during this period, that Donald Church Balfour came to Rochester. Balfour was born in Toronto, Ontario, in 1882 and grew up in Hamilton, Ontario, approximately forty miles southeast of Toronto. After attending the Hamilton Collegiate Institute, Balfour went to the University of Toronto and graduated with a Bachelor of Medicine degree in 1906. He returned home and served an internship at the Hamilton City Hospital from 1906 to 1907. At the end of his internship, he heard about an opening in the Mayo practice from a friend who was working there. Balfour applied for the job and was hired to work in surgical pathology. A year later, he was promoted to a clinical assistant. In 1909 he became a junior surgeon, performing minor operations and assisting senior doctors with operations. Balfour fit the Mayo work ethic and the Mayo social scene. His place in the practice was ensured in 1910 when he married Dr. Will’s eldest daughter, Carrie. He was promoted to surgeon in 1911 and was given his own section of general surgery the next year. He earned his Doctor of Medicine degree from the University of Toronto and was made a participating partner in 1914, the sixth and last partner to join the practice.

Central to Balfour’s promotion was his talent as a surgeon. After his promotion to surgeon, he performed over two hundred consecutive operations without any deaths, an impressive record given the challenging cases he treated. He also continued a Mayo tradition of improving and inventing surgical instruments as needed. In 1911 he developed an instrument for holding open an incision, known as the Balfour retractor, for lower pelvic surgery. This instrument is still commonly used today. He also designed an operating table, an operating mirror, and a rack for holding solution bottles in the operating room. Following a Mayo policy that doctors produce articles on a regular basis, Balfour published forty four articles by 1920 and an additional sixty-three articles by 1930. He specialized in diseases of the stomach and duodenum (part of the intestine) and was an internationally known gastric surgeon by the 1920s. His greatest contributions to the field were improvements in the preoperative preparation of patients and methods for avoiding postoperative complications. Balfour’s surgical career was cut short when he contracted pulmonary tuberculosis in the early 1930s. The disease’s debilitating effects made it physically impossible for Balfour to keep up with the practice’s operating schedules. After publishing an additional forty-eight articles and co-authoring a textbook. The Stomach and the Duodenum, with fellow Mayo practitioner Dr. G. B. Eusterman, Balfour focused his career on advancing medical education.

Medical education in the United States got off to a slow start in the nineteenth century. Medical schools and the profession, in general, were not governed by law or an accreditation system. While Europeans were conducting research in scientific laboratories and applying new-found knowledge to practical medicine, most physicians in America did not have laboratories and were skeptical of the new theories.

Many graduated from proprietary medical schools, which focused on teaching new techniques in a two to three-week period. Others learned medicine as apprentices to established physicians. Before the 1880s, the most well-trained doctors in the United States had attended European medical schools. German medical programs, which were often part of larger university systems, were very popular.

A modem and reputable medical program were not established in the United States until 1871. Harvard University was the first to adopt a curriculum and absorb its independent medical school into the university system, requiring the school to meet the university’s academic requirements. Harvard was followed by the University of Pennsylvania and the University of Michigan. The programs included new scientific subjects, took three years to complete, required laboratory work for each student, and were taught by full-time medical scientists. Further progress in medical education was made when The Johns Hopkins University announced plans for a medical school in the late 1870s. After a long gestation period, the school opened in 1893 and became the prototype for the new American medical program. Students were required to have a college degree for admission. The program was four years long, with each term lasting nine months. Classes were limited to small groups, and laboratories and hospitals were the usual teaching arenas. In addition, the university hired full-time faculty who also conducted medical research.

In Minnesota, medical education followed the national trends. Several medical schools had formed around the Twin Cities between 1870 and 1886. While all began independently, two merged into Hamline University to become its department of medicine. Although the 1851 legislation creating the University of Minnesota included provisions for a medical department or school and talk of establishing a program recurred over the years, no action was taken until 1883 when the board of regents created a department of medicine. The department, however, was to “examine all candidates for licenses and degrees in medicine of the University” and “would be in no way connected with the preparation of such candidates for such examination.” In 1888 the university abolished the ineffective department and established a new department to teach medical students. The new program initially followed Harvard’s three-year model, but the committee overseeing the department was also watching the development of the Johns Hopkins medical school closely. In 1894 Minnesota’s course was lengthened to four years and the academic year extended from six to nine months, but admission requirements were lax. The entrance requirements were raised to the same level as other university departments in 1900, and the quality of education continued to improve. The university absorbed Hamline’s medical department in 1908, and as all other schools in the state had been absorbed or had ceased to exist, medical education was centralized at the University of Minnesota.

The Carnegie Foundation for the Advancement of Teaching reviewed all medical schools in the United States in 1910. The results were published in Medical Education in the United States and Canada, known as the Flexner report for its author, Abraham Flexner. Out of the 165 medical schools in the United States, the report found only 65 to be legitimate programs. Minnesota received an excellent review for having unified all medical schools into one program at the university. That same year the American Medical Association commended the university for having the best general level medical training in the country.

The medical school continued its progressive curriculum in 1911 when internships were added as a fifth year of study. Minnesota was the first school in the country to make the internship a requirement for the Doctor of Medicine degree. A few other schools were quick to follow, although by 1932 only seventeen of the country’s medical schools required an internship before conferral of a degree. Minnesota’s progress, however, was not without setbacks. In 1913 the president of the university, George Vincent, reorganized the medical school as a necessary cost-cutting measure. Out of 184 faculty positions, only 70 remained after the changes. This created ill will between the university and the Twin Cities’ medical community, where most of the faculty conducted private practices.

During this same period, Vincent, Graduate School Dean Guy Stanton Ford, and the Mayo brothers began talks concerning a cooperative graduate program. After establishing basic standards for medical school curricula, many of the top medical schools focused on graduate programs. A four- or five-year undergraduate program led to a Doctor of Medicine degree, but a doctor wanting to specialize in a specific field had to apprentice with an authority in that field. To improve this ad hoc process, medical schools gradually developed residency programs that placed doctors in hospitals to do extensive work in a chosen field. The University of Minnesota had officially begun a medical graduate program as part of the Graduate School in 1905. The program allowed students who had completed bachelor and Doctor of Medicine degrees to conduct research, but never developed beyond one or two students each year. In 1914 the university’s medical graduate program was revived with new admission and curriculum requirements. A year later the Mayo Clinic and the University of Minnesota’s Board of Regents signed an agreement for a program to enable university students to study in Rochester. Although a vocal contingent of doctors from around the state protested the affiliation for fear the Mayos would take over the entire medical school, it was finalized in 1917 after a two-year probationary period.

The university approached the Mayo’s because of the unique organizational and educational system that had evolved at the Mayo Clinic in the first decade of the 1900s. The clinic had a staff of brilliant specialists and a large collection of case records that were ideal for research. The practice’s administrative structure was suitable for education. Each surgeon or senior physician had his or her own office or “section.” Junior surgeons were assigned to a specific section and remained there until the senior partners thought the doctor capable of running his or her own section. Balfour was an early “graduate” of the system. He had started out assisting in the pathology section but had become interested in surgery and applied for a position in one of those sections. As a junior surgeon he had assisted four of the clinicians, as senior staff members were known, and had worked his way into Dr. Will’s section before being promoted. Initially, each surgical section was classified as general surgery, but sections became known for the specialties clinicians developed. Dr. Will handled most of the gastrointestinal surgery; Dr. Charlie, most of the eye, ear, and throat surgery. In 1912, the training side of the practice was formalized when a committee was formed to supervise the assistants, who became “fellows” of the Mayo Clinic. Fellows served a three-year rotation: a year in pathology, a year in diagnosis, and a year in surgery. The plan had some flexibility so that fellows could develop special interests and spend one-third of the rotation doing laboratory research. This fellowship program was melded with the university’s curriculum to create a unique graduate school.

The Mayo Foundation for Medical Education and Research (Mayo Foundation) was an entity separate from, but incorporated by, the Mayo Clinic in 1915. The foundation was endowed with $1.5 million from the Mayo brothers. They stipulated, however, that the endowment could not be used until an additional $500,000 had accumulated. The Mayo Clinic covered all the foundation’s costs until $2 million had accrued. A board of trustees independent of the Mayo Clinic oversaw the endowment until the probationary period ended. Then, the University of Minnesota Board of Regents took over the financial management. The university’s medical school nominated and approved a Board of Scientific Directors, who oversaw the running of the foundation and the staff, many of whom were Mayo Clinic physicians. All students matriculated and registered through the university and paid tuition and fees to the university. The medical school had complete oversight of the curriculum. The program offered training in the Mayo Clinic’s laboratories and operating rooms at a low cost to the university. By coordinating with the wealthy clinic, the University of Minnesota could afford to improve the graduate program and keep apace of progressive national trends in medical education. The university’s medical school was considered one of the most respectable in the nation, and the Mayo graduate program ranked with other top medical schools that had developed similar programs.

Many members of the Mayo Clinic staff were approved as instructors in the Mayo Foundation. Balfour was named an Associate Professor of Surgery in 1915 and was promoted to Professor of Surgery and Chief of the Division of Surgery of the Mayo Foundation in 1923. He oversaw only the surgical sections in the Mayo Foundation; the Mayo Clinic had its own chiefs. In addition to his academic duties, Balfour was involved in the clinic’s administration. In 1919, to ensure that the clinic could survive after the partners had gone, the partners signed over all assets of the Mayo Clinic to the Mayo Properties Association (Mayo Association), a non-profit organization that held the financial reigns of the Mayo system. (Dr. Christopher Graham opposed the changes and resigned his position, leaving only five partners.) Balfour and the other partners were the first trustees, along with three lawyers and Harry Harwick, the Mayo brothers’ business manager. Responsibility for operating the Mayo Clinic shifted from the partnership to a voluntary association in 1923. Under the voluntary association, a board of governors consisting of the former partners, Harry Harwick, and two Mayo Clinic staff members oversaw the clinic’s administration. Balfour sat on the Board of Governors from 1923 until 1947, when he retired from the Mayo Clinic. He served as chairman of the board from 1933 to 1936. Finances in the tri-part Mayo system worked in a circular way. The Mayo Association covered the costs of the Mayo Foundation’s medical education and research. The Mayo Foundation provided fellows to assist the physicians of the Mayo Clinic. The Mayo Clinic collected money from patients and paid “rent” to the Mayo Association for the use of buildings, equipment, and patients’ records.

Balfour shifted his energies from surgery to the Mayo Foundation after retiring from his surgical career in 1933, although he remained active in his specialty, being elected president of the American College of Surgeons in 1935. The same year he was appointed assistant director of the foundation under Dr. Louis B. Wilson, who had headed the program since 1915 and was nearing retirement. After Wilson’s retirement in 1937, Balfour became director of the foundation. In 1939 both Dr. Will and Dr. Charlie died, and the Mayo Clinic was left to the board of governors, although Harry Harwick essentially controlled the organization’s finances, as Dr. Will had done. Balfour, who was “a tall, handsome figure who walked, talked and gesticulated like a Shakespearean actor” and “had the gentlest disposition,” was also looked to as a leader of the staff and students. A former assistant later wrote, “In many ways he was regarded as having inherited Dr. Will’s ‘mantle’ although Mr. Harry Harwick probably wielded as much real authority as he in the governance of Clinic affairs.

Through World War II, both the Mayo Clinic and Foundation continued to function, although the number of staff and fellows decreased significantly. Balfour organized training for 1,500 army and navy medical officers and helped the clinic ration personnel when the number of patients increased to 300 a day, more than any pre-war year. For his war work he received citations from the secretaries of war and of the navy, and a Certificate of Merit from President Harry S. Truman.

In 1947 Balfour retired from the Mayo Clinic and Foundation at sixty-five years of age, the clinic’s obligatory retirement age. He continued his involvement with the clinic, though, retaining the title of director emeritus and serving in an advisory capacity as a professor of surgery and a senior consultant in surgery positions. After forty years with the Mayo Clinic and two careers, one as a surgeon and one as an educator, it was not surprising when Balfour began to receive awards honoring his work. In 1950 he was awarded the “Builder of the Name Award” from the University of Minnesota. Five years later he received the Distinguished Service Medal from the American Medical Association, at the time “regarded as one of the highest honors in American medicine.” A year later, in 1956, he was honored with the Frieden Wald Medal of the American Gastroenterological Association for his outstanding contributions to knowledge in the field of gastroenterology. Added to these were numerous honorary degrees and fellowships from organizations around the world, including Carleton College, Northfield, Minnesota; McMaster University, Hamilton, Ontario; Northwestern University, Chicago, Illinois; the University of Toronto; and medical associations in Mexico, Great Britain, Ireland, Belgium, France, Italy, Greece, Hungary, Australia, and Asia. The Balfour Fund at the Mayo Clinic and the endowed Donald Church Balfour Lecture series, begun in 1927 at the University of Toronto’s Medical School, carried on the doctor’s legacy to education.