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Dr. William Worrall Mayo likely wasn't thinking dynasty when he opened his small medical practice in Rochester in 1864. 


He certainly wouldn't have guessed that 150 years later his name would come to define medical excellence and innovation around the world.


Mayo's sons William and Charles, though, transformed their father's small practice into the Mayo Clinic of today, the largest private employer in Minnesota. Its Rochester campus attracts hundreds of thousands of patients and visitors each year from around the globe. 


As Mayo marks a century and a half, MPR News asked Mayo Clinic museum director Matt Dacy to pick the clinic's five most-important medical contributions. Here are his choices.


"The needs of the patient come first." It's a phrase heard regularly at Mayo from bedside nurses to Mayo's chief executive, Dacy said. The philosophy goes back to 1910, when one of the Mayo brothers gave a commencement speech at a medical college in Chicago, he added. 


While discoveries come and go, the organization's primary value will live forever, Dacy said. "We have to deal with economics, we have to deal with technology and systems, but we do those in service to patients. And I think that's helping to set Mayo apart from other health care providers, even more so today."


Dr. Henry Plummer was among the Mayo brothers' early hires. He was a keeper.


Plummer brought organization to the operation and developed what's become the 

 and the clinic's integrated approach to treating patients.


Before that, "Every doctor had a ledger, like a big old banker's book," said Dacy. "You'd open it up and flip the page and write the notes. Well, of course, when the patient comes back three weeks later, you'd have to riffle back and find the old record."


As doctors saw more patients, those notes and records became more chaotic. Plummer developed a paper dossier, a folder that moved around by conveyor belts, pulleys and pneumatic tubes. 


It became "the institution's record for everyone," Dacy said. "Each doctor contributed to that record, but the record moved around and was stored centrally. It allowed the Mayo practice to leap forward."


At the turn of the 19th century, the Mayo brothers began to invest half their income in a philanthropic fund. That became the base of a gift and the beginnings of the clinic's status as a nonprofit. The value of that gift today would top $100 million, Dacy said.


"They decided that the way to secure the future of Mayo Clinic was to give it away," he added. "They signed over all the assets of the organization -- the land, the buildings, the equipment and the majority of their own personal life savings -- to endow what we call Mayo Clinic as a nonprofit organization."


Mayo researchers won a Nobel Prize in 1950 for their discovery and clinical application of the anti-inflammatory steroid cortisone. 


What really made it a breakthrough was the way Mayo took its research and applied it to patient care, Dacy said.


"Research here is so connected to outcome" and Cortisone's history reflects that, he said. "Whatever condition you may have, whatever health need you have, we're doing research for that." 


As World War II approached, observers realized aviation would play a key role. But there was a problem.


"Mechanics had evolved so planes could fly at higher altitudes, but human physiology had not changed," Dacy said. "Pilots and crews were blacking out, crashing their planes and often times being badly hurt or dying in the crash."


Mayo brought physicians, nurses and technicians together in what was called the Mayo Clinic Aeromedical Unit. Their research was groundbreaking. Versions of the work -- including the high altitude mask and the anti-blackout G-suit -- are still used today.


The clinic charged the U.S. government $1 per year for this top-secret research.

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