Sayre began in Athens Township in 1870 near the Susquehanna River at the junction of three small railroads called Southern Central Junction, and activity there led to the rise of a community that grew with the Lehigh Valley Railroad. By 1900, after thirty years of phenomenal growth, the town had expanded westward into adjacent farmland including West Sayre, north and west to South Waverly, and northeast to include Milltown, while its population rose to more than 5,300 under founder Howard Elmer and through the many jobs created by major Lehigh Valley Railroad shops, rail yards, stations, and offices. Shortly after 1900, Sayre had an all-new downtown, and the forty-room mansion of the late railroad executive, civic leader, and philanthropist Robert Packer had already been donated as a community hospital, especially for railroad workers, creating the six-bed Robert Packer Hospital and beginning in 1885 the medical facility later known as Guthrie Healthcare. Although the railroad was the keystone of Sayre's rise, the medical center later became the community's sustaining force. The Sayre City Hall, built in 1908 on West Packer Avenue for the recently incorporated borough government, housed the police and fire departments, borough council chambers, and community meeting space, and by 1916 the town had its first motorized fire truck. Growth in Sayre and nearby Waverly, South Waverly, Athens, and Athens Township also led to a valley-wide trolley system, and the Waverly, Sayre and Athens Traction Company operated twenty-four hours a day on twelve miles of track until automobiles brought its end in 1930.