Arthel “Doc” Watson, the legendary North Carolina guitarist and one of the most iconic American musicians of the 20th century, died Tuesday evening at Baptist Hospital in Winston-Salem. He was 89 years old.

Watson had been ailing since having colon surgey on Thursday.

“Different systems were failing the last few days,” said David Holt, Watson’s longtime sideman. “But I got to say goodbye, even though he wasn’t conscious. Maybe he heard us. We told him how much we loved him, and how much other people loved him. We told him about all the letters and e-mails that were coming in from all over, just thanking him for being who he was.”

Watson was never a big record-seller, making the Billboard charts only once in his entire career (and then no higher than No. 193, in 1975 with the album “Memories”). But he transcended mainstream popularity, earning eight Grammy Awards including a lifetime achievement award in 2004. From ’70s country-rock to ’90s jam bands and beyond, Watson’s influence was vast, on audiences as well as other musicians.

“He was a great and groundbreaking guitarist, but Doc was more than that,” said Wayne Martin, executive director of the North Carolina Arts Council. “He made musical traditions of Western North Carolina and the Blue Ridge Mountains accessible to millions. His guitar was a powerful tool to get people’s attention, but I don’t think it was his greatest legacy.”

Watson was instrumental in transforming guitar from a background rhythm role to a lead instrument in acoustic music. Yet few players in any style came close to duplicating his elegantly flawless flatpicking style. Generations of acoustic guitarists would spend hours trying to match the grace and speed Watson combined as he played tunes such as “Black Mountain Rag” and “Billy in the Lowground.”

All the same, Watson never went out of his way to call attention to himself. Durham’s Barry Poss, who released 13 of Watson’s albums on his Sugar Hill Records label, used to get frustrated with Watson’s modesty in the recording studio.

“If there’s another guitar player around, he’ll almost always defer to that other player and lay back,” Poss said of Watson in 2003. “He really has no interest in pretentiousness, showing off, ‘Here’s what I can do.’ It just never happens. In the studio, it can be hard to get him to take a hot lead.”

While he played all over the world, Watson still lived most of his life in the vicinity of the Deep Gap community where he was born in 1923. Blind since infancy, Watson’s first childhood instrument was harmonica. His father made him a banjo at age 10, and he learned the basics of guitar from a neighbor.

Watson was always pragmatic about music as a way to make a living. He began playing for money in the 1940s because, as a blind man, he had few other career options. Jack Lawrence, who played with Watson for more than a quarter-century, frequently said that Watson preferred home to being on the road and was less interested in being remembered for his music than as “the good ol’ boy down the road.”

By the 1950s, Watson was playing electric guitar in a rockabilly band. Thanks to an unreliable fiddle player who didn’t always show up for gigs, Watson had to improvise, learning to transpose fiddle parts to guitar – a technique he later applied to old-time fiddle tunes.

In the wake of the Kingston Trio’s 1958 hit “Tom Dooley,” a folk-music boom swept American college campuses in the early 1960s. That was when folklorist Ralph Rinzler discovered Watson, playing behind old-time banjo player Clarence “Tom” Ashley.

Rinzler convinced Watson to go back to acoustic guitar and the traditional mountain songs he’d grown up with. Playing lightning-fast versions of “Railroad Bill,” “Deep River Blues” and other old-time songs, Watson was an immediate sensation on the folk-festival circuit.

“Doc has been an influence on every player of traditional music that I know,” said Joe Newberry, who works for the state arts council and plays in various ensembles. “I used to say that Doc is what North Carolina sounds like. But somebody posted on my Facebook wall, no, Doc is what America sounds like. He’s been a good face to the world for North Carolina.”

Watson’s teenage son Merle Watson joined the act in the late 1960s, and they were folk-festival fixtures until the mid-1980s. Their mainstream peak came in 1972, when they played on the Nitty Gritty Dirt Band’s country-rock landmark “Will the Circle Be Unbroken” – an intergenerational summit pairing rock musicians with country and folk elders including Maybelle Carter, Roy Acuff and Earl Scruggs. The album sold more than a million copies.

Merle died at age 36 in a 1985 tractor accident, and the elder Watson nearly gave up touring. But the story goes that Merle appeared to Doc in a dream, urging him to keep playing. So Watson returned to the road.

Recent years found Watson cutting back his touring schedule, but he never gave it up completely. In 2008, Watson underwent surgery to remove a growth from a lung. Remarkably, he was back out playing shows scarcely a month later.

“I think the only way he’d retire was if he just couldn’t physically do it anymore,” said his playing partner at the time, David Holt. “He loves to play, it’s what he does, and he’s still so great at it. And it’s not too bad to have a couple thousand people patting you on the back with handclaps. That’s always good for the spirit.”

Watson leaves behind a legacy of numerous accolades, including a National Heritage Fellowship in 1988. Perhaps his most visible legacy is Merlefest, the annual bluegrass festival that began in 1988 in memory of Merle Watson.

With Doc serving as master of ceremonies, Merlefest has grown into one of the top acoustic-music events in the country. He played there again this year. But even in Doc’s absence, Merlefest will continue next year and beyond. Still up in the air is the fate of a June 30 date at Raleigh’s NC Museum of Art, “Celebrating Doc,” featuring Holt, Deep River Rising and other like-minded acts.

Watson’s death follows the passing of another giant of North Carolina music, Shelby native Earl Scruggs, the banjo master who died March 28.

“It’s ironic that Doc passed just two months after Earl Scruggs,” said Martin. “We’ve lost two of our state and our nation’s greatest artists. It’s a big blow, and a sad day.”

Menconi: 919-829-4759 or blogs.newsobserver.com/beat