JMS Pearce 
Hull, England, United Kingdom

In much of the nineteenth century, ”internal medicine” dominated medical practice in the United States. Specialism was widely disdained and faced hostility and scepticism,ⁱ, not least from the influential Sir William Osler:

There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs.ⁱⁱ

Two US physicians who initiated neurology as a specialty were Silas Weir Mitchell and William Alexander Hammond (1828-1900), both contemporaries of Hughlings Jackson (1835-1911). Amongst many other talented nineteenth century American neurologists were: George Miller Beard (1839 –1883); Bernard Sachs (1858 –1944); James J Putnam (1846–1918); and Charles Dana (1852–1935). In the same period, James S. Jewell (1837-1887), and Edward Séguin (1843 – 1898) were accomplished neurologists. Clinical practice dominated: there were few excursions into the basic neurosciences.ⁱⁱⁱ

In December 1874, the American Neurological Association was founded, largely the inspiration of Hammond.^iv It was a small, exclusive society, initially for the academics of American neurology. Its roots can be traced to studies of brain and nerve injuries of soldiers, conducted by Weir Mitchell ^v,vi and Hammond during the American Civil War. The Association thrived despite Hammond’s early retirement in 1878, and Mitchell’s aversion to medical meetings (which he regarded as “debating clubs”). Before this time, neurology was studied mainly in Germany, Vienna, London, and Paris; American physicians would travel abroad to find training and specialized knowledge at these centers.

Seventy years later, in October 1947, A. B. Baker  invited a group of young neurologists to create a second neurological society. The American Academy of Neurology was formed with much disagreement and debate in 1948. Indeed ED Louis wrote: “the long-existing American Neurological Association actively resisted the new organization. There was reluctance to accept the new idea on a conceptual level, a formal attempt to hijack the new organization and discussions about punitive actions against its founder.,” ^vii

William Alexander Hammond (1828-1900)

Hammond (Fig 1.) was a pioneer of American neurology. Born in Annapolis, Maryland, he was influenced by his father, the physician John Wesley Hammond, and by William Holme Van Buren, a surgeon who had previously served in the US Army. Hammond studied at University Medical College in New York (now New York University School of Medicine) and trained at the Pennsylvania Hospital in Philadelphia from 1848. He was then commissioned as an assistant surgeon in the US Army. From 1849, he fought in the campaign against the Sioux Indians and studied snake venoms and ordeal poisons ¹ with his friend Weir Mitchell until he resigned in 1860 to take the chair of anatomy and physiology at the University of Maryland Medical School. Of boundless energy, intelligent and dedicated to scientific methods, during the 1850s he was recognized as a naturalist and an original laboratory investigator.

He resigned his professorship in May 1861 and re-entered the army as an assistant surgeon where he had previously held higher rank. In 1862, President Abraham Lincoln appointed him, aged just thirty-three, as the US Army’s Surgeon General. In this elevated post he radically changed and improved the hygiene of food and ventilation and imposed stringent but unpopular rules for doctors at military hospitals. His authoritative dealings met with formidable opposition. A genial but overbearing and arrogant man, he became embroiled in vehement arguments with Edwin Stanton, the Secretary of War, culminating in Hammond’s dishonorable discharge at a court-martial in 1864 on trumped-up charges.^viii After fourteen long years an Act of Congress reversed this in 1878; ^ix though he remained without allowances or pay.

Hammond took up private practice in New York and specialized in diseases of the nervous system with great success. In 1867 he was appointed Professor of Neurology at Bellevue Hospital Medical College. In 1874 he moved to the University of the City of New York.

In 1871 he published his Treatise on Diseases of the Nervous System, partly based on the lectures of Charcot. This was described as “the first textbook of neurology written in the English language,” ^x although Romberg’s more scholarly Lehrbuch der Nerven-Krankheiten des Menschen had been re-published in English by the Sydenham Society in 1853.

He was perhaps best known for his introduction of the term “athetosis” (Greek ἄθετος, without position or place) and its distinction from chorea. His textbook of 1871 describes ^xi two patients and remarkably, predicts the site of disease:

Under the name of athetosis, I propose to describe an affection … mainly characterised by an inability to retain the fingers and toes in any position in which they may be placed and by their continual motion. (p. 654) … The analogies of the affection are with chorea and cerebrospinal sclerosis [multiple sclerosis], but it is neither of these diseases. One probable seat of the morbid process is the corpus striatum.

A prolific writer on diverse topics, (see Blustein’s valuable biography ^vii) his medical works included Diseases of the Nervous System, translated into French and Italian; Physiological Memoirs, Insanity and Its Medico-Legal Relations, and Physics and Physiology of Spiritualism. Hammond was one of the originators of The New York Medical Journal, and established The Quarterly Journal of Psychological Medicine and Medical Jurisprudence. He wrote several novels. As a naturalist, the western spadefoot toad bears the name Spea hammondii; he collected the first specimens of the two-striped garter snake, Thamnophis hammondii; and the Hammond’s flycatcher, Empidonax hammondii (Fig 2.) of western American coniferous forests recalls his work in ornithology.

At times however, his extravagant but ill-supported claims and his flamboyance gradually undermined his medical repute, and he became increasingly isolated. Eventually he relinquished his thriving practice and moved to Washington, D.C. to set up a private sanatorium and a business that marketed animal extracts and an elixir of life. Unsurprisingly, his professional standing further declined.

Hammond’s first wife, Helen, bore five children. Graeme Monroe Hammond became a neurologist, and Clara Hammond Lanza was a novelist with whom he wrote Tales of Eccentric Life (1886). Still active and vigorous, he died suddenly in Washington on 5 January 1900 of heart disease and was buried with military honors at the Arlington National Cemetery.

Success in any profession results from a blend of innate cleverness, the capacity for hard work, and above all a congenial personality and its effects on others. It was this last factor that beset Hammond for most of his life. Once one of the leading scientific physicians of his age, Hammond is now all but forgotten.^ix

Note

1. The bark of the sassy tree used in Africa as an ordeal, to which persons suspected of witchcraft, secret murder, etc., were subjected as a test of their innocence or guilt.

References

1. Casper ST, Welsh R. British Romantic Generalism in the Age of Specialism, 1870–1990, Social History of Medicine 2016;29:154–174.
2. Osler William, The Principles and Practice of Medicine, NY & London, D. Appleton And Company 1892.
3. DeJong RN. A History of American Neurology. New York: Raven Press, 1982.
4. Denny-Brown D, Rose AS, Sahs AL (Eds). Centennial Anniversary Volume of the American Neurological Association 1875-1975. New York: Springer, 1975.
5. Mitchell SW, Morehouse GR, Keen WW. Gunshot wounds and other injuries of nerves. Philadelphia, Lippincott. 1864.
6. Pearce JMS. Silas Weir Mitchell (1829 – 1914)  and causalgia. J. Neurology Neurosurgery & Psychiatry 1990; 53 : 763
7. Louis ED. The early struggles of the fledgling American Academy of neurology: resistance from the old guard of American neurology, Brain 2013;136:343–354,
8. US Army Medical department Office of Medical History. http://history.amedd.army.mil/surgeongenerals/W_Hammond.html
9. Blustein Bonnie Ellen. Preserve Your Love For Science: Life of William A. Hammond, American Neurologist.  Cambridge University Press; New Ed edition, 2010.
10. Spillane JD. Hughlings Jackson’s American Contemporaries: The Birth of American neurology’ J. Royal Society of Medicine 1976;69:393-408
11. Hammond WA. A treatise on diseases of the nervous system. p. 654. New York: Appleton, 1871.p.654