ndersen er an - Gundersen Health System

successes and failures of medical leadership
was reported by his son, Graeme Hammond, in 1890. 34 There
was indeed a lesion involving the lenticular nucleus, the posterior
thalamus, and part of the internal capsule (Figure 3). Graeme
Hammond “called attention to the fact that the motor tract was
not implicated in the lesion, and claimed that this case was further
evidence of his theory that athetosis was caused by irritation of the
thalamus, the striatum, or the cortex, and not by a lesion of the
motor tract.”
Despite the confirmation of a proposed clinicopathological
association, athetosis was, and remains, controversial, being
considered by many late 19th - and 20th - century neurologists as a
form of posthemiplegic chorea or part of a continuum between chorea
and dystonia 35-38 Charcot, in particular, dismissed Hammond’s
athetosis as “simply choreiform movements” or as “only a variety
of post-hemiplegic hemichorea,” to which Hammond retorted, “I
have only to say that the distinction between the two conditions
is as well marked as between chorea and disseminated cerebrospinal
sclerosis. In athetosis the movements are slow, apparently
determinate, systematic, and uniform; in post-hemiplegic chorea
they are irregular, jerking, variable, and quick. Moreover, athetosis
is not by any means necessarily post-hemiplegic.” 36 Even modern
authors have erroneously indicated that Hammond’s original cases
were examples of a posthemiplegic movement disorder, but, as
emphasized by Hammond, “In the original case there had never
been hemiplegia, nor was there such a state in the second case,
on which [Hammond’s] description of the disease was based.” 39
Hammond’s cases both occurred after convulsions and loss of
consciousness, and both were associated with some sensory loss.
Hammond accepted that hemiplegia could be an antecedent in
some cases, but “Where the motor tract is implicated there will be
hemiplegia, spastic spasm, and exaggerated reflexes in addition to
the athetosis.” 39
Hammond also published volumes of other scientific articles
on matters large and small; his topics included insanity, male and
female sexuality, baldness, temperance, drugs both recreational and
therapeutic, syphilis, psychosis, evolution, and sleep. 3 Hammond’s
more than 400 articles and 30 published books are a testament
to the enormous energy he put into his work, although some
are of less than optimal quality and some were primarily for selfpromotion.
Even into his later career, he continued to carry out
experiments, frequently using himself as the subject, as he did for
tests on cocaine 40 and testosterone 41 (parenthetically, he added “not
that I thought I required the injection for any infirmity”).
Although he was himself quite prominent, Hammond achieved
little success in his efforts to foster the acceptance of neurology
as a specialty among the masses of general practitioners or, for
that matter, among the superintendents of insane asylums in the
late 19th century. His arrogance, obstinacy, and flamboyance
proved to be counterproductive, and some general practitioners
and psychiatrists (or alienists as they were then called) considered
Hammond’s fees not only exorbitant but criminal. 42
Battles with Alienists
Although Hammond and many 19th - century American
neurologists practiced some psychiatry, there was at the time
considerable animosity and antagonism between neurologists and
the superintendents of asylums for the insane. The superintendents,
despite being physicians, were relatively isolated from the rest of
the medical profession, adopted primarily managerial roles, and
dealt largely with institutionalized patients in a custodial fashion.
Nevertheless, these superintendents were powerful, often had
strong political ties, were supported by public funds, and controlled
significant numbers of jobs.
Beginning in the 1870s, Hammond and other neurologists
repeatedly argued that psychiatric illnesses, and particularly
neurasthenia, would be better managed by neurologists under
an organic paradigm, but offered no clearly better alternative to
the management of asylum patients. 43-47 Attempts by Hammond
and other neurologists to undermine the authority of the
superintendents and to take control of the asylums led predictably
to open conflict between these groups.
The conflicts between neurologists and asylum superintendents
received increasing media attention and public notice as
representatives of these groups testified as expert witnesses on
opposing sides in a number of high-profile legal cases involving
insanity pleas. 22 In the late 1870s, hostilities escalated and erupted
in bitter verbal and printed attacks between the neurologists,
championed by Hammond and New York neurologist Edward
Charles Spitzka (1852-1914), and the asylum superintendents,
championed by John Purdue Gray (1825-1886), a powerful and
contentious individual who was an asylum superintendent from
Utica State Hospital, New York, 1 of the 13 founders of the
Association of Medical Superintendents of American Institutions
for the Insane (which later became the American Psychiatric
Association) and the editor of the American Journal of Insanity
(now the American Journal of Psychiatry), and Eugene Grissom
(1831-1902), who was an asylum superintendent from Raleigh,
North Carolina, and a friend of Gray’s. 48 In May 1878 at a meeting
of the Association of Medical Superintendents, Grissom, perhaps
at the instigation of Gray, verbally attacked Hammond and labeled
him a “supposed expert,” the “Benedict Arnold of his profession,”
“[a] man lost to conscience and honor,” and “a Judas Iscariot of
humanity, selling the blood of his children for thirty pieces of
silver…. Now at last we shudder as we recognize that the false
expert is no man at all, but a moral monster, whose baleful eyes
glare with delusive light; whose bowels are but bags of gold, to feed
which, spider-like, he casts his loathsome arms about a helpless
prey.” 42 This diatribe was reported to have produced thunderous
applause among the superintendents, and the speech was soon
published (not surprisingly) in the American Journal of Insanity.
This personal attack on Hammond resulted in an interchange
of open letters from Hammond and Grissom presenting their
cases and rebutting each other, followed closely by announcements
and editorials in general medical, neurological, and psychiatric
journals — many of which (outside of the psychiatric literature)
supported Hammond. 49,50 For example, an editorialist in the Saint
Louis Clinical Record concluded that “Dr. Hammond was attacked
for expressing his opinion on the asylum question, fearlessly and
openly as he did. . . . [It] is but natural that we should ask ourselves,
why Dr. Hammond was singled out for attack. There can be no
doubt, after the evidence adduced, that he has been attacked for
being the most prominent member on the committee appointed
to memorialize the legislatures in regard to charges made against
asylums…. The real motive for attacking Dr. Hammond, was
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