Adam Hammer and the Reform of Higher Medical Education in the United States: The Creation of the Humboldt Institute in St. Louis
Adam Hammer was a German physician who immigrated to St. Louis, after having participated in the uprising in Baden. Soon after his arrival in the United States he became aware of the deficiencies in the American medical education system. He determined that the most effective remedy for the situation would be to carry out a comprehensive reform of the medical sector using the educational and medical practices of Germany as a model. Hammer’s entrepreneurial significance is found in his contributions to society as a social entrepreneur in the worlds of academia and public health, rather than as a profitable commercial entrepreneur.
Adam Hammer[*] (born December 27, 1818 in Mingolsheim, Grand Duchy of Baden; died August 4, 1878 in Bad Griesbach, Free State of Bavaria, German Empire) was a German physician who immigrated to St. Louis, after having participated – together with Friedrich Hecker, the leader of the Revolution of 1848 – in the uprising in Baden. Unable to pursue his professional career due to the looming threat of arrest, he decided to leave his home country. Soon after his arrival in the United States he became aware of the deficiencies in the American medical education system. He determined that the most effective remedy for the situation would be to carry out a comprehensive reform of the medical sector using the educational and medical practices of Germany as a model. In 1855 Adam Hammer founded the St. Louis College of Medical and Natural Sciences, which closed the following year, and in 1859 he inaugurated the German-speaking Humboldt Institut. In 1866, he renamed the school the Humboldt Medical College and began offering classes in English. During these years he also attempted to make money in the commercial sector, operating a pharmacy for a short time and becoming involved in a brewery enterprise, a traditional entrepreneurial trajectory for German immigrants. These business activities were not successful, however. Hammer’s entrepreneurial significance is found, in his contributions to society as a social entrepreneur in the worlds of academia and public health, rather than as a profitable commercial entrepreneur. Though none of his educational institutions were blessed with longevity, he was an important pioneer in the field of higher medical education in the United States and many years later some of his suggested reforms were put into practice by American medical schools. In addition, he had a considerable impact on other sectors within the medical profession: Hammer became famous for his surgical skills and proficiency with specific operations, for being the first doctor to carry out surgery under anesthesia in 1847, and for being the first physician to diagnose a heart attack in a living person in 1876. Therefore, he was highly respected not just in St. Louis, but in the broader American and German medical communities due to his multifaceted achievements.
Early Years in Germany
Adam Hammer was born on December 27, 1818, in the town of Mingolsheim in the Grand Duchy of Baden, not far from Mannheim and Heidelberg. He was the first of eleven children of Wilhelm Hammer, a miller and geometer, and his wife Margaretha Hammer (née Ganther). From 1830 until 1837 he attended the Gymnasium (a college preparatory school) in Bruchsal and it was during these years that he had his first contact with politics due to his father being detained on the charge of fomenting a rebellion after he led a group of angry citizens against the arrogant and brutal mayor of Mingolsheim. In December 1837 Hammer entered the renowned University of Heidelberg, pursuing studies in natural sciences and mathematics. In the summer semester of 1839, he transferred to the faculty of medicine and attended the classes of surgeon Maximilian Joseph van Chelius (1794-1876), gynecologist Franz Karl Joseph Naegele (1778-1851) and anatomist Friedrich Tiedemann (1781-1861). Three years later, in 1842, he received his degree from the university after having successfully passed exams in all three fields of medicine – surgery, obstetrics, and internal medicine.
During Hammer’s studies in Heidelberg, at the beginning of 1839, his father decided to immigrate to the United States with four of his children, with the aim of improving his difficult life circumstances after his arrest, and also due to his general dissatisfaction with the political situation in Baden and the other German lands. He initially settled in Ohio, and a year later was joined by his elderly parents, Wilhelm and Magdalena, and two additional sons and their families. From Ohio, the Hammer clan later moved westward to Illinois.
In spite of his outstanding marks at the university, Hammer could not pursue further studies for a doctorate degree or open his own medical practice due to his difficult financial situation. In December 1842 he began serving as a medical officer in the dragoon regiment of Mannheim and spent the next three years in army service for Baden as an assistant surgeon. In August 1845, Hammer converted to Deutschkatholizismus [German Catholicism], a religious movement formed the year before under the leadership of Johannes Ronge, by German dissidents from the Roman Catholic Church who stood for democratic ideals in church governance and in politics. They were viewed suspiciously by the authorities and suffered repression after 1848. Hammer was one of the founding members of the German Catholic community in Mannheim and was elected to its board. This caused him severe difficulties in his profession, which led him to resign his job with the army and establish himself in private practice in Mannheim. Here he met Helene Leip from Alzey and married her on February 15, 1846.
During these years, the German lands were affected by a famine caused by crop failure and the potato blight. Hammer offered medical treatment free of charge for children with rickets, a disease caused by malnutrition, which highlights his strong social awareness and commitment as a doctor. He promoted the development of a Turnverein in Mannheim, acting as its founding member, and fostering physical activities for sick children or those with physical deficiencies. The Turner movement was also closely aligned with the liberal and democratic opposition movement. Together with Friedrich Hecker and Gustav von Struve in November 1846, they founded the Verein zur Beförderung des Wohls der arbeitenden Classen [The Association for the Promotion of Working-Class Welfare], an organization tasked with helping members of the underprivileged working class by offering healthy food, clothing, heating fuel, and other means to improve their situation. Hammer’s social commitment can also be seen in connection with his affiliation with the German Catholic Church, where charitable work was considered important, as well as in the context of his political engagement: Many of the German Catholics were involved in politics and Ronge himself would emerge as a key figure in the revolt of 1848.
When in November 1847 the short civil war in Switzerland – known as the Sonderbund War – broke out, Hammer saw another opportunity to offer his services to what he considered to be a just cause. He volunteered to serve as an army surgeon on the staff of General Ochsenbein, one of the leaders of the Swiss federal forces. The same year he celebrated his first important contribution to his profession. He was the first doctor in Mannheim and the third in the German lands to undertake an operation on a patient sedated with a sulfur-based anesthesia. A week later, he used the same form of anesthesia successfully on a woman in labor for a pain-free birth, and he was the fifth man in the history of surgery to make a complex excision of the scapula. It was this pioneering work, and the book he published about it, that made him known in broader circles within the medical sector.
The beginning of the February 1848 revolution in France had an immediate impact on politics in Baden and across the German lands – a revolt against the established government under Prussian king Frederick William IV broke out. The revolutionaries aimed to abolish the monarchy and introduce a republic. Many of the inhabitants of Baden joined the movement, among them Hammer, who had already participated in the initial meetings of ideological supporters. At that time, he was a captain in a voluntary corps under commanding officer Franz Siegel, and in March, together with Siegel and Struve, he tried to persuade the royal garrison in Mannheim to desert, so that they could not be used against the voluntary corps. In the same month, the men issued a proclamation summarizing their demands for a free republic, which served as an inspiration for other revolutionaries and as a catalyst for the revolution. It also initiated Hammer’s path into the more radical wing of the movement. In cooperation with Struve and Hecker, he became very active in revolutionary activities during the following months. Nevertheless, the revolt was short lived, and, as a consequence, Hecker and his friends were forced to seek asylum. In April 1848 they fled from Mannheim to Strasbourg, and from there they decided to immigrate to the United States. Together with his friend Hecker, Hammer departed from the English port of Southampton on September 20, 1848, on board the ship Hermann. After two weeks on sea, they arrived in New York City on October 4, where they were received with much cheering by the population, who had been informed by an extra edition of the New York Sun of their arrival along with other 48ers. Thus, Hammer was among a larger group of people that the German lands lost in the nineteenth century; another talented person that due to professional limitations, and political or religious repression, was encouraged to improve his situation by looking for an adoptive home. The United States was in the position to receive and incorporate them into its emerging society.
Early Entrepreneurial Activities in the United States
Whereas his friend and companion Friedrich Hecker started his new life in the United States as a farmer in Lebanon, Illinois, a community near the German stronghold of Belleville, Hammer decided to settle further west in St. Louis, Missouri. He arrived there on October 28, 1848, and soon opened a private doctor’s office. The reasons for his decision to settle in St. Louis might have been his wish to be closer to his family, along with the high demand for physicians in the town, which offered good conditions for opening a medical practice. St. Louis had large a German community, was prosperous due to its strategic location on the Mississippi River, and had much to offer from an intellectual and cultural standpoint. Furthermore, many inhabitants of the city expressed support for the aims of the German revolutionaries and had empathy for the suffering that their freedom-seeking countrymen had experienced.
Adam Hammer was thirty years old when he immigrated to the New World. He possessed an excellent education, considerable experience in different fields, and was full of energy and ideas. His personal and professional development had been rather limited in the German lands due to political, financial, and religious reasons, but he now found himself in completely different circumstances under which to start his new life. In the United States, he engaged in social entrepreneurship not only to improve both the political and social situation that he encountered in St. Louis, but, in particular, to address the deficient conditions he discovered in the field of medical sciences. Hammer manifested extraordinary energy all these causes.
Like many 48ers, Hammer followed political developments in the German lands with great attention after he settled in St. Louis and began to participate in the political life of its local German community. By December of 1848, he and Hecker had decided to create an association in order to support the liberal reform movement in their homeland. Hammer was elected to a committee that drafted a note directed to the German population. One month later, the local immigrant community founded the German Republican Association of St. Louis. Soon the commission issued an “address of the German population of St. Louis to the German nation,” encouraging the various states to unite as a free republic using the United States as a model. In spite of Hammer’s vigorous involvement in activities aimed at improving the situation for Germans at home, he seems to have considered the United States to be his adopted homeland nearly from the time of his arrival and he proved willing to integrate into American society at all levels.
Hammer’s medical skills caught the attention of his colleagues in St. Louis shortly after his arrival. In 1850, at the request of Dr. M. L. Linton, Hammer became a member of the St. Louis Medical Society. The society, which had been founded in 1837, took aim at fraudulent practices within the medical sector due to doctors practicing medicine without necessary training and advocated for legislation to address this problem. Members of the society felt that a German-educated doctor would prove valuable to their campaign.
In 1853, Hammer returned briefly to Europe in order to perfect his medical skills. First, he went to Paris, an important capital of medical science along with Vienna and Berlin. Here he obtained a doctorate in medicine, and then moved to Würzburg to join the medical faculty of its university. It is likely that he did this under an assumed name in order to avoid prosecution for having participated in the events of 1848. The reason why he chose Würzburg was that the eminent physician Rudolph Virchow held a position there as a professor of pathological anatomy, which attracted students from all over Europe who wished to study with him. In the summer semester of 1853, Hammer attended Virchow’s class on “Special pathological anatomy,” as well as lectures given by Albert Koelliker on physiology.
After he returned to the United States, Hammer engaged in various political, social, medical, and cultural projects over the next two decades. While his activities focused primarily on improving the desolate situation he encountered in the medical sciences – his field of professional expertise – he ventured into the business world for a few years. For a short time, together with his colleague Dr. A. Behr, he owned and operated a pharmacy in St. Louis. Later, motivated by his brothers Karl (also spelled Carl) and Philipp Hammer, he became involved in professional brewing, a rather typical entrepreneurial activity among German immigrants in the United States, beginning in 1858. The brothers acquired the struggling Bavarian Brewery, but eventually recognized that they lacked the necessary knowledge and skills to run the business successfully. In November of 1858, Karl and Philipp Hammer left the company. Adam Hammer had to secure a new partner and one month later Dominic Urban joined the business. Due to their good connections to St. Louis’ financial community, they were able to obtain the necessary credit to continue operating the brewery. Under their new partnership, Hammer and Urban, they modernized the brewery and increased production considerably, but even then the business did not become profitable. They now produced more beer than they could sell to the local community and thus in January 1860 had to file for bankruptcy, since they were unable to make monthly payments to their creditors. Eberhard Anheuser, who had extended credit to them, decided to purchase the entire company from the partners and their other creditors. Over time, he transformed the new E. Anheuser & Co. brewery into a profitable enterprise, renaming it Anheuser-Busch Brewing in 1879 following his partnership with Adolphus Busch.
Besides his business activities, Hammer engaged in various projects to conserve German language and culture. He was connected to the German Opera in St. Louis, opened by Heinrich Boernstein, which was the only German theater in the West at the time. He promoted the introduction of German-language instruction in St. Louis public schools and served as a member of the local board of education.
Hammer also continued to be involved in politics. He joined the Republican Party after it was founded in 1854, partially due to his strong opposition to slavery. Later, he became a member of the Emancipation Society of Missouri, which was founded in April 1862. During the 1856 election campaign he spoke publicly in favor of Republican presidential candidate John C. Fremont. In 1860, he was a delegate at the Republican National Convention in Chicago.
At the beginning of the Civil War, he served briefly as a lieutenant colonel in the unionist Fourth Missouri Volunteer Infantry regiment, and from June 1862 until the end of the war worked as a brigade surgeon for the Union Army at the rank of major. At the same time he also directed the Marine Hospital and the Refugee Hospital in St. Louis. This work gave him the opportunity to carry out many different types of surgical interventions and to apply the latest knowledge that he had acquired in Europe in various pioneering treatments such as amputations and eye operations.
In order to understand Hammers’ political and social engagement in the United States, and his vision for American society, it is important to recognize that he was practicing social entrepreneurship in addition to traditional entrepreneurship. His engagement as a social entrepreneur was an inherent aspect of his personality and can be traced back to his early years in the German lands. Hammer was not motivated primarily by financial interests in the New World. He did not reap significant monetary rewards from his various entrepreneurial activities. The social impact of his actions is what mattered most to him, and political outcomes often influenced his decision making as well. His charitable activities were not based merely on relieving short-term symptoms of social problems. His primary concern was changing the conditions that had led to these problems in the first place. Almost all of his different entrepreneurial commitments were directed towards improving the living conditions of people in direct or indirect ways. He was willing to experience personal privations and take risks to achieve his goals, just as traditional entrepreneurs often did to gain monetary rewards. His for-profit pharmacy and brewery businesses may be perceived as outliers in his broader project of social engagement, but they can also be seen as a means for funding a wide range of social and cultural activities that offered little return of a monetary nature. Perhaps, as a consequence, Hammer showed less enthusiasm for the pharmacy and brewing enterprises and seemed less willing to invest significant time and effort to overcome initial difficulties. He may have viewed the economic reward from his business enterprises as insufficient to justify such a significant investment of his energy. Instead, he may have preferred to focus his time and effort on his core entrepreneurial activity, the improvement of medical education and the medical system in the United States.
Improving Higher Medical Education in the United States
In the mid-nineteenth century, medical education in the United States lagged far behind medical education in Europe. Even as late as 1914, a high proportion of the most talented and ambitious American medical students still studied abroad, mostly at German universities. Soon after Adam Hammer’s arrival in the New World, he became convinced that the American medical sector needed to be improved and set out to be an agent of reform. In 1852, the president of the Missouri State Medical Association asked him to provide an evaluation of medical education in the United States. Hammer’s article appeared later that year in the association’s journal. He criticized the state of medical education in the U.S. and identified deficiencies that he later sought to rectify through new educational institutions. Hammer noted that students of medicine with no previous education in the field could graduate from a medical school after assisting a physician for one year and completing two four-month courses. With German standards in mind, he argued that students must first obtain fundamental knowledge in the natural sciences before specializing in a medical field such as anatomy, physiology, pathology, theoretical medicine, surgery, or obstetrics. “A man who intends to become a physician, must necessarily commence his studies with the natural sciences. These are physics, chemistry, zoology, botany, and mineralogy.”
Hammer highlighted other deficiencies including insufficient regulation of the medical profession, the ease with which prospective physicians could obtain diplomas and open doctor’s offices, and medical students’ disinterest in investing time, money, and effort to secure a rigorous education in the field. Hammer provided a detailed list of suggestions for reform, among them a requirement that students should prove that they possessed an adequate educational background, as well as prior experience, before being admitted to medical school, and that all medical students should be required to take three courses of six-months study followed by an oral and written exam before receiving a medical degree. Other obstacles noted by Hammer in his exposé included medical professors’ lack of sufficient qualifications and a decline in medical school standards for students due to competition among the large number of medical schools in the U.S.
These deficiencies within the medical education sector, as well as the presence of insufficiently trained physicians in many medical offices, had been criticized by other doctors previously, but Hammer was the first to present a detailed list of suggestions for reforming the profession, and, more importantly, he was willing to take an active part in the reform process: “While the American Medical Association was meeting, and resolving, year after year, that something ought to be done to advance the standard of education of physicians, Dr. Adam Hammer was acting.”
The inadequate state of medical education in the United States during those years was also lamented by the nation’s medical press, for instance the Humboldt Medical Archives, edited by Adam Hammer and J.C. Whitehill,  and the Transactions of the American Medical Association. According to the editors of the Humboldt Medical Archives, they wished to publish a medical journal that reflected the progress of medical science in the West and in St. Louis in particular. Thus, their goal was to publish columns filled with original articles of a practical character from renowned authors, as well as lectures delivered by eminent professors, while experienced translators would furnish them with the latest medical news from other European nations and from English, Scottish, and Irish journals. In order to keep medical practitioners informed of recent scholarship, reviews of important publications would also be included in the journal.
Hammer made great efforts to develop a comprehensive and well-thought-out program for improving the medical sciences at different levels, introducing the latest German knowhow, methods, and instruments to his American audience. He envisioned that this knowledge transfer from the German lands to the United States would be carried out through publications and lectures, as well as through American medical schools hiring German professors to teach new forms of surgical interventions and provide cutting-edge information on treatments for diseases. Critical aspects of his plan to improve higher medical education included imposing stricter admissions standards for students, requiring longer periods of training, instituting graded courses, as well as implementing more demanding requirements for examinations. Taking a holistic approach to the problem, he also sought to create a hospital where new medical science would be practiced, and, on the political level, he argued in favor of mandating national medical licensing for physicians in order to improve the standards of applied medical science and prevent quackery.
During the 1850s and 1860s, Hammer founded a number of institutions in St. Louis that offered medical education modeled after German university practices. At the beginning of 1855, Hammer received a license to open the St. Louis College of Medical and Natural Sciences. This took place shortly after he had obtained graduate medical degrees in Europe. He outlined four main aspects of education that would set his new college apart from all other medical colleges in the nation. These improvements addressed the shortcomings of the U.S. medical education system that Hammer had identified previously. As a result, the St. Louis College would have a longer term of study to allow students to thoroughly master a number of specialties. The curriculum was based around graded courses, matriculation was contingent upon fulfillment of a set course of study, and, finally, the school had designated faculties for instruction in different specialties. Though previously Hammer had envisioned three semesters of six months each, he now decided on four-month semesters. He also imposed strict standards for instructors at his institution. They had to be noted professors, physicians, or natural scientists. The curriculum included classes on microscopic anatomy, experimental physiology, experimental physics, mineralogy, geology and general botany, embryology, pathological anatomy, and non-syphilic diseases of the genito-urinary organs. Most of these specialized fields of study were not yet offered by other American medical colleges. For the fall 1855 semester, four German-speaking professors had agreed to start teaching at the college: Josef Hamernik from the University of Prague; J. Planer from the University of Vienna; Jakob Schiel from the University of Heidelberg; and Friedrich Hauck from the University of Marburg.
In spite of the quality education offered by Hammer’s medical college, only three students enrolled for the first semester of study. Potential applicants may have been dissuaded by the college’s fees, which were higher than those at other institutions, as well as by the strict requirements for students and the greater amount of effort that they were expected to invest in their training. Hammer was cognizant of these initial difficulties and he maintained a realistic attitude toward the challenges faced by his new institution:
We are quite aware that for some time we need not calculate on having a great number of students. This, however, shall not retard us, for we do not wish to have those students whose only desire is to get a Diploma in the shortest time and at the smallest expense. All we aim at, is to assemble a select class of talented and industrious young men…. And [to] give them a thourough [sic.] medical education.
Nevertheless, Hammer soon encountered a new problem: The distinguished foreign professors who had promised to join his college failed to appear. While their reasons remain unclear, it is likely that they opted to stay in the familiar German lands rather than face the uncertainty of immigrating to a foreign country. Hammer’s institute was unable to offer all of the scheduled courses due to the faulty shortage and had to close in 1856 after only one year in operation. Thus his first attempt at revolutionizing American medical education was short lived.
Despite his failure, Hammer continued to believe that St. Louis needed a European-inspired educational facility for physicians. In 1859, assisted by a new faculty, he founded the Humboldt Institut, also called the Deutsche Naturwissenschaftlich-Medicinische Schule (German Scientific Medical School). Adhering to the same high standards previously implemented at the St. Louis College, the Humboldt Institut required that students participate in sixteen months of study and pass a public examination in order to receive a Doctor of Medicine degree. However, one important difference between the Humboldt Institut and Hammer’s previous college was that the Humboldt Institute used German as the main language of instruction and administration. This requirement was intended to promote both German science and also the German language in St. Louis. The new institute received more support from the community than had its predecessor. It was praised by local newspapers as an important representative for the German medical sciences. The faculty consisted of seven professors from the German lands. Ten students graduated successfully from the program in 1861.
In 1856, Hammer launched another initiative as part of his broader social entrepreneurship campaign. He founded a hospital for poor people in St. Louis, where eye operations and other types of surgeries were carried out free of charge. The initiative was well received by the St. Louis population, as well as throughout the entire state of Missouri and neighboring states. In spite of the hospital’s delicate financial situation, Hammer was able to keep its doors open until the beginning of the Civil War. Hammer also created the German Institute for Science, Art and Commerce in 1856, since he considered it to be the responsibility of Germans in America to promote German knowledge and education, particularly in difficult times. Moreover, in 1860, he worked on a project to establish a German hospital connected with the Humboldt Institut. His plan faced obstacles, however, due to financial limitations and also the jealousy of some of his colleagues who sought to limit German influence in St. Louis. It was therefore not possible for Hammer to carry out this project. Nevertheless, all these initiatives show how well thought through his reform program was. He sought to implement solutions for the lack of medical education and access on different levels and created various interconnected institutions and associations to carry out his objectives.
Despite the success of the Humboldt Institut, Hammer was forced to shutter the institution for two years due to the outbreak of the Civil War. During this time, he began to raise money to build a new, more appropriate school building across from the St. Louis City Hospital. In 1863, courses resumed at the new location and three years later the faculty and administration of the institute were reorganized. The name was changed to the Humboldt Medical College and the official language of instruction was switched to English in order to make it accessible to students without knowledge of German. The first course of lectures held after the reorganization came in the winter of 1866. A total of twenty-two students graduated from the college, receiving the Humboldt Medical College Diploma, a document written in Latin, with a lithographic picture in circular form of Alexander von Humboldt.
During the years 1867-1868, the Humboldt Medical College also published the aforementioned journal, the Humboldt Medical Archives. The first issue contained an article by Adam Hammer with his observations on the medical sciences in St. Louis and his vision for the institution. The journal was also a platform through which Hammer contributed to American medical science. Under his title, [Professor] of Surgery, Ophthalmology and Pathological Anatomy of the Humboldt Medical College of St. Louis, he published several articles and lectures. Beginning in 1868, however, tensions and disputes among the faculty led to the dissolution of the institute. In the summer of 1869, ten years after his first attempt to establish a venue for European-style medical education in St. Louis, the faculty of Hammer’s school resigned en masse and the Humboldt Medical College was abandoned. Several members of its faculty, led by the college’s dean and professor of surgery, Dr. Louis Bauer, and its secretary, Dr. J. A. Steele, formed the first St. Louis College of Physicians & Surgeons, an institution that Hammer did not join.
All of the institutions that Hammer founded struggled due to lack of funding and the unstable economic situation in the United States in the late antebellum period, as well as due to the outbreak of the Civil War, which disrupted everyday life in St. Louis. Moreover, rivalries between medical professionals created problems. Faculty at the two older and more powerful medical schools that existed in St. Louis at the time – the St. Louis Medical College and the Missouri Medical College – persistently fought every proposal for reforming higher medical education that Hammer advanced. These two medical colleges were graduating doctors after four or four-and-a-half months of training compared to the sixteen months of classes required by Hammer. By comparison, even the prestigious medical faculty of Harvard University had argued for four months of coursework in preference to a longer course of study for a medical degree and the University of Pennsylvania and the College of Physicians & Surgeons of New York had similar requirements. Hammer’s new educational institute and public advocacy challenged these established institutions and threatened to undermine the success of the local medical schools in St. Louis.
It’s important to consider why Adam Hammer chose to name his reformist institution after the Prussian explorer and scientist, Alexander von Humboldt. Following his visit to the United States in the spring of 1804, Humboldt had maintained strong connections to the American political and scientific elite over the next fifty-five years. By the time of his death on May 6, 1859, he was widely known and respected throughout the country. The 1869 centennial of his birth was commemorated with parades, speeches, concerts, banquets, and dedications of monuments across the United States. More places were named after Humboldt in the United States than in any other part in the world.
Since Hammer’s institute opened in 1859, the year of Humboldt’s death, he probably named it after Humboldt in order to honor the famous Prussian’s life. It may also have been an attempt to attract attention to his college by establishing a connection to Humboldt. More importantly, Humboldt was considered a scientific pioneer in exploring South America, a hero of natural science, and a role model for the deluge of scholars, explorers, and science organizers who came after him, both in the United States and throughout the world. The name Humboldt stood for progress in the sciences and the betterment of living conditions for humanity – goals that Adam Hammer shared. Furthermore, like his famous compatriot, Hammer was aware of the importance of networking, of connecting people and ideas, as well as the importance of popularizing science. Though it remains uncertain if Hammer had read Humboldt’s writings, and was knowledgeable about the content of his scientific work, it seems safe to suppose that he liked to perceive himself as coming from the same intellectual tradition as the learned Prussian.
Hammer may have felt a certain ideological identification with Humboldt. Both were involved in a large number of scientific projects and both fought actively for what they believed in. Humboldt and Hammer were active in the anti-slavery movement, and both supported Republican candidate John C. Fremont in the election of 1856. Hammer may have hoped to receive the same appreciation for his work in the United States as Humboldt had received, or hoped that his enterprises would be as successful as those of the illustrious Prussian. Finally, Hammer was not alone in his decision to name educational institutions after Humboldt. In 1862 Stephen Taft moved from New York to the Iowa prairie with the hope of establishing an intellectual community that would rival that found in eastern U.S. cities. He founded the settlement Humboldt and in 1872 inaugurated Humboldt College. Though the college remained open until the early twentieth century, and thus had a longer life than Hammer’s school in St. Louis, no more than three people ever obtained degrees from the Humboldt College of Iowa. Adam Hammer thus followed the tendency of Americans, particularly German-American immigrants, to celebrate the famous German scientist and intellectual.
Return to Germany
After the Humboldt Medical College closed in 1869, Hammer received a position as professor of surgery at the Missouri Medical College. Hammer had had a contentious relationship with the previous director of the institution, Joseph N. McDowell, and with A.P. Lankford, a brilliant surgeon who occupied the position of director of the college’s surgical department in 1870. They clashed regarding Hammer’s desire to implement an exam system for granting medical diplomas, but also due to intense professional rivalries. The St. Louis Medical Society, which Hammer led at the time, became aware of the conflict and tasked three members with investigating the situation. The committee severely criticized Hammer’s actions and expelled him from the society for “alleged improfessional [sic.] conduct.” Hammer pursued a successful court case against the St. Louis Medical Society challenging his removal, but his relationship with other members of the society deteriorated further. He was considered a rather moody and quarrelsome person. As a result, despite having his membership reinstated by the society in 1872, he resigned from the organization and his teaching position at the Missouri Medical College.
Around this time, Hammer began to entertain the possibility of returning to Europe. He had his eye on the position of American consul for the newly-unified German Empire, but though he received the support of Carl Schurz, the German revolutionary who had been elected to the U.S. Senate from Missouri in 1868, Hammer was not successful in his attempt. Following this disappointment, he started to lead a more secluded life, dedicating his time exclusively to his personal medical practice. During a visit to Vienna in May 1876, he was the first to diagnose a thrombotic occlusion of a coronary artery as the cause of a heart attack in a living patient. The diagnosis was later confirmed by a post-mortem autopsy. Hammer undertook profound research on this case, consulting the newest publications, as well as other specialists in the field and finally publishing his findings in an article in the Wiener Medizinische Wochenschrift, which was translated into English and published by a Canadian journal in 1878.
Hammer likely used his 1876 European trip to prepare for his permanent return to Germany in April 1877. He had a number of reasons for wanting to spend his remaining years in the land of his birth. Besides his various personal and professional conflicts in St. Louis, which dimmed his prospects for further professional or educational enterprises, he most likely made the decision due to ongoing health problems. As a result of an 1862 amnesty, he no longer ran the risk of arrest or prosecution for his revolutionary actions, so returning to Germany became a much simpler prospect. Hammer and his wife settled in Wiesbaden, a spa town near the Rhine River, where they established a medical practice for surgery and gynecology in their home. Unfortunately, Hammer’s health problems increased and he sought help at Griesbach, a health spa in the Black Forest. Medical experts were unable to improve his condition and on August 4, 1878, he passed away in the sanatorium.
Adam Hammer was remembered in St. Louis following his death, though public memorials were rather reserved. Just a few weeks after he died, a meeting of St. Louis medical professionals issued a memorial resolution. The August 28 declaration reflects a certain emotional distance, which was rather unusual for this kind of statement:
Dr. Hammer had his friends and his enemies; but what man of talent has not? Now that he is dead, let us forget his faults and cherish his memory as that of one whose first and last love was for his profession; one whose great mind and good deeds entitle him to be enrolled among the benefactors of mankind; one whom the members of the medical profession of St. Louis will ever be proud to acknowledge as their companion and compeer.
Several other obituaries reflected the public’s historical memory of his actions in St. Louis in the 1850s and 1860s. The St. Louis Clinical Record described Hammer as “one who scattered the seeds of knowledge broadcast, and put new life and energy into others by his example and precept,” while Der Deutsche Pioneer celebrated him for his restless activity on behalf of German culture in the United States. In the St. Louis Medical and Surgical Journal, an article highlighted his rare acuteness and versatility in medical sciences, and Albert J. Steele, his former colleague from the Humboldt Institut, gave Hammer credit in the Transactions of the American Medical Association for his achievements in the political and medical sectors.
Social Status, Networks, Family: Private vs. Public Life
With the exception of his last years, Adam Hammer was a very outgoing person. He engaged with political and social affairs in the German lands and in the United States as both a participant and a leader. He strongly believed that community engagement could bring about political and social change, and thus he founded several associations, institutions, and other types of groups with political, charitable, or religious aims. Hammer was not a person who tried to achieve things solely by himself, but rather sought out like-minded individuals to help him accomplish his goals.
From his arrival in St. Louis, Hammer was involved with German immigrant networks. He actively promoted German culture, education, and language in the city, and believed that German knowledge and values could improve American society. He also viewed the local medical community as an important agent of reform in St. Louis. He became a member, and later president, of the St. Louis Medical Society. He engaged with other networks, too, and identified with the problems and concerns of his adoptive country, such as the emancipation movement and the Civil War. Over time, he became a much respected member of St. Louis society and was elected to leadership positions for several associations and societies.
From all accounts, Hammer was a very determined person who remained steadfast in his decisions and beliefs despite difficulties and tribulations. Moreover, he was very altruistic and promoted numerous philanthropic causes. He appears not to have been motivated primarily by his own personal economic interests. Instead, he sought to improve living conditions for those around him and thus engaged in a variety of social entrepreneurial activities in different but generally related fields. This aspect of his personality emerged early in his life and continued to manifest itself until shortly before his death. Nevertheless, various sources paint a picture of him as a difficult person who did not seek to avoid conflicts or confrontations with his colleagues, and, over time, this aspect of his personality had an impact on his career and professional networks.
Adam Hammer and his wife, Helene, did not have children during their marriage. She was apparently not directly involved in any of his social or entrepreneurial projects. Besides the short period of time during which he operated the Bavarian Brewery, he did not venture into any joint project with his brothers. Family ties appear not to have had a strong impact on his entrepreneurship and his diverse projects were not developed within a family network, but rather with people with whom he shared common interests, political concerns, or professional convictions.
Hammer’s German ethnicity had a major influence on his life’s work. His life and education in the German lands provided him with experience, ideas, and skills that proved to be valuable as he sought to improve the society he encountered in the New World. As someone who stood between two cultures, Hammer was able to draw on the best of both worlds and combine it in a constructive manner. Germany provided him with an excellent education at the University of Heidelberg and then at Würzburg, where he was in contact with the latest medical knowledge, methodologies, and leading professors in his field. The United States, on the other hand, offered a dynamic society that was receptive to someone with an active, entrepreneurial personality like Hammer. It provided him with opportunities to put his ideas into practice without the hindrances he would have faced in the Old World.
Hammer seems to have struck a good balance between maintaining German cultural values and ties and assimilating into American society. His immigration experience, in general, was rather positive. Even though he had to leave the German lands due to fear of arrest and prosecution, this did not prevent him from continuing his professional career or from carrying out his various reform projects. Nor was he forced to cut ties with his family, as was the case for many immigrants, since his family had preceded him to the United States. Immigration, in fact, enriched his professional, personal, and political aspirations. Furthermore, his economic situation was not affected by leaving his native land. Hammer never expressed major financial aspirations and therefore he did not dedicate significant portions of his time to commercial entrepreneurship. While such activities would likely have improved his financial situation, he nevertheless managed to obtain sufficient financial resources to live comfortably and pursue his diverse social entrepreneurial agendas. Ultimately, neither his professional ambitions nor his private life seemed to have been affected by his limited means.
Hammer faced few challenges due to his German ethnicity and status as an immigrant. Though he was cut off from earlier social and professional ties after he fled the German lands, he quickly established social and professional connections within the German community of St. Louis. Most of the problems he encountered throughout his career in St. Louis had little to do with his ethnicity and much to do with professional conflicts that he stirred up through his campaign to improve American medical education. Established professors of medicine had a vested interest in defending their institutions and Hammer’s prickly personality and new, outsider ideas rubbed many the wrong way.
Hammer certainly benefitted from the presence of a strong, German scholarly community in St. Louis and the surrounding region. In 1848, a number of physicians emigrated from the German lands to the United States, among them Ernst Schmidt, a student under Virchow in Würzburg and participant in the 1848 revolutions, who developed his professional and political career in Chicago. Eminent German naturalists Friedrich Adolph Wislizenus and Georg Engelmann settled in St. Louis. Hammer initially connected with fellow 48er expats who had fled the German lands for similar reasons, and together they advocated for liberal and democratic reforms in the German lands. In later years, however, these political issues became less of a concern for him and he directed his energy to medical and public health projects and advocacy. Compared to some 48ers who stayed in the United States for only a brief period of exile, Hammer’s expressed desire was to relocate permanently in the United States. His eventual return to the Old World seems to have been a consequence of his personal health problems, his bitter professional disappointments, and a lack of visions for his remaining years, rather than any inherent dislike of the United States.
Adam Hammer was very inclined to engage in pioneering activities, whether traveling to foreign regions, investigating new fields of medicine, promoting improvements in education, or advancing new political, social, and religious ideas. Being an extremely active person, he sought to bring about reforms in various fields including politics, religion, education, medical knowledge, poverty, health care, and emancipation. Hammer neither hid from problems, nor focused on narrow niche matters, but instead sought out solutions for society at large.
In spite of various difficulties, Hammer left a major mark in the two professional fields in which he was active. He fostered ties between the land of his birth and his adopted homeland through his efforts to reform medical education in the United States by promoting German medical knowledge and through his contributions as a surgeon. His entrepreneurial failure as a brewery owner seems not to have had a lasting impact on him, since his interests were clearly in other professional fields and he appears to not have been terribly concerned with accumulating personal wealth.
Among Hammer’s contributions to the field of American medical education were the German-language institutions he founded, which he staffed with graduates from famous German universities. Since these men had broad educational training, and were well versed in the natural sciences, as well as in the medical arts, medical education in St. Louis benefitted through the teaching of neighboring sciences. As a surgeon, Hammer displayed his abilities and his thirst for knowledge about new surgical methods and practices. He was skilled in general surgery and in ophthalmology, and was able to share his knowledge of current practices with others. He performed operations that other surgeons declared impossible. Furthermore, he was a pioneer in the study of surgical pathology in the United States, and his lectures on pathological anatomy and descriptions of his successful operations were published in the Humboldt Medical Archives.
It took some time, though, for the scholarly community to recognize the importance of his pioneering work as a surgeon. Thirty years passed after his death before he was acknowledged for his specific contributions to medicine. Other publications commemorated and honored his larger body of work, as well as his contribution to the history of science in St. Louis. Greater recognition of his medical accomplishments has only happened in recent years as his legacy in the field of medicine has become better known. His work thus had a considerable impact in both Germany and the United States – though this was only truly perceived years after his death.
It is important to recognize that in spite of Hammer’s various failures, he always stayed faithful to his principles and goals and served as an example for others. His campaign to extend the educational and training requirements for American physicians eventually bore fruit, though he did not live to see it. In 1871, Harvard Medical School reformed its medical education curriculum and required that medical students attend nine-month courses for three years. Soon other universities adopted these new pedagogical standards, and, by 1890, twenty-six medical colleges in the United States had embraced the requirements that Hammer had advocated thirty years earlier.
Though Adam Hammer’s efforts to better the political and social situation in the German lands were mostly unsuccessful due to the violent response from the ancient régime, he was able to carry out his social and educational reform agenda in the United States. In this mission, he did not express any overtly nationalistic sentiments; he simply sought to improve the broader medical situation in the U.S., as well as address specific inadequacies. He was persistent in his reform efforts and fought for what he considered to be right. He undertook the steps he considered important, even though this led to conflicts with others and inconvenienced him personally. Initial failure did not dissuade him from engaging in further attempts. He maintained a dogged, entrepreneurial determination to bring about social change regardless of where he found himself, and his ethnic background allowed him to forge unique ties with the land of his birth and serve as a conduit to bring knowledge and educated scientific and medical professionals to St. Louis.
Hammer is certainly not representative of the majority of German entrepreneurs who immigrated to the United States during the mid-nineteenth century. Aside from his brief brewing career, he engaged in a unique set of social entrepreneurial activities that combined his medical education and experience with his desire to bring about reforms in the educational and medical professions. As a German-trained physician, he could have used his skills as a means to acquire personal wealth and achieve upward social mobility in the United States. However, he chose to assume a role as a public health advocate and educator. A less determined person might have opted for a more stable career and life, but Hammer’s entrepreneurial persistence and risk-taking personality enabled him to carry on with his diverse projects, in spite of all the obstacles and difficulties he faced over the years.
Adam Hammer’s life and career was characterized less by financial success and failure and more by his efforts to make a positive impact on society through his various educational activities and advocacy efforts. Entrepreneurship in the business world, as well as in the social sector, requires effort, strength, perseverance, and a willingness to risk failure. People who believe in their ideas, initiate change, search for solutions, and venture into new fields engage in entrepreneurial behavior. This applies equally to both economically motivated projects and social entrepreneurial projects such as those devised by Adam Hammer for the betterment of society. The significance of social entrepreneurs’ work lies in the fact that their actions are intended to serve as examples and provide inspiration for others. In this sense, due to his significant contributions to German-American medical collaboration and the transnational exchange of scientific knowledge in the mid-nineteenth century, Adam Hammer can certainly be considered a model entrepreneur.
[*] This article has been elaborated in the frame of a Marie Curie Grant awarded by the European Commission
Research Executive Agency (AHumScienceNet, project number 327127, FP7-PEOPLE-2012-IOF)
 Several articles have been published so far on Adam Hammer’s life and his contribution to medical science and the advancement of medical education in the United States: James Moores Ball, “Dr. Adam Hammer, surgeon and apostle of higher medical education,” Journal Missouri State Medical Association 6 (1909): 155-177; Ralph H. Major, “Adam Hammer und das Humboldt-Institut: Eine deutsche medizinische Akademie in St. Louis, USA,” Sudhoffs Archiv fuer Geschichte der Medizin und der Naturwissenschaften, 44. 1 (1960): 76-80. In 1997 a well-documented dissertation on Hammer’s interesting life was submitted at the University of Heidelberg, published a year later: Werner Streckfuss, Adam Hammer – Ein badischer Achtundvierziger (Sinsheim: Heimatverein Kraichgau, 1998). This publication is the most comprehensive and reliable source on Adam Hammer.
 Streckfuss, Adam Hammer, 20.
 Ibid., 37-36.
 Adam Hammer, Die Anwendung des Schwefeläthers im Allgemeinen und besonders bei Geburten (Mannheim: Selbstverlag, 1847).
 Adam Hammer, “Sucessful Extirpation of the Entire Left Scapula and Acromial End of Clavicle, with Preservation of the Arm,” The Medical Reporter 1 (1866/67): 1-8.
 Streckfuss, Adam Hammer, 53.
 Friedrich Schnake, “Geschichte der deutschen Bevölkerung und der deutschen Presse von St. Louis und Umgebung,” Der Deutsche Pionier 4 (1872/73): 85-88, 233-236, here 85.
 Streckfuss, Adam Hammer, 54.
 Ball, “Dr. Adam Hammer,” 158.
 Streckfuss, Adam Hammer, 58.
 Susan K. Appel, “The German Impact on Nineteenth-Century Brewery Architecture,” in The German Forty-Eighters in the United States, ed. Charlotte L. Brancaforte (New York: P. Lang, 1989), 243-256.
 Streckfuss, Adam Hammer, 71.
 It is not known if the revenue they earned was enough to repay all the credit that had been extended to them.
 For more information see: Henry Geitz, ed., German influences on education in the United States to 1917 (Cambridge: Cambrigde Univ. Press, 1995); Bonner, Thomas Neville, American doctors and German universities: a chapter in international intellectual relations, 1870 – 1914 (Lincoln: Univ. of Nebraska Press, 1963); Philipp Löser and Christoph Strupp, eds., Universität der Gelehrten – Universität der Experten: Adaptionen deutscher Wissenschaft in den USA des neunzehnten Jahrhunderts (Stuttgart: Steiner, 2005).
 Adam Hammer, “On Medical Education,” Transactions of the Medical Association of the State of Missouri 2 (1852): 81-90.
 Ibid., 84
 Ibid., 89.
 Ibid., 86
 Ball, “Dr. Adam Hammer,” 157.
 Only the first two issues of the The Humboldt Medical Archives (1867-1868) were published by the Humboldt Institut, afterwards the name changed to Medical Archives.
 The Humboldt Medical Archives 1, (1868) 1-3.
 Circular of the St. Louis College (St. Louis: Republican Book and Job Office, 1855) 16.
 E.J. Goodwin, Humboldt Medical College. A history of medicine in Missouri (1905), 136.
 Adam Hammer, “Humboldt Medical College,” The Humboldt Medical Archives 1 (1867-68): 60-64.
 Adam Hammer, “Medical Education,” The Humboldt Medical Archives 1 (1867-68): 109-110.
 Transactions American Medical Association, VII (1854) 58.
 See Joseph P Thompson, Francis Lieber, Charles P. Daly, A. D. Bache, and George Bancroft Guyot, “Proceedings: Alexander von Humboldt Commemoration.” Journal of the American Geographical and Statistical Society 1. 8 (1859): 225-46. This article describes the immediate reaction to Humboldt’s death in the United States; it consists of various letters containing personal memories of Humboldt that were read at a meeting of the American Geographical and Statistical Society in New York City on June 2, 1859.
 For information on how the centennial of Humboldt’s birth was celebrated in different places in the United States, see Cora Lee Nollendorfs, “Alexander von Humboldt Centennial Celebrations in the United States: Controversies Concerning His Work,” Monatshefte 80. 1 (1988): 59-66. Numerous references to Humboldt in the popular press throughout the remainder of the nineteenth century attest to his enduring popularity. As America expanded and new territories were settled during the nineteenth century, Humboldt’s name was affixed to many sites and features including towns, streets, and counties. Lakes were named after him, as were a river, a bay, a marsh, and a reservoir. Humboldt Flats, Humboldt Heights, Humboldt Mountain, Hill, Peak, Sink, and Forest, Humboldt Cave, Humboldt Mine, as well as numerous Humboldt Parks reflected his celebrity. See Ulrich-Dieter Oppitz, “Der Name der Brüder Humboldt in aller Welt,” in Alexander von Humboldt, Werk und Weltgeltung, Heinrich Pfeiffer edit. (München: R. Piper and Co., 1969): 277-429. A group of Free State immigrants to Kansas trumpeted their antislavery politics by naming their town after the Prussian, and the state of Nevada would have become the state of Humboldt if the proposal had been approved at the Constitutional Convention of 1864. As the then-secretary of war, John Buchanan Floyd, wrote to Humboldt in 1858: “Never can we forget the services you have rendered not only to us but to all the World. The name of Humboldt is not only a household word throughout our immense country, from the shores of the Atlantic to the Waters of the Pacific, but we have honored ourselves by its use in many parts of our territory, so that posterity will find it everywhere linked with the names of Washington, Jefferson and Franklin.” See John B. Floyd to Humboldt, July 14, 1858, in Alexander von Humboldt und die Vereinigten Staaten von Amerika: Briefwechsel, Schwarz, Ingo, ed. (Berlin: Akademie Verlag, 2004), 457 (French original: “Nous ne saurions oublier vos services, ni les bienfaits que le monde a reçus de vous—Non seulement le nom de Humboldt est dans toutes les bouches, sur notre immense continent, des bords de l’Atlantique à ceux de la mer Pacifique mais en outre, nous en avons honoré nos rivières et plusieurs points de notre territoire et la posterité le retrouvera partout à côté des noms de Washington, Jefferson et Franklin”).
 Stephen H. Taft, An address delivered on the opening of Humboldt College, with appendix, embracing remarks made on other occasions (Humboldt, Iowa, C.W. Calkins & Co. 1873).
 Streckfuss, Adam Hammer, 97.
 Adam Hammer, “Ein Fall von thrombotischem Verschlusse einer der Kranzarterien des Herzens,” Wiener Medizinische Wochenschrift 28.5 (1878): 97-102.
 Adam Hammer, “A case of Thrombotic Occlusion of One of the Coronary Arteries of the Heart,” Canadian Journal of Medical Science 3 (1878): 353-357
 Thomas Kennard, Thos., T. F. Prewitt, and Adolphus Neubert. “Dr. Adam Hammer.” Missouri Medical and Surgical Journal XXXV.5 (1878): 314-316.
 “Dr. Adam Hammer,” St. Louis Clinical Report 5 (1878): 151.
 “Dr. Adam Hammer,” Der Deutsche Pionier 10 (1878): 242.
 “Dr. Adam Hammer,” St. Louis Medical and Surgical Journal 35 (1878): 314-316.
 Albert J. Steele, “Dr. Adam Hammer, M.D.,” Transactions of the American Medical Association 30 (1879), 823.
 Axel W.O. Schmidt, Der rothe Doktor von Chicago: ein deutsch-amerikanisches Auswandererschicksal (Frankfurt a.M.: Lang 2003).
 Other reasons for his departure are not known.
 Adam Hammer, “The Operation for Varicocele Simplified and Improved,” The Humboldt Medical Archives 1 (1867/68): 78-81; “Operation for the Cure of Double Hare Lips, by a New and Improved Method,” Ibid., 141-146.
 See Ball 1909 and John C. Hemmeter, “Deutscher Einfluss auf die Entwicklung der amerikanischen Medizin und Chirurgie,” in Das Buch der Deutschen in Amerika, ed. Max Heinrici (Philadelphia, 1909), 328.
 Warren B. Outten, “Dr. Adam Hammer. Glimpses of early St. Louis medical history,” Medical Fortnightly, 33-34 (1908): 171-173; Julius Pagel, “Adam Hammer,” in Biographisches Lexikon der hervorragenden Aerzte aller Zeiten und Voelker, August Hirsch, ed., (Wien/Leipzig 1886), 43; Ball, “Dr. Adam Hammer,” 155-177; Mary J. Klem, “The History of Science in St. Louis,” Transactions of the Academy of Science of St. Louis 23 (1914-1920), 79-127, here 111-112.
 J T Lie, “Mingolsheim, Germany, birthplace of Adam Hammer (coronary thrombosis), Adolf Kussmaul (periarteritis nodosa) and Edgar von Gierke (glycogen storage disease),” The American Journal of Cardiology, 46.3 (1980): 529-529; M Goerig, “Adam Hammer (1818 – 1878) – Anmerkungen zu einem vergessenen Pionier der Ätheranwendung in der Geburtshilfe,”Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 39.5. (2004): 265-75; J T Lie, “Recognizing coronary heart disease: selected historical vignettes from the period of William Harvey (1578-1657) to Adam Hammer (1818-1878).” Mayo Clinic Proceedings, 53.12 (1978): 811-817; J T Lie, “Centenary of the first correct antemortem diagnosis of coronary thrombosis by Adam Hammer (1818-1878): English translation of the original report,” The American Journal of Cardiology, 42.5 (1978): 849-852.
 Streckfuss, Adam Hammer, 93.