James Hill (surgeon)
[2] On 17 May 1723 he was apprenticed to the Edinburgh surgeon, physician and philosopher George Young (1692-1757),[3] from whom he learned the value of careful observation and scepticism in medicine.
On 28 January 1733 he married Anne McCartney,[8] whose father John owned the Blacket (or Blaiket) estate, in the Parish of Urr and it was there that they established the family home.
[3] Of these one, Benjamin Bell (1749-1806) was to achieve international fame largely through the success of his best selling textbook A System of Surgery first published in 1783.
[12] After various therapies including laudanum, tonics, claret and Dr Plummer's pills were unsuccessful, he resorted to mercury, a recognised treatment for syphilis and fumes were thought to be the fastest mode of delivery.
Although able to diagnose hydatid disease he thought the condition arose because ‘some people have hydatic constitutions.’[13] In 1772 Hill published Cases in Surgery a summary of his life's work as a surgeon.
[5] Sibbens is now known to be endemic syphilis, a Treponemal infection spread by non-sexual social contact and seen in association with deprivation, especially overcrowded living conditions, poor sanitation and malnutrition.
Subsequent writers credited Hill and his physician colleague and friend Dr Ebenezer Gilchrist (bap1708-1774) with providing the most precise description of the clinical features and natural history of the disease in Scotland.
He concludes that his results justify his recommendation that tumours, including ‘the most trifling,’ should be ‘cut entirely out.’[20] It is Hill's chapter entitled ‘Disorders of the head from external violence’ that marks him out as a careful clinician and an innovative surgeon able to achieve remarkable outcomes by the standards of the day.
Head injuries, he asserts, have been treated in ‘a much more rational manner’ in the previous 15 years as a result of discoveries and ‘valuable publications’ over that period.
He gives ‘a historical view of the gradual progress of the improvements made by others as well as by myself.’[21] His first patient, a five-year-old boy, sustained a depressed frontal fracture associated with an epidural haematoma (EDH).
When the fracture was elevated and the haematoma drained by trepanning the skull, the boy ‘immediately recovered his senses’ but after some days the ‘stupor’ returned, indicating that 'some matter was lodged under the meninges’.
Hill's outcomes in treating patients with head injury compares favourably with those of his contemporaries with a mortality rate of 25%, much lower than that of le Dran (57%) or Percival Pott (51%).
He advanced the understanding of the treatment of head injury by showing that epidural and subdural haematoma could be recognised from clinical features and successfully treated by trepan and surgical drainage to relieve compression.
He appreciated the importance of cerebral compression and the significance of unilateral limb weakness in lateralising intracranial bleeding and determining on which side to operate.
