Robert Gardiner Hill
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Robert Gardiner Hill MD (26 February 1811 – 30 May 1878) was a British surgeon specialising in the treatment of lunacy. He is normally credited with being the first superintendent of a small asylum (approximately 100 patients) to develop a mode of treatment in which reliance on mechanical medical restraint and coercion could be dropped altogether. In practice he reached this situation in 1838. The debate concerning the merits of his methods continued for many years. Hill was marginalised by medical colleagues, in particular for his insistence that standard medical procedures had nothing to offer in the treatment of
mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
.


Early career

The son of Robert Hill of Louth, Deene and lately of Leamington, he was born at Louth, Lincolnshire, on 26 February 1811; John Harwood Hill was an elder brother. At the age of 14 he was apprenticed to a surgeon in Louth. He then studied at
Edward Grainger Edward Grainger (1797–1824) was an English teacher of anatomy and dresser to Sir Astley Cooper. Grainger opened an anatomical school in Webb Street, Southwark, London in 1819 after his offer to teach at Guy's Hospital was rejected. The sch ...
's anatomy school,
Guy's Hospital Guy's Hospital is an NHS hospital in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the King's Health Partners, an academic health science centre. ...
, and
St. Thomas's Hospital St Thomas' Hospital is a large NHS teaching hospital in Central London, England. It is one of the institutions that compose the King's Health Partners, an academic health science centre. Administratively part of the Guy's and St Thomas' NHS Fo ...
, becoming a member of the
Royal College of Surgeons The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations a ...
of England in 1834. On passing as a surgeon Hill went into practice at Lincoln, and in the same year obtained the appointment of house-surgeon to the General Dispensary there. At the Dispensary Hill worked with Dr.
Edward Parker Charlesworth Edward Parker Charlesworth (1783–1853) was an English physician, known as an innovator in psychiatric treatment. Life He was son of John Charlesworth, rector of Ossington, Nottinghamshire, and was brother of John Charlesworth, the father of ...
, who befriended him.


"Non-restraint"

Hill, with Charlesworth's assistance, was elected house surgeon to the Lincoln Lunatic Asylum. There he introduced the system of
moral management Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly fr ...
in use at the
York Retreat The Retreat, commonly known as the York Retreat, is a place in England for the treatment of people with mental disorders, mental health needs. Located in Lamel Hill in York, it operates as a Non-profit organisation, not for profit Charitable tru ...
. Charlesworth had already experimented with reducing the dependence at the asylum on mechanical restraint. Hill, soon after his appointment, looked into the registers of the asylum, and began to think that he might dispense with coercion altogether. It appears from a comparison of the table of restraints for 1830, with the table for 1835, given in the appendix to Hill's book, that whereas, with a number of patients in the house, during the first of these years, amounting only to 92 (male and females included), the total number of instances of restraint had been 2364; in the latter of these years, with a number of patients greater, namely, 108, the total number of instances of restraint had only been 313; being a diminution of five-sixths of the number in the former year. One of the improvements introduced by Hill in pursuance of his system was the dormitories, almost entirely established for the prevention of suicides. He attributed most bad cases to alcohol abuse, with religious factors as the next most important. Hill had trouble maintaining a non-restraint system, without a better staff. The governors, however, would not offer higher pay without clear and convincing results. The system in fact required Hill to supervise the staff closely; it caused serious tensions in the asylum. By about 1839 the situation in the institution had become untenable. In 1840 Hill resigned from his post.


Legacy

Despite the problems Hill experienced, his system won admirers. One of them was Sergeant John Adams, who was an assistant judge. He took an interest in the asylum when circuit duties took him up to Lincoln. In his other capacity as chairman of the Middlesex magistrates and member of the Visiting Justices to
Hanwell Asylum St Bernard's Hospital, also known as Hanwell Insane Asylum and the Hanwell Pauper and Lunatic Asylum, was an asylum built for the pauper insane, opening as the First Middlesex County Asylum in 1831. Some of the original buildings are now part of ...
, he encouraged the newly appointed superintendent Dr.
John Conolly John Conolly (27 May 1794 – 5 March 1866) was an English psychiatrist. He published the volume ''Indications of Insanity'' in 1830. In 1839, he was appointed resident physician to the Middlesex County Asylum where he introduced the princip ...
to visit
Lincoln Asylum The Lawn is an early nineteenth century Greek revival building on Union Road, in Lincoln, Lincolnshire, England, to the west of Lincoln Cathedral. The complex features a walled garden and children's play area. The building housed The Lawn Hos ...
and witness Hill's methods. This Conolly did in the month before taking up his appointment at Hanwell, where it is recorded in the visitors' book that he admired Hill's system.


Career after Lincoln Asylum

Hill remained in the mental health field, working in a number of asylums. He entered into partnership with Richard Sutton Harvey in 1840, and became proprietor of Eastgate House private asylum, Lincoln. On 29 October 1851 he was given a public dinner in Lincoln and presented with a testimonial as the "author and originator of the non-restraint system in lunacy"; the claim was disputed, In November 1852 he was chosen mayor of Lincoln, and he was elected a Fellow of the Society of Antiquaries of London on 17 February 1853. In the later 1850s he was at
Wyke House Asylum John Robinson (1727–1802) was an English lawyer, politician and government official. He was a treasury secretary of obscure origin, characterized by extraordinary diligence, efficiency, persistence, and deep conservatism. Life Born on 15 Jul ...
, in partnership with Edmund Sparke Willett; the partnership was dissolved in 1860, with Willett remaining as proprietor.Lyttleton Forbes Winslow, ''Manual of Lunacy; a handbook relating to the legal care and treatment of the insane in the public and private asylums of Great Britain, Ireland, United States of America, and the Continent'' (1874), p. 78
archive.org.
/ref> Hill became a licentiate of the
College of Physicians, Edinburgh The Royal College of Physicians of Edinburgh (RCPE) is a medical royal college in Scotland. It is one of three organisations that sets the specialty training standards for physicians in the United Kingdom. It was established by Royal charter ...
in 1859. In October 1863 Hill moved to London and became resident medical proprietor of Earl's Court House, Old Brompton, a private asylum for women, a residence formerly inhabited by John Hunter. He died of apoplexy at Earl's Court House, London, on 30 May 1878, and was buried on the western side of
Highgate cemetery Highgate Cemetery is a place of burial in north London, England. There are approximately 170,000 people buried in around 53,000 graves across the West and East Cemeteries. Highgate Cemetery is notable both for some of the people buried there as ...
(plot no.22660). The grave is on the right-hand side of the main path almost opposite the tall Gothic Mears family monument. Two of his sons James Robert Hill and Hugh Gardiner Hill also became doctors in asylums. His wife and at least three daughters were also closely involved in the care of the insane both before and after his death. They managed Peterborough House in Fulham and then Fenstanton House, Tulse Hill.


Publications and controversy

Hill published: * ''Total Abolition of Personal Restraint in the Treatment of the Insane. A Lecture, with Statistical Tables'' (1839). * ''A Concise History of the entire Abolition of Medical Restraint in the Treatment of the Insane and of the success of the Non-Restraint System'' (1857). * ''Lunacy, its Past and its Present'' (1870). He also wrote articles "On Total Abolition of Personal Restraint in Treatment of the Insane" in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...
'', 11 April 1840, p. 93, and 22 February 1851, pp. 226–7; and ''Psychological Studies'', six articles in the ''Medical Circular'', 6 January 1858, p. 1 et seq. Hill's priority claim on non-restraint was put forward in ''The Lancet'' in 1850, in response to Charlesworth and Conolly. He did so again in the ''Concise History'', in a response to Conolly.
Sir James Clark, 1st Baronet Sir James Clark, 1st Baronet, KCB (14 December 1788 – 29 June 1870) was a Scottish physician who was Physician-in-Ordinary to Queen Victoria between 1837 and 1860, and was previously physician to poet John Keats in Rome. Early life and career ...
wrote a ''Memoir of John Conolly'' that appeared in 1869, and Hill contributed further to the debate in 1870, in ''Lunacy''.


Lectures

* Hill Robert Gardiner (1839
A lecture on the Management of Lunatic Asylums and the Treatment of the Insane


See also

* Moral treatment * Haw Camilla
Yorston Graeme (2004) Thomas Prichard and the non-restraint movement at the Northampton Asylum.
Psychiatric Bulletin (2004) 28: 140–142


References

;Attribution A contemporary account by a visiting doctor. {{DEFAULTSORT:Hill, Robert Gardiner 19th-century English medical doctors People from Louth, Lincolnshire 1811 births 1878 deaths Burials at Highgate Cemetery English non-fiction writers English psychiatrists Psychiatric restraint Fellows of the Society of Antiquaries of London English male non-fiction writers 19th-century English male writers