The origins of Austin Bradford Hill's classic textbook of medical statistics

Abstract

Between January and April 1937 The Lancet published a series of seventeen articles on medical statistics by Austin Bradford Hill. The series was suggested by Dr MH (Pamela) Kettle, an assistant editor at The Lancet, and Hill was paid £3.3.0 (three pounds, three shillings, and no pence – roughly equivalent to £135 today) for each ‘installment’. The seventeen articles formed the chapters of Principles of Medical Statistics,1 which was also published in 1937. Over the next fifty-five years, the book was to run through twelve editions, and become renowned worldwide amongst physicians, epidemiologists, and medical statisticians. Hill had a very distinguished ancestry. ‘From James (b. 1724) and Sarah Hill (∼1733–1801) descended one of the most intellectual families that has ever arisen in England’2 (Gun, quoted by Hill). The family included Thomas Wright Hill (Hill's great-great grandfather, 1763–1851), an educational reformer who devised a system of shorthand, and wrote on the hexadecimal system of counting and proportional representation in parliamentary elections; Sir Rowland Hill (1795–1879), who introduced ‘the penny post’; Matthew Davenport Hill (1792–1872), a criminal-law reformer; George Birkbeck Hill (Hill's grandfather, 1835–1903), writer and critic renowned for his edition of Boswell's Life of Johnson; Rosamund Davenport Hill (1825–1902), a prominent member of the old London School Board; Sir Maurice Hill (1862–1934), a High Court judge; and Sir Leslie Scott (1869–1950), a politician and judge who was briefly the Solicitor General. (He was the eldest son of Sir John Scott (1841–1904), another distinguished judge, whose sister, Annie (1830–1902), was the wife of George Birkbeck Hill; George's sister, Laura, was the second wife of Edward Scott, Sir John's father). Hill's father, Sir Leonard Erskine Hill (1866–1952), became professor of physiology at the London Hospital (where he recruited Major Greenwood, widely regarded as the first medical statistician in Britain, in 1905), and, from 1914, head of the Department of Applied Physiology of the newly-formed Medical Research Committee (fore-runner of the Medical Research Council). Unfortunately there is no biography of Austin Bradford Hill, although brief descriptions of aspects of his life, career, and contributions to statistical and medical research are available, for example, Doll,3,4, Farewell and Johnson,5–7 Gehan and Lemak,8 Keating,9 and Statistics in Medicine.2 In 1927 Hill joined Major Greenwood's department at the London School of Hygiene and Tropical Medicine (LSHTM), having obtained an honours degree in economics at University College London in 1922, and then a grant from the Medical Research Council to examine the high mortality in young adults in rural areas of England. While carrying out this study he attended Karl Pearson's course on statistics at London University. Hill's first four papers, for all of which he was the sole author, were published in 1925. The following year he was awarded a PhD by the University of London with a thesis entitled 'A physiological and economic study of the diets of workers in rural areas as compared with those of workers resident in urban areas,’ which consisted of these four papers (we have not been able to trace the identity of Hill's examiners). In 1930 Hill obtained a DSc from the University of London, with a thesis entitled 'An investigation of sickness in various industrial occupations.’ This comprised eight (single-authored) papers published between 1925 and 1929, including the four submitted for his PhD degree. His external DSc examiner was WP Elderton, author of Frequency curves and correlation (1906) and Primer of statistics (1906). Major Greenwood was the internal examiner. By 1936 Hill had published thirty-nine book reviews, eight research reports, and sixteen papers, including nine in the British Medical Journal or The Lancet, and four in the Journal of the Royal Statistical Society. Many of the reviews were of books about population, poverty, industrial working conditions, migration, mortality, and the social conditions in London, subjects of obvious central interest at the LSHTM. However Hill also reviewed Hartshorne and May's Studies in Deceit, Burgess's Introduction to the Mathematics of Statistics, Fisher's The Genetical Theory of Natural Selection, and the second edition of Pearl's Introduction to Medical Biometry and Statistics, thus demonstrating an interest extending into statistics, genetics, and beyond. Most of Hill's papers also reflected a focus on mortality, longevity, social conditions, and industrial working conditions (including those of nurses), reflecting the rapid development of analyses of vital statistics which had occurred over the previous one hundred years. But his interests extended beyond mortality to cricket, experimental epidemiology, and medical practice.