Leonard Erskine Hill • LITFL • Medical Eponym Library

Sir Leonard Erskine Hill (1866 – 1952) was an English physiologist.

He was a renowned medical researcher, with interests in the cerebral circulation, where he designed a pressure gauge screwed into a trephine hole in the skull of a dog to measure intracranial pressure; ultraviolet and infrared rays in therapy.

Involved in the sphygmomanometric measurement of the systolic blood pressure by palpation of the brachial artery and the dorsalis pedis or posterior tibial artery. Remembered for his description of Hill’s sign in 1909

Biography

Born 2 June 1866, Tottenham, England
1885-89 – Awarded the conjoint medical qualifications M.R.C.S. and L.R.C.P. from University College London. Awarded the Bruce gold medal for surgery, and other awards for anatomy and physiology
1890 – Achieved M.B. degree from London University
1890-91 – Awarded the Sharpey Scholarship from University College London
1891 – Pursued research in Oxford as an assistant to Burdon-Sanderson’s department. Then returned to University College London as an assistant professor to Sir EA Schafer (Sharpey-Schafer)
1895 – Lecturer in physiology at the London Hospital
1900 – Elected a Fellow of the Royal Society, U.K.
1912 – Professor of physiology at London Hospital
1914 – Director of the applied physiology department at the National Institute of Medical Research
1930 – Made Knight Bachelor
1930 – Director of Research at the St John Clinic and Institute of Physical Medicine
1931 – Honourary L.L.D. from the University of Aberdeen
Died 30 March 1952, Corton, Suffolk

Medical Eponyms

Hill’s sign (1909)

Increased systolic arterial pressure in lower (popliteal) compared to upper (brachial) limbs in cases of aortic insufficiency.

Hill’s initial investigations were prompted by his colleague Dr W Holtzmann of the London Hospital (and recognised as such in the byline of the published paper)

[Holtzmann] tried the pressure in 2 or 3 cases of aortic regurgitation, and told us that he found a noticeable difference between arm and leg reading in such.

Hill described his sign in 10 cases of aortic insufficiency (1909), and later confirmed the findings (1912) with an in depth explanation of the systolic popliteal-brachial gradient in aortic regurgitation.

A difference between arm and leg systolic readings is most marked in all cases of aortic regurgitation, and when such patients are lying quiet in bed this difference is a diagnostic sign of aortic regurgitation.
…we found that in all cases of aortic regurgitation there is this marked difference, which is not abolished by the method of oscillating the pressure up and down near the obliteration pressure. So marked is this difference that we believe we could pick out cases of aortic regurgitation by it alone
Hill 1909

Controversies

Sir Hill chose medical research which he stated was

…the path which saves the millions when found”, over medical practice which he described as “a two-horse chariot and a heavy butler, to be gained by honest practical work and a holy regard for respectable conventionality

Without taking his M.D. degree, it was not until 1931 that he was strictly given the ‘doctor’ title from the University of Aberdeen honorary L.L.D.

Hill suffered two bouts of tuberculosis infections in 1904 and 1916, which he overcame through time off and rest in the English countryside.