His account of this case also shows that he appreciated the concept that paralysis on one side of the body indicated compression on the opposite side of the brain. This patient, who crucially did not have a fracture, demonstrates Hills appreciation that it was injury to the brain that caused symptoms rather than the fracture itself. Percival Pott (1714–1788) by contrast would only operate if a fracture were present. Hills understanding of concepts of cerebral compression is demonstrated further by his use of the word ‘compression’ and by his recording of cerebral pulsation or tension in all but one of the operations described. Both of his patients who exhibited poor or absent cerebral pulsation had sustained primary cerebral damage and both died. Hill more than any other eighteenth century writer appreciated the importance of cerebral pulsation as an indicator of cerebral health. Further evidence of his understanding of the need to decompress where possible is shown by his use of the technique of relieving pressure by shaving off cerebral hernias caused by raised intracranial pressure, a technique he learned from the writing of Henri Francois Le Dran (1685–1770). Hills 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%). This was the result of Hills appreciation of the concept of cerebral compression and his better understanding of the indication for and location of the trephine.
James Hill (30 October 1703 – 18 October 1776) was a Scottish surgeon working in Dumfries who advocated curative excision for cancer rather than the palliative approach adopted by many leading surgeons of the day. By follow-up of his patients over years he demonstrated that his radical approach resulted in better outcomes than those published by contemporaries. His experience in diagnosing and treating intracranial bleeding after head injury by directed trephine resulted in the best results published in the 18th century and represent an important landmark in the management of post-traumatic intracranial haemorrhage. Early life
James Hill was the son of Rev James Hill (1676-1743), minister of the parish church of Kirkpatrick Durham in Kirkcudbrightshire, and his wife Agnes Muirhead (1678-1742), daughter of a Dumfries merchant. James Hill was born in the village of Kirkliston, West Lothian on 30 October 1703. On 17 May 1723 he was apprenticed to the Edinburgh surgeon, physician and philosopher George Young (1692-1757),  from whom he learned the value of careful observation and scepticism in medicine. It is known from Hills later writing that Young was a powerfully influential figure to his young apprentice during the latters formative professional years. Hill, like many Edinburgh surgical apprentices attended lectures at Surgeons’ Hall but like the majority of apprentices of the period did not proceed to a surgical diploma or a medical degree in the newly established University of Edinburgh Medical School. During Hills apprenticeship there was no teaching hospital in Edinburgh.