Colonial surgeon Patrick Hill (1794–1852): unacknowledged pioneer of Australian mental healthcare

Background to colonial Australian mental healthcare

When the First Fleet arrived in Australia from Britain in 1788, they landed in a continent that was home to over 250 separate nations of Indigenous people who shared more than 60,000 years of history (Duke, 2007). Australia’s Indigenous people led one of the most sustainable lifestyles in the world, supported by a natural environment filled with thousands of unique animal and plant species they had learned to manage and cultivate (Horton, 1994; Miller, 2009). They had an ancient external attribution belief system that explained health as being linked to forces outside the self. This meant they tended not to view mental illness as separate from physical sickness, but more often attributed it to the land, culture and spirituality (Vicary and Westerman, 2004).

In contrast to Indigenous approaches, the British colonists who landed as part of the First Fleet in 1788 were members of a culture that had shifted centuries earlier from hunter-gatherer societies into towns and cities. In the process of urbanization, their ideas about health and mental illness had changed (Porter, 2002). Colonial British mental healthcare was heavily custodial, and this was reflected in orders given to the naval officer chosen to lead the First Fleet, Captain Arthur Phillip, who set sail for NSW with more than 1000 convicts and crew in 1787.

Captain Phillip received two documents referred to as ‘commissions’ outlining the British Government’s orders for his voyage. The first commission was brief and in essence an official employment contract, appointing him Governor of the territory known as NSW. As such, he was obliged to follow all orders given by the British Government ‘according to the rules and discipline of war’ (British Government, 1786: 1). His second commission was a more detailed document which described the powers of government available to him. The first four paragraphs appropriated power to use the seal of the British Government on documents, to give oaths, appoint government officials, and pass judgment in criminal matters. The fifth and sixth paragraphs empowered him with authority to manage people who experienced mental illness and their estates. Instructions related to mental healthcare included the following:

Whereas while such ideots and lunaticks and their estates remain under our immediate care, great trouble and charges may arise to such as shall have occasion to resort unto us for directions respecting such ideots and lunaticks and their estates. We have thought fit to entrust you with the care and commitment of the custody of the said ideots and lunaticks and their estates. (p. 1)

During the early years of military settlement, management of mental healthcare in the colony of NSW was therefore located entirely in the hands of the Governor. It is notable that instructions in the second commission regarding the management of mental illness in the new colony was considered so important that it was addressed in the fifth paragraph of a document that was several pages long. These instructions were written directly below a paragraph regarding how the Governor should manage criminals, thus conveying the general attitude of late nineteenth-century Britain, that mental illness was a condition requiring custodial care.

For Governor Phillip, establishing British rule of law and provision for healthcare in a new colony, far from any British infrastructure or social welfare system, presented challenges unimaginable to the bureaucrats of Britain who provided his original orders. The upshot was that, from the beginning of settlement in NSW, providing care for physical illnesses was prioritized ahead of mental disorders. A team of six medical staff led by principal surgeon John White arrived with the First Fleet and quickly set to work establishing a series of tents, which served as an early hospital on the west side of Sydney harbour. By 1790 the hospital had been upgraded to a wooden building which, despite being infested with white ants, continued to serve as the colony’s hospital until the arrival of Governor Lachlan Macquarie in 1810.

Following on from the orders outlined in Governor Phillip’s second commission, lunacy and idiocy were considered conditions requiring custody and management and were not viewed as the responsibility of the colonial medical service. However, due to the low number of educated people within the early colony, many surgeons whose main employment was within the colonial medical service were also appointed by the Governor to function as magistrates. Therefore, while colonial surgeons in NSW were required to be involved in providing care to people with mental disorders, they were often in charge of court cases that sought to investigate cases of lunacy and order appropriate custodial sentences. As a consequence of this approach, for the first two decades of colonial NSW people found to be experiencing mental disorders were incarcerated alongside criminals in gaols, at the Hyde Park Barracks and at Parramatta Gaol.

Medical practice focused on physical health, so people experiencing mild mental health problems who did not come to the attention of colonial authorities largely depended on the pastoral services provided by the church. NSW’s first chaplain, Reverend Richard Johnson, arrived as a member of the First Fleet in 1788 and assumed initial responsibility for social welfare (Cummins, 1979). Despite working without any church building infrastructure, he became well known for his compassionate approach, providing pastoral care and open-air moral teachings as well as baptisms, marriages and burials. During the particularly brutal early years of colonization, one convict wrote in 1790: ‘Few of the sick would recover if it was not for the kindness of the Rev. Mr Johnson, whose assistance out of his own stores makes him the physician both of soul and body’ (Cable, 1967: 17–19). Unfortunately, Reverend Johnson’s own mental health soon deteriorated, and he left the colony in 1800. In spite of this, his work ‘caring for the soul’ had provided solace to many. As the turn of the nineteenth century approached and as the population of the colony grew, formal mental healthcare gradually became a more important priority for the colonial government. The colony’s second and most influential early chaplain, Reverend Samuel Marsden, who arrived to assist Johnston in 1794, played an important role in its early development.

A driven man with a prodigious capacity for work, Marsden was a passionate preacher who started churches in both Australia and New Zealand. In addition to his religious duties, as one of the educated elite in the early Australian colony, he was appointed as a magistrate. He had a flare for building powerful political relationships and, as his influence grew, so did his land holdings. The government awarded him a series of grants, and by the end of his life in 1838 he owned over 11,000 acres (Ellis, 1958: 429).

Marsden was influential when the management of mental illness in the early colony evolved in response to the need and social status of the people involved. One such example occurred in the case of landowner Charles Bishop. Concern had been raised for some time that Bishop was unwell, and in 1805 a jury was arranged to examine whether he was a ‘lunatic’. It found that Bishop was incapable of looking after himself, and his estate was therefore committed to the care of the wealthy landowners Reverend Marsden and John Macarthur (Neil, 1992: 82). When Lachlan Macquarie finally established Australia’s first lunatic asylum in a disused military barracks building at Castle Hill in 1811, Marsden was put in charge. Unfortunately, he had little time for the lunatic asylum because he was occupied with establishing churches in New Zealand. In consultation with Marsden, Governor Macquarie appointed a new full-time superintendent, the businessman and botanist William Suttor (Raeburn et al., 2017a).

Despite the appointment of a new superintendent, the Castle Hill asylum was overcrowded. It was also beset with political infighting between Superintendent Suttor and successive doctors, William Bland and Thomas Parmeter. By 1825, several government inquiries into Castle Hill’s operation concluded that a purpose-built asylum should be built. While Governor Darling agreed that a new facility was required, it would be another decade until the colony was able to build such an establishment. In the meantime, the Governor decided to shut down Castle Hill and open a new temporary asylum in Liverpool in September 1826 (Darling, 1827). An agreement was struck with Samuel Marsden’s colleague, the Reverend Robert Cartwright, that the government would rent the parsonage of St Luke’s church in Liverpool as the premises for the new asylum (Raeburn et al., 2017b). The new asylum fell under the remit of a young Scottish naval surgeon, Dr Patrick Hill.

Method

This paper provides a description of the life of Dr Patrick Hill and his contribution to mental healthcare in Australia, using the historical method promoted by Tosh (2015). A literature search using CINAHL, PubMed and Google Scholar was conducted up to August 2017 (no date restrictions were applied). Primary sources held by the State Records Authority of New South Wales were also searched manually, as were archived sources at the State Library of NSW, the Liverpool Library and the Liverpool Regional Museum. International records available through the website Ancestry.com were also accessed. A range of original documents publicly available, including reports, patient lists, letters, government documents and newspaper articles, were found and reviewed. From these sources, we extracted information on Hill which is summarized in the following sections.

Hill’s early life and career as a naval surgeon

Born in Perth, Scotland, on 13 January 1794, Patrick Hill grew up in the midst of the Scottish Enlightenment. This occurred in the late eighteenth and early nineteenth centuries and was an era of rapid philosophical, scientific, artistic, educational and economic development. The period produced a vast array of influential Scottish intellects including economist Adam Smith, philosopher David Hume, the inventor of the steam engine James Watt. Progress was not only intellectual however. Rapid urban development as a consequence of the industrial revolution transformed Scotland from a predominantly rural society into a nation of towns and cities. Prior to 1800, most towns in Scotland were inhabited by less than 10,000 people and communities were heavily reliant on verbal communication such as town criers for news and knowledge. There was an absence of written town directories in most Scottish towns prior to 1800 and relatively few printed newspapers until 1820 (Harris, 2014: 12). After this, the print media became important in the transmission of information.

In an increasingly literate society, Patrick Hill’s parents, Thomas Hill and his wife Amelia (maiden name Murray), were prominent printers and booksellers in Perth, Scotland. Although there is little direct record of his childhood, a description of Patrick’s early life can be derived from records concerning his younger brother, David Octavius Hill, who became one of Scotland’s most famous pioneers of photographic art (Stevenson, 2002: 5–7).

Patrick Hill grew up in an environment where books were ever present as part of the family business, and education was highly valued. His parents enrolled their sons in the Perth Academy, one of Scotland’s most renowned early high schools (pp. 5–7). While it is unclear how Patrick developed his interest in medicine, his brother David’s paintings and photographs of boats and fishing suggest that Patrick would have been very familiar with water and boats from an early age. Records show that Patrick Hill had joined the Royal Navy by the age of 18 and was assigned as an assistant surgeon (Clarke and Macarthur, 1813/2010).

Posted on board the ship Leviathan in 1813 (Clarke and Macarthur, 1813/2010), Hill experienced a rapid introduction to medicine when it sailed to the West Indies in 1814 and more than 150 crew members were struck with fever. On returning to England the boat was immediately quarantined, and Hill was joined in his duties by a fellow assistant surgeon Campbell France. The two young men got along well, forging a lifelong friendship as shown by a letter to France written by Hill in 1833 while he was working in Liverpool, NSW (Hill, 1833) and France was employed in the West Indies. The letter contains notes about life in Sydney, including Hill’s personal observations regarding the mental ill health of colonial businessman John Macarthur. It also mentions the thriving nature of the NSW colony’s wool industry, and the increasing rate of immigration of free settlers to the colony.

By 1815 Hill had been transferred to work as an assistant surgeon on board the ship Tartarus (Clarke and Macarthur, 1815/2010). He impressed his superiors and within a year had been elevated to the positon of head surgeon on the Atlas, a transportation ship which arrived in Sydney Cove in July 1816 (Macquarie, 1816). With the permission of Governor Macquarie, Hill returned to England on board the ship Willerby in 1816 (Hill, 1816). By 1818 he was surgeon on board the Salisbury, and by October 1819 he was assigned as surgeon aboard the ship Raleigh (Constable, 1819: 382). In 1820 he was assigned as surgeon aboard the Earl St Vincent, another transportation ship bound for Sydney (Hill, 1820).

As was customary for surgeons aboard transport vessels, Hill kept journals during his voyages. Although some journals have been lost, journal entries made during his voyage on the Earl St Vincent describe his involvement in a variety of duties, fulfilling his primary role as ship surgeon while also acting as a stand-in chaplain and superintendent of convicts. The chaplaincy roles he fulfilled during the voyage included leading religious services, distributing Bibles, and coordinating reading lessons for convicts who were unable to read or write. In his role as ‘superintendent’ he inspected convicts in groups of 16 at a time, instructing them about cleanliness and cautioning them against removing their irons. On occasion he was required to act as a disciplinarian, administering lashings to convicts who caused trouble or attempted escape.

In his role as ship surgeon, Hill was responsible for a six-bed medical clinic where he administered medical treatments. Common conditions experienced by sailors and convicts during the voyage included diarrhoea, fever, tonsillitis and inflamed throat. There was one case of apoplexy, which led to a convict’s death. Hill was also responsible for coordinating a range of basic hygiene measures during the voyage, including fumigation of convicts’ sleeping quarters, the guard room and sailors’ berths, as well as the coordination of early morning baths and regular haircuts for all convicts (it was customary that every prisoner had their hair cut short). Arriving in Sydney on 23 August 1820 the soldiers and convicts were inspected by Governor Macquarie, who was impressed with the care that had been provided to them (Hill, 1820). It was not long before the Governor offered Hill a position as assistant surgeon in Liverpool, south-west of Sydney, and in 1821 Hill accepted the position (Colonial Secretary, 1821), making his transition from life on the high seas to settlement on land.

The earliest remaining record of Patrick Hill’s life in Liverpool is not related to medicine but to zoology. Early in 1821, with nine other gentlemen interested in science, Hill had become one of the original members of Australia’s first scientific fellowship known as the ‘Philosophical Society of Australasia’. The society provided a platform for members to share new knowledge about the natural environment of NSW. Each week a meeting was held at different members’ homes, at which a member would present a scientific paper and share books. Members were fined (£10) if they failed to present a paper on their allocated date. Society members also paid £5 each to begin a small museum and library in the office of the Colonial Secretary. This small collection eventually provided the foundation for what would become the Australian Museum in Sydney (Tyler, 2012).

During 1821 while out hunting, Hill captured an amphibious animal which at the time was referred to as ‘Ornithorhynchus paradoxus’ (known today as a platypus). Aware of the interest the species would receive from his Australian society and from the scientific community back in Europe, Hill decided to anatomize the animal and write about his findings. His paper, entitled ‘On the Ornithorhynchus Paradoxus or Mullingong, its venomous spur, and general structure’, was sent to the London-based ‘Linnea Society’, in 1821. It was later published for wide dissemination in the Philosophical Magazine and Journal in 1823 (Hill, 1823b). In the article, Hill describes learning about the animal from a local Aboriginal chief named ‘Cookoogong’ of the ‘Boorah Boorah’ tribe. The Aboriginals informed Hill that they were very familiar with the animal, often observing it running on grass far away from water. The Aboriginal people knew how to find platypus eggs and had learnt that the platypus had a spur on the back of its feet. They stated the animal was not edible and that the native name for it was ‘Mullingong’.

By 1823 Lachlan Macquarie had returned to England, and Hill wrote to the new Governor, Thomas Brisbane, requesting his first allotment of land, which he describes as being next door to Dr Charles Throsby’s property. In his letter, Hill also states that the land he was interested in was referred to as ‘Mogororo’ by the local Aboriginal people (Hill, 1823a). Hill’s interest in the views of local Aboriginal people reflected the approach of Dr Throsby, who was an influential pastoralist, explorer and politician, well known for his positive views of Aboriginal people.

Hill’s work as a surgeon in Liverpool, NSW

By the 1 January 1829, Hill had been promoted from assistant surgeon to the rank of ‘head surgeon’ for the town of Liverpool, meaning he assumed medical oversight of the hospital, lunatic asylum, local children’s homes and all associated health services in the district (NSW Government, 1828b). It is testament to his leadership that Liverpool lunatic asylum only ever had one superintendent, Thomas Plunkett. Together, the surgeon and superintendent coordinated a team of staff that included a keeper, a nurse, a bullock driver, a gardener and a cook (Plunkett, 1828). This team was reportedly more collegial than those at the previous lunatic asylum in Castle Hill, but despite their best efforts the Liverpool lunatic asylum quickly became overcrowded, accommodating 36 patients in a small two-storey building – 10 females and 26 males – by 1828 (NSW Government, 1828a).

Liverpool lunatic asylum was responsible for the care of people of all ages, with a variety of mental and physical conditions. The youngest patient recorded as being cared for was Sophia Adcock, aged 11 years in 1828 (Plunkett, 1828). Adcock had been born in Sydney (St Phillips Church, 1817), and Dr Hill described her in his notes as ‘An idiot and paralytic’ (Plunkett and Hill, 1834a), a condition that colonial families would have found extremely challenging to bear. The oldest recorded male was John Mortlock, who died in the asylum aged 90 in 1834 (St Lukes Church, 1826–38). Described in Dr Hill’s notes as being ‘Debilitated with Confirmed Insanity’ (Plunkett and Hill, 1834a), Mortlock had arrived as a convict with a life sentence aboard the transportation ship Coromandel in 1802, and as late as 1825 had worked as an assigned servant for pastoralist John Macarthur. The oldest woman recorded as being a patient in the asylum was Elizabeth Hall, who died there aged 83 in 1835. She had previously spent time in Castle Hill asylum, having arrived as a convict aboard the Lady Penrhyn as part of the First Fleet in 1788 (St Lukes Church, 1826–38).

By September 1834, the patient population of this asylum was very overcrowded, with 73 patients (48 men and 25 women). In the midst of the challenges presented by overcrowding, Hill appears to have been influenced by the mental health treatments used in Europe and Britain, which included three main approaches of increasing intensity: moral treatment, medication and finally mechanical restraint. Moral treatment had become popular through the success of the ‘York Retreat’ in England and the writing of Phillippe Pinel in France. It attempted to engage patients in occupational and recreational activities to re-socialize them and to instil discipline without the use of punitive measures (Porter, 2002: 104–5). Well suited to the environment provided by the church parsonage in Liverpool, moral treatment promoted gentleness, benevolence and compassion, and was delivered in a physical environment that encouraged spiritual reflection. In accordance with the principles of the approach, records show that Hill classified each patient according to type of mental illness and their stage of recovery (Plunkett and Hill, 1834a, 1834b). His most favoured term to describe a patient’s condition at Liverpool was ‘confirmed insanity’, which he used to describe 22 of 73 patients in September 1834. Other common terms included ‘idiot’, ‘paralytic’, ‘cripple’ and ‘epileptic’ (Plunkett and Hill, 1834b), each being accepted diagnostic labels of the era. Once diagnosed, patients deemed capable were then allocated to daily activities such as garden work, kitchen work or pulling carts. ‘Pulling carts’ was a common activity for convicts, and Liverpool was at the centre of convict roads and clearing gangs for the south-western expansion of the colony (Liston, 2009: 14).

Alongside work-based activities, moral treatment also supported administration of a range of medical treatments when deemed necessary. Notes from 13 March 1843 for a patient named Joseph Burgess show that his medical treatment included ‘blisters to the head, castor oil freely administered, solution of lilac emetic, and opiates to allay nervous irritability’ (Eckford, 1843). Such interventions were generally designed as an attempt to purge the body of illness and, although these treatments may now seem barbaric, they were common in the nineteenth century. Perhaps unsurprisingly, Burgess’s medical notes conclude that ‘none of these remedies seem to have done him much good but only afford slight temporary relief of his symptoms’.

Finally, mechanical restraints were used. It is clear, however, that they were only used sparingly at Liverpool. Not only was Dr Hill renowned for adopting a gentle approach to patients, but the asylum had only seven ankle cuffs in stock when there were over 70 patients, as recorded in the checklist of asylum equipment made by the superintendent Thomas Plunket. Despite the overcrowding and limited medical treatments available during Dr Hill’s career at Liverpool, references in his notes to patients being ‘convalescent’ were common. On discharge, some patients were then described as ‘Sane’ (Plunkett and Hill, 1834b). The use of such terms indicates that, even during times of considerable challenge and with limited treatments available, Dr Hill delivered care in the hope that patients would recover.

In a colonial environment without any substantial welfare infrastructure, the likelihood of a patient being discharged from a lunatic asylum did not rely only on their stage of recovery. It also depended on the ability of the patient’s family and friends to care for them following discharge. A letter regarding the discharge of the patient Eliza Donavan from Tarban Creek lunatic asylum in 1845 illustrates this point. Written by Eliza’s husband, the letter (Donovan, 1845) offers reassurance that he understands the seriousness of assuming responsibility for her care following discharge: ‘Being able and willing to keep my wife Eliza Donavan … I am willing to undertake the charge of her and engage to provide for her maintenance and keep her from being in any way of danger to the public. Signed: Jeremiah Donovan.’

Dr Hill’s reputation as a trusted member of the local community was illustrated by his relationship with the Brooks family, who were pioneer settlers of the area referred to as ‘Denham Court’ in south-west Sydney. Captain Richard Brooks had made his fortune as a mercantile marine involved with the East India Company and settled in Sydney, eventually acquiring a landholding of 500 acres. Brooks died suddenly, killed by a bullock while working on his farm on 16 October 1833, and his wife Christina died two years later on 15 April 1835. The Brooks family were buried in a crypt on their property, and had set aside money for a church to be built over the crypt. They had appointed Dr Patrick Hill to be the executor of their wills (Watson, 1923).

By the time the first purpose-built lunatic asylum was ready to open at Tarban Creek in NSW in 1837, Dr Hill was so well regarded that he was appointed as head surgeon for the new asylum and magistrate for the Parramatta area. In another example of how highly Dr Hill was regarded, a newspaper reported in 1841 that a group of representatives from the Liverpool community visited him in his new home in Parramatta and presented him with a special plate to commemorate his 20 years of service in Liverpool, saying:

All classes of our little community cordially join in the sorrow with which we look forward to your departure, an event to be regretted as removing from us one who has long proved himself a benefactor ready at any moment to render the most kind and disinterested services … (Anon., 1841)

Hill’s reply included the following:

It is gratifying to receive the testimonial of friendship and esteem which you have had the kindness to convey to me from the inhabitants of the town and neighbourhood of Liverpool. I beg you will assure them of the regret with which I leave so many kind friends, of the pleasure I look back to a period of twenty years … (Anon., 1841)

Hill’s life outside medicine

In the early nineteenth century one’s position in society was all important, and for many colonial Australians this was measured according to the number of acres of land they owned. In common with his peers, Dr Hill took an interest in acquiring pastoral land and large amounts of it. He was first granted just over 1¼ acres of land by Governor Macquarie in Liverpool, next to the hospital grounds, where in 1821 he built a house (Anon., 1841). On 30 May 1823, Hill wrote to Governor Brisbane requesting a further grant of land in the County of Argyle, about 30 miles south of Dr Charles Throsby’s land holdings at Bong Bong, near the present-day Tallong in NSW (Hill, 1823a). He would have known of this land from a journey of exploration by James Meehan and Dr Charles Throsby, who passed through the area in March 1818 while looking for a route for wheeled vehicles from Parramatta to Jervis Bay. As Dr Throsby’s medical advisor and friend, Dr Hill was well placed to get information. The connection with the Throsby family then became even closer when Mary Throsby, Dr Throsby’s niece and his heir’s (also named Charles) sister, married Patrick Hill in 1827 (Cartwright, 1827).

Dr Hill was subsequently granted 2000 acres in 1823 by Governor Brisbane and an additional 560 acres by Governor Darling in May 1827. After various land purchases from other grantees, by 1837 Hill owned two properties, named Caoura and Bosworth, which encompassed nearly 5000 acres of land between the Tallowa and Shoalhaven Rivers (Colonial Secretary, 1826–56). Very little is known about the early development of these properties, but a Daybook covering the years 1834–7 has survived and a copy is held at the Mitchell Library, Sydney, NSW (Badgery Family Papers, 1821–1910).

Due to his medical work, Dr Hill was largely an absentee landowner and the properties were managed by an overseer employed on a yearly contract. Weekly accounting of rations suggest that on average in the years 1834–5 there were 20–25 people living on the properties. Most of these were assigned convicts, and it is noticeable that they received the same basic rations and conditions as those who were categorized as ‘free’. During the years 1834–7, Dr and Mrs Hill visited their properties only a couple of times a year, although they were regularly there in December/January to supervize the harvest.

At other times, Dr Hill sent letters approximately monthly and they took about seven days to arrive from Liverpool. Produce was sent approximately every second month to Liverpool by dray which returned in about 20 days, on average, carrying basic supplies such as sugar, tea and clothing. Outside his medical career Hill took up cheese-making as a hobby, and by February 1843 John Parker of Church Street, Parramatta, was advertising ‘a superior and a very heavy stock of Colonial Cheese from the well-known dairy of Dr Hill’ (Advertisement, 1843).

Hill’s later career and death

Despite turbulent changes, which included reorganization of medical services under a variety of governors and the end of transportation of convicts to NSW in 1841, Dr Hill’s practice in Parramatta continued to provide him with career success. By 1847 he was the highest paid doctor in the colony (Cummins, 1979: 38). In 1848, as part of a reorganization of medical services, he was appointed as Chief Medical Officer in NSW with the title ‘Advisor to the Government on Medical matters, Inspector and Consulting Physician to the Lunatic Asylum’ (Hill, 1849c). As his role within the medical establishment of the colony became more senior, Hill juggled responsibilities as a magistrate, a consultant physician and an administrator.

For example, in his role as a magistrate, he wrote a letter dated 16 June 1849 discharging John Chapman, a patient from Tarban Creek: ‘In reply to your letter supplying a medical certificate of the sanity of the person named in the margin (Chapman) I have the honour to herewith award under the hand of his excellency the provision for the discharge of Chapman from the lunatic asylum at Tarban Creek’ (Hill, 1849a). Five days later (21 June 1849), Hill wrote a letter indicating his willingness to visit and assess four inmates at Darlinghurst gaol: ‘The persons named in the margin have appeared to be insane. I have request [sic] and will be pleased to visit the gaol in order to give the medical certificate for their removal to the Lunatic asylum at Tarban Creek’ (Hill, 1849b).

Perhaps most challenging for Dr Hill was the volume of his administrative duties. In a letter (6 June 1849) to his friend Dr Frances Campbell, he reflected on the weight of responsibility he felt in coordinating care at Liverpool hospital, Tarban Creek asylum, the Female Factory at Parramatta and a variety of orphan schools (Hill, 1849c). At the time the government was considering converting the Female Factory into a lunatic asylum to assist the overstretched lunatic asylum at Tarban Creek. Political pressure was rising, and Hill wrote in another letter (25 June 1849) that he did not wish to let the Governor down: ‘I promised his Excellency the Governor on Saturday that I would estimate the probable expense to be increased incurred in the removal of the Female Lunatics from Tarban Creek to the usage of cells at the factory in Parramatta’ (Hill, 1849d).

Despite the demands of his multifaceted role, Hill maintained his enthusiasm for mental healthcare and appears to have gradually developed his acumen in this area. This is exemplified by the evolving diagnostic terminology he used in descriptions of patients at Tarban Creek asylum compared with the classifications he had used 20 years earlier at Liverpool. He started to use new descriptive terms such as ‘mania with melancholy’, ‘mania with delusions’ and ‘perceptual mania’. In addition, of the 35 Tarban Creek patients described in an 1849 report (Hill, 1849d), he described six of them as ‘cured’, suggesting that he continued to maintain the belief he had held during his years at Liverpool: that people with mental illness were capable of recovery.

The circumstances of Patrick Hill’s death are somewhat unclear, although it appears to have been sudden. He died aged 58 on the 13 March 1852 at his farm in Camden, south-west Sydney, after a ‘few hours of illness’ (Family Notices, 1852). Unusually for the time, in his will Dr Hill left his entire estate to his ‘dear wife Mary Hill, absolutely and for her sole use and benefit’ (Hill, 1849e). If Mary had predeceased Dr Hill, half of his estate was to be inherited by his sister Mary Watson, a widow, and the other half was left to his two brothers Alexander and David Octavius Hill. When Mary Hill died in 1857 (Family Notices, 1857), she followed his wishes with regards to the disposal of the estate as if she had predeceased him, with only minor bequests of her personal furniture and jewellery to her friends and an extensive collection of Throsby relatives (Hill, 1852a).

Patrick and Mary Hill are buried next to one another in the graveyard of Christchurch in Bong Bong, NSW. It is testament to Hill’s reputation that Mary’s uncle, Charles Throsby junior, and his wife Elizabeth named their third daughter Mary Hill Throsby and their sixth son Patrick Hill Throsby. Dr Hill had no children, but when he died he was fondly mourned by staff he had worked with in western Sydney. This was shown in a poem written by Edward Statham, who was the superintendent of the Parramatta asylum at the time of Hill’s death. It appeared in the Sydney Morning Herald under the title ‘On the death of the much lamented Patrick Hill, Esq., Colonial Surgeon’, and included the following lines:

Well may the poor feel sorrow steal

Still closer round their weary heart –

Since that kind hand is linked with death

That once made poverty depart.

Ye sufferers! breathe a heavier sigh

For him who knew your wants – your woes …

(Statham, 1852)

Discussion

Modern histories have often analysed the sociological ideas that facilitated the growth in the power of medicine and psychiatry in Western society. In his book Madness and Civilization, Foucault (1965) contended that power was developed in asylums through an emphasis on punishment and correction of madness by discipline and work. Feminist histories such as Showalter’s The Female Malady (1985) have linked the rise of psychiatry as a medical speciality to patriarchal ideas about madness. These analyses have contributed to understandings about how modern mental healthcare has developed. Despite this, they fail to account adequately for the influence of physicians such as Dr Patrick Hill, who spent decades quietly serving communities who came to respect the role of medical doctors for the individual care they provided. His life is a reminder that the influence medicine has developed in the modern age is not only due to overarching political ideologies related to power and masculinity, but by and large it is due to the reputation built in local communities by doctors like Hill.

A member of the Scottish diaspora that spread throughout the world during the nineteenth century, Hill lived in a rapidly changing world and made a substantial contribution to the development of mental healthcare in colonial Australia. Primary records reviewed in this paper reveal that he was an intelligent and compassionate physician who was admired in the communities he served. His early career as a ship surgeon of the British Royal Navy was esteemed by Governor Lachlan Macquarie, who invited him to settle and assist the development of healthcare within the colony of NSW (Colonial Secretary, 1821). Influenced by the Scottish Enlightenment and the value it placed on new knowledge, Hill had a keen and inquisitive mind. This was shown by his capture, anatomization and subsequent publication regarding a platypus in 1821, as well as the interest he took in the knowledge of local Aboriginal people near Liverpool.

Despite Liverpool lunatic asylum quickly becoming overcrowded and being housed in a facility that was not purpose built, it is clear from his notes that Dr Hill adopted a moral treatment approach, promoting the idea that people who experienced mental illness should be treated with humanity and as little custodial care as possible (Plunkett and Hill, 1834a, 1834b). Moral treatment in this context essentially involved trying to provide a clean, safe, home-like environment, using mechanical restraints such as straitjackets and chains sparingly and encouraging patient involvement in structured work activities so that they could rehabilitate.

Not only did Hill promote a moral treatment approach, but he also ensured that Liverpool lunatic asylum was staffed better than Australia’s first lunatic asylum at Castle Hill had been. He oversaw improved treatment of staff, as Liverpool became the first lunatic asylum in Australia to record payment of wages to a female nurse (Raeburn et al., 2017b). Better treatment of staff led to improved retention, exemplified by the asylum’s superintendent Thomas Plunkett, who remained at Liverpool throughout its 13 years of operation. In contrast to the problems among doctors who had worked at Castle Hill asylum (Best, 1992), there is no record of any negative events or relationships related to Hill’s years of service at Liverpool. When his two decades of practice there ended, the local community presented him with a commemorative plate. Dr Hill’s loyal service at Liverpool led to his appointment to provide leadership when the government finally built Australia’s first purpose-built lunatic asylum at Tarban Creek in 1838.

As Hill became established in Parramatta, approaches to mental health in colonial NSW were changing. Since the arrival of the First Fleet in 1788, final authority for management of people with mental illness had been in the hands of the Governor of NSW, in accordance with Arthur Phillips’ second commission (British Government, 1786). This began to change in 1843 when the NSW Parliament (formed in 1824) passed its first piece of mental health legislation titled the ‘Dangerous Lunatics Act’ (NSW Parliament, 1843), designed to provide for the lawful custody of people found not guilty of crime due to insanity. The Act allowed for people to be detained if there was concern that they may be of unsound mind and considering either suicide or involvement in crime. If a person was apprehended under the Dangerous Lunatics Act, two Justices of the Peace reviewed the case, and if they agreed that the person was of unsound mind, he or she was required to be assessed by two medical practitioners. If the doctors agreed with the finding of unsound mind, then the person could be held within a hospital or gaol until transfer to a lunatic asylum could be arranged by the Governor (NSW Parliament, 1843).

Medical practitioners like Dr Hill had been involved in reviewing and treating people who experienced mental illness in the colony for many years prior to this law being passed. However, the inclusion of a requirement in law for two medical practitioners to assess a person was significant in NSW because it signalled a shift away from absolute power for mental healthcare lying in the hands of the Governor. This Act of Parliament enshrined principles at law that began to influence a gradual shift, when mental disorders became increasingly accepted, like physical illness, as conditions more in need of care than of custody.

The esteem with which Dr Hill was held in medical and political circles eventually led him to become the Chief Medical Officer for NSW. It is apparent, however, that he was first and foremost a physician, dedicated to serving patients, and he appears to have struggled with the stressors of being responsible for the administration of multiple institutions. Despite extra administrative duties, he maintained regular work with patients. A poem published in the Sydney Morning Herald mourned his death, referring to him as a ‘friend of the poor’ (Statham, 1852).

Conclusion

Surgeon Patrick Hill played a vital role in the development of Australian mental healthcare. His career spanned three decades and the terms of five different governors of the colony of NSW. Turbulent changes occurred during his career, including the transition from temporary lunatic asylums at Castle Hill and Liverpool to Australia’s first purpose-built asylum at Tarban Creek in 1838, the reorganization of medical services under successive governors and the end of the transportation of convicts to NSW in 1841. In the midst of all the change, Dr Hill built a reputation as such a well-respected physician that he was elevated to the most senior office in medicine in NSW by the end of his career.

In spite of his career success Dr Hill remained firmly committed to serving the poor and mentally ill throughout his life, and he was fondly remembered by the communities he served. Colonial medical care provided by well-respected doctors such as Dr Patrick Hill need to be taken into account when consideration is given to how medical power within modern society has evolved. It is likely that the trusted reputations cultivated by such doctors within their local communities, had at least as much influence on the rise of modern medicine as the sociological ideas thought to have dominated the era in which they lived.