Austin Bradford Hill

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Lore & Background

Hill was born in London on 8 July 1897, one of the sons of Sir Leonard Erskine Hill FRS, a distinguished physiologist, and Janet Alexander. He was the grandson of noted scholar George Birkbeck Hill. As a child he lived at the family home, Osborne House, Loughton, Essex; he was educated at Chigwell School, Essex. He served as a pilot in the First World War but was invalided out when he contracted tuberculosis. Two years in hospital and two years of convalescence put a medical qualification out of the question and he took a degree in economics by correspondence at London University. In 1922, Hill went to work for the Industry Fatigue Research Board. He was associated with the medical statistician Major Greenwood and, to improve his statistical knowledge, Hill attended lectures by Karl Pearson. When Greenwood accepted a chair at the newly formed London School of Hygiene and Tropical Medicine, Hill moved with him, becoming Reader in Epidemiology and Vital Statistics in 1933 and Professor of Medical Statistics in 1947. In 1947, he was appointed Honorary Director of the Medical Research Council's Statistical Research Unit. Hill had a distinguished career in research and teaching and as author of a very successful textbook, Principles of Medical Statistics, but he is famous for two landmark studies. He was the statistician on the Medical Research Council Streptomycin in Tuberculosis Trials Committee and their study evaluating the use of streptomycin in treating tuberculosis, is generally accepted as the first modern randomised clinical trial. The second study was rather a series of studies with Richard Doll on smoking and lung cancer. The first paper, published in 1950, was a case-control study comparing lung cancer patients with matched controls. Doll and Hill also started a long-term prospective study of smoking and health. This was an investigation of the smoking habits and health of 40,701 British doctors for several years (British doctors study). Fisher was in profound disagreement with the conclusions and procedures of the smoking/cancer work and from 1957 he criticised the work in the press and in academic publications.

Reader's Guide

Hill's significance rests on two foundational contributions. First, as statistician on the Medical Research Council Streptomycin in Tuberculosis Trials Committee, he helped design the study evaluating streptomycin for tuberculosis, generally accepted as the first modern randomised clinical trial. Second, with Richard Doll, he conducted the landmark case-control study published in 1950 comparing lung cancer patients with matched controls, and the long-term prospective British doctors study tracking the smoking habits and health of 40,701 British doctors. These studies faced criticism from Ronald Aylmer Fisher, who disagreed with their conclusions and procedures and from 1957 criticised the work in the press and academic publications. In 1965, built upon the work of Hume and Popper, Hill suggested several aspects of causality in medicine and biology, which have remained in use by epidemiologists to date. His textbook, Principles of Medical Statistics, was very successful. On Hill's death in 1991, Peter Armitage wrote, "to anyone involved in medical statistics, epidemiology or public health, Bradford Hill was quite simply the world's leading medical statistician."

Did You Know?

• Hill served as a pilot in the First World War but was invalided out when he contracted tuberculosis.
• He took a degree in economics by correspondence at London University after tuberculosis prevented a medical qualification.
• Hill was the statistician on the Medical Research Council Streptomycin in Tuberculosis Trials Committee, whose study is generally accepted as the first modern randomised clinical trial.
• The British doctors study tracked the smoking habits and health of 40,701 British doctors for several years.
• Ronald Aylmer Fisher was in profound disagreement with the smoking/cancer work and from 1957 criticised it in the press and academic publications.