William Hills was 33 years old when he became medical superintendent at Norfolk Lunatic Asylum on 17 October 1861 and he completed his working life there, retiring early in 1887. He had obtained his M.D. at Aberdeen and held membership of the Royal College of Surgeons and the Association of Asylum Medical Officers. Given the context of his appointment, the temptation to associate Hills’ regime with reform and ‘medicalisation’ at the asylum is strong. Evidence might include: a greater emphasis upon treatments, drugs and medicines; the public presentation of medical explanations of recovery, sickness or death; a more caring and therapeutic approach to patients by attendants and nurses; and revised concepts of management and of the political economy of the institution. Such changes can be exaggerated. Although Hills made an active beginning, the lunacy commissioners probably overstated improvements in their endorsement of his appointment. Between 1861 and 1887 patient numbers doubled, from 370 to over 730, pressuring the asylum fabric and facilities. Increasing acceptance of the asylum as an appropriate place of care, sometimes in the absence of suitable alternatives, also reflected further medical claims made on behalf of asylum therapies. Yet a sense of lost momentum later surrounded Hills’ retirement when, in turn, high hopes were transferred to his successor.

Meanwhile, continuity was provided in the stable membership of the committee of visiting justices. It still met monthly, though the variable timing of weekly visits, suiting the justices’ personal convenience, made inspections less predictable. The committee also retained formal control over the discharge of patients, and much routine continuity was embodied in longserving members of staff, not least the clerk to the justices, William Girling. More pertinently, the challenge of medicalisation to conventions and to contemporary authority may be questioned. Hills also brought to the NLA a heightened sense of economy, expressed in the desire to save costs and utilise patients’ skills. This was confirmed in his interpretation of work therapy, changes to the patients’ dietary and promotion of an auxiliary asylum as an efficiency aid. He linked the use of probation for patients with a proactive stance on the admission of boarders, acknowledging openly systems of crosssubsidy and savings to Norfolk ratepayers. Though Hills shared with the lunacy commissioners hopes of further improvements, notably in the care of ‘idiots’ and in nursing standards, he did not press the committee on such matters.