In Victorian Britain, children were dying. And often. The streets of London were littered with waifs and strays, families were unable to care for their offspring properly, and burgeoning industries preyed upon a cheap and seemingly inexhaustible workforce.
Doctors and some well meaning do-gooders were trying their best under the circumstances, but the battle seemed all but lost. It would take the work of a very special individual to bring about widespread change, and the institution of adequate child healthcare.
Born in London in 1816, Charles West first took an interest in medicine as a teenager, when he was apprenticed to a general practitioner in Buckinghamshire. Unfortunately, he was later barred from studying medicine at Oxford University as his father was a Baptist minister, religious persecution preventing him from furthering his schooling.
Not put off though, he trained as an apothecary1 and was later taken on as a medical student at St Bartholomew's Hospital in London. West went on to study in Europe, first at Bonn University in 1835, then Paris, Heidelberg and finally in Berlin, where he graduated as a Doctor of Medicines in September of 1837.
He returned to England and set up his own practice in London but it failed to thrive, perhaps due to some of the unrecognised techniques he had bought back from Europe. West then decided to further his field of expertise, and travelled to Dublin's Meath Hospital, specialising in gynaecology and midwifery. It was here he began to make a name for himself.
In 1842 West was made a member of the Royal College of Physicians and so returned to London, taking the post of Chief Physician at the Waterloo Road Universal Dispensary for Sick and Indigent Children. Dispensaries were a bold move in healthcare provision, operating as a central place from where people could see a doctor and receive properly prescribed medications.
Dispensaries also employed expert mothers that went around local areas helping other families in caring for their children. By 1875 these women were called Lady Home Visitors, and the modern British healthcare system now refers to them as Health Visitors. Dispensaries provided what was akin to outpatient services, and Waterloo Road was the only one in the city at the time. While working at the Dispensary, West was appointed Physician Accoucher2 at the Middlesex Hospital.
In 1845, he began to teach midwifery at his old training hospital, St Bartholomew's. Two years later, he gave a course of lectures at the Middlesex Hospital on children's diseases. The Medical Gazette published these lectures and in 1848 the notes were compiled to become the first proper English text book on paediatrics, 'Diseases of Infancy and Childhood'.
Prior to the publication of West's lectures, British doctors had to rely on books written in French or German to learn of children's medicine. Of the 6000 odd works written on paediatrics between the mid 18th and mid 19th Centuries none appeared in English, apart from Michael Underwood's 'A Treatise on the Diseases of Children', first published in 17843. West's book enjoyed great success, and was republished in America and later translated into German, French, Danish, Dutch, Russian, Italian and Spanish.
Meanwhile, he had tried and failed to transform the Waterloo Road Dispensary into a children's hospital, and as such became determined to found a hospital specifically for children. Up to this time specialist children's hospitals existed in most major European cities except London, with the first children's hospital in the world having opened in Paris as early as 1802. West wanted to treat children whose parents could not afford doctors' fees free of charge.
With fellow doctor Henry Bence-Jones, he helped form a committee in 1850 to investigate how this could be done. Supported by the likes of Lord Shaftesbury, Baroness Burdett-Coutts and Edwin Chadwick of the Board of Health, these contacts would later ensure that West would continue to have the necessary funds to keep his dream of a flagship children's hospital afloat.
Great Ormond Street Hospital
Great Ormond Street Hospital for Sick Children opened its doors to the public on 14 February, 1852, with Charles West appointed as its Chief Physician. The hospital started with a mere ten beds at a time when infant mortality, child malnutrition and cholera epidemics were rife amongst the population. West ensured that only children whose families could prove their poverty were admitted to the hospital, however. Those that could pay for a doctor were sent away.
West's principal ambitions for the hospital were the provision of healthcare to impoverished children, the encouragement of clinical research in paediatrics, and the training of paediatric nurses. Ahead of his time, he was well aware that children should be nursed differently to adults, by trained professionals, and as such respected the women who came to him wanting to nurse children;
I would not advise anyone whose health is indifferent, whose temper is fretful or whose spirits are low to undertake the office of a nurse.While getting the hospital together, West also wrote a book called 'How to Nurse Sick Children' in 1854, a good five years before the Crimean War's Lady with the Lamp, Florence Nightingale, published her 'Notes on Nursing', and as such should perhaps be heralded as the father of modern nursing, although his masculinity perhaps pays foul to that idea.
Charles Dickens, a personal friend of West's, gave regular public readings of his books to raise funds for Great Ormond Street Hospital. In his 1858 reading of A Christmas Carol at the London Freemason's Hall he highlighted the needs of children:
This is a pathetic case which I have put to you; not only on behalf of the thousands of children who annually die in this great city, but also on behalf of the thousands of children who live half developed.The money raised by Dickens was used to purchase an adjacent building to the hospital, thus expanding the number of inpatient beds from ten to 20. Great Ormond Street Hospital continued to grow in size and reputation throughout the 1860s, its necessary development publicised by other notable figures such as JM Barrie (creator of Peter Pan), Oscar Wilde, Lewis Carroll, and even the hospital's first patron, Queen Victoria.
In 1871 West was invited by the Royal College of Physicians to give the prestigious Lumelian Lectures. He presented a series of three lectures which were reported in the medical journals and published in full as 'On some Disorders of the Nervous System in Childhood'. During these lectures West warned against treating the child as a miniature adult, and argued against the views of the time stating that:
...the child is treated as though he were in mind, as well as in body, a miniature man, feebler in intellect, as he is smaller in strength, but differing in degree only, not in kind.
Charles West's views on child health were progressive for his day, and he would constantly tell his fellow practitioners of the importance and difference in examining and treating children. West became an expert in the field of children's health, in particular neurosciences, speech development and language disorders. Later child psychologists such as Jean Piaget and Lev Vygotsky may very well have been influenced by Charles West in their understanding of the childhood mind.
Educating Nurses & Doctors
West resigned from Great Ormond Street Hospital in 1877, following a spate of heated arguments with the Board of Management. Despite these differences of opinion, the Charles West School of Nursing was founded at the hospital, and in 1878 the first of many nurses to take written professional exams graduated as Children's Nurses. Other London hospitals had already instituted nursing courses, but West's focused on the care of the sick child. West would later spend the winter months in Nice in the south of France, away from the London fogs, but often visited Great Ormond Street. There he continued to use his knowledge to guarantee children and their families were treated by properly trained medical staff.
In 1895, the Great Ormond Street Hospital Medical School began training doctors in the field of paediatrics due to, in no small part, West's own influence and attitude towards children's healthcare provision. It also meant that the hospital was sure to have sufficient funding and remain open. Using his past influences amongst the upper classes and politicians, West managed to have a Bill passed through Parliament ensuring that any general practioner in England had to train for at least one year at Great Ormond Street Hospital before being able to practice medicine.
There was uproar, but West had the last laugh as the practitioners came to London in their droves - and of course needed somewhere to live. Needless to say, rent was quite high for medics training at Great Ormond Street, and some even related it to being imprisoned. Hearing this, West soon began to refer to the trainee doctors as interns (insinuating that they were interred there like prisoners), a practice still continued to this day.
A Forgotten Legacy
Charles West died in Paris on 19 March, 1898, on his way home to London from Nice. His work in developing healthcare for children in England went largely unrecognised, due perhaps in some part to his unpopularity amongst other physicians in almost blackmailing them to study at Great Ormond Street, his strong religious views in the wake of media darling Charles Darwin's evolutionary theories (to which West referred to as 'dreary creed'), and to Victorian society seeking heroes amongst their women - such as Queen Victoria herself, Grace Darling and of course, Florence Nightingale.
In spite of this lack of recognition, West's work in ensuring that children were nursed as children, by people especially trained for that specific role, continues to this day. However, many paediatric nurses may be quite unaware of the man whose amazing and groundbreaking work in the field of children's medicine helped cement the future of children's nursing. His simple edict remains the motto of Great Ormond Street Hospital;
The child, first and always.