DR CHARLES WEST ON THE PROPER APPROACH TO THE ILL CHILD (1850)

Abstract

Charles West (1816-1898), founder of the Children's Hospital, Great Ormond Street, London, has been described by Fielding H. Garrison, America's leading medical historian, as: "The greatest English pediatrist of his time, and perhaps the most genial practitioner of the art who ever lived." West's pediatric treatise, first published in 1848, opens with this admirable advice on the approach to the ill child. The quiet manner and the gentle voice which all who have been ill know how to value in their attendants, are especially needed when the patient is a child. Your first object must be not to alarm it; if you suceed in avoiding this danger, it will not be long before you acquire its confidence; do not therefore, on entering the room, go at once close up to the child, but, sitting down sufficiently near to watch it, and yet so far off as to attract its attention, put a few questions to its attendant. While doing this, you may, without seeming to notice it, acquire a great deal of important information; you may observe the expression of the face, the character of the respiration, whether slow or frequent, regular or unequal, and if the child utter any sound, you may attend to the character of the cry. All your observations must be made without staring the child in the face, little children, especially if ill, seem always disturbed by this, and would be almost sure to cry. If the child be asleep at the time of your visit, your observations may be more minute; the kind of sleep should be noticed, whether quiet or disturbed, whether the eyes be perfectly closed during it, or partly open as they are in many cases where the nervous system is disordered: you may, too, if the sleep seem sound, venture to count the frequency of the respiration, and the beat of the pulse, but in doing this you should be careful not to arouse the child. It should be awoke gently by the nurse or mother, and a strange face should not be the first to meet its eye on awakening. If it were awake when you entered the room, it will probably in a few minutes have grown accustomed to your presence, and will allow you to touch its hand, and feel its pulse.