To Speak like a Child: How Children Acquire Language Is a Question That Continues to Be of Fascination to Medical Scientists and Educationists. They All Owe a Debt to Charles West, 19th-Century Pioneer of Specialist Paediatrics

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The 21st century has seen an upsurge in interest in the speech of young children. Government reports, educational policies, newspaper articles and the 'Talk to Your Baby' campaign established in 2003 by the National Literacy Trust reflect growing concern that a significant minority of Britain's children are starting school with poorly developed speaking and listening skills. Poor communication within families attributed to current lifestyles is usually held to blame. Much recent discussion concerns remedial strategies to be carried out at school to encourage young children to listen and talk.

Interest in children's developing language skills is not a recent phenomenon. Charles West, founder of Britain's first paediatric hospital, Great Ormond Street in London, wrote extensively throughout a long, productive life on the treatment and prevention of disease in childhood, but he broke new ground in 1871. Almost 20 years after the opening of Great Ormond Street, West gave the Royal College of Physicians' Lumleian Lecture. He used the opportunity to focus attention on a hitherto neglected area: the loss or impairment of language in the child, pointing out that: 'Few things cause so much anxiety as when the time passes at which the infant usually begins to talk, and the mother waits on in mournful expectation for the sounds which are to prove her little one's right to full citizenship.'

Although couched in the language of the Victorian era, that sentence demonstrates important insights into the acquisition of language. To say what he did, West must have been aware of the distress caused by 'delayed' speech in children for, just as today, there were restricted life opportunities for those who failed to acquire 'normal' language function. Yet for much of the 19th century what we would call developmental language issues (how children acquire language, what constitutes language delay, articulation problems, word-finding difficulties, problems in understanding or in learning to read) came a poor second to interest in acquired language issues (difficulties following brain injury).

Medical interest in language per se was sparked by a debate on localisation of function in the brain. Between 1861 and 1865 the French physician Paul Broca published a series of seminal papers linking language loss to damage to a specific area of the left hemisphere. This acquired loss or disorder of language following some form of brain trauma became known by the term 'aphasia'. The condition attracted considerable debate both in the UK and on the continent; numerous physicians interested in the brain and, in particular, cerebral localisation of function, contributed papers. Yet few but West thought there a distinction worth making between cases affecting adults and those that involved children.

Opposition to medical specialisation was strong. West had already endured a long and fierce campaign to establish his paediatric hospital, in part due to the valid fear of infection spreading through crowded children's wards. Still, the need for a specialist hospital was great, with child mortality in London shockingly high. One of West's stated aims in the provision of specialist care was to increase the knowledge and understanding of childhood illness, a topic of little interest to most Victorian physicians. Manuals were published on the topic of childhood disease but these were aimed at the domestic rather than medical market; West himself wrote a handbook for mothers detailing how to care for the sick child in 1885. However, as the century progressed, West's aim was slowly realised with the founding of paediatric hospitals across Britain. Even so, throughout the 19th century, the universities of London, Oxford and Cambridge did not test knowledge of childhood disease in their medical examinations.

The developing child's mind became a focus of interest in the new field of psychology. …