In
June 1828 West married Mary Halsey Dashwood and their first daughter, Julia, was
born soon afterwards. A son, William Robert was born in 1834, and their last
child, James Edwin followed in 1840.
James
was a fine baby until he was four months. He then started having attacks in
which he bobbed his head up and down. These increased in frequency and power
until his head was forcibly drawn down to his knees followed immediately by
relaxation to the upright position. This happened between twenty and thirty
times in the space of a few minutes. He
had two to three episodes of these attacks a day, each of which was preceded by
a ‘strange noise.’ Initially he was unwell and lost weight, but after a few
months he recovered to look fit.
Unfortunately
it was soon noticed that he was developing neither physically nor mentally as he
should. By the age of a year he could not even hold his head upright. It was
ascribed to some irritation of the nervous system associated with teething. His
father treated him in the contemporary way. He was purged, had leeches applied
and had his gums lanced. All to no effect. West took him to London to the
foremost specialists, Sir Charles Clarke and Dr. Locock, both of whom had seen a
few cases previously and called it a ‘salaam convulsion’. They had no
treatment to offer. West took further advice from physicians in Dublin. Neither
could they help.
Sadly
West wrote to The Lancet (Lancet 1 1841 p724) describing the condition most
accurately and suggesting that it was a condition in its own right that had
previously escaped the attention of the medical profession. At a conference in
Marseille in 1964 the condition was called ‘syndrome de West’. Otherwise it
is now known as ‘infantile spasms’ or ‘infantile myoclonic encephalopathy’.
In 1989 damages of £441 527 were awarded against a general practitioner who
failed to diagnose the syndrome in a baby.
The
attacks continued, and by 1842 James had developed definite epileptic fits as
well. By the time he was three he could just get himself up into a chair and he
started to walk. At the age of seven when he could understand what was said to
him but could neither feed himself nor talk, Aston Key, a surgeon at Guy’s
Hospital and later surgeon to Prince Albert, suggested that he would benefit
from the society of other children. The poor boy was sent to school, which did
not last long. Neither did his
attempt to live in a nursery. This was not surprising as James had frequent fits
of idiotic laughter and rollings of the head.
A
remarkable operation
In
1833 West had been asked to the delivery of a lady aged 45. On ante – natal
examination he found an ovarian cyst in the pelvis which he was able to push
upwards into the abdominal cavity. She had a normal labour. By 1837 the cyst had
grown so large that life was becoming very difficult as she had difficulty in
breathing. She had previously tried other treatments, so, after much discussion,
she agreed to operation. West, assisted by two local practitioners, opened the
abdomen, drew more than twenty pints of fluid from the cyst which he then
removed. The abdomen was closed with four sutures and adhesive plaster. The cyst
was sent to Guy’s Hospital where it was exhibited in the museum.
This operation had only been successfully performed for the first time the previous year. Two surgeon apothecaries in Suffolk, Jeafferson of Framlingham and King of Saxmundham, had each had good results. West’s published series of three cures in four operations was remarkable before the days of anaesthesia and antisepsis. His pioneering work helped to make the operation acceptable, as it was not done at Guy’s until 1839.