Paying tribute to his family origins in the fishing industry, Fildes adds a fishing net hanging from the ceiling. His father was a mariner and shipping agent. The cottage setting has led some to believe that the painting was ordered by Queen Victoria to honour her own physician, Sir James Clark. This alternative account also originates in the story about her physician being sent to Balmoral to care for the sick child of a servant.  18th and 19th century concerns by society of the rise of scientific medicine also could have possibly influenced the format of the painting. The painting was first exhibited in 1891. Prior to completion, a number of sketches were made which are preserved at the Tate Gallery and depict various alternative compositions such as the doctor being on the right side of the canvas, the child seated rather than lying down, and different facial expressions for the doctor. Fildes built a model cottage to copy after visiting numerous cottages in north-east Scotland, ensuring that the picture included authentic detail of roof rafters, tablecloth, lampshade, and lighting. Particular attention was paid to ensuring the room had a poor, Victorian, multi-purpose appearance. The focus of the picture is the worried but sympathetic physician and the sick child, with everything else in the shadows. The child had experienced a 'crisis', the critical stage of a potentially life-threatening illness. The ' dawn' light through the window, represents recovery and hope as the child survived the night. The concentrated focus of the doctor on the child shows the patient as a person and individual and the doctor as a compassionate carer with empathy for the patient's suffering. In 2002, Douglas wrote in the "British Medical Journal", "So his manner is all, and Fildes captures it forever: the furrowed brow; the hand propping the firm bearded chin; the calm, concerned authority". The parents are insignificant, helpless, and not central to the picture. A dominating male father gives support to his weaker female wife by extending his arm and resting his hand on her shoulder. She appears to be crying and possibly praying. He, however, is also helpless and peers on at the doctor and child. The artificial light from the lamp on the table and the natural rising sunlight beginning to shine through the single window suggest that the doctor has been in attendance all night. A distressed, poor, and modest family is depicted by one small carpet and the washing suspended in a small room. Two mismatched chairs, pressed together, construct a makeshift bed in the labourer's cottage.