William John Little and the History of Cerebral Palsy

By Nelson Tang

What is cerebral palsy and what causes it or why does it occur? What are the symptoms of this condition? At what age do signs start to show? How many people does it affect and how common is it? How serious is the condition? How does it affect an individual in life? Are there any treatments and solutions? When was the first case documented and diagnosed? How much has changed with what we know about cerebral palsy since its discovery? What advancements and developments had been made since then? Who was William John Little and his contributions to the medical field and his connection to cerebral palsy? All of these questions will be mentioned through this article.

Believe or not, cerebral palsy dates back to ancient times from the Greeks and Romans to the Egyptians with a number of cases recorded down. Mentions of it have also been found in representative art, literary sources, and paleopathology. After careful analysis and examinations by medical historians, it is believed that the earliest documented case of cerebral palsy was in Egypt. This individual with the condition was the pharaoh Siptah who ruled from 1196 BC to 1190 BC where his mummified body showed that he had a severely deformed foot. It is also claimed that Siptah is the oldest physical evidence of a person with cerebral palsy. Moreover, the term had not been given until the 19th century by Sir William Osler who coined the term in 1887. Before that, it was just referred to as “Little’s Disease.”[1]. Osler would apply it to Dr. John Little’s research and wrote a book called The Cerebral Palsies in Children.  His book consisted of summaries of lectures that he had given on the condition, which included a number of case studies and the possible causes of cerebral palsy. [3].

Cerebral palsy is a physical disability and is caused by damage to a developing brain during pregnancy or shortly after birth. Premature birth seems to be the largest cause and it is also believed that genetic predisposition to certain characteristics such as heart problems can lead to it. It is an umbrella term that refers to a group of disorders that affects an individual’s mobility. It is a condition that affects people in different ways depending on the severity and it is a lifelong physical disability. Cerebral palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture, and balance. Other afflictions include visual, learning, hearing, speech, epilepsy, and/or intellectual impairments. Roughly 18 million people in the world live with cerebral palsy with about 1 million in the United States with 1 in 500 births as the possibility of it occurring. It is the most common lifelong physical disability with the effects becoming greater with age causing more muscle weakness and control.[2].

There are certain signs and indicators of cerebral palsy when it comes to a baby.  Such examples include low muscle tone or floppiness when picked up, being unable to hold up its own head while lying on their stomach or in a supported sitting position, muscle spasms or stiffness, poor muscle control, reflexes and posture, delayed development not being able to sit up or independently roll over by 6 months of age, feeding or swallowing difficulties or the preference to use one side of their body. For toddlers or children, indicators include not being able to walk by the age of 12 to 18 months or not being able to speak simple sentences by 24 months old.  Doctors typically take a look at this before diagnosing the disability to patients with the General Movement Assessment being conducted from birth to 3 months and an MRI. [2].

What are the different types of cerebral palsy? The types include spastic, ataxic, and dyskinetic cerebal palsy with each having different characteristics and effects on an individual.  Spastic Cerebal Palsy is the most common among the three and movement is characterized by stiffness or jerkness. This type is caused by damage to the motor cortex of the brain before or shortly after birth with this part of the brain being responsible for the control of body movement.  Spasticity is a form of hypertonia, or increased muscle tone. When performing movement or an action certain groups of muscles are activated, while some are turned off. However, for those with this disability, both groups are turned on creating difficulties in movement or speech.  Spasticity can cause bent elbows and wrists, or fisted fingers, flexion at the hip and knees, scissoring of the thighs, equinovarus foot posture, or hyperextension of the big toe. Ataxic Cerebral Palsy is caused from damage to the cerebellum, which is the part of the brain responsible for balance and posture. Individuals with this type have difficulties in maintaining balance and their movements are disorganized or jerky. The movements can sometimes be mistaken for a person who may be on drugs or alcohol. It affects a person’s legs, arms, hands, fingers, speech, eye movements and even muscles involved in swallowing. Dyskinetic cerebral palsy is caused by damage to the basal ganglia, which is the part of the brain responsible for voluntary movements interpreting signs between movement center and spinal cord. A person with this may experience repetitive and sustained movements, awkward postures, movements that are rapid or slow and are often painful, involuntary movements triggered by attempts at controlled movement or involuntary movements occur more frequently when the person is tired, anxious, tense or emotional.[2].

What are the different kinds of treatments for cerebral palsy? There are many interventions that help in easing or reducing the impacts it has on the body and improve one’s quality of life. When it comes to movement issues, solutions include medication, physical, and occupation therapy, and surgical procedures. For muscle, joint, or bones issues, solutions include casts, splints, and muscle strengthening, or surgical procedures. For communication issues, there is speech pathology. For learning and intellectual disabilities, there are assessments, special education, and learning strategies. As one can see there are different solutions based on specific issues. [2].

William John Little was born in 1810 in London with his father owning an inn. Little suffered from club foot from early childhood and it is unclear what had caused it. The possible causes were either from birth or the aftermath of early childhood polio. Little was exceptionally smart when it came to his studies and education, especially in language ability. His proficiency in French was so good that it rivaled that of a native Frenchman. In 1826,  he would start a 2 year practice in a pharmacy and start his medical studies at the London Hospital in 1828 and later at Guy’s Hospital. Shortly after, he became a teacher in anatomy, physiology, and pathology and was admitted into the Royal College of Surgeons in 1832. Little pursued further education in 1834 in Berlin after he failed to obtain a post as surgeon at the London Hospital. Little would return to London in 1837 where he performed a tenotomy of Achilles tendon on a 15-year-old boy developing his private practice.

He would also write a paper in 1839 on club foot treatment. Little would gain more and more recognition from successful surgeries and eventually got the job he desired in 1840 as a surgeon at the London Hospital. Furthermore, he was not only recognized as a practitioner, but also a theorist. Throughout his life he would go on to write papers and document children suffering from spasticity and stiffness of extremities, deformities of upper and lower extremities, paresis and paralysis.[4]. Little would also teach about this in his lectures such as in his series from 1843 to 1844 called Deformities of the Human Frame where he details “a peculiar distortion which affects new born children which has never been elsewhere described,… the spasmodic tetanus-like rigidity and distortion of the limbs of new-born infants, which… [he had] traced to asphyxia neonatorum, and mechanical injury to the fetus immediately before or during parturition” Moreover, he used data from 24 patients. [1].

In conclusion, cerebral palsy dates back to ancient times as it is mentioned in different types of sources throughout history. It is also proven through physical evidence such as the body of Pharaoh Siptah where his mummified body was shown to be the oldest physical evidence of a person with cerebral palsy. It is a disability that comes in several variations where different parts of the brain are damaged. Depending on which part was damaged, the conditions and symptoms vary. It affects those with the disability in different ways differing from person to person whether it be mentally, or physically. For some, it may be mild and for others it may be more severe. However, it is a lifelong physical disability for all afflicted with it.

Thanks to William John Little’s work and research, we have a better understanding as those who came after him built about his foundations. Just like any other disability, there needs to be more awareness and inclusion,and activism towards cerebral palsy. With more funding, it will lead to more research and development in the field. Thus, there will be more effective ways in treating cerebral palsy and potentially even maybe curing it one day in the future. 

References:

[1.] Barry S. Schifrin a, et al. “William John Little and Cerebral Palsy: A Reappraisal.” European Journal of Obstetrics & Gynecology and Reproductive Biology, Elsevier, 22 May 2000, www.sciencedirect.com/science/article/abs/pii/S030121150000261X

[2.] Foundation, Cerebral Palsy Alliance Research. “Signs and Symptoms of Cerebral Palsy.” Cerebral Palsy Alliance Research Foundation, cparf.org/what-is-cerebral-palsy/signs-and-symptoms-of-cerebral-palsy. 

[3.] “The History and Origin of Cerebral Palsy.” Cerebral Palsy Foundation, 9 Apr. 2020, www.yourcpf.org/blogs/history-origin-cerebral-palsy-sarah-kim/. 

[4.] Pietrzak, Krzysztof, et al. “William John Little (1810-1894).” Journal of Neurology, U.S. National Library of Medicine, May 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4859855/.