Historical vignette #9. Little big man: the life and genius of William John Little (1810-1894).

William John Little had in many respects a unique career. He suffered childhood poliomyelitis with residual left lower extremity paraparesis, complicated by severe talipes. As a youth he was an apothecary's apprentice, surrendering his indentures at the age of 18 and entering medical school at the London Hospital. He was admitted to the Royal College of Surgeons in 1832. He later travelled to Germany to study the technique of subcutaneous tenotomy with its originator, Louis Stromeyer, who subsequently corrected Little's deformed foot by this method. His doctoral dissertation (1837) was the first monograph on tenotomy ever published, and he became the apostle of this operation for the correction of skeletal deformity secondary to neuromuscular disease. Little founded the Royal Orthopaedic Hospital of London. Among his many publications was "On the Deformities of the Human Frame" (1853) in which he first described pseudohypertrophic muscular dystrophy (antedating Duchenne's paper by eight years), as well as cerebral spastic palsy (Little's Disease). The techniques originated by Stromeyer and applied by Little are used today in the surgical management of muscular dystrophy. William Little was one of the first to bridge the gap between neurology and orthopaedics and his important work continues to impact on both these fields.