18 March 2011

Book Review: Jacques Philippon & Jacques Poirier, Joseph Babinski: A Biography

In his Diseases of the Nervous System Francis Walshe observed that the plantar reflex was probably the most “important single physical sign in clinical neurology” (Walsh 1940, 22). That most important physical sign was first introduced in February 1896 at a meeting of the Société de Biologie by Joseph Babinski. Had it not been for this sign, which eponymously established his fame, it is likely that Babinski would not have become so famous in the history of neurology. In the case of this sign, a mere twenty-eight lines was all that was needed to establish an international reputation:

I have observed in a certain number of cases of hemiplegia or crural monoplegia caused organic lesion of the central nervous system a modification in the plantar reflex, which I can describe in a few words.

On the normal side, a pinprick of the plantar foot causes, as is usual, a flexion of the thigh toward the pelvis, of the leg towards the thigh, of the foot toward the leg, and of the toes toward the metatarsus. On the paralyzed side, the same stimulation causes, as is usual in the normal situation, a flexion of the thigh toward the pelvis, of the leg toward the thigh, and of the foot toward the leg, but the toes, instead of going into flexion, perform a movement of extension on the metatarsus.

I have had the opportunity to observe this disorder in cases of recent hemiplegia, dating back only a few days, as well in spasmodic hemiplegias lasting for several months; I have observed it in patients unable to voluntarily move their toes, but also in those who were able to perform voluntary movements of their toes. I must add, however, that this perturbation is not constant.

I have also observed in several cases of crural paraplegia of organic origin an extension movement of the toes after pinprick of the plantar foot, but because in this case there is no possible comparison between the two sides, the conclusion from the demonstration is less obvious.

In summary, the reflex movement caused by the pinprick of the plantar foot in crural paralysis related to a central nervous disorder shows a modification not only in its intensity, which is known, but also in its characteristics.

The remarkable man behind these terse observations is the focus of Jacques Philippon and Jacques Poirier’s study – another fine biography in a largely excellent series focusing on neurologists and being published by Oxford University Press. The volume, which does much to broaden our understanding of late 19th and early 20th century Parisian medicine, follows Babinski from childhood, boyhood, and youth through to his death in 1932 and his impact on subsequent generations.

In Philippon and Poirier’s richly documented biography, Joseph Babinski (of Polish ancestry, born in 1857) emerges in a turbulent period of French history. He was, it seems, a committed positivist, and yet he was also something of a mystic, a Romantic and a skeptic. Like most of his generation, he was influenced by the physiology of Claude Bernard and the scientific researches of Guillaume Duchenne, Louis Pasteur, Joseph Lister, Rudolph Virchow, and Moritz Romberg. By the time he had begun his medical training at the Faculté de medicine de Paris, Jean-Martin Charcot and Alfred Vulpian were among the more prominent figures in French medicine. Indeed, Babinski would study with both – Vulpian (who discovered adrenaline) in 1883 and, after receiving the silver medal in his competitive exams, Charcot from 1885 until 1893. It was after his time with Charcot that Babinski’s most active period would commence. From the turn of the century on he would devote himself to “cerebellar semiology…the study of tendon and bone reflexes…and treatment for his patients” (p. 15).

Like many elite physicians of his generation, Babinski was prone to nationalism, loved music and art, and emerges also as something of a gourmand – his brother was Ali-Bab of Gastronomie pratique fame. Babinski could be a snob. He was disdainful of fad and mode. And in his scientific and medical commentary, he could be positively devastating. He sniffed, for example, to George Shaltenbrand, who had proposed “pseudo-sclerosis” as a diagnosis, that any “neurologist who lays down the diagnosis of pseudo-sclerosis is not a neurologist but a pseudo-neurologist” (p. 31).

Paris, 1900
His inner circle of friends was comprised mainly of general physicians of whom his most intimate friend was Henri Vaquez. His work, like his circle, was of a general nature. From 1895, Babinski was head of the department of internal medicine at La Pitié, and he routinely treated cases of “bronchial and lung pathologies…cardiac diseases… and then… kidney insufficiency, diabetes, cirrhosis, anemia, chlorosis, extreme poverty, upset stomach, cachexia, senility, pain, varicose veins, etc” (p. 157). His Wednesday morning consultation was popular and regularly attended by visiting physicians; his Saturday Clinical Lectures were also popular.


Henri Bergson (1859-1941)
Many of the students who attended the lectures and consultations would become famous neurologists. What attracted them to Babinski? It seems that there can be little doubt that Babinski’s semiological methods were what established his reputation. Philippon and Poirier remark that Babinski’s conception of semiology: “was founded on the importance of objective signs, those that do not depend on the patient’s will.” (p. 195). Such clinical acumen was in some sense anathema to the times: by the early twentieth century, the intuitionism of Henri Bergson had become influential in France and beyond. Although Babinski was prone to interests in the paranormal, his semiology, especially his famous sign, seem derived from the positivist tradition of science. In that sense, perhaps, Babinski may be best described as an exemplar of a conservative empiricist tradition that slowly eroded with the birth of the Modern Age.

Philippon and Poirier’s biography might also be best described as a collective biography. The authors routinely describe in biographical terms developments in neurology and medical history. Much of what we learn about Babinski comes to us as if it were in an impressionist work of art, i.e. through blurred biographical sources penned by his students and colleagues. When the authors turn to consider the context of neurology in their penultimate chapter, they do so through a brief appraisal of the biographies of Babinski’s contemporaries in other nations. In consequence, their discussion of French neurology (and beyond) sometimes feels too dependent upon the peculiarities of personality. Indeed, by the final chapter, which focuses on Babinski’s posthumous reputation, the style has become somewhat repetitive. Nevertheless, as the bibliography of this volume underscores, there is an enormous quantity of research underlying this study. The thickness of the footnotes and the effort to uncover a life that left too little documentation behind is striking. The collective biographical approach, when situated alongside such a diligent effort at intellectual history, makes for an impressive study.

Joseph Babinski: A Biography

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