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.
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).
|Henri Bergson (1859-1941)|
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