The Babinski Sign: A Centenary

To anyone trained in examining the nervous system, the positive Babinski sign or reflex—the “upgoing toe” on scratching the sole of the foot—is basic for indicating a defective corticospinal tract on the side of its appearance. It has been that ever since its presentation at the Paris Société de Biologie in 1896 by the son of a Polish political immigrant. When the thirty-eight-year-old Joseph Babinski demonstrated his “toe phenomenon,” he had been working for several years in the Hôpital de la Pitié, associated with Charcot’s Salpêtrière, where he had acted as a chef de clinique since 1885. (The famous photograph of one of Charcot’s Tuesday demonstrations shows Dr. Babinski supporting the retroflexed hysterical female.) Owing to academic polemics, he failed to advance beyond the rank of médecin des hôpitaux—but he became chief of the Pitié’s neurology service, cofounder and one-year president of the Société de Neurologie, and the recipient of international acclaim. He also coined the term pithiatisme—a kind of persuasion—opposing Charcot’s organic interpretation of hysteria. On his death in 1932 Babinski’s bibliography, including abstracts, letters, and discussions, amounted to 288 items whose topics include his term and concept of anosognosia, cerebellar signs, the significance and best examination of the ankle jerk, and his promotion of neurosurgery with de Martel and Vincent. The highlights of his biography are given in the twenty pages of chapter 2.

The rest of the book’s 176 pages are devoted to the discussion of the Babinski sign and its history (in chapter 1), and 33 pages of bibliography. As to reflexes in general, we are briefly shown the way from Rufus of Ephesus, Galen, and Vesalius to Marshall Hall in the first half of the nineteenth century—via Descartes, Swamerdam, Haller, and Whytt—as well as Unzer and Prochaska, not to forget Bell and Magendie’s basic discovery. Also discussed is the concept of a “spinal soul” (Paton, Talma, Pfluger, and Lewis), before we get to Sherrington, Golgi, and Ramon y Cajal early in this century. The pyramidal syndrome, spasticity, and the cremasteric as well as the abdominal reflex get a brief mention, as does Erb and Westphal’s simultaneous but independent discovery of the tendon reflex in 1875. Also before Babinski was Brown-Sequard, who described the withdrawal syndrome of the legs when the examiner forcefully flexed the patient’s toes.

There was some controversy as to the normal or abnormal reaction of foot and toes to plantar stimulation. Five years after the first brief presentation of this reflex, Babinski added abduction of the big toe to dorsiflexion. Van Gijn provides a list of the twenty-eight studies worldwide confirming the Babinski sign, as well as a table listing twenty publications of “alleged false-positive Babinski signs,” which he criticizes. Several pages are also dedicated to the plantar reflex in infants, and to the translation of Babinski’s long lecture on his reflex given two years after its short first presentation. The rest of the book (including chapter 6, called “Practicalities”) is a further discussion of the phenomenon’s sidelines and pitfalls.

From the standpoints of both the historian and the specialist practitioner, this thorough, highly readable, and lavishly illustrated book—based on the author’s doctoral thesis and several other publications—certainly deserves praise.