Joseph Jules François Félix Babinski

Joseph Jules François Félix Babinski was one of a handful of French neurologists and other medical scientists who made Hôpital de Salpêtrière in Paris a world famous medical centre in the late nineteenth and early twentieth century. Both his name, and those of many of his colleagues, are still of eponymic fame. The others being, among others, Jean-Martin Charcot, Claude Bernard, and Joseph Jules Dejerine,

Joseph Babinski was the son of a polish engineer and his wife who in 1848 flew Warsaw for Paris because of a Russian reign of terror with the purpose of stalling Polish attempts at achieving independence. Joseph, who grew up on the Montparnasse, as a child was described as rather heavy and docile in temper, though being lively and intense when engaged. It was also said that Joseph showed signs of a constitutional neurosis, and it is conceivable that an element of obsession may have contributed to his relentless search for any imaginable deviations in neurological status.

As a young student of medicine Babinsky came early to Charcot at the Salpêtrière in Paris. Charcot soon recognised the greatness of this distinct observer, who was soon to become his favourite student. Babinski received his medical degree from the University of Paris in 1884 with a thesis – of outstanding merit - on multiple sclerosis, a topic suggested to him by Edmé Félix Vulpian (1826-1887). Babinsky became Médecin des hôpitaux in 1890.

In the daily clinical work Babinski was an extremely untalkative loner who, during his minute neurological examinations more often than not never uttered a word, sometimes not even afterward. His working manner was characterised by exceptional observational powers and thorough discussions of the neurological systemathology. He strived not so much to map the theoretical background, but was above all a clinical descriptive observer.

An academic row and its consequences
Another of Charcot's numerous students was Charles-Joseph Bouchard (1837-1915). He had first read medicine in Lyon, then at the age of 25 went to Paris to continue his studies under Charcot, who then, in 1862, was 37 years old. Bouchard was ambitious, gifted, and energetic, and, under Charcot's supervision his career pointed straight up. His efforts were finally crowned with a professorship of medicine. When Bouchard was well established as a professor the relationship to his tutor and mentor deteriorated. Slowly they became enemies, each establishing his school, instead of completing each other and cooperate to the benefit of French Neurology.

This slowly growing enmity culminated when Bouchard by a skilful play of academic intrigue succeeded in outmanoeuvring Babinski, Charcot's favourite student, at the appointment of a "professeur agrégé", a meriting necessary for further advancement to "professeur de la chair", full professor.

Charcot's death left Babinski without support, and he subsequently never participated at qualifying competitions for "professeur agrégé". Instead, in 1895, he became "chef de clinique" for the neighbouring Hôpital de la Pitié, where he worked until his retirement in 1922.

Deus ex machina
Babinski's failure to climb the academic ladder was to become of fundamental importance to French neurology. Lacking of an academic position he was passed over for appointments and lacked the opportunity to establish his own school. Of all Charcot's students Pierre Marie was, eventually, the only to be appointed full professor of neurology - a nomination that came 25 years after the death of Charcot. This appointment also caused an angry attack, this time from Dejerine, who came from the school of Bouchard. Babinski was, though, a member of the Académie de médecine from 1914. Charcot did not live to experience reconciliatory words from Bouchard. Reminded of who had been his teacher, however, Bouchard a decade after the death of Charcot expressed:

"It was Charcot who shaped our intellects; it was he who opened the gates to scientific work, it was he who took my hand and led me to the highest academic position I could reach. Confronted with his memory I shall always feel the deepest gratitude".

Ironically the names of the two antagonists are still mentioned in one breath today at the mention of the Charcot-Bouchard aneurysm, i.e. microaneurysm on small cerebral perforated vessels that may cause intracranial bleedings.

Free of teaching duties, Babinski’s work at the Hôpital de la Pitié left him ample time to devote himself to the symptomathology of neurology. He was a masterly clinician, considerably less dependent on neuropathological examinations and laboratory tests than most of his contemporary colleagues. He chose the path of the unassumpting search, which may not so often give results, but that, with a scientist of an extraordinary intellect and intuition may lead to epoch making discoveries.

In 1900, a year before Alfred Fröhlich, Babinski described the adiposo-genital syndrome in a case of pituitary tumour, a condition still termed Babinski-Fröhlich syndrome. The following year, 1901, he reported with Augustin Charpentier (1852-1916) on the Argyll-Robertson's pupil in neuro-syphilis as an expression of a lesion of the central nervous system. In 1902, with Jean Nageotte (1866-1948) he described the clinical symptoms caused by lesions in the postero-lateral part of pons, a complex of symptoms that still bears the name Babinski-Nageotte syndrome. In 1905 he described with insight the neurophysiological background of tabes dorsalis. He concerned himself with the pathology of the cerebellum and introduced the terms ataxia and dysdiakonesia as cardinal symptoms of cerebral lesions.

Farewell to hysteria
In the footsteps of his teacher, Jean-Martin Charcot, Babinski also took an interest in the pathogenesis of hysteria and was the first to present acceptable differential diagnostical criteria for separating hysteria from organic diseases. Jean-Martin Charcot thought he had discovered a new disease he called "hystero-epilepsy," a disorder of mind and brain combining features of hysteria and epilepsy. The patients displayed a variety of symptoms, including convulsions, contortions, fainting, and transient impairment of consciousness.

Joseph Babinski decided that Charcot had invented rather than discovered hystero-epilepsy. The patients had come to the hospital with vague complaints of distress and demoralization. Charcot had persuaded them that they were victims of hystero-epilepsy and should join the others under his care. Charcot's interest in their problems, the encouragement of attendants, and the example of others on the same ward prompted patients to accept Charcot's view of them and eventually to display the expected symptoms. These symptoms resembled epilepsy, Babinski believed, because of a municipal decision to house epileptic and hysterical patients together (both having "episodic" conditions). The hysterical patients, already vulnerable to suggestion and persuasion, were continually subjected to life on the ward and to Charcot's neuropsychiatric examinations. They began to imitate the epileptic attacks they repeatedly witnessed.

Babinski eventually won the argument. In fact, he persuaded Charcot that doctors could induce a variety of physical and mental disorders, especially in young, inexperienced, emotionally troubled women. There was no "hystero-epilepsy." These patients were afflicted not by a disease but by an idea. With this understanding, Charcot and Babinski devised a two-stage treatment consisting of isolation and counter suggestion.

Babinski's sign
When Babinski published it was most often commendably short and concise. Such was also the case when in 1896, at a meeting of the Société de Biologie in a 26 line presentation for the first time reported his "phenomène des orteils", i.e. the discovery that while the normal reflex of the sole of the foot consists of a plantar reflex of the toes, an injury to the pyramidal tract will show up in an isolated dorsal flexion of the great toe - Babinski's sign.

Although this sign had been reported three years before by Ernst Julius Remak (1849-1911), it was Babinski who first realized its diagnostic significance. In its simplicity, clinical importance, and physiological implications, Babinski’s sign has hardly an equal in medicine. The number of works devoted exclusively to ”Babinski” runs into the hundreds, yet in 1900 its diagnostic importance was declared to be ”minimal.” His description of the associated fanning of the toes, subsequently referred to as the signe de l’éventail, was published in 1903.

Two years later he published, in La Semaine médicale, a particularly complete description of the phenomena exemplified by case stories of patients with hemiplegia, Jackson's epilepsy, encephalitis and strychnine poisoning. The clinical description in this works even today stands out as remarkably complete. Even here Babinski drew the correct conclusion that the sign was to be explained by affection of the pyramidal tract (not necessarily structural) and also noticed that it is to be found in healthy infants. In 1903 he followed up his observations with another article containing a description of sign de léventail, the fanning of the toes often occurring simultaneously with the extension of the great toe in affections of the pyramidal tract.

In the name of justice it must be pointed out that Félix Alfred Vulpian, neuropathologist at the Salpêtrière, half a century earlier had observed the extension of the great toe in certain types of brain damage. It was, however, first through Babinski's brilliant observations and analysis of the phenomena that the clinician recognised the importance of this sign in lesions of the pyramidal tract. Babinski's sign received much international interest and was surprisingly soon to achieve routine neurological status worldwide. Babinski's pathogenetic conclusions could also be verified by Fulton in studies of chimpanzees, later also by Swedish neurologists, among them Erik Klas Henrik Kugelberg (born 1913).

Diagnostics of tumours in the spinal canal
On June 9th, 1887, Victor Horsley successfully conducted the first extirpation of a tumour in the spinal canal. At the turn of the century many attempts were made to surgically operate tumours in the spinal canal, but mostly the laminectomies were made at the wrong level - too low. In 1910 Babinsky demonstrated that a careful study of sensibility conducted according to specified principles without exception led to a diagnosis of level without correction. These observations were subsequently proved right.

In 1911 Babinski diagnosed a tumor in the spinal canal and sent the patient to Victor Horsley. Later the same year Babinski diagnoses one more spinal tumor, but remitted his patient to the then very well known French surgeon Paul Lecène (1878-1929). Babinski was, however, not satisfied with Lecène’s dexterity and decided to find another surgeon for his next case.

Rebirth of French neurosurgery
Through his student Clovis Vincent (1879-1947), later to become a famous neurosurgeon, Babinski became acquainted with Thierry de Martel, who declared himself willing to operate the next patient with a suspected spinal tumor. When Babinski towards the end of 1911 diagnosed a third such case, he therefore remitted his patient to Martel - who successfully removed a tumor in the spinal canal - localised exactly as foretold by Babinski.

This operation marks the rebirth of French neurosurgery. From then on Martel preferably devoted himself to neurosurgical cases, and soon other French neurologists, like Pierre Marie, Théophile Alajouanine (born 1880), Jacques Jean Lhermitte (1877-1959), Jean Alexandre Barré (1880-1967), and Auguste Tournay (1878-1969) followed Babinski's example in sending their patients in need of neurosurgical treatment to Martel.

Six days prior to his death a close friend asked Babinski what he considered his most lasting achievement in science. "Of your contributions "the sign" will certainly persist", uttered his friend. "Yes, the "sign" will be remembered", answered Babinsky, "but it was not my greatest contribution - that was my showing the direction for Martel and Vincent".

Babinski's last year
Babinski lived with his younger brother by twelve years, Henri Babinski, a distinguished engineer who was also a famous cook, well known with all food artists. Under the pseudonym of Ali Baba, Henri Babinski published several now classic works on cooking. It is said that Babinski once interrupted his ward round when the nurse in charge whispered to him that the soufflé was nearly perfect. He spent the evenings at the theatre, opera and ballet.

Joseph Babinski died on October 29, 1932. The last years of his life he suffered from Parkinson's disease, but he lived to see his achievements in French neurology internationally acknowledged. Neurologic profiles like Robert Wartenberg (1887-1956) and Samuel Alexander Kinnier Wilson (1878-1937) came to work and study with him. He was honoured by the American Neurological Society and several other foreign societies.

Babinski’s obituary in The Lancet ended with the following words: "None of Charcot's pupils is surer to be remembered for his achievements in the field of neurology." Babinski is buried on the Cimetière des Champeaux at Montmorency, about 13 km north of Paris, France.

With Édouard Brissaud (1852-1909), Pierre Marie (1853-1940), Joseph Jules Dejerine (1849-1917), Alexandre-Achille Souques (1860-1944), and others, Babinski founded the Société de neurologie de Paris, to which he was profoundly devoted.

One of those drawn to Babinsky was Antonio Caetano de Abreu Freire Egas Moniz (1875-1955), the Portuguese who was later to receive the Nobel Prize for physiology or medicine for his discovery of prefrontal lobotomy as a method of treatment in schizophrenia. Today, however, Egas Moniz is more remembered for his introduction of cerebral contrast-angiography in humans. The medical establishment rather coolly received this revolutionizing method of neurological diagnostisation, first adapted in 1927 after exhaustive studies of cadavers. Babinski, however, made an exemption in writing the preface to Egas Moniz monograph, published in 1931. Engaged and vividly he describes how Egas Moniz plans and carries out an exceptionally large project with an insight, a courage, and a single-mindedness leading his thought to his great fellow citizens, Bartolomeo Diaz and Vasco da Gama, as they embarked on their voyages to find the sea route to India. The description might as well go for Babinski's life-achievement.

We thank Matus Mikula and Peter Ziffling for information submited.

Babinski’s bibliography contains 288 items
• Oeuvre scientifique: recueil des principaux travaux.
  Publié par les soins de Barré, Chaillous, Charpentier, et al. Paris, Masson, 1934.
• J. Babinski:
  Étude anatomique et clinique sur la sclérose en plaques. Paris, 1885.
• Hystérie-pithiatisme et troubles nerveux d'ordre réflexe en neurologie de guerre.
  With Jules Froment (1878-1946). Paris, 1917; 2nd edition, 1918; translated into English.