Book Review

Joseph Babinski: A Biography

N Engl J Med 2009; 360:2037-2038May 7, 2009

Article

Joseph Babinski: A Biography
By Jacques Philippon and Jacques Poirier. 453 pp., illustrated. New York, Oxford University Press, 2009. $49.95. ISBN: 978-0-19-536975-5

Joseph Babinski (1857–1932) — recognized today primarily for the eponymous Babinski sign of the physical examination — became a pioneer of modern neurology when he broke with the tradition of his former mentor, Jean-Martin Charcot, to develop and promulgate the neurologic examination. Charcot, unquestionably the leading neurologist of the mid-19th century, had relied primarily on medical history taking and astute observation to formulate clinical assessments. He had also championed the idea that hysteria was a dynamic dysfunction of the cerebral cortex. Babinski, in contrast, doubted the utility and accuracy of medical history taking and emphasized the importance of a properly conducted neurologic examination. He argued that hysteria was an ill-defined psychological disorder that would be better labeled “pithiatism,” a term he coined from the Greek, meaning created by suggestion and curable by persuasion.

Joseph Babinski, circa 1904. Photograph by Eug. Pirou, Paris.

In this scholarly biography, Jacques Philippon and Jacques Poirier examine various facets of Babinski's “complex and captivating personality.” He was a “man of reason” who was exacting in his clinical analyses, as well as a doubting Thomas who was forever demanding verification, skeptical of patients' symptoms and of examinations that were performed by others. He was a masterful debater who was firm in his convictions, articulate, and willing if necessary to openly oppose prevailing wisdom. Vincenzo Néri, a former student, described Babinski at meetings of the Société de Neurologie de Paris as characteristically “alone against everybody, admirable to see and to listen to, with the precision of a beautiful gladiator.” He was also a “righter of wrongs,” but sometimes caustic and prone to public arguments with colleagues. A perfectionist workaholic who was plagued by an “illness of doubt,” he struggled to put pen to paper, then repetitively reworked manuscripts and obsessively reexamined patients. A stern taskmaster, he was nevertheless charismatic, warm, and collegial to a small circle of devoted friends, and his playful private humor was “sometimes in doubtful taste.”

The intrigues and politics of academic appointments and promotion in 19th-century France are well detailed and seem remarkably modern in character — or perhaps the ambitions, jealousies, and maneuvering for authority and power are universal and have changed little in the past century. In any case, Babinski was a victim of the rivalry between Charcot and Charcot's ambitious and ruthless former student, Charles Bouchard, who was seeking to establish his own school and envied Charcot's fame. As Charcot's influence faded, Bouchard successfully blocked the academic advancement of Charcot's students, including Babinski.

Like his American contemporary Silas Weir Mitchell, who was also denied a professorship in neurology, Babinski focused his energies on clinical practice and on developing the neurologic examination. Philippon and Poirier provide the most extensive bibliography available of Babinski's writings, summarize his incredible medical corpus, and provide interesting and little-known insights into some of his well-known contributions — including the Babinski sign, various techniques to distinguish between organic and hysterical disorders, the description of anosognosia, and the description of unilateral depression of the Achilles reflex in sciatica.

The authors appropriately emphasize the origin, description, and significance of the celebrated Babinski sign. Babinski's public statement that the sign was discovered through meticulous examination and comparison of patients with organic and hysterical disorders can be contrasted with Jean-Alexandre Barré's more colorful version that Babinski had noted different responses of the toes of two women in adjacent hospital beds — one who was hysterical and one who was suffering from spinal cord compression — as he affectionately patted the feet of his patients while passing through a ward of the Hôpital de la Pitié on a warm summer day.

Joseph Babinski is a fresh and balanced assessment of the man and his many contributions. Its authors illuminate the man behind the eponym, thoughtfully consider his legacy, and provide valuable (and surprisingly modern) insights on academic power struggles, the relative benefits of academic and nonacademic practice, and the difficulties of defining one's own career path as distinct from that of a supportive mentor.

Douglas J. Lanska, M.D., M.S.P.H.
VA Medical Center, Tomah, WI 54660
douglas.lanska@med.va.gov