THE PLANTAR REFLEX - RePub

These early reports did not reach many physicians outside Babinski's
own circle. The first confirmatory report came from the Belgian neurologist
van Gehuchten (1898 a); he surmised that the pathological reflex was
related to a lesion of pyramidal tract fibres. In the meantime, however,
Babinski (1897) had expressed similar views in a discussion at the
International Congress of Neurology in Brussels, drawing a parallel
between the pathological reflex and the occurrence of the toe phenomenon
in healthy new-born infants. He wrote about this to van Gehuchten, who
apologized gracefully and added that in Belgium the toe phenomenon was
designated 'the Babinski reflex' (van Gehuchten, 1898 b). Another feature
of the reflex was also noticed more or less independently by the two
clinicians: the predominance of the great toe in the abnormal extensor
movement (Babinski, 1897; van Gehuchten, 1898 a).
In 1898 Babinski devoted a more elaborate article to the toe phenomenon;
it was drafted as a clinical demonstration, and published in a weekly
medical journal. This is often referred to as his classical paper, and indeed
it is of outstanding lucidity (an accessible English translation is that of
Wilkins and Brody (1967)). Apart from reaching a wide audience, Babinski
added some further observations:
- in normal subjects the roes can remain immobile after plantar excitation
(but they never show an extensor movement)
- the response may vary according to the part of the sole that is
stimulated, extension being more easily elicited from the outer side (and
predominating in the first or first two toes), and flexion (especially of the
outer toes) from the inner side
- he had encountered the roe phenomenon during an epileptic seizure,
following a toxic dose of strychnine (to disappear afterwards), and in
meningitis
- presence of the phenomenon excludes hysteria. Babinski also gave some
advice to avoid misinterpretation of the toe reflex (see Chapter IV).
Five years later, while the upgoing toe phenomenon was already
established as the sign of Babinski, its originator added a new feature:
abduction of the toes after plantar stimulation, cleverly illustrated by a
photograph showing the shadow of the toes against the other leg
(Babinski, 1903 a; for an English version see again Wilkins and Brody
(1967)). Babinski thought it could be of use in cases of doubtful toe
extension, but started by saying that it had already been noted by others
(he might have mentioned Collier (1899) or Walton and Paul (1900)),
who attached little diagnostic value to it. Moreover, Babinski himself had
occasionally found it in normal subjects. This feature is now known as the
'fan sign' ('signe de l'eventail'), a term coined by Dupre but with little
appeal for Babinski (1903 b). In later years he rarely emphasized it again
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