THE PLANTAR REFLEX - RePub

Charcot's concepts about hysteria were founded on iatrogenic induction,
and he gradually realized that organic diseases could not truly be mimicked
by hysteria. The boundary was 'not a ditch but an abyss', and he patiently
looked for signs which could not be reproduced voluntarily, enabling him
to distinguish the two at the bedside.
Babinski was in an even better position to pursue his own studies after
he had been appointed to an independent consultant position ('medecin
des H6pitaux') at the Pi tie Hospital, in 1890. He was to stay here for more
than thirty years, although in 1892 he attempted to obtain an academic
position via a highly competitive examination ('agregation'). He was
unsuccessful because the chairman, Bouchard, favoured his own pupils
above those of Charcot (Satran, 1974); this was the more remarkable as
Bouchard had himself been a former student of Charcot. Meanwhile,
Babinski's financial situation had improved through Charcot's help, and
Henri could return. The brothers stayed together after the death of both
parents, near the end of the nineties (their father's last years were marred
by parkinsonism). Neither seems to have considered marriage, although a
famous actress is said to have died with Joseph's portrait in her hands.
Henri served as a secretary and cook to his brother - in the latter capacity
he was even a well-known author (Ali Bab, 1928).
The toe phenomenon was the most impressive, but by no means the
only physical sign that Babinski discovered and used to distinguish organic
from hysterical hemiplegia. In the arm he was able to demonstrate
hypotonia objectively by increased flexibility (Babinski, 1896 b) or by
exaggeration of passive movements (Babinski, 1909); he also noticed that
the organically affected arm was apt to pronate when supported only at the
extensor side of the wrist (Babinski, 1907 a). With regard to the face he
pointed out that organic weakness of the mouth on one side should be
accompanied by asymmetrical activity of the platysma, and in the same
study he stressed that rising from a couch often resulted in hip flexion on
the paralysed side (Babinski, 1900 a). Not only did he separate hysteria
from structural disease, he also gave it a practical definition: a pathological
state that could, in general, either be reproduced or dispelled by suggestion.
In consequence he proposed another name: 'pithiatisme', from the Greek
words for 'persuasion' and 'curable'. During the first world war he
practised these ideas very successfully in the French military hospitals.
Babinski's work as a whole (published in 1934) was almost exclusively
clinical - he preferred to study the living rather than the dead. Much of his
work has been incorporated into growing concepts. Other findings are still
applied unchanged: 'inversion' of the supinator jerk in lesions of the 5th
cervical root, dysdiadochokinesia and hypermetria in cerebellar disorders,
absence of the ankle jerk in sciatica- even when examined with the patient
kneeling on a chair.
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