1.18 That up-going toe, j.mac w.macgregor.pdf – samj archive … anoxic tank

1.18 THAT UP-GOING TOE, J.Mac W.MacGregor.Pdf – SAMJ archive

592 SAMT DEEL 71 2 MEI1987 that up-going toe J. MACW. MACGREGOR A sage once said, ‘it is ominous [Q aim for a fame that’s eponymous, for you’ll find, my dear friend, that in the end your existence is quite anonymous.’ there are a few eponymous states whjch we must accept, but one might question how many medical students regard argyll robenson as one man or two, and how many think of cheyne¬≠ stokes as two men or one. Among the host of eponyms, however, the name of babinski is alive and well, just over 90 years after joseph babinski wrote his fust paper on the reflex which carries his name.


He wrote at least nine papers on this reflex between 1896 and 1922 and it is of some interest to review the development and change of his thoughts for in neurological circles no name is evoked more often – many times every day – and few signs are less well understood.Anoxic tank joseph franc;ois felix babinski (1857 -1932) was parisian born of polish parents and looked more prussian than french; straight shouldered with a wispy kaiser wilhelm moustache, he commanded respect despite his rather shy demeanour. He lived most of his life with his elder brother henri, who was a distinguished gastronome and author of a famous recipe book which he published under the pseudonym of ali-bab. Henry miller l relates that it used to be said that if the ward sister whispered in joseph’s ear that the souffle was nearing perfection, he would abruptly leave his ward round, jump in his carriage and drive home to share his brother’s culinary triumph. Famed as babinski is for the reflex named after him, he worked in many other fields and was the first to localise a spinal tumour so that neurosurgeons knew where to operate.Anoxic tank he was a great clinician and it is said that the foundations of today’s examinations owe their methodology to him. When babinski sat his examination for professeur agrege he was not accepted. This was because the regulations stated that nine examiners must be present throughout. A dr see, who was one of the distinguished nine, took ill and was unable to continue. This resulted in the examination being declared invalid. There was much gallic emotion over this, but babinski never sat the examination again and held himself aloof from the general stream of french neurology that looked towards charcot as its fountainhead. It is sad to think that this great man, who enlivened neurology by his astute clinical data, ended his life in the stagnant embrace of parkinsonism.Anoxic tank henry miller l says that a few days before he died babinski said that he regarded his work in surgical neurology, especially his studies of spinal cord compression, as his most imponant contribution to neurology. Indeed this may have been true at that time, though today we honour him for a sign that, above all others, indicates a disorder of the pyramidal system, a system on which our slightest move depends. On 22 february 1896, babinski 2 wrote a shon paper on the sign which now bears his name, which referred to the plantar reflex in hemiplegia. He said (in translation): ‘on the paralysed side, stimulation [of the planta] seems to give rise to a flexion of the thigh on the pelvis, of the leg on the thigh, and of the medical centre, heerengracht, cape town J.Anoxic tank MACW. MACGREGOR, F.R.C.P. (ENG.), ER.C.P. (EDIN.), D.P.M. (LOND.) foot on the leg, but the toes, instead of flexing, give a movement of extension on the metatarsals.’ he uses the word orceils (toes) in the plural. In july 1898 babinski’ gave a lecture in which he expanded a little on his first account, pointing our that in what he called ‘the phenomenon of the toes’ the extensor movement was executed more slowly than the normal flexion and that there might be ‘formes frustes’ in which the plantar reflex may be ‘partly pathological and partly physiological’; he commented on the need for the patient to be relaxed and that the stimulus should be a nocuous one, applied to the outer pan of the foot.Anoxic tank when.Published, this lecture, which occupied 6 columns ofla semaine medicale, had many interesting features. Babinski mentions the false pseudo-extensor that occurs when there is a fixture of the metatarsal joints; the extensor plantar reflex in the newborn, and the fact that spinal lesions give a more prominent extension than cerebral lesions. Indeed, if everyone interested in the phenomenon of the toes were to read this paper once every decade we might fmd far better understanding of the phenomenon and a greater clarity in teaching its imponance to medical students. In 1903 babinski 4 published a third shon paper in revue N eurologique entitled ‘on the abduction of the toes’. This was the fust time that the fanning of the small toes was mentioned in counection with the extensor plantar reflex, and babinski said that he felt this feature was of value in cenain doubtful cases.Anoxic tank he showed this fanning in a very perspicacious way; it is not easy to show separation of the small toes, so babinski held up the patient’s foot, shone a bright light on it, so that the shadow of the foot was thrown on to the patient’s opposite bare leg and there, literally in black and white, the toes were seen to be separating one from another and farming outwards. Anyone who has seen this picture will never again be in doubt about the reality of le signe de l’evenrail, as it was named by babinski’ later that year. There was much controversy, some of it very heated as one might expect among french neurologists, as to whether this extensor plantar reflex was a separate phenomenon or pan of a general flexion reflex, and whether it indicated a pure pyramidal tract lesion or a lesion of a wider pyramidal system.Anoxic tank babinski himself was never very sure. Walshe,6 who may be considered the prime antiheresiarch of muddled neurological thinking, wrote an early paper on the extensor plantar reflex, considering it to be pan of a ‘defensive reflex’. Babinski did not for some years consider this factor, indeed in his second paper 3 he said: ‘to the present time I have not observed this sign a single time in a subject whose pyramidal system was completely sound.’ later in the same paper he said: ‘this sign, although it indicates the presence of a pyramidal system disturbance, does not denote its severity.’ note, he uses the term pyramidal system and not pyramidal tract. If anyone wants to get clarification on the confusion that arose about the plantar reflex in the first 60 years after babinski’s original description of it, a study of walshe’s 1956 paper in brain 1 is recommended.Anoxic tank since that date there have been a number of excellent studies of this reflex but none has taken us much beyond walshe’s original analysis. Landau and clare 8 showed clearly that specific activation of pain endings on the lateral side of the foot, with effective spatial and temporal summation, are necessary for both the flexor and extensor response. The unique feature of the pathological