Surgery stories

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Józef
Babiński

Pioneer of neurosurgery

Józef Babiński, one of the most famous neurologists in the world and a pioneer in neurosurgery, was born in 1857, in Paris. He was the son of Polis immigrants. Aleksander and Henryka Babińscy sent their children, Józef and Henryk to the secondary schools, maintaining patriotic traditions. In 1879, the younger son, Józef, completed his studies at the Faculty of Medicine at the University of Pais and quickly took a permanent position as an intern in the Paris Hospital. He gained his experience, among others, under guidance of Alfred Vulpian, known for his groundbreaking studies on adrenal glands and description of amyotrophic lateral sclerosis.

Surely, the cooperation with Vulpian served as the foundation of Babiński’s achievements in neurology. Only 6 years after he started his internship under care of the 
distinguished professor, Babiński obtained the title of a doctor in medicine, following presentation of a pioneer dissertation on multiple sclerosis. In the same year, he went to a hospital in Salpetriere, where he became an assistant of Jean-Martin Charcota, a head of the clinic of neurology. Babiński’s hard work bore fruits in the form of a series of successes – he was appointed Charcot’s first assistant, and in 1890, on the basis of competition examinations he obtained a title of a head of Paris hospitals. Unfortunately, divisions and professional competition with physician Charles Bouchard prevented Babiński from climbing up the ladder of scientific career, since in 1892 he became a victim of personal intrigues during his examinations for a French title of a reader (associate professor). However, he continued his academic development, giving lectures in private courses in neurology, which enjoyed a great international reputation.

Scientific achievements and Babiński reflex

During the course of his career, the hero of our story was the author of an outstanding output of publications – he wrote about 300 original papers. In his opinion, the foundation of neurology consisted in the thorough familiarisation with and examination of neurological symptoms, and their accurate differentiation into physiological and pathological reflexes. He is the most commonly known for describing a reflex described with the use of his surname: Babiński sign, Babiński reflex. Irritating the lateral side of the skin of the sole of a foot with a blunt object (for instance a neurological hammer) causes the spontaneous dorsal flexion of the hallux. In his short publication, presented in 1896 in the Paris Society of Biology, Babiński described the manner of developing a pathological reflex and associated it with the damage of the pyramid path and central spastic paresis. Babiński reflex is used during basic neurological examinations until present.

Doctor also devoted much of his scientific work to cerebellar disorders. In his publication of 1913, he presented the scheme for the differentiation between cerebellar and ventricular pathologies, still relevant today. Another of his scientific achievements involved suggested method of diagnosing a general paralysis of the insane through examination of reactions of pupils exposed to light. He proved that an absence of the said reflex constitutes a pathognomonic symptom of neurosyphilis, together with changes in aorta and myocardium. These pathologies were named, to honour him, the Babiński reflex. Even when he did not know the aetiology of said disease, he was one of the first promoters of treating syphilitic myelopathy (tabes dorsalis) with the use of anti-syphilis medicines.

He also contributed to the development of neurology, studying such syndromes as adiposogenital dystrophy in pituitary tumours (Babiński–Fröhlich syndrome), or a spinal cord damage syndrome, involving contralateral hemiplegia, numbness in the trunk and limbs, and Horner syndrome ( Babiński– Nageotte syndrome). During the IWW, he also conducted studies on the peripheral nervous system and the “paralysis syndrome”. He also described a notion of anosognosia – is a deficit of self-awareness, in which a person with some disability seems unaware of its existence as a result of damaged cerebral cortex.

Influenced by his mentor Charcot, Babiński got interested in the condition at the borderline of neurology and psychiatry – hysteria. During that period, physicians had dispute about aetiology of this disorder. Charcot tried to find its organic background, however, Babiński did not share his opinion and was convinced about the psychological reasons underlying hysteria. Their duet and disputes may be compared to another well-known pair of scientists – Freud and Jung.

At the beginning, we mentioned great achievements Babiński made in the field of neurosurgery. It is impossible to quote his publications that constitute the foundations of this domain of medicine. The brilliant doctor proposed, among others, an innovative procedure of skull trepanation reducing pressure. Moreover, he published many papers concerning intracranial tumours and wartime gunshot damages of the head. He was, undoubtedly, one of the pioneers of French neurosurgery.

Break in work, relationship with Poland and last years of life

It is an interesting point that in 1922, while being a head of the Hospital de la Pitié, he turned 65 years and – according to the binding law of that time – he had to cease his medical practice. However, thanks to the help of his friend, Henri Vaquez, he could still practise privately for the next few years. Thanks to that, he could still develop his practical skills, which cannot be learned when studying thick books during a compulsory break in work. Today, when we have basic kit sutures at hand, we are in a comfortable situation, unlike Józef. Even during break at work, we can improve surgical technique and skills in sewing simple stitches.

While practising in France, Babiński never forgot the home country of his ancestors. He was a member of many outstanding medical societies, took part in Conventions of Polish Neurologists, cocreated and published in Neurologia Polska (Polish Neurology), as well as ensured the opportunity for Polish doctors to work abroad and publish in French magazines. His brilliant publications were also translated into Polish.

Being an outstanding neurologist, he did not protect himself against Parkinson’s diseases during the last years of his life, which caused much suffering to Bagiński, as it previously had caused to his father. He was buried in Paris, the city which owes him so much.

Babiński’s legacy

During his whole medical career, the distinguished doctor believed that a thorough examination of a patient constitutes the basis of diagnostics. All his scientific works, exceptionally innovative and substantive, were based, first of all, on clinical observation of patients and outstanding logics of reasoning. Babiński was not against modern technologies, however, he believed that the basic tools in his works were such instruments, as a neurological hammer, needles or test-tubes with cold and hot water. He examined his patients thoroughly, in silence, often for many hours. It may be the reason why he is recalled as a genius, dreaded but respected. Undoubtedly, he is one of the fathers of the detailed scheme of taking patient’s history and neurological examination, binding until present, which is taught to students of medicine, as the basics of care over patients. Of course, each doctor knows the notion of “Bagiński reflex, however, the French physician with Polish origin gives an even more important lesson – knowledge of basics of physiology and pathophysiology, combine with logical thinking and accurate examination always constitutes a key to correct diagnosis.

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