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|NI FEATURE: JOURNEY THROUGH THE EONS - COMMENTARY
|Year : 2017 | Volume
| Issue : 3 | Page : 468-470
1892 and the tribulations of Joseph Babinski
Kalyan B Bhattacharyya
Department of Neuromedicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
|Date of Web Publication||9-May-2017|
Kalyan B Bhattacharyya
Amrapali Point, Flat C, 59F, Bosepukur Road, Kolkata - 700 042, West Bengal
Source of Support: None, Conflict of Interest: None
In the early 1880s, Joseph Babinski was appointed as Chef de Clinique under Jean-Martin Charcot at Salpétrière, Paris, in France. He appeared for the post of Professeur Agrégé, the pinnacle of academic distinction in France in 1892. Charles Bouchard, the earliest pupil of Charcot, who described the Charcot-Bouchard aneurysm along with his master, was the Chief of the Board of Jury. Charcot and Bouchard did not see eye to eye in the later period, and when German Sée, an external examiner did not join the board of examiners following illness, Bouchard, instead of seeking the assistance of an alternate examiner, employed the special right of Vote of Absence. Babinski and all other pupils of Charcot were unsuccessful, while those of Bouchard, came out with flying colors. An embittered Babinski, along with some of the other unsuccessful candidates, appeared before the Ministry of Public Assistance after a protracted legal battle for nearly 2 years but lost the case. They were even ordered by the court to pay on behalf of the the successful candidates for the legal battle. Babinski never sat for the examination again and this is the story of one of the most ignominious episodes in an examination anywhere.
Keywords: 1892, Charles Bouchard, German Sée, Jean Martin-Charcot, Joseph Babinski
This article describes an ignominious episode from the life of Joseph Babinski, the famous discoverer of several clinical signs in Neurology. That life often has ironic twists is well exemplified by the fact that despite all his achievements in the field of neuroscience, he could not be appointed to the academic post that represented the pinnacle of academic distinction, only due to the prejudice of his senior colleague.
|How to cite this article:|
Bhattacharyya KB. 1892 and the tribulations of Joseph Babinski. Neurol India 2017;65:468-70
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Jean-Martin Charcot was truly the emperor of French Neurology in the latter half of the 19th century, and he worked almost all his life at Salpêtrière, Paris, which literally means 'gunpowder.' It was founded by King Louis XIV as the Hospice de la Salpêtrière in the mid-17th century on the site of a gunpowder factory. When the French revolution broke out in 1789, the hospital was virtually a repository for criminals, lunatics, beggars, and prostitutes, who were removed from the streets and dumped there, and one historian aptly commented that Salpêtrière turned out to be the largest brothel in Europe. In the early 18th century, when Philip Pinel, a physician, approached the subject of psychiatry with a more humane and compassionate attitude towards the patients, Salpêtrière turned into a veritable center for the management of various psychiatric ailments. In this backdrop, Charcot laid the foundations of a remarkable centre for the study of neurological diseases there, accompanied by a host of brilliant students, who in later life, illumined the pages of neurosciences with a rare resplendence.
The list of Charcot's pupils at Salpétrière is overwhelming. Among others, Charles Bouchard, Edouard Brissaud, Joseph Babinski, Pierre Marie, Sigmund Freud, Gilles de la Tourette, Alix Joffroy, Victor Cornil, and Désiré-Magloire Bourneville were the shining stars in the firmament, who set scarlet standards in various fields in neurosciences. However, Babinski shines with a certain sheen that has led many neurologists to call him, “the most distinguished pupil of Charcot.” Yet, his life was not free from the trials and tensions of life.
Babinski, a French neurologist, with a name that perhaps suggests that he could as well be a Russian, was actually of Polish origin and his name in his native language was Józef Julian Franciszek Feliks Babinski. His parents were forced to leave Poland in 1848 and take refuge in France when a reign of terror was unleashed in Poland by the Russians in order to suppress Polish attempts at achieving independence from Russian domination. The defeat of his motherland left an indelible impression on young Babinski's mind. He joined the faculty of medicine as a medical student in 1875 and passed from the University of Paris in 1884. He passed “Internat,” the university examination, held in 1879 and secured the fourth position. He spent some time with Victor André Cornil at La Pitié, one more year with Alfred Vulpian, and following his commendable performance as an internee, Alix Joffroy recommended him to Charcot. During this time, Babinski and Henri Richardière were competing for the prize of the internship and a gold medal and the latter won it. Richardière was appointed for further 1 year as an internee and Babinski, the loser in the competition, was appointed as Chef de Clinique at Salpétrière, under Charcot, where he worked till the death of Charcot in 1893., He was awarded the doctorate degree in 1885 for a thesis on multiple sclerosis, the title being 'Etude Anatomique et Clinique sur la sclerose en plaques (Anatomical and Clinical study of Multiple Sclerosis). Charcot appreciated Babinski's talents as an astute clinical observer, and he was soon admitted to his affections; Sigmund Freud described him as the “preferred pupil of the Maitre,” and it has been said that their relation was not that of the mere master and student., His love and dependence on his pupil is well exemplified in the famous painting of André Brouillet where Charcot is delivering a lecture. It shows that he is commenting on Blanche Wittman, a so-called patient of hysteria, and Babinski is standing behind, supporting the patient, while Marguerite Bottard, Charcot's most trusted nurse is ready to assist. Sixteen pupils of Charcot Pierre Marie and Gilles de la Tourette, are assembled in front, watching the master endowed with enormous thespian talent, demonstrating in a most theatrical gesture, the proceedings.,
Following the fall of Napoleon Bonaparte in 1814, and the restoration of the monarchy, often known as the Bourbon restoration, the followers of Napoleon lost much of their control over academia and a new system of examination emerged in France. The medical faculty was expanded to 23 professors, and to develop a cadre of potential teachers, the position of professeur agrégé was created. The examination was held once every 3 years. It was open to all the French physicians and 36 agrégés were chosen on the basis of oral examinations, of which 24 were absorbed in teaching and the rest had to wait for 3 years before recompeting, for what was then considered, the acme of academic achievement in medicine in France. Their assignments were governed by the Ministry of Public Assistance. There was considerable political overtone behind these appointments, and it is said that such a coveted position was well-nigh impossible without benevolent patrons pulling the strings from behind the curtain, and incidentally, Charcot himself once failed in the examination in 1857. The story goes that his success 4 years later, owed much to the support and recommendation of Pierre Rayer, his supervisor in Paris Medical School and mentor, and later a member of the jury for the appointment to the position of professeur agrégé.,, Charcot at the helm of affairs in the 1880s, and thereafter, equally used his influence to promote his chosen students and Charles Bouchard was one of the early beneficiaries.
As the background for the complex history of the life of Babinski, it is important to note that Bouchard was 10 years younger to Charcot, and in 1868, the two of them described in the hypertensive small aneurysms in the cerebral vasculature, which has been named after them. Charcot's support helped Bouchard to rise quickly up the ladder, and in 1869, he was appointed as an agrégé. As R Satran writes, “proud, cold, learned and ambitious, Bouchard achieved the fame he desired.” With advancing fame, accompanied with acquisition of power, Bouchard broke away from Charcot's ideas, ridiculed his virtual obsession with hysteria, supported vivisection for the advancement of medical science, a practice that Charcot found repugnant, and paid little heed to his scientific views. Charcot on the other hand, felt that Bouchard's works “exhibited excessive pretensions in chemistry and bacteriology.” Charcot persuaded Babinski to sit for the examination for agrégation in 1892, and Bouchard was appointed the President of the Board of Jury. German Sée, one of the examiners and a professor of therapeutics at the Hétel Dieu, reported ill a few hours before the examination and could not attend., The prevailing system predicated that Bouchard was required by the law of ballot to choose an alternate examiner, but he suggested that the examination be postponed and therefore, it could not start before the next day. Sée arrived the next day, conducted the examination for 3 days, and then perforce, had to retire owing to his failing health. Bouchard did not seek the services of an alternative examiner and he himself assumed the role of a second jury implementing the authority of”Vote of Absence,”and though the candidates had the option to question the legitimacy of the assessors, no voice was raised, and as a result, Babinski failed.
A banquet was held in the honour of Charcot at the end of the examination by his former internees, and the judges as well as some of the candidates attended the dinner. Charcot by that time was awarded Legion de Honor, and Cornil, his first intern, described his master in laudatory terms and discussed at length his contributions to neurology. Charcot, in his turn, alluded to the brilliant works of Bouchard, mentioned him as his close colleague and wished him a long and successful life. However, when the results were declared, it was observed that of the 16 candidates appearing that year, 2 students of Charcot, namely Babinski and Gilles de la Tourette were unsuccessful, whereas Albert Charrin, Philippe Gaucher, and Pierre Eugene Menetriere, who trained with Bouchard, were rewarded. Among the successful candidates, George Henri Roger served as his Chief at Charcot's laboratory and only Jean Bernard Antoine Marfan was not associated with him in any capacity in the past. Five of the unsuccessful candidates namely, Babinski, Charles Achard, Albert Brault, Richardiere, and Robert Wurtz, took exception to the absence of German Sée (while Tourette stayed out), and appealed before the Ministry of Public Assistance, demanding annulment of the results., The question at the appeal was why the petitioners chose to wait till the results of the examination were published since they felt that a breach of protocol had taken place in conducting the examination. Curiously, no written marks were announced and only oral voting clinched the issue at the end of the examination. The issue of an instance of impropriety was also aired by others that the President was appointed by the ministry and not by the jurors and this left behind blatant scope of nepotism. Some, on the other hand, advocated in favor of the board of jury and wrote that the unsuccessful candidates lacked in original contributions in their curriculum vitae. Désiré-Magloire Bourneville denounced the method vociferously in Progrés Médical and being famed for describing tuberous sclerosis for the first time, hinted at an unholy nexus and bargain among judges during surreptitious dinner parties. Bouchard, on the other hand, defended the postponement of the examination as a gesture of courtesy and deference to an ailing assessor.,, Cornil was interviewed and he fervidly supported the cause of the petitioners, although he did not sign their petition. Moreover, he brought to light the obnoxious practice of getting favor based upon advancing pecuniary benefits as well, like receiving aid for the preparation for the written examination. He brought to light the intense, and at times, unhealthy and vulgar rivalry between Charcot and Bouchard, which was instrumental in the failure of some unfortunate candidates. A startling revelation was that German Sée possibly had a score to settle with Charcot, and at the beginning of the examination, he said, “I have been named a member of the jury to contribute to the downfall of the power of Charcot and he will repay me for never voting for me at the Institute. Do you wish to know the whole truth…?”
The bottomline of the story is that, in spite of the considerable public support and professional empathy, the Ministry of Public Assistance rejected the petition filed by Babinski and four others. The appeal was carried to the Council of State and it took 2 years for the Council to pronounce that there was no breach of protocol in organizing the examination. Those who passed the examination nursed an uncanny sense of premonition that the result might be abrogated, and therefore, appointed their private attorney to plead, if need be. Babinski and other petitioners were ordered by the court to pay the cost of the legal battle for the successful candidates contested, and, A d'Arsenval, a physician and one of the founders of experimental physiology, wrote to Charles-Ėdouard Brown-Sequard, his mentor, at College de France,”…hence the reign of Charcot at the medical school is over.”, The examination was held again in 1895, new regulations were laid down, and a new jury was selected. Achard and Wurtz, who belonged to the school of Charcot, were successful this time, along with Gilles de la Tourette, Léon Henri Thoinot, and Fernand Widal. However, the man who took the central stage in this high drama, did not appear again. An embittered Babinski was now a sad man and he left for La Pitié, where he was nominated as the chief in 1895 and retired in 1927, although he continued a weekly class on demonstration of clinical signs at the request of Louis Henri Vaquez, the hematologist and cardiologist, and a contemporary of Babinski. Like James Parkinson of England, he never held any faculty position anywhere. He described the extensor plantar response on the 22nd of February, 1896 before the Sociéte de Biologie, the forerunner of the French Neurological Society, Paris, in a paper consisting of only 28 lines. He died of Parkinsonism More Details in 1932.,,,
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