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History of Neurology
May 2004

Babinski's Clinical Differentiation of Organic Paralysis From Hysterical Paralysis: Effect on US Neurology

Author Affiliations

From the Departments of Neurology, Neurosurgery, and History, University of Florida McKnight Brain Institute, Gainesville (Dr Okun); and the Department of Neurology, Atrium Medical Center, Heerlen, the Netherlands (Dr Koehler).



Arch Neurol. 2004;61(5):778-783. doi:10.1001/archneur.61.5.778

Background  The formalized neurological examination developed near the end of the 19th century, and clinicians searched for signs to differentiate weakness due to structural lesions of the central nervous system (organic paralysis) from weakness caused by hysteria. Joseph F. F. Babinski worked in the shadow of his mentor, Jean M. Charcot, until 1893, but then developed independent studies to examine patients with both types of weakness.

Objectives  To elucidate the role of Babinski in differentiating organic paralysis from hysterical paralysis and to describe his influence on 2 US neurologists, Charles Gilbert Chaddock and Charles Franklin Hoover.

Design  Primary and secondary sources were studied to outline the discoveries of Babinski and to determine his influence on US neurology.

Results  Babinski described toe extension in cases of organic paralysis and specifically stated that this sign did not occur in cases of hysterical paralysis. Chaddock and Hoover were influenced by the work of Babinski and disseminated his discoveries to US neurologists, each developing additional techniques to differentiate the 2 forms of paralysis. Each considered his technique superior to the Babinski toe sign.

Conclusions  Although Babinski was only modestly appreciated by his contemporary peers of French neurology, his influence on US neurology was substantial. The Babinski, Chaddock, and Hoover signs that demonstrate whether structurally related upper motor neuron weakness exists continue to be useful maneuvers in separating these forms of paralysis from psychogenic weakness.

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