COMMENTARY

Did the Wise Men Notice the Babinski Sign in the Christ Child?

David J. Kerr, CBE, MD, DSc

Disclosures

December 24, 2020

This transcript has been edited for clarity.

Hello. I'm David Kerr, professor of cancer medicine at the University of Oxford.

As we approach Christmas, The BMJ accepts more laterally interesting papers, one of which caused me to take a small journey down memory lane.

This study was brought forward by some excellent French academicians who undertook an observational, systematic review of the prevalence of the Babinski reflex and response in 15th century Renaissance paintings of the Christ Child.

Let me unpack that a bit.

Via Google and established catalogs of fine art, these authors looked through depictions of the Christ Child by some of the most famous artists of all time, including Titian, Raphael, Leonardo da Vinci, Sandro Botticelli, van Eyck, and Albrecht Dürer. These are some of the greats of the Renaissance, a time when there was perhaps a truer depiction of the infant Jesus. Mannerist paintings tended to depict the human body in a rather idealistic way, whereas the Rhenish and Flemish painters sought to achieve something that was closer to an anatomic reality; they tried to transfer real life to the canvas.

Do you remember the first time you elicited the Babinski response? This is an important neurologic sign that was first introduced by [French neurologist] Joseph Babinski at the turn of the 19th century. Paris was a hotbed of neurologic inventions, with some of the greatest neurologists of all time.

Babinski first described this reflex in patients who have pyramidal dysfunction. If you stimulate the outside of the foot, then in the presence of pyramidal dysfunction or in an infant, you get an upward extension of the hallux, or big toe, by 30° or more.

I still remember learning about this as a medical student and the joy of eliciting physical signs. There's just something magical about being able to demonstrate these signs and to use the detective work associated with a physical examination to track down sometimes obvious, but sometimes subtle, neurologic defects.

A lot of that is gone now that we have MRI scanning and an ability to pinpoint precise neuroanatomic locations with modern scanners. Yet, I still remember the thrill, as a medical student, of being able to elicit a whole variety of neurologic responses. This paper made me think of that.

Pointing Forever Heavenward

These authors looked at a catalog of over 300 Renaissance paintings of the Christ Child and discovered that the Babinski sign was present in 30% of the paintings. How much truer to anatomy in real life could you find?

Also interesting, though not quite statistically significant, was that the Italian painters, who tended to be more Mannerist in outlook and sought to portray more of the ideal, were much less likely to show the Babinski reflex in their depiction of the infant Jesus.

Reading this careful analysis and looking at some of the pictures (reproduced with permission) made me smile. But it also made me think. When those shepherds, kings, and wise men first gathered in that little stable in Bethlehem, one wonders whether they noticed that the new baby Jesus, wrapped in swaddling clothes, did show the Babinski sign, that perhaps his big toe was pointing forever heavenward. Who could say or who could know?

Have a look at the paper. It's just beautiful and took me back to being a wee medical student in Glasgow all those years ago.

I wish you all a good, festive holiday and the very best for the coming year — one in which we have the fantastic advances of multiple effective vaccines. For the time being, Medscapers, over and out.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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