The presence of the Babinski sign has already been reported for some Renaissance paintings, and the first observations date from the beginning of the 20th century.23 More recently, several articles have highlighted paintings by Botticelli containing the Babinski sign.789 However, some other paintings with the toe phenomenon have scarcely been written about,810 and, until now, no systematic study of the Babinski sign in paintings of the Christ Child from the Renaissance period (1400-1550 CE) has been reported. We did such a study using a specific and strict method, and we observed that 30% (90/302) of the corpus of paintings portrayed the Babinski sign, with a stimulating factor in 53% (48/90) of cases.

This frequency mainly results from the artistic revolution of the 15th century. In the Middle Ages, when trying to illustrate Jesus Christ, painters often represented him as a small man, with a childs height but the body and the face of an adult. Even though this way of depicting the Christ Child is still used in some Orthodox traditions, it might be regarded as an incongruity, as highlighted by Huysmans: To make the inexpressible childhood of a God () they created a hybrid being, who is no longer a child, and who is not a God, some kind of monster.11 During the Renaissance, artists began to represent the nudity of the Christ Child to demonstrate the incarnation of Christ, who was subsequently portrayed in a very realistic form. Modern art historians postulate that the imagery of the overtly sexed Christ was an affirmation of kinship with the human condition.12

As a consequence of a growing desire for realism, most Renaissance painters no longer depicted the Christ Child as a small man but as a real infant. If they had live infants as models, they were more likely to involuntarily reproduce the Babinski sign. This realism was not merely the consequence of the Italian Renaissance revolution, as it is much more the hallmark of Flemish and Rhenish painters (particularly van der Weyden, Memling, Schongauer, and Grnewald), known for their tendency to paint precise, sometimes trivial, realistic details from everyday life. This trend towards realistic depictions is also shown by the fact that in these paintings, the infants, clothes, and general surroundings belong to the Western world contemporary to the painters and are not representative of the Middle East in the first century CE. This tendency may also explain the painters frequent reproduction of the Babinski sign as soon as representation of the infants nudity became acceptable, examples of which are given in figure 2 (A-C and E). By contrast, Italian painters tended to depict idealised human bodies, with a quest for perfect beauty, as seen in the models of antiquity. Therefore, some painters, such as Fra Angelico, Masaccio, or Tiziano, failed to reproduce the Babinski sign in paintings of the Christ Child.

The stimulating atmosphere of the Renaissance period and the need for a scientific approach and precise observation of live infants to improve likenesses has been proposed as a possible explanation of the representation of the Babinski sign in paintings of the Christ Child. The particular influence of the Renaissance led to accurate depiction of natural phenomena, especially in painting. Botticelli was an example of this new focus; 40% (12/30) of his paintings in this study depict a Babinski sign. Nevertheless, many great painters such as Raphael, known to have an eye for the finest details of their subjects, almost never depicted the Christ Child with an upgoing toe. Many Renaissance painters were aware of medical and anatomical realities; neurological abnormalities such as ulnar claw or facial dystonia appear in Renaissance paintings,1314 and some painters, such as Michelangelo and da Vinci, did anatomical dissections. However, this pursuit of anatomical knowledge seems not to have been a determining factor for the depiction of the Babinski sign in painting; da Vinci, who was an anatomist and contributed to the study of the nervous system,15 depicted the Babinski sign in only 22% (2/9) of his paintings of the Christ Child. Similarly, no Tiziano paintings portray the toe phenomenon. However, Tiziano, with his student Jan van Calcar (c1499-1545), certainly participated in the illustrations for the anatomical masterpiece De Corporis Fabrica by Andreas Vesalius (1514-64).16

To explain about 30% of the paintings displaying a Babinski sign in our study, two other mechanisms can be discussed: the master-student effect, and the copying effect. In our corpus, a master-student effect could be suspected regarding Leonardo da Vinci and his master Andrea del Verrochio. It is interesting to note that the three paintings of the Christ Child with a bilateral Babinski sign were produced by Andrea del Verrochio (The Virgin and Child with Two Angels, c1470) (fig 2, D) and Leonardo da Vinci (Madonna of the Carnation, c1479, and Madonna Benois, c1480). This hypothesis of artistic filiation is supported by the bilateral Babinski sign that was recently observed on a sculpture attributed to da Vinci (Virgin with the Laughing Child).17

The practice of copying works of art was frequent during the Renaissance, particularly for Virgin and Christ Child paintings. The painting Saint Luke Drawing the Virgin, of which many copies exist, is a clear example of this.18 However, examples of serial paintings, such as Madonna and Child with the Milk Soup by Grard David, which was reproduced in at least three versions, are rare. The Babinski sign is not present in the version of this painting exhibited in the Palazzo Bianco in Genoa, whereas it is present in the other two versions. Cranach the Elder frequently produced serial paintings of the Madonna and Child, reproducing the Babinski sign each time, but this phenomenon cannot explain the occurrence of the sign in other paintings by the same artist, such as The Virgin and Child with a Bunch of Grapes (Fig 2, E).

An alternative hypothesis is that the dorsiflexion of the toes in some of Botticellis or Cranachs infants is a Mannerist stylistic choice, as shown also by the formalised placements of the fingers.9 However, this cannot be the correct explanation, as Mannerism is an artistic style that emerged only in the later years of the Italian High Renaissance (around 1520), breaking all the codes of anatomical accuracy, proportion, and balance.19 Mannerism is clearly absent in paintings by Flemish painters such as Rogier van der Weyden or Grard David or Rhenish painters such as Martin Schongauer, who frequently depicted the Babinski sign. Examples of works containing the Babinski sign by these artists are in figure 2 (A, B, and C).

Many studies of the plantar reflex in infants have been published. These have sometimes reported contradictory findings about the flexion or extension response (Babinski sign) of this reflex. One reason for these heterogeneous results may be the interference of the grasp reflex of the toes, which is generally present during the first year of life. Taking the grasp reflex into account, the physiological response of the plantar reflex until the age of 6 months is hallux extension. The main factor in eliciting the hallux extension in infants seems to be the intensity of the stimulus.420 In our corpus, we observed stimulation of the foot in 53% (48/90) of the paintings. We obviously could not evaluate the intensity of this stimulus. Nevertheless, as already noted, in some cases the stimulus was directly applied to the lateral part of the sole, the site known to elicit the Babinski sign.7

At the age of 6 months, hallux extension usually ceases to be the manifestation of the plantar reflex.420 Nativity, Adoration of the Magi, and Presentation at the Temple paintings are supposed to be set during the first week of Jesuss life, and Madonna and Child paintings during the first year. Evidently, the age of the Christ Child as depicted in paintings does not correspond to the chronological reality of these events. We therefore cannot show a relation between the frequency of the Babinski sign and the subject matter of the paintings in our series. Even if a preoccupation with realism dominated in this artistic period, the painted Christ Child usually appears older than the reality. As determining the precise age of the model is difficult, we are not able to establish a correlation with the myelinisation of the nervous system. The use of older children as models might therefore explain the low frequency of the depiction of the Babinski sign by some painters.

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The Babinski sign in Renaissance paintingsa reappraisal of the toe phenomenon in representations of the Christ Child: observational analysis - The BMJ