International Giants in Otology: Robert Bárány

rbAccording to Pearce (2007),  Magnus Gustaf Retzius (1842–1919) initiated the anatomical studies of the semicircular apparatus. The physiologist Jean Pierre Flourens (1794–1867) in 1825 had observed that when a pigeon’s horizontal semicircular canal was destroyed, it went on turning horizontally in a circle. Purkinje (1787–1869) proved that changing the head position induced vertigo in man.   And then?

…………… total silence in vestibular research for over 40 years!rb1

As in many fields the discovery of very important fundamentals are often found by accident.  Such was the discovery of caloric irrigation, in the words of Nobel Laureate Dr. Robert Bárány:

A patient whose ears I was syringing said to me: “Doctor, I only get giddy when the water is not warm enough. When I do my own ears at home and use warm enough water I never get giddy.” I then called the nurse and asked her to get me warmer water for the syringe. She maintained that it was already warm enough. I replied that if the patient found it too cold we rb2should conform to his wish. The next time she brought me very hot water in the bowl. When I syringed the patient’s ear he shouted: “But Doctor, this water is much too hot and now I am giddy again.” I quickly observed his eyes and noticed that the nystagmus was in an exactly opposite direction from the previous one when cold water had been used. It came to me then in a flash that obviously the temperature of the water was responsible for the nystagmus.”

Another famous otologist that had a profound impact on Otology at the beginning of the 20th century was Robert Bárány (1876-1936).  Dr. Bárány was the student of Dr. Adam Politzer (1836-1920), at the University of Vienna.  The son of a Jewish banker and Mary Hock, the daughter of a famous Hungarian scientist;rb young Robert was the eldest of their 6 children and it was his mother’s intellectual influence that was most pronounced in the family.  Additionally, various sources cite that he was stricken with Tuberculosis at a young age which left him with a permanently stiff knee and that fostered his interest in medicine.  While of concern, he was always in the best of shape, through primary and grammar school and playing tennis, hiking and other sports throughout his life and the stiff knee was of little consequence.

After completing his medical studies at the University of Vienna in 1900 with Dr. Adam Politzer, Bárány attended the lectures of Professor C. von Noorden, a noted Frankfurt internist and pathologist for one year and then studied at the Freiburg psychiatric-neurological clinic with Professor Emil Kracpelin  a famous psychiatrist. Professor Kracpelin’s lectures were on the connections between brain biology and mental illness.  It was there that Bárány’s interest in neurological problems was first awakened. On his return to Vienna he became the pupil of the surgeon Professor Karl Gussenbauer, and finally, in 1903, he accepted a position as demonstrator at the Otological Clinic under Professor Politzer. In his own research Bárány followed up on the theories of Flourens, Purkinje, Ernst Mach, Josef Breuer and others, and clarified the physiology and pathology of human vestibular function.

For his seminal work on the vestibular mechanism, he was awarded the Nobel Prize for his work in this field in 1914. Of interest is that this was during World War I and Dr. Bárány was serving the rb2Austrian Army as a civilian surgeon.  After some months in the service of his country tending to soldiers with head injuries, he was captured by the Russian Army in 1914.   After his capture he was transported with other soldiers by cattle car to the town of Merv in central Asia.  His reputation was known to the camp medical commander who promptly charged him with directing the Otolaryngology service for both the Austrian prisoners and the Russian soldiers. Dr. Bárány’s fate was considerably better than the other Austrians in the camp as he treated the local mayor and was a regular dinner guest at his home. While army service had enabled him to continue his neurological studies on the correlation of the vestibular apparatus, the cerebellum and the muscular apparatus; the news of his Nobel Prize Award for 1914 reached Bárány while he was in the Russian prisoner-of-war rb4camp.  The telegram notifying him of the award did not reach him until 1915, and it was only after intervention by Price Carl of Sweden and Tsar Nicolas I on behalf of the Red Cross, he was released from the prisoner-of-war camp in 1916 (when most of the Austrian prisoners of war did not make it back).  He was presented with the Nobel Prize by the King of Sweden at Stockholm and delivered his lecture titled  “Some New Methods for Functional Testing of the Vestibular Apparatus and the Cerebellums”.

Bárány returned to Vienna the same year (1916) but was bitterly disappointed by the attitude of his Austrian colleagues, who reproached him for having made only incomplete references in his works to the discoveries of other scientists, on whose theories they felt HIS discoveries were based. These attacks resulted in Bárány leaving rb3Vienna to accept the post of Principal and Professor of an Otological Institute in Uppsala, Sweden where he remained for the remainder of his life.   Gunnar Holmgren and a number of famous Swedish otologists published a paper in defense of Bárány.  During the latter part of his life Bárány studied the causes of muscular rheurmatism, and continued working on a book dealing with this subject even after he had suffered a stroke and was partially paralyzed.rb8

Bárány married Ida Felicitas Berger in 1909. They had two sons; the elder became Professor of Pharmacology at the University of Uppsala, his brother Assistant Professor of Medicine at the Caroline Institute, Stockholm. They also had a daughter, who married a physician and lived in the U.S.A.   Bárány died at Uppsala, Sweden on April 8, 1936.

References:

Pearce, J. (2007). Robert Bárány.   J Neurol Neurosurg Psychiatry. 2007 Mar; 78(3): 302.  Retrieved November 23, 2015.

 Nobel Lectures (1967). Physiology or Medicine 1901-1921, Elsevier Publishing Company, Amsterdam.  Retrieved November 23, 2015.

Bracha, A. & Siang, Y. (2015).  Robert Bárány(1876–1936): The Nobel Prize-winning prisoner of war.  Sinapore Med. Journal, 56(1), pp. 5-6.  Retrieved November 24, 2015.

Images:

Lane, K. (2015). Apothacary and Cure.  Retrieved November 23, 2015.

Paper Repica.com (2105).  Nobel Prize.  Retrieved November 23, 2015.

Svoljsak, P. (2015).  The memory of you will be externalMilko Kos Historical Institute.  Retrieved November 23, 2015.

 

About Robert Traynor

Robert M. Traynor is a board certified audiologist with 45 years of clinical practice in audiology. He is a hearing industry consultant, trainer, professor, conference speaker, practice manager, and author. He has 45 years experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. Currently, he is an adjunct professor in various university audiology programs.