Robert Bárány

Robert Bárány was the 1914 recipient of the Nobel Prize for Physiology or Medicine, «for his work on the physiology and pathology of the vestibular apparatus».

Bárány was the son of Ignaz Bárány, a bank official, and Marie Hock. He studied medicine at the University of Vienna and received his doctorate there on April 2, 1900. He then trained in internal medicine as Carl Harko von Noorden's (1858-1944) assistant at the Städtisches Krankenhaus in Frankfurt am Main. He later studied with Emil Kraepelin (1856-1926) at the psychiatric-neurological clinic in Heidelberg and at the neurological clinic in Freiburg im Breisgau until April 1902, and then went to Paris.

In 1903 he returned to Vienna where he was a student of Sigmund Freud (1856-1939). A favourite story of his concerned Freud's theory that dreams were an expression of desire (Wunschträume). Freud used to tell his students "if you can't explain your dream, come and see me". Bárány did so and described for Freud a dream that had nothing to do with desire. Freud's retort was "That is very simple. You had the desire to contradict me".

In Vienna Bárány received his surgical training at Carl Gussenauer's (1842-1903) surgical clinic at the Vienna General Hospital, where he was an operator. On October 3, 1903, he entered service at the University of Vienna ear clinic under Adam Politzer (1835-1920), the founder of otology in Austria.

Bárány was impressed by the rhythmic nystagmus produced by syringing the ears, a phenomenon which, he discovered, was related to the temperature of the water. From his painstaking observations he was able to analyse the factors governing labyrinthine stimulation. There was always a question in Vienna of priority in this field, for Bárány is said to have commenced on the labyrinth after he had witnessed Alexander Spitzer's (1868-) demonstration of labyrinthine nystagmus in experimental animals.

Ear and equilibrium
It is the task of the human ear not only to hear but also to be involved in the maintenance of equilibrium, the apparatus for which is found in the inner ear and consists of a space filled with fluid. Before Bárány the organ of equilibrium had only been the subject of investigations by various theoretical workers - Pierre Flourens, Ernst Mach, Josef Breuer, Julius Ewald - who had used pigeons and rabbits. On the basis of his observations concerning vertigo and equilibrium disturbances in patients, the French scientist Prosper Menière (1799-1862) related these symptoms to the equilibrium system, thus terminating the period of theoretical speculative investigations into the organ.

Bárány's main contribution was the clinical application of these experimental data to humans, which led to the development of methods of investigating the human equilibrium system. It had been known for some time that this apparatus reacted to rotary sensations. Bárány discovered the laws governing these rotary reactions and thus was able to define the subjective sensations of dizziness by means of such objective indications as definite eye movements and reactions of the body muscular system. His most important discovery was the caloric nystagmus.

The organ of equilibrium can be stimulated by differences in temperature by irrigation of the ears with hot or cold liquid, a method that makes it possible to excite each organ separately. The technique is especially valuable because it can be used clinically at the bed of the patient. Incidentally, Bárány was able, in the course of his further studies, to investigate the relationship between the equilibrium apparatus and the nervous system, thus creating the basis for an entirely new field, otoneurology.

War and prize
In 1909 Bárány was habilitated in oto-rhino-laryngology and given the title of Dozent, and in 1912 received half the Politzer Prize. The following year he was awarded the ERB Medal (named for Wilhelm Heinrich Erb, German neurologist, 1840-1921) of the German Neurological Society, and in 1914 the Guyot Prize for his contributions to otology. The latter prize is named for Goyot, an eighteenth-century postmaster in Versailles who first catheterised the Tuba eustachi

Bárány was appointed Professor Extraordinarius shortly before the war. In spite of ankylosis in the knee, he volunteered for military service in 1914 in order to be able to test his ideas on the treatment of brain wounds. He served with the Austrian army, but was captured. In 1914, while a Russian prisoner of war in the fortress of Przemysl, he was awarded the Nobel Prize for physiology or medicine. Prince Carl of Sweden persuaded the Czar to release him and he received his prize in Sweden in 1915.

During his trip to Sweden Bárány was invited to take the chair of otology at the University of Uppsala, which he accepted in 1917, at first as Privatdozent and titular professor, and from 1926 as ordinarius. He built up a great reputation as an able surgeon for sinus disorders, deafness and cerebellar and cerebral abscesses.

Bárány adapted himself well to his new country, Sweden, where his activities as philanthropist, pacifist and humanist brought him further prominence. It was upon his instigation that the International Academy of Politics and Social Science for the Promotion of World Peace was founded in Sweden in 1929.

Now you see it – now you forget it
Bárány was essentially a man of theory. He would develop a theory and then put it to the experimental test. A victim of insomnia, he would lie in bed until the early hours thinking, thinking, thinking. His dependency on theory is illustrated by the following story. While he was in Berlin in Oskar and Cécile Vogt's laboratory he and the Vogts were performing an experiment on a monkey. Oskar Vogt syringed cold water in one ear and simultaneously stimulated the cortex of the same side while Cécile Vogt and Bárány watched the direction in which nystagmus occurred. On cessation of the ocular movements Bárány declared that they were to the left, whereas Cécile argued that they were to the right. The argument grew more and more heated for the ensuing five minutes. The next day Bárány came into the laboratory and stated that during the night he had reconsidered the matter. He conceded that Cécile was right. He had allowed himself to be so influenced by theory that he failed in the observation. The same happened to Bárány several times in the Vogts' laboratory. His unreliable memory for observed facts might well serve as an explanation for his forgetfulness of the work of Spitzer. There was no question that he was most honest and upright.

Bárány was a member or honorary member of numerous scientific societies. In 1924 he was awarded an honorary doctorate by the University of Stockholm. A quiet, withdrawn researcher who worked with fanatical devotion, he lived happily with his wife, Ida Berger, who bore him two sons and a daughter.

Bárány died after having been afflicted with thalamic pain for a year and a half. Had he survived two weeks longer he would have witnessed an appropriate celebration of the anniversary of his sixtieth birthday. His death occurred one hundred years after the birth of his teacher, Adam Politzer.

Robert Bárány published a total of 184 scientific papers.

• Ueber die vom Ohrlabyrinth ausgelöste Gegenrollung der Augen bei Normalhörenden.
  Archiv für Ohrenheilkunde, Leipzig, 1906, 68: 1-30.
• Untersuchungen über den vom Vestibularapparat des Ohres reflektorisch ausgelösten rhythmischen Nystagmus und seine Begleiterscheinungen. (Ein Beitrag zur Physiologie und Pathologie des Bogengangapparates).
  Monatsschrift für Ohrenheilkund, Berlin, 1906; 40: 193-297.
  Monatsschrift für Ohrenheilkund, Berlin, 1907; 41: 477-526.
  In book form, Berlin, Coblenz, 1906.
• Zeigeversuch. Neurol, 1910, 29: 748.
• Vestbularapparat und Zentralnerven System.
  Medizinische Klinik, München, 1911, 7: 1818-1821.
• Physiologie und Pathologie (Funktionsprüfung) des Bogengang-Apparates beim Menschen.
  Leipzig, Deuticke, and Vienna, 1907
• Funktionelle Prüfung des Vestibularapparates.
  With Karl Wittmaack (1876-). Jena, 1911.
• Klinik des Bogengangapparates. Leipzig, 1913.
• Die Geschichte der Physiologie des Vestibular Apparates seit 1850.
  In Adam Politzer's:
  Geschichte der Ohrenheilkunde, volume 2, Stuttgart, 1913.
  Translated into English with extensive commentary by D. G. Pappas. Annals of Otology, Rhinology and Laryngology, St. Louis, 1984, 93, Supplement 110.
• Historischer Rückblick auf die Entwicklung der Lehre vom peripheren und zentralen Bogengangaparat.
  Verhandlungen der Gesellschaft Deutscher Naturforscher und Ärzte. 85. Versammlung in Wien. Leipzig, 1913: 241-250.
• Klinik des Bogengangapparates.
  Verhandlungen der Gesellschaft Deutscher Naturforscher und Ärzte. 85. Versammlung in Wien. Leipzig, 1913: 241-250.
• Primäre Wundnaht bei Schussverletzungen, speziell des Gehirns. Wiener klinische Wochenschrift, 1915, 28: 525.
• [Nobel address September 11, 1916]. Nordisk tidskrift för oto-rhino-laryngologi, 1916, 1: 157.
• E. Wodak:
  Kurze Geschichte der Vestibularforschung.
  Stuttgart, 1956, pp. 18 ff, and 47 ff.
• H. Hartmann:
  Robert Bárány. Notring Jahrbuch, Wien, 1957, page 21.
• Robert Bárány.
  Lexikon der Nobelpreisträger. Frankfurt-Berlin. 1967, page 9.
• K. Burian:
  Robert Bárány.
  Österreichische Nobelpreisträger. Wien, 1961, page 9.
• C. O. Nylen:
  Robert Bárány.
  Archives of Otolaryngology, Chicago, 1965, 82: 316.