A Hungarian Jewish family in Vienna
Robert Bárány was born in Vienna on April 22, 1876, the eldest of six children. His father, Ignác Bárány, was a Hungarian Jew born in 1842 in Várpalota, in the Kingdom of Hungary, who worked as a bank official and as the manager of a farm estate. His mother, Maria Hock, was the daughter of a well-known scientist from Prague, and the Nobel Foundation’s biography says that it was her intellectual influence that was most pronounced in the family.
As a young boy Robert caught tuberculosis of the bones, which left him with a permanently stiff knee. His family believed that this illness first turned his mind to medicine. The disability did not stop him from playing tennis and walking in the mountains throughout his life. He was top of his class at primary school and at the gymnasium, and among the best students of his year at university.
Training in Vienna and Germany
Bárány studied medicine at the University of Vienna and graduated in 1900, at a time when the Vienna medical school was one of the most famous in the world. He then spent a year in Frankfurt am Main attending the lectures of the internist Carl von Noorden and worked at Emil Kraepelin’s psychiatric and neurological clinic in Germany, where his interest in the nervous system was first awakened. Back in Vienna he trained in surgery under Carl Gussenbauer.
In 1903 he joined the ear clinic of the University of Vienna under Adam Politzer, the founder of otology as a medical specialty. There he took up a puzzle that physiologists such as Pierre Flourens, Jan Purkinje, Ernst Mach and Josef Breuer had studied before him: how the fluid-filled loops deep in the inner ear, the semicircular canals of the vestibular system, tell the brain which way the head is moving.
Warm water, cold water
To understand why this mattered, it helps to know how balance works. Each inner ear contains three semicircular canals, set at right angles to one another and filled with fluid. When the head turns, the fluid lags behind and bends tiny sensory hairs, which signal the movement to the brain. The brain uses those signals to keep the eyes fixed on what we are looking at and to keep the body upright. When the system on one side fails, the brain receives conflicting messages, and the result is dizziness, nausea and unsteadiness.
The breakthrough came at a patient’s bedside. Ear doctors routinely syringed patients’ ears with water to clear them. Bárány noticed that some patients became dizzy and that their eyes made rhythmic, involuntary flicking movements, called nystagmus. According to a well-known account, one patient told him that he only felt giddy when the water was not warm enough. Bárány found that cold water caused the eyes to flick in one direction and warm water in the opposite direction, while water at body temperature caused nothing at all.
He realised why. The horizontal semicircular canal lies close to the ear canal, so warming or cooling the outer ear changes the temperature of the fluid, the endolymph, inside it. Warmed fluid rises and cooled fluid sinks, and that flow stimulates the balance sensors just as turning the head would. The eye movements are the brain’s reflex response. From 1906 Bárány published a series of studies of this “caloric reaction” and of the related reflexes produced by spinning a patient in a rotating chair.
A test that is still used today
The importance of Bárány’s discovery was practical. Because each ear can be tested on its own, the caloric test lets a doctor find out whether the balance organ on one side is working or damaged, something that had been very hard to establish before. It made it possible to diagnose diseases of the inner ear precisely and, as the Nobel Foundation notes, it had a major impact on their treatment, opening the way to surgery on the vestibular organ.
More than a century later the caloric test is still a standard part of the examination of patients with dizziness and vertigo, now usually recorded with video goggles or electrodes in a test called videonystagmography or electronystagmography. Millions of people with conditions such as vestibular neuritis, Ménière’s disease or damage from certain antibiotics are assessed with descendants of his methods. Bárány is also credited with the first description in the medical literature of the episodes of vertigo triggered by sudden head movements now known as benign paroxysmal positional vertigo, one of the most common causes of dizziness, which today is often cured in minutes with simple head manoeuvres.
Balance, the brain and pilots
Bárány also studied how the balance organs work together with the cerebellum, the part of the brain that coordinates movement. He devised a pointing test, in which a patient with eyes closed tries to point repeatedly at a target, to reveal disorders of the cerebellum and the vestibular system. A small clockwork noise box that bears his name was used for decades to mask hearing in one ear while testing the other.
His rotating chair outlived him in an unexpected setting. Spinning a person and then asking them to judge their own motion shows how easily the balance system can be fooled. The Bárány chair became a standard tool for teaching military and civilian pilots about spatial disorientation, the false sense of motion that has caused many fatal crashes in cloud and darkness, and it is still used in aviation training.
A prize received in a prison camp
When the First World War broke out, Bárány volunteered as a civilian surgeon with the Austro-Hungarian army, partly to study head wounds and the links between the balance organs, the cerebellum and the muscles. In 1915 the fortress of Przemyśl fell and he was taken prisoner by the Russian army. It was in a prisoner-of-war camp in Russia that he learned he had been awarded the Nobel Prize in Physiology or Medicine for 1914, “for his work on the physiology and pathology of the vestibular apparatus.”
Swedish otologists, led by Gunnar Holmgren, together with Prince Carl of Sweden and the Red Cross, pressed for his release, and in 1916 he was freed and received his prize from the King of Sweden in Stockholm. Soon afterwards he used his new right as a laureate to nominate Sigmund Freud for the prize. Freud, who had once declined to take Bárány as a pupil, responded with private bitterness at Bárány’s success.
In the prison camp Bárány continued to work as a doctor, treating soldiers with head injuries, which allowed him to keep studying how the balance organs, the cerebellum and the muscles are connected even in captivity.
Controversy and a new home in Sweden
Bárány’s return to Vienna in 1916 was unhappy. Several Austrian colleagues accused him of not giving enough credit in his publications to earlier researchers on whose work, they said, his own had built. The dispute deeply hurt him. Holmgren and other leading Swedish otologists published a paper in his defence, and in 1917 Bárány accepted the post of head of the ear, nose and throat clinic at Uppsala University in Sweden, where he spent the rest of his life.
The Swedish response was firm. A report in 1921 dismissed the claims that Bárány had failed to acknowledge his predecessors, and Uppsala gave him the platform he had lost at home. He became a full professor there in 1926 and remained in Uppsala for the rest of his career, teaching Swedish ear, nose and throat surgeons and continuing his research on the balance system and the cerebellum.
In Uppsala he continued to teach and research, later turning to the causes of muscular rheumatism. He learned Esperanto, the international language created by the Polish Jewish doctor Ludwik Zamenhof. He kept working on a book about rheumatism even after a stroke left him partially paralysed.
Family and identity
Bárány married Ida Felicitas Berger in 1909. They had two sons and a daughter. Their elder son, Ernst Bárány, became professor of pharmacology at Uppsala and a member of the Royal Swedish Academy of Sciences; the younger became an assistant professor of medicine at the Karolinska Institute; their daughter, Ingrid, became a psychiatrist. A grandson, the physicist Anders Bárány, later served as secretary of the Nobel Committee for Physics.
Bárány’s father was a Hungarian Jew, and he is counted among Jewish Nobel laureates by the Jewish Virtual Library and Wikipedia. Little is recorded about his own religious life. His move to Sweden in 1917 meant that he did not live to see the Nazi annexation of Austria in 1938, which drove out much of the Jewish medical community of the Vienna school in which he had trained.
Death and legacy
Robert Bárány died in Uppsala on April 8, 1936, two weeks before his sixtieth birthday.
His name lives on in clinics and cockpits. The Bárány Society, the international society for research on the vestibular system, is named after him, as are the Bárány chair and the Bárány test. Every time a patient with vertigo has warm and cool water or air run into each ear while a doctor watches their eyes, they are being examined with the method he discovered at a Vienna bedside more than a hundred years ago.
Sources & further reading
Robert Bárány, Biographical, NobelPrize.org · Robert Bárány, Facts, NobelPrize.org · Róbert Bárány, Life in the Fast Lane (LITFL) · Robert Bárány, Jewish Virtual Library · Robert Bárány, Wikipedia · Researched from the sources above and checked against them. Spotted an error? Tell us.
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