The beginning of a great story
This white bearded old man had been awarded the Nobel Prize in 1906 in recognition of his work on the structure of the nervous system. Nowadays, Santiago Ramón y Cajal (1852-1934) is widely recognized as the father of neurosciences, as he established the central principles of modern neurobiology: the neurone doctrine, which identifies the neuron as the basic anatomical and functional unit of the nervous system, and the law of dynamic polarization. Furthermore, he discovered the dendritic spines and the growth cone. Regarding neuro-otology, Cajal studied the innervation of the posterior labyrinth, including the endings of the vestibular afferents in the cristae of the semicircular canals of the birds, the paths of the vestibular nerve fibers, the vestibular nuclei describing the interstitial nucleus of Cajal in the midbrain reticular formation, which serves as the neural integrator for vertical and torsional eye movements. He detailed also the lateral vestibulospinal tract and the vestibulo-cerebellar connections.
The other bearded man was an Austrian professor of Otorhinolaryngology at Uppsala University that had also been awarded the Nobel Prize in Physiology or Medicine in 1914 for his discovery of the caloric tests. When he received the good news in 1915, he was in Turkmenistan, in Central Asia, and signed his response telegram to the Karolinska Institutet in Stockholm as “Dr. Bárány, prisoner of war”. Today, Robert Bárány (1876-1936) is acknowledged as the father of neuro-otology not only for the discovery of the caloric reaction and its clinical usefulness, as a test of vestibular function, but also for his systematization of the clinical examination of dizzy patients. Equally, he provided the first description of benign paroxysmal positional nystagmus.
The third man was a 21- year-old Spanish PhD student named Rafael Lorente de Nó (1902-1990) who had been working at Cajal´s Laboratorio de Investigaciones Biológicas since he was a fourth-year medical student. In 1922 he had published a seminal paper on the cerebral cortex of the mouse and during 1923 he had written several others on the vestibulo-cerebellar pathways. In December of that same year Robert Bárány was invited to give a 12-day course on vestibular physiology in Zaragoza, the home town of Lorente. So he returned home to attend the course. Immediately after the first talk he approached Bárány to ask him some questions. Bárány was astonished when the young Spaniard explained him how he could remove the fast component of nystagmus by making a short and exceedingly narrow incision in the middle line of the medulla and pons. The next morning Lorente de Nó performed an experimental demonstration in rabbits and Bárány raised the question about which ocular muscles where involved in the slow component of the nystagmus. Then, Bárány himself dissected the six eye muscles and removed the eyeball to observe that only both external rectus muscles were involved in the slow phase of the nystagmus provoked by rotation or caloric stimulation. Since Lorente de Nó did not have an equipment to record the activity of eye muscles, Bárány invited him to Uppsala where he could provide that necessary material. Next, they both travelled to Madrid where Bárány had been requested to give some other lectures and they visited old Cajal, who approved of Bárány´s plan. Subsequently, both Nobel laureates went to see the Prime Minister and obtained a grant for Lorente to work in Sweden with Bárány and also postponed his military service. Thus, the following year Lorente travelled to Uppsala where he continued studying the anatomy and physiology of the inner ear and the eighth nerve, along with the cytoarchitecture of the cerebral cortex. Up to 1934 he had published 25 papers mainly about the central structures and mechanisms involved in the generation of the fast-phase of nystagmus describing the complexity of the vestibulo-ocular reflex arc and underlining the role of interneurons. Later, he focused his efforts on describing the structure and function of the hippocampus and particularly the physiology of nerve conduction. However, at the end of his days he returned to the auditory system with a superb work on the primary acoustic nuclei.
Rene Descartes wrote that “the true intelligence is to discover the intelligence of others”. A fantastic coincidence turned into a great opportunity in the hands of two intelligences who knew how to see “beyond”. Lorente personalizes the ability of two geniuses to recognize the brilliance in a disciple and support him to the ultimate consequences. Something within reach of only the greatest masters.
Thus, we can realize that the meeting of these three scientific giants in Madrid was a turning point in the history of neuro-otology. Hence the forthcoming meeting of the Bárány Society in Madrid in 2020 will be a great opportunity to pay tribute to Santiago Ramón y Cajal, Robert Bárány and Rafael Lorente de Nó.
ANGEL BATUECAS-CALETRIO MD, PHD
JUAN MANUEL ESPINOSA SÁNCHEZ MD
History Comitee for the XXXI Barany Society meeting