By Marcello Cherchi, MD PhD
Dr. Margaret Ruth Dix (1902 – 1991) earned her medical degree in 1937. She began training as a surgeon, but suffered injuries (including to her eyes) during a German Blitz air raid in 1940 and had to cease operating. In 1945 she began working in the otological research unit at the National Hospital, Queen Square, London.
Probably the most widely recognized work she did was in collaboration with Charles Skinner Hallpike. In 1952 they co-authored papers discussing Ménière’s disease, vestibular neuritis and “positional nystagmus” (benign paroxysmal positional vertigo) (Dix and Hallpike 1952a, b). Regarding benign paroxysmal positional vertigo, Dix and Hallpike drew on earlier observations by Barany (Bárány 1920) and articulated the following maneuver:
“The reaction is induced… by a critical position of the head in space. This can be defined as follows: The patient is laid supine upon a couch with his head just over its end. The head is then lowered some 30 degrees below the level of the couch and turned some 30 degrees to 45 degrees to one side… The nystagmus [induced in this position] is chiefly rotatory, the direction of the rotation being towards the undermost ear” (Dix and Hallpike 1952a, b).
Some literature at that time referred to this maneuver as a “Lagerungsprobe” (positional test) (Maranhao-Filho, Nandi, Maranhao 2018), but it ultimately received the eponymous designation of the Dix-Hallpike maneuver, and is regarded as the clinical test for diagnosing benign paroxysmal positional vertigo (BPPV) involving the posterior canal. It was subsequently recognized that it can also diagnose anterior canal BPPV.
References
Bárány E (1920) Diagnose von Krankheitserscheinungen im Bereiche des Otolithenapparates [Diagnosis of symptoms in the area of the otolith apparatus]. Acta Oto-Laryngologica 2: 434-437. doi: 10.3109/00016482009123103
Dix MR, Hallpike CS (1952a) The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 45: 341-54.
Dix MR, Hallpike CS (1952b) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 61: 987-1016. doi: 10.1177/000348945206100403
Maranhao-Filho P, Nandi R, Maranhao ET (2018) Margaret Dix, Charles Hallpike and the ‘Lagerungs’ Manoeuvre. Arq Neuropsiquiatr 76: 563-565. doi: 10.1590/0004-282X20180075
