Home About clinic History Dr Laza Lazarević
Dr Laza Lazarević

Lasègue sign, designating pain provoked by straight leg raise enabling diagnosis of ischialgia is the best known among numerous diverse achievements of Ernest Charles Lasègue (1809-1883), one of the most original figures of the French neuropsychiatry of the 19th century. However, he was not the only one to describe the sign. In his paper entitled “A Review of Sciatica” from  1864,  Charles Lasègue, presented his opinion based on his own experience that the pain is aggravated as a consequence of “most probable nerve tension" in the malignant forms of sciatica, however the sign itself was not mentioned in the paper. Actually, one of his students, J.J. Forst  described and demonstrated the sign in his doctoral thesis in Paris in 1881, generously giving the credits to his teacher Professor Lasègue.

Having no intention to question significance of Lasègue’s work, the review was aimed at elucidating the role of the founder of Serbian neurology, Laza K. Lazarević (1851-1891), who had remained unknown to medical public, although his observations dealing with the same topic were published even before Forst’s. But – Who was Laza K. Lazarević?

Laza K. Lazarević was born on May 13th, 1851. in  Šabac  (Serbia), in a family of merchants. His life represents an exceptional contrast between personal tragedies and cruel limitations imposed by different circumstances on one side and impressive working energy, curiosity and achievements made during his short life of only 40 years, on the other. After his father died when he was 9, he took care of his mother and three sisters for all his life. He suffered from tuberculosis of the lungs, which was the cause of his premature death on January 10th, 1891. He experienced the tragedy of transmitting his disease to his sons, who both died as victims of tuberculous meningitis. He wrote the most expressive pages of the Serbian post-war prose, drawing his inspiration from his own experience as a participant in three wars, initially as medical assistant and later as military doctor. In 1876,  when Serbian-Turkish war broke out, he even discontinued his medical studies in Berlin. He started the studies in 1872, after a period of work as a public servant subsequent to graduation from law at the Advanced School in Belgrade.   As young enthusiast and according to his personal memoirs very poor student, he was additionally inspired and encouraged by presence of the outstanding teachers such as R.Virchow, H.L. von Helmholtz and E. Dubois-Reymond.  After his graduation with the thesis on medical effects of mercury, he came back to Serbia on August 1st, 1879.  As if he new that he will live only for another 12 years, he dedicated himself to medical profession and numerous activities with whole his hart. Soon thereafter he was appointed Head of the Internal Medicine Department within the General State Hospital in Belgrade.

The list of his achievements during his short career additionally interrupted with wars appears almost unbelievable. Thus, we shall mention herein only those that are the most outstanding: he is the founder of the laboratory diagnostics in Serbian medicine and founder of the special “Department for elderly patients", which was rather innovative for the time. The circumstances prevailing at his time forced him to develop different interests, and thus written evidence on his contributions in different branches of medicine, such as infectious diseases, internal medicine, surgery, psychiatry, gynecology and public health are available. During his tragically short professional career (1877-1890) he managed to publish as much as 78 papers and observations. Indeed, his contribution was the greatest in the field of neurology: 12 out of 78 publications were in the field of neurology (the very first description of Parkinson’s disease in the region, aphasia, spinal nosology, muscle dystrophies, brain tumors and application of arsenic in treatment of chorea). Owing to the specific circumstances, the best known contribution of  Laza K. Lazarević, whose characteristic gait (he was limping on his right leg) was the result of sciatic pain acquired during the war in 1876, was related to the topic and subject of his paper entitled " Ischiac postica Cotunnii" published in 1880 in Serbian Cyrillic. The paper was subsequently translated to German language and published in Vienna in 1884. In his study comprising 6 patients, he described a new sign based on onset or aggravation of pain upon attempt of rising of the affected leg without knee flexion with the patient in dorsal position.  In the first part of the test, the patient is from the erect position slowly bent forward at the waste without flexion of the knees (spinal flexion). In the second part of the test the patient lying on the back is brought to sitting position without bending of the knee joint. In the third part of the test, the patient is positioned in the dorsal position and the affected leg is raised. If the pain along the sciatic nerve appeared upon all three tests to be absent upon compression of the legs with flexed knees, it was explained by Lazarević as a consequence of sciatic nerve and its roots tension, which was in contradiction with the attitude prevailing at the time that onset of pain was the consequence of muscle compression of the nerve. Performing the measurements on his own body, he determined that when the leg was stretched, length of the nerve was increased by up to 8. The article is not aimed at establishing who was the first one to propose this highly important neurological test, particularly having in mind the fact that  Buchanan and Kean suggested that it was actually initially described in "The Edwin Smith Surgical Papyrus", as the oldest known medical document in the history of mankind.  Additionally, the role of Laze K. Lazarević was already recognized in numerous review articles in the field of neurology. The intention of the article is to recognize the true pioneers in the field of neurology who lived in different geographic regions and circumstances and dedicated their energy and passion to establishing of basis for development of modern neurology. A neurological sign connected accidentally two impressive figures of the 19th century who had also shared additional intellectual capacity.

Laza K. Lazarević had the energy and inspiration for literal creativity for which he was called  "Serbian Turgenev" owing to which he was elected corresponding member of The Serbian Royal Academy. Therefore it would be hard to decide whether it was the writer in him or farsighted neuropsychiatrist who wrote intriguing thought for the time: "dreams may reveal all that is hidden in our subconsciousness".


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Scientific papers

A list of scientific papers published by the employees of the Neurology clinic since 1981. Complete list can be found here.