Fidel Pagés
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Fidel Pagés Miravé (26 January 1886 – 21 September 1923) was a
Spanish Spanish might refer to: * Items from or related to Spain: **Spaniards are a nation and ethnic group indigenous to Spain **Spanish language, spoken in Spain and many Latin American countries **Spanish cuisine Other places * Spanish, Ontario, Cana ...
military
surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
, known for developing the technique of
epidural Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and ...
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
. He practised a wide range of traumatological and surgical techniques, both for war injuries and civil purposes, contributed to the modernisation of surgery in Spain and participated actively in the reorganisation of the Spanish Military Health system in the 1920s. Due to his early accidental death, his pioneering work in epidural anesthesia (or metameric anesthesia as he called it) went unnoticed for many years outside of Spanish speaking countries.


Early life and education

Fidel Pagés was born and grew up in the Spanish city of
Huesca Huesca (; an, Uesca) is a city in north-eastern Spain, within the autonomous community of Aragon. It is also the capital of the Spanish province of the same name and of the comarca of Hoya de Huesca. In 2009 it had a population of 52,059, almo ...
in an upper-middle-class family. His parents were Juan Pagés Maraque and Concepción Miravé Sesé. His father died when Fidel was 7 and his mother remarried, an episode which would have great effect in the personality of the child. In 1901 he started his studies of Medicine at the
University of Zaragoza The University of Zaragoza, sometimes referred to as Saragossa University () is a public university with teaching campuses and research centres spread over the three provinces of Aragon, Spain. Founded in 1542, it is one of the oldest universiti ...
, where he received his degree in Medicine and Surgery with honors in 1908. During these years he also learned the
German language German ( ) is a West Germanic languages, West Germanic language mainly spoken in Central Europe. It is the most widely spoken and Official language, official or co-official language in Germany, Austria, Switzerland, Liechtenstein, and the Ita ...
, something that would be of importance later in his career when it gave him the opportunity to exchange experiences with surgeons of German origin.


Career

Pagés entered the
Army Medical Corps A medical corps is generally a military branch or officer corps responsible for medical care for serving military personnel. Such officers are typically military physicians. List of medical corps The following organizations are examples of medica ...
in 1908 and, after one year at the Military Health Academy, received the rank of second medical officer in June 1909. The
second Rif War The Second Melillan campaign ( es, Campaña Guerra de Melilla ) was a conflict in 1909 in Morocco around Melilla. The fighting involved local Riffians and the Spanish Army. Historical background The Treaty of Peace with Morocco that f ...
was at its peak at this point: the Spanish Army had suffered a series of dramatic defeats ( Barranco del Lobo) and the medical services in
Melilla Melilla ( , ; ; rif, Mřič ; ar, مليلية ) is an autonomous city of Spain located in north Africa. It lies on the eastern side of the Cape Three Forks, bordering Morocco and facing the Mediterranean Sea. It has an area of . It was par ...
were overwhelmed. Pagés was sent in July 1909 as part of the medical reinforcements that were to set up several emergency military hospitals in the city. He stayed in Melilla for two years, first as surgeon's assistant during the six months of the campaign, and later also organizing the improvement of the equipment in mountain ambulances and instructing recruits in the Medical Corps. He returned to mainland Spain in the meantime, staying for some months in the Military Hospital of Carabanchel. During his stay in Melilla he gained fundamental experience in emergency surgery. He left Melilla in 1911, after he was promoted to first medical officer. He published his first paper in 1912, "The fight against infectious illnesses in campaign", analysing the techniques that Japanese doctors had successfully developed during the
Russo-Japanese War The Russo-Japanese War ( ja, 日露戦争, Nichiro sensō, Japanese-Russian War; russian: Ру́сско-япóнская войнá, Rússko-yapónskaya voyná) was fought between the Empire of Japan and the Russian Empire during 1904 and 1 ...
and which he had applied in Melilla. He served in several Spanish cities and earned a PhD in
Madrid Madrid ( , ) is the capital and most populous city of Spain. The city has almost 3.4 million inhabitants and a metropolitan area population of approximately 6.7 million. It is the second-largest city in the European Union (EU), and ...
in 1913. That same year he married Berta Concepción Bergenmann y Quirós, a Spanish woman of Spanish-German descent. He returned to Madrid in 1915 to work at the
Ministry of War Ministry of War may refer to: * Ministry of War (imperial China) (c.600–1912) * Chinese Republic Ministry of War (1912–1946) * Ministry of War (Kingdom of Bavaria) (1808–1919) * Ministry of War (Brazil) (1815–1999) * Ministry of Defence (Est ...
. That same year he placed first in a competition for a position at the Provincial Hospital of Madrid. Pagés' prestige grew during his stay in Madrid and he was appointed to attend in several occasions Queen María Cristina, with whom he would develop a personal friendship. In 1917, during
World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
, due to his knowledge of German language and his experience in war injuries, he was commissioned to inspect
prisoners of war A prisoner of war (POW) is a person who is held Captivity, captive by a belligerent power during or immediately after an armed conflict. The earliest recorded usage of the phrase "prisoner of war" dates back to 1610. Belligerents hold priso ...
camps in Austria and Hungary. During these months he also practised a great number of surgery operations in the
Vienna en, Viennese , iso_code = AT-9 , registration_plate = W , postal_code_type = Postal code , postal_code = , timezone = CET , utc_offset = +1 , timezone_DST ...
Military Hospital no. 2. Pagés was probably acquainted with the German and French medical literature on previous experiences with anaesthetics in the epidural space and had contact with German surgeons in Vienna who had experimented with that technique. After his return to Madrid, he continued practising surgery in the General Hospital of Madrid, publishing several medical articles (he became the editor in chief of the "Revista de Sanidad Militar", en, Journal of Military Health) and working in the Ministry of War. In 1919 he founded, together with doctor Ramírez de la Mata the "Revista Española de Cirugía" ( en, Spanish Journal of Surgery), where he published a great number of comments and articles about anesthesia (on
Meltzer Meltzer is a surname of German or Yiddish origin, meaning " malt or beer maker". Notable people with the surname include: *Albert Meltzer (1920–1996), British anarcho-communist activist and writer * Allan Meltzer (1928–2017), American economi ...
's endotracheal anesthesia, Ombredanne's inhaler, Trendelenburg's
cannula A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...
,
Victor Horsley Sir Victor Alexander Haden Horsley (14 April 1857 – 16 July 1916) was a British scientist and professor. He was born in Kensington, London. Educated at Cranbrook School, Kent, he studied medicine at University College London and in Berlin, Ge ...
's hedonal intravenous anesthesia and Le Filliatre's total spinal anesthesia). In 1920 he was assigned to the Emergency Military Hospital in Madrid, although he was stationed briefly in Melilla in 1921 as a result of the Spanish colonial
disaster of Annual The Battle of Annual was fought on 22 July 1921 at Annual, in northeastern Morocco, between the Spanish Army and Rifian Berbers during the Rif War. The Spanish suffered a major military defeat, which is almost always referred to by the Spanish ...
, where he practiced hundreds of surgical interventions on injured troops. Two of his main contributions during this time are the publication of his seminal article on epidural anesthesia and a series of articles defending early emergency interventions for abdominal injuries based on his war experiences (against the general opinion of the time when non-interventionism or late hospitalised intervention was recommended).


Work on epidural anesthesia

In 1901, the use of anaesthetics via the epidural space was first reported, mostly for the treatment of urological diseases but not for surgical procedures. Several techniques were developed in the following years, but never became popular for surgical purposes: most institutions made the transition from a slight sedation to twilight sleep to heavy sedation to general anaesthesia. Fidel Pagés published an article in July 1921 called "''Anestesia Metamérica''" (i.e. metameric anesthesia or epidural anesthesia) in the "''Revista Española de Cirugía''" and the "''Revista de Sanidad Militar''". In the article he explained the technique he had developed in order to be able to inject the
anesthetics An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two ...
in the
lumbar region In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
, leaving the
spinal canal The spinal canal (or vertebral canal or spinal cavity) is the canal that contains the spinal cord within the vertebral column. The spinal canal is formed by the vertebrae through which the spinal cord passes. It is a process of the dorsal body ca ...
untouched and without the need to reach complete anesthesia. The article explained how Pagés, who had frequently performed
spinal anesthesia Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarac ...
s, developed the idea of injecting the anesthetics through the lumbar space between the 4th and 5th vertebrae, described 43 operations using this technique, provided details on each step and advised on the right dose of anaesthetics (twice as much as was previously recommended in similar techniques). It also explained the effects of gradual insensibility and motor paralysis, the indications and
contraindications In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...
and concluded recommending the use of this technique for surgical interventions. The technique was widely put into practice in the following months during the Spanish campaign in the
Rif The Rif or Riff (, ), also called Rif Mountains, is a geographic region in northern Morocco. This mountainous and fertile area is bordered by Cape Spartel and Tangier to the west, by Berkane and the Moulouya River to the east, by the Mediterrane ...
.


Publications


Death and posthumous recognition

In 1922 Pagés was promoted to Major Medical. On 21 September 1923 he died in a traffic accident in Quintanapalla, near
Burgos Burgos () is a city in Spain located in the autonomous community of Castile and León. It is the capital and most populated municipality of the province of Burgos. Burgos is situated in the north of the Iberian Peninsula, on the confluence of t ...
, while returning to Madrid with his family from their summer vacation in
Cestona Zestoa ( es, Cestona) is a town located in the province of Gipuzkoa, in the autonomous community of the Basque Country, northern Spain , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg ...
, near
San Sebastián San Sebastian, officially known as Donostia–San Sebastián (names in both local languages: ''Donostia'' () and ''San Sebastián'' ()) is a city and Municipalities of Spain, municipality located in the Basque Country (autonomous community), B ...
. After his death, many tributes were performed in Spain. In the Urgency Hospital of Madrid, the Queen unveiled a plaque in his memory; another plaque was placed in the
Military Hospital A military hospital is a hospital owned and operated by a military. They are often reserved for the use of military personnel and their dependents, but in some countries are made available to civilians as well. They may or may not be located on a ...
in San Sebastián; and in 1926 the Docker Hospital in Melilla was renamed after him. His work had neither been translated nor presented in the few medical congresses of that time and was practically forgotten. In 1931, Italian surgeon Achille Mario Dogliotti described what he thought was a new type of regional anesthesia and was credited for some years with the discovery of epidural anesthesia. Only with the passage of time, an Argentinian scientific journal claimed recognition for the Spanish doctor, who was then given full credit by Dogliotti and the medical community. The Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) awards every two years a prize that bears Pagés' name.Premio Nacional de la SEDAR - Fidel Pagés
(in Spanish)
In addition, the Ministry of Defense of Spain in June 2007 created the Award for Military Health Research Fidel Pagés Miravé.


See also

*
History of neuraxial anesthesia The history of neuraxial anesthesia goes back to 1885. 19th century In 1855, Friedrich Gaedcke (18281890) became the first to chemically isolate cocaine, the most potent alkaloid of the coca plant. Gaedcke named the compound "erythroxyline". ...


References

{{DEFAULTSORT:Pages, Fidel 1886 births 1923 deaths 19th-century Spanish people 20th-century Spanish physicians Spanish military doctors People from Huesca