Fidel Pagés
Encyclopedia
Fidel Pagés Miravé was a Spanish
military surgeon
, known for developing the technique of epidural
anesthesia
.
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 until he was finally given full credit by the medical community in the 1930s and 40s.
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
, where he received his degree in Medicine and Surgery with honors in 1908. During these years he also learned the German language
, something that would be of importance later in his career when it gave him the opportunity to exchange experiences with surgeons of German origin.
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
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
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 in between, 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
and which he had applied in Melilla. He served in several Spanish cities and earned a PhD in Madrid 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. 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
, due to his knowledge of German language and his experience in war injuries, he was commissioned to inspect prisoners of war camps in Austria and Hungary. During these months he also practised a great number of surgery operations in the Vienna
Military Hospital no. 2. Pagés was probably acquainted with the German and French medical literature on previous experiences with anesthesics 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", 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" (Spanish Journal of Surgery), where he published a great number of comments and articles about anesthesia (on Meltzer's endotracheal anesthesia, Ombredanne
's inhaler, Trendelenburg
's cannula
, Victor Horsley
'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
, 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).
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 in the lumbar region, leaving the spinal canal
untouched and without the need to reach complete anesthesia.
The article explained how Pagés, who had frequently performed spinal anesthesias, 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 anesthesics (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 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
.
, near Burgos
, while returning to Madrid with his family from their summer vacation in Cestona, near San Sebastián
. 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 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 Achile 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. In addition, the Ministry of Defense of Spain in June 2007 created the Award for Military Health Research Fidel Pagés Miravé.
Spanish people
The Spanish are citizens of the Kingdom of Spain. Within Spain, there are also a number of vigorous nationalisms and regionalisms, reflecting the country's complex history....
military surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
, known for developing the technique of epidural
Epidural
The term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...
anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
.
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 until he was finally given full credit by the medical community in the 1930s and 40s.
Early life and education
Fidel Pagés was born and grew up in the Spanish city of HuescaHuesca
Huesca 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 the comarca of Hoya de Huesca....
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
University of Zaragoza
The University of Zaragoza or sometimes Saragossa University is a university located in Zaragoza, in the Aragon region of Spain...
, where he received his degree in Medicine and Surgery with honors in 1908. During these years he also learned the German language
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
, 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 CorpsSpanish Army
The Spanish Army is the terrestrial army of the Spanish Armed Forces responsible for land-based military operations. It is one of the oldest active armies - dating back to the 15th century.-Introduction:...
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
Rif War (1909)
The Second Melillan campaign was a conflict in 1909 and 1910 in Morocco around Melilla. The fighting involved local Rifains and the Spanish Army.- Prelude :...
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
Melilla is a autonomous city of Spain and an exclave on the north coast of Morocco. Melilla, along with the Spanish exclave Ceuta, is one of the two Spanish territories located in mainland Africa...
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 in between, 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
Russo-Japanese War
The Russo-Japanese War was "the first great war of the 20th century." It grew out of rival imperial ambitions of the Russian Empire and Japanese Empire over Manchuria and Korea...
and which he had applied in Melilla. He served in several Spanish cities and earned a PhD in Madrid 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. 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
Maria Christina of Austria
Maria Christina of Austria was Queen consort of Spain as the second wife of King Alfonso XII of Spain...
, with whom he would develop a personal friendship.
In 1917, during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
, due to his knowledge of German language and his experience in war injuries, he was commissioned to inspect prisoners of war camps in Austria and Hungary. During these months he also practised a great number of surgery operations in the Vienna
Vienna
Vienna is the capital and largest city of the Republic of Austria and one of the nine states of Austria. Vienna is Austria's primary city, with a population of about 1.723 million , and is by far the largest city in Austria, as well as its cultural, economic, and political centre...
Military Hospital no. 2. Pagés was probably acquainted with the German and French medical literature on previous experiences with anesthesics 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", 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" (Spanish Journal of Surgery), where he published a great number of comments and articles about anesthesia (on Meltzer's endotracheal anesthesia, Ombredanne
Louis Ombrédanne
Louis Ombrédanne was a French pediatric and plastic surgeon born in Paris. He was the son of general practitioner Emile Ombrédanne.In 1902 he became surgeon to Parisian hospitals, becoming a professor of surgery in 1907...
's inhaler, Trendelenburg
Friedrich Trendelenburg
Friedrich Trendelenburg was a German surgeon. He was son of the philosopher Friedrich Adolf Trendelenburg, father of the pharmacologist Paul Trendelenburg and grandfather of the pharmacologist Ullrich Georg Trendelenburg.Trendelenburg was born in Berlin and studied medicine at the University of...
's cannula
Cannula
A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
, Victor Horsley
Victor Horsley
Sir Victor Alexander Haden Horsley was an accomplished scientist and professor. He was born in Kensington, London. He was educated at Cranbrook School, Kent and studied medicine at University College London and in Berlin, Germany , and in the same year started his career as a house surgeon and...
'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
Disaster of Annual
The Battle of Annual was a battle fought in Spanish Morocco between the Spanish Army of Africa and combatants of the Rif region. It was a major military defeat suffered by the Spanish army on July 22, 1921 at Annual in northeastern Morocco during the Rif War...
, 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
Abdominal trauma
Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection...
based on his war experiences (against the general opinion of the time when non-interventionism or late hospitalised intervention was recommended).
The discovery of epidural anesthesia
In 1901, the use of anaesthesics 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 in the lumbar region, leaving the spinal canal
Spinal canal
The spinal canal is the space in vertebrae through which the spinal cord passes. It is a process of the dorsal human body cavity. This canal is enclosed within the vertebral foramen of the vertebrae...
untouched and without the need to reach complete anesthesia.
The article explained how Pagés, who had frequently performed spinal anesthesias, 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 anesthesics (twice as much as was previously recommended in similar techniques). It also explained the effects of gradual insensibility and motor paralysis, the indications
Indication (medicine)
In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. The opposite of indication is contraindication.-Drugs:...
and contraindications 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
Rif
The Rif or Riff is a mainly mountainous region of northern Morocco, with some fertile plains, stretching from Cape Spartel and Tangier in the west to Ras Kebdana and the Melwiyya River in the east, and from the Mediterranean Sea in the north to the river of Wergha in the south.It is part of the...
.
Death and posthumous recognition
In 1922 Pagés was promoted to Major Medical. On September 21, 1923 he died in a traffic accident in QuintanapallaQuintanapalla
Quintanapalla is a municipality located in the province of Burgos, Castile and León, Spain. According to the 2004 census , the municipality has a population of 116 inhabitants....
, near Burgos
Burgos
Burgos is a city of northern Spain, historic capital of Castile. It is situated at the edge of the central plateau, with about 178,966 inhabitants in the city proper and another 20,000 in its suburbs. It is the capital of the province of Burgos, in the autonomous community of Castile and León...
, while returning to Madrid with his family from their summer vacation in Cestona, near San Sebastián
San Sebastián
Donostia-San Sebastián is a city and municipality located in the north of Spain, in the coast of the Bay of Biscay and 20 km away from the French border. The city is the capital of Gipuzkoa, in the autonomous community of the Basque Country. The municipality’s population is 186,122 , and its...
. 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 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 Achile 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. In addition, the Ministry of Defense of Spain in June 2007 created the Award for Military Health Research Fidel Pagés Miravé.