Fidel Pagés

Fidel Pagés Miravé (26 January 1886 – 21 September 1923) 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.

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.

Career Pagés visiting injured soldiers at the Docker Hospital in Melilla in 1909. Pagés entered the Army Medical Corps 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 meantime, staying for some months in the Military Hospital of Carabanchel. During his stay in Melilla he gained fundamental experience in emergency surgery.

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", ) and working in the Ministry of War. In 1919 he founded, together with doctor Ramírez de la Mata the "Revista Española de Cirugía" , 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). 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 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.

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, 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 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. In addition, the Ministry of Defense of Spain in June 2007 created the Award for Military Health Research Fidel Pagés Miravé.