Luis Agote
Luis Agote (Buenos Aires, September 22, 1868 – Turdera, November 12, 1954), was an Argentine doctor and researcher. He was the first professional in the world who performed indirect blood transfusions without the blood coagulating in the container that contained it by using sodium citrate.He also had a role in politics in the Province of Buenos Aires between 1910 and 1920.
Biography
Luis Agote completed his secondary studies at the Colegio Nacional Central (now Colegio Nacional de Buenos Aires) in his hometown. He entered the Faculty of Medicine of the University of Buenos Aires in 1887, where he graduated as a doctor in 1893 with a thesis on suppurative hepatitis. In 1894 he took office as Secretary of the National Department of Hygiene and in 1895 he took over the management of the lazaretto on the island Martín García. In 1899 he was appointed Ward Physician at the Rawson Hospital (city of Buenos Aires), where he later became Ward Manager. In 1905 he was appointed Substitute Professor at the Faculty of Medicine and in 1915 Titular Professor of Medical Clinic at the University of Buenos Aires, the latter chair which he held until his resignation in 1929. In 1914 he founded the Instituto Modelo de Clínica Médica del Rawson Hospital, where he carried out a vast program of research, professional education and patient care. It was there that he developed and put into practice the method of preserving blood for transfusions by adding sodium citrate.
He did not want to patent his discovery: in those days of the First World War thousands of humans died daily in the trenches of Europe, so he preferred to cede it to all the countries that were at war at that time, knowing that this would save them millions of lives. He communicated it to the press, to the ambassadors of the countries involved and to international medical journals. That same year he published the work "New simple method for blood transfusions."
Agote's dedication to service did not end with medicine. He acted from a young age in Argentine political life. He was elected deputy and senator, in the province of Buenos Aires; appointed Municipal Commissioner of the General San Martín Party in 1912 and twice National Deputy for the Conservative Party (1910 and 1916). From this last bench he was the author of laws such as the creation of the National University of the Coast, the annexation of the National College from Buenos Aires to the University of Buenos Aires and the creation of the National Board of Abandoned and Delinquent Minors. He wrote on medical and health, literary and historical subjects, some of his works being New simple method for blood transfusion (1914); Study of public hygiene in the Argentine Republic, report of the National Department of Hygiene; Gastric and duodenal ulcer in the Argentine Republic (1916); Gallstones (1916); Illusion and reality (poem); Augustus and Cleopatra; Nero, his people and his time. A Psychopathology of the Roman Emperor (1912); My memories. Much of his medical work was published in the Anales del Instituto Modelo de Clínica Médica.
Throughout his life he received multiple distinctions, among others: Honorary Professor of the National College and the University of Buenos Aires; Honorary Member of the National Academy of Medicine; Honorary President of the National Academy of Fine Arts, of the Association for the Protection of Minors and of the 8th National Congress of Medicine. The Republic of Chile distinguished him, in 1916, with the Order of Merit.
Agote died in the city of Turdera (311 Pretti Street) on November 12, 1954, exactly three days after the 40th anniversary of the first blood transfusion that had him as the main protagonist. His remains rest in the Recoleta Cemetery.
Blood transfusion
Since remote times it was believed that blood was a factor of health and strength, and in some cultures human blood was given to drink to invigorate or revive the sick. There is evidence that in Imperial Rome the blood of wounded gladiators in the arena was used to cure epilepsy. The idea of blood transfusion already existed in 1056, when Jerome Cardano of Basel, in his work De Rerum Varietate, suggested replacing that of criminals.
First recorded transfusions
The first recorded blood transfusion was between dogs by the English physician Lower around 1666. In 1667 the French scientist Jean Baptiste Denys transfused a human using ram's blood, causing his immediate death. In the 19th century, direct blood transfusion experiences were carried out between people, sometimes with fatal consequences due to ignorance of blood incompatibilities. The delicate task was carried out by connecting the donor's artery with the recipient's vein through a complicated surgical procedure. A place with extreme asepsis was needed, the amount of blood transferred could not be accurately measured, the giver needed a long time to recover and was exposed to risks such as infections, embolisms and thrombosis.
In the year 1900, the Austrian researcher Karl Landsteiner identified some of the blood substances responsible for the agglutination of red blood cells, managing for the first time to identify blood groups and some of their incompatibilities.
Direct transfusions were still practiced at the beginning of the 20th century because it was impossible to keep the drawn blood unaltered for later use. After a few minutes (from six to twelve) it began to coagulate, initially manifested in a gradual increase in viscosity that ended with its almost complete solidification. Coagulation is a body defense to plug wounds and minimize bleeding. Today it is known that a clot is almost entirely made up of erythrocytes held together by a network of fibrin filaments. Fibrin does not normally exist in the blood, it is created from the plasma protein fibrinogen by the action of the enzyme thrombin. Thrombin, in turn, is not naturally present in the blood, it is generated from a precursor substance, prothrombin, in a process involving platelets, some calcium salts and substances produced by injured tissues. Since clots do not form if any of these elements are missing, the addition of sodium citrate (which removes calcium ions from the blood) prevents their formation.
Agote's investigation
Concerned about the problem of bleeding in hemophiliac patients, he addressed the problem of prolonged blood storage with the collaboration of laboratory technician Lucio Imaz. His first attempts, such as using special containers and keeping the blood at a constant temperature, did not work. He then searched for some substance that, added to the blood, would prevent clotting. After many laboratory tests in vitro and with animals, Agote, although without knowing the biochemical origin of the behavior, found that sodium citrate (salt derived from citric acid) prevented the formation of clots. This substance, moreover, was tolerated and eliminated by the body without causing major subsequent problems. The first test with people was carried out on November 9, 1914, in a classroom of the Instituto Modelo de Clínica Médica, having as witnesses the Rector of the University of Buenos Aires, Eufemio Uballes, the dean of the Faculty of Medicine, Luis Güemes, the general director of Public Assistance, Baldomero Sommer, and the municipal mayor, Enrique Palacio, as well as numerous academics, professors and doctors. During it, a patient who had suffered heavy blood loss received a transfusion of 300 cm³ of blood previously donated by an employee of the institution and preserved by the addition of sodium citrate. Three days later the patient, fully recovered, was discharged.
Far from the most important and advanced scientific centers, he managed to solve the problem of transfusions that anguished the thousands of doctors recruited by the European armies during the First World War. It was a great contribution to world medicine, which would since then have a simple, innocuous and easy method of blood transfusion to be carried out by a qualified professional. The American newspaper New York Herald published a synthesis of Agote's method and perceived its future projections, stating that it would have many other applications besides the treatment of acute hemorrhages.
Other researchers
After the First World War ended, there were attempts by professionals from other countries to claim the scoop on the discovery. The Belgian Albert Hustin (Academy of Biological and Natural Sciences of Brussels, Belgium, on 3/27/1914) and the American Richard Lewisohn (Mount Sinai Hospital, New York, USA, in 1915) claimed priority for the discovery. A long epistolary exchange between Agote and the aforementioned scientists then began, and interviews, articles, communications and citations in different medical journals about the disputed priority accumulated. In all this display, without heating up, the Argentine technologist limited himself to objectively pointing out dates and procedures. They were probably independent investigations that came to fruition more or less simultaneously. What is important to highlight is the supportive attitude of Agote, who did not try to patent his result, he immediately communicated it to the press, diplomatic representations of all the countries at war at the time and international medical journals, making it possible to save countless people in serious Death risk.
Tributes
In life, the University of Buenos Aires distinguished him as an honorary professor and the National Academy of Medicine of Argentina named him an honorary member. Chile decorated him, in 1916, with the Order of Merit.
To honor his contribution to Medicine, a street, a National School of Commerce, the Model Medical Clinic Institute, the National Institute for the Protection of Minors, the Hemotherapy Center of the Hospital de Clínicas were named after him —all of the city of Buenos Aires—as well as to primary schools, hemotherapy centers and blood banks throughout the country. A neighborhood in the city of Rosario is also named after her.
Fonts
- Luis Agote, clinical doctor.