Virginia Apgar (1909-1974)
An obstetrical anesthesiologist, she developed a 10-point system to rapidly assess newborns and record their status. The Apgar score – now given to all neonates, everywhere, at 1 and 5 minutes of life – changed the entire culture of the delivery room.
Apgar attended Mount Holyoke College, where she played in the college orchestra, played multiple varsity sports and worked on the school paper. She wrote to her parents - still living in New Jersey where she was born - “I’m very well and happy but I haven’t one minute even to breathe.”
She went to medical school at Columbia University’s College of Physicians and Surgeons, graduating fourth in her class in 1933, one of 10 female students. She completed a surgery residency at Columbia in 1937, but Allan Whipple, the chairman of surgery at Columbia, discouraged her from practicing. In one interview, she said she went into anesthesia because the surgical field was just overcrowded; in another she said she learned after 200 surgeries that “a lady couldn’t make a living in surgery. In those days anyway.”
Apgar went to train in anesthesia instead, at the University of Wisconsin-Madison, then at Bellevue Hospital. She returned to Columbia in 1938 to direct the new division of anesthesia. However, when anesthesia became an official department at Columbia in 1949, Apgar’s colleague Emmanuel Papper was assigned director - probably because Apgar was a woman. That year Apgar become the first female full professor at Columbia.
She noted that although the overall infant mortality rate was decreasing , the number of children dying in the first 24 hours of life remained constant. Like Sara Josephine Baker, she wondered if this could be prevented. In 1952 she presented a test to evaluate neonates at one and five minutes after birth based on heart rate, respiration, muscle tone, color, and reflex irritability – the now-famous Apgar score.
A baby could score 0, 1 or 2 points in each objective. Most healthy babies score 9 out of 10 at 1 minute (only 9 because hands and feet are still blue). Apgar found that scores less than 3 almost invariably indicated respiratory and metabolic acidosis, requiring resuscitation.
The Apgar score allowed physicians to study interventions and see infants’ responses. It changed the way physicians thought about deliveries. Apgar argued that pediatricians should be available at delivery so obstetricians could focus on the mother.
In her free time, Apgar was an avid musician. She played violin and viola, dabbled in cello, and even made her own stringed instruments. She never married or had children.
In mid-1958, in the wake of the success of the polio vaccine, the National Foundation for Infantile Paralysis – better known as the March of Dimes – shortened its name to the National Foundation and changed its goal from the conquering of polio to the prevention of birth defects. Virginia Apgar was named Director of Birth Defects Research. She received a master’s degree in public health from Johns Hopkins in 1959 to facilitate her work.
“I’m never retiring,” Apgar told one journalist. “I left Columbia at 50 because they retire you at 65. I took this job only because they never retire you here.” She never did retire from the National Foundation. Unfortunately she died at 65, after writing two books and about 70 articles, and leaving an incredible, lasting legacy of newborn assessment.
Morishima HO. Virginia Apgar (1909-1974). Journal of Pediatrics. 1996 November;129(5):768-70.
Essay by Alison Christy, MD, PhD