Saturday, April 2, 2016

Virginia Apgar, Medical Pioneer

New York World-Telegram and Sun, July 6, 1959
Virginia Apgar was a surgeon who studied the effects of anesthesia on newborn babies and their mothers and developed the Apgar score, the first standardized method for evaluating a newborn's health immediately following birth.

Virginia was born on June 7th, 1909 in Westfield, NJ to Charles and Mary Apgar. She was the youngest of three children and often described her family as one that "never sat down." The family shared a love of music and would give concerts in which Virginia played the violin, an instrument she would practice her whole life. Besides practicing music, the family had a laboratory in one of the rooms of their home, and Virginia's father built a telescope through which to survey the stars, and would conduct experiments with electricity and radio waves.

Perhaps it was this atmosphere of curiosity and invention or perhaps it was due to the ailing health of her brothers, one of whom suffered from tuberculosis when she was young, but during the course of high school Virginia decided to become a doctor.

At that time it was highly unusual for a women to attend college, but with the help of several scholarships Virginia enrolled in Mt. Holyoke College, where she quickly became known for her boundless energy and rapid style of talking. She played on seven sports teams, reported for the college newspaper, played in the orchestra as a violinist and a cellist, and competed her zoology degree in 1929, all while being described as her advisor and zoology professor as "exceptional."

Virginia began studying at Columbia University just before the Wall Street crash of October 1929 and the start of the Great Depression, and struggled financially to get by. In spite of financial hardships in 1933 she graduated from the College of Physicians and Surgeons, one of nine women in a class of ninety students.

She chose the field of surgery as her specialty and won an internship at Columbia. During her residency, she was encouraged by the chair of surgery Dr. Alan Whipple to consider anesthesia as a field of specialty, as it was considerably underdeveloped and he felt that innovation and improvements were needed if the field of surgery was to advance. In Apgar, he saw the ability and intelligence he felt was needed in that fledgling field. What's more, he had witnessed other women that he had trained in surgery later fail to establish successful careers, especially during that time of Depression, and did not want that same path for Apgar.

Virginia absorbed this advice and in 1937 when she completed her surgical residency she looked for a training program in the field of anesthesiology. She spent six months training with Dr. Ralph Waters' department of anesthesia at the University of Wisconsin-Madison, the first of its kind, then spent another six months training with Dr. Ernest Rovenstine at Bellevue Hospital in New York.

In 1938, Virginia returned to Columbia University as an attending anesthetist and the director of the division of anesthesia, but it was still under-developed as a field and she had trouble finding physicians to work for her. The pay was low and Virginia was the only staff member in the department until the mid-1940s, when anesthesiology began receiving acknowledgement as a specialty requiring residency.

In 1949 anesthesia research became an academic department, and Virginia was made the first woman full professor at Columbia's College of Physicians and Surgeons. She began researching obstetrical anesthesia, the effects of anesthesia given to the mother during childbirth on her newborn baby, and in 1952 developed an assessment called the Apgar test.

Given in the first minute after birth when physicians must make a critical assessment regarding the baby's ability to survive outside the womb without artificial respiration, the Apgar test measures a baby's condition by scoring skin color, pulse, reflexes, muscle activity, and breathing. Babies are scored 0, 1, or 2 points in each of these categories, and the points are totaled to arrive at the babies' score. Based on this, nurses and doctors can quickly determine in a standardized way if the baby is healthy or needs resuscitation.

Examining a newborn baby, 1966, by Al Ravenna

Virginia presented her scoring method at a scientific meeting in 1953, and while initially met with resistance, it was soon adopted, with one modification - though she first planned for the assessment to be given just once immediately following birth, it is now routinely administered both at one minute and five minutes intervals following birth, with health professionals taking measurements at longer intervals as necessary.

The introduction of this measurement to evaluate the health of infants as soon as they are born has saved countless lives and is used around the world today.

Diving further into her research of Apgar scores, Virginia was also able to trace the effects of labor, delivery, and maternal anesthetics on the baby's condition. With the help of fellow researchers Dr. Duncan Holaday and Dr. Stanley James, the team developed new methods of measuring a patient's blood gases and blood levels. Together they determined that mothers given a certain anesthesia (cyclopropane) during delivery was likely to result in a lower Apgar Score, and as a result, doctors stopped using it.

In the course of her research Virginia oversaw the birth of over 17,000 infants at twelve institutions and conducted an extensive study called the Collaborative Project, that concluded that the Apgar Score can predict neonatal survival and neurological development.

After these contributions as a surgeon, at the age of 50 Virginia embarked on a second career, and in 1959 completed a master's degree in public health from Johns Hopkins University. She joined the National Foundation of Infantile Paralysis (now called the March of Dimes) as the head of the birth defects division, and traveled internationally giving lectures, raising money for research, and educating the public about the prevention and treatment of birth defects.

A dynamic and informed speaker, her lectures were very popular with audiences and are generally acknowledged as the first time the issue of birth defects was brought out of the back rooms.

She died on August 7th, 1974 in New York City at the age of 65. On October 24th 1994 the U.S. Postal Service issued a commemorative stamp in her honor (which according to her great nephew Eric Apgar, would have pleased her very much - among her many hobbies and pursuits, stamp collecting was one of the favorites of this great medical pioneer).

In 1995, Apgar was inducted into the National Women's Hall of Fame in Seneca Falls, New York.

With her contributions in the field of aesthetics and the invention of the Apgar test, Virginia Apgar is credited by health professionals as doing more to improve the health of mothers, babies, and unborn infants than anyone else in the 20th century.

Favorite quote (of mine): 

"Nobody, but nobody, is going to stop breathing on me!" ~ Dr. Virginia Apgar, ca. 1950s, when asked why she kept her basic resuscitation equipment with her at all times.


Dr. Virginia Apgar, Changing the Face of Medicine
Virginia Apgar, Who Made America?
Apgar Scoring for Newborns,
The Virginia Apgar Papers, Profiles in Science

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