Medical instructor and researcher Virginia Apgar (1909-1974) revolutionized the field of perinatology —the care of infants around the time of birth—with her development of the Apgar Newborn Scoring System. Her method of rating a newborn's health in five major categories allows doctors to quickly establish if a child requires medical attention. Implementation of this basic practice throughout the United States and around the world resulted in a significant increase in infant survival rates.
Virginia Apgar contributed to many areas of medicine during her career, including anesthesiology, infant care, and the study and prevention of birth defects. It was her work with new babies and mothers, however, that has left the greatest mark in the health sciences. She was the creator of the Apgar Newborn Scoring System, a method of evaluating the health of infants minutes after birth in order to ensure the delivery of proper care. Apgar also contributed to infant health through her discovery that some anesthetics given to women during childbirth had a negative effect on babies. Her findings led doctors across the country to revise their use of painkillers during labor. Later in her career, Apgar was a vital force in the March of Dimes organization, where she directed research efforts, raised money, and educated the public about birth defects. Her lifetime of energetic work resulted in standard medical procedures for mothers and babies that have prevented thousands of infant deaths.
Apgar was born on June 7, 1909, in Westfield, New Jersey. Her childhood home contained a basement laboratory, where her father pursued scientific experiments with electricity and radio waves and built a telescope. Perhaps due to this atmosphere of curiosity and inquiry, Apgar set her sights on a scientific career in the field of medicine. After graduating from high school, she entered Mount Holyoke College with the intention of becoming a doctor. Although she received scholarships that helped to pay for her tuition, she still had to take a number of jobs to support herself through college. Despite the extra work, she graduated with a bachelor's degree in 1929.
Apgar's financial situation did not improve when she enrolled at the College of Physicians and Surgeons at Columbia University in New York City the following September. A month later, the stock market crashed, signaling the beginning of the decade of economic turmoil known as the Great Depression. Determined to stay in school, Apgar borrowed money in order to complete her course work. She emerged in 1933 with a medical degree and a fourth-place rank in her graduating class, but also with the burden of a large financial debt. Her high marks earned her a much sought-after internship in surgery at Columbia, but during this period of training Apgar began to consider how she could best support herself in the medical profession. She saw that even male surgeons had trouble finding work in New York City, and as a woman in what was then a male-dominated profession, she realized that her chances of success were even slimmer. She felt that she was more likely to be successful in the field of anesthesia.
Traditionally, nurses had been responsible for administering anesthesia, but at that time greater emphasis was being to be placed on the importance of anesthetics; doctors had begun entering the field in the hopes of making breakthroughs that would allow for improved surgery techniques. Women physicians, in particular, were encouraged to pursue medical anesthesiology, perhaps because it was still considered a female realm. So after finishing her internship at Columbia in 1935, Apgar began a two-year residency program in anesthesiology, during which time she studied not only at Columbia, but also at the University of Wisconsin in Madison and Bellevue Hospital in New York.
Apgar's choice of career did allow her to realize her goal of securing a job. She was hired as director of the anesthesia division at Columbia University in 1938. Her new position, however, proved to be a challenging one. She was the only person in the anesthesia area, leaving her with a heavy workload. In addition, she struggled to get surgeons to recognize the anesthesiologist as a fellow doctor, not a subordinate, and she fought against the policy that prevented anesthesiologists from being allowed to charge standard doctor's fees. Eventually, Apgar and her department began to receive more support and respect—she gradually increased the number of physicians in the division and won sufficient funding for the area and its employees in 1941, after threatening to quit her post if the school refused her requests. After World War II, anesthesiology began gaining more attention across the nation as an area of specialty and research, and Columbia University created a separate department of anesthesia for training physicians and conducting research. When the chair of the new department was selected in 1949, however, Apgar was passed over in favor of a male anesthesiologist. Instead, she was named a full professor in the department, making her the first woman to reach such a level at Columbia.
It was in this position as a teacher and researcher that Apgar would make her greatest contributions to medicine over the next decade. She began to focus her work in the area of anesthesia used during childbirth. Apgar realized that the period immediately following birth was a critical time for many infants; however, babies were usually not evaluated carefully by doctors, who were often more concerned with the welfare of the mother. Because of this lack of an organized examination, many life-threatening conditions were not identified in infants. To provide a quick and efficient means of determining which babies required special care, she devised a five-part test that scored a child's heart rate, respiration, muscle tone, color, and reflexes. The test, known as the Apgar Newborn Scoring System, was to be scored one minute after birth; the recommended timing of the test was later expanded to five and ten minutes as well. Although developed in 1949, a description of the system was not published until 1953. It eventually became a world-wide standard among physicians. A study by Apgar involving a dozen hospitals and more than 17,000 infants evaluated by the Apgar score proved that the testing method was a predictable indicator of a child's survival and rate of development.
Another victory for infant health was won with Apgar's research into the effects of anesthesia given to mothers during childbirth. Collaborating with pediatrician L. Stanley James and anesthesiologist Duncan Holaday, Apgar monitored the blood levels, blood gases, and pH levels of newborns whose mother received anesthesia during labor. These measurements, combined with the application of the Apgar score system, were designed to indicate to doctors what kinds of problems—such as a low oxygen level or a pH imbalance in the blood—needed to be addressed if a baby was doing poorly. To take such measurements and facilitate treatments, Apgar became the first person to place a catheter in the umbilical artery, now a standard practice in neonatal care. In the course of her research, Apgar found that the anesthesia cyclopropane had a noticeable negative effect on a baby's overall condition. Immediately ceasing her use of the gas for mothers in labor, other doctors across the country quickly followed suit after Apgar published her findings.
After a more than twenty-year career at Columbia, Apgar left her post as professor to earn a master of public health degree at Johns Hopkins University. Her new career took her to the March of Dimes organization in 1959, where she was hired as the head of the division on congenital birth defects. In 1969, she became the head of the March of Dimes research program; during her three-year stint in this role she changed the foundation's emphasis from the prevention of the crippling disease polio to a concentrated effort to prevent birth defects. In an effort to educate the public about the topic, she gave many lectures and cowrote a book titled Is My Baby All Right? in 1972. Apgar left her research position in 1973 to become vice president for medical affairs and a fund-raiser. She was a great success in both roles, increasing donations to the charity and channeling the new money into research on birth defects, resulting in better prevention and treatment of many conditions. At the same time, she held a research fellowship at Johns Hopkins University and a position as clinical professor at Cornell University, where she became the first U.S. medical professor to specialize in birth defects.
During her lifetime, Apgar made significant contributions to science not only in the laboratory, but also in the classroom. She instructed hundreds of doctors and left a lasting mark on the field of neonatal care. Apgar received a number of awards recognizing her role in medicine. She was honored with the Ralph Waters Medal from the American Society of Anesthesiologists and the Gold Medal of Columbia University, was named Woman of the Year for 1973 by Ladies' Home Journal, and was the recipient of four honorary degrees. In addition, a prize in her name was founded by the American Academy of Pediatrics and an academic chair was created in her honor at Mount Holyoke College.
Apgar, who never married, was unrelenting in her pursuit of knowledge. In her sixties, she began a course of study in genetics at Johns Hopkins University. She also found time, however, for a number of personal interests, including music, gardening, photography, and stamp collecting. On August 7, 1974, Apgar died in New York City at the age of 65. She was remembered as an honest and encouraging teacher who inspired numerous doctors in their medical practice and research. The modern fields of anesthesiology and neonatal care are greatly indebted to her pioneering work.
For more information see Apgar, Virginia, and Joan Beck, Is My Baby All Right?: A Guide to Birth Defects, Trident Press, 1972; Calmes, Selma, "Virginia Apgar: A Woman Physician's Career in a Developing Specialty," Journal of the American Medical Women's Association, November/December, 1984, pp. 184-188; Diamonstein, Barbaralee, Open Secrets: Ninety-four Women in Touch with Our Time, Viking Press, 1972; Vare, Ehlie Ann, and Greg Ptacek, Mothers of Invention: From the Bra to the Bomb—Forgotten Women and Their Unforgettable Ideas, William Morrow, 1988. □