Apgar, Virginia (1909–1974)

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Apgar, Virginia (1909–1974)

American physician, researcher and administrator known for her contributions in the prevention of birth defects and development of the Apgar Score for Evaluating New-Born Infants. Pronunciation: APP-gar. Born Virginia Apgar on June 7, 1909, in Westfield, New Jersey; died in New York City on August 7, 1974; daughter of Charles Emory (an automobile salesman) and Helen May (Clarke) Apgar; attended Westfield High School, diploma, 1925; Mount Holyoke College, B.A. in zoology, 1929; Columbia University College of Physicians and Surgeons, M.D., 1933; Johns Hopkins University, M.P.H., 1959; never married; no children.

Granted two-year surgical internship at Presbyterian Hospital after receiving her M.D. degree (1933); residency in anesthesiology at the University of Wisconsin and Bellevue Hospital, New York City(1937); instructor of anesthesiology at Columbia University (1938); assistant professor and clinical director of the Department of Anesthesiology at Columbia-Presbyterian Medical Center (1938); associate professor, Columbia (1942); full professor, Columbia (1949); head of Division on Congenital Malformations, The National Foundation (1967); lecturer in teratology, Cornell University Medical Center (1965); senior vice president for Medical Affairs, the National Foundation (1973); clinical professor of pediatrics, Cornell University (1971); lecturer in genetics, Johns Hopkins University (1973).

Every baby born in a modern hospital anywhere in the world is looked at first through the eyes of Virginia Apgar.
—Anonymous physician

Before 1952, it was routine practice for newborn babies to be whisked away in a blanket and taken to the nursery to be examined at a later time. A young anesthesiologist at Columbia-Presbyterian Medical Center by the name of Virginia Apgar was present during many such births and felt that the practice of deferring examination of newborn infants was dangerous. Many babies, she reasoned, could greatly benefit if early problems, especially those with the heart and lungs, were identified and treated immediately. In an interview with Women's Day magazine in 1966, Apgar related that she wondered, "who was really responsible for the newborn." In 1952, she presented her now classic Apgar Scoring System at an International Anesthesia Research Society meeting. In it, she proposed that infants be evaluated in five categories within one minute of birth and then again within five minutes after delivery. The five areas in which infants are observed and rated are: appearance, pulse, grimace, activity, and respiration. Each of these signs is given a numerical value of 0 to 2, with a maximum of 10 points possible for all five categories. This examination was designed to be conducted by a nurse or physician, and in just a few minutes provides an assessment of a child's reflexes, color, heart rate, respiration rate, and muscle tone. A total score of 7 or above is most desirable, with anything less indicating possible problems. The Apgar Scoring System became widely adopted throughout the United States and various other countries.

On June 7, 1909, in Westfield, New Jersey, Virginia Apgar was born to Charles Emory and Helen May Apgar. One of her brothers became a music professor at Earlham College in Indiana, while the other brother had died in 1903. During her childhood, Apgar was exposed to her parents' many interests and hobbies, such as science and music; the musically gifted family enjoyed sharing their talents in concert. Apgar began playing the violin at the age of six, and her love for music continued throughout her lifetime. She was also athletic and participated in sports during both her high school and college years. When she graduated from Westfield High School in 1925, Apgar knew she wanted to en-roll in medical school and become a doctor.

Attending Mount Holyoke College from 1925 to 1929, Apgar majored in zoology with minors in both physiology and chemistry, working hard to achieve her B.A. degree. In addition to her rigorous studies, she played violin in the school orchestra and lettered 11 times in athletics. Though she received scholarships to partially finance her education, she was also employed in various jobs, such as librarian and dining-service waitress, to pay expenses. Apgar even found time to serve as a reporter for the college newspaper.

While attending medical school at the Columbia University College of Physicians and Surgeons, she reportedly said that, in many respects, she found medical school easier than her under-graduate program. Graduating in 1933 with her M.D. degree, Apgar went on to do her internship in surgery at Presbyterian Hospital, New York.

Her internship lasted two years; however, Virginia Apgar was not to become a surgeon. Influenced by one of her professors, she became convinced that the surgical field was in many ways inaccessible to women. She was said to have remarked: "Women won't go to a woman surgeon. Only the Lord can answer that one." As a result, she switched to the field of anesthesiology, a specialty in its early stages of development. (Before becoming an area of medical specialization for physicians in the United States, anesthesiology was largely an area of expertise practiced during the early 20th century by nurses.) In 1937, having served her residency at the University of Wisconsin and at Bellevue Hospital, New York, Apgar was the 15th physician certified as an anesthesiologist by the American Board of Anesthesiology.

Upon her return to Columbia University in 1936, Apgar served as an instructor in anesthesiology. Two years later, she was promoted to assistant professor and served as head of the Department of Anesthesiology at Columbia-Presbyterian

Medical Center. She became an associate professor in 1942 and was the first woman to be promoted to full professor on Columbia's medical faculty in 1949. Apgar remained in this position until 1959, assisting in the training of over 250 physicians. During these years, she became intensely interested in obstetrics, finding the delivery room one of the most fascinating places in the hospital. Personally involved in administering anesthesia to thousands of mothers, she also had many opportunities to observe obstetric procedures. Her concern for treatment needs of the newborn culminated in her development of the Apgar Scoring System.

After assisting in over 17,000 births at various New York and New Jersey hospitals, Apgar resigned her position as teacher and practitioner and returned to the classroom, this time as a student at Johns Hopkins University School of Hygiene and Public Health. In 1959, she earned her Master of Public Health degree. That same year, she was approached by The National Foundation-March of Dimes to become the head of its division on congenital malformations. Though she confessed to knowing little about birth defects, the foundation convinced her to accept the position, claiming that she "could learn" anything else she needed to know.

One of Apgar's roles as head of the division on congenital malformations was to distribute over five million dollars annually in the form of research grants to scientists studying birth defects. In addition, she wrote extensively, as well as lectured widely, about congenital malformations. Apgar has been credited with her outspoken views on the importance of good prenatal care, advocating healthy lifestyle choices for the expectant mother, including good diet, avoidance of most drugs and radiation, and protection from exposure to infections such as measles. During this time, she also authored many articles geared toward the general public that appeared in widely circulated magazines such as Ladies Home Journal, Woman's Day, and Today's Health.

In 1967, Apgar was promoted to vice president and director of basic research at The National Foundation. Her position involved extensive travel and the delivery of presentations throughout the world. In 1972, she co-authored the well-known book Is My Baby All Right? with syndicated-columnist Joan Beck . In the widely acclaimed publication, the authors discuss children "who are born with defects and disorders occurring before or at the time of birth that are serious enough to require special medical care and/or educational help and that will change the course of their lives and the lives of their families in major or minor ways."

In 1973, Apgar, appointed senior vice president for medical affairs, continued to research, supervise funding, and write prolifically in the areas of birth defects and the need for sound prenatal care. She also authored over 60 articles that appeared in medical journals. During her tenure with The National Foundation-March of Dimes, Apgar lectured in the fields of teratology (the study of abnormal functions) at Cornell Medical School and genetics at Johns Hopkins University. From 1965 to 1971, she was a member of the Methodist Board of Hospitals and Homes and an alumnae trustee of Mt. Holyoke College.

During her lifetime, Apgar received many honors. She was awarded honorary doctorates from Woman's Medical College of Pennsylvania, Mt. Holyoke College, New Jersey College of Medicine and Dentistry, and Boston University. She was a fellow of the American College of Anesthesiology and served as chair in 1951 and 1952. She was also a fellow of the New York Academy of Medicine, the American Public Health Association, and the New York Academy of Sciences. Her other professional affiliations included the American Academy of Pediatrics, American College of Obstetrics and Gynecology, American Pediatrics Society, American Eugenics Society, Congenital Anomalies Research Association of Japan, American Society of Human Genetics, Teratology Society, Pan-American Society for Anesthesiology, Alpha Omega Alpha, Sigma Delta Epsilon, the Irish-American Pediatric Society, and the Drug Information Association.

Apgar's professional accomplishments were extraordinary in both number and quality, yet she was known as a modest, down-to-earth woman who was not comfortable with celebrity. In addition to her professional achievements, she had other interests: stamp collecting, gardening, golf, and photography. Through the years, she never lost her passion for music and was a member of the Amateur Chamber Music Players and the Catgut Acoustical Society. She continued to play violin, viola, and cello, while also studying the art of constructing stringed instruments.

Virginia Apgar died on August 7, 1974, in New York City of an apparent pulmonary embolism. Her obituary in Time magazine described her as a "wise, industrious specialist."