Virginia Apgar

Virginia Apgar was born on June 7, 1909, in Westfield, New Jersey, the youngest of three children of Helen Clarke Apgar and Charles Emory Apgar, an insurance executive and enthusiastic amateur scientist who built a telescope and tinkered with wireless radio in the family basement ^[1]. The household prized curiosity. One of her brothers died of tuberculosis in early childhood, and another suffered from chronic illness, experiences that biographers have linked to her early interest in medicine ^[2].

She was an energetic student at Westfield High School, playing violin, competing in athletics, and writing for the school paper. In 1925 she entered Mount Holyoke College in Massachusetts, where she majored in zoology and supported herself with a string of jobs, including waiting tables, catching cats for the zoology laboratory, and reporting for the college newspaper ^[1]. She graduated in 1929, months before the stock market crash, already fixed on a medical career.

Apgar enrolled that fall at the College of Physicians and Surgeons of Columbia University, one of only a handful of women in her class. Despite the financial strain of the Depression, which forced her to borrow heavily, she graduated fourth in her class in 1933 and won a coveted surgical internship at Columbia-Presbyterian Medical Center ^[2].

Apgar's surgical talent was evident, but her mentor, the surgery chairman Allen Whipple, discouraged her from continuing. He had watched other women struggle to build surgical practices in New York during the Depression and argued she would fare better in anesthesiology, then a neglected field usually left to nurses ^[3]. Whipple believed surgery could not advance without better anesthesia, and he saw in Apgar the intelligence and drive to build the discipline.

She took the advice. After completing her surgical internship in 1935, she trained in anesthesia with nurse anesthetists at Columbia, then studied under Ralph Waters at the University of Wisconsin, home of the first academic anesthesiology department in the United States, and with Emery Rovenstine at Bellevue Hospital in New York ^[3]. In 1938 she returned to Columbia-Presbyterian as director of the newly created division of anesthesia, the first woman to lead a division there ^[1].

The assignment was demanding. Apgar had to recruit physicians into a specialty that surgeons regarded as subordinate, negotiate for fair pay, and cover a punishing clinical schedule herself. Over the next decade she built the division into a respected service, though when Columbia elevated anesthesiology to full departmental status in 1949, the chairmanship went to a male colleague, Emanuel Papper. Apgar was instead appointed professor of anesthesiology, the first woman to hold a full professorship at the College of Physicians and Surgeons, and she turned her attention to obstetrical anesthesia ^[2].

Freed from administrative duties, Apgar concentrated on what happened to babies in the minutes after delivery. At mid-century, newborns who were blue, limp, or slow to breathe often received little systematic attention, and there was no standard way to judge which infants needed urgent help. According to a story she enjoyed telling, a medical student asked her over breakfast in the hospital cafeteria how one might evaluate a newborn, and she jotted down five signs on the nearest piece of paper ^[4].

Those five signs became the Apgar score: heart rate, respiratory effort, muscle tone, reflex irritability, and color, each rated zero, one, or two, for a maximum of ten points. She presented the system at a meeting of anesthesia researchers in 1952 and published it in 1953 in the journal Current Researches in Anesthesia and Analgesia ^[4]. The score, assigned at one minute and later also at five minutes after birth, gave delivery rooms a common language for a newborn's condition and a prompt to act when the number was low.

The test spread rapidly through American hospitals and then worldwide. In the early 1960s the pediatrician L. Joseph Butterfield popularized a backronym, APGAR, standing for Appearance, Pulse, Grimace, Activity, and Respiration, which helped clinicians remember the elements ^[5]. Working with colleagues including the pediatrician L. Stanley James and the anesthesiologist Duncan Holaday, Apgar went on to study newborn blood chemistry and the effects of obstetric anesthesia on infants, research that helped establish the field now called perinatology ^[3]. A collaborative study of many thousands of births later confirmed that the five-minute score predicted newborn survival, and versions of the score are still recorded for nearly every hospital birth in much of the world ^[4].

In 1958, nearing fifty, Apgar took a sabbatical to study public health at Johns Hopkins University. The move led to a complete change of career. In 1959 she left Columbia to join the National Foundation-March of Dimes, the organization that had funded the polio vaccine effort and was redirecting itself toward the prevention of birth defects ^[1]. She began as head of its division on congenital malformations and rose to become vice president for medical affairs and later senior vice president in charge of basic medical research ^[2].

Apgar proved a gifted fundraiser and public educator. She traveled tens of thousands of miles a year, lecturing to medical societies, parent groups, and journalists about prematurity, rubella in pregnancy, and Rh incompatibility, and she pressed for immunization and prenatal testing during the rubella epidemic of 1964 and 1965 ^[5]. Annual giving to the foundation grew substantially during her tenure, a rise colleagues attributed in part to her plainspoken charm on the lecture circuit.

She also kept a foot in academia. Apgar taught teratology, the study of birth defects, at Cornell University Medical College beginning in 1965, reportedly the first faculty appointment of its kind in the United States, and later lectured on genetics at the Johns Hopkins School of Public Health ^[2]. In 1972 she co-wrote a popular book for parents, Is My Baby All Right?, with the writer Joan Beck, explaining the causes and prevention of birth defects in accessible language ^[6].

Apgar never married and had no children, remarking with characteristic dryness that she had simply never found a man who could cook ^[5]. She lived with energy that impressed everyone around her. Colleagues recalled that she habitually carried resuscitation equipment, saying that nobody was going to stop breathing on her watch ^[1].

Music remained a lifelong passion. She played violin and cello in amateur chamber groups wherever she traveled, and in her fifties she took up instrument making with a friend, the musician and craftswoman Carleen Hutchins, building a violin, a viola, a cello, and a mezzo violin by hand ^[6]. A frequently retold episode involves the two women quietly substituting a phone booth shelf made of curly maple that Hutchins judged perfect for a viola back; a replacement shelf was installed to cover the borrowing ^[6].

Her other enthusiasms included gardening, fly fishing, golf, and stamp collecting, and past the age of fifty she began taking flying lessons, telling friends she hoped one day to fly under the George Washington Bridge ^[1]. Students remembered her as an exuberant, fast-talking teacher who was generous with her time and impatient with pretension.

Apgar remained professionally active into the 1970s even as progressive liver disease, cirrhosis, undermined her health ^[2]. She continued lecturing for the March of Dimes, teaching, and collecting honors. Among many awards, she received the Elizabeth Blackwell Award from the American Medical Women's Association in 1966, the Distinguished Service Award of the American Society of Anesthesiologists in 1961, and the Ralph M. Waters Award in 1973, and in 1973 Ladies' Home Journal named her Woman of the Year in science ^[2].

She died on August 7, 1974, at Columbia-Presbyterian Medical Center in New York, the hospital where she had spent most of her career, at the age of 65 ^[1]. She was buried in Fairview Cemetery in Westfield, the New Jersey town of her birth.

Recognition continued after her death. In 1994 the United States Postal Service issued a twenty-cent stamp bearing her portrait in its Great Americans series, and in 1995 she was inducted into the National Women's Hall of Fame in Seneca Falls, New York ^[5].

Any list of Virginia Apgar achievements begins with the score that carries her name. More than seventy years after its publication, the Apgar score is still assigned to newborns in delivery rooms on every continent, an unusually durable run for a clinical tool devised in the early 1950s ^[4]. Its deeper effect was cultural: by requiring someone to look closely at every baby at one minute of life, the score made the newborn a patient in his or her own right and helped drive the growth of neonatal intensive care.

Apgar also left a mark as an institution builder. She trained a generation of physician anesthesiologists at Columbia when the specialty was young, and her research with L. Stanley James and others on infant oxygenation and the placental transfer of anesthetic drugs laid groundwork for modern perinatal medicine ^[3]. At the March of Dimes she helped turn birth defects from a private sorrow into a subject of public research funding and prevention campaigns.

For readers of any Virginia Apgar biography, the facts of her life carry a second lesson about barriers and persistence. Steered away from surgery because she was a woman, she built a career of the first rank in the fields left open to her, without, by most accounts, dwelling on the obstacles. Mount Holyoke College and Columbia University preserve her papers and honor her name, medical students still learn her five signs in their first obstetrics rotation, and among Virginia Apgar facts perhaps the most fitting is the tribute repeated by colleagues after her death: every baby born in a modern hospital is looked at first through the eyes of Virginia Apgar ^[1].