History Minute: Apgar’s system saves countless lives

Sometimes noticing the smallest detail can make the biggest difference. This is true not only in everyday life but in science as well. Dr. Virginia Apgar developed a system of noticing the smallest details into a life-saving tool for newborns, a test that has saved countless lives.

Apgar was born in New Jersey in 1909. Her father, Charles Apgar, was a stock broker and insurance salesman and had an active interest in astronomy and radio. Her two older brothers were beset by health problems, with the eldest dying of tuberculosis. As a result, she decided from an early age to go into medicine.

After graduating high school, she enrolled in Mount Holyoke College in 1925, a noted women’s college in Massachusetts. She graduated with a degree in zoology in 1929 and immediately went to the medical school at Columbia University in New York, graduating in 1933.

Though she wanted to become a surgeon, she was encouraged to move into anesthesiology. She began working with Columbia-Presbyterian Medical Center in New York City in 1938 as the head of the new anesthesiology division, becoming the first woman to head a medical department at that hospital. In 1949, she became a professor at the medical school at Columbia.

By 1952, she developed what became her defining legacy in medicine, her method of rapid evaluation of the health of newborns. As it caught on within the medical community, it was soon known as the Apgar Test. It was a test of five features on newborns, to be conducted within the first few minutes after birth. The five criteria were: appearance, pulse, grimace, activity, and respiration. She discussed her system with her colleagues and asked for their help in testing it. The potential usefulness of this rating system was not lost on other doctors and nurses and the hospital. They quickly agreed to participate to see how well it could work. Ultimately, more than 700 newborns were tested for these basic vital signs in the initial study.

The Apgar Score is on a ten-point scale. However, Apgar noted that a perfect ten is actually rare, while a score of seven is considered normal.

Apgar noted in her 1953 medical journal article discussing the procedure that there would be possible shortcomings to this test. The heavy sedation that was commonly administered to women during childbirth in the 1950s also slowed down breathing and pulse rates in newborns, sometimes to the point of masking the overall condition of the infant. Coloration of the skin, Apgar also observed, could not always be an effective way of determining whether a newborn was getting enough oxygen.

While it does not cover all possible complications, the Apgar Score has become a standard tool in delivery rooms as a quick shorthand for determining the most life-threatening conditions. It has helped save countless lives in the decades since its development.

She never married, but she had an esoteric mix of interests that kept her active outside of medicine. She was a violin player, an active golfer, gardener, and even learned how to make musical instruments. In the 1960s, she began learning to fly airplanes. As she traveled across the country on speaking tours, she often playing violin with local musicians along the way.

After Apgar left the hospital in 1959, she began working to educate the general public on health issues. She quickly earned a masters degree in public health from Johns Hopkins University in Maryland.

In 1959, Apgar also began working for the March of Dimes. The organization was founded in the 1930s to combat polio, and the successful vaccine effectively ended polio in the United States by the 1960s. Apgar convinced the March of Dimes to shift its focus to preventing birth defects and premature births, giving the organization a new purpose. She continued to work with the charity for the next 15 years.

As part of her efforts to prevent birth defects, she pushed for universal vaccination for measles in the early 1960s, noting the debilitating effects of the disease on expectant mothers and how it could be transmitted during pregnancy or cause miscarriages.

She also began teaching at the Cornell University School of Medicine in 1965, becoming one of the first medical school professors to hold a teaching position specializing in the study of birth defects.

She continued to be an active writer and researcher. She ultimately wrote more than 60 academic articles. In 1972, she published a widely-respected book on childbirth and development, Is My Baby All Right?

Apgar died in 1974 at age 65. However, her simple test continues to save lives to this day.

Dr. Ken Bridges is a professor of history and geography at South Arkansas Community College in El Dorado and a resident historian for the South Arkansas Historical Preservation Society. Bridges can be reached by email at kbridges@ southark.edu.