Virginia Apgar: our Jimmy

Yasaswi Paruchuri
Michigan State University, United States (Summer 2014)

 

Virginia Apgar (1909- 1974)
Virginia Apgar (1909- 1974)

Known for developing the Apgar score, a measurement of newborn management, Dr. Virginia Apgar (1909- 1974) was often the only woman in a room of professional peers. Dr. Apgar developed the scoring strategy, “to find a way to get doctors to pay attention to the baby.”1 Alongside this enduring medical contribution, she held noteworthy warmth and professional dedication, “With her, life was exciting.”2 She may have been the only woman in the room, but such singularity hardly measured her worth.

Known as “Our Jimmy Apgar”3 by her Mount Holyoke classmates, Dr. Apgar graduated in 1929 with an AB in Zoology, and that same year began medical school at Columbia University’s College of Physicians and Surgeons. In her class of ninety medical students, she accompanied eight other women. She next completed a surgical residency and an anesthesiology residency. In 1938 she returned to Columbia Presbyterian Medical Center, and by 1949 she was a full professor of anesthesiology, the first woman to hold that title. While at Columbia she devised her innovative newborn scoring system, publishing her work in 1953.4 Still it was several years, and not by Dr. Apgar’s design, before she would serve as an eponym for her scoring system.  In 1960 Dr. James Butterfield wrote to inform Dr. Apgar that a student had begun to use an acronym of her name:5

A – appearance (color)

P – pulse

G – grimace (reflex irritability)

A – activity (muscle tone)

R – respiration

With this scoring system, Apgar and colleagues were able to correlate the newborn status at one minute with likelihood of asphyxiation, facilitating early intervention and decreased infant mortality. Apgar recognized flaws in the score,6,7 and a modified version emerged and survives to this day.8

The Apgar score was just the beginning of her recognized contributions. In 1959 she earned an MPH from Johns Hopkins. She left Columbia to become Chief of Congenital Malformations at the National Foundation – known later as the March of Dimes – where she cemented her national recognition.

She achieved her greatest visibility in later years in her drive to highlight the need for early detection of birth defects. She was the finest ambassador the National Foundation ever had. Through her vigor their income increased from $19 million when she first arrived to $46 million when she died.2

In the final ten years of her life, Dr. Apgar received numerous awards, including the Distinguished Service and the Ralph Waters Award from the American Society of Anesthesiologists, the Elizabeth Blackwell Medal from the American Medical Women’s Association, and the Alumni Gold Medal for Distinguished Achievement from Columbia Presbyterian and the Sloane Alumni Association at Columbia University. In 1973 Ladies Home Journal recognized her as Woman of the Year in Science.

Dr. Apgar’s professional accomplishments are many, yet her vigor for life holds equal glory. At Mount Holyoke, she played on seven sports teams, worked several part-time jobs, wrote for the school newspaper, and acted in a drama production. Her yearbook editor asked; “Frankly, how does she do it?”5 Her boundless voracity continued into later life – she drove her own car and “[her] tires never wore out because they never touch the ground.”2 At 59 years old, she began flying lessons. Supplementing these maverick hobbies was a charming sense of humor. On a treatise to widen understanding of birth genetics, Dr. Apgar wrote,

Oddly enough, papa also is responsible exclusively for passing along excessively hairy ears seen among some natives of India and Ceylon. It is a reasonable assumption that, as our knowledge of chromosomes in the male increases, we will find more birth defects attributable to him.9

A skilled musician, “Jimmy” abhorred meddlesome bureaucracy,2,7 exemplified when she defied the Columbia hospital administration by replacing a hospital bookshelf made of high quality wood with one of inferior wood. Under the tutelage of one of her patients, she then transformed the liberated wood into a viola.1,7

It is clear that Dr. Apgar deserved her honors. At her funeral in 1974,10 “the memorial service…was attended by a mix of prominent medical and local people, including the local traffic policeman with whom she had so many encounters during her fast driving days.”1 She was 65 years old. Her namesakes are symbolic of her persona – she was an avid stamp collector and there is a stamp dedicated to her.7,11 The Apgar musical society performs at pediatric events, and the instruments are the very ones that she made.12 Her most lasting accomplishment, the APGAR score, reflects Dr. Apgar’s intuit and concern for the baby. Today’s young physicians can find lasting inspiration in Dr. Apgar’s path – it is possible to be smart, funny, dedicated to one’s patients, and still maintain the wildness of youth.

 

References

  1. Baskett, Thomas F. 2000. “Virginia Apgar and the Newborn Apgar Score.” Resuscitation 47 (3) (December): 215–217. doi:10.1016/S0300-9572(00)00340-3. http://www.sciencedirect.com/science/article/pii/S0300957200003403.
  2. James, L. Stanley. 1975. “Fond Memories of Virginia Apgar.” Pediatrics 55 (1) ( 1): 1–4. http://pediatrics.aappublications.org.proxy1.cl.msu.edu/content/55/1/1
  3. “Profiles in Science; National Library of Medicine.” 2012. Online Exhibit. The Virginia Apgar Papers. http://profiles.nlm.nih.gov/CP/
  4. Apgar, Virginia. 1953. “A Proposal for a New Method of Evaluation of the Newborn Infant.” Anesthesia & Analgesia 32 (4) (July–August): 260–7. http://journals.lww.com/anesthesia-analgesia/Fulltext/1953/07000/A_Proposal_for_a_New_Method_of_Evaluation_of_the.6.aspx.
  5. “Profiles in Science; National Library of Medicine.” 2012. Online Exhibit. The Virginia Apgar Papers. http://profiles.nlm.nih.gov/CP/
  6. Papile, Lu-Ann. 2001. “Editorial: The Apgar score in the 21st century.” The New England Journal of Medicine 344 (7) (February 15): 519–520. http://search.proquest.com.proxy2.cl.msu.edu/docview/223950536/14173E7975355DFFD04/7?accountid=12598
  7. Goodwin, James W. 2002. “A personal recollection of Virginia Apgar.” Journal of obstetrics and gynaecology Canada: JOGC = Journal d’obstétrique et gynécologie du Canada: JOGC 24 (3) (March): 248–249.
  8. Papile, Lu-Ann. 2001. “Editorial: The Apgar score in the 21st century.” The New England Journal of Medicine 344 (7) (February 15): 519–520. http://search.proquest.com.proxy2.cl.msu.edu/docview/223950536/14173E7975355DFFD04/7?accountid=12598
  9. Apgar, Virginia. 1968. “How the March of Dimes Fights Birth Defects.” Atlanta Daily World (1932-2003), January 10. http://search.proquest.com.proxy2.cl.msu.edu/docview/491323287/abstract/1417402A382473FA4C0/37?accountid=12598
  10. Bamberger, Werner. 1974. “Dr. Virginia Apgar Dies at 65; Devised Health Test for Infants: Named Vice President Professor at Columbia.” New York Times, August 8. http://search.proquest.com.proxy2.cl.msu.edu/docview/120048567/abstract/14173A938D3E644233/8?accountid=12598#
  11. “Virginia Apgar (1909-74).” 1994. The Lancet 344 (8932) (November 5): 1287. http://search.proquest.com.proxy2.cl.msu.edu/docview/198962387/citation/14173E7975355DFFD04/15?accountid=12598
  12. Skolnick AA. 1996. “APgar Quartet Plays Perinatologist’s Instruments.” JAMA 276 (24) (December 25): 1939–1940. doi:10.1001/jama.1996.03540240017009. http://dx.doi.org/10.1001/jama.1996.03540240017009

 


 

YASASWI PARUCHURI, BS, is a MD candidate, Class of 2015, at the College of Human Medicine at Michigan State University. She enjoys sailing in her spare time.