Women’s History Month: Virginia Apgar, doctor

Virginia Apgar, M.D. (1909 – 1974) was an American obstetrical anesthesiologist, best known as the inventor of the Apgar score, a way to quickly assess the health of a newborn child immediately after birth. She was a leader in the fields of anesthesiology and teratology, and introduced obstetrical considerations to the established field of neonatology.  She was also the first woman to become a full professor at Columbia University College of Physicians and Surgeons.

She had aspirations to go into the medical field from a young age, inspired by her eldest brother’s early death from TB and another brother’s chronic childhood illness.  She attended Mt Holyoke College.  She performed as a violinist in the college orchestra while majoring in zoology. She then attended the College of Physicians and Surgeons at Columbia just before the Great Depression.  She graduated fourth in her class in 1933.  She earned a surgical internship at Columbia.  Dr Alan Whipple, the chair of surgery, tried to dissuade her from being a surgeon based solely on her gender.  He pushed her toward anesthesia but because it was not considered a specialty at the time, she struggled to find the ability to offer a significant contribution.  She completed her residency in 1937 after struggling to find a training program to complete her surgical residency.  At the University of Wisconsin-Madison she would train with Dr Ralph Waters who led the United States’ first ever department of anesthesia.  Afterward she would study under Dr Ernest Rovenstine at Bellevue Hospital in New York.

In 1938 she secured a position at Columbia University as the director of the division of anesthesia and as an attending anesthetist. Because surgeons did not accept anesthesiologists as equals, and the pay was low, she found it difficult to secure staff. Apgar was the only staff member until the mid-1940s. By 1946, anesthesia began to become an acknowledged medical specialty with required residency training.  In 1949, when anesthesia research became an academic department, Dr. Apgar was appointed the first woman full professor at the Columbia University College of Physicians and Surgeons.

Through her study of the effects of anesthesia on mothers during labor (and on their newborn baby), she was able to contribute greatly to the field.  She created a method of evaluating a newborn’s transition to outside the womb.  This evaluation included testing the infant’s heart rate, respiratory function, muscle tone, reflexive response and color.  Each are observed and rated with a 0, 1 or 2.  The total is the score. She published this evaluation in 1953 and after resistance the score was accepted as standard throughout the world.  With the assistance of Dr Duncan Holaday and Dr Stanley James, she was able to relate the score to the effects of labor and to demonstrate that babies with low levels of blood oxygen and highly acidic blood received low scores.  With this observation, giving cyclopropane anesthesia to mothers resulted in a lower score.  The Collaborative Project which included studying 17,221 babies at 12 institutions, established the score as a prediction of neonatal survival and neurological development.  Apgar earned her master’s degree in public health from John Hopkins and decided to not return to academic medicine.  She would devote her life to the prevention of birth defects through education and fundraising for research.  She became a director for the National Foundation for Infantile Paralysis in their division of congenital defects.  The organization would go on to become the March of Dimes.  She would receive numerous honors for her work.

If you would like to learn more about Virginia Apgar, following are a couple links and some video:

https://www.famousscientists.org/virginia-apgar/

https://www.britannica.com/biography/Virginia-Apgar

 

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