Virginia Apgar

1909-1974

American Obstetric Anesthesiologist

Virginia Apgar was an obstetric anesthesiologist best known for developing a scoring system to evaluate newborn babies that is now used around the world. Apgar published more than 60 papers in professional journals on topics related to anesthesiology, birth defects, and resuscitation. During her career she trained about 250 anesthesiologists and administered anesthesia in over 20,000 operations and over 17,000 births.

Virginia Apgar was born in Westfield, New Jersey, on June 7, 1909. She graduated from Mount Holyoke College in Massachusetts in 1929. During her undergraduate days she played in the college orchestra and on several athletic teams and reported for the college newspaper. Her energetic pursuit of diverse interests continued beyond college training. Apgar completed medical school at Columbia University's College of Physicians and Surgeons in New York City in 1933 and spent 1934 and 1935 completing a surgical residency at the city's Presbyterian Hospital.

Although Apgar did very well in the residency, the Chairman of Surgery, Dr. Alan Whipple, encouraged her to pursue anesthesia as a career. At that time the U.S. was deep in the Great Depression, and Whipple knew that even male surgeons were having difficulty succeeding in New York, where numerous surgeons wanted to practice. Whipple also knew that anesthesia, which was an underdeveloped specialty at the time, must advance for surgery to advance as well and that anesthesia needed doctors like Virginia Apgar.

Apgar took her mentor's advice and in early 1936 began anesthesia training at Presbyterian Hospital. In 1937 she spent six months in Madison, Wisconsin, to study anesthesia with Dr. Ralph Waters, who had created the first academic anesthesia training program in the United States more than a decade earlier. When she returned to New York City, Apgar spent six more months training under Dr. E.A. Rovenstine—another student of Waters's—at Bellvue Hospital. Thus Apgar had the finest anesthesia education available to her at the time.

In 1938 Apgar was named Director of the Anesthesia Division in the Department of Surgery at Columbia. She faced numerous obstacles in attempting to run her department. The clinical case load was enormous, and Apgar had trouble recruiting other physician-anesthesiologists in an era when anesthesia was still considered a nurse's job. Apgar faced conflicts with surgeons over who was in charge during operations and was poorly compensated for her work; at first, she was not allowed to bill patients for her work. Yet Apgar prevailed, and remained in this department until 1959. She managed the clinical load and attempted to add a research component to her division. In 1949 Dr. Emmanuel Papper, an anesthesiologist at Bellvue with a strong research interest, became chief of the division, and he and Apgar were both named full professors in the medical school. Apgar was the first woman to reach that position at Columbia.

Since she was no longer involved in the administrative duties of the division, Apgar could develop her interest in obstetric anesthesia. At mid-century evaluation of newborn babies was a haphazard process. In 1949 during breakfast in the hospital cafeteria, a medical student remarked on the need to evaluate newborns. Apgar quickly wrote down five items needed in such an evaluation and began to test her ideas. Her scoring method was presented at a medical meeting in 1952 and published the following year. The evaluation of newborns at one- and five-minute intervals quickly became standard delivery room practice, and today the Apgar Score is known around the world.

For the next decade Apgar continued to research the application of her scoring system to the condition of newborns. She also studied the effects on the baby of anesthetics given to the mother during delivery. By 1959 Apgar was ready for a change. She left Columbia and moved to Johns Hopkins University in Baltimore, Maryland, and earned a masters degree in public health. When the March of Dimes organization asked her to lead a new division of birth defects, she accepted and spent the last 15 years of her life in that position.

Apgar never married or had children of her own. She did maintain throughout her life the interest in music demonstrated in her undergraduate college years. Whenever she traveled, she carried along her viola and played with local musicians as often as possible. In October, 1994, a 20-cent stamp honoring Apgar was issued by the U.S. Postal Service. At the ceremony releasing the stamp, four musicians played a viola, cello, violin, and mezzo violin that Apgar herself had made. In 1996 these instruments were donated to the Columbia University College of Physicians and Surgeons, where this remarkable woman did so much to improve the health of newborn infants.

A. J. WRIGHT