Biography: Dr. Virginia Apgar

Virginia Apgar, M.D., the first woman to become a full professor at Columbia University College of Physicians and Surgeons, designed the first standardized method for evaluating the newborn's transition to life outside the womb—the Apgar Score. Newborn babies still benefit from Dr. Virginia Apgar's groundbreaking research into the effects of anesthesia during childbirth and advocacy on the prevention of birth defects.

By the time she graduated from high school,Virginia Apgar was determined to be a doctor. She may have been inspired by her father's scientific hobbies, or by her eldest brother's early death from tuberculosis, and another brother's chronic childhood illness. With the help of several scholarships, she attended Mt. Holyoke College, performing in the college orchestra as a gifted violinist and cellist and graduating with a major in zoology in 1929.

Apgar entered the College of Physicians and Surgeons at Columbia University just before the Wall Street crash of October 1929, the beginning of the Great Depression. Despite financial problems, she graduated fourth in her class in 1933. Determined to become a surgeon, she won a surgical internship at Columbia and performed brilliantly. Nevertheless, the chair of surgery, Dr. Alan Whipple, discouraged her from continuing because other women he had trained in surgery failed to establish successful careers in the specialty. Whipple also believed that innovations and improvements were needed in anesthesia (at that time handled mostly by nurses) if surgery was to advance, and he saw in Apgar "the energy, intelligence, and ability needed to make significant contributions in this area." Because anesthesiology was not generally recognized as a specialty until the mid-1940s, Apgar struggled to find a training program when she completed her surgical residency in 1937. She spent six months training with Dr. Ralph Waters' department of anesthesia, the first in the United States, at the University of Wisconsin-Madison. She then spent six months with Dr. Ernest Rovenstine at Bellevue Hospital in New York.

In 1938, Dr. Apgar returned to Columbia University as the director of the division of anesthesia and as an attending anesthetist. Despite her title, she had trouble recruiting physicians to work for her. Surgeons did not accept anesthesiologists as equals, and the pay for the less well-respected specialty was low. Apgar was the only staff member until the mid-1940s. By 1946, anesthesia began to become an acknowledged medical specialty with required residency training, and 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.

She began studying obstetrical anesthesia—the effects of anesthesia given to a mother during labor on her newborn baby—where she made her greatest contribution to the field, the Apgar Score. This was the first standardized method for evaluating the newborn's transition to life outside the womb. "Five points—heart rate, respiratory effort, muscle tone, reflex response, and color—are observed and given 0, 1, or 2 points. The points are then totaled to arrive at the baby's score." The score was presented in 1952 at a scientific meeting, and first published in 1953. Despite initial resistance, the score was eventually accepted and is now used throughout the world. Apgar first planned the score to be taken one minute after birth, as a guide to the need for resuscitation. Others began to take measurements at longer intervals, to evaluate how the baby had responded to any necessary resuscitation. Eventually, the one- and five-minute Apgar Score became standard.

Apgar went on to relate the score more closely to the effects of labor, delivery, and maternal anesthetics on the baby's condition. Colleagues Dr. Duncan Holaday and Dr. Stanley James helped her make these connections, providing new methods of measuring blood gases and blood levels of anesthesia, and contributing specialized knowledge in cardiology. Together, they were able to demonstrate that babies with low levels of blood oxygen and highly acidic blood had low Apgar Scores and that giving cyclopropane anesthesia to the mother was likely to result in an infant's low Apgar Score. Finally, the Collaborative Project, a twelve-institution study involving 17,221 babies, established that the Apgar Score, especially the five-minute score, can predict neonatal survival and neurological development.

In 1959, while on sabbatical leave, Apgar earned a master's degree in public health from the Johns Hopkins University. Deciding not to return to academic medicine, she devoted herself to the prevention of birth defects through public education and fundraising for research. She became the director of the division of congenital defects at the National Foundation for Infantile Paralysis (now the March of Dimes) and received many honors and awards for her work.