Virginia Apgar (June 7, 1909August 7, 1974) was an American

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

obstetrical Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgic ...

anesthesiologist Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicin ...

and medical researcher, best known as the inventor of the

Apgar Score The Apgar score is a quick way for doctors to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation. It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar ...

, a way to quickly assess the health of a newborn child immediately after birth in order to combat

infant mortality Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

. In 1952, she developed the 10-point Apgar score to assist physicians and nurses in assessing the status of newborns. Given at one minute and five minutes after birth, the Apgar test measures a child's breathing, skin color, reflexes, motion, and heart rate. A friend said, "She probably did more than any other physician to bring the problem of birth defects out of back rooms." She was a leader in the fields of

anesthesiology Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...

and

teratology Teratology is the study of abnormalities of physiological development in organisms during their life span. It is a sub-discipline in medical genetics which focuses on the classification of congenital abnormalities in dysmorphology. The relate ...

, and introduced obstetrical considerations to the established field of

neonatology Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The ...

Early life and education

The youngest of three children, Apgar was born and raised in

Westfield, New Jersey Westfield is a Town (New Jersey), town in Union County, New Jersey, Union County, New Jersey, United States, located southwest of Manhattan. As of the 2010 United States census, the town's population was 30,316,Charles Emory Apgar. Her father was a business executive and amateur astronomer whose

amateur radio Amateur radio, also known as ham radio, is the use of the radio frequency spectrum for purposes of non-commercial exchange of messages, wireless experimentation, self-training, private recreation, radiosport, contesting, and emergency commu ...

work exposed an espionage ring during World War I. Her older brother died early from

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...

, and her other brother had a chronic illness. She graduated from Westfield High School in 1925, knowing that she wanted to be a doctor. Virginia Apgar playing her violin

Apgar graduated from

Mount Holyoke College Mount Holyoke College is a private liberal arts women's college in South Hadley, Massachusetts. It is the oldest member of the historic Seven Sisters colleges, a group of elite historically women's colleges in the Northeastern United States. ...

in 1929, where she studied zoology with minors in physiology and chemistry. In 1933, she graduated fourth in her class from

Columbia University College of Physicians and Surgeons Columbia University Vagelos College of Physicians and Surgeons (VP&S) is the graduate medical school of Columbia University, located at the Columbia University Irving Medical Center in the Washington Heights neighborhood of Manhattan. Founded ...

(P&S) and completed a residency in surgery at P&S in 1937. She was discouraged by

Allen Whipple Allen Oldfather Whipple (September 2, 1881 – April 6, 1963) was an American surgeon who is known for the pancreatic cancer operation which bears his name (the Whipple procedure) as well as Whipple's triad. Whipple was born to missionary parent ...

, the chairman of surgery at

Columbia-Presbyterian Medical Center NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), also known as the Columbia University Irving Medical Center (CUIMC), is an academic medical center and the largest campus of NewYork-Presbyterian Hospital. It includes Co ...

, from continuing her career as a surgeon because he had seen many women attempt to be successful surgeons and ultimately fail. He instead encouraged her to practice anesthesiology because he felt that advancements in anesthesia were needed to further advance surgery and felt that she had the "energy and ability" to make a significant contribution. Deciding to continue her career in anesthesiology, she trained for six months under

Ralph Waters Ralph Milton Waters (October 9, 1883 – December 19, 1979) was an American anesthesiologist known for introducing professionalism into the practice of anesthesia. Medical career Waters attended Western Reserve University Medical School and start ...

at the

University of Wisconsin–Madison A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United Stat ...

, where he had established the first anesthesiology department in the United States. In a 1937 photograph of Waters and his residents, she is the only woman among Waters and fifteen other men. She then studied for a further six months under Ernest Rovenstine in New York at

Bellevue Hospital Bellevue Hospital (officially NYC Health + Hospitals/Bellevue and formerly known as Bellevue Hospital Center) is a hospital in New York City and the oldest public hospital in the United States. One of the largest hospitals in the United States ...

. She received a certification as an anesthesiologist in 1937, and returned to P&S in 1938 as director of the newly formed division of anesthesia. She later received a master's degree in

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

at Johns Hopkins School of Hygiene and Public Health, graduating in 1959.

Work and research

Apgar was the first woman to head a specialty division at

(now

NewYork–Presbyterian Hospital The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New Y ...

) and

. In conjunction with

, she started P&S's anesthesia division. She was placed in charge of the division's administrative duties and was also tasked with co-ordinating the staffing of the division and its work throughout the hospital. Throughout much of the 1940s, she was an administrator, teacher, recruiter, coordinator and practicing physician. Virginia Apgar

It was often difficult to find residents for the program, as advances in the medical field had only recently elevated the practice of anesthesia to anesthesiology, a fully-fledged medical specialty. New anesthesiologists also faced scrutiny from other physicians, specifically surgeons, who were not used to having an anesthesia-specialized in the operating room. These difficulties led to issues in gaining funding and support for the division. With America's entrance into

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...

in 1941, many medical professionals enlisted in the military to help the war effort, which created a serious staffing problem for domestic hospitals, Apgar's division included. When the war ended in 1945, interest in anesthesiology was renewed in returning physicians, and the staffing problem for Apgar's division was quickly resolved. The specialty's growing popularity and Apgar's development of its residency program prompted P&S to establish it as an official department in 1949. Due to her lack of research, Apgar was not made the head of the department as was expected and the job was given to her colleague, Emmanuel Papper. Apgar was given a faculty position at P&S.

Obstetrics

In 1949, Apgar became the first woman to become a

full professor Professor (commonly abbreviated as Prof.) is an academic rank at universities and other post-secondary education and research institutions in most countries. Literally, ''professor'' derives from Latin as a "person who professes". Professo ...

at P&S, where she remained until 1959. During this time, she also did clinical and research work at the affiliated

Sloane Hospital for Women The Sloane Hospital for Women is the obstetrics and gynecology service within NewYork-Presbyterian Hospital and the Department of Obstetrics and Gynecology of the Columbia University College of Physicians and Surgeons (P&S) in New York City. It was ...

, still a division of

. In 1953, she introduced the first test, called the

Apgar score The Apgar score is a quick way for doctors to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation. It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar ...

, to assess the health of newborn babies. Between the 1930s and the 1950s, the United States

infant mortality rate Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

decreased, but the number of infant deaths within the first 24 hours after birth remained constant. Apgar noticed this trend and began to investigate methods for decreasing the infant mortality rate specifically within the first 24 hours of the infant's life. As an obstetric anesthesiologist, Apgar was able to document trends that could distinguish healthy infants from infants in trouble. This investigation led to a standardized scoring system used to assess a newborn's health after birth, with the result referred to as the newborn's "

". Each newborn is given a score of 0, 1 or 2 (a score of 2 meaning the newborn is in optimal condition, 0 being in distress) in each of the following categories: heart rate, respiration, color, muscle tone and reflex irritability. Compiled scores for each newborn can range between 0 and 10, with 10 being the best possible condition for a newborn. The scores were to be given to a newborn one minute after birth, and additional scores could be given in five-minute increments to guide treatment if the newborn's condition did not sufficiently improve. By the 1960s, many hospitals in the United States were using the Apgar score consistently. In the 21st century, the score continues to be used to provide an accepted and convenient method for reporting the status of the newborn infant immediately after birth . In 1959, Apgar left Columbia and earned a

Master of Public Health The Master of Public Health or Master of Philosophy in Public Health (M.P.H.), Master of Science in Public Health (MSPH), Master of Medical Science in Public Health (MMSPH) and the Doctor of Public Health (Dr.P.H.), International Masters for Healt ...

degree from the Johns Hopkins School of Hygiene and Public Health. From 1959 until her death in 1974, Apgar worked for the

March of Dimes March of Dimes is a United States nonprofit organization that works to improve the health of mothers and babies. The organization was founded by President Franklin D. Roosevelt in 1938, as the National Foundation for Infantile Paralysis, to comb ...

Foundation, serving as vice president for medical affairs and directing its research program to prevent and treat

birth defects A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

. As

gestational age In obstetrics, gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Su ...

is directly related to an infant's Apgar Score, Apgar was one of the first at the March of Dimes to bring attention to the problem of

premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ...

, now one of the March of Dimes' top priorities. During this time, she wrote and lectured extensively, writing articles in popular magazines as well as research work. In 1967, Apgar became vice president and director of basic research at The National Foundation-March of Dimes. During the

rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...

pandemic A pandemic () is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic disease with a stable number of in ...

of 1964–65, Apgar became an advocate for universal

vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...

to prevent

mother-to-child transmission A vertically transmitted infection is an infection caused by pathogenic bacteria or viruses that use mother-to-child transmission, that is, transmission directly from the mother to an embryo, fetus, or baby during pregnancy or childbirth. It can ...

of rubella. Rubella can cause serious congenital disorders if a woman becomes infected while pregnant. Between 1964 and 1965, the United States had an estimated 12.5 million rubella cases, which led to 11,000

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemica ...

s or

therapeutic abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnan ...

s and 20,000 cases of

congenital rubella syndrome Congenital rubella syndrome (CRS) can occur in a developing fetus of a pregnant woman who has contracted rubella, usually in the first trimester. If infection occurs 0–28 days before conception, the infant has a 43% risk of being affected. If t ...

. These led to 2,100 deaths in infancy, 12,000 cases of

deafness Deafness has varying definitions in cultural and medical contexts. In medical contexts, the meaning of deafness is hearing loss that precludes a person from understanding spoken language, an audiological condition. In this context it is written ...

, 3,580 cases of blindness due to

cataract A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble ...

s and/or

microphthalmia Microphthalmia (Greek: grc, μικρός, mikros, small, label=none, grc, ὀφθαλμός, ophthalmos, eye, label=none, also referred as microphthalmos, is a developmental disorder of the eye in which one (unilateral microphthalmia) or both ( ...

and 1,800 cases of

intellectual disability Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation, Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signif ...

. In New York City alone, congenital rubella affected 1% of all babies born at that time. Apgar also promoted effective use of Rh testing, which can identify women who are at risk for transmission of maternal

antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of ...

across the

placenta The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mate ...

where they may subsequently bind with and destroy

fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "hol ...

s, resulting in fetal hydrops or even

. Apgar traveled thousands of miles each year to speak to widely varied audiences about the importance of early detection of birth defects and the need for more research in this area. She proved an excellent ambassador for the National Foundation, and the annual income of that organization more than doubled during her tenure there. She also served the National Foundation as Director of Basic Medical Research (1967–1968) and vice-president for Medical Affairs (1971–1974). Her concerns for the welfare of children and families were combined with her talent for teaching in the 1972 book ''Is My Baby All Right?'', written with Joan Beck. Apgar was also a lecturer (1965–1971) and then clinical professor (1971–1974) of pediatrics at Cornell University School of Medicine, where she taught teratology (the study of birth defects). She was the first to hold a faculty position in this new area of pediatrics. In 1973, she was appointed a lecturer in medical genetics at the Johns Hopkins School of Public Health. Apgar published over sixty scientific articles and numerous shorter essays for newspapers and magazines during her career, along with her book, ''Is My Baby All Right?''. She received many awards, including honorary doctorates from the Woman's Medical College of Pennsylvania (1964) and Mount Holyoke College (1965), the Elizabeth Blackwell Award from the American Medical Women's Association (1966), the Distinguished Service Award from the American Society of Anesthesiologists (1966), the Alumni Gold Medal for Distinguished Achievement from Columbia University College of Physicians and Surgeons (1973) and the Ralph M. Waters Award from the American Society of Anesthesiologists (1973). In 1973 she was also elected Woman of the Year in Science by the ''

Ladies Home Journal ''Ladies' Home Journal'' was an American magazine last published by the Meredith Corporation. It was first published on February 16, 1883, and eventually became one of the leading women's magazines of the 20th century in the United States. In ...

''. Apgar was equally at home speaking to teens as she was to the movers and shakers of society. She spoke at March of Dimes Youth Conferences about teen pregnancy and congenital disorders at a time when these topics were considered taboo.

Personal life

Throughout her career, Apgar maintained that "women are liberated from the time they leave the womb" and that being female had not imposed significant limitations on her medical career. She avoided women's organizations and causes, for the most part. Though she sometimes privately expressed her frustration with sex inequalities (especially in the matter of salaries), she worked around these by consistently pushing into new fields where there was room to exercise her considerable energy and abilities. Music was an integral part of family life, with frequent family music sessions. Apgar played the violin and her brother played piano and organ. She traveled with her violin, often playing in amateur chamber quartets wherever she happened to be. During the 1950s, a friend introduced her to instrument-making, and together they made two violins, a viola and a cello. She was an enthusiastic gardener and enjoyed fly-fishing, golfing and stamp collecting. In her fifties, Apgar started taking flying lessons, stating that her goal was to someday fly under New York's

George Washington Bridge The George Washington Bridge is a double-decked suspension bridge spanning the Hudson River, connecting Fort Lee, New Jersey, with Manhattan in New York City. The bridge is named after George Washington, the first president of the United S ...

Death

Apgar never married or had children, and died of

cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue rep ...

on August 7, 1974, at Columbia-Presbyterian Medical Center. She is buried at Fairview Cemetery in Westfield.

Legacy

Apgar has continued to earn posthumous recognition for her contributions and achievements. In 1994, she was honored by the

United States Postal Service The United States Postal Service (USPS), also known as the Post Office, U.S. Mail, or Postal Service, is an independent agency of the executive branch of the United States federal government responsible for providing postal service in the ...

with a 20¢

Great Americans series The Great Americans series is a set of definitive stamps issued by the United States Postal Service, starting on December 27, 1980, with the 19¢ stamp depicting Sequoyah, and continuing through 1999, the final stamp being the 55¢ Justin S. Morr ...

postage stamp A postage stamp is a small piece of paper issued by a post office, postal administration, or other authorized vendors to customers who pay postage (the cost involved in moving, insuring, or registering mail), who then affix the stamp to the f ...

. In November 1995, she was inducted into the

National Women's Hall of Fame The National Women's Hall of Fame (NWHF) is an American institution incorporated in 1969 by a group of men and women in Seneca Falls, New York, although it did not induct its first enshrinees until 1973. As of 2021, it had 303 inductees. Induc ...

in Seneca Falls, New York. In 1999, she was designated a

Women's History Month Women's History Month is an annual declared month that highlights the contributions of women to events in history and contemporary society. It is celebrated during March in the United States, the United Kingdom, and Australia, corresponding with ...

Honoree by the

National Women's History Project The National Women's History Alliance (NWHA) is an American non-profit organization dedicated to honoring and preserving women's history. The NWHA was formerly known as the National Women's History Project. Based out of Santa Rosa, California sinc ...

. On June 7, 2018, Google celebrated Apgar's 109th birthday with a

Google Doodle A Google Doodle is a special, temporary alteration of the logo on Google's homepages intended to commemorate holidays, events, achievements, and notable historical figures. The first Google Doodle honored the 1998 edition of the long-running an ...

. - Archived a
Ghostarchive
and th
Wayback Machine

Honors and awards

* Honorary doctorate,

Women's Medical College of Pennsylvania A woman is an adult female human. Prior to adulthood, a female human is referred to as a girl (a female child or adolescent). The plural ''women'' is sometimes used in certain phrases such as " women's rights" to denote female humans regar ...

(1964) * Honorary doctorate,

(1965) * Distinguished Service Award from the

American Society of Anesthesiologists The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians organized to raise the standards of the medical practice of anesthesiology and to improve patient care. As of 2021, the organizat ...

(1966) * Elizabeth Blackwell Award, from the American Women's Medical Association (1966) * Honorary doctorate, New Jersey College of Medicine and Dentistry (1967) * Alumni Gold Medal for Distinguished Achievement,

(1973) * Ralph M. Waters Award, American Society of Anesthesiologists (1973) * Woman of the Year in Science, ''

'' (1973) * Fellow of the New York Academy of Medicine, the American Public Health Association, and the New York Academy of Sciences. * Inductee into the

New Jersey Hall of Fame The New Jersey Hall of Fame is an organization that honors individuals from the U.S. state of New Jersey who have made contributions to society and the world beyond. The Hall of Fame is a designated 501(c)(3) non-profit organization, overseen by ...

(2020)

Selected works

* *

References

External links

Virginia Apgar papers at Mount Holyoke College

National Women's Hall of Fame

o
WhoNamedIt.com

The Virginia Apgar Papers
– Profiles in Science, National Library of Medicine {{DEFAULTSORT:Apgar, Virginia 1909 births 1974 deaths 20th-century American physicians 20th-century American women scientists American anesthesiologists American medical researchers American pediatricians Women pediatricians Columbia University faculty Columbia University Vagelos College of Physicians and Surgeons alumni Deaths from cirrhosis Johns Hopkins Bloomberg School of Public Health alumni Bellevue Hospital physicians Mount Holyoke College alumni People from Westfield, New Jersey Teratologists Westfield High School (New Jersey) alumni 20th-century American women physicians Alcohol-related deaths in New York (state) American women academics