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"Nobody, but nobody, is going to stop breathing on me!"
--Dr. Virginia Apgar, ca. 1950s, explaining why she kept basic resuscitation equipment with her at all times.
It has been said that every baby born in a modern hospital anywhere in the world is looked at first through the eyes of Dr. Virginia Apgar. Her simple, rapid method for assessing newborn viability, the "Apgar score," has long been standard practice. Developed in the early 1950s and quickly adopted by obstetric teams, the method reduced infant mortality and laid the foundations of neonatology. While best known for this achievement, Apgar was also a leader in the emerging field of anesthesiology during the 1940s and in the new field of teratology (the study of birth defects) after 1960.
Apgar was born in Westfield, New Jersey, on June 7, 1909, to a family that (as she often described them) "never sat down." She was the youngest of the three children of Charles E. Apgar, an insurance executive, and Helen May Apgar. The family was a musical one, and Virginia learned to play the violin as a child, and continued throughout her life. Her early interest in science and medicine may have been inspired by her father, an amateur inventor and astronomer. By her high school years, she had already decided to pursue a medical career. An excellent student in the sciences, she did poorly in home economics courses, and (according to several friends) never did learn how to cook. She graduated from Westfield High School in 1925 and entered Mount Holyoke College the same year. There she majored in zoology and supported herself with a number of part-time jobs. Her rapid speech and seemingly endless energy, already noted by her high school yearbook editor ("...frankly, how does she do it?") became her trademark in college. She played on seven sports teams, reported for the college newspaper, acted in dramatic productions, and played violin in the orchestra. Even with all these activities, her academic work was exceptional; in her last year, her zoology professor and advisor noted, "It is seldom that one finds a student so thoroughly immersed in her subject and with such a wide knowledge of it."
Apgar received her AB from Mount Holyoke in 1929 and began her medical training at Columbia University's College of Physicians and Surgeons (P & S), one of only nine women in a class of ninety. She completed her MD in 1933 and started a two-year surgical internship at Presbyterian Hospital (currently New York-Presbyterian Hospital/Columbia University Medical Center). Despite her promising performance in surgery, after her first year her mentor Allen Whipple--worried that economic prospects for woman surgeons would be very poor during the Depression--suggested that she pursue anesthesiology instead. At the time, anesthesiology was just beginning to take shape as a medical, rather than nursing, specialty. Apgar accepted this advice, and, after her second year of internship, trained for a year at Presbyterian's nurse-anesthetist program, then attended residency programs headed by Ralph Waters at the University of Wisconsin and Emery Rovenstine at New York's Bellevue Hospital. In 1938 she returned to Presbyterian Hospital as director of a new Division of Anesthesia within the Department of Surgery. She was the first woman to head a division at Presbyterian. There she was responsible for recruitment and training of anesthesiology residents, teaching medical students who rotated through the anesthesia service, and coordinating anesthesia work and research at the hospital. During the next eleven years Apgar transformed the anesthesia service at Presbyterian into one staffed with physicians rather than nurses, and established the anesthesiology education program there, in the process becoming a legendary and beloved teacher.
In 1949, the Division of Anesthesiology became a department. Apgar expected to be named chair, but the position was given to a male colleague, Emanuel Papper. Apgar, however, was appointed a full professor of anesthesiology at P & S, the first woman to hold that rank there. Free of administrative duties, she continued to teach and devoted more time to research in obstetrical anesthesia. She was especially interested in the effects of maternal anesthesia on the newborn, and in lowering the neonatal mortality rates. Infant mortality in general had decreased since 1900, but rates for neonates were still high. By 1952 Apgar had developed a scoring system to evaluate the health status of newborns, based on their heart rate, respiration, movement, irritability, and color one minute after birth. For the next few years, she worked with L. Stanley James, Duncan Holaday, and others to relate "Apgar scores" to the effects of labor, delivery, and maternal anesthesia practices. Their work on neonatal blood chemistry provided physiological support for the value of Apgar testing immediately after birth. The Apgar evaluation became standard practice, and is now performed on all children born in hospitals worldwide.
By the late 1950s, Apgar had attended over 17,000 births. In the course of refining the scoring system, she had encountered many cases of birth defects, and she began to correlate these with each other and with the scores. In 1958, she took a sabbatical leave and enrolled in the Master of Public Health program at the Johns Hopkins School of Public Health, intending to develop more proficiency in statistics for her work at Columbia. However, she had become increasingly interested in birth defects and how they might be prevented, or at least ameliorated. When the National Foundation-March of Dimes (NF)--then expanding its efforts beyond polio to other childhood disabilities--asked her to head its new Division of Congenital Malformations, she accepted. She received her MPH in 1959, and took up her new duties that June.
Apgar brought her legendary energy and "people skills" to the new job. She 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 NF, 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 lecturer in medical genetics at the Johns Hopkins School of Public Health.
Although her work kept her busy, Apgar found time to pursue her many outside interests. 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.
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.
Throughout her career, Apgar maintained, with her characteristic optimism, 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 gender 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.
Apgar never retired, and remained active until shortly before her death, though she was slowed down by progressive liver disease during her final years. She died on August 7, 1974, at Columbia-Presbyterian Medical Center, where she had trained and then worked for much of her life. Her friends, colleagues, and former students remembered her as much for her warmth, vivacity, and wicked sense of humor as for her sharp intelligence and professional competence. She was honored with a commemorative U.S. postage stamp in 1994, and she was inducted into the National Women's Hall of Fame in 1995.