Letter from Virginia Apgar to L. Joseph Butterfield
Butterfield and his residents at the University of Colorado Medical Center modified the order and wording of the Apgar score's
five points, so that they spelled "APGAR." This epigram form proved a useful teaching device, and Butterfield passed
it along to Apgar. As this response indicated, Apgar was delighted by the innovation. By the late 1960s it had become the
standard for Apgar score forms.
Number of Image Pages:
2 (80,360 Bytes)
1961-08-01 (August 1, 1961)
Butterfield, L. Joseph
University of Colorado Medical Center. Department of Pediatrics
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Reproduced with permission of Peter A. Apgar.
Medical Subject Headings (MeSH):
Second Career: The National Foundation-March of Dimes, 1959-1974
Letter from L. Joseph Butterfield to Virginia Apgar (July 27, 1961)
I chortled aloud when I saw the epigram. It is very clever and certainly original. You might like to hear a greeting I received
at Boston Lying-In one day by a secretary, who said "I didn't know Apgar was a person, I thought it was just a thing."
In reply to your question about premies and the scoring system, I have extracted a few figures from a paper which I hope to
get finished this month. In it are discussed 30,000 babies, of whom 698 are under 2000 grams. You are right that there is
no predictive value of survival for tiny babies under 1000 grams, but in the other weight groups, there are highly significant
If the three clinical states are compared (Poor-0,1,2,3; Fair-4,5,6; Good-7,8,9,10) using neonatal deaths as the criteria
for comparison, the results are as follows:
Weight; No. of Infants; x2; d.F.; p.
501-1000 gms.; 97; 5.15; 2; .06>p>.05
1001-1500 gms.; 192; 32.8; 2; p<.001
1501-2000 gms.; 409; 37.7; 2; p<.001
2001-2500 gms.; 1724; 118.4; 2; p<.001
If, in the smallest group, groups of five and under (all the good babies) are omitted, since chi square is not reliable in
groups of that size, the results do become significant. x2 -7.8974, d.f. =1, p<.01. Naturally, I believe the results in
a group of 698 infants are more reliable than in 14 infants in Boston.
Stan James at Presbyterian Hospital has quite a bit of evidence for a positive correlation of score and respiratory distress.
Murdina Desmond at Baylor has much information about the course of infants of varying scores.