Letter from L. Joseph Butterfield to Virginia Apgar
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. By the late 1960s it had become the standard for Apgar score forms.
Number of Image Pages:
2 (72,325 Bytes)
1961-07-27 (July 27, 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 Tate Butterfield Ulrich.
Medical Subject Headings (MeSH):
Second Career: The National Foundation-March of Dimes, 1959-1974
Letter from Virginia Apgar to L. Joseph Butterfield (August 1, 1961)
Enclosed is an epigram of your scoring system which has been quite helpful in
instructing medical students, interns and nursing personnel. This was suggested to me by one of our former residents and I
send it on to you in the form that I have used in a teaching slide.
We are presently writing up a clinical evaluation of the effect of early feeding of 20 per cent glucose to premature infants
with the respiratory distress syndrome. There were 34 infants, weighing 1030 - 1700 grams, in the group; 20 of whom developed
the respiratory distress syndrome. In this small series, we were unable to see a correlation of the Apgar score with either
the respiratory distress syndrome or mortality. Although your reports of larger numbers of premature infants have shown a
positive correlation, I wonder whether the smaller prematures also revealed that association--since in the 14 infants reported
in Auld's recent paper (Am J Dis Child, 101:713, 1961), there was scattered mortality and in Phillips 1959 report in the
Canad MAJ, 61 infants, less than 1750 grams, had as many deaths in the eight plus group (10 of 33) as in the seven minus group
(9 of 28).
Although I would appreciate your comments on the latter points, I primarily wanted
to send you this epigram (at Doctor Lubchenco's encouragement) and tell you that
we have found the scoring system an effective means of evaluating the larger infants at birth.
L. Joseph Butterfield, M.D.
Department of Pediatrics
Infant Evaluation at Birth
A=Appearance; Blue; Body Pink, Ext. Blue; Pink
P=Pulse; Absent; Below 100; Over 100
G=Grimace; Absent; Grimace; Cough Sneeze
A=Activity; Limp; Flexion; Active
R=Respiration; Absent; Slow, Irregular; Good Crying