Virginia Apgar: The woman who knew the score

January 1, 2009

A review of the life of Virginia Apgar, MD, a pioneer in child health, who would have been 100 in 2009.

You may remember the mnemonic device for the Apgar test, a quick assessment to determine a newborn child's health: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

But "Apgar" isn't an acronym–it's a woman. Virginia Apgar, MD, was a pioneering pediatrician and anesthesiologist. 2009 marks her 100th birthday.

After putting herself through Mount Holyoke University in 1929 (she received a BA in zoology), Apgar attended Columbia University's College of Physicians and Surgeons, with the intention of being a surgeon. Despite being fourth in her class, she was up against an all-male world-and the Great Depression.

Because few had studied the field, Apgar realized she was using undertested drugs in patients. The pregnant women who received obstetrical anesthesia weren't experiencing adverse events, but there was another person in the delivery room not considered: the baby.

Apgar devised a test to test vital reflexes and responses in newborns who receive their moms' anesthesia via the umbilicus. (It was originally given one minute after birth: later, a second test would be added five minutes after birth.) Each child received a 0, 1, or 2 for heart rate, respiratory effort, muscle tone, reflex responses, and color. The closer to ten, the healthier the baby.

Apgar's other studies revealed lower scores for mothers who took cyclopropane versus other types of anesthesia, and that the scores could predict long-term survival and neurological development. She wrote over 60 papers.

Columbia established a department of anesthesiology in 1949. Apgar was passed over for the department chair position. As a consolation prize of sorts, she was made full professor, the first female professor at Columbia University.

A few years later, Apgar took a sabbatical to gain a masters in public health from Johns Hopkins University. In 1959 she started working for the March of Dimes (then the National Foundation for Infantile Paralysis). It had been devoted to curing polio, but after Jonas Salk in 1955, it was looking for a greater purpose.

Apgar was brought on to head up the division of congenital birth defects. (The charity decided to focus on increasing infant health in general.) A decade later, she headed up its research program, and helped an effort to prevent birth defects before they happened.

Later in life, Apgar taught at Cornell University, coauthored a book, Is My Baby All Right?, and became the first US professor specializing in birth defects. She was named Woman of the Year in 1973 by Ladies' Home Journal. The American Academy of Pediatrics named a prize after her. She died in New York in 1974, at age 65. Apgar never married, or had children.

Apgar's memory still remains well known. In 1994, she graced the US Post Office's great Americans stamp series. The following year, she entered the National Women's Hall of Fame. Just last year, a portrait of her hung in the Smithsonian as part of the Women of Our Time: Twentieth-Century Photographs exhibit.

But her greatest tribute isn't any of those honors. Apgar's grandest honor is, for over 50 years, having every obstetrician, delivery room nurse, midwife, and doula use her test. Not a minute goes by that her work doesn't get applied to help a newborn. Name recognition may be nice, but nothing could ever top having uncountable children receive better care because of her.