Who invented the Apgar Score?

 Dr. Virginia Apgar Biography,Physician, Anesthesiologist Developed Neonatal Health Assessment Standard

Dr. Virginia Apgar (1909-1974) developed the now-routine Apgar Score in 1952. By rating five vital signs, the test allows a rapid, objective measure of neonatal health.

Virginia “Ginny” Apgar was born June 7, 1909, in Westfield, New Jersey, to Charles Emory and Helen May (Clarke) Apgar. An insurance executive who dabbled in astronomy and inventing, Virginia’s father may have inspired her early fascination with science and medicine, as well as her lifelong love of music.

Although she held several part-time jobs while attending Mount Holyoke College (class of 1929), the young zoology major edited the college newspaper, played on seven sports teams, acted in school plays, played in the orchestra, and still excelled academically.

As one of only nine women out of a class of 90 at the Columbia University College of Physicians and Surgeons (CUCP&S), she was a superb surgeon but was advised by her mentor, Allen Whipple, to choose a different specialty. After two years she found Whipple’s predictions of gender discrimination to be true, and switched to anesthesiology.

Boundless Energy and Enthusiasm

Growing up in a home where living-room concerts were routine, Apgar became an accomplished violinist and cellist, and rarely traveled without taking an instrument. In 1956, Apgar set up a workshop in her tiny apartment and handcrafted her own violin, cello, mezzo violin, and viola.

Rarely idle, Apgar did everything in high gear, including talking, confounding students and colleagues alike with her rapid-fire delivery. She was an avid stamp collector—ironically, in 1994 she was a U.S. Postal Service honoree as part of the “Great Americans” stamp series—and loved fly-fishing, golfing, and watching baseball. Apgar even took up flying not long before her death.

A Rich Medical Legacy

In January 1938, Apgar became the first director of Columbian-Presbyterian Hospital’s new Division of Anesthesiology, for which she and Whipple had drawn up the organizational plans several months earlier. Simultaneously, she became the first woman to hold a professorship at CUCP&S. Having no textbooks, she co-wrote one with nurse-anesthetist Anne Penland; it was still in use as late as the 1950s.

Apgar had a reputation for being curious, clever, and resourceful. She always carried a penknife, endotrachial tube, and laryngoscope—she advised students to do the same—in case she need to do an emergency tracheotomy. She often said, “Nobody, but nobody, is going to stop breathing on me.”

Apgar Test Reduced Infant Mortality

In 1952, Apgar noted that at least half of newborn deaths were due to anoxia, yet it was not standard delivery room procedure to check airways and administer oxygen. Further, there was no common procedure or language for evaluating newborns. When a resident asked how to do a quick but meaningful neonatal assessment, Apgar reportedly scribbled down what would become known as the Apgar Score, outlining five objective conditions, to which she subsequently added a point scoring system. Later they were reworded into a mnemonic acronym: Appearance (color), Pulse (heart rate), Grimace (reflex irritability) Activity (muscle tone), and Respiration. Apgar is often credited as one of the founders of neonatology.

Apgar became interested in studying genetics and the causes of birth defects (teratogenesis) in 1959 while on sabbatical at Johns Hopkins, where she read for her master’s degree in public health. This led to her joining the National Foundation for Infantile Paralysis (now the March of Dimes Birth Defect Foundation) as director for the division of congenital malformations, and later vice president and director of basic and senior vice president in charge of medical affairs. Inducted into the National Women’s Hall of Fame in 1995, Apgar never retired but worked as a phenomenally successful fundraiser, advocate, educator, and public speaker until her death on August 7, 1974, at the age of 65 of liver disease.

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