Virginia Apgar, an accidental anesthetist

All medical students are taught Apgar score, a 10-point scale to grade a just-born as healthy or at risk. This has made Virginia Apgar quite immortal. She however was neither a pediatrician (a doctor for children) or an obstetrician (a doctor who delivers). Rather, she initially trained as a surgeon, and accepted to be an anesthetist. An accidental anesthetist, she pursued her interest in birth defects and genetics in last few decades of her life.

Virginia Apgar (b1909) was person with immense energy, she played on seven sports teams, reported for the college newspaper, acted in dramatic productions, and played violin in the orchestra. She graduated from Columbia University in 1933, and completed her surgical residency in 1937. Her mentor was a legendary surgeon Allen Whipple. Much is written about how she was convinced to move from surgery to Anesthesia.

Whipple thought that Apgar, being a female would not do good as a surgeon. Anesthesiology – then a new specialty was more of a background work, often delegated to nurses. It was mostly a task of keeping patients undergoing surgery calm, by making them inhale stupefying gasses. Maybe it was a prejudiced advice, but Apgar accepted it to change her life-course. In third year she joined nurse-anesthetist program, and by 1938 she was back in New York after training in anesthesia under Ralph Waters in Wisconsin.

In 1938 she headed division of anesthesiology at Presbyterian hospital in New York. Over next 11 years, she established a training program, and could convert a nurse-staffed division to a physician-staffed one. It was quite a challenge in those days to find willing physicians choose anesthesiology as a specialty. In 1949, when the division was upgraded into a department, Apgar was not made its chair. The position went to Emanuel Papper, a male colleague, while Apgar became a professor. Free of administrative work, Apgar would outshine others in years to come.

By 1952 Apgar had developed a scoring system to evaluate the health status of newborns. This 10-point scale was based on their heart rate, respiration, movement, irritability, and color one minute after birth. Over next few years she could relate this score to effects of labor, delivery, and maternal anesthesia practices. By 1960s, calculating Apgar score became a standard practice across the world. Apgar famously wrote, “Nine months’ observation of the mother surely warrants one-minute observation of the baby.”

She also introduced principles of resuscitation into immediate newborn care. The score was later fashioned to match her name – Appearance, Pulse, Grimace, Activity and Respiration. In 1959, Virginia Apgar went on to John Hopkins to enroll in a Masters in Public health course, to learn statistics. Later she developed a keen interest in birth defects, an advocate for universal vaccination, and for social causes around them.

Despite instances of gender discrimination, Apgar maintained her characteristic optimism. She went on to state 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 never retired and continued working till her last day on 7th August 1974.