Virginia Apgar’s dream  (1909-1974) was to become a surgeon. After a degree reached with not little difficulties for her economic situation due to the crisis in 1929, in 1933 Virginia obtained a place for a specialisation in surgery at the Columbia Presbyterian Hospital of New York, under the supervision of the head physician Alan Whipple. At the hospital though there were already 4 other people with the same credentials but, unlike her, all males. Alan suggested to explore the world of Anesthesiology, back then still a rather unexplored field which could give good opportunities to doctors with acute capabilities such as her.

Miss Apgar accepted the advice with enthusiasm but in the US the paid positions as an anesthetist  were not many, so she was forced to finish the specialisation as a surgeon at the Columbia. In 1936, although the pressure exerted by her male colleagues, she managed to keep her job at the Columbia Hospital, and learned the principles of anesthesiology by the nurses of the hospital, back then in charge of the sedation of the patients.

On the 1° January 1937 she left for Wisconsin heading towards the Madison Hospital. The outcome here is paradoxical: Virginia, as a lone woman, did not find an accomodation, so she had to come back to New York. There, at the Bellevue Hospital, she succeed to finish her specialisation in Anesthesiology with Ernest Rovenstine.

In 1938, she is first woman ever nominated as head physician of anesthesiology  at the Columbia Presbyterian Hospital

Her career, despite difficulties and pressures from the back then dominant sex in the medical world, took off. In the following 12 years as a head physician she became a luminary of anesthesiology and many students from all over the States were willing to do their specialisation with her supervision.

Obstetrical anesthesiology

The anaesthesia during labour was a field still unexplored. At the beginning of the century doctors had started the attempt with the so called “Twilight Sleep”, with dramatic consequences. In the 50’s the knowledge about the quantity of anaesthetic to administer to the pregnants was scarce and the death rate still pretty relevant. Miss Apgar was a strong supporter of the epidural anaesthesia instead of the general one. The results obtained  by the epidural one were breathtaking and its use quickly spread in many hospitals of the US.

The APGAR score

Both the epidural anaesthetic and the newborns owe a lot to the doctor Virginia Apgar. The woman, in fact, noticed a dramatic lack when it came to how the infants were evaluated by pediatricians, without a specific set of measurements of their own state of health. Virginia Apgar spotted 5 parameters  to define the state of health of the newborns:

Heart rate
Respiratory effort
Muscular tone
Reflex irritability
Color
The evaluation is based on a score, from 0 to 2, whose total defines the clinical status of the child.

A score of 7 points defines a normal condition, a score between 4 and 6 shows a risk whilst a score below 4 requires immediate intervention.

The invention of the score was probably random: according to the sources Virginia had this insight in response to a question of a student asked to her, on how you were supposed to evaluate the state of health of an infant. She wrote down the 5 parameters and from that point onwards they immediately became a useful method for doctors to use.

In 1952 it was presented the“Newborn Scoring System” to the congress of the International Anesthesia Research Society, but only in 1963 it obtained the name of APGAR, when the pediatrician Joseph Butterfield used its creator surname for the first time. The name it’s also an acronym and it’s written this way:

A – Appearance
P – Pulse
G – Grimace
A – Activity
R – Respiratory effort

The APGAR Score is today utilised as a basis procedure to control the newborns, repeated every 5 minutes to overlook the trend of the patient’s condition over time.

Virginia Apgar continued her work as a researcher and collaborated with the National Foundation for Infantile Paralysis for the prevention and cure of children affected by congenital pathologies. In a particular way her diffusion of the antipolio vaccine, whose efficacy was approved in 1962 and thanks to it cases of poliomyelitis went down in the US. At that time the States counted about 20,000 infections a year.

Virginia Apgar died in 1974. On her gravestone the epitaph: “Creator of the APGAR score”

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Matteo Rubboli

I am a publisher specialised in the digital distribution of culture and founder of the portal Vanilla Magazine. I don't wear a tie or branded clothes, I keep my hair short so I don't have to comb it. That's not my fault but just the way I've been drawn as...

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