On Thursday, Sept. 19, a symposium commemorates Virginia Apgar, the first woman to achieve the rank of full professor at the College of Physicians & Surgeons (P&S) and famous for the neonatal viability test that bears her name. This month marks the 50th anniversary of Apgar's proposal for a systematic method of evaluating newborns, long used in hospitals throughout the world.
"Her work has touched and continues to touch so many lives," says Ruth Fischbach, professor of bioethics and director of Columbia's Center for Bioethics. "We've put together an exciting program that we hope will reflect Apgar's important contributions to medicine."
Born in 1909, the late Virginia Apgar was one of only four women to enter P&S in 1929. After graduating fourth in her class, she was offered a prestigious surgical residency at Columbia Presbyterian Medical Center. On completing two years of excellent work, the chief of service informed her that he doubted a woman could have a successful surgical practice. Encouraged to enter the emerging field of anesthesiology, Apgar decided to obtain the best training available and in 1937 went to the University of Wisconsin -- the only school then offering physicians a graduate program in anesthesia. After six months there, she completed her training with Emery Rovenstine at Bellevue Hospital.
In 1938, at the age of 29, Apgar was invited to head Columbia Presbyterian's new division of anesthesiology. Over the next 11 years, in addition to her responsibilities for clinical care, she built a solid residency program. In 1949, Apgar was succeeded by Emanuel Papper, a younger man with greater research expertise. On receiving promotion to full professor that same year, Apgar decided to focus her attention on obstetrical anesthesia. In the delivery room, she noticed there was no systematic assessment of newborns during the first critical moments of life. In answer to a medical student's question about how best to evaluate neonatal viability, she used a napkin to sketch the easily observable components of what became the Apgar score: heart rate, respiratory effort, reflex irritability, muscle tone, and color.
In September of 1952, Apgar made a formal presentation at a medical meeting proposing her score. Her idea was swiftly accepted and implemented in delivery rooms here and abroad. Over the years, the Apgar score's predictive power has remained strong. In 2001, the "New England Journal of Medicine published data on the score's value in more than 150,000 births; researchers concluded: "The Apgar scoring system remains as relevant for the prediction of infant survival today as it was almost 50 years ago."
In 1959, Apgar went to Johns Hopkins to obtain a master's degree in public health. Study with pioneer geneticist Victor McKusick enhanced her interest in birth defects. This led her to accept an executive position with the March of Dimes. For the next 14 years, until her death in 1974, Apgar served as an advocate, fund-raiser, and educator. Her work was instrumental in transforming the public's view of birth defects from private family tragedies to a national health problem. Surgeon General Julius Richmond credited her with having "done more to improve the health of mothers, babies, and unborn infants than anyone in the 20th century."
The Sept. 19 symposium begins with the 20th Annual Hyman Lecture on the History of Anesthesiology and Medicine. The afternoon sessions feature a keynote address by Mary Ellen Avery, noted pediatrician and president-elect of the American Association for the Advancement of Science. Other speakers include Thomas Jessell, professor of biochemistry and molecular biophysics at P&S, discussing neonatal brain development, and Selma Calmes, chairwoman of anesthesiology at the Olive View-UCLA Medical Center, in Sylmar, Calif., delivers the capstone address. A reception and concert, featuring P&S faculty and students using stringed instruments made by Apgar and former patient and noted luthier Carleen Hutchins, will conclude the day's events.
Click for more information about the symposium.