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Thu Jun 7, 2018, 11:57 AM

Google Doodle Honors Dr. Virginia Apgar, the Anesthesiologist Credited With Saving Many Newborn Babi

Google Doodle Honors Dr. Virginia Apgar, the Anesthesiologist Credited With Saving Many Newborn Babies' Lives

Google is celebrating Dr. Virginia Apgar, a groundbreaking figure in the field of anesthesiology known for inventing a scoring system that is credited with saving countless newborn babies’ lives, with its new Google Doodle.

Born in 1909 in New Jersey, she is best known for inventing the Apgar Score, the first standardized way to test a newborn baby’s health in the first few minutes after the baby is born. Babies are assessed under five factors: appearance, pulse, grimace, activity and respiration. The first letter of each factor spells out Apgar’s name. While Apgar died in 1974, the Google Doodle celebrates what would have been Apgar’s 109th birthday and features a cartoon of her conducting her namesake test, which was invented the test in 1952.

Aside from the Apgar Score, she also accomplished numerous feats throughout her career. Apgar was the first woman to become a full professor at Columbia University College of Physicians and Surgeons. But her path to success was filled with numerous obstacles. Although she was determined to become a surgeon, Apgar was discouraged from the pursuit by Dr. Alan Whipple, who was the chair of surgery at Columbia. Whipple maintained that the other women he had trained had failed to establish successful careers in surgery. (and one wonders how much his derision and smug sexism contributed to those failures) But Whipple also recognized that Apgar’s skill could further the field of anesthesia, and she spent a year training in it after completing her surgical residency in 1937. Ahead of her time, Apgar had trouble finding people to work for her until anesthesia became a more acknowledged specialty in the 1940s, according to the U.S. National Library of Medicine.

Later, Apgar’s studies of obstetrical anesthesia led to her creating the Apgar score. After some initial resistance, the testing method became widely used throughout the world and is still used today.


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Work and research

As the first woman to head a specialty division at Columbia-Presbyterian Medical Center (now NewYork–Presbyterian Hospital) and Columbia University College of Physicians and Surgeons, Apgar faced many obstacles.[examples needed] In conjunction with Dr. Allen Whipple, she started P&S's anesthesia division. Apgar was placed in charge of the division's administrative duties and was also tasked with coordinating the staffing of the division and its work throughout the hospital. Throughout much of the 1940s, she was an administrator, teacher, recruiter, coordinator and practising physician.[2]

It was often difficult to find residents for the program, as anesthesiology had only recently been converted from a nursing specialty to a physician specialty. New anesthesiologists also faced scrutiny from other physicians, specifically surgeons, who were not used to having an anesthesia-specialized MD in the operating room. These difficulties led to issues in gaining funding and support for the division. With America's entrance into World War II in 1941, many medical professionals enlisted in the military to help the war effort, which created a serious staffing problem for domestic hospitals, Apgar's division included.

When the war ended in 1945, interest in anesthesiology was renewed in returning physicians, and the staffing problem for Apgar's division was quickly resolved. The specialty's growing popularity and Apgar's development of its residency program prompted P&S to establish it as an official department in 1949. Due to her lack of research, Apgar was not made head of the department as was expected and the job was given to her colleague, Dr. Emmanuel Papper. Apgar was given a faculty position at P&S.[2]


In 1949, Apgar became the first woman to become a full professor at P&S,[7] where she remained until 1959.[5] During this time, she also did clinical and research work at the affiliated Sloane Hospital for Women, still a division of NewYork–Presbyterian Hospital.[8] In 1953, she introduced the first test, called the Apgar score, to assess the health of newborn babies. Between the 1930s and the 1950s, the United States infant mortality rate decreased, but the number of infant deaths within the first 24 hours after birth remained constant. Apgar noticed this trend and began to investigate methods for decreasing the infant mortality rate specifically within the first 24 hours of the infant's life. As an obstetric anesthesiologist, Apgar was able to document trends that could distinguish healthy infants from infants in trouble.

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These problems, especially research and finances, continued to play out over the time she was Director. Recruitment was difficult. There seemed to be no funds for resident salaries or for their living quarters. The first resident arrived 10 months later, after she threatened to cancel cases, thus “greatly inconveniencing the surgeon,” because of lack of manpower.i She wrote Waters, asking him to refer to her resident applicants he could not use, adding “no women yet.”j Her first 3 residents were men. The first faculty member, Ellen Foot, arrived in August 1941.11 Struggles over the right of anesthesiologists to send bills to private patients were a recurring theme. Apgar even had to fight for her own salary. World War II brought a big increase in work as large numbers of physicians were drafted for war service. During this incredibly busy time, she also served as Treasurer of the newly formed American Society of Anesthetists (later the American Society of Anesthesiologists) from 1940 to 1945. She made important contributions to the financial stability of the new organization by adopting standard bookkeeping, improved budgeting, improved cash flow from dues collection, and developing funding for the new journal Anesthesiology. 12

Many now recognized the importance of research for anesthesiology, and research was developing slowly at the national level. Apgar wrote multiple plans to develop research at Columbia and tried to recruit the few suitable candidates. She offered at least 3 men positions as head of research. Proposals to the new surgery chairman, George H. Humphreys II (1903–2001), in 1948 reveal that Apgar expected to be the chair and have the director of research report to her.k But it was not to be; she could not recruit the few suitable candidates. And the institution may not have been ready for a woman department chair. Finally, anesthesiologist Emanuel Papper, who had research experience and who Apgar knew from her time at Bellevue, was recruited from Bellevue-New York University in 1949 as professor and chair of the Division of Anesthesiology. Full department status was reached in 1952.11 There are reports of Apgar’s disappointment at not being chair of the department.l However, Papper’s appointment freed her from the burden of administration, which she disliked. This failure to become a chair marked a pivotal point in her career. Apgar advanced to full professor (the first woman full professor in the medical school), took a 1-year sabbatical, returned to Columbia, and moved into obstetric anesthesia. And opportunity called again.

She had always been interested in this then-neglected area. Anesthesia residents began rotating on the labor and delivery floor for the first time, and she was their instructor. The anesthesiologists at Columbia gathered daily for breakfast at the hospital cafeteria. This was where the Apgar Score was born. At the time, newborns were essentially ignored in the delivery room. One day, a medical student rotating on anesthesia remarked at breakfast about the need to evaluate newborns. According to someone who was present, Apgar said, “That’s easy, you’d do it like this.” She grabbed the nearest piece of paper, a little card that said, in essence, “Please bus your own tray,” (she often used those cards for other notes) and scribbled down the 5 points of the Apgar Score. She then dashed off to the labor and delivery suite to try it out.

With a research nurse, Apgar worked to refine and test the score.m She presented it at an IARS meeting in 1952, and it was published in 1953.1 There was some resistance initially, focused on who was to score the baby. Obstetricians, who delivered the babies and so had a stake in their outcomes, were thought to score too high. Apgar planned that a neutral person, such as a circulating nurse, would do the score and that it be done 1 minute after birth. This would identify which babies needed help. Others started measuring it also at 5 minutes after birth, to evaluate how the baby responded to resuscitation if that was needed. Eventually, the 1- and 5-minute scores became standard. An epigram was introduced in 1962 to help staff remember the various points of the score.13 (Many still do not realize that “Apgar” was a person’s name but think of it only as an epigram.) A clipboard with timers for 1 minute and 5 minutes, developed by anesthesiologist MA Colon-Morales, became available in 1968 and helped to improve the accuracy of timing of the score.n The Apgar Score spread around the world. Its method of structured thinking for evaluating clinical situations also led to numerous other clinical scores, among them the Aldrete Score, the Glasgow Coma Score, the Trauma Score and, recently, the Surgical Apgar Score.

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