At a breakfast meeting at P&S in 1949, a medical student observed that a method to evaluate newborn health was sorely needed in the delivery room. Dr. Virginia Apgar said: "That's easy," jotted down five signs of health and rushed off to test it, according to Dr. Selma Calmes, chairwoman of anesthesiology at the Olive View-UCLA Medical Center and a biographer of Dr. Apgar, who died in 1974.
Three years later, on Sept. 21, 1952, Dr. Apgar first presented the scoring system that would make her famous. The Apgar score measures a baby's heart rate, respiratory effort, muscle tone, reflex irritability, and color one and five minutes after birth and is now used throughout the world. In February 2001, the New England Journal of Medicine reported the Apgar score still to be the best predictor of infant health in the first month of life.
Dr. Calmes, who gave the capstone address at a day-long Columbia University Health Sciences symposium on Sept. 19 to honor Dr. Apgar and the 50th anniversary of the Apgar score, noted how Dr. Apgar's "prepared mind" and good fortune not to have administrative responsibilities at the time helped her create the score.
While the score was a key achievement in her life, Dr. Apgar's professional activities also influenced anesthesiology, obstetrics, perinatology, and knowledge about birth defects.
Born in 1909, Dr. Apgar graduated fourth in her class at P&S in 1933, one of only four women that year. But after two successful years in a surgical residency program at Presbyterian Hospital, she was told women surgeons would not succeed and should consider anesthesiology. After a year of anesthesia training at the University of Wisconsin and New York University, Dr. Apgar returned to P&S in 1938 as director of Columbia-Presbyterian's fledgling anesthesiology division in the Department of Surgery.
Eleven years later, when the anesthesiology division matured into an independent department Dr. Emanuel Papper, who had more research experience than Dr. Apgar, was named chairman, instead of her. Despite the disappointment, she became P&S's first female full professor later that year and focused on obstetrical anesthesia for the next decade.
Dr. Apgar's score and her other efforts led doctors to pay greater attention to the infant in the delivery room instead of only attending to the mothera point emphasized by many speakers at the conference, including Dr. Mary Ellen Avery, president-elect of the American Association for the Advancement of Science and symposium keynote speaker, and Dr. Allen Hyman, professor of anesthesiology at P&S and one of the symposium's co-chairs. Such increased awareness of the newborn's condition helped decrease infant mortality rates by 75 percent since the 1950s, Dr. Avery said.
Dr. Apgar's awareness of the baby's needs also led her to explore infant resuscitation, helping start an evolution in resuscitation strategies. Today, improved methods have enabled Columbia-Presbyterian's Children's Hospital of New York to reduce chronic lung disease in newborns by using less invasive ventilation and fewer drugs, said Dr. Richard Polin, professor of pediatrics at P&S.
Dr. Apgar also studied the effects of anesthesia on mothers in labor in the delivery room. Doctors now have refined obstetrical anesthesia to rely more on regional rather than general anesthesia, which is more risky and eliminates doctor-mother communication, said Dr. Richard Smiley, associate professor of clinical anesthesiology at P&S.
At age 50, Dr. Apgar earned a master's degree in public health from Johns Hopkins University and became director of research and development at the National Foundation-March of Dimes. Dr. Nancy Green, medical director of the March of Dimes, spoke about how Dr. Apgar pursued her passion for perinatal research, public health, and public education at the March of Dimes. In that role, Dr. Apgar fostered national discussion about the previously taboo topics of birth defects and prematurity.
Increased awareness of birth defects helped propel the study and diagnosis of such problems. Dr. Mary D'Alton, interim chairwoman of obstetrics and gynecology, summarized at the conference the latest advances in perinatology and noted how technologies, such as ultrasound, are now used to test for Down's syndrome before birth.
Dr. Thomas Jessell, professor of biochemistry and biophysics at P&S, discussed the Apgar score as a window to view the developing nervous system and its function at birth.
Dr. Ruth Fischbach, conference co-chairwoman, professor of bioethics, and director of Columbia's Center for Bioethics, addressed how Dr. Apgar's criteria for the health of an infant provided more information for doctors who, given today's technology, must grapple with choosing between what they should do for a sick infant rather than what they can do.
The tribute to Dr. Apgar, which began with grand rounds by Dr. Hyman on the history of infant resuscitation, ended with a concert by a quartet of P&S students playing music Dr. Apgar treasured on string instruments that she made.
Symposium attendees received a perennial calendar dedicated to Dr. Apgar written by Dr. Marion Hunt, special consultant to the dean and member of the conference planning committee.
Memories of Dr. Apgar's contributions to medicine and daring personality always will remain strong. "She drove her convertible like an airplane," Dr. Calmes said. "Once she took off, the wheels seemingly never touched the ground."