Dr. Virginia Apgar’s “Eureka Moment”—and the Scientific Skill That Made It Possible

July 12, 2022
Editor's Notes, July/August issue of Healthcare Innovation: How well do you know the story of Dr. Virginia Apgar? The story behind the Apgar score is fascinating and in some ways surprising.

Editor's Notes, July/August issue of Healthcare Innovation

In their excellent 2019 book 10 Women Who Changed Science and the World, Catherine Whitlock and Rhodri Evans share the stories of ten pioneering women in science and medicine, including Marie Curie, Rachel Carlson, Dorothy Hodgkin, and Rita Levi-Montalcini.

Of course, in addition to the globally famous Marie Curie and Rachel Carson, the name of Virginia Apgar, M.D., is extremely well known in U.S. and world medicine, for it is Apgar (1909-1974) who created the famous “Apgar score” that Dr. Apgar created while practicing anesthesiology at Columbia Presbyterian Hospital in New York City in 1952.

As the authors write, “Virginia Apgar was born in Westfield, New Jersey on June 7, 1909. The family was delighted to welcome a girl into the family, following the birth of two older brothers, Charles and Lawrence. The Apgar household was a happy, productive, and enterprising one. Virginia once said that she came from a family that ‘never sat down,’ a trait that she inherited.” One of only three women in her 1929 entering class at Columbia University’s College of Physicians and Surgeons, Virginia graduated fourth in her class in 1933, and took a surgical post at Columbia Presbyterian Hospital. Concerned about the shortage of available fellowships in surgery, a mentor there convinced her to pursue anesthesiology instead, and she was to rise by the age of 46 to become the head of obstetric anesthesiology.

Significantly, Apgar saw that most of the focus in the delivery room in the late 1940s and early 1950s was on the mothers rather than the babies, and that there was no standardized examination of newborns’ vital signs. As the authors write, “Virginia’s eureka moment occurred one morning while she was having breakfast in the hospital canteen. One of her medical students asked her how to evaluate newborn babies’ well-being. Virginia replied, ‘That’s easy. You would do it like this,’ and jotted down the five vital signs to look for. Initially called the Newborn Screening System, it was the first version of what became the Apgar test.” Indeed, Apgar developed a research study of the test, presenting her findings in a clinical journaling in 1952, to universal acclaim. “Ten years later,” in 1963, “the newborn screening test was officially designated the Apgar test, when Dr. Joseph Butterfield at the Children’s Hospital in Denver suggested an acronym musing Virginia’s surname to help users remember what to look for: Appearance, Pulse, Grimace, Activity, and Respiration. When he wrote to Virginia about it,” the authors write, “she replied, ‘I chortled aloud when I saw the epigram. It is very clever and certainly original.’” Sadly, Apgar herself died on August 7, 1974, at the age of 65, having lost her battle with cirrhosis of the liver.

But her natural skills of observation created a clinical protocol that has been used globally now for decades. It is precisely those kinds of skills that are most needed in the current operating environment of U.S. healthcare—in every area of operations. This issue’s cover story (p. X) looks at the financial challenges facing hospitals and health systems in the current moment, and the potential for using advanced analytics, including AI, to help turn things around.

All healthcare leaders need to look forward by using keen powers of observation and developing them into processes that work over time. Let’s all keep Dr. Virginia Apgar in mind as we continue to move forward into the unpredictable near-term future of U.S. healthcare.

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