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Dr. Virginia Apgar

2015-07-06 | 🔗

Dr. Virginia Apgar broke new ground in the fields of obstetrics and anesthesiology in the middle of the 20th century. When babies are born today, one of the tools doctors use to measure whether they're thriving on their own is the Apgar score.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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second season I'll, be diving into some big issues like this country's devastating maternal mortality rate, the rise of astrology and a little called the presidential election, listen to next question, It comes out every Thursday on the eye, radioactive apple podcast or what where you get your favorite shows stuff you missed, industry from house works, low and welcomed the land Tracy me. Well, then, I'm handling frying have you got a baby and like the last sixty years or been present when somebody else had a baby urbane even to watch tv show in which babies were born, probably heard people talking about half an hour yeah, but I never gave it much thought not being regularly a baby person. I thought this was an acronym,
and while somebody did rework the parts of that our score so that it matched up with the letters of her name and about nineteen sixty two, the score itself: as from earlier than that it is the work of Doktor Virginia after he really new ground in the fields of obstetrics and anesthesiology, as well as other in the middle of the twentieth century today, you may ask our score is really part of the standard of care for new for newborn babies in much of the world and its totally to the credit of this one particular doctor and this one particular doktor Vince. Car was born in West Field, New Jersey on June, seventh of nineteen o nine. Her father was an insurance executive who was fond of science and was an amateur astronomer, and she also had a brother who died of tuberculosis at a very young age, so it's possible that both of these things influence her decision to become a doctor, but regardless that decision was made before she even got out of high school. To that end, she went amount holier college, where.
She studied zoology. In addition to being an excellent student in that programme, she worked several part time. Jobs to make ends meet He also played the cello in the violent in the orchestra and acted and wrote for the college newspaper and played on seven different steams she's like I've, medical school version of Leslie, Nope yeah, that's a great description. Families. You describe her family one point as just people who never sat still and ass. She seems to have been constantly doing her whole life She graduated in nineteen, twenty nine and she started medical school at the Columbia University College of Physicians and surgeons that same year there were ninety people in her class, and she was one of only nine women
She scraped together enough money to stay in school in spite of the great depression and she graduated near the top of her class. In nineteen thirty three, so she really wanted to become a surgeon and she was accepted into a surgical internship. Material hospital which is now New York, Presbyterian Hospital Columbia, University medical center. She did we well in her first year of this residency but Doktor Alan Whipple, who was the chair of the surgical department, encourage her to change specialities to anesthesiology. He was concerned that she would not be able to make a profitable career as a surgeon, especially given the economic climate at times was still in the wake of the great depression.
He also basically had other plans for her. He wanted her to study, anesthesiology and then come back to Presbyterian Hospital to help started teaching programme for future anesthesiologists. There were lots of reasons for doktor after to change specialities. It was definitely difficult for women to be respected as surgeons at this point and there were lots of train surgeon, so competition for jobs was really stiff and doktor after would have had to stand out even more because of her gender Doktor Whipple had seen his other female surgical. Students really have trouble getting hired a surgeons at all and doktor after had graduated from medical school in debt, so taking on a specialty in which he would probably have trouble finding a job was a really risky proposition. At the same time, Bible.
by becoming an interface ya'll, just instead of a certain, she was really setting out to pursue a specialty that did not even really exist. Yet, as recently as nineteen eleven, the American Medical Association had even rejected a request to start and Anna Theseus section for its members. So, while back after essentially had a job waiting for her after she was done with her study of anesthesiology. It was going to be a tough one because it was in a specialty that was not regarded as a specialty. So let's talk about why that was for for most of western medical history surgery was actually seen as inferior to the rest of medicine. So before like modern anesthesia and the germ theory of disease. Surgeons mostly perform things like amputations, and it was not always likely that their patients were going to survive eventually, as developments in medicine made it possible for people to live through surgeries without bleeding to death or immediately dying from infect
surgery, only gradually became a more respected field. They'll surgeons have basically claw their way too, stability and, for the most part in the early, ways of surgery as a more prestigious position, anesthesia was being administered by nurses. I wanna be super clear on this. Nurse anesthetist are still are The important part of the field of anesthesiology today, but at the time, instead of working under the direction of anesthesiologists, who were specialists and how to keep a patient simultaneously unconscious and pain, free and made medically state.
A nurse and ass, the tests were usually working on the under the direction of the surgeon who was performing the procedure. This meant that even as advances and surgical techniques and infection control, practices meant, patients could survive longer and more complex surgeries. Anesthesiology wasn't advancing quickly enough to keep up outside of teaching and research. Hospitals were surgeons might be dedicating some of their focus to anesthesia. This was not the priority, and then there was the basic fact that keeping a patient properly and ass the ties Also performing a surgical procedure is really a lot to juggle at one time, plus after having been viewed as inferior to doctors for so long, a lot of surgeons just did not want to hand over control of part of the surgical process to another person, even if the,
they are going to be handing it off to you was somebody who saw focus was on being the best in the world of anesthesiology, so Doktor Whipple hoped that he and doktor after my work together to change all of that and we're going to talk about that. Some are but first we're gonna have a word from a sponsor, Hey pack has listeners. Have you ever wanted to share a love story with someone, but you may be wanted to do it in a really unique in interesting way, or you were struggling to get the exact rate words in place. Will you don't know To worry about that, you can put it into a book, and that is where love book comes in love, books, help customers express their sentiments that there working hard to make their own unique thing, and each book is come. We customizable most customers use them to list the reasons why they love someone. But you can you kinds of things. Can create characters. It look like yourself and the research re done outfits and accessories, you personalized each page as much as you want, but you,
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Thought that doctor apt, our might really have a knack for this. He described her as having quote the energy intelligence inability needed to make significant contributions in this area, because physiology wasn't yet recognised as a specialty for medical doctors, there really weren't a lot of training programmes for it. At this point there were thirteen of them in the United States, ranging in length from two weeks to three years. And only two of those rightly paid residencies. Neither of these residency programmes had a spot open when doktor after replied the obviously like a two week training programme in Annex ii. The algae is not nearly the same thing as the work that it would be needed. To take on a new medical, specialty yeah. That's why that's a wide range of too weak to three year, but yeah yeah. So after finishing her second
for surgical internship that doctor after went through Presbyterians training programme foreigners and ass the tests. She then spent six months studying under Doktor Ralph waters at the University of Wisconsin Madison in a visiting position, so doktor waters was really one of America's earliest pioneers and anesthesiology, and he just made critical and ground by breaking contributions to this field. When she was done study the doktor waters. She spent another six months with Doktor Earnest Rove esteem in New York, Bellevue Hospital. He had also trained with doktor waters. So it's you could easily call doktor waters like the the key. down in a lot of anesthesiology work and the United States. At this point, so from their in nineteen thirty, eight doktor our went back to Columbia, University and Presbyterian Hospital and became the director of the division of anaesthesia and in attending invested hissed. This made her the first woman to headed division at the hospital.
Doktor avatar and Doktor Whipple have formulated a plan for the division of anesthesia to become dedicated to trading doctors to be anesthesiologists, but because of the prevailing attitudes running about anesthesia if this point and the low pay that came along with them, she really had trouble recruiting peers to work with her. She was the These staff member in the division through the mid nineties forties. But at the same time, she became a beloved teacher, as the existing staff of nurse and estimate is left. The hospital to get married or pursue other jobs, residents filled their positions and studied anesthesiology Underduk doktor after four between one and three years after the teaching programme was solidly establish. The division also turned its focus research to improve the practice of anesthesiology thats, really a long and difficult process for the first years of the programme.
after after only had a couple of residents and she and her colleagues had to write their textbook themselves, because there was no anesthesiology textbook, it was nineteen five before anesthesia was more often administered by doctors than by nurses at Presbyterian, which is really notable because at this point, that the whole point was trying to find new doctors. Gradually, though perceptions about the validity of anesthesiology is a specialty started to improve and it became recognised as a real specialty and nineteen. Forty six Three years later, doktor outdoor became the first woman to be named a full professor at the Columbia University College of Physicians and surgeons, along with us in the same year, The division of anesthesiology became its own department and Doktor a manual There was a pet selected to be the chair of that apartment, so after an hour had sort of thought, she was going to be the person appointed to this position
but the fact that she no longer had that department had kind of role to take a part of the time, she was able to focus a lot more. Teaching and on her work and obstetric anesthesiology during world war. Too many doctors insurgents during the military which led to a labour shortage of presbyterian Hospital and Doktor Outdoors department having more involvement in the field of obstetric anesthesiology, because the doctors and nurses who had been doing so had gone to serve So at this point that the United States, women have generally move from usually delivering babies at home to Europe. Bring babies and hospital, but this really hadn't improved out. as for the women and their babies, although in Mortality in general had dropped the reign of infant mortality within the first twenty four hours after birth had hardly budged. Even though people were now being
a hospital. This is where Doktor ACT, our really started to focus when she was freed up from her previous administrative duties as a department head, and it was no one at that as the department head, and it was no one at that point that oxygen- that deprivation played a part in at least half of those babies deaths. It seems obvious to doktor, after that, if it became a standard practice to examine the baby and determine whether it needed oxygen and then give it oxygen. If so, then, a lot of these deaths could potentially be prevented. Shoes, bathers, ain't, gonna, look these babies. Let me look at them, so I mean today the seams absurdly obvious. You should look at the baby, make sure the baby is ok, but at the time in delivery rooms, medical efforts tended to be a lot more focused on the mother than on the baby. A lot of times the most do. People in the room were the ones who were seeing to the baby after it was born,
They rarely had any training and anesthesiology or any knowledge of how the drugs that were used during a valuable delivery. It's very infection could affect the baby. Sometimes they were really at the very beginning of their medical study. They just were not trained, particularly well on what to do when the baby came out of their vat, ITALY on they probably dont, have the confidence to wake, make kind of snap decisions about treatments plus it's not gonna, come as a surprise to anyone. Who's ever witnessed any conversation on the internet about people's appeal. On childbirth, birth, a whole lot of arguing going on about how to best deliver babies and not a whole lot of concrete data. Backing up people's opinions and even when there was data, it was often disregarded in favour of what everybody quote already knew about it still doktor guard. A standardized way of analyzing.
the baby was doing after it was born and involved, evaluating five treats the baby's heart rate, respiratory effort, muscle tone, reflex and color, giving each of those a score of zero one or two, when you add up those five numbers and that's the baby's apt, our score, that mnemonic device that we mentioned at the top of the epidemic, substituted appearance for color pulse for heart rate, grimness for reflex babies, make a grimacing faces, a reflex activity for muscle, tone and respiration, which was on the original list, reportedly backtrack car. With quite delighted in
when a resident rewrote the letters and our score to match up with her name's. They could remember what they our and what's really important, is that she assigned actual measurable criteria to these. So a zero for heart rate meant that the heartbeat was absence. A two month of a heartbeat was between one hundred and one hundred. Forty beats a minute. Zero for muscle tone meant that there was no muscle tone and a too the baby was actively moving. It really got rid of a lot of the subjectivity and figuring out with her baby was doing well or not. So, in addition to the extremely obvious you need to look at the baby slick. You need to look at the baby and measure these things like that, and it won't. We will help you understand whether the baby needs to be facilitated The baby is thriving outside of the womb. She then,
a study using this scoring method on one thousand twenty one babies? You were born at the Sloan Hospital for women at Presbyterian. She found definite correlations between them the delivery, the type of anesthesia used on the mother and the baby's up our scores. She recommend that New Europe that newborn babies be evaluated a minute after their birth and also important that stuff other than the attending obstetrician. Do it because she noticed a pattern that Obese tended to score. Their end quote verbiage that they delivered higher than other people in the delivery room. Did.
This will sound familiar to anyone who is heard our episode on Doktor repeaters, who helped revolutionise the treatment of Hodgkin's lymphoma when Doktor Apt our presented her paper at the twenty seventh annual Congress of Anne S, the tests in nineteen fifty two the audience was sceptical, but she publish the work and nineteen fifty three and it has since become a standard of care in delivery rooms in much of the world with the score measured once a minute after birth and again, five minutes after birth. So, basically, if the baby, the score is not get after a minute in the recesses eight. Maybe you do that they could again in five minutes was one of those times where it's kind of baffling. That is now it's just such a standard thing. The babies born and check it out and make sure everything the right. This was
Quite as big of a focus with the medical team in the room was so much more focused on them other than on both the mother and baby fell along with Doktor Duncan holiday and Doktor Stanley James. For after went on to evaluate these correlations between delivery and the baby's ask scores. They slowly connected the line the difficulty of the delivery and the type that amounts of anaesthesia given to the mother, you know where there was a vast number- is very unfair. All these other things with trains and the baby scores. They figured out the baby With a score under three needed to be resuscitated, kind of, obviously, because that would be a baby, that's like blue and not moving and doesn't have a false, but maybe that have a score of seven to ten had a statistically better chance of surviving their first month of life, then babies, you scored, six are lower. There would be kind of a baby. You are right, but maybe not quite thriving, this evolving body of data aloud
the tree fins and obstetric anesthetist really refined their practices to improve newborn babies, survival rates, and we have really talked about the pre massive differences between anesthesia, typically used delivery. Ribs now worsens what was used in the late nineteenth fifties totally different world. In terms of like we not standard practice to put women essentially unconscious to deliver babies in american hospitals anymore, Guph episode of stuff you miss than history glasses, brought to you by Norton three sixty with life. Luck with your shopping online with your smartphone. Its super feels like ear. Personal information is just right there in your hand, but that's not always the case, because, as soon as you hit submit, your personal information could start going other play
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theme also went one step further and studied newborn babies, blood chemistry, framing clear physiological links between the outward appearance of the traits examined to calculate in Afghanistan score and what was actually physiologically going on in the baby's Bobby. violate nineteen fifteen Doktor Carr had attended more than seventeen thousand births. During that time she had seen of another children who were born with congenital disabilities, also sometimes known as birth defects and inside cases that really seem like there was a correlation between the disability and the baby's ask our score. So in nineteen fifty eight she would On a sabbatical pursued a masters degree in public health from Johns Hopkins University, originally, her intent was to improve our knowledge of statistics and bring that knowledge back to her work at Presbyterian Hospital, which increasingly involved statistics, but as she studied, she became increasingly into
in whether some of the congenital issue she was seeing when babies were born, could somehow be prevented. During this time she was approached by the National Foundation for can paralysis, which is now known as the March of dimes Originally, the National Foundation was primarily focused on polio. It had sponsored the vaccine, research of backdoor Jonas Salk and once the YO vaccine was introduced and the of the rate of polio infection just dropped dramatically foundation. to find a new place to expand its work and other conditions that they could help with, that were affecting babies and children. The foundation started a new too when called the division of congenital malformations. The nest
found asian ass, doktor out guard to lead this new department and she accepted beginning her new role after she completed her masters programme. In this role, doktor after became a huge advocate of early detection and treatment of congenital issues, including prenatal testing and treatment. She travelled extensively to talk directly to parents and doctors education is about congenital disabilities and other issues that were related to prenatal, Indy, worn health. This was almost directly the opposite of her experience, train a start and innocent easy ology programme. While that field wasn't it
can see. Congenital disabilities and disorders were huge news in the United States. At this point, the drugs the little mind which had been given to pregnant women in much of Europe, both as a sedative and to combat morning sickness, had been implicated in causing babies to be born with missing or incorrectly formed limbs. The FDA had not approved the drug to be used in the United States, which the media played up as a near miss. This was also during the postwar baby boom. So parents to be were hungry for information and doktor APP car was really an ideal doktor to be involved in all this. She had decades of experience and she was just extremely personable and empathy, egg and compassionate with people. She was talking to you in nineteen sixty four remaining sixty five, a huge rubella outbreak in the United States, led to more than twelve million cases of rubella and twenty thousand cases of congenital rubella
syndrome which occurs on a pregnant woman contracts. Rubella congenital rubella syndrome can cause premature delivery. Miscarriages an stillbirths in a while variety of potential disorders and disabilities, which can affect virtually any system of the body. These include blindness, heart problems, bone lesions, hepatitis and developmental disabilities. In the wake of this outbreak doktor after led vaccination campaigns. After one became available in nineteen sixty nine, she joined the faculty of the School of Pediatrics Cornell University School of medicine in nineteen sixty five and she taught there until nineteen. Seventy four she's specialised and terror Policies out sometimes was characterized the study of congenital disabilities, but it really incorporates any kind of the disability or disorder that around
This is, as an organism is developing. Second include like as a child is growing transitioning into adolescents. Are things like that? She was actually the first person to hold a faculty position dedicated to this aspect of pediatrics in nineteen. Seventy two doktor up was part of a joint effort of the American Medical Association, the American College of obstetrics and gynecologists, the American Academy of Failing physicians, the American Academy of Pediatrics in the March of dimes the first committee on Perinatal Health, the committee's goal was to put together a plan to improve maternal health and lower infant mortality nationwide. Sadly, she died before the committee's landmark report towards improving the outcome of pregnancy was released in nineteen. Seventy six doktor after published bore them.
He papers hearing her career along with the book, if my baby, all right, which seek a route with Joan, back and tell us and nineteen. Seventy two answers that book that walked through several different congenital situations. That can happen using a real examples. It was a book that there is a great need for at this point, because a lot of people have no knowledge of any things are or what to do. She also received numerous honorary doctorate and professional accolades during her career. She was given a commemorative postage stamp and nineteen eighty four and was inducted into the National Women's Hall of Fame and ninety ninety five. Throughout her life, she continued to pursue all kinds of activities and passions. In addition to all this work of being a doktor there sort of continued what she had been doing.
When she was on seven different sports teams are also being a great student. She also in web, maybe as the most awesome thing in this episode, carried a penknife an end, though tracheal too, and I'll layer into scope with her at all times. Just in case someone near stop breathing. She said nobody, but nobody is going to stop reading on me. She really medical Leslie enough is because you so I have. I don't know I just about this deep farmers for her in this episode, because she's like Medical Leslie, open, we ve told we ve told you all before how much I love parks and recreation. cried and it was over, but also a her name is Virginia my grandmother's names and when you look at pictures of her she's got like the same kind of very from the fifty I wear that we see I'm pictures of my grandmother's. She reminds me of like
If my grandmother's had been like levelling down when they were young and she actually never retired. She only slow down a little at the very end of her life because she had progressive liver disease, which eventually was the cause of her death. On August seventh of nineteen, seventy four she died at Columbia, Presbyterian Medical Center, where she had spent much of her career. So we ve talked a few times about this shows sought owns, which is so that medical history, which is their co production of Sydney Mcelroy, who is a doctor and her husband, Justin Mcelroy, and they are charming level if you don't listen to that, show a highly recommended, as for the maximum Podcast network. I don't think they have done an episode that they have done this, but the whole time I was working on it. When I got to this part were doktor out. Our was like the problem is nobody's. Looking at these babies, I just kept hearing sudanese voice. In my being like you, gotta look at the baby is looking Albanians
are you looking at the baby's like seems so obvious. Wicked babies who would be important, I have two wondering I I will you know show off my my ignorance in this arena like away The thinking was like why they weren't focusing on the babies and they were only focusing on the mothers where they just so accustomed to mortality rate that they really will the baby may or may not make it. The stronger arrive late make sure the mom gets through. I cried a wonder that. As I was me, I didn't find a lot of a lot of information about why this is the way it is, but because the infant mortality rate was so pronounced. At that point, let seems like. Maybe that would be maybe not a deliberate conclusion, but just sort of like the operating parameters that were in people's minds. They were making decisions in in the delivery room so yeah. I was very curious in my mind about Thou, so I hope, like nobody
Grandfather was an obstetrician, a nineteen. Fifty I'd I'd have not tried to be hurtful now I mean here. If we working at the baby's made a big, there was just one of those you know elements of like shifting approaches and attitudes that happen gradually over time. It does it all mean that the people involved were being negligent or even only just it hadn't shifted yet now why we got we gotta listen email that I have not read, because it was those who personal this directly read. But it came after that episode that we did about Doktor Vieira Peters, where we talked about women who have loves in their breasts would basically be put under. Go, get a biopsy, and if they had cancer, they would wake up without a breast anymore. And how like, in today's mindset, that's horrifying her story with about having had children during this part of history and how, basically, you would go to the hospital and you would be put under and you would wake up.
With the baby and the sea at this whole story about a doctor that was delivering her children had a clear preference for delivering male children and said some things that were pretty and sensitive when he delivered daughter so yeah, I would say that there is still a way to go in terms of you know: women and babies getting the best possible medical care, maybe not too much babies anymore, but I know like there are still I know my mom personally had difficulty getting doctors that take her seriously when she knew that something was wrong with her health and they just get writing her off as being a stressed out female, which was not what was going on. She Edwards problem. Yeah fell medical care, better still room to improve, and I also have listener mail, which is always will that related to the medical field? This for Maggie Maggie says Holly and Tracy. Unlike many
listeners. I've only been listening for the last year or so, but I've been entirely hooked since then, as a former history major in my undergrad days, it super funds. A fine. All these new dimensions of the things I learned back then ran remind fell by actually remember things too. I wanted to specifically thank you for your episode. Rather contents cafeteria riots. I work with college students to spread mental health awareness and enact advocacy on their campuses to make these spaces safer for all people to live learning grow. Our organization is called active mines and we support over four hundred student run chapters on campuses across the: U S, Canada, and in Ecuador. I had never learned so much about the competence cafeteria riots. I had heard about it in passing, but, as you mentioned, we often bypass these events in favour of discussing stolen.
which is obviously important, but not the loan significant event. In those early days of this civil rights movement as a mental health educator and advocate, and a member of the elderly to community. I especially appreciated your mention of Trans Mental Health statistics and the violent acts, often perpetrated against that community health, meta q? Mental health has become a particular area of focus among our students and for us at the national level, and partnership with France, at the healthy mind network at the University of Michigan, we were able to carry the below infographic, about transit eligibility to mental health on campuses, and then she gives links to them. What we ll put in our shared it, You so much for spreading awareness about these important events. We as a general popular
don't know nearly enough about the social movement that define our recent history between this story and your recent story on special education. You're doing that. Thank you so much Maggie. I wanted to share this one specifically because it is so important to have mental health resources that are specifically devoted to young people like young people's mental health issues and adult people's mental health is,
are not the same things in a lot of times. Treatments are really different, so I was really pleased to learn about the screw. That is doing a whole lot to promote that cop college campuses, which I think is critically important and so will put links today's MPEG Rafik in our show notes. If you would like to write to us or about this or any other subject, we are his reply to ask. The house for Stockholm were also on Facebook and Facebook that harm Flash missed in history it on twitter and industry are tumblr is missing. History that we're not fond of offshore Pinterest interests are complex than history. We have spreadsheet store, it has a pretty new shirt. It fell. I heart exhumation, but the car is a real heart. We ve ever so you can get back her at our Starwood, dismissed in history that spreadsheet backup, brothel cooking up some ideas for the motion. That sort if you like
We're about. We talked about the day comes when I hear it. Companies website, which has our support, but the word childbirth, into the search bar and you will bind childbirth court. You can also comes a higher website, which is missing history, dot com that elsewhere, so notes are who we're we're gonna put links to these infographic, but I just mentioned you can also find an archive of every single episode we have ever and so notes for the episodes Holly and I have worked on it. You can do all that and a whole lot more at hast upwards. That complements the mystery more on this and thousands of other colleagues who have worked on Bobby round. Welcome to my party has beyond the baby
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