Virginia Apgar, the Woman Whose Name Saves Newborns

March of Dimes/Library of Congress via Wikimedia // Public Domain
March of Dimes/Library of Congress via Wikimedia // Public Domain

How important is Dr. Virginia Apgar to the modern practice of obstetrics? Here is the way the National Library of Medicine’s website puts it: “[E]very baby born in a modern hospital anywhere in the world is looked at first through the eyes of Dr. Virginia Apgar.”

Apgar created a quick and reliable way to determine the health of a newborn baby, an examination that is usually referred to today as a baby’s Apgar test. Before her test, invented in 1952, there was no objective way to determine the health of a newborn, and babies were given little medical attention immediately after birth. Problems often escaped notice until they became critical.

To determine an Apgar score, a nurse, midwife, or physician examines the baby for five criteria—skin color, heart rate, reflexes, muscle tone, and breathing—at both one minute and five minutes after birth (and sometimes in further follow-up tests). Each criterion is given zero, one, or two points. A score over seven is considered normal. A score below three is seriously low. Babies often have lower scores at one minute after birth, but by five minutes have perked up and score in the normal range.

Because a common mnemonic for the criteria uses the letters APGAR (appearance, pulse, grimace, activity, and respiration) to create a “backronym,” or retrofitted acronym, many people do not realize Apgar is an eponym—named after a person. Apgar herself was often amused when people were surprised to find she was a real individual.

But in person, Virginia Apgar was hard to forget. She was a pioneer in several fields of medicine, helping to establish anesthesiology as a medical specialty, working to study and improve obstetrical anesthesia, and advancing the study of birth defects. She helped organize and administer the first Division of Anesthesia at Columbia University College of Physicians & Surgeons, her alma mater, and became the first woman to be a full professor there.

As a teacher of medicine, Apgar was known for her uninhibited sense of humor and could talk about anything without embarrassment. Because her own tailbone was at an odd angle, she would have medical students feel for it to help them learn how to administer spinal anesthetics. She always traveled with a resuscitation kit that included a penknife and an endotracheal tube (a plastic tube inserted into the windpipe to ventilate the lungs). "Nobody, but nobody, is going to stop breathing on me!" she reportedly declared.

In the late 1950s, after Apgar had already made a name for herself with her work in anesthesiology and the creation of the Apgar score, she turned her attention to the study and prevention of birth defects. She was asked to join what was then the National Foundation for Infantile Paralysis-March of Dimes (now simply the March of Dimes), which started researching and advocating for those with birth defects after it met its original goal of creating a vaccine against polio. As a director and later vice president at the March of Dimes, Apgar championed research that showed how factors such as infectious diseases, radiation exposure, substance abuse, and chemical exposure could cause birth defects. In her years with the organization, she also traveled the country speaking and calling attention to the issue of birth defects.

Outside of medicine, Apgar was a gardener, fly fisherman, and took flying lessons. Throughout her life, she was an excellent amateur violinist who often played in chamber ensembles. She even learned to make stringed instruments, including violins, a viola, and a cello.

In fact, her work as an amateur luthier even led her to a short career as a thief. In 1957, a musician friend noticed that a maple shelf in a phone booth at Columbia-Presbyterian Medical Center would make an excellent back for a viola. The friend and Apgar set out to take the shelf at night and replace it with another piece of wood, which they managed to stain to just the right color. But the piece they brought was slightly too long, and needed to be shortened. While her friend went into a nearby ladies’ room to do the sawing, Apgar guarded the door. The piece became the back of Apgar’s viola, and was one of four instruments she handcrafted that were played by pediatricians at a 1994 ceremony to honor a commemorative U.S. stamp with Apgar’s image. (The instruments were later donated to Columbia, where they can still be rented.)

Virginia Apgar died of liver disease at the age of 65 in 1974, but her name lives on around the world—even though many don’t know it—in the life-saving score she designed for infants.

Sushruta, Ancient Indian Surgeon and Father of the Nose Job

If you were a petty criminal, a prisoner of war, or an adulterous woman in the ancient world, you might have had the tip of your nose cut off as a punishment [PDF]. But rather than walking around disfigured, if you had the means—and lived in ancient India—you might have had your nose reconstructed thanks to an ancient surgical method espoused by the Indian physician and surgeon Sushruta.

There's some debate around whether Sushruta was a real individual or a legendary figure. Said to have been the son of a sage who lived around 600 BCE, he's primarily known today for the classic treatise Sushruta Samhita, or Compendium of Sushruta. The treatise is considered one of the foremost achievements of Indian medicine, and went on to influence the West. Along with Charaka and Vagbhata—two other possibly legendary authors of key texts—Sushruta is honored in India as one of the "Triad of Ancients."

The Sushruta Samhita describes more than a thousand diseases (including a very early awareness of diabetes), and about 650 types of drugs. The text includes a special focus on surgery, which it considers the apex of the healing art. The roughly 300 surgical procedures it describes include cataract surgery, the removal of bladder stones, hernia repair, eye surgery, and Cesarean sections. The treatise also describes how to control bleeding, set broken bones, use wine and other drugs to anesthetize the patient, and employ large ants as wound clips (apparently, their strong mandibles can close a gash in lieu of stitches). The text also stresses the importance of cleanliness in both surgeons and their instruments—safeguards Europe wouldn’t adopt for the better part of two millennia.

But the most famous part of the text is its technique for repairing and recreating a nose, known today as reconstructive rhinoplasty. Sushruta recommended using a long, broad "leaf of a creeper" as a template for cutting a flap of skin from the cheek or forehead. After scarifying the flap with a knife, the skin was then placed over the missing nose, after which "the coolheaded physician should steadily tie it up with a bandage decent to look at," the text says. Two small pipes—reeds or tubes from the castor oil plant—were inserted into the nostrils to facilitate breathing. The nose was then dusted with medicinal powders, enveloped in cotton, and sprinkled with sesame oil.

An 1816 image from a nose surgery using the Indian method
An image from J.C. Carpue's "An account of two successful operations for restoring a lost nose," 1816

Sushruta’s knowledge took a long time traveling west. The Sushruta Samhita was translated into Arabic around the 8th century CE, and that version may have arrived in Europe before the Renaissance; Sushruta’s techniques were apparently known to surgeons in Italy in the 1400s and 1500s. The Indian method for repairing a nose was then lost to Western medicine for a couple of hundred years, although of course Indian surgeons continued to practice it.

Then, in 1793, two British surgeons observed the procedure being carried out on a cart driver who had been taken prisoner by a sultan in the Third Anglo-Mysore war, and an acquaintance of theirs published an account of the surgery in London's Gentleman's Magazine the following year. A British surgeon named Joseph Constantine Carpue read about the procedure, and practiced it on cadavers for 20 years before performing the operation (successfully) on a patient in 1814. His subsequent publication popularized the procedure in Europe, and by the 1830s the technique had made it to the United States.

Sushruta is widely honored in India today. The country boasts several statues of him, and his image is on the seal of the Association of Plastic Surgeons of India. A version of his procedure, often called the Indian method, is still one of the preferred ways of repairing noses around the world.

John Tradescant, Royal Gardener and Forefather of the Natural History Museum

Portrait of John Tradescant the Elder, attributed to Cornelis de Neve
Portrait of John Tradescant the Elder, attributed to Cornelis de Neve
Alamy

Two ribs of a whale, a dragon’s egg, the hand of a mermaid, and a picture made entirely from feathers: These were just a few of the items displayed at the curiosities museum that John Tradescant the Elder opened around 1630.

Tradescant is best known for two accomplishments: being the forefather of the modern English garden, and opening the first public museum. He collected seeds and plant samples on his extensive travels, then incorporated these flowers into the envy-inspiring gardens he was hired to create for the British nobility. That would be a noteworthy accomplishment on its own, but Tradescant is also remembered for his cabinet of curiosities, which eventually grew to become the nucleus of the Ashmolean Museum at Oxford, England.

Not much is known about the Tradescant the Elder’s early years. Thought to have been born around 1570, he made his first mark in the historical record when he married in 1607. Two years later, he was appointed gardener to Robert Cecil, the first Earl of Salisbury. Tradescant continued to work for the Cecil family for about six years, then took a job with Edward, Lord Wotton, for another eight years. Lord Wotton released him for two major collecting journeys: one as part of a diplomatic mission to the Russian Arctic in 1618, which resulted in him introducing the larch tree, a valuable timber source, to England; and one as part of a 1621 expedition against Algerian pirates. Although the mission failed to do much about the pirates, Tradescant did succeed in bringing back samples of gladioli, wild pomegranate, and Syringa persica—better known as lilac, which became a favorite in English gardens.

Tradescant then served George Villiers, Duke of Buckingham, for five years, before the duke was assassinated by a disgruntled army officer and King Charles I himself summoned Tradescant's services. The king appointed Tradescant the Keeper of his Master’s Gardens, Vines, and Silkworms at Oatlands Palace, an estate occupied by his queen, Henrietta Maria. Tradescant would become celebrated as the gardener to the "Rose and Lily Queen."

On Tradescant's travels, he tended to favor trees and flowers that looked interesting above those with a pleasant aroma, since he had no sense of smell. From his trips to France, the Netherlands, and Belgium, he returned with tulips, anemones, irises, clematis vines, and poppies. He also began actively seeking out curiosities, such as "a goose which has grown in Scotland on a tree," and "the passion of Christ carved very daintily on a plumstone," according to one 1638 accounting of his collection. (He also collected what we might today consider more run-of-the-mill cultural artifacts, like clothing and weapons.) Aside from his own collecting, he contacted British trading ships and asked merchants and diplomats around the world to find him “All Maner of Beasts & Fowels & Birds Alyve.”

Tradescant first began displaying his collection of oddities—fondly known as The Ark—at his home in Lambeth, London in 1628. The museum was a chance for Londoners to see creatures previously unknown to them—animals like salamanders and pelicans were on view—and to touch fantastic relics, such as wood that supposedly came from the cross used in the crucifixion of Jesus. Like other cabinets of curiosity of its era, it combined scientific curiosities and mythological artifacts without strict organizing principles: A brightly colored parrot might be displayed next to a gourd, a precious coin, and some artistically arranged shells. At some point, the collection also incorporated a dodo, described in a 1656 accounting as being a “Dodar, from the Island Mauritius; it is not able to flie being so big." (While most of the specimen was disposed of due to rot in the mid-18th century, the head—now the only soft tissue dodo specimen known to exist—and several other parts of the specimen are currently in the collection of Oxford's Museum of Natural History.)

Tradescant charged visitors sixpence to view his curiosities, which became one of London's most popular and famous attractions for nearly half a century (it was especially popular with schoolchildren). One early visitor praised it as a place "where a Man might in one daye behold and collecte into one place more curiosities than hee should see if hee spent all his life in Travell."

Although the museum was a success, it was not a full-time project. Tradescant also continued to garden for nobility until his death in 1638; his last project, undertaken a year before he died, was a Physic Garden for herbal remedies at Oxford.

Tradescant is called the "Elder" because he also had a well-known son, John Tradescant the Younger (1608–1662), who carried on his work. The younger botanist also gardened for nobles, traveled the world, and collected both plants and curiosities. In 1638, he assumed his father’s title as Keeper of his Majesty’s Gardens, Vines, and Silkworms at Oatlands Palace in Surrey. All the while he kept collecting, adding to the Tradescant legacy.

Tradescant the Younger had a son he hoped would carry on the family tradition, but his heir died at 19. Heartbroken, he deeded the collection to a friend and antiques aficionado, Elias Ashmole. It was a decision they came to regret after a variety of squabbles and a court case, which upheld Ashmole's right to the collection. Ashmole paid for and helped compile a catalog of the Tradescant objects in 1656, the first printed catalog of a museum collection in England.

Detail of the Tradescant tomb St Mary-at-Lambeth, London
Detail of the Tradescant tomb St Mary-at-Lambeth, London
Alamy

Ashmole donated the Tradescant curiosities to his old school, the University of Oxford, in the 1670s, alongside some items he had acquired himself. The museum built to exhibit the whole collection officially opened in June 1683, and remains open today.

But it's not the only museum inspired by the work of the Tradescants. The church where the Tradescants (both Elder and Younger) are buried is now known as the Museum of Garden History; it was initially created to preserve the their magnificent tomb. Carved with images from their travels and collections, it incorporates a long epitaph attributed to John Aubrey that describes their curiosities as "a world of wonders in one closet shut."

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