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.

Bernarr Macfadden: Bodybuilder, Publisher, and Eccentric Prophet of Physical Culture

The History Collection/Alamy Stock Photo
The History Collection/Alamy Stock Photo

Bernarr Macfadden, who almost single-handedly launched the twin American obsessions with diet and exercise, wanted you to picture a roaring lion when you said his name out loud. Not content with his birth name, Bernard, the young Macfadden had his name legally changed so it supposedly better resembled a roar: Bernarr.

Macfadden certainly did roar his way through life. Born August 16, 1868 as Bernard McFadden on a farm in Mill Spring, Missouri, he was orphaned by the time he was 11. Macfadden’s father died from delirium tremens (alcohol withdrawal), and his mother from tuberculosis. The young boy was briefly installed in a Chicago boarding school, then housed, equally briefly, with relatives who ran a hotel in the city. He then worked as a farm laborer in northern Illinois for two years before he took to the open road, working as a miner, a dentist's assistant, a wood chopper, a printer’s apprentice, and a water boy for a construction team.

Because he spent his childhood dreading the arrival of the same tuberculosis symptoms that had killed his mother, Macfadden grew increasingly obsessed with physical fitness and healthy eating as wards against disease. By his late teenage years, he had set himself up in St. Louis, where he diligently practiced a well-honed exercise routine that included repeat sets with dumbbells and the horizontal bar, as well as daily six-mile walks carrying a 10-pound lead bar. He also decided on his purpose in life: spreading the gospel of exercise.

Around 1887, he rented a gym space in St. Louis, Missouri, and set a bold sign out front: "Bernarr Macfadden-Kinistherapist-Teacher of Higher Physical Culture." If you've never heard of a kinistherapist before, neither had Macfadden. The nonexistent profession just sounded good to him. And it sounded good to the people of St. Louis too. In a short while, business was booming.

But Macfadden had bigger dreams than St. Louis could fulfill. His drive to spread the gospel of physical culture soon led him to leave behind his St. Louis gym and head for New York City, where he rented a place in Manhattan and invited the press over for a “Physical Culture Matinee.” Surprisingly, the press actually showed up; their entertainment that afternoon consisted of Macfadden “chatting and posing in an interesting way,” according to one observer.

In 1899, at 30 years old, Macfadden launched Physical Culture magazine as a showcase for his ideas on bodybuilding, exercise, and diet. Those ideas boiled down to a simple formula: eat good foods, exercise often, and go on occasional fasts (his focus on fasting is seen as the precursor to today's popular ketogenic diet, by some accounts). However, his enthusiasm often overwhelmed his sensible ideas. He frequently campaigned against doctors and vaccinations, and generalized American “prudery.”

A portrait of Bernarr Macfadden
Wikimedia // Public Domain

Despite its quirky character, Physical Culture was a near-immediate hit. Macfadden’s tireless promotion and obvious zeal for his ideas were aided by convenient timing: Just as the magazine launched, Americans were turning for the first time en masse to improving their diet and exercise routines, encouraged by a similar craze in Britain as well as nationalistic fitness efforts like the gymnasiums favored by German-American immigrants. Macfadden was in the right place at the right time to be the prophet of the diet and exercise movement.

Like other self-styled prophets before him, however, Macfadden’s outsized personality became one of his greatest obstacles. He was given to fits of mooing and braying, which he believed aided in voice development. He wore his hair thick, wild, and long (at least by early 20th century standards) as proof of the efficacy of his cure for baldness (a “cure,” by the way, that involved vigorous pulling on the hair). He believed shoes were unnatural, so he frequently tramped about barefoot. He slept on the floor, with windows wide open even in winter. His hatred for the fashion industry led him to wear his clothes for years until they were literally hanging from his body in tatters. This last habit led to some unfortunate confrontations with the doormen at his New York apartment building, who frequently mistook him for a hobo.

Nevertheless, Physical Culture magazine made Macfadden wealthy and provided the seed money to launch twin empires in publishing and health. By the 1920s, he owned 10 highly successful magazines and was worth upward of $30 million. His publishing ideas were innovative and profitable, despite their often tawdry character. He launched the first true confession magazine, True Story, in 1919, as well as a number of other magazines in the same vein, such as True Romance and True Detective. He also launched the legendary New York Evening Graphic, one of the forerunners of modern tabloid newspapers. With article titles such as “I Taught My Wife to Drink,” “I Am the Mother of My Sister’s Son,” and “I Killed Him, What’ll I Do?,” the sordid stories of sin, guilt, and redemption in Macfadden's titles were hugely popular with the American masses.

The cover of "True Detective Mysteries," July 1926
Internet Archive // Public Domain

Macfadden simultaneously spread his Physical Culture empire into the health arena as well. He opened a chain of Physical Culture restaurants, with the gimmick of charging one cent for every item on the menu, following the idea that the best foods for you were also the cheapest. He also established four spas, dubbed “healthoriums,” in upstate New York, Long Island, the New Jersey Pine Barrens, and Battle Creek, Michigan. At the Macfadden spas, participants could aim to achieve “an absolute purity of their blood through a regimen of exercise, fresh air, bland diet, and no medicines.” Macfadden’s empire-building reached its zenith at his spa in the New Jersey Pine Barrens, which he vigorously—and unsuccessfully—campaigned to have incorporated into a new town dubbed “Physical Culture City.”

Macfadden’s outsized ego and overbearing convictions reportedly made him a difficult marital partner. His first two marriages quickly ended in divorce. His third marriage, arguably more successful, came about in a particularly Macfadden-ian way: Bernarr was in England, judging a contest he’d organized to find “the most perfectly formed female.” The winner was one Mary Williamson, a competitive swimmer, who was subsequently convinced to become Macfadden's third bride. He later would assert that her prize for winning the contest was … him.

Their marriage survived 34 years and produced seven children, named (by Bernarr, of course): Byrnece, Beulah, Beverly, Braunda, Byrne, Berwyn, and Bruce (although some sources call him Brewster). In 1946, Mary obtained a divorce, in drawn-out and very public proceedings.

Bernarr MacFadden and family members at the Capitol, where they were demonstrating how to keep fit to legislators.
Bernarr MacFadden and family members at the Capitol, where they were demonstrating how to keep fit to legislators.
Harris & Ewing, Wikimedia // Public Domain

Meanwhile, Macfadden’s fortunes began to diminish. The New York Evening Graphic, despite some early success, was quickly derided as one of America’s worst papers—thanks to sleazy headlines like “Weed Parties in Soldiers’ Love Nest.” The newspaper’s gradual collapse drained millions from Macfadden’s bank account. An ill-conceived run for the Republican nominee for president in 1936 also led to widespread public derision for “Body Love Macfadden.” A third blow was the failure of his chain of one-cent restaurants; the gimmick couldn’t withstand the reality of restaurant overhead.

Macfadden was married a fourth time, briefly, to a woman half his age, who shortly after had the marriage annulled. He sold off his remaining magazine interests in the 1940s and spent his last years, and the last of his fortune, on a variety of stunts and schemes. He ran for the U.S. Senate in Florida, offered a prize for the best biographical play about his life, and, when he turned 81, celebrated the accomplishment by parachuting out of an airplane. That feat became an annual event for Macfadden, who proudly defied his advancing years by parachuting into the Hudson River every birthday, and once, when he turned 84, into the Seine in Paris. He said he’d continue every year until he turned 120.

Sadly, he died a few years later, at age 87, in 1955. His cause of death, depending on the source, was either cerebral thrombosis (a blood clot in a cerebral vein in the brain) or an attack of jaundice following a three-day fast. By the time he died, Macfadden had about $50,000 left of his fortune and was generally regarded as an eccentric hovering on the edges of fame, always angling for a new way to see his name in the paper.

Macfadden’s ideas, however, outlived him, and some of them ended up having some merit. He was one of the first Americans to loudly proclaim the benefits of exercise and dieting. He railed against corsets and white bread, both of which have substantially declined in popularity. Today, you can find thousands of people jogging and lifting weights in cities across the country—highly unusual pursuits before Macfadden started spreading the doctrine of Physical Culture.

Additional Source: Great American Eccentrics

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.

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