1 00:00:02,400 --> 00:00:05,960 Speaker 1: Happy Saturday. Today we are going back to with our 2 00:00:05,960 --> 00:00:09,639 Speaker 1: episode on Virginia Apgar, who developed the app car score 3 00:00:09,640 --> 00:00:11,920 Speaker 1: for newborn babies, and I have a soft spot for 4 00:00:11,960 --> 00:00:14,920 Speaker 1: her because she reminds me of my grandmother. Although my 5 00:00:14,960 --> 00:00:17,239 Speaker 1: grandmother didn't walk around with everything she would need to 6 00:00:17,280 --> 00:00:21,400 Speaker 1: do an emergency tracheotomy just in her handbag. That was 7 00:00:21,440 --> 00:00:25,079 Speaker 1: not how my grandmother operated. No, I think my grandmother 8 00:00:25,160 --> 00:00:28,480 Speaker 1: maybe could have cobbled together the required items, but it 9 00:00:28,560 --> 00:00:31,639 Speaker 1: wasn't necessarily her goal. One of the things that we 10 00:00:31,720 --> 00:00:34,519 Speaker 1: talked about in this episode is how when Appgar started 11 00:00:34,520 --> 00:00:37,360 Speaker 1: practicing medicine, there was a lot more focus on what 12 00:00:37,440 --> 00:00:40,040 Speaker 1: was going on with laboring mothers than on what was 13 00:00:40,080 --> 00:00:42,800 Speaker 1: going on with their newborns, and that focus has really 14 00:00:42,840 --> 00:00:45,960 Speaker 1: swung in the opposite direction in the decades since then, 15 00:00:46,440 --> 00:00:48,400 Speaker 1: to the point that there have been a lot of 16 00:00:48,440 --> 00:00:52,199 Speaker 1: headlines and studies about an ongoing maternal health crisis in 17 00:00:52,200 --> 00:00:55,360 Speaker 1: the three years since this episode came out. So that's 18 00:00:55,520 --> 00:00:58,720 Speaker 1: part of this whole arc of history that is definitely 19 00:00:58,800 --> 00:01:05,280 Speaker 1: still developing. Welcome to Stuff You missed in History Class 20 00:01:05,319 --> 00:01:14,160 Speaker 1: from how Stuff Works dot Com. Hello, and welcome to 21 00:01:14,160 --> 00:01:17,480 Speaker 1: the podcast. I'm Tracy B. Wilson and I'm Holly Frying. 22 00:01:18,040 --> 00:01:19,800 Speaker 1: So if you if you've had a baby in like 23 00:01:19,880 --> 00:01:22,720 Speaker 1: the last sixty years, or been present when somebody else 24 00:01:22,760 --> 00:01:24,720 Speaker 1: had a baby, or maybe even just watched a TV 25 00:01:24,840 --> 00:01:28,039 Speaker 1: show in which babies were born, you've probably heard people 26 00:01:28,040 --> 00:01:32,200 Speaker 1: talking about a car scores. Yeah, but I never gave 27 00:01:32,240 --> 00:01:35,360 Speaker 1: it much thought, not being particularly a baby person. So yeah, 28 00:01:35,360 --> 00:01:37,920 Speaker 1: I thought this was an acronym. And while somebody did 29 00:01:37,959 --> 00:01:40,240 Speaker 1: rework the parts of the Acar score so that it 30 00:01:40,280 --> 00:01:42,319 Speaker 1: matched up with the letters of her name in about 31 00:01:42,400 --> 00:01:46,160 Speaker 1: nineteen sixty two, the score itself is from earlier than that, 32 00:01:46,240 --> 00:01:49,240 Speaker 1: and it's the work of Dr Virginia Apgar, who really 33 00:01:49,320 --> 00:01:52,280 Speaker 1: broke new ground in the fields of obstetrics and anesthesiology, 34 00:01:52,880 --> 00:01:54,920 Speaker 1: as well as other fields in the middle of the 35 00:01:54,920 --> 00:01:58,600 Speaker 1: twentieth century. Today, the Apcar score is really part of 36 00:01:58,640 --> 00:02:01,480 Speaker 1: the standard of care for new for newborn babies and 37 00:02:01,720 --> 00:02:05,000 Speaker 1: much of the world, and it's totally to the credit 38 00:02:05,080 --> 00:02:09,080 Speaker 1: of this one particular doctor, and this one particular doctor. 39 00:02:09,160 --> 00:02:12,480 Speaker 1: Virginia Apgar was born in Westfield, New Jersey, on June 40 00:02:12,520 --> 00:02:15,680 Speaker 1: seven of nineteen o nine. Her father was an insurance 41 00:02:15,720 --> 00:02:18,960 Speaker 1: executive who was fond of science, and was an amateur astronomer. 42 00:02:19,480 --> 00:02:21,840 Speaker 1: And she also had a brother who died of tuberculosis 43 00:02:21,880 --> 00:02:25,000 Speaker 1: at a very young age, So it's possible that both 44 00:02:25,000 --> 00:02:27,600 Speaker 1: of these things influenced her decision to become a doctor. 45 00:02:27,720 --> 00:02:31,120 Speaker 1: But regardless, that decision was made before she even got 46 00:02:31,120 --> 00:02:34,200 Speaker 1: out of high school. To that end, she went some 47 00:02:34,240 --> 00:02:38,600 Speaker 1: Mount Holyoke College where she studied zoology. In addition to 48 00:02:38,680 --> 00:02:42,200 Speaker 1: being an excellent student in that program, she worked several 49 00:02:42,240 --> 00:02:45,239 Speaker 1: part time jobs to make ends meet. Then she also 50 00:02:45,280 --> 00:02:47,519 Speaker 1: played the cello and the violin and the orchestra, and 51 00:02:47,639 --> 00:02:50,960 Speaker 1: acted and wrote for the college newspaper and played on 52 00:02:51,120 --> 00:02:56,280 Speaker 1: seven different sports teams. She sounds like a medical school 53 00:02:56,400 --> 00:03:04,720 Speaker 1: version of Leslie. Nope. Yeah, that's a great description her family. 54 00:03:04,840 --> 00:03:06,840 Speaker 1: She described her family at one point as just people 55 00:03:06,840 --> 00:03:09,760 Speaker 1: who never sat still, and that's just she seems to 56 00:03:09,840 --> 00:03:14,240 Speaker 1: have been constantly doing her whole life. She graduated in 57 00:03:14,440 --> 00:03:17,440 Speaker 1: nine nine, and she started medical school at the Columbia 58 00:03:17,560 --> 00:03:21,240 Speaker 1: University College of Physicians and Surgeons that same year. There 59 00:03:21,240 --> 00:03:23,359 Speaker 1: were ninety people in her class, and she was one 60 00:03:23,440 --> 00:03:26,799 Speaker 1: of only nine women. She scraped together enough money to 61 00:03:26,960 --> 00:03:29,400 Speaker 1: stay in school in spite of the Great Depression, and 62 00:03:29,480 --> 00:03:32,560 Speaker 1: she graduated near the top of her class in ninety three, 63 00:03:33,480 --> 00:03:36,240 Speaker 1: so she really wanted to become a surgeon, and she 64 00:03:36,400 --> 00:03:40,600 Speaker 1: was accepted into a surgical internship at Presbyterian Hospital, which 65 00:03:40,640 --> 00:03:44,560 Speaker 1: is now New York Presbyterian Hospital Columbia University Medical Center. 66 00:03:45,320 --> 00:03:48,040 Speaker 1: She did really well in her first year of this residency, 67 00:03:48,080 --> 00:03:50,600 Speaker 1: but Dr Alan Whipple, who was the chair of the 68 00:03:50,600 --> 00:03:55,800 Speaker 1: surgical department, encouraged her to change specialties to anthesiology. He 69 00:03:55,960 --> 00:03:58,280 Speaker 1: was concerned that she would not be able to make 70 00:03:58,280 --> 00:04:02,080 Speaker 1: a profitable career as a siren, especially given the economic 71 00:04:02,160 --> 00:04:04,280 Speaker 1: climate at the time. This was still in the wake 72 00:04:04,360 --> 00:04:08,080 Speaker 1: of the Great Depression. He also basically had other plans 73 00:04:08,120 --> 00:04:11,120 Speaker 1: for her. He wanted her to study anesthesiology and then 74 00:04:11,160 --> 00:04:13,960 Speaker 1: come back to Presbyterian Hospital to help start a teaching 75 00:04:14,040 --> 00:04:18,599 Speaker 1: program for future an enthusiologists. There were lots of reasons 76 00:04:18,600 --> 00:04:22,120 Speaker 1: for Dr Apgar to change specialties. It was definitely difficult 77 00:04:22,160 --> 00:04:24,479 Speaker 1: for women to be respected as surgeons at this point, 78 00:04:24,640 --> 00:04:27,200 Speaker 1: and there were lots of trained surgeons, so competition for 79 00:04:27,279 --> 00:04:30,600 Speaker 1: jobs was really stiff, and Dr Apgar would have had 80 00:04:30,600 --> 00:04:33,880 Speaker 1: to stand out even more because of her gender. Dr 81 00:04:33,920 --> 00:04:37,279 Speaker 1: Whipple had seen his other female surgical students really have 82 00:04:37,400 --> 00:04:40,760 Speaker 1: trouble getting hired as surgeons at all, and dr Apgar 83 00:04:40,839 --> 00:04:43,479 Speaker 1: had graduated from medical school in debts, so taking on 84 00:04:43,520 --> 00:04:46,200 Speaker 1: a specialty in which she would probably have trouble finding 85 00:04:46,200 --> 00:04:51,560 Speaker 1: a job was a really risky proposition. At the same time, 86 00:04:51,040 --> 00:04:55,000 Speaker 1: by becoming an anathusiologist instead of a surgeon, she was 87 00:04:55,080 --> 00:04:57,640 Speaker 1: really setting out to pursue a specialty that did not 88 00:04:57,800 --> 00:05:01,320 Speaker 1: even really exist yet. As Reese as nineteen eleven, the 89 00:05:01,360 --> 00:05:05,000 Speaker 1: American Medical Association had even rejected a request to start 90 00:05:05,040 --> 00:05:09,479 Speaker 1: an anesthesiast section for its members. So while dr Apgar 91 00:05:09,680 --> 00:05:12,520 Speaker 1: essentially had a job waiting for her after she was 92 00:05:12,560 --> 00:05:15,440 Speaker 1: done with her study of anesthesiology, it was going to 93 00:05:15,440 --> 00:05:18,040 Speaker 1: be a tough one because it was in a specialty 94 00:05:18,160 --> 00:05:22,280 Speaker 1: that was not regarded as a specialty. So let's talk 95 00:05:22,320 --> 00:05:25,400 Speaker 1: about why that was. For a moment um. For most 96 00:05:25,480 --> 00:05:29,719 Speaker 1: of Western medical history, surgery was actually seen as inferior 97 00:05:29,839 --> 00:05:33,119 Speaker 1: to the rest of medicine. So before things like modern 98 00:05:33,160 --> 00:05:37,000 Speaker 1: anesthesia and the germ theory of disease, surgeons mostly performed 99 00:05:37,000 --> 00:05:39,760 Speaker 1: things like amputations, and it was not always likely that 100 00:05:39,800 --> 00:05:43,640 Speaker 1: their patients were going to survive. Eventually, as developments in 101 00:05:43,680 --> 00:05:46,560 Speaker 1: medicine made it possible for people to live through surgeries 102 00:05:46,560 --> 00:05:50,600 Speaker 1: without bleeding to death or immediately dying from infection. Surgery 103 00:05:50,640 --> 00:05:55,160 Speaker 1: only gradually became a more respected field, so surgeons had 104 00:05:55,160 --> 00:05:57,880 Speaker 1: to basically claw their way to respectability, and for the 105 00:05:57,920 --> 00:06:00,839 Speaker 1: most part, in the early days of surgery as a 106 00:06:00,880 --> 00:06:05,960 Speaker 1: more prestigious position, anesthesia was being administered by nurses. I 107 00:06:06,000 --> 00:06:09,160 Speaker 1: want to be super clear on this. Nurse anesthetists are 108 00:06:09,640 --> 00:06:12,960 Speaker 1: still a really important part of the field of anesthesiology today, 109 00:06:13,000 --> 00:06:15,679 Speaker 1: but at this time, instead of working under the direction 110 00:06:15,720 --> 00:06:19,240 Speaker 1: of anesthesiologists who were specialists and how to keep a 111 00:06:19,279 --> 00:06:25,040 Speaker 1: patient simultaneously unconscious and pain free and medically stable, nurse 112 00:06:25,080 --> 00:06:28,039 Speaker 1: anesthetists were usually working on the under the direction of 113 00:06:28,080 --> 00:06:31,440 Speaker 1: the surgeon who was performing the procedure. This meant that 114 00:06:31,560 --> 00:06:35,320 Speaker 1: even as advances in surgical techniques and infection control practices 115 00:06:35,400 --> 00:06:40,239 Speaker 1: meant patients could survive longer and more complex surgeries, anesthesiology 116 00:06:40,520 --> 00:06:44,159 Speaker 1: wasn't advancing quickly enough to keep up. Outside of teaching 117 00:06:44,200 --> 00:06:47,159 Speaker 1: and research hospitals where surgeons might be dedicating some of 118 00:06:47,200 --> 00:06:51,440 Speaker 1: their focus to anesthesia, this just was not the priority. 119 00:06:51,480 --> 00:06:53,279 Speaker 1: And then there was the basic fact that keeping a 120 00:06:53,320 --> 00:06:57,159 Speaker 1: patient properly anesthetized while also performing a surgical procedure is 121 00:06:57,360 --> 00:07:01,240 Speaker 1: really a lot to juggle at one time. Plus, after 122 00:07:01,320 --> 00:07:04,720 Speaker 1: having been viewed as inferior to doctors for so long, 123 00:07:05,040 --> 00:07:07,160 Speaker 1: a lot of surgeons just did not want to hand 124 00:07:07,200 --> 00:07:10,560 Speaker 1: over control of part of the surgical process to another person, 125 00:07:11,040 --> 00:07:12,760 Speaker 1: even if the person they were going to be handing 126 00:07:12,760 --> 00:07:16,520 Speaker 1: it off to was somebody who's sole focus was on 127 00:07:16,800 --> 00:07:21,400 Speaker 1: being the best in the world of anesthesiology. So Dr 128 00:07:21,440 --> 00:07:24,400 Speaker 1: Whipple hoped that he and Dr Apgar might work together 129 00:07:24,480 --> 00:07:26,840 Speaker 1: to change all of that. And we're going to talk 130 00:07:26,840 --> 00:07:28,680 Speaker 1: about that some more, but first we're gonna have a 131 00:07:28,720 --> 00:07:38,440 Speaker 1: word from a sponsor. So to get back to Dr 132 00:07:38,480 --> 00:07:43,440 Speaker 1: Whipple and Dr Apgar's plans for anesthesiology, Dr Whipple basically 133 00:07:43,480 --> 00:07:46,280 Speaker 1: thought that Dr Apgar might really have a knack for this. 134 00:07:46,480 --> 00:07:49,440 Speaker 1: He described her as having quote the energy, intelligence, and 135 00:07:49,480 --> 00:07:53,840 Speaker 1: ability needed to make significant contributions in this area. Because 136 00:07:53,840 --> 00:07:57,680 Speaker 1: anesthesiology wasn't yet recognized as a specialty for medical doctors, 137 00:07:57,720 --> 00:07:59,880 Speaker 1: there really weren't a lot of training programs for it 138 00:08:00,080 --> 00:08:02,640 Speaker 1: this point. There were thirteen of them in the United States, 139 00:08:03,080 --> 00:08:06,000 Speaker 1: ranging in length from two weeks to three years, and 140 00:08:06,120 --> 00:08:09,720 Speaker 1: only two of those were actually paid residencies. Neither of 141 00:08:09,760 --> 00:08:15,400 Speaker 1: these residency programs had a spot open when Dr Apgar applied. Yeah, obviously, 142 00:08:15,560 --> 00:08:18,480 Speaker 1: like a two week training program and anesthesiology is not 143 00:08:18,480 --> 00:08:21,080 Speaker 1: not nearly the same thing as the work that it 144 00:08:21,080 --> 00:08:25,240 Speaker 1: would be needed to take on a new medical specialty. Yeah, 145 00:08:25,240 --> 00:08:27,640 Speaker 1: that's a that's a wide range, a two week to 146 00:08:27,760 --> 00:08:33,280 Speaker 1: three year play. Yeah. Yeah. So, after finishing her second 147 00:08:33,360 --> 00:08:37,559 Speaker 1: year of her surgical internship, dr Afgar went through Presbyterians 148 00:08:37,600 --> 00:08:42,080 Speaker 1: Training Program for Nurse Anesthetists. She then spent six months 149 00:08:42,160 --> 00:08:45,640 Speaker 1: studying under Dr Ralph Waters at the University of Wisconsin, 150 00:08:45,720 --> 00:08:49,319 Speaker 1: Madison in a visiting position. So Dr Waters was really 151 00:08:49,400 --> 00:08:53,240 Speaker 1: one of America's earliest pioneers in anesthesiology and he just 152 00:08:53,320 --> 00:08:57,600 Speaker 1: made critical and ground breaking contributions to this field. Once 153 00:08:57,640 --> 00:09:00,520 Speaker 1: she was done studying under Dr Waters, she spent another 154 00:09:00,640 --> 00:09:04,720 Speaker 1: six months with Dr Ernest Rovstein in New York Bellevue Hospital. 155 00:09:05,160 --> 00:09:08,920 Speaker 1: He had also trained with Dr Waters, So it's you 156 00:09:08,960 --> 00:09:12,520 Speaker 1: could easily call Dr Waters like the the keystone in 157 00:09:12,559 --> 00:09:15,800 Speaker 1: a lot of anesthesiology work in the United States at 158 00:09:15,800 --> 00:09:20,559 Speaker 1: this point. So from there in Dr Apgar went back 159 00:09:20,600 --> 00:09:24,680 Speaker 1: to Columbia University in Presbyterian hospital and became the director 160 00:09:24,800 --> 00:09:28,880 Speaker 1: of the Division of Anesthesia and in Attending Anesthetist. This 161 00:09:28,960 --> 00:09:31,120 Speaker 1: made her the first woman to head a division at 162 00:09:31,120 --> 00:09:35,960 Speaker 1: the hospital. Dr Apgar and Dr Whipple had formulated a 163 00:09:36,000 --> 00:09:39,560 Speaker 1: plan for the Division of Anesthesia to become dedicated to 164 00:09:39,600 --> 00:09:43,600 Speaker 1: training doctors to be anesthesiologists, but because of the prevailing 165 00:09:43,640 --> 00:09:47,240 Speaker 1: attitudes running about anesthesiology at this point and the low 166 00:09:47,320 --> 00:09:50,520 Speaker 1: pay that came along with them, she really had trouble 167 00:09:50,720 --> 00:09:53,679 Speaker 1: recruiting peers to work with her. She was the only 168 00:09:53,800 --> 00:09:57,000 Speaker 1: staff member in the division through the mid nineteen forties, 169 00:09:58,840 --> 00:10:01,760 Speaker 1: but at the same time she became a beloved teacher. 170 00:10:02,400 --> 00:10:05,600 Speaker 1: As the existing staff of nurse anesthetists left the hospital 171 00:10:05,960 --> 00:10:09,200 Speaker 1: to get married or pursue other jobs, residents filled their 172 00:10:09,240 --> 00:10:13,480 Speaker 1: positions and studied anesthesiology under Dr Apgar for between one 173 00:10:13,559 --> 00:10:17,600 Speaker 1: and three years, and after the teaching program was solidly established, 174 00:10:17,640 --> 00:10:20,640 Speaker 1: the division also turned its focus to research to improve 175 00:10:20,679 --> 00:10:24,560 Speaker 1: the practice of anesthesiology. This was really a long and 176 00:10:24,640 --> 00:10:28,200 Speaker 1: difficult process. For the first years of the program, dr 177 00:10:28,240 --> 00:10:30,439 Speaker 1: Apgar only had a couple of residents, and she and 178 00:10:30,480 --> 00:10:33,559 Speaker 1: a colleague had to write their textbook themselves because there 179 00:10:33,679 --> 00:10:38,360 Speaker 1: was no Anesthesiology textbook. It was ninety five before anesthesia 180 00:10:38,520 --> 00:10:43,520 Speaker 1: was more often administered by doctors than by nurses at Presbyterian, 181 00:10:43,559 --> 00:10:46,000 Speaker 1: which is really notable because at this point the whole 182 00:10:46,080 --> 00:10:51,479 Speaker 1: point was trying to train new doctors. Gradually, though, perceptions 183 00:10:51,520 --> 00:10:54,840 Speaker 1: about the validity of anesthesiology as a specialty started to 184 00:10:54,880 --> 00:10:57,920 Speaker 1: improve and it became recognized as a real specialty in 185 00:10:58,000 --> 00:11:01,839 Speaker 1: nineteen forty six. Three years later, dr Apgar became the 186 00:11:01,880 --> 00:11:04,040 Speaker 1: first woman to be named a full professor at the 187 00:11:04,080 --> 00:11:09,000 Speaker 1: Columbia University College of Physicians and Surgeons. Along with this, 188 00:11:09,120 --> 00:11:12,720 Speaker 1: in the same year, the division of Anesthesiology became its 189 00:11:12,760 --> 00:11:17,040 Speaker 1: own department, and doctor Emmanuel Papper was selected to be 190 00:11:17,080 --> 00:11:20,079 Speaker 1: the chair of that department. So dr Apgar had sort 191 00:11:20,120 --> 00:11:21,960 Speaker 1: of thought she was going to be the person appointed 192 00:11:22,000 --> 00:11:25,280 Speaker 1: to this position, but the fact that she no longer 193 00:11:26,280 --> 00:11:29,080 Speaker 1: had that department had kind of role to take up 194 00:11:29,080 --> 00:11:31,200 Speaker 1: part of her time. She was able to focus a 195 00:11:31,240 --> 00:11:36,360 Speaker 1: lot more on teaching and on her work in obstetric anesthesiology. 196 00:11:37,200 --> 00:11:40,920 Speaker 1: During World War Two, many doctors and surgeons joined the military, 197 00:11:40,960 --> 00:11:44,360 Speaker 1: which led to a labor shortage at Presbyterian Hospital and 198 00:11:44,440 --> 00:11:47,520 Speaker 1: to dr Apgar's department having more involvement in the field 199 00:11:47,520 --> 00:11:50,839 Speaker 1: of obstetric anesthesiology because the doctors and nurses who had 200 00:11:50,840 --> 00:11:54,760 Speaker 1: been doing so had gone to serve so. At this 201 00:11:54,800 --> 00:11:58,480 Speaker 1: point in the United States, uh women had generally moved 202 00:11:58,559 --> 00:12:02,560 Speaker 1: from usually delivering babies at home to usually delivering babies 203 00:12:02,600 --> 00:12:06,719 Speaker 1: in the hospital, but this really hadn't improved outcomes for 204 00:12:06,760 --> 00:12:10,760 Speaker 1: the women and their babies. Although infant mortality in general 205 00:12:10,920 --> 00:12:13,960 Speaker 1: had dropped, the rate of infant mortality within the first 206 00:12:14,000 --> 00:12:17,880 Speaker 1: twenty four hours after birth had hardly budged, even though 207 00:12:18,040 --> 00:12:21,480 Speaker 1: people were now being born in the presumably more medically 208 00:12:21,520 --> 00:12:25,080 Speaker 1: safe area of a hospital. This is where dr Apgar 209 00:12:25,240 --> 00:12:27,800 Speaker 1: really started to focus once she was freed up from 210 00:12:27,840 --> 00:12:32,000 Speaker 1: her previous administrative duties as a department head, and it 211 00:12:32,120 --> 00:12:35,360 Speaker 1: was known at that point that oxygen deprivation played a 212 00:12:35,440 --> 00:12:38,360 Speaker 1: part in at least half of those babies deaths. It 213 00:12:38,400 --> 00:12:40,800 Speaker 1: seemed obvious to dr Apgar that if it became a 214 00:12:40,840 --> 00:12:43,760 Speaker 1: standard practice to examine the baby and determine whether it 215 00:12:43,760 --> 00:12:47,200 Speaker 1: needed oxygen and then give it oxygen if so, then 216 00:12:47,240 --> 00:12:51,240 Speaker 1: a lot of these deaths could potentially be prevented. She 217 00:12:51,320 --> 00:12:53,319 Speaker 1: was basically saying, y'all need to look at these babies 218 00:12:53,880 --> 00:12:59,160 Speaker 1: like I need to look at them. So, I mean, 219 00:12:59,160 --> 00:13:01,720 Speaker 1: today this seems early obvious. You should look at the baby, 220 00:13:01,800 --> 00:13:04,120 Speaker 1: make sure the baby is okay. But at the time, 221 00:13:04,400 --> 00:13:07,360 Speaker 1: in delivery rooms, medical efforts tended to be a lot 222 00:13:07,360 --> 00:13:10,040 Speaker 1: more focused on the mother than on the baby. A 223 00:13:10,080 --> 00:13:12,560 Speaker 1: lot of times, the most junior people in the room 224 00:13:12,640 --> 00:13:14,480 Speaker 1: were the ones who were seeing to the baby after 225 00:13:14,520 --> 00:13:18,400 Speaker 1: it was born. They rarely had any training in anesthesiology 226 00:13:18,480 --> 00:13:20,600 Speaker 1: or any knowledge of how the drugs that were used 227 00:13:20,880 --> 00:13:23,800 Speaker 1: during a vaginal delivery or a cesarean section could affect 228 00:13:23,840 --> 00:13:27,520 Speaker 1: a baby. Sometimes they were really at the very beginning 229 00:13:27,640 --> 00:13:32,000 Speaker 1: of their medical study. They just were not trained particularly 230 00:13:32,120 --> 00:13:38,160 Speaker 1: well on, uh, what to do when the baby came out. Yeah, 231 00:13:38,320 --> 00:13:40,360 Speaker 1: if they're that early on, they probably don't have the 232 00:13:40,440 --> 00:13:45,800 Speaker 1: confidence to like make kind of snap decisions about treatment. Uh. Plus, 233 00:13:46,160 --> 00:13:48,160 Speaker 1: it's not gonna come as a surprise to anyone who's 234 00:13:48,160 --> 00:13:51,760 Speaker 1: ever witnessed any conversation on the Internet about people's opinions 235 00:13:51,760 --> 00:13:54,719 Speaker 1: on childbirth. There's a whole lot of arguing going on 236 00:13:54,760 --> 00:13:57,040 Speaker 1: about how to best deliver babies and not a whole 237 00:13:57,080 --> 00:14:00,520 Speaker 1: lot of concrete data backing up people's opinions. And even 238 00:14:00,520 --> 00:14:03,000 Speaker 1: when there was data, it was often disregarded in favor 239 00:14:03,000 --> 00:14:07,040 Speaker 1: of what everybody quote already knew about it. So dr 240 00:14:07,160 --> 00:14:12,040 Speaker 1: Apgar developed a standardized way of analyzing how the baby 241 00:14:12,120 --> 00:14:15,800 Speaker 1: was doing after it was born and involved evaluating five 242 00:14:15,840 --> 00:14:19,640 Speaker 1: traits the baby's heart rate, respiratory effort, muscle tone, reflex, 243 00:14:19,680 --> 00:14:22,920 Speaker 1: and color, giving each of those a score of zero, 244 00:14:23,160 --> 00:14:26,120 Speaker 1: one or two. Then you add up those five numbers 245 00:14:26,160 --> 00:14:29,080 Speaker 1: and that's the baby's app CAR score. That mnemonic device 246 00:14:29,160 --> 00:14:32,960 Speaker 1: that we mentioned at the top of the episode substituted 247 00:14:33,000 --> 00:14:37,720 Speaker 1: appearance for color, pulse for heart rate, grimace for reflex 248 00:14:38,320 --> 00:14:40,840 Speaker 1: uh because babies make a grimacy face as a reflex, 249 00:14:41,440 --> 00:14:44,320 Speaker 1: activity for muscle tone and respiration, which was on the 250 00:14:44,320 --> 00:14:49,680 Speaker 1: original list. Reportedly, dr Apgar was quite delighted when when 251 00:14:49,680 --> 00:14:52,760 Speaker 1: a resident rewrote the letters in the Apgar score to 252 00:14:52,800 --> 00:14:54,360 Speaker 1: match up with her name so they could remember what 253 00:14:54,440 --> 00:14:58,160 Speaker 1: they all were. And what's really important is that she 254 00:14:58,240 --> 00:15:02,800 Speaker 1: assigned actual measurable criteria to these. So a zero for 255 00:15:02,880 --> 00:15:05,960 Speaker 1: heart rate meant that the heartbeat was absent to meant 256 00:15:06,000 --> 00:15:09,080 Speaker 1: that the heartbeat was between one and one forty beats 257 00:15:09,080 --> 00:15:11,800 Speaker 1: a minute. Zero for muscle tone meant that there was 258 00:15:11,840 --> 00:15:14,040 Speaker 1: no muscle tone and a two meant the baby was 259 00:15:14,080 --> 00:15:16,800 Speaker 1: actively moving. It really got rid of a lot of 260 00:15:16,800 --> 00:15:19,400 Speaker 1: the subjectivity in figuring out whether her a baby was 261 00:15:19,440 --> 00:15:22,240 Speaker 1: doing well or not. Yeah, so, in addition to the 262 00:15:22,320 --> 00:15:29,080 Speaker 1: extremely obvious, you need to look at the baby. It's like, 263 00:15:29,120 --> 00:15:31,080 Speaker 1: you need to look at the baby and measure these 264 00:15:31,120 --> 00:15:35,040 Speaker 1: things like that, and it will help you understand whether 265 00:15:35,080 --> 00:15:37,560 Speaker 1: the baby needs to be resuscitated, whether the baby is 266 00:15:37,640 --> 00:15:41,960 Speaker 1: thriving outside of the womb. She then conducted a study 267 00:15:42,280 --> 00:15:45,360 Speaker 1: using this scoring method on one thousand, twenty one babies 268 00:15:45,480 --> 00:15:48,960 Speaker 1: who were born at the Sloane Hospital for Women at Presbyterian. 269 00:15:49,480 --> 00:15:52,880 Speaker 1: She found definite correlations between the method of delivery, the 270 00:15:52,920 --> 00:15:55,560 Speaker 1: type of anesthesia used on the mother, and the baby's 271 00:15:55,600 --> 00:15:59,280 Speaker 1: After our scores, she recommended that New York that newborn 272 00:15:59,320 --> 00:16:02,760 Speaker 1: babies be of evaluated a minute after their birth, and 273 00:16:03,680 --> 00:16:08,280 Speaker 1: also important that someone other than the attending obstetrician do it. 274 00:16:08,920 --> 00:16:13,160 Speaker 1: This is because she noticed a pattern that obs tended 275 00:16:13,200 --> 00:16:16,760 Speaker 1: to score their end quote their babies that they delivered 276 00:16:17,200 --> 00:16:23,160 Speaker 1: higher than other people in the delivery room did. This 277 00:16:23,200 --> 00:16:26,120 Speaker 1: will sound familiar to anyone who has heard our episode 278 00:16:26,120 --> 00:16:29,240 Speaker 1: on Dr VERA. Peters, who helped revolutionize the treatment of 279 00:16:29,280 --> 00:16:34,800 Speaker 1: Hodgkins lymphoma. When dr Apgar presented her paper at Annual 280 00:16:34,840 --> 00:16:40,320 Speaker 1: Congress of Anesthetists in the audience was skeptical, but she 281 00:16:40,400 --> 00:16:42,920 Speaker 1: published the work in three and it has since become 282 00:16:42,960 --> 00:16:45,400 Speaker 1: a standard of care in delivery rooms in much of 283 00:16:45,440 --> 00:16:48,360 Speaker 1: the world, with the score measured once a minute after 284 00:16:48,400 --> 00:16:52,240 Speaker 1: birth and again five minutes after birth. So basically, if 285 00:16:52,280 --> 00:16:54,360 Speaker 1: the baby's score is not good after a minute, you 286 00:16:54,400 --> 00:16:58,280 Speaker 1: need to resuscitate the baby. You do that, take it 287 00:16:58,320 --> 00:17:01,360 Speaker 1: again in five minutes. Uh, it's this is one of 288 00:17:01,400 --> 00:17:05,639 Speaker 1: those times where it's kind of baffling, Uh that this 289 00:17:06,280 --> 00:17:08,359 Speaker 1: you know, Now, it's just such a standard thing. The 290 00:17:08,359 --> 00:17:10,040 Speaker 1: baby is born and you check it out and make 291 00:17:10,080 --> 00:17:14,760 Speaker 1: sure everything's all right. Uh, this was not quite as 292 00:17:14,760 --> 00:17:17,200 Speaker 1: big of a focus when the medical team in the 293 00:17:17,280 --> 00:17:19,080 Speaker 1: room was so much more focused on the mother than 294 00:17:19,160 --> 00:17:23,560 Speaker 1: on both the mother and the baby. So, along with 295 00:17:23,680 --> 00:17:27,400 Speaker 1: Dr Duncan Holiday and Dr Stanley James, dr Apgar went 296 00:17:27,440 --> 00:17:31,679 Speaker 1: on to evaluate these correlations between delivery and the baby's 297 00:17:31,720 --> 00:17:36,639 Speaker 1: AFCAR scores. They slowly connected the length and difficulty of 298 00:17:36,680 --> 00:17:39,440 Speaker 1: the delivery and the types and amounts of annesthesia given 299 00:17:39,480 --> 00:17:41,600 Speaker 1: to the mother. You know, whether it was a vaginal 300 00:17:41,640 --> 00:17:44,400 Speaker 1: birth or a cesarean section, all these other things. With 301 00:17:44,480 --> 00:17:47,480 Speaker 1: trends in the baby's scores, they figured out that babies 302 00:17:47,480 --> 00:17:50,040 Speaker 1: with a score under three needed to be resuscitated kind 303 00:17:50,080 --> 00:17:52,959 Speaker 1: of obviously because that would be a baby that's like 304 00:17:53,000 --> 00:17:56,000 Speaker 1: blue and not moving and doesn't have a pulse. Uh. 305 00:17:56,119 --> 00:17:58,280 Speaker 1: But babies that have a score of seven to ten 306 00:17:58,600 --> 00:18:01,640 Speaker 1: had a statistically better chance of surviving their first month 307 00:18:01,720 --> 00:18:04,280 Speaker 1: of life than babies who scored six or lower, So 308 00:18:04,280 --> 00:18:05,760 Speaker 1: that would be kind of a baby that's doing all right, 309 00:18:05,800 --> 00:18:10,119 Speaker 1: but maybe not quite thriving. This evolving body of data 310 00:18:10,600 --> 00:18:15,560 Speaker 1: allowed obstetricians and obstetric anesthetists to really refine their practices 311 00:18:15,600 --> 00:18:18,160 Speaker 1: to improve newborn babies survival rates. And we haven't really 312 00:18:18,160 --> 00:18:22,400 Speaker 1: talked about the pretty massive differences between anesthesia that's typically 313 00:18:22,440 --> 00:18:25,280 Speaker 1: used in delivery rooms now versus what was used in 314 00:18:26,280 --> 00:18:31,560 Speaker 1: the like nineteen fifties, a totally different world um in 315 00:18:31,680 --> 00:18:35,920 Speaker 1: terms of, like, we it's not standard practice to put 316 00:18:36,119 --> 00:18:40,080 Speaker 1: women essentially unconscious to deliver babies in American hospitals anymore. 317 00:18:40,840 --> 00:18:44,080 Speaker 1: Dr Apgar and team also went one step further and 318 00:18:44,160 --> 00:18:48,720 Speaker 1: studied newborn babies blood chemistry, finding clear physiological links between 319 00:18:48,760 --> 00:18:51,679 Speaker 1: the outward appearance of the traits examined to calculate an 320 00:18:51,680 --> 00:18:55,639 Speaker 1: Apgar score and what was actually physiologically going on in 321 00:18:55,680 --> 00:18:59,399 Speaker 1: the baby's body. By the late nineteen fifties, dr Apgar 322 00:18:59,480 --> 00:19:03,280 Speaker 1: had attended more than seventeen thousand births. During that time, 323 00:19:03,359 --> 00:19:05,960 Speaker 1: she had seen a number of children who were born 324 00:19:06,000 --> 00:19:10,480 Speaker 1: with congenital disabilities also sometimes known as birth defects, and 325 00:19:10,720 --> 00:19:13,359 Speaker 1: in some cases it really seemed like there was a 326 00:19:13,400 --> 00:19:19,040 Speaker 1: correlation between the disability and the baby's Afcar score. So 327 00:19:19,119 --> 00:19:22,760 Speaker 1: in night she went on a sabbatical and she pursued 328 00:19:22,800 --> 00:19:27,240 Speaker 1: a master's degree in public health from Johns Hopkins University. Originally, 329 00:19:27,320 --> 00:19:30,159 Speaker 1: her intent was to improve her knowledge of statistics and 330 00:19:30,240 --> 00:19:32,960 Speaker 1: bring that knowledge back to her work at Presbyterian Hospital, 331 00:19:33,320 --> 00:19:37,800 Speaker 1: which increasingly involved statistics. But as she studied, she became 332 00:19:37,840 --> 00:19:40,959 Speaker 1: increasingly interested in whether some of the congenital issues she 333 00:19:41,000 --> 00:19:44,280 Speaker 1: was seeing when babies were born could somehow be prevented. 334 00:19:45,400 --> 00:19:48,200 Speaker 1: During this time, she was approached by the National Foundation 335 00:19:48,280 --> 00:19:51,120 Speaker 1: for Infantile Paralysis, which is now known as the March 336 00:19:51,160 --> 00:19:56,280 Speaker 1: of Dimes. Originally, the National Foundation was primarily focused on polio. 337 00:19:56,359 --> 00:19:59,399 Speaker 1: It had sponsored the vaccine research of Dr Jonas Salk, 338 00:19:59,720 --> 00:20:03,680 Speaker 1: and once the polio vaccine was introduced and the rate 339 00:20:03,840 --> 00:20:07,840 Speaker 1: of polio infection just dropped dramatically, the Foundation wanted to 340 00:20:07,840 --> 00:20:10,600 Speaker 1: find a new place to expand its work and other 341 00:20:11,480 --> 00:20:14,320 Speaker 1: conditions that they could help with that we're affecting babies 342 00:20:14,320 --> 00:20:18,119 Speaker 1: and children. The Foundation started a new department called the 343 00:20:18,160 --> 00:20:22,880 Speaker 1: Division of Congenital Malformations. The National Foundation asked Dr Apgar 344 00:20:23,000 --> 00:20:25,760 Speaker 1: to lead this new department, and she accepted, beginning her 345 00:20:25,760 --> 00:20:30,080 Speaker 1: new role after she completed her master's program. In this role, 346 00:20:30,240 --> 00:20:33,679 Speaker 1: dr Apgar became a huge advocate of early detection and 347 00:20:33,720 --> 00:20:38,359 Speaker 1: treatment of congenital issues, including prenatal testing and treatment. She 348 00:20:38,480 --> 00:20:42,359 Speaker 1: traveled extensively to talk directly to parents and doctors and 349 00:20:42,560 --> 00:20:46,320 Speaker 1: educators about congenital disabilities and other issues that were related 350 00:20:46,359 --> 00:20:50,840 Speaker 1: to prenatal and newborn health. This was almost directly the 351 00:20:50,840 --> 00:20:54,000 Speaker 1: opposite of her experience trying to start an in enthusiology 352 00:20:54,040 --> 00:20:58,520 Speaker 1: program while that field was in its infancy. Congenital disabilities 353 00:20:58,520 --> 00:21:00,920 Speaker 1: and disorders were huge new us in the United States 354 00:21:00,960 --> 00:21:03,760 Speaker 1: at this point. The drug Thelida mind, which had been 355 00:21:03,800 --> 00:21:06,440 Speaker 1: given to pregnant women in much of Europe both as 356 00:21:06,440 --> 00:21:10,000 Speaker 1: a sedative and to combat morning sickness had been implicated 357 00:21:10,000 --> 00:21:12,760 Speaker 1: in causing babies to be born with missing or incorrectly 358 00:21:12,800 --> 00:21:16,119 Speaker 1: formed limbs. The FDA had not approved the drug to 359 00:21:16,160 --> 00:21:18,560 Speaker 1: be used in the United States, which the media played 360 00:21:18,600 --> 00:21:20,960 Speaker 1: up as a near miss. This was also during the 361 00:21:21,000 --> 00:21:24,080 Speaker 1: post war baby boom, so parents to be were hungry 362 00:21:24,119 --> 00:21:29,000 Speaker 1: for information, and dr Apgar was really an ideal doctor 363 00:21:29,040 --> 00:21:32,680 Speaker 1: to be involved in all this. She had decades of experience, 364 00:21:32,760 --> 00:21:37,240 Speaker 1: and she was just extremely personable and empathetic and compassionate 365 00:21:37,280 --> 00:21:39,679 Speaker 1: with the people she was talking to you. In nineteen 366 00:21:39,720 --> 00:21:42,960 Speaker 1: sixty four and nineteen sixty five, a huge rubella outbreak 367 00:21:42,960 --> 00:21:45,280 Speaker 1: in the United States led to more than twelve million 368 00:21:45,320 --> 00:21:49,720 Speaker 1: cases of rubella and twenty thousand cases of congenital rubella syndrome, 369 00:21:50,040 --> 00:21:54,080 Speaker 1: which occurs when a pregnant woman contracts rubella. Congenital rubella 370 00:21:54,119 --> 00:21:58,119 Speaker 1: syndrome can cause premature delivery, miscarriages, and still births, and 371 00:21:58,160 --> 00:22:01,280 Speaker 1: a wide variety of potential disorders and disabilities which can 372 00:22:01,320 --> 00:22:05,439 Speaker 1: affect virtually any system of the body. These include blindness, 373 00:22:05,560 --> 00:22:10,919 Speaker 1: heart problems, bone lesions, hepatitis, and developmental disabilities. In the 374 00:22:10,960 --> 00:22:14,520 Speaker 1: wake of this outbreak, dr Apgar led vaccination campaigns after 375 00:22:14,600 --> 00:22:18,600 Speaker 1: one became available in nineteen sixty nine. She joined the 376 00:22:18,640 --> 00:22:22,000 Speaker 1: faculty of the School of Pediatrics at Cornell University School 377 00:22:22,000 --> 00:22:24,199 Speaker 1: of Medicine in nineteen sixty five, and she taught there 378 00:22:24,240 --> 00:22:29,000 Speaker 1: until nineteen seventy four. She specialized in teratology. So sometimes 379 00:22:29,000 --> 00:22:32,560 Speaker 1: this is characterized as a study of congenital disabilities, but 380 00:22:32,640 --> 00:22:36,720 Speaker 1: it really incorporates any kind of disability or disorder that 381 00:22:36,800 --> 00:22:39,960 Speaker 1: arises as an organism is developing, So that can include 382 00:22:39,960 --> 00:22:42,920 Speaker 1: like as a child is growing or transitioning into adolescents, 383 00:22:43,000 --> 00:22:47,640 Speaker 1: or things like that. She was actually the first person 384 00:22:48,119 --> 00:22:52,359 Speaker 1: to hold a faculty position dedicated to this aspect of pediatrics. 385 00:22:53,680 --> 00:22:56,399 Speaker 1: In nineteen seventy two, Dr Apgar was part of a 386 00:22:56,480 --> 00:23:00,359 Speaker 1: joint effort of the American Medical Association, the American College 387 00:23:00,359 --> 00:23:04,560 Speaker 1: of Obstetrics and Gynecologists, the American Academy of Family Physicians, 388 00:23:04,760 --> 00:23:08,000 Speaker 1: the American Academy of Pediatrics, and the March of Dimes. 389 00:23:08,400 --> 00:23:12,040 Speaker 1: It was the first committee on perinatal health. The committee's 390 00:23:12,040 --> 00:23:14,560 Speaker 1: goal was to put together a plan to improve maternal 391 00:23:14,560 --> 00:23:18,880 Speaker 1: health and lower infant mortality nationwide. Sadly, she died before 392 00:23:18,880 --> 00:23:22,560 Speaker 1: the committee's landmark report toward Improving the Outcome of Pregnancy, 393 00:23:22,720 --> 00:23:27,840 Speaker 1: was released in nineteen seventy six. Dr Apgar published more 394 00:23:27,880 --> 00:23:30,600 Speaker 1: than sixty papers during her career, along with the book 395 00:23:30,640 --> 00:23:32,879 Speaker 1: is My Baby All Right? Which she co wrote with 396 00:23:33,040 --> 00:23:36,040 Speaker 1: Joan Beck and published in nineteen seventy two. This was 397 00:23:36,080 --> 00:23:39,159 Speaker 1: a book that walked through several different contentital situations that 398 00:23:39,200 --> 00:23:42,640 Speaker 1: can happen, using real examples. It was a book that 399 00:23:42,680 --> 00:23:44,480 Speaker 1: there was a great need for at this point because 400 00:23:44,480 --> 00:23:46,280 Speaker 1: a lot of people had no knowledge of any of 401 00:23:46,280 --> 00:23:50,119 Speaker 1: these things or what to do. She also received numerous 402 00:23:50,200 --> 00:23:54,639 Speaker 1: honorary doctorates and professional accolades during her career. She was 403 00:23:54,680 --> 00:23:58,440 Speaker 1: given a commemorative postage stamp in and was inducted into 404 00:23:58,480 --> 00:24:03,639 Speaker 1: the National Women's Hall of Fame. Throughout her life, she 405 00:24:03,720 --> 00:24:07,199 Speaker 1: continued to pursue all kinds of activities and passions in 406 00:24:07,240 --> 00:24:09,359 Speaker 1: addition to all this work of being a doctor. So 407 00:24:09,440 --> 00:24:11,399 Speaker 1: it sort of continued what she had been doing in 408 00:24:11,400 --> 00:24:13,680 Speaker 1: college when she was on seven different sports teams while 409 00:24:13,680 --> 00:24:18,159 Speaker 1: also being a great student. She also, in what maybe 410 00:24:18,280 --> 00:24:21,560 Speaker 1: is the most awesome thing in this episode, carried a 411 00:24:21,600 --> 00:24:25,480 Speaker 1: pen knife, an endo, tracheal tube, and a laryngoscope with 412 00:24:25,520 --> 00:24:28,800 Speaker 1: her at all times, just in case someone near her 413 00:24:28,840 --> 00:24:32,439 Speaker 1: stopped breathing. She said, nobody, But nobody is going to 414 00:24:32,480 --> 00:24:39,720 Speaker 1: stop breathing on me. She medic Leslie, Nope. Is she well, 415 00:24:39,760 --> 00:24:41,760 Speaker 1: she's so I have I don't know. I just developed 416 00:24:41,760 --> 00:24:43,840 Speaker 1: this deep fondness for her in this episode because she's 417 00:24:43,880 --> 00:24:46,480 Speaker 1: like medical Leslie Nope. And we've told we've told you 418 00:24:46,520 --> 00:24:49,200 Speaker 1: all before how much I love parks and recreation and 419 00:24:49,240 --> 00:24:52,520 Speaker 1: cried when it was over. But also, her name is Virginia, 420 00:24:53,520 --> 00:24:56,600 Speaker 1: my grandmother's names, and when you look at pictures of her, 421 00:24:56,800 --> 00:25:01,240 Speaker 1: she's got like the same kind of uh very from 422 00:25:01,240 --> 00:25:05,640 Speaker 1: the fifties I wear that you see pictures of my grandmother's, 423 00:25:05,760 --> 00:25:09,880 Speaker 1: she just reminds me of like if my grandmother's had 424 00:25:09,960 --> 00:25:14,719 Speaker 1: been like Leslie Nope when they were young. And she 425 00:25:14,880 --> 00:25:17,679 Speaker 1: actually never retired. She only slowed down a little at 426 00:25:17,680 --> 00:25:19,800 Speaker 1: the very end of her life because she had progressive 427 00:25:19,840 --> 00:25:22,440 Speaker 1: liver disease, which eventually was the cause of her death 428 00:25:22,800 --> 00:25:27,560 Speaker 1: on August seven, nine. She died at Columbia Presbyterian Medical Center, 429 00:25:27,600 --> 00:25:37,800 Speaker 1: where she had spent much of her career. So we've 430 00:25:37,840 --> 00:25:40,320 Speaker 1: talked a few times about the show sabb Owns, which 431 00:25:40,359 --> 00:25:44,040 Speaker 1: is a snow about medical history, which is the co 432 00:25:44,200 --> 00:25:48,679 Speaker 1: production of uh Sidney McElroy who's a doctor, and her husband, 433 00:25:49,080 --> 00:25:52,080 Speaker 1: Justin McElroy, and they are charming and delightful. If you 434 00:25:52,080 --> 00:25:53,959 Speaker 1: don't listen to that show, I highly recommend it. It's 435 00:25:53,960 --> 00:25:57,160 Speaker 1: from of the Maximum Fund podcast network. I don't think 436 00:25:57,200 --> 00:26:00,679 Speaker 1: they have done an episode that that touched on. But 437 00:26:00,760 --> 00:26:02,359 Speaker 1: the whole time I was working on it, when I 438 00:26:02,359 --> 00:26:04,119 Speaker 1: got to this part where dr Apgar was like, the 439 00:26:04,119 --> 00:26:06,439 Speaker 1: problem is nobody is looking at these babies, I just 440 00:26:06,520 --> 00:26:08,639 Speaker 1: kept hearing Sydney's voice in my head being like, you 441 00:26:08,720 --> 00:26:12,640 Speaker 1: gotta look at the babies. Look at the babies. Why 442 00:26:12,640 --> 00:26:15,919 Speaker 1: aren't you looking at the babies, Like it seems so 443 00:26:15,960 --> 00:26:20,080 Speaker 1: obvious look at the babies when they were born? It does? 444 00:26:20,320 --> 00:26:23,320 Speaker 1: I have to wonder, and I will, you know, show 445 00:26:23,359 --> 00:26:26,720 Speaker 1: off my um my ignorance in this arena. Like what 446 00:26:26,920 --> 00:26:29,359 Speaker 1: the thinking was like why they weren't focusing on the 447 00:26:29,359 --> 00:26:31,880 Speaker 1: babies and they were only focusing on the mothers. Were 448 00:26:31,880 --> 00:26:34,280 Speaker 1: they just so accustomed to a high mortality rate that 449 00:26:34,280 --> 00:26:35,520 Speaker 1: they were like, well, the baby may or may not 450 00:26:35,600 --> 00:26:37,879 Speaker 1: make it. The strong ones survived, Let's make sure the 451 00:26:37,920 --> 00:26:40,960 Speaker 1: mom gets through. I kind of wondered that as I 452 00:26:41,000 --> 00:26:43,159 Speaker 1: was I mean I didn't find a lot of a 453 00:26:43,240 --> 00:26:45,320 Speaker 1: lot of information about why this was the way it is, 454 00:26:45,359 --> 00:26:48,600 Speaker 1: but because the infant mortality rate was so pronounced at 455 00:26:48,600 --> 00:26:51,119 Speaker 1: that point, like it seems like maybe that would be 456 00:26:52,400 --> 00:26:55,239 Speaker 1: maybe not a deliberate conclusion, but just sort of like 457 00:26:55,320 --> 00:26:57,959 Speaker 1: the operating parameters that were in people's minds as they 458 00:26:57,960 --> 00:27:03,400 Speaker 1: were making decisions in in the delivery room. Uh So, yeah, 459 00:27:03,440 --> 00:27:07,160 Speaker 1: I was very curious in my mind about that. Also. Um, 460 00:27:07,520 --> 00:27:11,119 Speaker 1: I hope like nobody's grandfather was an oppetrician in nineteen fifty. 461 00:27:11,359 --> 00:27:14,879 Speaker 1: I have not tried to be hurtful, No, I mean, seriously, 462 00:27:14,920 --> 00:27:17,840 Speaker 1: looking at the babies made a big difference. Well, it's 463 00:27:17,920 --> 00:27:21,000 Speaker 1: just one of those, you know, elements of like shifting 464 00:27:21,720 --> 00:27:24,960 Speaker 1: approaches and attitudes that happened gradually over time. It doesn't 465 00:27:25,000 --> 00:27:28,399 Speaker 1: always mean that the people involved were being negligent or 466 00:27:28,400 --> 00:27:32,320 Speaker 1: even wrong. They just hadn't shifted yet. No. Well, and 467 00:27:32,359 --> 00:27:34,960 Speaker 1: we got we got a listener email that I have 468 00:27:35,040 --> 00:27:36,840 Speaker 1: not read because it was just it was a little 469 00:27:36,840 --> 00:27:39,159 Speaker 1: too personal just directly read. But it came after that 470 00:27:39,200 --> 00:27:41,359 Speaker 1: episode that we did about Dr Vera. Peters where we 471 00:27:41,440 --> 00:27:44,920 Speaker 1: talked about women who had lumps in their breasts would 472 00:27:44,960 --> 00:27:47,840 Speaker 1: basically be put under to go get a biopsy, and 473 00:27:47,880 --> 00:27:49,639 Speaker 1: if they had cancer, they would wake up without a 474 00:27:49,640 --> 00:27:54,360 Speaker 1: breast anymore. And how like in today's mindset, that's horrifying. 475 00:27:55,560 --> 00:27:58,640 Speaker 1: Her story was about having had children during this part 476 00:27:58,640 --> 00:28:00,760 Speaker 1: of history and how basic you would go to the 477 00:28:00,800 --> 00:28:03,880 Speaker 1: hospital and you would be put under and you would 478 00:28:03,920 --> 00:28:08,679 Speaker 1: wake up with a baby. Uh and uh. She had 479 00:28:08,720 --> 00:28:11,159 Speaker 1: this whole story about the doctor that was delivering her 480 00:28:11,240 --> 00:28:15,640 Speaker 1: children had a clear preference for delivering male children and 481 00:28:16,000 --> 00:28:18,880 Speaker 1: said some things that were pretty insensitive when he delivered 482 00:28:18,920 --> 00:28:23,479 Speaker 1: her daughter. So yeah, I would say that there is 483 00:28:23,560 --> 00:28:28,359 Speaker 1: still a way to go in terms of, you know, 484 00:28:28,400 --> 00:28:31,400 Speaker 1: women and babies getting the best possible medical care. Maybe 485 00:28:31,400 --> 00:28:33,920 Speaker 1: not so much babies anymore, but I know, like there 486 00:28:33,960 --> 00:28:38,800 Speaker 1: are still I know my mom personally had difficulty getting 487 00:28:38,840 --> 00:28:41,240 Speaker 1: doctors to take her seriously when she knew that something 488 00:28:41,280 --> 00:28:43,240 Speaker 1: was wrong with her health, and they just kept writing 489 00:28:43,240 --> 00:28:46,640 Speaker 1: her off as being a stressed out female, which was 490 00:28:46,680 --> 00:28:50,480 Speaker 1: not what was going on. She had a legitimate problem. 491 00:28:50,560 --> 00:28:59,960 Speaker 1: So medical care better still room to improve. Thank you 492 00:29:00,240 --> 00:29:03,720 Speaker 1: so much for joining us for this Saturday Classic. Since 493 00:29:03,760 --> 00:29:05,800 Speaker 1: this is out of the archive, if you heard an 494 00:29:05,800 --> 00:29:08,320 Speaker 1: email address or a Facebook U r L or something 495 00:29:08,400 --> 00:29:10,960 Speaker 1: similar during the course of the show that may be 496 00:29:11,200 --> 00:29:14,640 Speaker 1: obsolete now, so here is our current contact information. We 497 00:29:14,680 --> 00:29:17,440 Speaker 1: are at History podcast at how stuff works dot com, 498 00:29:17,480 --> 00:29:20,280 Speaker 1: and then we're at Missed in the History. All over 499 00:29:20,360 --> 00:29:24,440 Speaker 1: social media that is our name on Facebook, Twitter, Tumblr, Pinterest, 500 00:29:24,720 --> 00:29:30,600 Speaker 1: and Instagram. Thanks again for listening. For more on this 501 00:29:30,760 --> 00:29:33,280 Speaker 1: and thousands of other topics. Is it how stuff works 502 00:29:33,280 --> 00:29:40,200 Speaker 1: dot com.