1 00:00:01,080 --> 00:00:04,600 Speaker 1: Welcome to Stuff you missed in History Class from works 2 00:00:04,640 --> 00:00:14,200 Speaker 1: dot Com. Hello, and welcome to the podcast. I'm Tracy V. 3 00:00:14,360 --> 00:00:17,240 Speaker 1: Wilson and I'm Holly Frying. So if you've if you've 4 00:00:17,280 --> 00:00:19,720 Speaker 1: had a baby in like the last sixty years, or 5 00:00:19,840 --> 00:00:22,119 Speaker 1: been present when somebody else had a baby, or maybe 6 00:00:22,120 --> 00:00:25,200 Speaker 1: even just watched a TV show in which babies were born, 7 00:00:25,560 --> 00:00:29,800 Speaker 1: you've probably heard people talking about a car scores. Yeah, 8 00:00:29,840 --> 00:00:32,240 Speaker 1: but I never gave it much thought, not being particularly 9 00:00:32,240 --> 00:00:35,320 Speaker 1: a baby person, So yeah, I thought this was an acronym. 10 00:00:35,479 --> 00:00:37,760 Speaker 1: And while somebody did rework the parts of the Apgar 11 00:00:37,880 --> 00:00:39,960 Speaker 1: score so that it matched up with the letters of 12 00:00:39,960 --> 00:00:43,559 Speaker 1: her name in about nineteen sixty two, the score itself 13 00:00:43,640 --> 00:00:45,360 Speaker 1: is from earlier than that, and it's the work of 14 00:00:45,479 --> 00:00:48,600 Speaker 1: Dr Virginia Apgar, who really broke new ground in the 15 00:00:48,640 --> 00:00:52,600 Speaker 1: fields of obstetrics and enthusiology as well as other fields 16 00:00:52,600 --> 00:00:55,760 Speaker 1: in the middle of the twentieth century. Today, the Apgar 17 00:00:55,880 --> 00:00:58,080 Speaker 1: score is really part of the standard of care for 18 00:00:58,200 --> 00:01:01,720 Speaker 1: new for newborn babies in much of the world, and 19 00:01:01,800 --> 00:01:05,160 Speaker 1: it's totally to the credit of this one particular doctor. 20 00:01:06,200 --> 00:01:09,920 Speaker 1: And this one particular doctor, Virginia Apgar was born in Westfield, 21 00:01:09,920 --> 00:01:13,200 Speaker 1: New Jersey, on June seven, nineteen o nine. Her father 22 00:01:13,440 --> 00:01:16,040 Speaker 1: was an insurance executive who was fond of science and 23 00:01:16,160 --> 00:01:18,920 Speaker 1: was an amateur astronomer. And she also had a brother 24 00:01:18,959 --> 00:01:21,600 Speaker 1: who died of tuberculosis at a very young age. So 25 00:01:22,080 --> 00:01:25,160 Speaker 1: it's possible that both of these things influenced her decision 26 00:01:25,200 --> 00:01:28,680 Speaker 1: to become a doctor, But regardless, that decision was made 27 00:01:28,720 --> 00:01:32,119 Speaker 1: before she even got out of high school. To that end, 28 00:01:32,200 --> 00:01:36,119 Speaker 1: she went to Mount Holyoke College, where she studied zoology. 29 00:01:36,280 --> 00:01:39,840 Speaker 1: In addition to being an excellent student in that program, 30 00:01:39,880 --> 00:01:42,400 Speaker 1: she worked several part time jobs to make ends meet. 31 00:01:43,000 --> 00:01:45,040 Speaker 1: Then she also played the cello and the violin and 32 00:01:45,080 --> 00:01:48,320 Speaker 1: the orchestra, and acted and wrote for the college newspaper 33 00:01:48,680 --> 00:01:53,440 Speaker 1: and played on seven different sports teams. She sounds like 34 00:01:53,480 --> 00:02:00,480 Speaker 1: a medical school version of Leslie. Nope. Yeah, that's a 35 00:02:00,520 --> 00:02:04,400 Speaker 1: great description her family. She described her family at one 36 00:02:04,400 --> 00:02:06,920 Speaker 1: point as just people who never sat still, and that's 37 00:02:07,000 --> 00:02:10,239 Speaker 1: just she seems to have been constantly doing her whole life. 38 00:02:11,560 --> 00:02:15,120 Speaker 1: She graduated in ninety nine and she started medical school 39 00:02:15,160 --> 00:02:18,280 Speaker 1: at the Columbia University College of Physicians and Surgeons that 40 00:02:18,400 --> 00:02:21,200 Speaker 1: same year. There were ninety people in her class, and 41 00:02:21,240 --> 00:02:24,600 Speaker 1: she was one of only nine women. She scraped together 42 00:02:24,720 --> 00:02:26,840 Speaker 1: enough money to stay in school in spite of the 43 00:02:26,840 --> 00:02:29,480 Speaker 1: Great Depression, and she graduated near the top of her 44 00:02:29,480 --> 00:02:33,320 Speaker 1: class in ninety three. So she really wanted to become 45 00:02:33,320 --> 00:02:37,119 Speaker 1: a surgeon, and she was accepted into a surgical internship 46 00:02:37,120 --> 00:02:41,079 Speaker 1: at Presbyterian Hospital which is now New York Presbyterian Hospital 47 00:02:41,160 --> 00:02:45,079 Speaker 1: Columbia University Medical Center. She did really well in her 48 00:02:45,120 --> 00:02:48,120 Speaker 1: first year of this residency, but Dr Alan Whipple, who 49 00:02:48,160 --> 00:02:51,280 Speaker 1: was the chair of the surgical department, encouraged her to 50 00:02:51,360 --> 00:02:55,880 Speaker 1: change specialties to anesthesiology. He was concerned that she would 51 00:02:55,880 --> 00:02:58,640 Speaker 1: not be able to make a profitable career as a surgeon, 52 00:02:59,080 --> 00:03:01,920 Speaker 1: especially given the economic climate at the time. This was 53 00:03:02,160 --> 00:03:04,959 Speaker 1: still in the wake of the Great Depression. He also 54 00:03:05,120 --> 00:03:07,840 Speaker 1: basically had other plans for her. He wanted her to 55 00:03:07,880 --> 00:03:11,440 Speaker 1: study anesthesiology and then come back to Presbyterian Hospital to 56 00:03:11,440 --> 00:03:16,280 Speaker 1: help start a teaching program for future anathusiologists. There were 57 00:03:16,320 --> 00:03:19,320 Speaker 1: lots of reasons for Dr Apgar to change specialties. It 58 00:03:19,440 --> 00:03:22,280 Speaker 1: was definitely difficult for women to be respected as surgeons 59 00:03:22,320 --> 00:03:24,799 Speaker 1: at this point, and there were lots of trained surgeons, 60 00:03:24,800 --> 00:03:28,519 Speaker 1: so competition for jobs was really stiff and dr Apgar 61 00:03:28,600 --> 00:03:30,680 Speaker 1: would have had to stand out even more because of 62 00:03:30,720 --> 00:03:34,400 Speaker 1: her gender. Dr Whipple had seen his other female surgical 63 00:03:34,440 --> 00:03:37,839 Speaker 1: students really have trouble getting hired as surgeons at all, 64 00:03:38,440 --> 00:03:41,280 Speaker 1: and dr Apgar had graduated from medical school in debts, 65 00:03:41,360 --> 00:03:43,760 Speaker 1: so taking on a specialty in which she would probably 66 00:03:43,800 --> 00:03:47,119 Speaker 1: have trouble finding a job was a really risky proposition. 67 00:03:48,320 --> 00:03:52,280 Speaker 1: At the same time, by becoming an anathusiologist instead of 68 00:03:52,280 --> 00:03:54,960 Speaker 1: a surgeon, she was really setting out to pursue a 69 00:03:55,000 --> 00:03:58,560 Speaker 1: specialty that did not even really exist yet. As recently 70 00:03:58,600 --> 00:04:02,280 Speaker 1: as nineteen eleven, the Erican Medical Association had even rejected 71 00:04:02,280 --> 00:04:06,040 Speaker 1: a request to start an anesthesiast section for its members. 72 00:04:06,640 --> 00:04:09,880 Speaker 1: So while dr Apgar essentially had a job waiting for 73 00:04:09,960 --> 00:04:13,000 Speaker 1: her after she was done with her study of anesthesiology, 74 00:04:13,320 --> 00:04:15,280 Speaker 1: it was going to be a tough one because it 75 00:04:15,320 --> 00:04:19,080 Speaker 1: was in a specialty that was not regarded as a specialty. 76 00:04:19,600 --> 00:04:23,040 Speaker 1: So let's talk about why that was. For a moment um, 77 00:04:23,200 --> 00:04:26,640 Speaker 1: for most of Western medical history, surgery was actually seen 78 00:04:27,240 --> 00:04:31,120 Speaker 1: as inferior to the rest of medicine. So before things 79 00:04:31,120 --> 00:04:34,599 Speaker 1: like modern anesthesia and the germ theory of disease, surgeons 80 00:04:34,640 --> 00:04:37,720 Speaker 1: mostly performed things like amputations, and it was not always 81 00:04:37,720 --> 00:04:41,400 Speaker 1: likely that their patients were going to survive. Eventually, as 82 00:04:41,440 --> 00:04:44,159 Speaker 1: developments in medicine made it possible for people to live 83 00:04:44,200 --> 00:04:48,039 Speaker 1: through surgeries without bleeding to death or immediately dying from infection, 84 00:04:48,560 --> 00:04:53,440 Speaker 1: surgery only gradually became a more respected field, so surgeons 85 00:04:53,440 --> 00:04:56,120 Speaker 1: had to basically claw their way to respectability, and for 86 00:04:56,200 --> 00:04:59,160 Speaker 1: the most part, in the early days of surgery, as 87 00:04:59,200 --> 00:05:03,920 Speaker 1: a more prestige jist position, anesthesia was being administered by nurses. 88 00:05:04,320 --> 00:05:07,320 Speaker 1: I want to be super clear on this. Nurse anesthetists 89 00:05:07,360 --> 00:05:10,080 Speaker 1: are still a really important part of the field of 90 00:05:10,120 --> 00:05:13,400 Speaker 1: anesthesiology today, but at this time, instead of working under 91 00:05:13,560 --> 00:05:17,320 Speaker 1: the direction of anesthesiologists who were specialists and how to 92 00:05:17,400 --> 00:05:22,640 Speaker 1: keep a patient simultaneously unconscious and pain free and medically stable, 93 00:05:23,240 --> 00:05:26,359 Speaker 1: nurse anesthetists were usually working on the under the direction 94 00:05:26,400 --> 00:05:29,760 Speaker 1: of the surgeon who was performing the procedure. This meant 95 00:05:29,800 --> 00:05:33,200 Speaker 1: that even as advances in surgical techniques and infection control 96 00:05:33,240 --> 00:05:37,320 Speaker 1: practices meant patients could survive longer and more complex surgeries, 97 00:05:37,720 --> 00:05:42,159 Speaker 1: anesthesiology wasn't advancing quickly enough to keep up outside of 98 00:05:42,200 --> 00:05:45,400 Speaker 1: teaching and research hospitals, where surgeons might be dedicating some 99 00:05:45,520 --> 00:05:49,880 Speaker 1: of their focus to anesthesia. This just was not the priority. 100 00:05:49,920 --> 00:05:51,719 Speaker 1: And then there was the basic fact that keeping a 101 00:05:51,720 --> 00:05:55,599 Speaker 1: patient properly anesthetized while also performing a surgical procedure is 102 00:05:55,800 --> 00:05:59,679 Speaker 1: really a lot to juggle at one time. Plus, after 103 00:05:59,720 --> 00:06:03,160 Speaker 1: having been viewed as inferior to doctors for so long, 104 00:06:03,480 --> 00:06:05,600 Speaker 1: a lot of surgeons just did not want to hand 105 00:06:05,640 --> 00:06:09,000 Speaker 1: over control of part of the surgical process to another person, 106 00:06:09,480 --> 00:06:11,200 Speaker 1: even if the person they were going to be handing 107 00:06:11,200 --> 00:06:14,960 Speaker 1: it off to was somebody who's sole focus was on 108 00:06:15,240 --> 00:06:19,840 Speaker 1: being the best in the world of anesthesiology. So Dr 109 00:06:19,880 --> 00:06:22,839 Speaker 1: Whipple hoped that he and Dr Apgar might work together 110 00:06:22,880 --> 00:06:25,240 Speaker 1: to change all of that. And we're going to talk 111 00:06:25,279 --> 00:06:27,360 Speaker 1: about that somewhere, but first we're gonna have a word 112 00:06:27,360 --> 00:06:30,039 Speaker 1: from a sponsor. So to get back to Dr Whipple 113 00:06:30,080 --> 00:06:34,960 Speaker 1: and Dr Apgar's plans for anesthesiology, Dr Whipple basically thought 114 00:06:35,040 --> 00:06:37,480 Speaker 1: that Dr Apgar might really have a knack for this. 115 00:06:37,680 --> 00:06:40,640 Speaker 1: He described her as having quote the energy, intelligence and 116 00:06:40,680 --> 00:06:45,039 Speaker 1: ability needed to make significant contributions in this area. Because 117 00:06:45,040 --> 00:06:48,919 Speaker 1: anesthesiology wasn't yet recognized as a specialty for medical doctors, 118 00:06:48,920 --> 00:06:51,080 Speaker 1: there really weren't a lot of training programs for it. 119 00:06:51,080 --> 00:06:53,039 Speaker 1: At this point, there were thirteen of them in the 120 00:06:53,080 --> 00:06:56,960 Speaker 1: United States, ranging in length from two weeks to three years, 121 00:06:57,040 --> 00:07:00,679 Speaker 1: and only two of those were actually paid residencies. Neither 122 00:07:00,839 --> 00:07:03,520 Speaker 1: of these residency programs had a spot open when Dr 123 00:07:03,520 --> 00:07:08,200 Speaker 1: Apgar applied. Yeah, obviously, like a two week training program, 124 00:07:08,200 --> 00:07:11,720 Speaker 1: and anesthesiology is not not nearly the same thing as 125 00:07:11,720 --> 00:07:14,640 Speaker 1: the work that it would be needed to take on 126 00:07:14,680 --> 00:07:17,480 Speaker 1: a new medical specialty. Yeah, that's a wide that's a 127 00:07:17,480 --> 00:07:22,080 Speaker 1: wide range, a two week to three year play. Yeah. Yeah. So, 128 00:07:23,360 --> 00:07:26,600 Speaker 1: after finishing her second year of her surgical internship, Dr 129 00:07:26,680 --> 00:07:31,800 Speaker 1: Afgar went through Presbyterians Training Program for Nurse Anesthetists. She 130 00:07:31,920 --> 00:07:35,520 Speaker 1: then spent six months studying under Dr Ralph Waters at 131 00:07:35,520 --> 00:07:39,040 Speaker 1: the University of Wisconsin, Madison in a visiting position. So. 132 00:07:39,280 --> 00:07:42,920 Speaker 1: Dr Waters was really one of America's earliest pioneers in 133 00:07:42,960 --> 00:07:47,320 Speaker 1: anesthesiology and he just made critical and ground breaking contributions 134 00:07:47,320 --> 00:07:50,760 Speaker 1: to this field. Once she was done studying under Dr Waters, 135 00:07:50,880 --> 00:07:54,400 Speaker 1: she spent another six months with Dr Ernest Rovestein in 136 00:07:54,600 --> 00:07:58,800 Speaker 1: New York Bellevue Hospital. He had also trained with Dr Waters, 137 00:07:59,160 --> 00:08:02,760 Speaker 1: So it's you could easily call Dr Waters like the 138 00:08:02,760 --> 00:08:06,200 Speaker 1: the keystone in a lot of anesthesiology work in the 139 00:08:06,280 --> 00:08:10,920 Speaker 1: United States at this point, so from there in dr 140 00:08:11,000 --> 00:08:14,920 Speaker 1: Apgar went back to Columbia University in Presbyterian Hospital and 141 00:08:14,960 --> 00:08:18,080 Speaker 1: became the director of the Division of Anesthesia and in 142 00:08:18,160 --> 00:08:21,680 Speaker 1: Attending Anesthetist. This made her the first woman to head 143 00:08:21,680 --> 00:08:26,280 Speaker 1: a division at the hospital. Dr Apgar and Dr Whipple 144 00:08:26,320 --> 00:08:29,480 Speaker 1: had formulated a plan for the Division of Anesthesia to 145 00:08:29,560 --> 00:08:34,080 Speaker 1: become dedicated to training doctors to be anesthesiologists, but because 146 00:08:34,080 --> 00:08:37,800 Speaker 1: of the prevailing attitudes running about anesthesiology at this point 147 00:08:37,840 --> 00:08:40,640 Speaker 1: and the low pay that came along with them, she 148 00:08:40,760 --> 00:08:44,160 Speaker 1: really had trouble recruiting peers to work with her. She 149 00:08:44,320 --> 00:08:47,000 Speaker 1: was the only staff member in the division through the 150 00:08:47,040 --> 00:08:51,959 Speaker 1: mid nineteen forties, but at the same time she became 151 00:08:52,000 --> 00:08:55,880 Speaker 1: a beloved teacher. As the existing staff of nurse anesthetists 152 00:08:56,000 --> 00:08:59,000 Speaker 1: left the hospital to get married or pursue other jobs, 153 00:08:59,440 --> 00:09:03,880 Speaker 1: residents filled their positions and studied anesthesiology under Dr Apgar 154 00:09:04,000 --> 00:09:07,040 Speaker 1: for between one and three years, and after the teaching 155 00:09:07,080 --> 00:09:10,480 Speaker 1: program was solidly established, the division also turned its focus 156 00:09:10,480 --> 00:09:14,719 Speaker 1: to research to improve the practice of anesthesiology. This is 157 00:09:14,800 --> 00:09:18,400 Speaker 1: really a long and difficult process for the first years 158 00:09:18,440 --> 00:09:21,280 Speaker 1: of the program, dr Apgar only had a couple of residents, 159 00:09:21,280 --> 00:09:23,600 Speaker 1: and she and a colleague had to write their textbook 160 00:09:23,640 --> 00:09:27,679 Speaker 1: themselves because there was no anesthesiology textbook. It was nine 161 00:09:28,280 --> 00:09:32,760 Speaker 1: five before anesthesia was more often administered by doctors than 162 00:09:32,800 --> 00:09:36,040 Speaker 1: by nurses at Presbyterian, which is really notable because at 163 00:09:36,040 --> 00:09:41,640 Speaker 1: this point the whole point was trying to train new doctors. Gradually, though, 164 00:09:42,000 --> 00:09:45,920 Speaker 1: perceptions about the validity of anesthesiology as a specialty started 165 00:09:45,960 --> 00:09:49,040 Speaker 1: to improve and it became recognized as a real specialty 166 00:09:49,080 --> 00:09:52,960 Speaker 1: in nineteen forty six. Three years later, dr Apgar became 167 00:09:53,000 --> 00:09:55,160 Speaker 1: the first woman to be named a full professor at 168 00:09:55,160 --> 00:10:00,240 Speaker 1: the Columbia University College of Physicians and Surgeons. Along with this, 169 00:10:00,360 --> 00:10:03,920 Speaker 1: in the same year, the Division of Anesthesiology became its 170 00:10:03,960 --> 00:10:08,240 Speaker 1: own department, and doctor Emmanuel Papper was selected to be 171 00:10:08,280 --> 00:10:11,280 Speaker 1: the chair of that department. So dr Afkar had sort 172 00:10:11,320 --> 00:10:13,160 Speaker 1: of thought she was going to be the person appointed 173 00:10:13,200 --> 00:10:16,480 Speaker 1: to this position, but the fact that she no longer 174 00:10:17,480 --> 00:10:20,280 Speaker 1: had that department had kind of role to take up 175 00:10:20,280 --> 00:10:22,400 Speaker 1: part of her time. She was able to focus a 176 00:10:22,440 --> 00:10:27,520 Speaker 1: lot more on teaching and on her work in obstetric anesthesiology. 177 00:10:28,400 --> 00:10:32,120 Speaker 1: During World War two, many doctors and surgeons joined the military, 178 00:10:32,160 --> 00:10:35,559 Speaker 1: which led to a labor shortage at Presbyterian Hospital and 179 00:10:35,640 --> 00:10:38,720 Speaker 1: to dr Avgar's department having more involvement in the field 180 00:10:38,720 --> 00:10:42,040 Speaker 1: of obstetric anesthesiology because the doctors and nurses who had 181 00:10:42,040 --> 00:10:45,960 Speaker 1: been doing so had gone to serve so. At this 182 00:10:46,000 --> 00:10:49,680 Speaker 1: point in the United States, uh women had generally moved 183 00:10:49,760 --> 00:10:53,760 Speaker 1: from usually delivering babies at home to usually delivering babies 184 00:10:53,800 --> 00:10:57,920 Speaker 1: in the hospital, but this really hadn't improved outcomes for 185 00:10:57,960 --> 00:11:01,440 Speaker 1: the women and their babies. All. Though infant mortality in 186 00:11:01,520 --> 00:11:04,800 Speaker 1: general had dropped, the rate of infant mortality within the 187 00:11:04,840 --> 00:11:08,880 Speaker 1: first twenty four hours after birth had hardly budged, even 188 00:11:08,920 --> 00:11:12,120 Speaker 1: though people were now being born in the presumably more 189 00:11:12,280 --> 00:11:15,880 Speaker 1: medically safe area of a hospital. This is where dr 190 00:11:15,960 --> 00:11:18,760 Speaker 1: Apgar really started to focus once she was freed up 191 00:11:18,800 --> 00:11:23,080 Speaker 1: from her previous administrative duties as a department head, and 192 00:11:23,120 --> 00:11:26,480 Speaker 1: it was known at that point that oxygen deprivation played 193 00:11:26,520 --> 00:11:28,880 Speaker 1: a part in at least half of those babies deaths. 194 00:11:29,480 --> 00:11:31,920 Speaker 1: It seemed obvious to dr Apgar that if it became 195 00:11:31,960 --> 00:11:34,840 Speaker 1: a standard practice to examine the baby and determine whether 196 00:11:34,880 --> 00:11:37,360 Speaker 1: it needed oxygen and then give it oxygen. If so, 197 00:11:38,160 --> 00:11:40,679 Speaker 1: then a lot of these deaths could potentially be prevented. 198 00:11:42,360 --> 00:11:44,120 Speaker 1: She was basically saying, y'all need to look at these 199 00:11:44,120 --> 00:11:50,360 Speaker 1: babies like you need to look at them so. I mean, 200 00:11:50,400 --> 00:11:52,920 Speaker 1: today this seems absurdly obvious. You should look at the baby, 201 00:11:53,000 --> 00:11:55,360 Speaker 1: make sure the baby is okay. But at the time, 202 00:11:55,600 --> 00:11:58,560 Speaker 1: in delivery rooms, medical efforts tended to be a lot 203 00:11:58,559 --> 00:12:01,439 Speaker 1: more focused on the mother than the baby. A lot 204 00:12:01,440 --> 00:12:04,000 Speaker 1: of times, the most junior people in the room were 205 00:12:04,000 --> 00:12:05,800 Speaker 1: the ones who were seeing to the baby after it 206 00:12:05,840 --> 00:12:09,719 Speaker 1: was born. They rarely had any training in anesthesiology or 207 00:12:09,760 --> 00:12:12,360 Speaker 1: any knowledge of how the drugs that were used during 208 00:12:12,360 --> 00:12:15,720 Speaker 1: a vaginal delivery or a cesarean section could affect a baby. 209 00:12:15,840 --> 00:12:19,360 Speaker 1: Sometimes they were really at the very beginning of their 210 00:12:19,480 --> 00:12:26,040 Speaker 1: medical study. They just were not trained particularly well on, uh, 211 00:12:26,080 --> 00:12:29,400 Speaker 1: what to do when the baby came out. Yeah, and 212 00:12:29,480 --> 00:12:31,560 Speaker 1: if they're that early on, they probably don't have the 213 00:12:31,640 --> 00:12:37,000 Speaker 1: confidence to like make kind of snap decisions about treatment. Uh. Plus, 214 00:12:37,360 --> 00:12:39,360 Speaker 1: it's not gonna come as a surprise to anyone who's 215 00:12:39,360 --> 00:12:42,959 Speaker 1: ever witnessed any conversation on the Internet about people's opinions 216 00:12:42,960 --> 00:12:45,720 Speaker 1: on childbirth. There was a whole lot of arguing going 217 00:12:45,760 --> 00:12:48,080 Speaker 1: on about how to best deliver babies and not a 218 00:12:48,080 --> 00:12:51,480 Speaker 1: whole lot of concrete data backing up people's opinions, and 219 00:12:51,480 --> 00:12:53,840 Speaker 1: even when there was data, it was often disregarded in 220 00:12:53,880 --> 00:12:57,480 Speaker 1: favor of what everybody quote already knew about it. So 221 00:12:58,360 --> 00:13:03,240 Speaker 1: dr Atgard develop uh standardized way of analyzing how the 222 00:13:03,280 --> 00:13:07,120 Speaker 1: baby was doing after it was born, and involved evaluating 223 00:13:07,120 --> 00:13:11,240 Speaker 1: five traits the baby's heart rate, respiratory effort, muscle tone, reflex, 224 00:13:11,240 --> 00:13:14,480 Speaker 1: and color, giving each of those a score of zero, 225 00:13:14,720 --> 00:13:17,679 Speaker 1: one or two. Then you add up those five numbers 226 00:13:17,720 --> 00:13:20,680 Speaker 1: and that's the baby's a car score. That mnemonic device 227 00:13:20,720 --> 00:13:24,520 Speaker 1: that we mentioned at the top of the episode substituted 228 00:13:24,559 --> 00:13:30,079 Speaker 1: appearance for color, pulse for heart rate, grimace for reflex uh, 229 00:13:30,120 --> 00:13:33,640 Speaker 1: because babies make a grimacy face as a reflex activity 230 00:13:33,800 --> 00:13:37,599 Speaker 1: for muscle tone and respiration, which was on the original list. Reportedly, 231 00:13:37,720 --> 00:13:42,480 Speaker 1: dr Agar was quite delighted when when a resident rewrote 232 00:13:42,559 --> 00:13:44,800 Speaker 1: the letters in the ACRE score to match up with 233 00:13:44,840 --> 00:13:48,160 Speaker 1: her names, they could remember what they all were. And 234 00:13:48,200 --> 00:13:52,280 Speaker 1: what's really important is that she assigned actual measurable criteria 235 00:13:52,400 --> 00:13:55,199 Speaker 1: to these, So a zero for heart rate meant that 236 00:13:55,240 --> 00:13:58,280 Speaker 1: the heartbeat was absent too meant that the heartbeat was 237 00:13:58,320 --> 00:14:02,120 Speaker 1: between one and one forty beats a minute zero for 238 00:14:02,240 --> 00:14:04,360 Speaker 1: muscle tone, but that there was no muscle tone, and 239 00:14:04,400 --> 00:14:07,480 Speaker 1: a tow meant the baby was actively moving. It really 240 00:14:07,480 --> 00:14:09,880 Speaker 1: got rid of a lot of the subjectivity in figuring 241 00:14:09,880 --> 00:14:13,160 Speaker 1: out whether her a baby was doing well or not. Yeah, so, 242 00:14:13,200 --> 00:14:17,080 Speaker 1: in addition to the extremely obvious, you need to look 243 00:14:17,120 --> 00:14:21,240 Speaker 1: at the baby. It's like, you need to look at 244 00:14:21,240 --> 00:14:24,360 Speaker 1: the baby and measure these things like that, and it 245 00:14:24,440 --> 00:14:28,280 Speaker 1: will help you understand whether the baby needs to be resuscitated, 246 00:14:28,320 --> 00:14:31,960 Speaker 1: whether the baby is thriving outside of the womb. She 247 00:14:32,040 --> 00:14:35,920 Speaker 1: then conducted a study using this scoring method on one thousand, 248 00:14:36,000 --> 00:14:39,040 Speaker 1: twenty one babies who were born at the Sloane Hospital 249 00:14:39,120 --> 00:14:43,200 Speaker 1: for Women at Presbyterian. She found definite correlations between the 250 00:14:43,200 --> 00:14:46,320 Speaker 1: method of delivery, the type of anesthesia used on the mother, 251 00:14:46,440 --> 00:14:49,800 Speaker 1: and the babies. After our scores, she recommended that New 252 00:14:49,880 --> 00:14:53,680 Speaker 1: York that newborn babies be evaluated a minute after their birth, 253 00:14:54,120 --> 00:14:59,400 Speaker 1: and also important that someone other than the attending obstetrician 254 00:14:59,520 --> 00:15:02,960 Speaker 1: do it. This was because she noticed a pattern that 255 00:15:03,440 --> 00:15:07,640 Speaker 1: obs tended to score their end quote their babies that 256 00:15:07,720 --> 00:15:12,080 Speaker 1: they delivered higher than other people in the delivery room did. 257 00:15:14,560 --> 00:15:17,240 Speaker 1: This will sound familiar to anyone who has heard our 258 00:15:17,280 --> 00:15:20,440 Speaker 1: episode on Dr VERA. Peters, who helped revolutionize the treatment 259 00:15:20,720 --> 00:15:25,200 Speaker 1: of Hodgkins lymphoma. When dr Apgar presented her paper at 260 00:15:25,200 --> 00:15:30,840 Speaker 1: the Annual Congress of Anesthetists into the audience was skeptical, 261 00:15:31,520 --> 00:15:33,960 Speaker 1: but she published the work in three and it has 262 00:15:34,000 --> 00:15:36,560 Speaker 1: since become a standard of care in delivery rooms in 263 00:15:36,680 --> 00:15:39,400 Speaker 1: much of the world, with the score measured once a 264 00:15:39,400 --> 00:15:43,720 Speaker 1: minute after birth and again five minutes after birth. So basically, 265 00:15:43,720 --> 00:15:45,840 Speaker 1: if the baby's score is not good after a minute, 266 00:15:45,920 --> 00:15:49,200 Speaker 1: you mean to resuscitate the baby. You do that and 267 00:15:49,560 --> 00:15:52,720 Speaker 1: take it again in five minutes. Uh. It's this is 268 00:15:52,760 --> 00:15:56,920 Speaker 1: one of those times where it's kind of baffling, Uh 269 00:15:57,000 --> 00:15:59,760 Speaker 1: that this you know, Now, it's just such a standard thing. 270 00:15:59,840 --> 00:16:01,320 Speaker 1: The baby is born and you check it out and 271 00:16:01,520 --> 00:16:06,160 Speaker 1: make sure everything's all right. Uh, this was not quite 272 00:16:06,160 --> 00:16:08,720 Speaker 1: as big of a focus when the medical team in 273 00:16:08,720 --> 00:16:10,440 Speaker 1: the room was so much more focused on the mother 274 00:16:10,520 --> 00:16:14,880 Speaker 1: than on both the mother and the baby. So, along 275 00:16:14,960 --> 00:16:18,680 Speaker 1: with Dr Duncan Holiday and Dr Stanley James, dr Apgar 276 00:16:18,800 --> 00:16:22,880 Speaker 1: went on to evaluate these correlations between delivery and the 277 00:16:22,880 --> 00:16:28,080 Speaker 1: baby's AFCAR scores. They slowly connected the length and difficulty 278 00:16:28,160 --> 00:16:30,560 Speaker 1: of the delivery and the types and amounts of fantasy 279 00:16:30,560 --> 00:16:32,520 Speaker 1: as you given to the mother, you know, whether it 280 00:16:32,560 --> 00:16:34,760 Speaker 1: was a vaginal birth or a cesarian section, all these 281 00:16:34,760 --> 00:16:38,440 Speaker 1: other things. With trends in the baby's scores. They figured 282 00:16:38,440 --> 00:16:40,400 Speaker 1: out that babies with a score under three needed to 283 00:16:40,400 --> 00:16:43,680 Speaker 1: be resuscitated. Kind of obviously, because that would be a 284 00:16:43,680 --> 00:16:46,080 Speaker 1: baby that's like blue and not moving and doesn't have 285 00:16:46,120 --> 00:16:48,960 Speaker 1: a pulse. Uh, But babies that have a score of 286 00:16:49,000 --> 00:16:52,560 Speaker 1: seven to ten had a statistically better chance of surviving 287 00:16:52,600 --> 00:16:55,200 Speaker 1: their first month of life than babies who scored six 288 00:16:55,240 --> 00:16:56,720 Speaker 1: are lower, so it would be kind of a baby 289 00:16:56,720 --> 00:16:59,720 Speaker 1: that's doing all right, but maybe not quite thriving. This 290 00:17:00,040 --> 00:17:05,320 Speaker 1: evolving body of data allowed obstetricians and obstetric anesthetists to 291 00:17:05,400 --> 00:17:09,160 Speaker 1: really refine their practices to improve newborn babies survival rates. 292 00:17:09,160 --> 00:17:12,320 Speaker 1: And we haven't really talked about the pretty massive differences 293 00:17:12,400 --> 00:17:15,960 Speaker 1: between anesthesia that's typically used in delivery rooms now versus 294 00:17:15,960 --> 00:17:21,320 Speaker 1: what was used in the like nineteen fifties, a totally 295 00:17:21,320 --> 00:17:25,800 Speaker 1: different world um in terms of like we it's not 296 00:17:25,960 --> 00:17:29,880 Speaker 1: standard practice to put women essentially unconscious to deliver babies 297 00:17:30,000 --> 00:17:34,560 Speaker 1: in American hospitals anymore. Dr Apgar and team also went 298 00:17:34,600 --> 00:17:38,560 Speaker 1: one step further and studied newborn babies blood chemistry, finding 299 00:17:38,600 --> 00:17:41,720 Speaker 1: clear physiological links between the outward appearance of the traits 300 00:17:41,760 --> 00:17:45,240 Speaker 1: examined to calculate an apgars to score and what was 301 00:17:45,320 --> 00:17:49,280 Speaker 1: actually physiologically going on in the baby's body. By the 302 00:17:49,359 --> 00:17:52,520 Speaker 1: late nineteen fifties, dr Apgar had attended more than seventeen 303 00:17:52,560 --> 00:17:56,399 Speaker 1: thousand births. During that time, she had seen a number 304 00:17:56,440 --> 00:18:00,400 Speaker 1: of children who were born with congenital disabilities also sometimes 305 00:18:00,400 --> 00:18:04,040 Speaker 1: known as birth defects, and in some cases it really 306 00:18:04,080 --> 00:18:07,800 Speaker 1: seemed like there was a correlation between the disability and 307 00:18:07,840 --> 00:18:12,359 Speaker 1: the baby's AFCAR score. So in Night she went on 308 00:18:12,440 --> 00:18:15,600 Speaker 1: a sabbatical and she pursued a master's degree in public 309 00:18:15,640 --> 00:18:19,679 Speaker 1: health from Johns Hopkins University. Originally, her intent was to 310 00:18:19,720 --> 00:18:22,800 Speaker 1: improve her knowledge of statistics and bring that knowledge back 311 00:18:22,800 --> 00:18:27,160 Speaker 1: to her work at Presbyterian Hospital, which increasingly involved statistics. 312 00:18:27,400 --> 00:18:31,040 Speaker 1: But as she studied, she became increasingly interested in whether 313 00:18:31,119 --> 00:18:33,439 Speaker 1: some of the congenital issues she was seeing when babies 314 00:18:33,480 --> 00:18:37,840 Speaker 1: were born could somehow be prevented. During this time, she 315 00:18:37,920 --> 00:18:41,400 Speaker 1: was approached by the National Foundation for Infantile Paralysis, which 316 00:18:41,400 --> 00:18:44,679 Speaker 1: is now known as the March of Dimes. Originally, the 317 00:18:44,760 --> 00:18:48,800 Speaker 1: National Foundation was primarily focused on polio. It had sponsored 318 00:18:48,800 --> 00:18:51,879 Speaker 1: the vaccine research of Dr Jonas Salk, and once the 319 00:18:52,000 --> 00:18:56,600 Speaker 1: polio vaccine was introduced and the rate of polio infection 320 00:18:56,720 --> 00:19:00,119 Speaker 1: just dropped dramatically, the Foundation wanted to find a new 321 00:19:00,119 --> 00:19:03,959 Speaker 1: place to expand its work and other conditions that they 322 00:19:03,960 --> 00:19:07,560 Speaker 1: could help with that we're affecting babies and children. The 323 00:19:07,600 --> 00:19:11,919 Speaker 1: Foundation started a new department called the Division of Congenital Malformations. 324 00:19:12,400 --> 00:19:15,280 Speaker 1: The National Foundation asked Dr Apgar to lead this new 325 00:19:15,320 --> 00:19:18,200 Speaker 1: department and she accepted, beginning her new role after she 326 00:19:18,280 --> 00:19:22,840 Speaker 1: completed her master's program. In this role, dr Apgar became 327 00:19:22,920 --> 00:19:27,040 Speaker 1: a huge advocate of early detection and treatment of congenital issues, 328 00:19:27,400 --> 00:19:31,800 Speaker 1: including prenail testing and treatment. She traveled extensively to talk 329 00:19:31,880 --> 00:19:36,280 Speaker 1: directly to parents and doctors and educators about congenital disabilities 330 00:19:36,320 --> 00:19:39,480 Speaker 1: and other issues that were related to prenatal and newborn health. 331 00:19:40,840 --> 00:19:44,080 Speaker 1: This was almost directly the opposite of her experience trying 332 00:19:44,119 --> 00:19:47,320 Speaker 1: to start an inn entusiology program while that field was 333 00:19:47,359 --> 00:19:51,600 Speaker 1: in its infancy. Congenital disabilities and disorders were huge news 334 00:19:51,640 --> 00:19:54,720 Speaker 1: in the United States at this point. The Drugslida mind 335 00:19:54,760 --> 00:19:56,800 Speaker 1: which had been given to pregnant women in much of 336 00:19:56,840 --> 00:20:00,000 Speaker 1: Europe both as a sedative and to combat morning signal. 337 00:20:00,040 --> 00:20:02,920 Speaker 1: This had been implicated in causing babies to be born 338 00:20:03,000 --> 00:20:06,840 Speaker 1: with missing or incorrectly formed limbs. The FDA had not 339 00:20:06,880 --> 00:20:09,159 Speaker 1: approved the drug to be used in the United States, 340 00:20:09,160 --> 00:20:11,800 Speaker 1: which the media played up as a near miss. This 341 00:20:11,880 --> 00:20:14,639 Speaker 1: was also during the post war baby boom, so parents 342 00:20:14,680 --> 00:20:18,919 Speaker 1: to be were hungry for information and dr Apgar was 343 00:20:19,040 --> 00:20:21,720 Speaker 1: really an ideal doctor to be involved in all this. 344 00:20:22,280 --> 00:20:26,000 Speaker 1: She had decades of experience and she was just extremely 345 00:20:26,119 --> 00:20:29,600 Speaker 1: personal and empathetic and compassionate with the people she was 346 00:20:29,640 --> 00:20:32,960 Speaker 1: talking to. In nineteen sixty four and nineteen sixty five, 347 00:20:33,080 --> 00:20:35,800 Speaker 1: a huge rubella outbreak in the United States led to 348 00:20:35,840 --> 00:20:39,080 Speaker 1: more than twelve million cases of rubella and twenty thousand 349 00:20:39,160 --> 00:20:42,760 Speaker 1: cases of congenital rubella syndrome, which occurs when a pregnant 350 00:20:42,760 --> 00:20:48,400 Speaker 1: woman contracts rubella. Congenital rubella syndrome can cause premature delivery, miscarriages, 351 00:20:48,440 --> 00:20:51,720 Speaker 1: and still births, and a wide variety of potential disorders 352 00:20:51,720 --> 00:20:55,159 Speaker 1: and disabilities which can affect virtually any system of the body. 353 00:20:55,840 --> 00:21:01,760 Speaker 1: These include blindness, heart problems, bone lesions, hepatite and developmental disabilities. 354 00:21:02,320 --> 00:21:05,240 Speaker 1: In the wake of this outbreak, dr Apgar led vaccination 355 00:21:05,280 --> 00:21:09,520 Speaker 1: campaigns after one became available in nineteen sixty nine. She 356 00:21:09,680 --> 00:21:12,679 Speaker 1: joined the faculty of the School of Pediatrics at Cornell 357 00:21:12,840 --> 00:21:15,399 Speaker 1: University School of Medicine in nineteen sixty five, and she 358 00:21:15,400 --> 00:21:19,720 Speaker 1: taught there until nineteen seventy four. She specialized in teratology. 359 00:21:19,840 --> 00:21:23,800 Speaker 1: So sometimes this is characterized as a study of congenital disabilities, 360 00:21:24,080 --> 00:21:27,840 Speaker 1: but it really incorporates any kind of disability or disorder 361 00:21:28,160 --> 00:21:31,080 Speaker 1: that arises as an organism is developing, So that can 362 00:21:31,119 --> 00:21:34,480 Speaker 1: include like as a child is growing or transitioning into adolescents, 363 00:21:34,560 --> 00:21:39,200 Speaker 1: or things like that. She was actually the first person 364 00:21:39,680 --> 00:21:43,919 Speaker 1: to hold a faculty position dedicated to this aspect of pediatrics. 365 00:21:45,240 --> 00:21:47,960 Speaker 1: In nineteen seventy two, dr Apgar was part of a 366 00:21:48,040 --> 00:21:51,919 Speaker 1: joint effort of the American Medical Association, the American College 367 00:21:51,920 --> 00:21:56,119 Speaker 1: of Obstetrics and Gynecologists, the American Academy of Family Physicians, 368 00:21:56,320 --> 00:21:59,560 Speaker 1: the American Academy of Pediatrics, and the March of Dimes. 369 00:22:00,040 --> 00:22:03,600 Speaker 1: It was the first committee on perinatal health. The committee's 370 00:22:03,640 --> 00:22:06,120 Speaker 1: goal was to put together a plan to improve maternal 371 00:22:06,119 --> 00:22:10,440 Speaker 1: health and lower infant mortality nationwide. Sadly, she died before 372 00:22:10,480 --> 00:22:14,119 Speaker 1: the committee's landmark report toward improving the Outcome of pregnancy 373 00:22:14,280 --> 00:22:19,400 Speaker 1: was released in nineteen seventy six. Dr Apgar published more 374 00:22:19,440 --> 00:22:22,160 Speaker 1: than sixty papers during her career, along with the book 375 00:22:22,240 --> 00:22:24,480 Speaker 1: Is My Baby All Right? Which she co wrote with 376 00:22:24,600 --> 00:22:27,399 Speaker 1: Joan Beck and published in nineteen seventy two. As this 377 00:22:27,520 --> 00:22:30,639 Speaker 1: was a book that walked through several different contentital situations 378 00:22:30,680 --> 00:22:34,040 Speaker 1: that can happen using real examples, it was a book 379 00:22:34,080 --> 00:22:35,760 Speaker 1: that there was a great need for at this point 380 00:22:35,800 --> 00:22:37,720 Speaker 1: because a lot of people had no knowledge of any 381 00:22:37,760 --> 00:22:40,960 Speaker 1: of these things or what to do. She also received 382 00:22:41,119 --> 00:22:46,000 Speaker 1: numerous honorary doctorates and professional accolades during her career. She 383 00:22:46,119 --> 00:22:49,800 Speaker 1: was given a commemorative postage stamp in and was inducted 384 00:22:49,840 --> 00:22:54,560 Speaker 1: into the National Women's Hall of Fame in n Throughout 385 00:22:54,600 --> 00:22:57,800 Speaker 1: her life, she continued to pursue all kinds of activities 386 00:22:57,840 --> 00:23:00,200 Speaker 1: and passions in addition to all this work of being 387 00:23:00,200 --> 00:23:02,679 Speaker 1: a doctor, so sort of continued what she had been 388 00:23:02,720 --> 00:23:04,840 Speaker 1: doing in college when she was on seven different sports 389 00:23:04,840 --> 00:23:08,280 Speaker 1: teams while also being a great student. She also and 390 00:23:08,520 --> 00:23:11,920 Speaker 1: what maybe is the most awesome thing in this episode. 391 00:23:12,560 --> 00:23:16,760 Speaker 1: Carried a penknife, an endo, tracheal tube, and a larynoscope 392 00:23:16,880 --> 00:23:20,200 Speaker 1: with her at all times, just in case someone near 393 00:23:20,240 --> 00:23:23,879 Speaker 1: her stopped breathing. She said, nobody, But nobody is going 394 00:23:23,920 --> 00:23:29,600 Speaker 1: to stop breathing on me. She medal Leslie, nope, is 395 00:23:29,760 --> 00:23:32,720 Speaker 1: she well, she's so I have I don't know. I 396 00:23:32,800 --> 00:23:34,960 Speaker 1: just developed this deep fondness for her in this episode 397 00:23:35,000 --> 00:23:37,720 Speaker 1: because she's like medical Leslie Nope. And we've told we've 398 00:23:37,720 --> 00:23:40,199 Speaker 1: told you all before how much I love parks and 399 00:23:40,240 --> 00:23:43,199 Speaker 1: recreation and cried when it was over. But also her 400 00:23:43,280 --> 00:23:46,920 Speaker 1: name is Virginia, my grandmother's names, and when you look 401 00:23:46,960 --> 00:23:49,680 Speaker 1: at pictures of her, she's got like the same kind 402 00:23:49,720 --> 00:23:55,280 Speaker 1: of uh very from the fifties I wear that you 403 00:23:55,359 --> 00:23:58,280 Speaker 1: see pictures of my grandmother's, she just reminds me of 404 00:23:58,320 --> 00:24:02,840 Speaker 1: like if my grand mother's had been like Leslie Nope 405 00:24:02,840 --> 00:24:07,840 Speaker 1: when they were young. And she actually never retired. She 406 00:24:08,040 --> 00:24:09,919 Speaker 1: only slowed down a little at the very end of 407 00:24:09,920 --> 00:24:12,879 Speaker 1: her life because she had progressive liver disease, which eventually 408 00:24:12,960 --> 00:24:15,679 Speaker 1: was the cause of her death. On August seven of nineteen, 409 00:24:16,960 --> 00:24:19,719 Speaker 1: she died at Columbia Presbyterian Medical Center, where she had 410 00:24:19,720 --> 00:24:23,720 Speaker 1: spent much of her career. So we've talked a few 411 00:24:23,720 --> 00:24:26,040 Speaker 1: times about the show sawt Owns, which is the snow 412 00:24:26,080 --> 00:24:31,280 Speaker 1: about medical history, which is the co production of uh 413 00:24:31,320 --> 00:24:35,359 Speaker 1: Sidney McElroy who's a doctor, and her husband Justin McElroy, 414 00:24:35,600 --> 00:24:37,840 Speaker 1: and they are charming and delightful. If you don't listen 415 00:24:37,840 --> 00:24:39,560 Speaker 1: to that show, I highly recommend it. It's from the 416 00:24:39,640 --> 00:24:43,120 Speaker 1: Maximum Fund podcast network. I don't think they have done 417 00:24:43,160 --> 00:24:46,480 Speaker 1: an episode that that touched on this, But the whole 418 00:24:46,480 --> 00:24:47,960 Speaker 1: time I was working on it, when I got to 419 00:24:48,000 --> 00:24:49,920 Speaker 1: this part where Dr Atgar was like, the problem is 420 00:24:49,960 --> 00:24:52,359 Speaker 1: nobody is looking at these babies, I just kept hearing 421 00:24:52,359 --> 00:24:54,479 Speaker 1: Sydney's voice in my head being like, you gotta look 422 00:24:54,480 --> 00:24:58,320 Speaker 1: at the babies. Look at the babies. Why aren't you 423 00:24:58,320 --> 00:25:02,480 Speaker 1: looking at the babies, Like it seems so obvious look 424 00:25:02,520 --> 00:25:05,720 Speaker 1: at the babies when they were born? It does? I 425 00:25:06,080 --> 00:25:08,960 Speaker 1: have to wonder, and I will, you know, show off 426 00:25:09,040 --> 00:25:12,359 Speaker 1: my um my ignorance in this arena. Like what the 427 00:25:12,440 --> 00:25:15,119 Speaker 1: thinking was like why they weren't focusing on the babies 428 00:25:15,160 --> 00:25:17,400 Speaker 1: and they were only focusing on the mothers. Were they 429 00:25:17,440 --> 00:25:19,760 Speaker 1: just so accustomed to a high mortality rate that they 430 00:25:19,760 --> 00:25:21,280 Speaker 1: were like, well, the baby may or may not make it. 431 00:25:21,480 --> 00:25:23,960 Speaker 1: The strong ones survived, let's make sure the mom gets through. 432 00:25:24,520 --> 00:25:27,000 Speaker 1: I kind of wondered that as I was, I mean, 433 00:25:27,000 --> 00:25:29,360 Speaker 1: I didn't find a lot of a lot of information 434 00:25:29,400 --> 00:25:31,679 Speaker 1: about why this was the way it is, but because 435 00:25:31,760 --> 00:25:34,320 Speaker 1: the infant mortality rate was so pronounced at that point, 436 00:25:34,400 --> 00:25:38,159 Speaker 1: like it seems like maybe that would be maybe not 437 00:25:38,280 --> 00:25:41,359 Speaker 1: a deliberate conclusion, but just sort of like the operating 438 00:25:41,359 --> 00:25:43,840 Speaker 1: parameters that were in people's minds that they were making 439 00:25:44,520 --> 00:25:48,919 Speaker 1: decisions in in the delivery room. Uh So, Yeah, I 440 00:25:48,960 --> 00:25:52,520 Speaker 1: was very curious in my mind about that. Also, Um, 441 00:25:52,880 --> 00:25:56,480 Speaker 1: I hope like nobody's grandfather was an obpetrician in nifty. 442 00:25:57,000 --> 00:25:59,840 Speaker 1: I'm not trying to be hurtful, No, I mean there 443 00:26:00,359 --> 00:26:03,240 Speaker 1: looking at the babies made a big difference. Well, it's 444 00:26:03,280 --> 00:26:06,359 Speaker 1: just one of those, you know, elements of like shifting 445 00:26:07,080 --> 00:26:10,320 Speaker 1: approaches and attitudes that happened gradually over time. It doesn't 446 00:26:10,359 --> 00:26:13,760 Speaker 1: always mean that the people involved were being negligent or 447 00:26:13,760 --> 00:26:17,639 Speaker 1: even wrong, They just hadn't shifted yet. No. Well, and 448 00:26:17,720 --> 00:26:20,320 Speaker 1: we got we got a listener email that I have 449 00:26:20,400 --> 00:26:22,200 Speaker 1: not read because it was just it was a little 450 00:26:22,200 --> 00:26:24,400 Speaker 1: too personal to just directly read. But it came after 451 00:26:24,440 --> 00:26:26,680 Speaker 1: that episode that we did about Dr Vera. Peters where 452 00:26:26,720 --> 00:26:30,000 Speaker 1: we talked about women who had lumps in their breasts 453 00:26:30,000 --> 00:26:33,040 Speaker 1: would basically be put under to go get a biopsy 454 00:26:33,119 --> 00:26:34,920 Speaker 1: and if they had cancer, they would wake up without 455 00:26:34,920 --> 00:26:39,720 Speaker 1: a breath anymore. And how like in today's mindset, that's horrifying. 456 00:26:40,920 --> 00:26:44,000 Speaker 1: Her story was about having had children during this part 457 00:26:44,000 --> 00:26:46,119 Speaker 1: of history and how basically you would go to the 458 00:26:46,160 --> 00:26:49,280 Speaker 1: hospital and you would be put under and you would 459 00:26:49,280 --> 00:26:54,040 Speaker 1: wake up with a baby. Uh and uh. She had 460 00:26:54,080 --> 00:26:56,560 Speaker 1: this whole story about the doctor that was delivering her 461 00:26:56,640 --> 00:27:01,000 Speaker 1: children had a clear preference for delivering mail children and 462 00:27:01,359 --> 00:27:04,240 Speaker 1: said some things that were pretty insensitive when he delivered 463 00:27:04,280 --> 00:27:08,840 Speaker 1: her daughter. So yeah, I would say that there is 464 00:27:08,920 --> 00:27:13,719 Speaker 1: still a way to go in terms of, you know, 465 00:27:13,800 --> 00:27:16,760 Speaker 1: women and babies getting the best possible medical care. Maybe 466 00:27:16,760 --> 00:27:19,440 Speaker 1: not so much babies anymore, but I know, like there're 467 00:27:19,480 --> 00:27:24,600 Speaker 1: still I know my mom personally had difficulty getting doctors 468 00:27:24,640 --> 00:27:26,720 Speaker 1: to take her seriously when she knew that something was 469 00:27:26,720 --> 00:27:28,760 Speaker 1: wrong with her health, and they just kept writing her 470 00:27:28,800 --> 00:27:32,200 Speaker 1: off as being a stressed out female, which was not 471 00:27:32,240 --> 00:27:36,000 Speaker 1: what was going on. She had a legitimate problem. So 472 00:27:36,840 --> 00:27:39,920 Speaker 1: medical care better, still room to improve, and I also 473 00:27:39,960 --> 00:27:43,800 Speaker 1: have listener mail, which is all is a little bit 474 00:27:43,840 --> 00:27:46,800 Speaker 1: related to the medical field. This for Maggie. Maggie says 475 00:27:46,800 --> 00:27:49,240 Speaker 1: Holly and Tracy. Unlike many of your listeners, I've only 476 00:27:49,240 --> 00:27:51,320 Speaker 1: been listening for the last year or so, but I 477 00:27:51,400 --> 00:27:54,320 Speaker 1: have been entirely hooked since then. As a former history 478 00:27:54,359 --> 00:27:57,280 Speaker 1: major in my undergrad days. It's super fun to find 479 00:27:57,359 --> 00:27:59,840 Speaker 1: all these new dimensions of the things I learned about 480 00:28:00,040 --> 00:28:03,640 Speaker 1: and remind myself I actually remember things too. I wanted 481 00:28:03,680 --> 00:28:06,080 Speaker 1: to specifically thank you for your episode about the Compton's 482 00:28:06,119 --> 00:28:09,800 Speaker 1: Cafeteria riots. I work with college students to spread mental 483 00:28:09,840 --> 00:28:13,480 Speaker 1: health awareness and enact advocacy on their campuses to make 484 00:28:13,560 --> 00:28:16,359 Speaker 1: these spaces safer for all people to live, learn and grow. 485 00:28:16,800 --> 00:28:20,040 Speaker 1: Our organization is called Active Minds, and we support over 486 00:28:20,119 --> 00:28:24,360 Speaker 1: four hundred student run chapters on campuses across the US, Canada, 487 00:28:24,440 --> 00:28:27,360 Speaker 1: and in Ecuador. I had never learned so much about 488 00:28:27,359 --> 00:28:30,200 Speaker 1: the Compton's Cafeteria riots. I had heard about it in passing, 489 00:28:30,240 --> 00:28:32,399 Speaker 1: but as you mentioned, we often bypassed these events in 490 00:28:32,440 --> 00:28:35,919 Speaker 1: favor of discussing Stonewall, which was obviously important but not 491 00:28:36,000 --> 00:28:38,400 Speaker 1: the loan significant event in those early days of this 492 00:28:38,600 --> 00:28:42,440 Speaker 1: civil rights movement. As a mental health educator and advocate 493 00:28:42,520 --> 00:28:46,160 Speaker 1: and a member of the lgbt community, I especially appreciated 494 00:28:46,160 --> 00:28:49,280 Speaker 1: your mention of trans mental health statistics and the violent 495 00:28:49,280 --> 00:28:54,720 Speaker 1: acts often perpetrated against that community. Lgbt Q mental health 496 00:28:54,760 --> 00:28:58,480 Speaker 1: has become a particular area of focus among our students 497 00:28:58,560 --> 00:29:01,720 Speaker 1: and for us at the national level. In partnership with 498 00:29:01,720 --> 00:29:04,120 Speaker 1: our friends at the Healthy Minds Network at the University 499 00:29:04,160 --> 00:29:07,360 Speaker 1: of Michigan, we were able to create the below infographics 500 00:29:07,400 --> 00:29:10,719 Speaker 1: about trans and LGBTQ mental health on campuses, and then 501 00:29:10,760 --> 00:29:12,080 Speaker 1: she gives links to them, which we will put in 502 00:29:12,080 --> 00:29:15,280 Speaker 1: our show notes. Thank you so much for spreading awareness 503 00:29:15,360 --> 00:29:18,560 Speaker 1: about these important events. We as a general population don't 504 00:29:18,560 --> 00:29:20,920 Speaker 1: know nearly enough about the social movements that have defined 505 00:29:20,960 --> 00:29:23,960 Speaker 1: our recent history. Between this story and your recent story 506 00:29:24,000 --> 00:29:27,320 Speaker 1: on special education, you're doing that. Thank you so much, Maggie. 507 00:29:27,840 --> 00:29:32,560 Speaker 1: I wanted to share this one specifically, UM because it 508 00:29:32,680 --> 00:29:35,880 Speaker 1: is so important to have mental health resources that are 509 00:29:35,920 --> 00:29:39,920 Speaker 1: specifically devoted to young people. UM Like, young people's mental 510 00:29:39,960 --> 00:29:42,760 Speaker 1: health issues and adult people's mental health issues are not 511 00:29:42,960 --> 00:29:45,080 Speaker 1: the same things, and a lot of times treatments are 512 00:29:45,120 --> 00:29:48,920 Speaker 1: really different. So I was really pleased to learn um 513 00:29:48,960 --> 00:29:51,000 Speaker 1: about this group that is doing a whole lot to 514 00:29:51,000 --> 00:29:53,560 Speaker 1: to promote that on college campuses, which I think is 515 00:29:54,120 --> 00:29:57,000 Speaker 1: critically important, and so we'll put links to those infographics 516 00:29:57,080 --> 00:29:59,480 Speaker 1: in our show notes. If you would like to write 517 00:29:59,480 --> 00:30:03,800 Speaker 1: to us for about this or any other subject um. 518 00:30:03,840 --> 00:30:06,040 Speaker 1: We are a history podcast at how stuffworks dot com. 519 00:30:06,160 --> 00:30:08,600 Speaker 1: We're also on Facebook at Facebook dot com slash missed 520 00:30:08,600 --> 00:30:10,880 Speaker 1: in History and on Twitter at miss in History. Our 521 00:30:11,000 --> 00:30:13,440 Speaker 1: tumbler is missed in History dot tumbler dot com, and 522 00:30:13,480 --> 00:30:15,920 Speaker 1: we're also on Pinterest at pinterest dot com slash miss 523 00:30:15,960 --> 00:30:18,960 Speaker 1: in History. We have a spreadshirt store. It has a 524 00:30:18,960 --> 00:30:23,960 Speaker 1: pretty new shirt in it. It says, I heart exhumations, 525 00:30:24,080 --> 00:30:26,440 Speaker 1: but the heart is a real heart. We love it. 526 00:30:26,600 --> 00:30:28,960 Speaker 1: So you can get that at our at our store 527 00:30:28,960 --> 00:30:31,120 Speaker 1: which is missed in History dot spreadshirt dot com. We're 528 00:30:31,120 --> 00:30:33,239 Speaker 1: also cooking up some ideas for some more shirts in 529 00:30:33,240 --> 00:30:36,400 Speaker 1: that store. Uh. If you would like to learn more 530 00:30:36,400 --> 00:30:38,000 Speaker 1: about what we talked about today, you can come to 531 00:30:38,040 --> 00:30:40,640 Speaker 1: our parent company's website, which is how stuff works dot com. 532 00:30:41,040 --> 00:30:43,720 Speaker 1: Put the word childbirth into the third bar and you 533 00:30:43,720 --> 00:30:46,840 Speaker 1: will find how childbirth works. You can also come to 534 00:30:46,880 --> 00:30:49,120 Speaker 1: our website, which is missed in history dot com. That 535 00:30:49,240 --> 00:30:51,239 Speaker 1: is where our show notes are, which is where we're 536 00:30:51,240 --> 00:30:53,840 Speaker 1: gonna put links to these infographics that I just mentioned. 537 00:30:54,600 --> 00:30:57,320 Speaker 1: You can also find an archive of every single episode 538 00:30:57,320 --> 00:30:59,440 Speaker 1: we have ever done, and show notes for the episodes 539 00:30:59,520 --> 00:31:01,560 Speaker 1: that Holly I have worked on. So you can do 540 00:31:01,600 --> 00:31:03,320 Speaker 1: all that and a whole lot more at how stuff 541 00:31:03,320 --> 00:31:09,360 Speaker 1: works dot com or miss the history dot com for 542 00:31:09,480 --> 00:31:11,840 Speaker 1: more on this and thousands of other topics because at 543 00:31:11,880 --> 00:31:16,040 Speaker 1: how stuff works dot com. M