Until the early 1950s, physicians had no reliable means of assessing the health of newborns in the critical first minutes of life. As a result of delays in diagnosis, conditions that might have been corrected sometimes proved fatal. In 1952, Virginia Apgar (1909-1974), a physician then affiliated with Columbia-Presbyterian Medical Center in New York, introduced a scoring system that became the standard instrument for immediate evaluation of newborns. Known as the Apgar score, the test is administered one minute after birth and again five minutes after birth. A rating of 0, 1, or 2 is given in each of these five categories: "A"--Activity (muscle tone), "P"--Pulse; "G"--Grimace (reflex irritability or response to stimulation); "A"-- Appearance (skin color); and "R"--Respiration. For example, in the Appearance (color) category, a baby who possesses a healthy skin tone receives 2 points, whereas a bluish infant receives only 1 or 0 points. The highest possible total score is 10. It is not unusual for infants to score 7 at one minute of age and 9 or 10 at five minutes of age; by this time, they generally have a healthier skin tone and are breathing better. Armed with information provided by the Apgar score, medical personnel can take immediate measures to ensure a newborn's survival. An initial score of 3 or lower is a signal that the baby's condition is critical and requires urgent attention; a score of 7 or higher signifies that all is well. Studies of the extended Apgar score (the five-minute recheck) have shown it to be an accurate indicator of an infant's chances for survival and normalcy. Apgar, one of the first female graduates of Columbia University's College of Physicians and Surgeons and the first woman ever to hold a full professorship there, invented this system after years of studying the effects of anesthesia in childbirth. Anesthesia is one of the factors that can suppress the Apgar Score; others include lack of oxygen, inhalation of amniotic fluid, and maternal drug use.