Evaluating newborns
Here’s an interesting article about how Virginia Apgar came up with the Apgar scoring system for newborn babies, back in 1952. Till then:
There [had been] no routine examination of the newborns’ vital signs and, if there was, the methods varied from hospital to hospital and were often unscientific, and even unsafe. Doctors were missing signs that a baby was, for example, starved of oxygen, a factor in half of newborn deaths. Some doctors assumed that babies that were underweight or struggling to breathe should be left to die. “It was considered better not to be aggressive. You dried them, you shook them and some doctors patted them on the backside and that was it,” said Professor Alan Fleischman, professor of pediatrics at the Albert Einstein College of Medicine in New York.
There was a dire need for a system that checked vital signs, such as heartbeat and breathing rate, from the minute a baby was born. That way, the appropriate special care could be put into place before it was too late.
This is a sad story, but I wonder what the outcome is going to be- legally speaking. We’ve reached a time when it’s apparently up to the mother to decide if a newborn that is the result of an abortion should be treated for survival or not – is this any different? If the woman claims that her drinking was a method of abortion…does that eliminate the possibility of a charge of murder? Even if it _isn’t_ an attempt at abortion, if abortions are legal up to actual delivery, does the mother’s drinking make her liable for causing the baby’s death? (there’s no question that her drinking _did_ cause the baby’s death, but is she legally responsible?)
Just for the record, I consider abortion morally wrong, but the legal question is somewhat different. I don’t think the law can be used to enforce moral issues, though certainly moral positions may affect the laws we make. Still, I’m really puzzled by the fact that in California at least, a man was condemned to die because he was found guilty of two murders – that of his wife and their unborn child – although even at that time, his wife could have gone to an abortionist and aborted the child with no legal consequences. Logically speaking….how can that be? I realize that that case was many years ago, but it doesn’t seem to me that the issue has been clarified in any way since then.
https://www.foxnews.com/us/minnesota-newborn-dead-intoxication-mother-drinking-bender
Don’t forget the Margaret Sanger scoring system!
At best tangential to the posting, but I think vitally important, is this from a comment by AesopFan ( my boldface) at
https://www.thenewneo.com/2019/02/13/the-philosophy-of-transgenderism/ :
All my adult I have had endogenous (“clinical”) depression. (It wasn’t until the mid-’90s that I said Eff-it and got started on Prozac. Quoting the psychiatrist: “What a difference!” Amazing, too, how my marriage perked up. But you get acclimatized to Pr. within months, so there was almost a decade of experimentation. Finally another doc had me try Effexor, which for me at least is an excellent solution, non-addictive, no side-effects that I can tell, and if I’m off it for a few days I can tell the difference, but in less than an hour after I restart by taking one, my mood starts to lift.)
My point: In the later ’90s I read what to me was a wonderfully helpful book by a psychologist, Dr. Robert Ratey, called
Shadow Syndromes: The Mild Forms of Major Mental Disorders That Sabotage Us
https://www.amazon.com/s?i=stripbooks&rh=p_27%3ARatey%2Cp_28%3AShadow+Syndromes&s=relevanceexprank&Adv-Srch-Books-Submit.x=0&Adv-Srch-Books-Submit.y=0&unfiltered=1&ref=sr_adv_b
This book was immensely helpful, because of its thesis that just because you have this or that “psychological” malady to some degree or other doesn’t mean you’re “alone.” I suppose most of us know this in our heads, but when you feel so awful from depression (at least) it’s hard to believe that anyone could know how it feels. (Not that it takes all of us the same way.)
I think all of us are helped by knowing that some other people share our particular burden in one way or another, to some extent or another. It doesn’t have to be a personal disorder of some kind. It’s whatever trial life sends our way. The book articulated that idea for me, in the case of my personal depression: It was good to read that I wasn’t a freak or something not-quite-human.
Now, to Aesop’s comment: My own belief is that almost every human begins, from the moment of conception, to develop a degree of the potential to develop any given human trait (to the extent that the physical body is not lacking the potential to develop trait X: for example, I assume the anencephalic baby who never develops a brain lacks all potential to develop intelligence.)
In any one of us, at any stage, each potential characteristic increases or diminishes; the ones that develop greatly come to be our strengths or our talents, or our serious weaknesses or maladies or physical or social pathologies. (E.g., we all start with a potential to develop an allergy to X, which however may or may not in fact ever be realized. Yet some of us may be born with only the weakest potential to develop that allergy, while others have such a strong potential that, given the “right” environment for the allergy to develop, do develop it.)
So, at any point in our lives, Aesop’s observation is absolutely correct.
That’s the basic idea, anyway.
Apologies for going to such length and in a way, so far O/T … but I just happened to run across Aesop’s remark while looking for something else, and I wanted to call attention to it ASAP.
Correction: Author is Dr. John Ratey, M.D.
Julie near Chicago: My mother, father and aunt were depressives who committed suicide in their forties/fifties. I spent most of my 20s-50s wandering in and out of depression, sometimes severely. I’m now 67 and realize that much of my life has been about not getting so depressed that I kill myself.
I’ve read the literature about my genetic heritage and my chaotic upbringing. The literature is not my friend. My sisters have been on antidepressants for over twenty years now. I refused to go that route because I saw my mother’s problems substantially worsened by psychiatric meds.
I did a lot of stuff instead of the psychiatrist route. St. John’s Wort! Therapy! Weight lifting! Massage! Ballroom dancing! Tony Robbins! I’m not sure what made the difference or didn’t, but I stopped getting clinically depressed.
I’m now back in therapy after uprooting my San Francisco life for Albuquerque where I know no one and am dealing with my new status as a retired senior. New ball game. My therapist doesn’t know what to make of me. He calls me a survivor and I tell him not to. I don’t want a survivor identity.
I don’t have a particular point beyond a suspicion that this stuff is complex and the science is not settled.
huxley:
I have a few responses to what you wrote, so perhaps you’d like to email me.
huxley,
I’m very sorry to hear about your parents. Hard for (most of us, anyway) to lose our parents at any time, but when they are still so young, and by suicide — it must be very difficult to bear.
I’m glad that for whatever reason, your own depression has lifted. For me, too, depression waxed and waned. I was never suicidal — never even got to the point of being so will-less that I couldn’t get out of bed, for instance (and if you ask me, the first thing serious depression does is to destroy motivation). But there are many stories about people’s inability to do much of anything when they were seriously depressed, because they had no will, no motivation to do anything. I’ve experienced that myself, but not to such an extreme degree.
Neo knows about all this in depth, no doubt, but I’m just a layman who’s lived with my version of it for at least half a century. So FWIW, it seems to me that clinical depression may develop as an internal, strictly physical malfunction, with no external trigger at all; and sometimes it follows an event that causes the body’s biochemical balance to be upset and then it never gets back to what used to be relatively “normal” (still, “shadow syndromes” … I imagine the majority of people feel “down” once in awhile “for no good reason” … just the body’s body’s chemistry out of whack, briefly, for some value of “briefly”).
But sometimes the biochemistry does come back to a state where the weight of depression is gone. Maybe some external event triggers a rebalancing, or even a change of diet or getting some exercise. (Neither of those did a thing for me.)
Anyhow, I do hope that you’re over it for good, and I wish you the very best.
“Some doctors assumed that babies that were underweight or struggling to breathe should be left to die.”
Color me shocked.
When my mother was born prematurely, at @3 lbs, in 1927, the doctor told my grandmother to wrap her in cotton and place her on the oven door to keep her “comfortable” until she died.
Instead, my grandmother fed my mother with an eye-dropper until she had grown enough to take food more normally.
Julie near Chicago: I have no answers on depression other than if one is clinically depressed one had better do something.
I’m not sure how I found my way out. I’d like to give Tony Robbins more credit than the other things, but I don’t know for sure. On the other hand I also know people who have found antidepressants crucially helpful.
Julian Simon, the economist, wrote a book, “Good Mood: The New Psychology of Overcoming Depression” in which he described resolving his lifelong depression by changing the negative self-comparisons in how he thought about himself. That’s part of how I changed.
Then again, I wonder if part of my current well-being is just getting past 50 to the other side of the U-Shaped Happiness Curve.
https://www.brookings.edu/research/happiness-stress-and-age-how-the-u-curve-varies-across-people-and-places/
There are a lot of ways of looking at depression. I imagine depression has its place in human functioning, but becomes a problem if it goes too long.
Julie near Chicago: Thanks for the good wishes. I wish the best for you too!
Huxley,
Moving is one of those life challenging events, similar to a death in the family.
Recognize that and just go out there and do what you did in San Francisco — get involved with groups, volunteer, weight lift, take field trips into the beautiful country that you have just moved into. You took the right path to fight depression at your former address. Do it again with the new faces and locale.
You are a strong man to have beaten this as you did, and you can continue to do so.
Edward: I’m not depressed. I’m seeing a therapist because it seemed the right thing to do, given the new environment and new phase of life. I do worry about depression returning, though I haven’t been that way in nearly 20 years beyond the usual ups and downs.
I’ve returned to college, UNM, and I’m taking challenging STEM courses. I’ve taken up piano and photography again. I have my favorite cafe, where I work on my studies and talk to others. I move slowly, but I do move. Now that I’ve got college more or less wired (that was an adjustment too) I’ll be looking into social clubs and dating. I take the position that these are the good old days.
I don’t know where my story fits into depression, but it seems it ought to have a place. I tried a lot of things and fought hard. I’m not sure what worked or whether I just outgrew it. Knock on wood!
Huxley: congrats and good luck and continued success beating that monster.
I’ve been there myself a few times and like you I tried various things to beat it, mainly nutrients and supplements for both brain and body health, working out, and some mental re-framing to get out of the emotional prison of “I need major change in my life because of something I’m not happy with but I see no solutions here”.
The emotional prison is such a big challenge for a lot of people and there are lots of ways to beat it — but each person has to conquer that in their own way, and mostly on their own.
Very interesting comment thread — depression and other mental health challenges are always more common than we think and not knowing that gives it even more power over us.
And to Julie in Chicago thanks for the book recommendation, we’ve got some family stuff happening right now and I know two people who could benefit from the ideas in that book.
One more thought: two years ago I started a new career that has a major Sales component to it and in the training one idea is consistently pushed: focus on what you can control and let go of everything else.
Such **great** advice for your entire life. I spent decades of my life focusing on things I definitely could **not** control and that is a recipe for depression, frustration, and other unpleasantness.
I have found that by realizing what you have control over, and then executing like a maniac on those things, you gain a level of control over your sense of well-being and feelings of accomplishment and “getting things done” that builds you up, and then by letting go of other things (that year you down) you relieve the built-in anxiety over things you have no control over anyway.
It’s literally life-changing. Our attitudes are everything. I would say the two most important lessons in life are learning how to love another and learning how to adapt to life’s circumstances with the right attitude.
When my mother was born prematurely, at @3 lbs, in 1927, the doctor told my grandmother to wrap her in cotton and place her on the oven door to keep her “comfortable” until she died.
Instead, my grandmother fed my mother with an eye-dropper until she had grown enough to take food more normally.
In 1969, as a surgery resident at LA County Hospital, I operated on a baby that weighed 1 pound 10 ounces who had a bowel obstruction. We did her surgery under local anesthesia. She thrived even though infant respirators had not yet been developed. I put a little gastrostomy tube in her stomach and the nurses fed her with a dropper. By the time she was three pounds she could kick herself down to the end of the bed in the incubator. She went home at 4 pounds. We were busy and never wrote up her case. A year later, some surgeons in Florida operated on a 2 pound 2 ounce baby and got national attention.
I have often wondered what happened to her.
Jeff Brokaw: Good stuff! I’ve taken similar approaches with similar results. To some degree we can improve our moods and resourcefulness with positive mental habits. That’s a piece of it anyway.
Physical exercise helps too.
However, I suspect depression is not one simple thing. There are people, like author William Styron, who sank into such depths he could barely get out of bed and lost the ability to drive. He came very close to suicide but his better angels intervened and he checked himself into a hospital.
Everyone feels blue now and then but real depression lasting months is a serious problem and requires serious attention.
(s/b “tear you down” not “year you down” above)
PhDs in immunology and astrophysics commenting on medicine in which they cite just one pediatrician who was not even born when Apgar developed her scoring leaves me cold, especially when laced with subtle smears of superiority against pediatricians and obstetricians of the time.
My chief resident in internal medicine was born at home in rural Kentucky in 1941, weighing (!) 700 grams. His nursery at home was a box inside a larger box, the gap between filled with rocks heated in a fireplace to keep him warm.
Just an anecdote to show that human effort has good outcomes sometimes. Survival at that birth weight at that time was truly extraordinary.
Apgar did what other MDs in other areas have also done. See the staging of cancers, for example. Apgar was important but hardly unique in her concern, care and understanding of patients. Yes, her scoring was rapidly and widely adopted, but not because docs did not previously note respiratory rates and heartbeat rates in newborns, rather because it was a nice organization of immediately accessible data.
The other old rule in Obstetrics was that every baby born out of asepsis (BOA in the jargon) was an Apgar 10. These babies had quick labors with far less stress than a normal labor. One of my granddaughters, her mother’s third delivery, was almost BOA but a nurse, for reasons that escape me, tried to retard delivery by pushing the baby’s head back until the OB got there. That little girl had respiratory troubles for months. Fortunately she recovered and is now a swimmer but the nurse made a terrible error.
PhDs in immunology and astrophysics commenting on medicine
The cardiologist who just implanted a loop recorder in me has a PhD from MIT in astrophysics. She was also a summa cum laude in Astrophysics at Princeton.
That should be good story if I can get her to tell me,.
Cicero:
You seem to have taken on the “curmudgeon” mantle from “froggy” an oncologist and regular commentor from Louisiana who has been absent for at least 6 months. I hope “froggy,” though sometimes grumpy, is still out and about.
huxley: Yes, William Styron was one of the people I was thinking of, who lost just about all motivation to do anything.
And one of the things we are warned about is that when people’s serious depression begins to lift, they sometimes regain enough “energy” to actually commit suicide. To me, that means that sometimes will — motivation — becomes strong enough to overcome what had recently been near-complete enervation.
I’m very happy to hear you have a whole bunch of new or revived interests to pursue! Going back to school … what a treat! Do I remember that you’re tackling the dread Calculus again? And, you’re getting back to the piano. Hooray! Where I am now (living with my kid & her husband) there’s no room for my piano, so it’s on indefinite loan to the local music-and-theater society. I miss it. Both my parents were musicians (classical), and I’ve played piano all my life. Unfortunately, I was probably about seven when I figured out I was never going to be Horowitz. :>(((((
.
Jeff, for me the book was a wonderful confirmation that my ups & downs were just an occurrence of a somewhat more intense or frequent occurrence of a normal human condition. Support groups work for some people with some problems, I guess. I’ve attended a few meetings of a couple of different support groups, though not ones focussed on depression, and for me they were a big fat zero. But the book was entirely different. For one thing, a reader doesn’t have to devote any attention to social behavior! For another, the style of the book isn’t touchy-feely, just matter-of-fact, but the undertone is not scolding or lecturing or hectoring. It just helps in locating yourself (or others) on the human spectrum and well within its bounds. And I found it very readable.
Anyhow, good luck to you and your family. :>))
Sigh. No Edit.
Given the discussion on depression, may I suggest this as reading material?
It’s quite uplifting.
https://www.albertbridgecapital.com/drew-views/2019/6/17/stay-in-the-game?fbclid=IwAR2aG6R7_7_2g0BKbQlo05sxYlPPM_tnLiRSg9kt4_JjDGvlAHJQv_vmcmk
om: I just try addressing facts; facts lead to opinions. I do not agree that my fact-based opinion here deserves a “curmudgeon” designation. Instead of addressing my points, you lapse into ad-hominem. That is enough to tag you as a leftist. Beware!
Come the eschaton, people will use the term ‘ad hominem‘ properly.
Cicero:
Sensitive, are we? You disparage other physicians and their writing with your opinion of their educational background and call it “fact.” That seemed a bit grumpy and curmudgeonly to me. Oh noes, to be tagged a “leftist” by Cicero! I quake. :0
Ed, thanks so much for that link. So poignant, so beautifully told, and such a wonderful ending. I’m so happy for the parents, both the boys, and Chica too. It’s enough to put a girl in a good mood! 😀
And one of the things we are warned about is that when people’s serious depression begins to lift, they sometimes regain enough “energy” to actually commit suicide.
Julie near Chicago: That’s exactly how my mother and father went. People thought they were getting better. Then, not so much.
My mother and stepfather were classical musicians. So I do have a background there.
Have you checked out the digital pianos? I bought the Yamaha P71 with 88 weighted-action keys for $400. It’s a marvel for the price and takes up very little space.
My mother had a Steinway, which is what I learned on. So I know what a good piano feels like. The Yamaha isn’t at that level but is plenty adequate for my needs. I’m still in a studio apartment. I’ve got the Yamaha set up on top of a bank of parts drawers and practice standing up.
Yep, still on Calc 3. Tomorrow’s the final exam. I’m sorry I discovered the Professor Leonard YouTubes this late in the game, but he is great. I wish I had been watching him from the beginning.
Take care, Julie. Thanks for the encouragement!
om:
I did not “disparage other physicians”. Kindly read my words clearly: “one pediatrician”.
I do not think highly of a degreed astrophysicist writing about the history of medicine, negatively at that. Such a person lacks standing, as one might say in a court of law. I expect the same appropriate reaction from him should I write disparagingly about astrophysics and its practitioners.
Argumentation by Credentialism: only Dr.s can write about medicine. You aren’t a lawyer so your opinion about the law is worth what? How do those shoes fit?
To clarify the Cicero standard of acceptance: only Dr.s who are also PhD historians can write about the history of medicine, and only write about their specific field of practice. Standards of acceptable discourse will of course change, and all medical history articles must acquire the Cicero stamp of approval before publication. PhDs in dodgy fields, aka, astrophysics need not bother writing anything. 🙂
Thanks, huxley. It’s a good idea, if the housemates would permit it. Worth considering. :>))) Good luck on today’s exam!
Julie: Digital pianos come with slider volume controls and you can play them very quietly. And if that’s not good enough, you can also feed the output into headphones and no one can hear you play!
Well, I did OK on the exam though not as well as I hoped. After about an hour the numbers, letters and symbols start to swim around. Teacher will post the grades tomorrow. Overall I believe I’ll manage a C or slightly better, but I had hoped for more.
Still
Well, huxley, I appealed to the Great Frog to see you safely through the test. Sad to say, I don’t think I have as much influence there as I have every right to expect.
Thanks for the info on the keyboards. :>)
Am I the only one here who thought APGAR was an acronym?
And me with 4 kids.
Yackums:
“APGAR” is an acronym and it was also chosen because it spells out her actual name. So it’s both.