The Soranus score

In the second century AD, Soranus of Ephesus described a method of assessing the health status of newborns that very much resembles today's Apgar score. Soranus studied in Alexandria and eventually moved to Rome, where he practised medicine. He authored close to 20 works on topics ranging from internal medicine and surgery to the nature of the soul.

In his influential treatise on gynecology,¹ part of which has survived in the original Greek, Soranus devoted an entire section to the care of newborns. He begins with instructions on “How to recognize the newborn that is worth rearing.” He suggests to midwives that the following characteristics are indicative of a worthy infant: “its mother has spent the period of pregnancy in good health … it has been born at the due time, best at the end of nine months … when put on the earth it immediately cries with proper vigor … it is perfect in all its parts, members and senses … its ducts, namely of the ears, nose, pharynx, urethra, anus are free from obstruction … [and] the natural functions of every member are neither sluggish nor weak.” Finally, Soranus pointed out that the joints should bend and stretch, and that the newborn should be of “due size and shape” and “properly sensitive in every respect” (which could be tested by pricking or squeezing).

Both Soranus' assessment and the Apgar score recommend the evaluation of muscle tone, reflex or irritability and respiratory effort. Soranus, however, does not specifically mention heart rate or colour of the newborn as prognostic factors. Of greater importance, though, is the fact that these evaluations had different objectives. The Apgar score is used as a reflection of the condition of the neonate. Soranus' assessment was used to determine whether the newborn should be accepted or rejected. Acceptance was symbolized by the paterfamilias picking up the newborn from the earth where the midwife had placed it. Rejection meant that the family would not raise the child and could legally dispose of the baby in a number of ways.

Figure. Soranus of Ephesus (died circa AD 129) Photo by: US National Library of Medicine, History of Medicine Division

Figure. Virginia Apgar (1909–1974) Photo by: US National Library of Medicine, History of Medicine Division