November 22, 1963
Dear Doctor Wendl:
I am certainly surprised and pleased to see the newborn scoring system in German!  The only suggestion I have is in the last line, Farbe.  The score 1 is meant to describe a baby with blue hands and feet, and a pink body, a common situation.  Would it be well to add the word "extremitaten" to that description?
No, there have been no fundamental changes in the scoring system since 1953.  However, since some clinics do not have a catheter in the delivery room equipment, an alternative method of eliciting reflexes is in use.  This consists simply of slapping the feet briskly.
In a U.S. Government study of 20,000 babies it has been found useful prognostically, to apply the score several times, such as 3, 5, 10 and 15 minutes, as well as at 60 seconds.  In fact, it turned out, to my surprise, that the development of neurological disorders was closely correlated to the score at one minute.
I am taking the liberty of including a few more reprints.  Thank you for your efforts to introduce the score in Hamburg.
Sincerely yours,
Virginia Apgar, M.D., M.P.H.
Director, Division of Congenital Melformations