Carolyn Lipchik
Ohio, United States

“The dean of the College of Medicine recalled Dr. Mitchell looking over blueprints and declaring, ‘We’ll have something here. There’ll be nothing like it in the world.’”¹

Cincinnati Children’s Hospital Medical Center (CCHMC) has a long history of commitment to medical research. Leadership in the 1920s modernized the hospital and infused it with a pioneering and innovative culture that has attracted exceptional researchers for decades, resulting in many important and life-saving medical advancements. The role of this culture in leading to early research achievements can be highlighted with the success stories of Josef Warkany and Albert Sabin, two of the most esteemed researchers to call Cincinnati home.

In 1921, a newly organized board of trustees, for what was then known as the Protestant Episcopal Hospital, aimed to vastly expand the mission and vision of Cincinnati’s small charity hospital. Led by William Cooper Procter, the president of Procter and Gamble, the board raised money to purchase land near the University of Cincinnati College of Medicine with the intention of building its new hospital in an area dedicated to education and research. The board voted to change the institution’s name to “Children’s Hospital,” to reflect the consolidation of pediatric clinics across the city into one modern institution. To help lead the expansion efforts, Procter hired Albert Graeme Mitchell, MD as the hospital’s second endowed B. K. Rachford Professor of Pediatrics. He oversaw the planning of the new facility and its staff expansion. Mitchell was equally, if not more, dedicated to the principles of education and research as Procter, and worked to coordinate an affiliation between Children’s Hospital and the University of Cincinnati College of Medicine.² Together they founded the Department of Pediatrics, where the researchers and clinicians at Children’s continue to maintain their academic appointments to this day.

Mitchell was not satisfied with merely establishing academic affiliation with the university. “In a letter to the board, he argued that ‘unless effort is made to study and investigate problems in a manner which will add in a constructive way to existing knowledge, we have all of us failed to function to the fullest extent.’” His arguments persuaded Procter to donate $2.5 million dollars for an additional construction project. Established as the Children’s Hospital Research Foundation (CHRF) in 1931, it marked Children’s Hospital as the only pediatric institution in the nation to build space devoted entirely to research.³ Today, the Research Foundation carries out its mission in over one million square feet of state-of-the-art laboratories.

Indeed, Mitchell “had the vision to create the department … he became the originator of the Children’s Hospital Research Foundation. He could convince Mr. Procter that research in pediatrics would be very important because it would take care not only of the diseases of children, but also prevention,” recalled Josef Warkany, MD.⁴ Warkany received his medical degree in Vienna and began his research early as a medical student, studying Vitamin D and phosphorus.  He enjoyed telling a story about this work performed on a rabbit in his research lab. He asked the director for another rabbit when he could no longer effectively bleed his subject.  The director responded, “You already have one!”  After graduating, Warkany was accepted for a one-year research scholarship under Mitchell at Children’s Hospital. Warkany was thrilled by the opportunity to have “as many rabbits and rats as he wanted.” Before completing his fellowship, Mitchell asked Warkany to join the CHRF as a permanent staff member.⁵

Warkany continued to focus his studies on congenital malformations, or teratology, and carried out a series of pioneering studies that showed many malformations were caused by maternal nutritional deficiency, or exposure to environmental factors. In one clinical case in 1945, Warkany accidentally discovered that mercury poisoning caused acrodynia, an ailment commonly found in regions where there was high exposure to the heavy metal. This led to the preventative removal of mercury from medicines, where it had been a common additive.⁶ His discovery was the result of working in a culture that promoted clinical innovation, and having the laboratory resources to run the tests necessary to achieve results. Later, Warkany’s reputation in science and medicine earned the CHRF federal grants to build an additional research building in the 1960s dedicated to studying developmental and cognitive disorders.⁷  The Institute for Developmental Research (IDR) “doubled office and laboratory space, quadrupled animal facilities, and allowed a large influx of basic scientists.”⁸ With this project, the CHRF had the opportunity to expand its resources to a new generation of researchers.

Warkany was just one of many outstanding researchers recruited by Mitchell. In 1938, Mitchell pushed the CHRF to initiate the process of outside review by a Scientific Advisory Committee, comprised of leaders in the medical field. They advised Children’s Hospital to establish a division of virology and immunology. The committee recommended Albert B. Sabin, MD, a young researcher at the Rockefeller Institute. In an interview, Sabin indicated that he had had the choice of three opportunities: to be promoted to a tenured position at the Rockefeller Institute, to pursue his research in Sweden, or to come to Cincinnati. He said that he chose the CHRF because “I wanted an opportunity to be able to study patients myself, to have access to patients, and to do my own laboratory work.”⁹ Children’s Hospital offered a unique cultural environment where Sabin could fuse his clinical and scientific research, a culture that persists to this day.

Sabin joined the CHRF in 1939. Though his work at Children’s was interrupted by the Second World War, he returned from the Medical Corps having developed vaccines for Japanese encephalitis and dengue fever.¹⁰ After the war, Sabin resumed studying poliomyelitis, which had been his primary focus since the 1931 polio epidemic in New York. Sabin developed a live attenuated vaccine, insisting that the live virus offered quicker and longer-lasting immunity than the rival Salk vaccination already in use in the United States in the 1950s. In addition to Sabin’s scientific advantage, his vaccine was delivered orally, which kept costs low and made it more accessible to communities and to less developed areas than standard injections.¹¹

The international success of Sabin’s vaccine was the result of years of development and clinical trials supported by the CHRF. After testing the viral strains on hundreds of monkeys and chimpanzees housed at Children’s, he began trials on a prison population in Chillicothe, Ohio in 1954, and convinced the Soviet Union to test the vaccine on a large-scale basis in 1958.¹² By 1960, over fifteen million people in the Soviet Union had been vaccinated, and the United States allowed the vaccine to be licensed for local use.¹³ With approval from the US Surgeon General, Children’s Hospital worked with the County Medical Society to offer the vaccine free of charge to all school children in Cincinnati.¹⁴

Children’s Hospital was among the first medical institutions to dedicate space and resources to promote discovery when pediatrics was a relatively novel field of medicine. Clinical and basic research continues to be a driving force in the vision for CCHMC. When its latest construction, a fourteen story building dedicated to translational research, opens in the summer of 2015, Children’s will once again have the most space dedicated to research of any pediatric institution in the nation.¹⁵As an institution, its academic culture offers to new faculty today the same unique opportunities that it has for decades: an environment supportive of research and innovation with unparalleled research infrastructure that can catalyze clinical and translational outcomes and basic research. Mitchell’s prediction about CCHMC was right; there is nothing else like it in the world.

Notes

1. Beatrice Katz, ed., Images of America: Cincinnati Children’s Hospital Medical Center. (Chicago: Arcadia Publishing, 2008), 22.
2. Katz, Images, 19, 21.
3. Katz, Images, 19.
4. Josef Warkany, interviewed by William J. Gerhardt and Peter Dignan. “Dr. Josef Warkany Interview 1987,” Cincinnati Children’s Hospital Medical Heritage Series video, 1:16:30, posted by Cincinnati Children’s Hospital Medical Center, February 11, 2010, http://www.cincinnatichildrens.org/research/cincinnati/support/pratt/heritage-videos/.
5. Warkany Interview.
6. Robert W. Miller, “Josef Warkany,” The Journal of Pediatrics, 126 (1995): 669-672.
7. Miller, “Warkany,” 669-672.
8. Katz, Images, 45.
9. Albert Sabin, interviewed by William K. Schubert and Thomas Forristal. “Dr. Albert B. Sabin, MD (1987),” Cincinnati Children’s Hospital Medical Heritage Series video, 53:38, posted by Cincinnati Children’s Hospital Medical Center, February 11, 2010, http://www.cincinnatichildrens.org/research/cincinnati/support/pratt/heritage-videos/
10. Joseph L. Melnick and Florian Horaud, “Albert B. Sabin,” Biologicals, 21 (1993): 299-303.
11. Stuart Blume and Ingrid Geesink, “A Brief History of Polio Vaccines,” Science, 288 (2000): 1593-1594.
12. Florian Horaud, “Albert B. Sabin and the Development of Oral Poliovaccine,” Biologicals, 21 (1993): 311-316.
13. Blume and Geesink, “A Brief History,” 1593-1594.
14. Albert Sabin, interviewed by Benjamin Felson and Saul Bennison. “Dr. Albert B. Sabin, MD (1979),” Henry R. Winkler Center for the History of the Health Professions Oral Hisory Series video, 51:32, posted by Cincinnati Children’s Hospital Medical Center, February 11, 2010, http://www.cincinnatichildrens.org/research/cincinnati/support/pratt/heritage-videos/
15. About the Clinical Sciences Building. http://www.cincinnatichildrens.org/research/cincinnati/ccrf/facilities/clinical-sciences-building/default/. Accessed January 14, 2015.