Dr. Frederick C. Robbins, a.k.a. Fred, Uncle Fred and FCR (nobody dares call him Freddie), was born in Alabama and grew up in Columbia, Missouri, where his father was professor of botany at the University.

He received his BA. at the University of Missouri in 1936 and completed the first two years of his medical education there. (At that time, there were six or seven two-year pre-clinical medical schools in the U.S. Their graduates, so-called junior transfers, were in great demand by the four year schools that wanted to increase their class sizes but couldn't afford to enlarge the basic lab space required for the first two years.) Fred transferred to Harvard and received his MD in 1940. He then went to Boston Children' s for pediatric training, spending the first year there as resident in bacteriology, as mandated by the hospital for all pediatric trainees. (No residency-training program would get away with that today.) He then served his pediatric internship, leaving for the army in 1942.

Because of his bacteriology training, the army assigned him to diagnostic and research efforts in viral and rickettsial diseases, primarily in Italy and North Africa. His clinical, epidemiologic and laboratory studies of Q fever in Italy constituted major contributions to the understanding of that disease, and started him on his research career.

He left the army as a major in 1946; whether this was because he was passed over for lieutenant colonel is unknown. He returned to Boston Children's to complete his pediatric training. This included three months at Vanderbilt where a noteworthy event established his reputation as an astute clinician. When testing for meningismus by flexing the neck of a child with perplexing manifestations of the Guillain-Barre syndrome, he felt a small lump over the child's occiput. Removal of this lump (a tick) resulted in prompt cure of this case of tick paralysis, thus gratifying the family and the child but not the tick, which Fred had silver-plated as a memento. His clinical skills persisted; at Cleveland City Hospital on rounds it was astounding to watch a child with high fever of unknown cause defervesce and the rash of roseola pop out just as Fred appeared at the bedside.

Upon completion of his pediatric training, Fred spent three and one-half years in the infectious disease research laboratory at the same hospital working with Drs. John Enders and Thomas Weller. Their successful cultivation of poliomyelitis viruses in tissue culture resulted in the award of the Nobel Prize in 1954. Their achievement was a notable contribution to the public health for three major reasons.

1. The ability to grow polioviruses in tissue culture facilitated diagnosis of the disease, epidemiologic studies, and assessment of serologic immunity.

2. It enabled the development and production of the inactivated (Salk) and live, attenuated (Sabin) poliovirus vaccines. Use of these vaccines has eradicated poliomyelitis from the Western Hemisphere and it is anticipated that worldwide eradication will be achieved.

3. The methods developed by Enders, Robbins and Weller were adapted to other infectious viruses in similar ways, and opened up avenues to their control. Thus, their achievement opened the door to a new era in immunization.

Small wonder their work received the Nobel award. A sidelight of the trip to Stockholm was that, in deference to Dr. Enders, who felt he had exhausted his luck in the air as a World War I pilot, the group went to England on the Queen Mary and then across the North Sea aboard a small steamer during a wild storm. After recovering from grade IV mal de mer, Dr. Enders decided to ignore his wartime experiences and fly home, which the group did.

However, by the time he received the award Fred had been at Cleveland City Hospital (now MetroHealth Medical Center) and Western Reserve University (now Case Western Reserve) for more than two years. In what might be described as sort of a package deal, his close friend, the late Bill Wallace, and he came from Boston together to head the departments at B&C and City respectively. In 1952, when Fred " arrived, the department at City was being held together single handedly by Bob Eiben, which was no easy task. There was no approved pediatric residency at City; the wards (and they were wards) were staffed by rotating interns and three-second year residents from B&C who served six months at City. There were about 3,500 newborns annually, and a pediatric clinic that (fortunately because of the staff size) met only two afternoons a week. The department had about 1,000 admissions annually, about half to the polio divisions in Toomey Pavilion.

Within a year, Fred established an approved pediatric residency program, which soon attracted top-notch house staff. Additionally he recruited a very compatible group of productive young faculty whose careers he guided, stimulated and fostered in his quiet way, often without their knowing it. The 14 years during which he led that department were most interesting, productive and enjoyable for his faculty, to say nothing of students and house staff; this type of contribution is never reflected in an antiseptic CV.

Some of Fred's other achievements are not evident in his CV. How many people know, or remember, the origin of the Child Life and Education Programs that exist in most children's hospitals? As part of Toomey Pavilion 40 or so years ago there was a children's TB unit housing up to a score of kids whose home situations did not provide assurance that the prescribed chemotherapy would be administered. There was little or no stimulation for these otherwise healthy kids; certainly, it could not be provided by the bare bones nursing staff. The fact that the only medical care needed was for a physician to drop by once a week and order an x-ray every month or so inspired Fred's idea that the unit might better be run like a full-time nursery school. Accordingly, with a little grant support. he recruited Emma (Nuschi) Plank. a highly trained nursery school teacher, and placed her in charge of the unit with the physician serving largely as a medical consultant. As is well known, the idea worked, and soon it was adapted to the general pediatric divisions as well, in spite of their medical exigencies. Soon Nuschi trained others to work with her and elsewhere, and the idea spread. The impact that these programs have had on children in hospitals is immeasurable.

Another little recognized accomplishment at City (ultimately "Metro") was the teaching program that he fostered. He established a "teaching resident" program in which the two third year residents each spent six months as the service resident and six months parenting the students. He was one of the first pediatric department heads to recognize the importance of outpatient care; he insisted that all faculty (including himself) precept in the general clinic at least once weekly. Further, he made a practice of strolling through the clinic every day, perhaps to check whether assigned faculty were there. A unique innovation was the installation of an incubator with media on hand in the house staff lab in Toomey Pavilion. House staff inoculated cultures and each morning the resident assigned to Toomey Pavilion reviewed the cultures with a faculty member. They were then sent off to pathology so they could bill for them. One reason for reading them before sending them was that the bacteriology lab in the pre-Wolinsky days was unable to distinguish strep from pinworms. Residents found doing their own cultures sufficiently interesting that several set up their own labs in their offices.

One of the unique aspects of the 14 years that Fred was at City-CMGH was the close relationship that he and the late Charles Rammelkamp established between internal medicine and pediatrics. There were joint conferences, cooperative research efforts in a variety of areas, and closer relationships between internal medicine and pediatric faculty than those that exist among faculty in the same department in many institutions today.

As a teacher, Fred developed his own style, which is a variant of the Socratic method. On rounds or at seminars he simply asks questions. At City many students and residents, accustomed to spoon-fed expositions of knowledge analogous to cadenzas, were at first perplexed by this approach. Indeed, they thought he didn't know anything, which was certainly true in some areas, such as cardiology or dermatology, but they soon realized and appreciated the fact that he was trying to make them think.

As Dean, he conducted the affairs of the School in a unique way. His office was wasted space; it is said that he transacted the business of the School in the hallways and over the lunch table. This is still his habit.

As may be seen from the appended more formal synopsis of his career, at the IOM and subsequently his influence has been felt in broader areas, including health policies here and elsewhere.

It is important to note that Fred was one of the first people at this School to emphasize the importance of relating to the community in which we exist. Indeed, he did this at a time when it was not academically respectable. His relationships, then and now. contribute greatly to the credibility of the School.



Frederick Chapman Robbins, M.D.