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Benjamin Castleman (1906–1982) Robert E Chapter Benjamin Castleman (1906–1982) Robert E. Scully enjamin Castleman (fi gure 8.1) was born Dr. Mallory assigned two projects to his pupil: Bin Everett, Massachusetts, on May 17, 1906, the fi rst a study of carcinoid tumors in the ileo- the eldest of three sons, to religious Jewish par- cecal region, and the other the organization of ents who had emigrated from Russia and owned specimens that had been fi xed in jars in a confer- a small grocery store. Th e family soon moved ence room. Dr. Mallory was impressed with Dr. to Dorchester, Massachusetts, where, as a teen- Castleman’s work on his projects as well as his ager, he worked, contributing his income to sup- popularity with other personnel in the depart- port the education of his younger brothers, who ment. Upon graduation from Yale Medical became lawyers and moved to Detroit to join a relative in a legal fi rm. After high school, Castleman worked his way through Harvard College, gaining entrance despite the quota for Jews in existence at the time. He was unsuccessful, however, in his attempt to enter Harvard Medical School (HMS). Having a prosperous relative in New Haven with whom he could live, he applied to and was accepted by Yale Medical School, where he excelled. His idol and champion there was Dr. Milton C. Winternitz, Chairman of the Pathology Department and later Dean of the medical school. Eager to return to the Boston area to practice medicine, Dr. Castleman volunteered to spend the summers of 1929 and 1930 as an unpaid assistant in the Pathology department at the Massachu- setts General Hospital (MGH). He was accepted by Dr. Tracy B. Mallory, Chief of Pathology at MGH (see chapter 5). During his second year as a volunteer, he had an attack of rheumatic fever; there was no evidence of residual cardiac damage, according to Dr. Paul Dudley White, to whom he had been referred for evaluation. Figure 8.1 Benjamin Castleman 116 pathology_chap8.indd 116 8/16/11 10:15 AM Benjamin Castleman (–) School, Dr. Castleman applied to the MGH research. (Subsequently, residents doing autopsies for an internship in pathology, and at the same were required to locate all four parathyroids and time to Peter Bent Brigham Hospital and Johns submit them for microscopical examination.) Hopkins Hospital for a medical internship. Two In 1935 Drs. Castleman and Mallory coau- months before he was to report to the MGH, thored the classic 73-page paper on the pathology he had a second attack of rheumatic fever, this of the parathyroid glands. Th is paper was the fi rst one with arthritis of the left elbow and an apical of many published throughout Dr. Castleman’s systolic murmur. He apologized to Dr. Mallory career that covered various areas of pathologic because of his illness and expressed his eagerness anatomy. to get back to work, but Dr. Mallory delayed his Th e most memorable of his publications were: return and convinced him that he should pursue • Th ose on parathyroid disorders, about which a career in pathology instead of medicine because he wrote many articles and two Armed of his heart disease. He trained at the MGH from Forces Institute of Pathology (AFIP) tumor 1931 to 1935. fascicles, the second with his coauthor San- In 1935, Dr. Castleman joined the MGH staff ford I. Roth (MGH). as an Assistant Pathologist. About that time he • Th ose on diseases of the thymus and medi- began to court his future wife, Anna Segal, who astinum, about which he wrote an AFIP was four years younger than he. She was also the tumor fascicle. daughter of Russian immigrants, who were pros- • perous friends of his parents; she had graduated A paper with V. Pardo (Cuba) and L. Iverson from Wellesley College in 1934. Ben and Anna (AFIP) on a newly recognized lymph node agreed to stop dating until he earned a salary disorder that led to the eponym “Castleman’s of $4,500, which he attained in July 1937. Th ey disease,” and a later paper senior-authored by were married in December of that year. Anna Albert R. Keller (MGH) reviewing 81 cases of was a charming, attractive woman who adored the disease and dividing them into hyaline- her husband; she was well known to his friends vascular and plasma cell types. (including his staff , residents, and fellows) as a • Coauthorship with S. H. Rosen (AFIP) and gracious hostess. Th e couple had three children, A. A. Liebow (Yale Medical School) of the a son, who graduated from Harvard and became initial description of alveolar proteinosis. a medical computer entrepreneur, and two well- • Coauthorship with David Korn (MGH) educated daughters, one of whom married a and others of a paper fi rst reporting multiple physician who became Professor of Medicine at minute chemodectomas of the lung. Jewish Hospital in St. Louis, and the other who • Coauthorship with A. A. Liebow (Yale Medi- married a space physicist in Florida. cal School) of a paper describing initially Preparation for Dr. Castleman’s fi rst major multiple clear cell (sugar) tumors of the lung. paper began when he was still a resident. Dr. • Edward D. Churchill, Professor of Surgery, asked Many articles on the clinicopathological Dr. Mallory to appoint a resident in pathol- features of pulmonary vascular disorders, ogy (Dr. Castleman was selected) to locate and some written with the renowned radiologists remove all four parathyroid glands for micro- Aubrey O. Hampton and Felix Fleischner scopical examination during 30 autopsies, in col- (both MGH). laboration with Dr. Oliver Cope, the surgical res- • Coauthorship, mainly with R. H. Smithwick ident chosen by Dr. Churchill. Th e two residents (Boston University) of multiple articles on became close friends and later collaborators in essential hypertension, proving that renal 117 pathology_chap8.indd 117 8/16/11 10:15 AM Keen Minds to Explore the Dark Continents of Disease arteriolosclerosis is secondary to, instead of another great pathologist, Dr. Lauren V. Acker- preceding and causing, the hypertension. man (Washington University, St. Louis). Th eir • A paper senior-authored by William M. opinion was eventually deemed incorrect by a Th urlbeck (MGH) reporting a high inci- great majority of pathologists and surgeons. dence of atheromatous emboli to the kid- Many of these papers were written in the 23 ney after aortic surgical operations, which years (1951–1974) during which Dr. Castleman resulted in improvements in surgical tech- was editing the Case Records of the MGH, which niques accompanied by a greatly improved were published in the New England Journal of survival. Medicine (NEJM). Being Editor usually included • A series of papers on diseases of the heart and presentation of the pathological fi ndings of the aorta, coauthored by P. D. White, Edward case in addition to presiding at the exercise and Bland, and other MGH cardiologists, review- editing the recorded version of the discussion. ing large numbers of cases of various disor- During his years as Editor, Dr. Castleman par- ders, mostly confi rming previous fi ndings ticipated in almost 1,200 cases. His feats as Edi- in the literature rather than presenting new tor were celebrated in an NEJM editorial entitled observations. “Ben Castleman—Champion of the CPC” (1). • After Dr. Mallory’s death in late 1951, Dr. Coauthorship with Richard R. Kelley and Castleman initially became Acting Chief of Fairfi eld Goodale (both MGH) of an article Pathology. In 1953 he became the offi cial Chief on the dynamics of rheumatic and calcifi c of Pathology at MGH (fi gure 8.2). As chief, Dr. (Th e article was based aortic valve disease. Castleman was responsible for naming the hos- on construction of a machine into which a pital’s pathology laboratories when they were human heart could be inserted and made moved into a newly constructed building facing to contract, simulating contraction of a the Charles River in 1956. Before the move, he heart in vivo). Motion pictures of normal had reviewed Dr. James Homer Wright’s great human hearts as well as those with valvular contributions to pathology and medicine and abnormalities were made. Th ese movies were suggested to the hospital Trustees that the entire widely used at HMS and elsewhere in teach- building be named in Dr. Wright’s honor, but ing cardiovascular pathophysiology. the Trustees preferred that the Warren family • Papers on medical education, mostly dealing receive that honor, and that the new laboratories with the use of clinicopathological confer- be named the James Homer Wright Pathology ences (CPCs) for teaching medical students, Laboratories. A spacious library on the second residents, and senior physicians. fl oor was named the Tracy Burr Mallory Memo- Dr. Castleman also authored the proceed- rial Library. ings of two prestigious slide seminars (the 50th Th e move to the new building also marked Dr. Anniversary of the American Society of Clini- Castleman’s establishment of two annual post- cal Pathologists Seminar and the Penrose Hos- sophomore fellowships, during which a student pital Slide Seminar). In these sessions he and spent half a year at MGH in diagnostic pathol- other experts discussed in detail 50 and 15 cases, ogy, and the other half in research. Th e program respectively. yielded many leaders in pathology, oncology, and Objectivity requires the admission that Dr. research, including one Nobel Prize–winner (J. Castleman coauthored four papers on large- Michael Bishop). intestinal adenomatous polyps, concluding that It is a testament to Dr. Castleman’s remarkable they were not premalignant, a view shared by drive and work ethic as chief of the department 118 pathology_chap8.indd 118 8/16/11 10:15 AM Benjamin Castleman (–) Figure 8.2 Benjamin Castleman in the chief’s offi ce, Warren Building (Photo courtesy of Fairfi eld Goodale) that he was so productive a medical author and his wit was not as subtle as that of his audience.
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