By Stanley Schrier, MD
2009-07-01
In the fall of 1959, at the almost-regular meetings of the Bay Area
Blood Club in San Francisco, I first met Ralph Wallerstein. I was a
very new instructor in hematology at Stanford, and Ralph was arguably
the leading hematologist in the Bay Area with the academic rank of
clinical professor in medicine and laboratory medicine at the
University of California, San Francisco (UCSF). The competition between
Stanford University School of Medicine and UCSF was no secret, but
perhaps it had quieted somewhat because Stanford University School of
Medicine had just abandoned San Francisco to UCSF and moved onto the
main Stanford University campus adjacent to Palo Alto. With that
background I didn’t know what to expect from Ralph, but he was cordial,
and he became my colleague, my occasional collaborator (We were among
the first to identify the dwarf binucleate megakaryocyte in a patient
with MDS.), and, I hope, my friend.
I had a hard time pigeonholing Ralph; I even had a hard time
figuring out all the jobs he was doing. He was not a full-time
academician at UCSF, but I learned that he was then chief of hematology
at SF General (1952-1981) - a UCSF affiliate - and later chief of staff
(1968-1972) at the Children’s Hospital. Furthermore, he was a long-time
hematology consultant to the Letterman Army Hospital at the San
Francisco Presidio and consultant to the VA. But the biggest surprise
was to learn that his major and continuing activity was his private
practice in both general internal medicine and, increasingly,
hematology. On occasion we exchanged patients, and, invariably, I found
that they loved him. He was a strong believer in the importance of
morphology, was meticulous in reviewing the slides on all of his
patients, and probably was the first to identify one of the hallmarks
of chloramphenicolinduced aplastic anemia, the vacuolated normoblast.
He went on to publish an important epidemiologic study focusing on the
likely role of chloramphenicol in causing a very severe form of
aplastic anemia.
All of these activities were essentially local, limited to the Bay
Area and California. But Ralph had a drive to improve medicine on a
larger scale. He became interested in ASH early on at a time when I
think that ASH was struggling to find its niche. He convinced me to
join, and he became ASH president in 1978. I believe he was the only
ASH president who was essentially a full-time private practitioner. I
was his scientific program chair and got a close-up view of how he
worked. Bill Mentzer and I read all 782 abstracts and each of the two
reviews that were provided by outside experts. We then met with Ralph
and made our recommendations. We discovered that he had also read all
of the abstracts, and we spent an entire Saturday putting the annual
program together.
I think that his commitment to hematology got him interested in the
American Board of Internal Medicine (ABIM), which at that point was
branching out from accreditation in general internal medicine to
accreditation in the subspecialties. Ralph’s work on the ABIM was so
highly regarded that he was elected to the Board of Governors and then
became president from 1982 to1983.
Ralph never forgot that he started practice as a general internist,
and he continued to care for his earliest general medicine patients. He
became increasingly involved in activities with the American College of
Physicians and served as its president in 1988.
Ralph was born in Aachen, Germany, and left when the Nazis made
life difficult for Jews. He was closely related to the family of Ann
Frank; that branch had left Germany to live in Holland. He recalled a
visit to Aachen after the war and spending the afternoon with a high
school class answering the students’ many questions, including “Was he
bitter?” He said that he wasn’t. I never saw any sign of bitterness. I
saw a man devoted to family and to a larger view of our profession. I
never understood how he did it all and so well.
Those who knew Dr. Wallerstein are invited to sign his guestbook on the ASH Web site.
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