By Gustavo Montana, MD
Question: I have the pleasure, privilege and honor to interview one of the people that has made very significant contributions over the years to our specialty and to our society. This is Dr. Morton Kligerman. Klig, as we all call you. First of all, where were you born?
Dr. Kligerman: Philadelphia.
Question: Tell me a bit about your parents.
Dr. Kligerman: They were both born in Russia. Mother came here at the age of 3, my father at the age of 12. He became a farmer. His father and his several brothers ran the farm. It was the largest peach orchard in the Philadelphia area. Later he moved into the city and had a small grocery store. It was a small mom and pop store. And that is where I grew up.
Question: Did you have brothers and sisters?
Dr. Kligerman: Yes. I had two brothers and a sister. My older brother was a photographer and a manual training teacher in the public high schools. My sister was typical of that age. She was a secretary, married and had three children. I have a younger brother who is an electrical engineer.
Question: So you went to school in Philadelphia?
Dr. Kligerman: That is right. I went to the public schools. I received my BS at Temple and went to medical school there. I went to college during the depression, and if you got a certain grade average in science in the Temple College, you were admitted to medical school after three years. I happened to get all A’s in science. That saved a lot of money in those days.
Question: So medical school at Temple and then a master’s degree?
Dr. Kligerman: Yes, I received it when I was a resident in radiology. In those days, you had 18 months to two years in diagnosis and the rest of the time in therapy. But World War II broke out when I was a second-year intern. I had enlisted in the Army as a medical officer, but I was not called up. So I began my radiology training. At that time, radioactive phosphorous was just becoming available. Dr. Robley Evans controlled the cyclotron up at MIT. He placed the inactive phosphorous right inside the cyclotron, which produced a very high specific activity. I was lucky that the chief, Dr. W. Edward Chamberlain, chose me to use it under his supervision. The first patient was a child just a few months old with acute leukemia. This had 100 percent mortality in those days. During the treatment of that child I thought, ‘My goodness. Suppose I cure him and he does not grow?’ That thought made me do the research project for which I received a master's degree. I administered radioactive phosphorous to weaning and adolescent rats and compared the femoral bone growth with that in untreated controls.
Question: Along with your honorary degrees from Yale and Penn, I see you have an honorary degree from the New School of Music.
Dr. Kligerman: It is an honorary doctorate degree in fine arts because of the help I have given to musical organizations and schools.
Question: Klig, in terms of your professional life, you have devoted it to academic medicine. Essentially you started out at Temple as an instructor and then you soon went to Columbia. Tell me about Columbia.
Dr. Kligerman: When I got out of the Army in 1947, I came back to Temple for six months and was on the faculty there. The big hospital in those days was Columbia, and they needed a diagnostic radiologist. The chairman there, Dr. Ross Golden, asked my chief if there was someone he could recruit. I started working directly with Dr. Golden. It was a very big department. After 21 months, the man in charge of the radiotherapy clinic quit. Dr. Golden came to me and said, ‘Klig, would you go up and do the therapy on the clinic side because I will not be able to get anyone to fill that spot until July?’ I said, ‘Chief, I am a diagnostic radiologist.’ He said, ‘I know you are. But I want you to go up there and take charge of the training program.’ I said, ‘I do not know enough to take charge of a training program.’ He said, ‘In two years you will.’ In three weeks I knew I would never leave therapy.
Question: So you were at Columbia for 10 and a half years and then you went to Yale?
Dr. Kligerman: When I went to Yale, they did not have an academic department. The radiotherapy department was really a hospital service. Appointments and promotions came through the surgical department. Yale has always been known for its big research output. When they decided to create a radiology department, the search committee decided that therapeutic radiology would produce more good basic science than diagnostic radiology. That is why I was appointed director of the entire radiology department. I practiced, of course, as a radiation oncologist, radiotherapists we were called.
Question: You also had a very good pharmacology department at Yale.
Dr. Kligerman: Yes. Dr. Arnold Welch was the head of it. One of the reasons that I went to Yale was because of Welch. At Columbia, in 1952 and 1953, I began using chemotherapy combined with radiation therapy. My first papers from Columbia were on a combination of chemotherapy and radiotherapy.
Question: Klig, you were at Yale for a number of years and then you went to New Mexico to head the Pi Meson Project.
Dr. Kligerman: Yes, and to build a cancer center for the university. And, you know, Yale gave me an endowed chair, but I told the dean that if something better happens elsewhere, I would leave. I was told, ‘No one leaves Yale.’
The Pi Meson facility had been built at the Los Alamos Scientific Laboratory. Around 1964, an English scientist wrote an article saying that the optimal way to treat cancer should be with negative pi mesons. I served on the committee of the University of New Mexico, when it was planning its new medical school. The university selected five chairmen of clinical departments around the country to form this search committee. The man I suggested, Gil Brogdon, became the head of radiology.
Four years later, Brogdon asked me if I would head radiotherapy and the negative pi mesons facility. I said, ‘I am not leaving Yale, but I have a sabbatical coming up and I am willing to go out there, recruit people and get the pi meson program started.’
I was really very excited about Los Alamos. There were so many interesting projects. Howard Agnew was the head of the lab at that time. My wife, Barbara, loved the west. She would come home excited every evening after being taken around New Mexico and ask, ‘Have you accepted the offer?’ I said, ‘Barbara, I am not leaving Yale.’ By the third or fourth day, I was up in Los Alamos sitting in Agnew's office. I found myself saying, ‘You know, we could this with that; we could do this …’
Writing the grants, getting the money and designing the buildings was exciting. The last grant I put in was 1988. The sum requested was very large. The NCI sent 25 people to review us. One of the people who came out was Bob Goodman, my professional grandson. He was then chairman at Penn. He said to me, ‘You know you are crazy,’ He told me how old I was. I did not think I was old. He told me that I had never been paid adequately. He continued, ‘You know, I have a good department, but I have not got any elder people in it. Would you come join me and do whatever you want?’ I went back to Philadelphia, my home town. There I continued the preliminary work on the amifostine, which I started in New Mexico.
Question: One of the things that I noticed in reviewing your CV is that you have been president and gold medalist of ASTRO.
Dr. Kligerman: ASTRO owes its being to Juan del Regato. He started a club back in the fifties. Those of us who went to RSNA would have a luncheon meeting which Dr. del Regato arranged. Then we would have a few papers later on that afternoon as part of the RSNA meeting. Juan felt that we should not become a society too soon. First of all, there were not very many full-time radiation therapists. I think when I began radiotherapy full-time, there were others in this country, maybe a few more, practicing. The year I was president—1968-1969—Juan said it was okay to become a society. I appointed a committee, which was chaired by Luther Brady, to come up with a proposal for ASTR, the American Society of Therapeutic Radiology. The members of the club passed it. And that is when we became a society.
Question: Klig, when you began in radiation oncology, what was the role of the radiation oncologist in the decision-making management of patients?
Dr. Kligermn: In the 1950s and 1960s the number one person in cancer was the surgeon. There were certain areas where radiation was superior and the surgeons knew it, such as the larynx, mouth and cervix. However, we did all the palliation just like the medical oncologists do now. Patients died in our arms. We were on 24-hour call. We came in at any hour when the patient was sick in the hospital. We had our in-service beds and we took care of them. I think that is one of the things missing in our training today.
Question: What were some of the major events that propelled our specialty?
Dr. Kligerman: I think there is no question, the development of super voltage equipment starting with cobalt and then the linear accelerator and the betatron. They gave us a real step up. You know, if you tried to treat a lung tumor with ortho voltage, you got so much scattered that a large part of a lung was made nonfunctional. I think the development of super voltage, and the support which physicists gave us, started the new era. Added to this was the concern over the radiation effects of the atomic bomb, which led to the support of radiobiology.
Question: What was the status of training when you started?
Dr. Kligerman: There was two years of diagnosis and one year of therapy. Very often, therapy was skimped if a radiologist was needed to do diagnosis. The only person that I can remember in this country doing training only in radiation oncology was Juan del Regato. He trained a good number of people who are alive and working today. He deserves a lot of credit for that.
Ken Endicott was head of the National Cancer Institute in the late fifties and sixties. Henry Kaplan got his ear and convinced him that something ought to be done about radiation oncology. Patients were not getting the benefits that radiation could offer. A meeting was called in a suburb of Chicago—Highland Park. There were 10 radiotherapists, one radiation physicist and one statistician. And we argued and argued about what we needed to develop to bring radiation oncology into a full clinical, academic and research specialty.
Eventually the vote came that we needed to do something about broadening and deepening radiation therapy. And out of that a white paper was produced, and that said we had to have special support from NCI to develop radiation therapy and the sciences of radiation therapy, which would be radiation physics and radiation biology. And that is when radiation therapy began in this country. And, like I said, it was 1961 or thereabout. Eventually, after many hot moments of debate, it was agreed that deepening and broadening radiation therapy was a must. With Henry Kaplan as the chair we produced a "white paper" that the specialty needed special support from the NCI to develop radiation therapy and the sciences that support it, namely radiation physics and radiation biology. The time was 1961-1963, and the NCI agreed.
Question: Are there any things you would like to see training programs do?
Dr. Kligerman: A lot of my best friends disagree heartily with me, but I feel that our specialty and especially our training programs need an in-patient service. We should have a few beds for which we are responsible and in which we take care of patients. In many places, our patients must be admitted to the medical oncology or surgical in-patient service. These are patients coming in for radiotherapeutic treatment. I think that this is wrong. We lose the confidence of referring physicians. We lost a lot to the medical oncologists when we gave up our role as the doctor for advanced patients.
Question: Is there a study that you would say is your most important contribution to our specialty?
Dr. Kligerman: Well, I think I was one of the earliest persons to be interested in the combination of chemotherapy and radiotherapy. My first clinical paper on combined treatment was 1953. I had coauthored such papers before that. Chemo-radiation has really developed well. I was also interested in radiation protection. When John Yuhas and I got started on the clinical use of the radioprotector WR2721, my original suggestion to him was to combine a radiation sensitizer and a radiation protector.
We only did one animal experiment on that and that one did not work out too well. I think our design was not as good as it should have been. Of course, I did keep plugging away at amifostine clinically and that did come out to be worthwhile.
Question: I would add one thing to your many, enormous and significant contributions, that is your philosophy about training programs and your philosophy about the patients; your concern and your great interest in the welfare of the patients; and your effort to do the best that you could for the patients. I want to thank you on behalf of our society, on behalf of the History Committee and on my own behalf for being here today for this interview.
Dr. Kligerman: Well, thank you. It has been fun.