Council on Children with Disabilities:
Arnold J. Capute Award

2005 Capute Award Recipient

Pasquale J. Accardo, MD, FAAP

Dr. Accardo’s remarks on receiving the Arnold J. Capute Award:

I was at a crab feast last Sunday, and as I took one crab in each hand to compare their respective weights, my wife commented, ‘Doesn’t this remind you of Arnold?’ Yes, one of the more important lessons I learned from him was that life is too short to waste precious time cracking a light crab. It was his version of Sutton’s Law.

I would like to thank the Council on Children with Disabilities of the American Academy of Pediatrics for this award. To receive an award named after Arnold Capute is an honor; to be numbered among its distinguished past recipients is an additional honor.

I was born in the 1940’s, raised in the 1950’s and by all accounts should have been a child of the 1960’s. Through some fluke, however, the 60’s pretty much passed me by. I successfully avoided the draft - by enlisting.

I actually wrote my first book when I was in college (an unlucky omen). Thank God it was never published. How embarrassing it would be if that feeble first effort were still floating around somewhere out there. Several chapters of the book did however get published in a journal; a few years later that journal folded. Perhaps that was another sign of things to come. My first medical text book, Mental Retardation with Arnold Capute, was published by University Park Press - which promptly folded after our fourth series volume with them, and more recently I had a long-running series of books with York Press - they closed shop with our book on Early Intervention earlier this year. I need to categorically disavow any causal association between my submissions to these publishers and their subsequent disappearance from the scene.

I probably owe the direction of my medical career to industrial lead and mercury. As a child I used to chew the paint flakes off the windowsills. I have often remarked to professionals working with lead poisoning, that not only is lead-based paint easier to apply but from a child’s point of view it is quite sweet. When I was completing medical school, the impact of that subclinical lead ingestion presumably restricted my specialty choice to pediatrics.

Growing up in an immigrant family, we ate a lot of fish. A half century ago, fish was the food of the poor; the well-to-do ate meat. Presumably the fish led to the buildup of a mercury level that in turn contributed to a personality profile much more compatible with developmental pediatrics. In my generation, it was not uncommon for developmental pediatricians to be themselves developmentally, at the very least, ‘peculiar’.

My first formal exposure to child development was via a lecture during my pediatric clerkship. I do not recall the name of the speaker, but he made mental retardation seem clear, interesting, and challenging with regard to both diagnosis and management. Like many exposures to development it was far too brief and isolated to have any lasting impact.

I recall as a pediatric intern standing at attention on morning rounds where a deep ethical discussion was being entertained at the bedside as to the advisability of using antibiotics to treat a case of infant pneumonia. Could the use of antibiotics possibly be justified in prolonging the ‘suffering’ of a baby with Down syndrome? I began to understand that such highfalutin pontifications were not related to the real world. I had grown up in a neighborhood where a young man with Down syndrome was a non-suffering part of the community. Whatever their ethical principles, these people just didn’t have their facts straight.

In 1974 while I was completing my pediatric residency, I attended two educational sessions on what was then a ‘hot topic’: “Sterilization and the Mentally Retarded Child”. (There was no person-first language back then.) One conference was a regional one held at Indiana University, the other was a seminar at the annual AAP meeting. What struck me was that in all the case presentations (by child psychiatrists) not a single child they discussed was actually mentally retarded. Multigenerational problem families, children with challenging behaviors, learning disabilities, school underachievement – but all with IQ scores that were quite clearly not in the range of mental retardation. I was just a lowly pediatric resident, but these speakers didn’t have a clue!

I worked with my first severely retarded child while on a Strategic Air Command base in central Ohio. An infant had been treated in our emergency room for an ear infection by our ENT surgeon. About a week later his partially treated and smoldering meningitis was diagnosed, but he was left mildly to moderately retarded. Back then the Red Book counseled against immunizing children with ‘brain damage’. So at 18 months he developed measles encephalitis that left him severely to profoundly retarded. I remember working with a very skilled mother who would carefully titrate the drops of Mellaril suspension to control his challenging behaviors. (This was pre-behavior modification and Functional Behavioral Assessments) I learned that mothers know best and that what the PDR called lethal doses weren’t necessarily so.

I completed my pediatrics training at Riley Children’s Hospital in Indianapolis where I had the pleasure to work with Gail Landy and Sterling Garrard. In those days most developmentalists were focused on single disorders rather than the broader spectrum of disabilities. Gail was into hearing impairment and autism; Sterling was a national expert on mental retardation. I learned that Gail knew autism but could not operationalize what she knew – we were a long way from anything approaching symptom checklists. I learned from Sterling that any discussion of the ethics of mental retardation was also a discussion of the theology of mental retardation: he said that whenever he presented the facts about mental retardation, he felt like he was preaching a sermon. Being essentially a stick-in-the-mud, I would have liked to stay on at Indiana University, but they had only a single fellowship slot, and it was already taken by Jeff Alexander. Jeff was a wonderful human being whom I had the opportunity to work with for almost a year; all those who knew him were taken aback by his sudden tragic death in a hiking mishap at a much too early age.

Meanwhile I went searching for a training program and found one in Baltimore. My first experience driving in to Hopkins from the airport was something of a shock. In the early 70’s the city had not yet recovered from the riots of the late 60’s and gave a reasonable semblance of a European city that had been saturation-bombed by the Allies in WWII.

From the first time I met Arnold Capute, it was readily apparent that he was a ‘character’. I do boast that I was probably the only fellow applicant in the 70’s who brought up “primitive reflexes” to him; I had read my Illingworth carefully. I have always suspected that that is what got me the fellowship position. That, and the not unimportant facts that I was breathing and willing to drive into Baltimore.

In 1994 I edited a Capute Festschrift for Clinical Pediatrics. My contribution was an essay on “Arnoldisms”. Some of these include:

Most of the rest of my history is fairly public and it would be ingenuous of me to review it here. I do confess that when people ask for a brief biographical sketch with which to introduce me as a speaker, I sometimes offer them two: one is the standard boilerplate academic summary. The other is a bit different:

Dr. Accardo has published two volumes of poetry, a novel and several short stories. He has written extensively on Sherlock Holmes (including, to date, a half dozen books), and four volumes on GK Chesterton - including the definitive Complete Annotated Father Brown. He has published a book on Dante, a volume on fairy tales, and several works on medical history. His translations range from Sigmund Freud to a play from Spain’s Golden Age by Pedro Calderon de la Barca. Incidentally he has made several contributions to the field of developmental pediatrics.

There is one striking difference between these two bibliographies. In the non-medical one, almost all the entries are single-authored; in the medical one, almost all the entries have multiple authorship. In no field is it so apparent that one never works alone, that any significant achievement is the result of teamwork. I was astounded when I reviewed my CV at the wide variety of professionals – mostly leaders in the field - with whom I have had the privilege of working over the past quarter of a century. (I don’t normally bother to read my own CV, but I recently came up for tenure and had to restructure the document according to university guidelines.)

I took the liberty of drawing up a list of co-authors and co-editors – not everybody, just the ones to which I could readily place a face - professionals with whom I published a book, paper, chapter. Not everyone- or we’d be here all afternoon…

The list is in almost alphabetical order with two exceptions:

Alphabetical Order Exception # 2: Jennifer Accardo

When One see toys that you played with (and destroyed) as a child or dishware off which you ate (and broke) as a child being sold as ‘antiques’, it gives one pause. When you realize you are a becoming a part of ‘history’, you begin to feel old. I suppose that a number of things I have been involved with might contribute a short chapter in the history of medicine: the Primitive Reflex Profile, the Capute Scales, the sub-board endeavor.

Encyclopedia Britannica, 1967: “The history of medicine is not a branch of medicine; it is medicine itself….its study enables one to recapture in some degree the broad outlook of the early days, when a physician was also a philosopher.”

Some of you may not have been amused at my earlier facetious remarks about lead and mercury. Recently I went back and read completely a rather huge work that I had previously sporadically dipped into over many years - Lynn Thorndike’s History of Magic and Experimental Science. Fascination with the purported properties of lead and mercury goes back literally thousands of years as documented by innumerable anecdotal reports and observations. Whenever I want to argue against parents’ over reliance on such anecdotal reports, I remember that most of the lessons I have learned came from specific parents and unique cases.

If fifty or a hundred years from now someone interested in writing a history of developmental pediatrics were to investigate its subspecialty certification approval process - a historical oddity if only by its duration of nearly a quarter a century, I suspect the narrative might resemble that of the Vietnamese War: people will disagree as to who won and who lost, whether the debate was at all worth the sacrifice, how we were all really after the same thing, and how time has erased all differences. Such a postmodernist deconstruction of history lies somewhere between a fairy tale (remember I wrote a book on fairy tales) and a lie. What would be lost in such a pseudo-history would be the courage, the perseverance against odds, the refusal to be beaten down by repeated failures, weathering deliberate if not diabolical misunderstandings, the impugning of motives, and numerous other ad hominem criticisms – in short, everything that makes human history a great adventure, and everything that Arnold Capute so eminently represented.

Having mentioned poetry before, let me close by subjecting you to a brief sample not entirely inappropriate to our meeting here today. I had the privilege of writing a biographical sketch of Arnold Capute for the Journal of Child Neurology last December. I closed it with the following lines – that I am certain would have irritated Arnold no end:

If I ever go back to Baltimore
In the state with Mary’s name
I will meet no more the master
Of infant reflex fame.

CAT and CLAMS posilipo
Were his favorite measures
Henri Matisse and Montrochet
In blue jay blue his treasures.

When spastic and crippled children
Were reclassified DD,
He pioneered a new field
For the spectrum NDD.

Higher cortical dysfunction
A continuum he read:
Of this Straussian subspecialty
He became the honored “head”.

From the sacred halls of Hopkins
His loyal soul is gone
To live in the hearts of his students
And the Heart of Mary’s Son.

It is an honor to receive an award named for Dr. Capute. It was a greater honor to have been trained by him, to have worked with him, to have been his friend, to have known him. Thank you.

Congratulations Dr Accardo!