Polio Wars

by Rogers, Naomi

  Perhaps as a result of such confusion among experts or the power of public support Kenny’s influence expanded. With the support of Billy Hughes, the federal minister of health, and a wealthy philanthropist, she had set up a clinic attached to the Royal North Shore Hospital in Sydney that was in Hughes’ constituency.65 Now the New South Wales minister for health, citing evidence that North Shore patients had shown “improvement,” opened the state’s second Kenny clinic at Newcastle Hospital.66 Most importantly, the Queensland government offered Kenny control of Ward 7 at the Brisbane General Hospital. It was highly unusual to have a nonphysician in charge of inpatients at a large city hospital. As one Brisbane physician later recalled, she “wasn’t under anybody” and she reported directly to the minister of health.67

  Kenny’s success in Brisbane was partly the result of alliances with influential administrators. Abraham Fryberg, for example, who had directed Kenny’s George Street clinic in 1936, continued to support her after he joined the Queensland health department.68 An even more powerful ally was Aubrey Pye, a prominent surgeon who directed the entire Brisbane Hospital complex. During the late 1930s Pye became the gatekeeper for every clinical demonstration she sought to make.69 Pediatric surgeon Felix Arden, the director of the Children’s Hospital in the Brisbane Hospital complex, whose own father was in a wheelchair, was sympathetic to the difficulties faced by physically disabled people. Arden asked parents whose children were sent to the Children’s Hospital if they wanted Kenny or orthodox methods of treatment. If they expressed no preference he alternated the patients fifty/fifty.70 Elsewhere Kenny’s clinics received far less administrative support. At the North Shore hospital her outpatient clinic, housed in the basement of one of hospital buildings, was visited by neither the hospital’s medical director nor the hospital residents. Other clinics suffered similar neglect. But this disregard afforded Kenny and her staff complete clinical control.71

  In a series of lectures and clinical demonstrations at the Brisbane hospital a more confident Kenny began to articulate bolder claims. Not only did splints worsen muscle spasm, she argued, but the use of iron lungs could harm patients, even those with serious respiratory paralysis. She shocked hospital physicians by taking one child out of an iron lung and treating him with hot packs. The child did not die and learned to breathe on his own.72 Her efforts to explain how her methods worked were less successful. She argued that the conditions created by immobilization—lessened circulation, poor nutrition of the skin, increased joint stiffness—led to diminished nerve impulses. Immobilization also interfered with “the normal function of the subconscious mind” and gave patients “an adverse psychological outlook.” The principles of the “orthodox system” were, she said, the opposite of the principles of her system of treatment. If muscle spasm was unrecognized and untreated the consequences were dire. She spoke awkwardly of maintaining “maximum vitality and volitional control” through an “efficient” circulatory system that allowed a patient to maintain an uninterrupted stream of “neural impulses.” To explain why some patients found it difficult to move muscles that were no longer in pain or spasm she began to use the term “alienated” or speak of “a state of diminished awareness of the affected parts.” Convinced that he no longer had any control over paralyzed muscles, the patient lay in bed “frightened to move or [to] permit anyone to move him.”73 Other than neuroanatomist Herbert Wilkinson whose foreword in her 1937 textbook had speculated on the functioning of motor neurons and muscle fibers, Kenny found that none of her Australian allies could explain why her methods worked.74 She was sure that somewhere experts would know how to explain them.

  Kenny was convinced that polio care must be practiced her way. Changing the way polio care was practiced, she recognized, involved a vast array of cultural and social resources, not just a few clinics and a handful of medical allies. It also required changing how clinicians understood the pathophysiology of polio. Despite her use of unorthodox methods, Kenny’s broader view of clinical change was based on a strong faith in scientific explanations to gird her clinical work and lead physicians to adopt it. Investigations by “men of science,” she hoped, would lead physicians to take seriously “the signs and symptoms… previously left unnoticed and unattended.”75 Aware that some nurses she had trained were returning to institutions full of antagonistic colleagues, she urged hospital officials to recognize them as specialists in the “Kenny system of treatment,” perhaps with a special certificate to help them gain appropriate status in their hospitals.76

  In September 1939 Britain and Australia declared war on Germany and government officials paid more attention to readying troops than to domestic disease. Laudatory statements by physicians, Kenny discovered, were now “buried by war news.”77 After reading an admission in JAMA by a polio specialist that polio had no effective therapy, Kenny was sure that the United States, a country not immersed in the European conflict, needed her help.78 This idea was strengthened when Alan Lee, a sympathetic Brisbane surgeon, returned from a trip there and told her about the founding of the NFIP. Lee, who had spoken to Mayo Clinic orthopedist Melvin Henderson about his work with the foundation, urged Kenny to visit the Mayo Clinic.79 Pye, Fryberg, Wilkinson, and her other Brisbane allies helped organize her trip to America including Hanlon’s approval of £300 to cover the round-trip fare and a letter of introduction to the head of the NFIP from the Premier of Queensland.80 Without a clear idea about how American medicine worked, Kenny left for the United States, believing that American physicians would be more open than their Australian and British counterparts.

  A MEDICAL FRONTIER

  Kenny knew she needed to find an arresting way to sell her ideas without sounding like a quack. Attacks on patent medicine promoters and unorthodox practitioners were part of a widely publicized policy of the American Medical Association (AMA). Inspired by the German model of medical education and reinforced by education reformer Abraham Flexner’s 1910 Report, America’s physicians claimed to be social experts free of creed or partisanship. In theory, doctors in white coats were aloof from the commercialized world, although a number continued to appear in advertisements for cigarettes, patent medicines, detergents, and other products. The Great Depression had buffeted the stability of this medical culture. Many physicians who had seen themselves as independent businessmen were forced to consider other forms of work, including group practice, contract practice for a school system or a factory, or government health positions. Private practitioners retreated into their local medical societies and civic clubs, resentful of the privileges claimed by elite specialists at medical schools and teaching hospitals. Seeking a politics that would bind these groups across class and regional lines, the AMA held tightly to certain ethical guidelines defining professional legitimacy. One principle was the restriction on selling: no respectable physician should directly advertise his services to the public or claim any special abilities or techniques that would “cure” disease. How then could an unknown nurse promote a method that contradicted mainstream practice to a professional community in which selling had such base, shoddy implications?

  Kenny intended to demonstrate her professional respectability through her dignified appearance, her unusual accent, and written testimonials from Australian doctors and politicians. Her letters of introduction stated that she had made a distinctive “contribution” to polio care and that she had “given her services entirely voluntarily” and did not “seek personal gain.”81 They were mostly, however, written by unknown physicians, including government health officials who in both Australia and America were seen as partisan appointees. Kenny wanted a chance to demonstrate her method on paralyzed patients in order to convince American experts to try them, recognize their value, and call for the transformation of polio care everywhere. In seeking out NFIP officials and Mayo Clinic physicians Kenny sought formal, official approval of her work, something she assumed she would never get from leaders of the organized American profession if they were anything like the elite phys
icians she had encountered in Australia. She hoped that a polio philanthropy would be less beholden to the medical establishment and that her Brisbane allies’ personal connections to Mayo specialists would give her an opportunity to show her methods in a more welcoming atmosphere than Australian specialists had provided.

  Kenny’s appeal also drew on a popular notion of the open-minded American. Just as science popularizer Paul De Kruif imagined scientists hunting microbes and fighting hunger and death, so Kenny saw the American physician as a kind of frontiersman.82 This stereotype drew on the antielitist heroes she had seen in Hollywood movies at the Brisbane cinema, where she had often escaped from professional tensions during the 1930s. Cinematic heroes were courteous to ladies, strangers, and even friendly Indians; they were receptive to challenge and quick to adapt unusual technological means to achieve their mastery of nature and fight against evil. They laughed at orthodox conservatism, and achieved love and riches by ignoring or conquering it. Doctors in this distinctive culture, Kenny believed, had that “quality which has put the United States in the forefront in almost every department of science—that is, an eagerness to know what it is really all about, in order that he may not be the one left behind if there is something to it.”83 Kenny was an innovator; this new audience valued—perhaps even preferred—the new and improved.

  Kenny had been certain that in the United States, as in Australia and Britain, there was a polio orthodoxy she would need to identify and challenge. Before O’Connor returned to New York, she was invited to the NFIP headquarters at 120 Broadway to meet Peter Cusack, the NFIP’s executive secretary. Greeting her “with the utmost courtesy” Cusack “showed interest” in the material Kenny gave him and in return gave her Bulletin No. 242, a Public Health Service pamphlet on polio care written by physical therapists Henry Kendall and Florence Kendall. This pamphlet, which Kenny studied “carefully,” had, as she saw it, the combined formal approval both of the nation’s medical establishment and its federal government. The Kendalls argued that weak muscles must be protected from fatigue, shortening, and overstretching by the use of splinting and rest to maintain joints in a neutral position.84

  In approaching American physicians, Kenny faced a fundamental strategic decision. Should she present her work simply as an improvement to rehabilitative therapy, or should she claim that orthodox polio care was based on a flawed understanding of the disease? In 1940 Kenny did not really have a well-developed theory of polio. She spoke of distinctive clinical signs that only she had recognized, and warned that if they were not treated patients would be left deformed. She knew her method was distinctive, indeed opposed to elements of standard care.85 Recalling conservative Australian physicians who saw her as an ignorant upstart she came to believe that only the boldest approach would allow her to open eyes and change minds.

  Kenny’s sense that there was a single, approved method of polio care in the United States was intensified at another meeting with physicians at the Ruptured and Crippled. As she read a paper on her work, “the look of something like boredom” spread over their faces. Some of the men, she recalled later, took naps as she talked, and “one member of the group with a cartoonist kink amused himself by drawing an outline of my features on his cuff.”86 This kind of disdain and ridicule was familiar to her; it had occurred during her demonstration at the Brisbane General Hospital in 1933. Her suspicion that minor NFIP officials were trying to get rid of her before O’Connor returned was reinforced when Cusack urged her to leave New York and go to Chicago to speak to the head of the AMA’s Council on Physical Therapy. Reflecting on her many antagonistic experiences with Australian physicians, Kenny had planned to avoid the headquarters of the AMA and turned down Cusack’s proposal.87 She was, however, willing to test the openness of New York’s scientific establishment, and using a letter of introduction she began explaining her ideas on the phone to a prominent research worker. She had not gone far when this man (probably Thomas Rivers, a prominent virologist at the Rockefeller Institute who was the head of the NFIP’s advisory committee on scientific research) advised her to follow Cusack’s advice, adding, “I do not think I wish to meet you.” Unable to curb her “nerves and temper” Kenny retorted “I do not only think I have no wish to meet you. I am sure of it.” So, she reflected later, “ended my first effort to make contact with a research institution in the United States.”88

  POLIO PHILANTHROPY

  Kenny now had an introduction from the NFIP to a Chicago specialist in physical medicine as well as introductory letters from Australia to physicians at the Mayo Clinic. In New York she had faced disdain, condescension, and dismissal. But nonetheless she stayed there instead of traveling west. What was she waiting for?

  The NFIP, as Kenny shrewdly recognized, was becoming a crucial institution in funding polio care. Formally incorporated only 2 years earlier, it was in the midst of reshaping itself into what became a model for all voluntary health agencies: a sophisticated disease philanthropy committed to funding research, professional training, and patient care on a national scale. Yet it had already had to weather accusations of corruption and dangerous experimentation. Roosevelt had bought the Warm Springs resort in 1926 and established the Georgia Warm Springs Foundation (GWSF), a nonprofit corporation to help him raise funds for it. Both the GWSF and the resort had been accused of corruption and racism, and had been tied too closely to Roosevelt’s own political fortunes. The GWSF, further, had become a forum for activist polio survivors who, inspired by their community at Warm Springs, attacked the widespread neglect of patients with polio and other disabled Americans. Calling themselves the Polio Crusaders, the group had called for expanding the rights of the disabled. By 1933, however, Roosevelt’s presidential advisors realized that disabled children were more appealing and far less dangerous than vocal adult subjects. A new fundraising organization based around the president’s birthday subsumed the GWSF and removed disability rights from its national agenda. Despite efforts by the newly established Birthday Ball Committee to encourage local communities to expand their own centers, Warm Springs continued to be considered a national center for polio rehabilitation.

  An even more dramatic setback occurred in 1935 when a polio vaccine supported by the Birthday Ball Committee led to the paralysis and death of 11 children. The vaccine disaster followed by disappointing trials of a zinc sulfate nasal spray convinced O’Connor that the NFIP must stop funding what a science writer later called “trial-and-error ‘miracle cures.’ ”89 By 1940 a reorganized NFIP had developed a new strategy of providing grants for mostly basic science research approved by elite “known” scientists and clinicians. The NFIP’s major aim was paying for medical care for patients with polio who could not afford it and it was structured around a sophisticated fundraising program based on the efforts of local and regional chapters run by volunteers but including influential physicians and welfare officials. An invigorated professionally trained public relations staff continued to market hope along with fear, stressing the likelihood that anyone’s child could be a victim, the pathetic disabled polio survivor, and the civic virtue of giving.

  Although the NFIP claimed it was not in the business of judging polio therapies, that was not quite true. It had to define best polio care when it funded training in the latest methods of diagnosis, treatment, and prevention. The pamphlets it distributed similarly laid out therapies reflecting a particular vision of polio’s pathology. Thus, The Nursing Care of Patients with Infantile Paralysis emphasized the need for rest during polio’s early stage and the usefulness of “orthopedic appliances” such as frames and splints to protect muscles from overstretching.90 The NFIP also sponsored polio exhibits at national conferences such as the National Congress of Physiotherapy and the American Academy of Orthopedic Surgeons.91 While the NFIP never resolved how to define best practice, by the early 1940s it followed the least partisan policy possible, agreeing to pay for any form of therapy recommended by a physician who was legally recognized by a state’s licensi
ng laws. The NFIP’s research policies, however, became far stricter and more centralized: local and state chapters were forbidden to use any of their funds for research and grants were offered only to individuals or groups based at an institution that the NFIP recognized as equipped to pursue scientific work.

  NFIP officials expected Kenny to be another kook but were hesitant to dismiss someone recommended by physicians, however unknown. Kenny’s reiteration of the many letters after their names—M.S., F.R.C.S., F.R.A.C.P.—was powerful in a country without Royal Colleges and with diverse medical standards. Her claim to be a “representative” of the Australian government was even more impressive. NFIP officials contacted officials in Washington to verify this claim. Unknown to Kenny as she waited in New York, Richard Casey at the Australian embassy (then known as the Legation) sent a telegram to Canberra to ask whether Kenny was in fact “sponsored by the Australian Government.”92 An Australian federal health official based in Brisbane had a “long talk” with Raphael Cilento, now both Queensland’s health director-general and head of the state’s medical society. Cilento, no friend of Kenny’s, claimed that “Sister Kenny had herself decided to go to America” and showed the official a copy of Forgan Smith’s letter to the NFIP, pointing out its “non-committal” tone.93 In a less antagonistic manner, the Canberra office informed Casey that although the Australian government had not sponsored Kenny, the Queensland government had given her £300 and a letter of introduction to the NFIP.94 NFIP officials did not confront Kenny with this information, but it may well have influenced their cautious dealings with her and their care to have her assessed by eminent American physicians.