Polio Wars

by Rogers, Naomi

  Kenny recognized that her textbook would have to contain evidence that, unlike her Australian 1937 text, she intended to control closely. Her Treatment of Infantile Paralysis in the Acute Stage was published by a local Minneapolis company in September 1941.142

  Its 264 pages were divided into 17 chapters and 3 appendices. The prose was repetitive and disjointed with many of its chapters simply versions of lectures Kenny had given in Brisbane in the late 1930s and then in Minneapolis. The book included 61 photographs of patients as well as several images of Kenny clinics in Australia and England. The images of the patients, Kenny explained in her preface, were “photographic confirmation” of the value of her work; the images of the buildings and wards were probably included for the same reason.143 As the book was intended to be used as a pedagogic resource, most of its chapters were organized by body part: Chapter 9 on the neck, Chapter 10 the shoulder girdle, Chapter 11 the forearm and hand, and Chapters 13 and 14 the limbs. The remaining chapters and appendices provided an intellectual defense of her scientific contribution.

  Kenny believed that this text would play a crucial role in establishing her work as a serious medical contribution as “it must be understood by all that it is impossible to teach without a book of reference.” Even more crucially, the book’s detailed explanations of her work would “insure its permanency.”144 Designed for those learning to be Kenny technicians, it was filled with descriptions of detailed techniques that were distinctively different from those used in standard polio care. Kenny had long ago found that skeptical professionals, especially nurses, tended to be “impressed by the authority associated … with the printed word.”145 The book would stand in for her own voice when she left America, providing both a warning and a defense for her technicians and their medical supervisors who would otherwise “have slipped back into the wrong method if it was not recorded in the book how damaging would be this procedure.”146

  Even those sympathetic to Kenny’s cause were disappointed by this book. A Chicago surgeon told Gudakunst that its awkward prose meant it was “not very easily read or easily understood.”147 Still, its pictures and detailed instructions made it a useful clinical guide. Perhaps it was a bit too accessible, Cole warned Gudakunst, so “that there is great danger of this book being misused by poorly trained or irregular practitioners.” Nonetheless Cole felt “that the part of the book dealing with methods has been very excellently prepared and that a lot of the stuff in the book is good.”148 In publishing this text, Kenny had gone over the head of the NFIP to reach American medical professionals directly. When professionals and members of the public asked the NFIP for a copy Gudakunst explained that the book had been written and published “without the knowledge of the Foundation” and distributed “in spite of the Foundation.” Its poor quality, he told one physician frankly, was the reason “it is necessary that the Foundation prepare a pamphlet of its own describing some of the main points of her technique.”149 In 1942 NFIP produced a pamphlet based on reports by Kenny’s Minnesota medical supervisors.150

  Efforts to ensure that the textbook was not seen to have the imprimatur of the NFIP were, however, mostly in vain. Both Gudakunst and O’Connor were convinced that the book had breached the NFIP’s policy that grant recipients “refrain from writing articles for public or professional magazines, lecturing or releasing information in any way except through this Foundation.”151 In his role as the head of the NFIP Committee on Information Fishbein phoned John Bruce, head of the Bruce Publishing Company, to warn him of this breach of contract.152 Bruce knew nothing about any contract with the Foundation, and repeated Kenny’s assurance that she had “entered into no contracts and made no commitments.” His publishing company, Bruce emphasized to Fishbein, intended “to market this book [only] to the medical profession” and he believed that “nothing in the book or in Kenny’s method” conflicted “in any way with ethical medical practices.” Gudakunst asked Cole to make sure that Bruce agreed “to insert a flyleaf giving a statement to the effect that the National Foundation had no responsibility for the publication nor does it sponsor the distribution of the book.”153 “We could of course take the necessary steps to stop the publication,” Fishbein reflected in a rare letter to O’Connor marked “Personal,” “[but] this would, I fear, do more harm than good.” Whatever Bruce claimed about marketing the book only to physicians, Fishbein could see that “it will naturally be worked over by the lay press when it published.” “I shall of course arrange to have a suitable review of the book in the Journal of the American Medical Association and sooner or latter [sic] I shall write a piece about Sister Kenny to put her in proper perspective,” he assured O’Connor. Perhaps, Fishbein added wickedly, Kenny should be allowed to speak at the NFIP meeting that December, maybe “a two minute presentation so that [the] audience can get the full flavor of her personality.”154

  In a haughty defense of her book Kenny protested to Fishbein that she was under control of neither her Minnesota supervisors nor her NFIP sponsors. In one phone call Fishbein told her that although he had “advised the Foundation to allow the publication … when we review the book, we shall call attention to such misstatements of fact as appear.”155 Kenny then “minutely examined” her book and told him she “could not find the mistakes referred to.” The idea of a contract breach was nonsense, she added, as the lectures that made up the book did not deal with the results of work carried out under the NFIP grant.156 “She was very much on her high horse,” Fishbein said when he described this conversation to O’Connor, and had declared “ ‘Well, I don’t care for America anyway. I merely came over here to get my book published, and I am going back to Australia as soon as I can.’ I asked her if she would authorize me to use that statement to the press, and then I hung up on her.” “She is, of course, an impossible person as far as concerns any sensible conversation,” he added, “I propose to have nothing further to do with her.”157 But as Fishbein recognized, such a policy of high-minded neglect was not going to work. Privately O’Connor agreed with Fishbein’s desire to have nothing further to do with Kenny but as NFIP director he had no such option. After discussing the problem of her book with Gudakunst, O’Connor decided to ignore her claim that the book established the worth of her work. He assured Fishbein that he would continue to point out to her, as he had repeatedly, that the University of Minnesota’s medical school “is our grantee to evaluate her work, and we therefore look to that institution rather than to her.”158

  In a move that gained her even more publicity Kenny cooperated with Lois Maddox Miller in the writing of “Sister Kenny vs. Infantile Paralysis,” the featured article in the December 1941 issue of Reader’s Digest. Fishbein had assured O’Connor a few months earlier that he knew Miller, “a friend of mine,” was working on an article on Kenny; “however, all of the medical articles of the Digest are submitted to me and I will have the opportunity to go over that one.”159

  Miller, a freelance science journalist, deftly drew a picture of Kenny that intrigued American readers. In 5 pages her article moved from “the lonely outlands where she served as visiting nurse, midwife, and counselor to the sparsely settled families” to a “small boy, his legs strapped in splints, his face contorted from pain” to the 8 government-supported large hospital clinics in Australia where “hundreds of nurses take the two-year postgraduate course which fits them to use the Kenny method.” These exaggerated claims—the hundreds of nurses, the formal 2-year course, and the 8 government clinics—were part of a story Kenny had developed since her return from Australia in June. Having “dedicated her life to extending her merciful work as widely as possible” Kenny (“the British give chief nurses the title of ‘Sister’ ”) had looked toward the United States and discovered that “the United States has maintained the most enlightened and realistic attitude toward the problem—has tried hardest to push research into polio’s mysteries, has done more in after-therapy, and, through the great National Foundation of Infantile Paralysis, supported by contr
ibutions from the entire nation, has demonstrated its determination to reach out for the best and newest at any cost.”160 Such hyperbole showed Fishbein’s likely hand.

  In this picture, Kenny was a “tall, gray-haired, motherly woman [who] proudly refers to herself as a ‘bush baby.’ ” Miller described her age as “some 50 years”; in fact Kenny had just turned 61. Kenny’s methods were contrasted with the effects of ordinary treatment during which “there is a long, grim siege of pain—anywhere between two weeks and many months.” Miller’s description of the method itself was somewhat inaccurate: spasm, an important symptom “which apparently doctors had not noticed before,” was relieved by hot foments, massage, manipulation, and passive exercise.161 Kenny was usually annoyed when professionals or the press talked about “massage” (she fought for and later won a JAMA retraction) but here she made no comment.

  The spectacular results of Kenny’s work were exemplified by the miraculous recovery of Kenny’s American patients. Rita N. a patient with bulbar poliomyelitis had been given last rites by a priest but after 20 days of Kenny treatment she recovered fully. Her mother said “ ‘It seemed like a miracle—we had given up hope.” Joan B., who would have been placed in an iron lung, was “completely cured” in 6 weeks. The bulk of the article dealt with Kenny’s effort to convince physicians: some denied the “phenomenon of spasm, or minimized its importance”; many considered her “bold refusal to use splints or braces… unwise and hazardous.” But Kenny had been victorious, proving her work was new and revolutionary.162

  In a section that most closely showed Fishbein’s editing hand, Miller tried to establish that Kenny herself, however unorthodox and shocking her methods, was not challenging the medical hierarchy. Kenny was an enthusiast, but she also knew her place. She had “devoted her life to the one crusade, demonstrating to physicians, training other nurses in her methods, spreading her influence with missionary zeal.” Yet “the nurse practicing the Kenny method does not replace the doctor, but works with him. She does not cure the disease—medical science knows no cure for it. But she does make it easier to bear, and does cut down—often completely eliminates—aftereffects.” Most of all, Kenny had “turned a deaf ear to suggestions that she would get ahead faster if she ignored the doctors. ‘This treatment can be developed only within the medical profession,’ she said, and stuck to it.” Miller left ambiguous whether Kenny’s contribution was simply a treatment or a new concept as well. She quoted Kenny’s Australian mentor Aeneas McDonnell, probably via Kenny herself, saying “She has knocked our theories into a cocked hat; but her treatment works, and that’s all that counts.”163

  This story had something for everyone. It provided polio survivors and their families as well as other disabled readers with hope in a scientific form. Physical therapists and nurses dissatisfied with current polio practices were intrigued about this miracle healer. Readers seeking alternatives to surgery saw Kenny’s work as natural, domestic, and pain-free. Here was a sympathetic picture of a middle-aged, yet still vigorous nurse who both worked within the traditional restraints of her career and gender—a physician’s helpmeet, a care-giver who touched bodies and dealt with the messy stuff of pain and disability—and yet stood outside it, challenging orthodoxy in thinking as well as practice, telling doctors what to do. Miller called Kenny motherly for she cared for children, but such a designation could also call up a picture of mothers fiercely defending their young, or perhaps the kinds of characters featured in Wild West movies where the rancher’s wife knew how to use a gun to warn off marauders. This nurse, readers were assured perhaps too vehemently, was committed to orthodox medicine, its culture, and its professional hierarchy. But what if she moved away from the auspices of the respected medical school? What if her patients’ families began demanding that she take control of polio care instead of their doctor? What if she felt that the NFIP was not properly supporting and promoting her work?

  Despite her protests, Kenny was a quick study. She began to consider writing another book with the explicit sponsorship of the NFIP and her medical supervisors. Her next textbook, as we will see, was published in 1943 with a preface from O’Connor and an afterward by Knapp, and was co-written with Pohl.

  APPROVED BY THE MARCH OF DIMES

  The pinnacle of Kenny’s early success came on December 5, 1941, 2 days before Pearl Harbor. At the second annual meeting of the NFIP’s medical advisors held in New York—to which Kenny was not invited—the Committee on Research for the Prevention and Treatment of After-Effects announced that, based on reports from Minneapolis, the Kenny method used during the early stages of polio “greatly reduced … the length of time during which pain, tenderness, and spasm are present” and prevented “contractures caused by muscle shortening during this period.” The general physical condition of her patients also seemed to be better than patients treated by other methods.164 In a dramatic policy announcement, the NFIP’s medical advisors then recommended that health officials throughout the nation should promptly be given information “regarding the nature of the Kenny technique and its integration with other measures of treatment”; the NFIP should establish training programs for physicians, nurses, and physical therapists to become “fully trained in the essentials and principles of the Kenny method”; and it should produce “a concise manual providing the essential principles and details of the Kenny method and of other applications of hydropathy and physical treatment in the early stage of infantile paralysis.”165 With careful timing, Fishbein published a sympathetic editorial in JAMA arguing that recent physiology research had shown that immobilization might be harmful as normal groups of muscle fibers could become atrophic with the restriction of “the flow of these proprioceptive impulses.” The editorial firmly rejected the concept of alienation, arguing, as the Kendalls had done, that “no experimental evidence” supported “the contention that single muscle units might, as a result of appropriate manipulation, be encouraged to send their nerve fibers to muscles fibers which had been rendered atrophic by anterior horn cell degeneration.” In his description of Kenny’s technique Fishbein deliberately provided few details, and the details he did provide were casual and inaccurate. “If all available motor units in paretic muscles are to retain their maximum physiologic capacity,” Fishbein wrote, then “massage and freedom of movement” were “clearly indicated.”166 Neither massage nor free muscle movements were part of Kenny’s work.

  Here were explicit signs of clinical change and proposed policies for the inculcation of this work into medical practice. Defending this change in NFIP policy in promoting a kind of polio care that sounded so different from standard methods, O’Connor sought to downplay both Kenny and her clinical results. At the NFIP meeting’s annual dinner at the Hotel Pierre, O’Connor emphasized that the Minnesota clinicians’ conclusions were supported by NFIP-funded physiological research, including animal experiments from Iowa State University and the University of Toronto that suggested that restricted motion could delay muscle recovery. To placate skeptical orthopedists O’Connor referred to research by eminent Iowa orthopedist Arthur Steindler that had shown that shortening and distortion could be caused by contractions of severely paralyzed muscles that were allowed to remain in one place for too long.167

  Despite these efforts to incorporate Kenny’s work within serious scientific research the press delighted in the story of a crusading nurse and her revolutionary method of treatment. With headlines like “Sister Kenny’s Triumph,” Time and Newsweek explained that her methods, unlike standard clinical practice, stimulated rather than immobilized muscles in early cases, and that JAMA—“organized medicine’s leading publication”—had “formally approved” her work.168 “Kenny Paralysis Treatment Approved by U.S. Medicine” agreed the New York Times, quoting O’Connor’s statement that her methods had been proven “superior to the present orthodox methods of treatment.”169

  In vain Fishbein prepared a further JAMA editorial that urged American physicians to remember that the conclusion
s of the NFIP’s advisory committees were based on “reports from various experimental laboratories and clinics.” He also sought to move the work out of Kenny’s hands, describing Knapp’s detailed study of the Kenny method that would enable Knapp and other physicians “to continue with the teaching after Miss Kenny and her staff return to Australia.” The new method “represents an elaboration of well recognized principles in the treatment of acute paralysis” and was based on “scientific research on the physiology of the nervous system which explains the value of the technic.”170 It was, in other words, not a strange, unscientific system developed by an innovative nurse, but the practical articulation of methods that fit into mainstream medical science and were therefore worthy of funding and further study.

  Annoyed at the inaccuracies of the first editorial, Kenny was irate that this second editorial portrayed her work as simply part of the progress of medical science. “It is impossible to merge any other existing treatment with the Kenny treatment,” she protested to O’Connor. “All other systems have been evolved for symptoms that do not exist. Dr. Gudakunst admitted this to me when I spoke to him.”171 Urging Kenny to complain to Fishbein directly, O’Connor implied that he had little influence over the AMA’s journal but Kenny would have none of it. “I quite understand the Foundation has no control over the American Medical Journal,” she pointed out to him, “but I should imagine it has the power to correct the misleading statements made in connection with the Foundation’s activities.”172

  Kenny was right. The NFIP was able to exert influence over JAMA, but O’Connor refrained from doing so until Fishbein published an anonymous review of Kenny’s textbook. Mealy-mouthed in its praise and sharp-tongued in its criticism, the review by Edward Lyon Compere, an eminent Chicago orthopedic surgeon, found Kenny’s book full of “infinite detail” and providing a “confusing discussion of pathologic principles.” A nurse might not be expected to understand polio’s complexities, he argued, but any physician “thoroughly grounded in physiology, anatomy and pathology” who had observed “the degenerative changes in the anterior horn cells … will find much in the Kenny theory that is absurd and unscientific.” Irrespective of the author’s “enthusiasm” that appeared in every chapter of the book and bordered “on religious fanaticism,” Compere noted, there would continue to be patients who needed splints, those who would undoubtedly die if they were not in an iron lung, and those would never walk a step “without the aid of the braces she condemns.” Still, the medical profession owed Kenny “a debt of gratitude for having made us realize that prolonged splinting without exercise, without heat and moisture applied to the limbs, is harmful.” Compere hoped his peers would be “sufficiently liberal minded to accept the good elements of the Kenny theory without losing our balance and falling head over heels into a pit which both Galen and Hippocrates succeeded in climbing out of many centuries ago.”173 This pit, JAMA readers could assume, was empirical, symptomatic medical care, bereft of the rigor of male Western scientific knowledge.