Polio Wars

by Rogers, Naomi

  Outraged, Kenny called Gudakunst twice, reversing the charges, to complain that the AMA’s official journal had called her ideas “absurd and unscientific.” If the review was not retracted, she said, she would return immediately to Australia “since there was no use trying to fight the American Medical Association.” Gudakunst urged her to forget the review and go on with her work, but Kenny said she was too upset. Shifting her argument to an appeal to populism she declared that she would go on a lecture tour to appeal directly to the public for Americans had supported her more than the NFIP or the University of Minnesota.174 She also wrote to Fishbein, accusing his reviewer of not keeping “abreast with current literature” such as “the acknowledgment of the official observers of the Medical School, University of Minnesota.” It was not true that the condition of spasm was familiar to polio experts. In Kenny’s experience, based on the many thousands of cases seen in different parts of the world, polio authorities had ignored “this painful and damaging condition.” Trying to be both courteous and vehement, Kenny “respectfully” suggested the reviewer “come to Minneapolis as soon as possible, and I will produce the evidence to convince him that he is altogether wrong in his concept, and how unwise it is to condemn a work he knows nothing whatever about.”175 Discovering the reviewer’s identity, Kenny contacted Compere directly and urged him to come to Minnesota and see her work for himself.176

  NFIP officials were becoming familiar with Kenny’s threats of leaving and her demands for public recognition. But after the NFIP’s December decision to promote her work Kenny could now more confidently challenge critics with evidence that its own elite medical advisors recognized her methods as a valuable improvement to former polio therapies.

  Kenny found that she was able to win over critics of her written work with the clinical evidence of her patients. In response to her letters and phone calls, Compere traveled to Minneapolis for a day’s observation and returned to Chicago, he admitted to NFIP officials, “very much more sold on her methods than I had been before.” His opinion of the book did not “represent my opinion of the treatment itself.” While he did not “understand why she achieved some of her results” and was not “prepared to accept all of her theory” he was convinced that “her methods are definitely good.”177 Gratified that she could now count Compere among her supporters, Kenny now reminded him of his promise “to rectify the erroneous ideas you had about my work” by writing a statement that could be published in JAMA.178 While Compere did not write a correction, he did invite Kenny to come to Chicago to discuss her work before an audience of doctors, nurses, and physical therapists at the Wesley Memorial Hospital. Fishbein, whom Kenny invited, did not attend.179 Her lecture, Compere told her later, was a great success. He hoped she would return to give another talk and demonstration and he promised to explain “the advantages of the Kenny method” at the next meeting of the Chicago Orthopedic Society.180 A delighted Kenny thanked him, but wanted to correct a comment about Cole and Knapp’s skepticism that had been made during her trip. “I asked Dr. Cole and Dr. Knapp where they disagreed with me, and they said that they do not disagree with me anywhere. They did at first but not now.”181 Perhaps Compere, having met Kenny in person, could guess that Cole and Knapp had learned not to engage in debates with their Australian visitor.

  Even before Compere’s visit Gudakunst had also traveled to Minnesota, a visit that led him, like Compere, to change his mind. He had been appointed the NFIP’s medical director only a few months before Kenny’s arrival in New York in April 1940. As Michigan’s state health officer during the 1930s he had survived many stormy experiences, and his position as medical advisor to O’Connor, who was a lawyer and not a doctor, gave him ample opportunities to confront and dissuade aspiring polio innovators, and to “weed out the obviously sorry applications.”182 He had organized the visits of the 5 physical therapists to see Kenny in Minneapolis and read their mixed reports. Concerned that she was a publicity seeker and perhaps a bit crazy, he had begun to caution others not to laud her too extravagantly. When the NFIP was consulted by Parents Magazine about the advisability of making its annual award on behalf of children to Kenny in 1941, Gudakunst had warned that “it would be unwise to have such an award made immediately.” The award was not given to Kenny until the following year.183

  When Gudakunst arrived in Minneapolis, Kenny eagerly demonstrated her work and gave a lengthy lecture during which she called on the NFIP “to correct the erroneous statements” in the first JAMA editorial. These mistakes, she claimed, had harmed patients by suggesting to patients and medical professionals that massage was part of her work. Further, its lack of detail had resulted in some patients having to undergo “the [unnecessary] operation of appendectomy … owing to the lack of knowledge of the true symptoms of the disease.” She quoted tributes made by “all visiting doctors to this clinic,” such as a group of Ohio orthopedists who told her “they could only look back with sorrow and regret at the mistakes made in the past.” Shrewdly, her lecture included not only a defense of her ideas but also the claim that her work returned patients to economic independence. Thus, an 18-year-old patient who had gained “a certain amount of recovery in all muscle groups” could now wash and feed herself and stand up alone, and she had won a scholarship to study commercial art.184

  His visit to Minneapolis convinced Gudakunst both of the value of Kenny’s work and the danger of inaccurate publicity, which was hurting both the NFIP’s promotion of the new method and the fund’s own reputation. He became convinced that the AMA was deliberately undermining Kenny and thereby her philanthropic sponsor. After a radio program sponsored by the AMA “gave her an extensive plug but described her work as consisting of early active exercise,” he suggested that someone from the AMA “should go to Minneapolis to visit Miss Kenny and see what she is doing,” and that whatever JAMA published about Kenny “be reviewed by such an informed individual.” The ill-advised JAMA editorial, he added, repeating another point Kenny had made to him in Minneapolis, may even have harmed patients if physicians used “active massage in the early stage of the disease” acting “under the misconception” that they were “using at least a modification of the Kenny method.”185 To O’Connor he also wondered whether “a conference with Dr. Fishbein might not be out of order.”186

  Gudakunst began to use Kenny’s explanations to defend her work. One of her objections to splints, he told one skeptic, “is that the pressure of the splint on the skin serves to stimulate the reflexes and produce additional spasm,” admitting “I’m getting so I talk like Kenny.”187 When Henry Viets, an editor of the New England Journal of Medicine, sent him a draft of an editorial on Kenny, Gudakunst protested that “the techniques developed by Miss Kenny call for an intimate knowledge of muscle anatomy and function” and praised “the excellent end results seen in her cases” and her specialized physical therapy that treated “incoordination and alienation as well as through the proper application of heat during the stage of spasm.”188 Like Kenny, Gudakunst rejected the idea proposed in JAMA that Kenny’s work “represents an elaboration of well recognized principles in the treatment of acute paralysis.” Her view of polio was not simply part of the progression of medical science, he assured Fishbein’s JAMA assistant Larry Salter, for nowhere in the medical literature with which he was familiar was polio described as having symptoms that were “primarily spastic contractures of the muscles.” Previous medical teaching “very definitely has been that loss of function was due to paralysis and that there was no other damaging involvement of the nervous system,” yet Kenny “has demonstrated that actually the paralysis of this disease is a very minor contributing factor to disability” and “the inability to use ‘healthy muscles’ really accounts for the disfunction creating disability.” Gudakunst realized that defensive physicians might be unable to admit the extent of Kenny’s innovation. “There is a revolutionary element,” he told Salter, “hence, the unwillingness and even the inability to appreciate just what she has.”
189 After reading Compere’s report of his visit Gudakunst wrote to him agreeing that “there is much of good in the Kenny method” and the NFIP had “a tremendous responsibility” to acquaint “American physicians with her work.” While Gudakunst “wholeheartedly” agreed that “Miss Kenny’s book is a sad mistake,” he was “in complete sympathy with your attitude and what you say—that the book does not express an opinion of the treatment itself.”190

  Gudakunst also developed a new way of looking at polio patients. When he visited patients at Cleveland’s contagious disease hospital a few weeks after his Minneapolis visit, he reported that they were “in very good shape, [but] they in no way compare with those treated by the Kenny method.” Indeed, Gudakunst himself was able to identify “evidence of definite spasm in the hamstrings and gastric-nemius groups in several patients,” a sign, he felt, of the patients’ inadequate care.191

  But clinical results were one thing; scientific theory was another. Fishbein, Salter, and other AMA officials retained their skepticism that a nurse could use clinical experience alone to come up with any credible explanation for understanding the physiology or pathology of a disease. In “my personal opinion,” Salter told Gudakunst bluntly, “when she starts to discuss anyone else’s opinion of her theories—in contrast to her method—she is on controversial ground and the less she says about differing opinions, and even her own theories on how her method works, the better off she will be and the happier she will make you, me and a lot of other people who are continuously dragged into her ‘fights.’ ”192

  In mocking Kenny’s theories Fishbein’s assistant was drawing on a familiar tradition of denigrating those outside the medical establishment who could be valued perhaps for pragmatic techniques but not for theoretical contributions to medical science. The poor quality of her textbook helped to reinforce this distinction, and even supporters such as Gudakunst and Compere began to defend her work based more on its clinical efficacy than its intellectual originality. Thus, as Gudakunst admitted to one Connecticut health official, Kenny’s book “is one of the worst attempts to describe a technique that I have ever encountered. But this does not mean that Miss Kenny’s work is not good. I sincerely believe that she has made a real contribution to the treatment of early poliomyelitis.”193

  A BREAK AWAY FROM PRESENT METHODS

  By early 1942, a year after the physical therapists’ visit to Minneapolis, many things had changed. The Reader’s Digest article had solidified Kenny’s status as an exciting new figure in medicine—an exotic nurse from a distant land. She had also acquired powerful new allies. Even Gudakunst was now a proponent, willing on occasion to use the power of the NFIP. After protests by Gudakunst and a phone conversation with O’Connor, for example, Fishbein did publish a “Correction” in the mid-January issue of JAMA, correcting not Compere’s review but his first editorial. Massage did not have any part in Kenny’s procedure, the editor now admitted, and “according to her concept, the cardinal symptoms of infantile paralysis are ‘muscle spasm, muscle incoordination and muscle alienation,’ ” a phrase from Kenny’s letter to Fishbein.194 Here was a reference, however reluctantly, to both her clinical techniques and her ideas.

  As physicians began to take Kenny’s work seriously they were eager to demonstrate the fair, scientific, and open-minded nature of their profession by welcoming the woman and the work. But the battle was not over. While it was obvious that Kenny’s methods were becoming a central part of NFIP publicity, the question of authority over clinical care remained undecided. Kenny’s textbook had been published, but despite Kenny’s efforts to make the text serious and scientific, many readers saw it as the work of an overenthusiastic nurse, partly because it was poorly written and partly because it challenged the views of orthopedists who had been trained in more pessimistic, less activist therapies. Seeking to capture the cautious tone of the NFIP’s medical advisors, Gudakunst began preparing an NFIP text based on the work of Cole, Knapp and Pohl.195 His pamphlet on The Kenny Method and the courses that the NFIP began to set up in hospitals and health science schools outside Minneapolis suggested that wiser, more experienced polio experts were in control of this clinical innovation.

  As physicians, nurses, and physical therapists began to alter their practice, they struggled to decide how significant clinical observation was and should be. Kenny had claimed to be seeking scientific explanations for the new symptoms she had identified, and initially she, like her critics, saw laboratory research by physiologists and pathologists as epitomizing scientific truth, a more reliable truth than one that clinicians could hope to establish. Even clinical experts expressed caution in judging Kenny’s work solely by its clinical results. In a 3 page section on the Kenny treatment in The 1941 Year Book of Physical Therapy Richard Kovacs noted that although “the last word has not yet been spoken as to the most effective treatment,” this method clearly was a break “away from the present method of prolonged complete immobilization.” It might sound “revolutionary” to those who believed in “standard’ treatment,” but in mild yet hopeful words Kovacs felt its results appeared “encouraging.”196 Viets’ editorial in the New England Journal of Medicine praised her methods and, unlike the JAMA editorials, argued that Kenny’s method “completely revolutionizes modern ideas regarding the treatment of acute poliomyelitis” by rejecting “muscle testing, splinting, avoiding of overstretching, absolute rest and many other procedures.” What his editorial did not refer to was any part of her growing articulation of a new view of polio itself.197 To their surprise when orthopedists and physical medicine specialists turned to laboratory research to compare Kenny’s claims to serious studies of the impact of the polio virus on muscles they discovered there were few such studies.

  As Fishbein had anticipated, Kenny’s book was indeed read by ordinary Americans, and this led to growing popular demand for her work. James Gray of the St Paul Pioneer Press praised her “blunt, matter-of-fact and sensible” tone and her publicized decision to work within the medical establishment.198 Members of NFIP chapters began demanding more information about this method and urged the NFIP’s national office to publicize it more extensively. A physician from Tacoma, Washington, who was a member of his local chapter, suggested to Gudakunst that “some of our publicity in connection with the Roosevelt Birthday Ball next month could be well devoted to a discussion of the present status of Sister Kenney’s [sic] work” and urged the NFIP to offer “some official recognition of this nurse and her work.”199 The chair of the NFIP chapter in Magnum, Oklahoma, similarly told O’Connor that the Reader’s Digest article was “the best article on the subject that I have ever read.” Reprints of it, he believed, “should be in the hands of every Committee for Infantile Paralysis in the U.S.”200 During the NFIP’s March of Dimes January campaign the link between polio and President Roosevelt inspired some Americans to insist that Kenny share this national attention. After reading about Kenny in the Reader’s Digest and the New York Times Ann van Kavcren, a nurse working with polio patients at the Boston Children’s Hospital, expressed herself “greatly shocked to learn that this treatment has been used for many years in Australia, and that we are just now hearing about it.” Kenny, she argued, should be recognized in some public way, and the appropriate moment might be the March of Dimes’ upcoming celebration of the president’s 60th birthday in January 1942.201 It was the beginning of a new moment in America’s polio history with Kenny at the center.

  NOTES

  1. “Paralysis Sufferers’ Pleas Come in Flood” Minneapolis Star-Journal February 5 1941; Willis M. Kimball “City May Become National Center in Study of New Polio Treatment” Minneapolis Star-Journal January 30 1941.

  2. Paul A History, 312–317.

  3. Kenny with Ostenso And They Shall Walk, 211.

  4. Albert B. Sabin “Etiology of Poliomyelitis” JAMA (July 26 1941) 117: 267–269. On conferences funded by the NFIP in the early 1940s see Roy L. Chambliss, Jr. “A Social History of the National Foundation of Infantile
Paralysis, Inc, 1938–1948,” Master of Science in Social Service dissertation, Fordham University School of Social Service, New York, 1950, Public Relations, History, MOD, 82.

  5. John R. Paul “The Epidemiology of Poliomyelitis” Infantile Paralysis; A Symposium Delivered at Vanderbilt University, April, 1941 (New York: National Foundation for Infantile Paralysis, 1941), 147–153; see also pathologist Ernest Goodpasture who admitted that many experts no longer saw polio as “essentially an infection of the central nervous system”; Ernest W. Goodpasture “The Pathology of Poliomyelitis” JAMA (July 26 1941) 117: 273–275.