Kenny was pleased that her ideas and techniques were being taken seriously by exactly the experts she had hoped to impress, but she could see that others were trying to take control of her teaching. While O’Connor had “asked me to present some scheme about instructing people,” she complained to Dean Diehl a few weeks later, “it is evident that that had already been arranged before he saw me.”39 The NFIP had indeed, as Kenny guessed, begun to discuss how to institutionalize her work not just at the University of Minnesota but at a variety of centers.40 At O’Connor’s urging Robert Bennett, the medical director of Warm Springs, visited Minneapolis where he “talked at great length with the medical and technical personnel working with Miss Kenny.”41
Like Kenny, Bennett recognized the power relations in polio care. Most patients with polio were cared for by hospital nurses and physical therapists who practiced under the supervision of physicians in institutions with set routines. Patients in polio’s acute stage—the stage at which Kenny insisted her work must begin—were sent first to infectious disease hospitals where there were strict contagion rules. To alter clinical practice Kenny technicians had to be admitted to these hospitals and then be able to continue their work during a patient’s convalescent stage whether in a hospital or a child’s own home. Such changes required the support of supervising physicians, professionals who were the lynchpin between Kenny’s teaching and hospital routine.
Bennett believed that the most important immediate need was “to acquaint the medical profession with all available scientific proof supporting the concepts of this system and to outline to them the treatment in their own language.” Physicians who directed physical therapy schools should be sent to Minnesota so this system could be quickly incorporated into physical therapy teaching programs. Although Bennett clearly saw Kenny’s work more as a clinical innovation than a radical reinterpretation of polio’s pathology, he did agree that there was a need for fundamental research that would “be the basis upon which all long range estimations of the system could be evaluated.” In a frank letter to O’Connor he admitted that, considering the skepticism of many of his peers, it would be “wise at present that all research should be designed to prove the merits of the system rather than to disprove them.”42 Here then was a deliberate plan to institutionalize clinical change, with an emphasis on physicians as supervisors and potential researchers. In addition to the Kenny courses at the University of Minnesota, the NFIP began funding courses at other medical and nursing schools around the country including Stanford, the University of Southern California, Northwestern, New York University, the D. T. Watson Home in Pittsburgh, and Warm Springs.43
Kenny’s pedagogic philosophy was based on changing the minds of physicians and retraining the hands of nurses and physical therapists. She was careful to make her technician courses as formal as possible. Students attended lectures and demonstrations, worked with patients under the supervision of her Australian staff, and after experience with acute patients (something that depended on the erratic nature of polio outbreaks) sat an examination. Only then were they awarded what was called a certificate of efficiency.44 By early 1943 more than 100 had become Kenny technicians.45 This teaching, Kenny believed, was and should be a struggle, for her students “are taught symptoms and condition of a disease … they had no idea exists.”46 She had little sympathy when students complained about her teaching style. The Webber scholarship nurses, she reflected in 1943, “rebelled and wept and thought they were being requested to learn too much” but later came to “thank me for the knowledge given them and the way it was given.”47
Kenny was well aware of the pragmatic difficulties of introducing her work in institutions with antagonistic health professionals. Every technician, she explained to O’Connor, should have a “duly qualified medical practitioner” who could understand the method and supervise it. Still, she added, even if her technicians were only partly trained “no doubt, whatever they did it would be an improvement on previous treatment.”48 Kenny shortened this idea to “poor Kenny is better than the best orthodoxy,” and her students shortened it further to “P.K. is better than B.O.”49 With her technicians’ medical supervisors, however, she argued that the complexity of her work required full training. She had hoped to be invited to Warm Springs, but instead Robert Bennett sent 3 of his physical therapists to Minnesota, assuring her that they were “particularly keen individuals who have excellent knowledge of applied anatomy and who are very sympathetic with your work.” When Bennett recalled his therapists to Georgia after only 3 weeks, Kenny warned him that it had been “impossible for them to learn the work during their short stay” for, in an argument she used frequently, “the time has been so short that the ideas have not had any time to sink in and, therefore, will not be permanent.”50 Later she was annoyed to hear that Warm Springs was offering courses in the Kenny technique.51
For their part her graduates reveled in a method they saw as a break from older unsatisfactory practices. One New York City therapist—who described herself as still “green”—told Kenny there were “hundreds of Physiotherapists who are grateful to you for enriching their profession with your knowledge.” Kenny’s training had given her a sense “of Anatomy and Body Mechanics, far clearer and with a deeper foundation than all the books, lectures, and 200 hours of dissection I have had.”52 For physical therapists and nurses familiar with the careful, repetitive work necessary to rehabilitate disabled bodies, Kenny’s method seemed fresh and modern, an attack on medical orthodoxy in a safe way. This treatment “has added new zest to a job I was already crazy about,” one graduate admitted, “it is fun to be doing polio work when there are such bright prospects for the patients.”53
Technicians returned to their home institutions armed with fervor, new skills, and the promise of impressive results. For some, this training made them minor celebrities; for many it provided an opportunity to become teachers in their own hospitals, instructing not only their peers but also their supervisors. At the Children’s Hospital in Los Angeles Dorothy Behlow was confident that she had proved to the medical staff at her hospital that “there is a great deal more to the Kenny Treatment than just packing” and that it was “far superior to any other form of treatment.” She proudly described how her clinical results had countered pessimistic prognoses. With one patient “the tendon work-up is wonderful. At first, no anterior tibial; ‘Gone,’ cried the doctors and other physiotherapists, but hear them now when it appears when working up the tendons! It is the most exciting and thrilling work I have ever done.” In a postscript Behlow added that “If I lived to be 100 yrs. old I could not begin to repay you for [the] knowledge you have given me. Thank you Sister, from the bottom of my heart.”54
FIGURE 3.2 Kenny technician Valerie Harvey demonstrating a muscle to a group of physical therapists, flanked by Sister Kenny (left) and Mary Kenny (far right) [perhaps 1942 or 1943]. Box 11, Elizabeth Kenny Papers, Minnesota Historical Society, St Paul.
Taking Kenny’s course in Minnesota was also exhilarating. A cult of personality emerged, especially among the first generation of Kenny technicians. “You are the first truly great woman I have ever known personally,” Adelaide Smith of Pittsburgh gushed.55 With their minds full of the stories Kenny had told them about antagonists and converts, her students saw their own struggles to convince other professionals as part of the same narrative. One therapist was treating 27 patients and “at night, after hours and hours of work, I return home discouraged and tired, ready to quit but I seem to get a lift as I glance at your photograph and think how brave and courageous you were thru [sic] all the years with barriers all along the way.”56 The personal loyalty among Kenny technicians to their teacher occasionally pitted therapists against their supervisors. Thus, after NFIP medical director Don Gudakunst visited the Kenny technicians working in Little Rock during the 1942 epidemic and told them that there were “too many of us down here” and he would send some to other places, Ethel Gardner, one of the Webber scholarship students, let
Kenny know that she and the other technicians had replied flatly that “you sent us here and here we stay until you tell us to come home. We don’t pay any attention to him and will not do a thing for him without orders from you.”57
Technicians told Kenny about their successes and failures. My “whole community is thrilled over the Kenny Method,” Emily Griffin wrote from the Monmouth Memorial Hospital in Long Branch, New Jersey. Administrators at her hospital had been “wonderfully cooperative” and had turned an isolation ward into a Kenny Ward. Griffin was teaching hot pack classes to other therapists and nurses who were all enthusiastic.58 Other graduates grew discouraged. Lorraine Paulson had come from the D. T. Watson Home in Pittsburgh to study with Kenny for 6 weeks and she left vowing “she would prefer not to treat a patient at all if she had to resort to the old method.” But Paulson was not able to change polio practices in her institution, and within a few weeks Kenny received letters from the parents of patients complaining that splints had been reapplied.59 A single physical therapist or nurse could not alter the entire routine of a hospital’s entrenched practices or the views of medical skeptics. A New York therapist became so frustrated by one mocking physician that she “burst out, hurt the gentle doctor’s ego” and then was reprimanded and asked to resign. In her experience physicians were inherently resistant to change. “I am surprised you are still sane after the trouble you have had dealing with the most jealous, egotistic and blind profession,” she told Kenny bitterly.60
Kenny and her technicians fought to ensure that Kenny training remained on a strictly professional level, available only to respectable professionals and used solely for altruistic purposes. After studying with Kenny and returning to San Diego, Ruth Giaciolli complained that a local woman osteopath “thinks I will teach her your method in two easy lessons [but] … I have no intention of trying to teach your method to any persons likely to use it for personal gain. It should remain on the sound ethical basis upon which you began it.”61 Giaciolli was not the only technician to note that “many unscrupulous practitioners of massage & Chiropractory [sic] are only too willing to accept money for treating chronic polio with Kenny Hot packs.”62
In Honolulu technician Charlotte Anderson, working at an Emergency Poliomyelitis Hospital run by the Office of Civilian Defense, was pressured to offer short training courses by her hospital’s medical director who, Anderson told Kenny, was “very anxious to have us teach other technicians.” But Anderson resisted, believing “the only place to get proper training is with you.” She asked Kenny to explain to her hospital director the necessity of a formal course with high standards. He was planning to visit Minneapolis and “perhaps you can make him realize it would not be right for us to do” this training, without, she hoped, “mentioning our names.”63
These experiences left both Kenny and her technicians more than ever convinced that supervising physicians must visit Minneapolis to learn to understand and respect the Kenny method. Miland Knapp shared this view. “It is obviously impossible for a technician to treat a case under the supervision of the doctor who knows nothing about the method being used,” he reflected after a year as director of the Kenny courses. In his experience “one of the most satisfactory ways for the Kenny treatment to be established is to have the doctor come to a class first and become so enthusiastic about the method that he arranges to have a technician and nurse trained.” Aware of the tensions inherent when a subordinate hospital staff member tried to institute change not understood or appreciated by senior staff, Knapp had on occasion “considered refusing the application of technicians where a physician has not agreed to take the course also.”64
EARLY MEDICAL CONVERTS
Physicians may have been wary of the purple prose in popular magazines but they were impressed by reports in JAMA and other medical journals indicating that old-fashioned polio therapy was being modernized. So many researchers now admit that immobilizing limbs causes “destruction of muscle fibers as well as irreparable joint changes,” one physician remarked in January 1942, that “it is hardly necessary to devote much time to the benefits derived by discarding immobilization.”65
The first formal course for physicians began in March 1942. Led by Pohl and Knapp, with a number of lectures and demonstrations by Kenny, the courses were intended to turn the curious into converts, and to inspire them to send their nurses and physical therapists to Minneapolis for full training. Knapp’s lectures on pathology and physiology were very good, one physician commented, impressed by Knapp’s comments that “there has been no research yet which refuted Miss Kenny’s ideas on the pathology in Infantile Paralysis” and that her work was “opening up a field of research to you doctors unafraid to face new ideas.”66 With funding from local NFIP chapters class size ranged from 10 to 34 physicians. Although Kenny and NFIP officials hoped to attract supervisors in infectious disease hospitals where acute stage patients were treated, most physicians in the classes supervised convalescent care: pediatricians, orthopedic surgeons, and physical medicine specialists.67 By early 1943 around 200 physicians had attended.68 A number of other physicians who could not travel to Minnesota began to use a version of Kenny’s methods after reading about them.69
In an era when nurses were expected to defer to physicians and when women rarely taught medical or science subjects to men, it must have been a shock for these physicians to see and hear Kenny. With a style perhaps closest to the matron of a nursing school, she was uncompromising in asserting the truth and logic of her own ideas. Not interested in a middle ground, she refused to present her ideas as a development of established standards or to alter her distinctive and sometimes confusing terminology by making analogies to more familiar terms. She told the physicians in her courses, as she recalled it in 1943: “if they wished to learn what I had to teach them, they must begin by understanding that the disease they were so familiar with simply did not exist.” On the other hand, “if they wished to continue treating for symptoms with which they were familiar, then my lectures and demonstrations were a waste of time.”70 She understood that she was overwhelming men and women not used to being overwhelmed.
Kenny saw doctors as supplicants who needed to be converted and many did become believers. One epidemiologist told her that “after seeing from day to day your work and results I had to admit that we were wrong and you were right. I thank you all very much for the ‘conversion of ideas.’ ”71 Even suspicious physicians were eager to hear from those who had seen Kenny in action. Floyd Clarke, a member of the June 1942 class, gave a talk on the Kenny treatment for the Omaha-Midwest Clinical Society to an audience of around 700.72 Some of the doctors who attended the courses were amused; most were intrigued; and many left determined to convince their own colleagues and hospital directors that patients needed these new methods and properly trained technicians.
Still, many physicians who praised her work’s clinical applications distanced themselves from her theories. Thus, pediatrician Irvine McQuarrie told everyone that although he was not convinced by most of Kenny’s ideas, if his own child had polio he would want to have Kenny’s method used.73 Perhaps, Kenny hoped, this sort of endorsement was only the first step and gradually physicians would want to seek out explanations for the efficacy of her methods.
Other physicians who publicly identified themselves in favor of these new clinical practices were nonetheless careful to present their change of heart as the result of scientific skepticism.74 Mayo physician medicine expert Frank Krusen knew he would be taken more seriously when he hesitated to affirm his belief in Kenny’s work. In his “Observations on the Kenny Treatment of Poliomyelitis” published in the Proceedings of the Staff Meetings of the Mayo Clinic in August 1942 Krusen reminded his colleagues of how skeptical he had been from the outset. When he had been asked by O’Connor to serve on a committee to evaluate Kenny’s work and had protested that he was skeptical about the whole procedure, O’Connor had assured him that “my skepticism eminently qualified me for membership on the committee
.” Only after he had finally visited Minneapolis himself and examined Kenny’s patients did he acknowledge how impressed he was with her clinical results.75 Kenny similarly saw that characterizing her medical allies as initially skeptical helped to demonstrate their credibility as scientific professionals. Krusen, she often pointed out, had “thought I was unbalanced when I arrived in the United States and presented my ideas.”76
The enthusiasm of Cole, Knapp, and Pohl continued to trouble their colleagues in orthopedics and physical medicine, especially when the NFIP published their June 1942 article in Archives of Physical Therapy as a separate pamphlet. To prove it was not the result of being swayed by Kenny’s personality all 3 physicians began to stress how skeptical they had initially been and how only the objectivity of close clinical observation had led them to change their minds. “Nothing occult is involved in her methods,” they assured their peers; indeed her complex therapies required “an intimate knowledge” of anatomy and the neuromuscular system.77 Pohl had been so skeptical of the work at first, Krusen claimed, that he had refused to have his name appear on the first publication in JAMA although he was now “a most enthusiastic advocate of the procedure.”78
Another skeptical convert was prominent Chicago orthopedist Philip Lewin, who taught at Northwestern’s medical school and was the chair of the NFIP’s Aftereffects Committee. His 1941 polio textbook had called Kenny’s methods “of questionable practical value” and Kenny had named Lewin’s book as an example of mistaken old-style polio care.79 But after Lewin came to Minneapolis to see her work in person, he “completely changed his views,” as the Saturday Evening Post put it.80 At the annual meeting of the Illinois State Medical Society in May 1942 Lewin argued that Kenny “has jarred the medical and allied professions out of their complacency into an immediate offensive attack on the local condition which she has proved exists.” Continuous rigid splinting “is not only ‘on its way out’ but … it is ‘out.’ ” Kenny’s patients, he declared, were “in better condition than any similar group I have seen anywhere in the world.”81 Kenny delighted in this admission of conversion and called Lewin her first American disciple.82
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