Polio Wars

by Rogers, Naomi

  Stimson’s JAMA article reinforced a general sense among American physicians that Kenny’s method was effective, especially for polio’s acute stage, and that Kenny herself was reliable. Although Stimson was convinced that her ideas were original and worthy of scientific investigation, not everyone agreed. Her training—as a nurse she presumably knew nothing of tissue culture or dissected bodies—and her gender made her sound like a technical innovator who had gone too far in talking about science and theory. How much should physicians use her new terms and her ideas? Were her ideas just lucky guesses, based in ignorance or perhaps clinical acumen, or were they based on a distinctive scientific understanding of the body? If what she argued made scientific sense must previous scientific explanations be rejected? Had standard polio therapies been based on poor science?

  In Canada observers of Kenny’s work took on the question of credibility. Drawing on their experience during and after a serious epidemic in Manitoba in 1941, physicians at Winnipeg’s Children’s Hospital argued that not only was Kenny’s work effective but it made scientific sense. Their arguments combined the evidence of their eyes and hands with a new understanding of the body based on Kenny’s theories. Kenny had “revolutionized our ideas on the symptomatology and treatment of acute anterior poliomyelitis” said orthopedist Alfred Deacon. During her visit to Winnipeg the medical staff “could feel the spasm she demonstrated and see the effects they were producing” and had been especially impressed—indeed “astounded”—by Kenny’s ability to show that some patients deemed paralyzed could indeed move “merely by restoring the patient’s mental awareness of those muscles, and thus correcting their alienation.” These results convinced the staff that her methods made sense physiologically and that “in most cases … the flaccid muscles are indeed alienated from their brain control.” The outcome of the new therapies was equally dramatic, for they produced “better results than any method we have hitherto used.”125 These impressive clinical results were also mentioned by the hospital’s administrator who, however, warned his board of trustees that the 1941 Reader’s Digest story had been “painted in too brilliant colors,” leaving the impression “that the method of treatment returns paralyzed muscles entirely to normal” with patients “returned to complete robust muscular health.”126

  “We cannot use the known pathology of the disease to justify a refusal to re-examine the clinical picture of this disease,” Children’s Hospital director Bruce Chown declared boldly in the Canadian Public Health Journal. Writing as a pathologist and a pediatrician, Chown cited recent work by Johns Hopkins virologists Howard Howe and David Bodian whose critique of the standard classification of polio, Chown argued, could explain the diverse “symptoms and signs” of temporary paralysis that Kenny called mental alienation. Speaking as a clinician, a researcher, and an administrator well aware of the routine of caring for patients during and after an epidemic, Chown was convinced that “the whole disease is in need of reassessment.” “Some have found the stimulus unpleasant,” he warned, “but reaction is taking place.”127

  Even more important was physiological research by University of Rochester orthopedist Plato Schwartz that established the existence of spasm through electronic analysis of muscles. In work funded by the NFIP Schwartz used the oscillograph he had developed in his Gait Laboratory to try to measure spasm. Schwartz and his colleague Harry Bouman took more than 500 records from 7 patients with acute polio and compared them to records of normal subjects and to patients without polio but with other kinds of “spastic” paralysis. Their research identified what they called “spasticity” (spasm) in patients with polio, although whether this was responsible for muscle weakening “cannot be answered at this time.” They also found evidence of “spasticity” in the muscles of patients with polio “where no clinical evidence of muscle weakening can be found” as well as in weakened muscles, suggesting both that spasm did exist but also that it could not necessarily be identified by clinical observation alone. Their JAMA article included 4 illustrations of “oscillographic records of muscle action currents” that showed “definite evidence of muscle spasm.”128 These 4 images seemed more serious and scientific than photographs of patients sitting up or walking.

  Both Kenny and the NFIP immediately saw the implications of this study. A photograph of Kenny with Schwartz at the University of Rochester was published in the Rochester Times and reprinted in the National Foundation News.129 In her speech as the guest of honor at the university’s annual alumnae dinner Kenny described Schwartz’s article as the first formal academic recognition of her work showing “scientific proof for her concept of poliomyelitis and its treatment.” Less effusively and without mentioning Kenny’s theory, Schwartz replied that he gave her “full credit for discontinuing methods of fixation or immobilization and for stressing early reeducation of muscles.”130 The NFIP’s newsletter featured the study, noting that a “laboratory equipped with delicate electrical instruments” had picked up and magnified minute electrical currents of nerve impulses and then measured, recorded photographically, studied, and analyzed them, providing “the first real proof that Miss Kenny was treating a condition which actually did exist.”131 Gudakunst similarly assured professionals and parents that this study proved Kenny’s work was not based on “wild theory and uncontrolled imagination” but “that Kenny has described exactly what does happen.”132

  Both Stimson’s and Schwartz’s studies were highlighted in the 1942 Yearbook of Physical Therapy that devoted 24 pages to studies of Kenny’s work compared to 3 pages the year before.133 At the American Congress of Physical Therapy Knapp similarly praised researchers such as Schwartz and Bouman who had begun to search for the physiological cause of spasm and referred to his own research conducted with a physiologist that supported “the fundamentals of the method.” While it was true that Kenny’s work was “based on radical changes in physiologic interpretations of the observed symptoms,” Knapp said, there was no disagreement with known pathology. Indeed her work had made clear how little physicians did know “about the fundamental pathologic physiology of poliomyelitis.”134

  In “Sister Kenny Wins Her Fight,” a follow-up Reader’s Digest story in 1942, Lois Miller declared that the NFIP’s approval of Kenny was “without precedent or parallel in medical history.” Boosted by clinical results described by Stimson and physiological evidence by Schwartz at the University of Rochester, “overnight the theories and practices that had been applied to the treatment of infantile paralysis for decades became outmoded; in their place came a new treatment—opposed to the old ideas—which had in its favor only one thing: it worked!” Miller did add that it was “still too early to inquire exactly how and why the treatment achieves its remarkable results.”135

  A COMMITTEE COMES TO VISIT

  In November 1942 5 members of the orthopedic committee formed during the summer’s AMA meeting came to Minneapolis. Some of them, Kenny recognized immediately, “had written most antagonistically and untruthfully” about her work. This enmity was clear when “one extremely antagonistic member of the group” using the fighting word “cure” asked Kenny “what do you call a cure for this disease?”136

  Ralph Ghormley was the committee’s chair, but he was not able to come to Minneapolis, so Melvin Henderson, Ghormley’s Mayo colleague who was not a member of the committee, had agreed to be its acting chair. In addition, Ghormley asked each of the visiting doctors to write his impressions of the visit. Kenny showed the visitors her patients, demonstrated her methods, and lectured on her theories, with some additional lectures from Pohl. She resented this further investigation of her work and while she was eager to prove her method’s efficacy she was also quick to hear quizzical comments as attacks.

  Almost all of the 5 visitors’ responses showed that their previous attitudes were not changed. Henderson was pointedly neutral and in a positive tone said that the visit convinced him that “there is a good deal more to this disease than merely the involvement of the anterior horn c
ells.”137 Edward Compere from Chicago, already known as a Kenny ally, was far more enthusiastic. He had begun to use Kenny’s methods by early 1942 and had praised them in the Archives of Physical Therapy. Though “not a cure,” he wrote, they did reduce the “severity of the paralysis.”138 Compere recognized that the visit had not gone well and did not want personal animosities to derail a fair assessment of Kenny’s contribution. While “it will not be easy to separate the personal equation,” he told Ghormley, “we should not judge the method, however, or the theory, on a basis of our dislike of some of the publicity which has so flooded the newspapers or because we may have had conflicts with Miss Kenny herself.”139 Robert Funston, chair of the Department of Orthopedic Surgery at the University of Virginia, had allowed his younger colleague to attend one of Kenny’s courses a few months earlier and had sent members of his hospital staff to Minneapolis for further training.140 In a noncommittal report Funston noted that Kenny’s patients had better flexibility and fewer “contractures” than other patients he had seen. As for her ideas about “the function of individual muscles,” in some “I think she is right and other[s] I do not.”141

  St. Louis orthopedists Albert Key and Relton McCarroll came and left as adversaries. Key distrusted the examples of “apparently normal children” Kenny showed the committee, seeing them as very mild patients who “would have recorded normal muscles whether or not they had had the Kenny treatment.” He admitted he was intrigued by X-ray films of a patient with mild scoliosis who had worn a spinal support for 3 years and then been treated by Kenny. The more recent X-rays showed curves in the lumbar and dorsal spine that “were slightly less than were those in the earlier film” and he felt that “this case would bear study.”142 Both men disliked Kenny’s rejection of orthopedic apparatus and her use of Kenny (short) crutches; both felt that such patients would be better off with braces “from an economic standpoint” and “that many of these patients will later choose a brace in preference to the crutches.” With no sympathy for Kenny’s new definition of “deformity,” McCarroll was annoyed by Pohl’s upbeat predictions of a patient whose peroneal muscles were still paralyzed after 14 months of treatment. Pohl had said that even if the muscles did not regain normal power “there would be no tendency to deformity in later years. How they can be so certain of this is impossible to see.”143 Both men also found Kenny rude and inflexible. According to Key “she made numerous dogmatic and, to my mind, obviously untrue statements and when questioned said to me on three occasions, ‘There are none so blind as those who will not see,’ and turned her back. On other occasions she merely said that she was wasting her time trying to show us anything.” Her claims of having “discovered a cure” and having “revolutionized the treatment of this disease” they saw as “nonsense,” and both berated the NFIP “for fostering this publicity.”144

  Kenny had hoped to sway the committee by a demonstration of mental alienation, using a trick she had developed years earlier. She asked the visitors to examine one of her patients and, as she recalled it, all “pronounced the extensors of the leg completely paralyzed. I disagreed and stepped forward. Again, as I had done in my own wild out-back of Australia thirty years before, I taught the muscle what to do, gave back to it its motor pattern, and then linked it up with the brain path. Full use of the muscle was restored in less than twenty seconds.”145 Then she declared dramatically “that muscle is normal; it was only alienated and I have restored its power.”146 Key and McCarroll were both unimpressed and perhaps also embarrassed to have been shown up.147 Nor did Kenny’s efforts to have the surgeons feel the clinical signs she had identified with their own hands succeed. McCarroll recalled that he was asked to compare a muscle in spasm with the same muscle in the opposite limb. “I very frankly could not detect any difference in the feel or the appearance of these muscles,” he reported to Ghormley. He saw no evidence that any of these muscles could return to their normal power, pointing out “they keep no detailed records on these muscles.”148

  A physician also present at this visit who openly embraced Kenny’s work was Ethel Calhoun. A 1925 medical graduate from the University of Michigan, Calhoun had worked as a private practitioner in Detroit before marrying and having a child. Now in her forties she found a new direction in her life as a passionate supporter of Kenny and her work.149 In her own letter to Ghormley, Calhoun was appalled by Key and McCarroll’s “ ‘chip on their shoulder’ attitude.” They had “started asking one question after the other in rapid fire order without waiting for Miss Kenny to finish an explanation” and were so “very rude” that Calhoun “could no longer keep silent.” She told them that she had just finished a week’s course and that as it “takes most doctors two days at least before they understand some of the basic principles of the Kenny concept” they should “stay long enough to know what she [Kenny] is talking about.” One of them got “very red in the face” and retorted “you don’t know what you are talking about or why we are here.” Calhoun told Ghormley her own child “would never get anything but Kenny treatment, at least not until some one can show me something better.” She regretted that any prejudiced physicians who felt that they “must continue their opposition as a ‘face saving’ method” should have been appointed to this committee.150 Back in Michigan she introduced the Kenny method to the polio wards of the infectious disease hospital in Pontiac and gained the support of her local NFIP chapter.151

  The one orthopedist who admitted that the visit had profoundly altered his views was Herman Charles Schumm.152 He had come to Minnesota from Milwaukee, he admitted to Ghormley, “very anti-Kenny” but he left convinced that “our ideas as to what muscles were paralyzed were all wrong.” Her method “certainly gives better results than I have seen in the past, or have been able to obtain.” She also convinced him that most patients “need no type of appliance or brace whatsoever and that they do much better without it.” Schumm was not put off by Kenny’s manner. He found her clinical results powerful and may even have become more sympathetic watching her battle with Key and McCarroll. “I have apologized to myself several times since my trip to Minneapolis for making up my mind that her treatment was no good before I had made an adequate investigation,” he concluded his report.153

  Kenny somehow obtained a copy of these reports. While she told Ghormley she would “overlook the unkind and hateful personal reference[s] … in the interests of humanity” she did protest the therapeutic and professional attacks. She had not been discourteous or “turned my back.” Her demonstrations had taken place before the opening of the spacious Institute. Forced to show her patients while her visitors stood in a circle around 2 tables, she had had to “keep turning from one table to another.” Kenny was not surprised by her visitors’ initial skepticism for she had shown them “a disease with which [each doctor] … was unfamiliar and had no idea existed.” But she was frustrated that her demonstration of mental alienation had not altered their skepticism and that her environment, supervised by a medical school, had not effectively shielded her from accusations that her recovered patients had not really had polio. Thus, when “Dr. McCarroll had doubted the diagnosis and asked me who had diagnosed the cases,” Kenny had replied with great satisfaction that “the pediatric staff was responsible.”154 At a meeting of the Academy of Orthopedic Surgeons a few months later she learned that Key and McCarroll remained antagonistic. Although during a visit to Wesley Memorial Hospital they had congratulated the hospital’s Kenny technician on her patients’ “splendid condition,” at the Academy meeting McCarroll declared that if the patients “had belonged to him he would hang his head in shame.” He later phoned the technician and “apologized for passing this remark,” adding that he had been “to use his own expression, ‘just mad.’ ” 155 A private phone call to one technician, Kenny feared, would hardly counter the profound impact of this public denigration of her work.

  Key remained one of Kenny’s most prominent critics. In “The Kenny Versus the Orthodox Treatment” in Surgery he arg
ued that the Kenny treatment of spasm was harmful for it rejected crucial therapies such as immobilization and rest. He defended “orthodox” treatment as “the result of the accumulated experience of many physicians” and “well standardized throughout the civilized world.” Not only was rest “probably the most important therapeutic measure in our armamentarium,” but patients also required well-padded and fitted plaster molds or padded metal splints in order to protect paralyzed muscles from stretching and to hasten “the disappearance of hyperesthesia, muscle tenderness, and contractures.” Despite Kenny’s claims, such apparatus “do not interfere with circulation nor are they left in place constantly.” Nor was there any evidence that the polio virus “attacks the muscles” or that the Kenny method would prevent “paralyzed muscles from stretching.” In any case, Key argued, none of her claims could be properly assessed for without records “it is not possible to verify the exorbitant claims of cures.”156

  TALES OF SACRIFICE

  Despite the brutal attacks of these critics, the Institute grew in public acclaim, a brick and mortar emblem of Kenny’s contribution to American medicine. Kenny’s methods—or at least key parts of them—were embraced by hospitals throughout the country. Publicity from Reader’s Digest, Life, Time, and other magazines confirmed Kenny as a celebrity. The Minnesota Public Health Association gave her a plaque for Outstanding Service to Humanity and Parents Magazine awarded her the magazine’s annual medal for Outstanding Service to Children, following former recipients such as Eleanor Roosevelt, Walt Disney, and Surgeon-General Thomas Parran.157 The Variety Clubs of America, a group of show business philanthropies focused on the needs of poor children, gave her its Humanitarian Medal for 1942, which was presented to her in Sacramento “in the presence of Governor Earl Warren of California and other people of note.” In her speech which was broadcast across the country by radio she compared her work’s results to those of patients treated “under orthodox methods from the orthodox concept.” Her contribution—“the result of lonely research [in] … the bush land of Australia”—was “an entirely new concept of the disease, with an entirely new treatment based on that concept.”158