Polio Wars

by Rogers, Naomi

  Kenny enlarged on these arguments in her 1943 autobiography And They Shall Walk, which brimmed with tales of sacrifice and justified outrage. The book described an outsider who moved from the Queensland bush to the city of Brisbane, and then from the exotic nation of Australia to the modern United States in order to obtain medical respect. Descriptions of wattle, black swans, koalas, and other distinctive flora and fauna gave this work the flavor of a travelogue. To remind readers that she was contributing to a global health problem—not one specific to Australia—there were descriptions of her extensive international traveling to treat patients. Her experiences in the United States were shown as the culmination of a life’s work of struggle and sacrifice.

  In the book, almost all negative examples of professional opposition take place in Australia or England. In the United States, physicians—although at first cautious and quizzical—are wonderfully open-minded and free of prejudice against either Kenny’s training or gender. “Such recognition, though late in coming, did much toward healing the wounds that had been left by scurrilous criticism and by the even more humiliating experience of being loftily ignored. It helped me to forget the bitter tears I had shed in solitude.”159 Positioning herself as a female medical pioneer, Kenny stresses her impatience with orthodoxy, the restrictive conventions of gender roles, and the inflexibility of medical thinking and professional ethics. Perhaps reflecting commercial pressure to add a love interest, a few pages present the story of Dan, a local farmer. Big and bronzed with kind blue eyes, Dan believes “a woman’s place was ‘in the home’ ” and he tells Kenny she “must give up this nursing nonsense if I were to take the place for which my Creator had ordained me.” When she chooses to attend a woman in labor instead of a dance, “we quarreled our last quarrel,” and she delivers the baby “fighting back the tears.”160

  Nowhere, other than on the book’s title page, was there a reference to Kenny’s co-author Martha Ostenso. Ostenso, a prize-winning novelist, later claimed that Kenny sometimes yelled when Ostenso altered her overblown phrases, but that she was delighted with the final version. The Dodd, Mead contract gave Ostenso 5 percent of the book’s profits, and she seems to have been willing to have the publisher advertise the book without highlighting her name as co-author.161

  Despite the numerous descriptions of exotic places, And They Shall Walk has only 3 illustrations, all photographs of Kenny in America. The first 2 reinforce the image of Kenny as a clinician capable of training other professionals. In the picture captioned “Sister Kenny demonstrates her revolutionary treatment,” Kenny is pointing to the strong legs of a boy on a treatment table as skeptical nurses look on. In “Training nurses to carry on the Kenny treatment,” eager nurses and physical therapists watch her wrap a child’s legs. The third photograph features Kenny with the world’s most famous polio survivor. The caption “President Roosevelt greets Sister Kenny” ignores the third person in this image: Basil O’Connor, the most powerful person in polio philanthropy. Yet in her introduction Kenny thanks the NFIP along with the citizens of Minneapolis and Cole, Knapp, and Pohl, “without whose support and encouragement wider recognition might have been indefinitely postponed.” She concludes with her declaration that “to the medical men of the United States of America I pass the torch.”162 But her growing stridency in response to critics belied this statement. And her new textbook published a few months later went further, arguing that only those experts who accepted her contribution would be able to guide the progress of polio science.

  Physicians who adopted Kenny’s work tried to express enthusiasm mixed with caution. “Our physiologists and pathologists must, and eventually will, give us the basis for these newer clinical manifestations,” Robert Bennett argued in the Southern Medical Journal.163 In the Archives of Physical Therapy he praised the patient, intelligent guidance of men such as Miland Knapp who had enabled Kenny to develop her techniques and, he was sure, equally keen and devoted researchers would now “support [or] … if necessary … intelligently alter that which she and other serious investigators have given us.”164 Importantly Arthur Steindler, one of the nation’s leading orthopedic researchers and teachers, declared in the Journal of Bone and Joint Surgery that he and his staff had accepted many of the “Kenny technics” to treat pain and spasm. Experiments in his department at the University of Iowa using novocaine on nerves affected by polio suggested, like the Kenny concept, that the cause of spasm “is peripheral and not central.” Thus, Steindler argued, “tendons, ligaments, and capsular reinforcements are involved in pathological changes, as are the muscles.”165

  These physicians were aware that many British professionals would see their support of Kenny as an unfortunate example of naive American enthusiasm. At the end of 1942, affecting the more objective perspective of a nation of great orthopedists, the editor of the British Medical Journal reminded readers that in the 1930s a London County committee had reviewed Kenny’s methods sympathetically but had concluded that they were of unproven value. In those days, the editor pointed out, “little was heard of any revolutionary ideas about the pathology.” The editor excoriated the “confusing and uncritical” ways in which physicians like Stimson, Pohl, and even the editor of JAMA were trying to rationalize Kenny’s theories. While there was certainly room for improvement in polio treatment, American physicians did not seem to be pursuing “critical inquiry upon strictly neurological lines.” Schwartz and Bouman’s study did not support “Miss Kenny’s theories,” and Lewin was wrong to claim in the Illinois Medical Journal that Kenny’s method was the last word in acute polio care. In any case many of Kenny’s ideas were hardly new. She had given “new names for old ideas” and inspired American proponents to give “extravagant credit to her work,” which was “detracting from traditional American orthopedics.” Physicians should properly seek a “road of conduct, free from orthodoxy and from radicalism.” Still, Kenny had “stimulated many of our American friends to favor heat” and along with “modification and development” this work would contribute to the proper understanding of polio.166 Here Kenny’s methods were not new and her ideas not good; her proponents in the United States were also sadly mistaken in their praise of her work.

  Her critics in the United States were further emboldened by an attack from Philadelphia orthopedist Bruce Gill. In a 14-page commentary which he sent to all 50 members of the Orthopaedic Correspondence Club and later published in the Journal of Bone and Joint Surgery, Gill reminded his peers that they could draw on their clinical experience—as supervisors of polio therapy and as surgeons—and on their specialized training in anatomy, pathology, and physiology. They knew what the polio virus did and did not do inside the body, and what the appropriate and safe technologies were to treat the symptoms of the disease. Conservative, steady orthopedic surgeons, he implied, should not follow the lead of easily swayed physical medicine doctors who were not strong enough to fend off ill-informed hospital trustees, uppity therapists, and demanding parents.

  Gill had retired from the University of Pennsylvania in 1942 after over 2 decades as chair of the department of orthopedic surgery. He continued his private practice and when Alfred Shands left for the army, Gill replaced him as director of the Alfred DuPont Institute, a hospital for disabled children in Wilmington, Delaware. He tried in vain to draw a line between necessary clinical improvement and slavish following of Kenny’s work. At a meeting of the Philadelphia chapter of the American Physiotherapy Association, divisions deepened after Rutherford John, a prominent surgeon on the board of directors of the Philadelphia Society for Crippled Children and an associate professor of orthopedic surgery at the University of Pennsylvania, called the Kenny method “very rational” and Gill retorted that John was “either stupid or willfully misrepresenting the truth.”167 Gill was appalled to see an advertisement for Kenny and Pohl’s new textbook whose publishers had “the unblushing audacity” to declare that “orthodoxy has erred both in recognition as well as in the interpretation of the physical finding
s in this disease” and that Kenny’s concept and treatment were “now generally accepted and approved by the medical professional everywhere.” He was also annoyed that 3 recent publications on Kenny had all proclaimed that Kenny’s work would be “the basis for the future treatment of infantile paralysis” and that her “original” and “revolutionary” concept was “fundamentally different from that hitherto prevailing.”168

  Kenny’s method, in Gill’s view, had become famous not through scientific research but “as the result of publicity designed for the public.” Under the influence of this publicity parents were demanding that their child be treated by the Kenny method; “in other words, the doctor is being told by the layman how he should treat a specific disease.” With an implicit jab at the NFIP Gill warned that allowing “methods of propaganda” to “outrun scientific research and clinical observations and rational analysis” was dangerous both for physicians as well as the public for it would lead physicians to be “swept away from their positions of scientific observation and rational criticisms” and they might subsequently “feel some inward embarrassment and humiliation.”169

  Gill again took up the argument that little in Kenny’s work was new. Many of her “concepts of principles and methods of treatment” were the same as those published by Robert Lovett and many other physicians in proceeding years and ignored “our common fund of knowledge concerning the nature and the pathology in infantile paralysis.” Proud of orthopedic treatment and its results, Gill believed “if any of us treat a child from the beginning of the disease and throughout the following months and deformities develop, we know that we are not following orthodox principles of treatment.” Nor did Gill believe that Kenny’s results had been fairly compared to patients treated by standard methods. In any case, a control study of polio would never be possible for even during the same epidemic patients had varying symptoms and there was an “uncertain prognosis in any individual case.” When the wide publicity around the Kenny movement had “run its course,” he concluded, the final result “whatever it may be, will depend not upon the statements now made by Miss Kenny and her followers, but upon scientific observation and reasoning.”170 In 1944, not long after his comments were published in the Journal of Bone and Joint Surgery, Gill replaced Ober as president of the American Orthopedic Association, a symbol of anti-Kenny orthopedic leadership.

  As Gill recognized, Kenny’s work had become central in NFIP publicity, featured in the NFIP’s 1942 annual report and the NFIP pamphlet The Kenny Method of Treatment. The National Foundation News, a monthly newsletter sent to all NFIP chapters, began urging local and state officials to send one or more persons to be trained in the Kenny method, explaining that “it is a wise and legitimate expenditure of funds for the Chapter.” The News carefully listed not only the Institute but 5 other centers that offered “Kenny Method Courses.”171 While pleased with these signs of philanthropic support Kenny remained dissatisfied. She was not convinced that the NFIP had fully revised its support of previous medical practice. It continued, for example, to distribute other pamphlets whose content contradicted her understanding of the disease. Doctor, What Can I Do?, she complained to O’Connor, referred to “damaging” treatment and “describes the symptoms of a disease which I have proved does not exist.” Both Splints: Their Distribution and Use and The Use of the Respirator in Poliomyelitis referred to “devices … for a disease that does not exist.”172

  Kenny had come to believe that her methods were being diluted in the various centers outside Minneapolis supported by the NFIP and that even sympathetic physicians were altering elements of her work when they returned to their home institutions. Where she had once bragged that treatment by even partly trained technicians would be an improvement on previous treatment, she now railed against deviation from any aspect of her method. Further, instead of her initial support for nurses and physical therapists who had trained at the Institute to work as teachers after receiving their certificates, by early 1943 she was no longer convinced that most of them were sufficiently trained to work as teachers. Kenny began to denigrate centers outside the Institute, using, as she often did, the words of others. Some of the physicians who had taken her class in early 1943, she reported, had gone to “other centers where the treatment is supposed to be taught” and stated “that the other centers have fallen far short of the standard at Minneapolis.”173 These comments contradicted efforts by the NFIP to integrate her work at diverse well-respected medical centers across the country. It also reflected her growing sense that the Institute must rank as the most important center for teaching her methods.

  THE ARGENTINA FIASCO

  The argument, made frequently in medical, nursing, and physical therapy journals, that Kenny had merely drawn attention to neglected, mainstream polio therapies, frustrated Kenny. She had identified clinical signs, which she argued were crucial and which had not been previously recognized; otherwise surely a physician would have developed therapies to treat them. The more that the “attention” argument was made, the more vehemently Kenny argued that her new signs could not be added onto the standard view of polio, that the success of her methods proved that she had developed a distinctive understanding of what caused polio’s paralysis. Thus, her work must replace standard care, not complement it.

  She became convinced that only her specially trained technicians could lead the national and international effort to alter polio’s clinical care. Eager to provide these technicians with opportunities to showcase their work she was delighted when the NFIP agreed to send Mary Kenny and Ethel Gardner, one of Kenny’s inner circle from the Institute, to travel to Argentina during a serious polio epidemic. In early 1943 the head of Argentina’s national department of health had asked for help from the NFIP and also contacted the Reader’s Digest, which had published an article on Kenny in its Spanish edition and set up a scholarship fund for South American nurses and doctors to train at the Kenny Institute.174 In Buenos Aires an American expert at the Rockefeller Foundation’s International Health Division reiterated the request for technical assistance, and, after O’Connor contacted Roosevelt, Gudakunst began working out the details.175 Sending aid of any kind to Argentina was tricky. Argentina was the only Latin American country that had not severed diplomatic relations with Germany and Italy, and its unstable government was allowing Nazi Germany to establish a spy network there.176 In a statement that combined U.S. foreign policy with its own philanthropic mission, the NFIP announced proudly that the trip would “not only aid those stricken by infantile paralysis but will, through that manifest assistance, further implement the Good Neighbor policy.”177

  Gudakunst had heard disturbing reports from Miland Knapp about the Little Rock epidemic in which patients had supposedly been discharged too early and the hot packing had been poorly organized, “partly due to lack of help and facilities and partly due to a feud between the nurse in charge of the floor and the nurses who had been sent to Minneapolis for Hot Pack training.”178 So as not to make “the same mistake that we made in Little Rock,” Gudakunst made sure that an approved physician accompanied the 2 Kenny technicians.179 His choice, Philadelphia orthopedist Rutherford John, had contacted Gudakunst in February proposing himself for the Argentina trip, for “the Army won’t take me, and my foot itches to do some traveling.”180 John had already declared at a meeting of the state’s chapter of the American Physiotherapy Association that he believed Kenny’s work was “very rational” and that her ideas “dovetail[ed] wonderfully with our scientific knowledge of the disease.”181 Gudakunst considered John “a top-notch man fairly well acquainted with the Kenny method” who had traveled in South America and therefore “knows something of the customs, and has a fair ability to converse in Spanish.”182 He also asked the opinions of Mayo orthopedist Melvin Henderson and Morris Fishbein, who both gave their approval.183

  John and the 2 technicians arrived in March 1943 and based themselves in Buenos Aires.184 Diplomatically, John stayed at a hotel instead of the hos
pital where the technicians were staying. Debates among Argentinean physicians about the proper way to treat patients with polio were ferocious, so staying at a hotel helped him, he explained to Gudakunst, “not be associated with any one clique.”185 In a letter to the Secretary of State, U.S. Ambassador Norman Armour praised the “tact, patience, and persistence of Dr. John and the nurses,” which had overcome obstacles such as “bureaucratic procrastination, professional rivalries, lack of trained personnel, inadequacy of material equipment, and want of a common language.” The local press was all “unanimously and enthusiastically favorable,” and “only the extreme nationalist and Nazi-Fascist sheets have ignored the visit.”186 John, however, was uncomfortable. He was unable to convince some of the local physicians who disliked both the Kenny method and its “wide publicity by the Argentine press.”187 He also found the federal and city polio commissions at odds and described the strain to “keep in with both.” He gave a series of lectures that were well attended and widely reported by local newspapers. But the course he organized on muscle reeducation was overwhelmed by applicants, most bringing letters from physicians. Mary Kenny and Gardner told him they could not handle more than a dozen students. As a result, he told Gudakunst, “I had to be hardboiled and have probably made many enemies [although] … we are still immensely popular with the Press and the people.” He recognized that many Argentineans wanted the technicians “to stay on indefinitely and teach but my feeling is that we have done what can be done in a short time and it might be wiser to leave at the height of the enthusiasm.”188 In early May John returned to Philadelphia.