Polio Wars

by Rogers, Naomi

  Bell suggested that the NFIP use Kenny as a figurehead in the upcoming campaign, pointing out the public’s “hero worship of football players, baseball players, pugilists, etc.” as well as Kenny’s own enjoyment of “the limelight.” The NFIP needed to be cautious of an emerging Kenny movement that it might not be able to control for neither O’Connor nor the NFIP, in Bell’s view, “can command the publicity or the sentiment that she possesses.”51 O’Connor recognized that Bell was placing the NFIP in a precarious position but he did not agree with Bell’s assessment. He saw more clearly than Bell that Kenny would not be amenable to being used as an NFIP figurehead and that it would not appease her.52 Still, he did recognize that her accusations were hurting the regional and national standing of the NFIP. His staff sent lengthy notes to individual wealthy donors declaring “the National Foundation is the people’s Foundation … we have no secrets. There is nothing the public cannot and should not know.”53

  THE MINNESOTA PROBLEM

  When Kenny complained to reporters that the University of Minnesota was not supporting her work, this created a serious public relations problem for the university. From the outset the university had put itself in her camp, using the growing reputation of Kenny and her work to establish its medical school and hospital as major polio centers. Relations between the university and city officials—who controlled the city hospitals where most of the medical school’s teaching took place—had often been strained. When the Institute was incorporated as a nonprofit company with its own board of directors, its administration moved further away from the medical school. Yet the Institute maintained a connection with the city; its board was headed by Mayor Marvin Kline and included other city officials.54 The University continued to seek good relations with these local politicians and to continue the medical school’s interdependence with city hospitals.

  Not only had the citizens of the Twin Cities adopted Kenny as a civic hero, but Kline, a Republican city councilman who was elected mayor in 1941, had firmly linked his career to Kenny, using her, as one NFIP official complained, “as a vehicle to popularize himself with the people of Minneapolis.”55 Kline had graduated from the University of Minnesota in architectural engineering and had worked in an architectural firm before being elected mayor. During the war he combined city and federal funds to sponsor housing, victory gardens, and salvage projects and set up a child care center and a veteran’s referral center.56 When he successfully ran for reelection against Democrat Hubert Humphrey in 1943, he boasted that “the work of Sister Kenny has taken the name of Minneapolis around the world” and that he considered “the establishment of the Elizabeth Kenny Institute as one of the major accomplishments of my administration.” During the campaign Humphrey had vainly protested that it was the Mayo Clinic and not Kline who deserved credit for bringing Kenny to the Twin Cities, and that her initial work at the city hospital had been welcomed by the city’s previous administration.57 Kenny was aware of some of the pitfalls of immersing herself in local politics, but she found it impossible to ignore the Republican stance of many of her friends. She told reporters that although she had “no wish to be involved in a political argument” she was pleased to note that “Mayor Kline has supported my work most wholeheartedly.”58

  Medical school Dean Harold Diehl, to his consternation, became a central player in the polio wars when Kenny demanded that the school endorse her method publicly, threatening that otherwise “it will be unnecessary for me to prolong my stay in the U.S.A.”59 At a genial but unproductive meeting with representatives of the university, the Institute and the city’s Board of Public Welfare Diehl explained that this demand was a sign that Kenny misunderstood academic etiquette. The University “does not and cannot officially endorse any method of treatment for infantile paralysis or any other disease. Things just are not done that way.”60 After the meeting Diehl stated publicly that while “the Medical School is interested in further investigation and development of this method” it did not endorse it. As for Kenny’s new method of early diagnosis, Diehl had not had it demonstrated to him but “when Sister Kenny reveals her new diagnostic theory, the University will cooperate fully in a study of it.”61

  Local physicians began to take sides. Wallace Cole “declined to serve” on the Institute’s new board.62 John Pohl in contrast confirmed his loyalty to Kenny and her work by joining the board and praising her work in the local press as “the finest and best treatment known at the present time.” He continued to supervise Kenny technicians at the city hospital and the Institute. After what observers later called “a hurriedly called meeting” that a number of board members were unable to attend, Pohl, aided by Kline, began to write a grant application to ask the NFIP to continue to fund the Institute’s teaching program and also to allow it to function as a research institute.63 Miland Knapp, who no longer directed the Institute’s teaching program, agreed to join the new board but publicly distanced himself from some of Kenny’s more controversial claims. In May 1944 in the Journal-Lancet, the state’s medical journal, he offered his “own opinion,” which was, he clarified, different from the opinion “of Sister Kenny.” While hot packs were “most valuable” in “the stage of acute spasm,” he conceded, on the basis of his clinical observations and recent physiological research, he could find no correlation between the appearance of spasm and the “severity or distribution” of muscle weakness. He also believed that Kenny’s concept of mental alienation was “probably only a minor factor” and was in any case an “unfortunate term,” for it implied “a physiologic cause of loss of function which is not justified by the clinical observations.”64 That fall as the newly elected president of the American Congress of Physical Therapy, Knapp reiterated his view that Kenny’s concept of mental alienation was wrong and that the location of spasm did not in any way correlate with the location of weak muscles.65

  After Diehl refused to endorse Kenny publicly, she began to tell a different story of her reception in Minneapolis. Instead of the enthusiastic acceptance she had described in her autobiography, she now claimed that physicians in nearby Rochester had been far more welcoming than those in the Twin Cities.66 She also began to speak more frankly about the crucial financial support she received from local businessmen, especially her friends in the Exchange Club. In this new story the NFIP’s grant in her early months in Minnesota had barely enabled her to survive. “Had I been absolutely dependent upon this assistance [from the NFIP],” she told Diehl, “the only value to the teaching profession would have been a presentation of my cadaver to the Anatomy Institute for teaching purposes, for I would have starved to death.”67

  THE AMA REPORT

  In June 1944 the war got hotter. The AMA held its first annual meeting during wartime. Physicians heard lectures on the use of penicillin for syphilis, gonorrhea, and meningitis, and the use of thyroid extracts for sterility. The AMA’s new president reminded them that “every physician in this country … [should] devote at least two hours a day to educating the people in his community” on the dangers of national or state health insurance legislation. There was also a symposium on the abuse of rest in treating disease. Los Angeles internist William Dock warned that it could lead to blood clots, bone atrophy, muscle wasting, and other disabilities.68 Such warnings sounded much like Kenny’s own rejection of immobilization in polio, but no one drew the analogy. Importantly, a group of orthopedic surgeons presented a harshly critical report, which Fishbein made sure was published simultaneously in JAMA.

  The committee of “seven university professors,” as the New York Times called them, had spent 2 years visiting 16 clinics in 6 cities (including Kenny’s Institute) and had examined 740 patients.69 St. Louis orthopedists Albert Key and Relton McCarroll both disliked Kenny. Key had published 2 articles defending “orthodox” care, and McCarroll, one of the authors of the 1941 study that had provided Kenny with dramatic statistics about the ineffective results of orthodox therapies, had attacked her work in JAMA.70 At the other end of the spectrum wa
s Chicago orthopedist Edward Compere who had introduced Kenny’s methods into Wesley Memorial Hospital as early as 1942 and Herman Schumm, a Milwaukee orthopedist who had been convinced of the veracity of her ideas after his visit to Minnesota. Robert Funsten from the University of Virginia had originally been supportive but had become uncomfortable with the ways Kenny technicians threatened to disrupt hospital power relations and now believed that Kenny’s “dynamic personality” had led her “to further her ideas and spread her theories.”71

  Neither Compere nor Schumm’s views were represented in the final report. Instead, it retained Key and McCarroll’s distaste for her style of practice and her claims, especially the idea that her work was revolutionary. Beginning treatment “as early as possible is desirable,” the committee agreed, yet in the “acute febrile stage the handling necessitated by the Kenny treatment can be detrimental.” The AMA committee reminded doctors, nurses, and physical therapists that therapy during this stage “is primarily a medical problem.”72

  The report rejected Kenny’s claim that her work bettered “orthodoxy.” In fact, there was “no satisfactory evidence,” the committee stated, “that the institution of early local treatment will alter the course or the extent of the paralysis.” The committee also attacked the significance of the signs and symptoms Kenny claimed to have identified and the methods she had developed to treat them. While it was true that pain could be relieved by “hot foments,” the committee argued, in fact, “pain is not an important feature of the disease in most instances and when present, can be relieved also by other measures.” Uncomfortable with Kenny’s word “spasm,” the committee used it only with quotation marks. Recovery from spasm, in any case, occurred in most patients spontaneously. Hot packs were not “a panacea in this disease” and her “rigid technique” was “neither important nor essential.” As orthopedists the committee members especially disliked Kenny’s cavalier rejection of standard orthopedic apparatus. Splints and braces remained “beneficial for some patients,” and “respirators saved many lives.”73

  The committee also found that those parts of Kenny’s work that were valuable were not original. This argument was succinctly summed up by Key, quoting the Australian reviewer of her 1937 textbook, that “what is good in the Kenny treatment is not new and what is new is not good.”74 Citing eminent polio experts who had written standard orthopedic textbooks and had taught at least a generation of surgeons and physical therapists, the committee noted that “proper positioning in bed” was standard orthopedic practice and “hot wet packs” and “moist heat” had been discussed by Lovett and Legg decades earlier. The idea of reeducating muscles and the warning that physicians should not use braces “unnecessarily” could be found in Lovett and Jones’ 1929 text Orthopaedic Surgery. Further, “stiffness, muscle tenderness and early contractures have been long recognized and considered an integral part of the acute phase of the disease.”75

  Her theory of polio as primarily a disease of muscles and skin was, the report said, simply wrong. The surgeons argued, as had McCarroll and Crego in 1941, that the “amount of residual paralysis” was dependent not on the physical therapy used but “on the amount of destruction in the central nervous system,” which varied “tremendously in different epidemics.” There was only one area in which Kenny could be correct, according to the committee. Perhaps there were, as Kenny claimed, “local changes in isolated muscles during the acute stage,” but the nature of such changes “must be studied further.” Mental alienation had already been described by Jones in 1911, but her statement “that the flaccid muscles are normal is obviously not true.” The concept of incoordination was “merely another term for the condition of muscle substitution,” a term used by Ray Lyman Wilbur in 1912, but it was “of relatively little importance.” Even Kenny’s much publicized new diagnostic sign was not new or revolutionary but had been described by William Aycock in 1928 and George Draper in 1931.76

  Most of all the committee condemned “the wide publicity which has misled the public and many members of the medical profession,” even though it may have “stimulated the medical profession to re-evaluate known methods of treatment of this disease and to treat it more effectively.” This was the old argument that Kenny so disliked.77 Echoing Bruce Gill’s arguments in his 1943 letter to the Orthopaedic Correspondence Club, the committee warned that her promises of recovery were false and accused her of “a deliberate misrepresentation of the facts of treatment by other methods.” “Despite reports in the medical literature that around 50–80 percent of patients paralyzed by polio had a ‘spontaneous recovery,’ ” she attributed “all improvement … to the treatment.” Her use of McCarroll and Crego’s statistics was drawn from a study that “dealt entirely with severely paralyzed patients,” yet she had “been told repeatedly that this is not a fair comparison to make.” Accurate statistics also did not support her claim that 80 percent of her patients recovered. Despite the caveat that “this we attribute to her overzealous desire to promote adoption of the Kenny treatment,” the committee was clearly accusing Kenny of deliberate exaggeration.78

  The surgeons who wrote the “Evaluation of the Kenny Treatment of Infantile Paralysis” hoped their report would end the debate around the worth of her work. But the report’s reception at the AMA meeting showed how mistaken they were. Far from being defining, it instead became a catalyst for a breakdown in physician unity. Its explicit attacks on both the work and its promoter were written in a way that cried out for quotation by newspaper reporters. Commentators noted that the report read “more like a prosecutor’s brief than a scientific document.”79 Kenny’s fight was now with the medical establishment. Patients, families, and ordinary doctors could support the high-handed AMA or take the side of an altruistic nurse trying to help crippled children.

  The popular press took sides. Albert Deutsch in PM found what he called the AMA’s “scathing attack” on Kenny’s work “a strangely unconvincing document, charged with emotional bias against Miss Kenny and her claims.” He guessed that at the base of the disagreement was money. He sharply contrasted “private orthopedic specialists who might be cut off from a lucrative source of income if Miss Kenny’s method should be generally adopted” to public health officials with “no axe to grind” who found her work valuable despite “some serious flaws in her concept.”80 “Paralysis Method Held Overpraised” argued the New York Times in contrast, quoting with approval the NFIP’s 1943 annual report that expressed regret at the “unprecedented publicity” given to the Kenny method, which had led to “exaggeration.”81

  On the first page of that month’s National Foundation News NFIP officials placed a special notice saying that the report “by a group of distinguished orthopedic surgeons” had resulted in “numerous inquires regarding the National Foundation policy.” Cautiously treading a path between Kenny and the AMA, the NFIP argued that “the somewhat controversial situation as to the exact merit of each phase of the Kenny method” did not alter the NFIP’s policy “in any way.” Many physicians “feel that a contribution has been made in the Kenny method and use various phases of the technique in their practice.” “The National Foundation is interested in only one thing—determining the value of the various phases of this technique by scientific study in laboratories of physiology and in clinics with a view to retaining such merit as it may possess.”82 Recognizing the upheaval this report had caused, O’Connor also began an extensive tour visiting chapters in 12 states and 21 cities in the West and Northwest to try to calm the waters and to present a rational, unflustered face to a philanthropy under siege.83

  Wily enough to know that the report would work best left on its own, Fishbein offered a brief editorial comment in JAMA, drawing on a study by Kabat and Knapp that argued that muscle spasm was “a reflex phenomenon” and that “there appears to be no direct relation between it and motor paralysis.”84 His editorial in Hygeia fulsomely praised the work of this “distinguished committee” whose members had “nothing to gain per
sonally by their report,” and reiterated that continuous hot packs were of “questionable value” and “a waste of manpower and hospital beds.” “Unfortunately people in general do not read as carefully as they should the reports that appear in the press regarding medical technics,” Fishbein added, and it was best to “get a competent doctors and to leave to his decision the method of treatment to be followed.” He praised Kenny’s “enthusiasm” and concluded that “she has acted like an enzyme or a ferment to hasten study and to encourage the earlier appearance of important facts.”85 Surgeon General Thomas Parran refused to get involved, explaining to Kenny by telegram that no action by the United States Public Health Service (USPHS) was indicated since the AMA report “points out [how] important your contribution [is] in stimulating scientific re-evaluation of various known methods of treatment.”86 The report, as its authors had hoped, provided a vocabulary and way of thinking that helped physicians distance mainstream medicine from Kenny’s work. A doctor at Chicago’s Michael Reese Hospital, one Kenny supporter noted, said to patients “we aren’t calling it the Kenny system any more. We have made a few changes and have our own system.”87 Similarly a prominent physician at Northwestern’s medical school claimed Kenny “hasn’t shown doctors anything that they didn’t know before. These nurses who get ideas over-value themselves because they don’t know the whole picture.”88

  In Minnesota Diehl’s effort to find a quiet middle ground was undermined by antagonists within his medical school led by physiologist Maurice Visscher who had been at the University of Minnesota since the 1920s. A researcher with a national reputation, Visscher was the recipient of several large research grants from the NFIP.89 In June 1944 he helped to organize a “Symposium on the Management of Infantile Paralysis” that, as one of the editors of the Journal-Lancet, he then published as a special issue the following month.90 Along with articles by neurologists and physiologists from the university, the July issue contained an editorial on “The Present Status of Poliomyelitis Management” written by Visscher and 3 other faculty members.91 The editors praised the “energetic use of hot packs” as certainly better than “rigid immobilization” and the “highly expert” use of physical therapy that had brought attention to “an altogether too frequently neglected aspect of poliomyelitis after-care.” But in pointed but not vitriolic prose, they argued that medical research had not demonstrated that any single polio therapy had “superiority over all others,” so physicians had to “continue to search for better ones.” More sharply, they stated that there was no proof to justify Kenny’s theory of the centrality of muscles in polio pathology or that her methods minimized early paralytic damage. Further, her terms spasm and alienation were “ill-defined” and “awkward” and her attention to these clinical signs was probably not original.92 The Journal-Lancet issue received strong praise from neurologists and physiologists around the country who particularly liked the editorial for having, as one man saw it, “the courage to bring out the good side of the Kenny method … against certain belligerent and reactionary groups who have acted as if their precincts in medicine were being taken from them.”93