Polio Wars
Page 43
Simultaneously the American Mercury published its own story of Kenny by muckraking journalist Albert Deutsch. In “The Truth About Sister Kenny,” Deutsch reveled in “the Amazonian figure of the gray-haired, steely-eyed, strong-jawed Elizabeth Kenny.” Money was at the heart of this new fight, Deutsch guessed, noting that Kenny had turned down “many tempting offers of financial reward,” and that the NFIP had “given but niggardly financial support to her activities while cashing in handsomely on the publicity she has received.” Orthopedists, Deutsch believed, saw Kenny as a competitor and were angered by her claims that her methods used early enough “could have saved many patients.” “This deep personal resentment” was manifest throughout the AMA report whose “bias is so obvious that it succeeds only in weakening the impact of certain criticisms which are not without merit.”159 Deutsch noted that Kenny was “a difficult person,” although she showed her child patients “consummate tenderness, inspiring courage and rare devotion.” But he also guessed that many of the doctors who “call her arrogant, arbitrary and domineering” resented “the reversal of their authoritarian role toward the nursing profession, with a lowly nurse telling the doctors where to get off!” Deutsch defended Kenny’s belligerence as the unsurprising result of her experiences with refractory physicians. “Can the medical profession justly expect only sweet reasonableness from a woman who, after years of personal sacrifice, feels that its blind opposition has cost the lives or health of thousands who might have been saved had she been given a chance to demonstrate her method in time?” He did not, however, agree with Kenny’s complaints that physicians had refused to assess her work. He had spent much of his career exposing the cruel and neglectful care of patients in state mental institutions and was no fan of organized medicine, having “occasionally crossed swords with Dr. Fishbein myself,” but he did believe that JAMA had “thus far provided a balanced forum for Kenny controversialists.”160 These articles magnified Kenny’s voice in response to the AMA report, critiquing both the NFIP and AMA orthopedists.
The “Pennies for Kenny” campaign enhanced Kenny’s presence as a civic celebrity, and not long after it ended Kenny was chosen as both the Minneapolitan and Minnesotan of 1944, according to a poll conducted by the Minneapolis Star-Journal.161 The Institute’s board proudly announced that the campaign had raised more than $350,000. These funds would be used for training programs in which “true Kenny methods will be taught in their entirety” and for clinical research on “neuromuscular disorders.”162 Not coincidently, the January 1945 March of Dimes campaign, just a few months later, made much of the effective patient care the NFIP had funded during the previous year’s epidemics, especially in Hickory, North Carolina. A short film starring Greer Garson, best known as MGM’s Madame Curie, dramatized the NFIP’s work during the Hickory epidemic as a battle against polio that brought people together, an implicit criticism of the divisive polio wars.163
In an effort to dampen antagonism in the Twin Cities and lay out a middle ground, Miland Knapp and 3 other physicians who headed departments in the city hospital published a brief analysis of patients with polio in the Journal-Lancet. They carefully described some of the “points in which we disagree with Miss Kenny’s methods and theories” and sought to balance this with their conclusion that her methods had led to a definite decrease of “deformities.” They praised patients’ improved general condition, the successful management of muscle shortening or “spasm,” and the overall “decreased incidence of deformity,” especially scoliosis and pelvic obliquity. Such results confirmed their decision to accept “some of the methods which appeared to be of the greatest value.” But they agreed with the AMA report’s criticism of the unfortunate publicity around Kenny’s “enthusiastic assertions” and reiterated that she had made “inaccurate comparisons of patients treated by her methods and by other methods.” In a muted critique of the AMA committee, they pointed out that to assess her methods required a close study of every patient paralyzed during a series of epidemics “after sufficiently long intervals,” for only then would there be “a fair and trustworthy set of facts … upon which a truly scientific evaluation can be based.” Thus, they concluded hopefully, “open-minded” physicians would continue to “study and observe the work of Miss Kenny” and “judge her efforts fair-mindedly,” for “full appraisal must await the passage of time.”164
Kenny saw the similarities between this analysis and the AMA report and complained to the Institute’s board that she deserved an apology from the AMA, Knapp and the other local physicians for “the accusation that I have made inaccurate comparisons has cost me much grief and humiliation.”165 Pohl began to prepare his own study of Institute patients. He was coming to share Kenny’s sense that the NFIP was part of a conspiracy to denigrate Kenny’s work and urged the board to publicize “the untruths, deceit, misrepresentation, and racketeering in human misery practiced by the National Foundation.”166 He was not surprised, however, when JAMA and the British Medical Journal rejected his paper. He was able to publish it in Minnesota’s Journal-Lancet the following year where it was countered by a series of antagonistic articles carefully choreographed by Maurice Visscher and the journal’s other editors.167
Former allies such as Gudakunst no longer supported Kenny’s “concept.” In an internal NFIP memorandum on “Questions Frequently Asked” Gudakunst noted that physicians had accepted the value of her method of treatment but not “her explanation as to the nature of the disease, her ideas as to pathology, or her ideas as to why her form of therapy is good.”168 In Parents Magazine he praised her “now famous method of treatment” but warned that the Kenny method was not a cure and would not “save a single nerve cell from death.” After all, he added, using a well-honed NFIP line, “treatment is not enough”: only through “research” could polio “eventually be brought under control.”169 In the American Journal of Nursing he also warned that despite “the exaggerated claims made in some lay publications” there was no “miracle cure for the paralysis caused by the disease.” Professionals, he added, needed to distinguish “between the Kenny treatment and Sister Kenny’s interpretation of the disease,” for her interpretation was “still under careful scrutiny.”170
Pressed by Kline, Gudakunst refused to concede that Kenny’s work had led American physicians to develop a new concept of polio. “Based on our knowledge of the pathology and its resultant symptoms,” he told Kline, polio was “a virus infection in which the princip[al] lesions involve the cells of the central nervous system.” Such pathological changes must be accepted for “the rational development of any reasonable and acceptable system of therapy.” In any case medical practice was more complicated. The therapeutic regime of most physicians was “not based upon any one [disease] concept [but was] … the result of years of experience and study in many parts of the world on the part of many professional persons and is continuously being modified and improved as the result of further scientific investigation and clinical experience.”171
In another scripted radio interview O’Connor reminded the public that the best polio care was provided not just at one center but at centers all over the country where hundreds of doctors and nurses trained under NFIP grants “stand ready to administer the Kenny treatment to all patients in their area.” Reiterating the image of Kenny as an insightful clinician O’Connor agreed that her work “completely reverses the old theory previously held by many doctors.” But, he claimed with a rhetorical twist, this “theory” was her rejection of immobilization.172 Even President Roosevelt, immersed in fighting the last stages of the war, was drawn into this other fight. In a fundraising statement, phrased as a letter to O’Connor, Roosevelt described the work of the NFIP “as one of the brightest pages in the history of how a nation of free people, working together, seeks to assure for its children the priceless gift of health,” and particularly praised the NFIP’s research program. “Treatment, no matter how adequate, cannot win this war against a disease aggressor,” Roosevelt declared,
but scientific research “will unquestionably conquer this disease.”173
MORE THAN POLIO
In March 1945 the NFIP finally sent the Institute’s board an official letter informing them that the NFIP’s board of trustees, advised by the NRC, had rejected the Institute’s grant application.174 By this time, many of the things that the NRC committee had feared had come to pass. Seeing themselves under attack, the Institute’s directors had reconstituted themselves formally as a nonprofit philanthropy, with the provocative name the Kenny Foundation (KF), and had begun to plan a national fundraising campaign. The new KF began to rely exclusively on professional publicity firms, and its board ignored the dangers of escalating administrative costs or the temptation for misuse of funds inherent in poorly supervised fundraising schemes. NFIP national officials, though, felt a sense of freedom. “For the first time, we are not supporting Kenny or her work,” Peter Cusack reflected in an internal note to Gudakunst.175
With the NFIP grant formally rejected, Kenny made a bold move: she accepted 6 patients who did not have polio to the Institute. After 2 of them were sent home “apparently normal” she began to teach her staff “the extra treatment for these special disabilities” for the remaining 4 who had cerebral palsy, transverse-myelitis, and arthritis. But Kenny made 2 missteps: only doctors were allowed to admit patients to city hospitals, and the Institute had been designated as a polio facility. Pediatricians on the hospital staff, appalled that Kenny had stepped over the bounds of her position, ordered her staff not to treat the new patients and told the Institute’s superintendent to expel them.176 This incident was immediately reported in the local press, and, according to a reporter, “touched off the long pent-up resentment felt by Sister Kenny against those who have denied her recognition.” Once again Kenny threatened to resign from the Institute and to return to Australia, claiming that she was facing an “organized opposition” to her work. Showing a sharp understanding of local politics, Kenny told the Minneapolis Morning Tribune that groups in Washington and New York had offered her “complete facilities” for research, treatment, and teaching if she would establish an institute in those cities.177
Kenny had treated patients disabled by cerebral palsy in rural Australia and her first textbook had described the way her techniques could aid both Infantile Paralysis and Cerebral Diplegia.178 She had continued to treat a few such patients in England in the late 1930s, and her methods with such patients were praised by the medical officer in charge of the Queen Mary’s wards in a British Medical Journal article.179 Although Kenny’s autobiography And They Shall Walk was mainly about her polio work, she did describe treating a child who was “a victim of that horrible disease, cerebral diplegia” as an example of “the cases the medical world turns its back upon.”180 In 1944 the Institute’s NFIP grant application had proposed pursuing clinical research in both polio and “Spastic Paralysis.”181
In a world where social and medical neglect of the disabled was common, cerebral palsy therapy was particularly poor. The term cerebral palsy was used to indicate a combination of genetic, fetal, and birth trauma disabilities, and most physicians assumed that people with these disabilities were also mentally disabled. There were few organized facilities or cerebral palsy specialists other than those at the multidisciplinary clinic at Children’s Hospital in Boston and the Children’s Rehabilitation Institute for Cerebral Palsy in Reisterstown, Maryland.182 There was some interest in the use of antispasmotic drugs to treat the condition, but so far their effectiveness was doubtful.183 On occasion an exceptional individual with cerebral palsy, such as Earl Carlson, was featured in the popular press. Carlson, a 1931 graduate of Yale’s medical school, began treating cerebral palsy patients like himself at the New York Neurological Institute and published his autobiography Born That Way in 1941.184
Cautiously Minnesota Republican Congressman Walter Judd praised Kenny’s methods for treating cerebral palsy patients as “definitely most helpful in many cases that I have seen personally.”185 Marvin Kline called a meeting of the city’s Board of Public Welfare to hear the “pleas of sorrowing parents.” The Johnsons of Salisbury, North Carolina, and the Coplans of Livingston, Montana, whose children had been expelled from the Institute, assured city officials “we aren’t interested in medical technicalities … we just want our babies to be normal.” Mrs. Coplan said she had shoveled sand in a Minneapolis foundry for more than 8 months to be able to pay for her daughter to have the Kenny treatment.186 Under this pressure the city’s welfare board ordered these 2 children readmitted to the Institute, although it did not amend its regulations to permit “spastic paralysis” patients to be treated at the Institute in the future.187 Back at the Institute, the Minneapolis Daily Times reported, Carol Lee Coplan “not only sits up but walks around her crib and even ruffles a book” while Allen Johnson’s parents—who were told by an expert that “nothing could be done for him”—“hope he will make the same progress.”188 City officials refused Kenny’s resignation and promised that they would “do everything humanly possible” to obtain the clinical research facilities she demanded.189
Kenny’s brief public foray into the field of cerebral palsy excited parents of children who had neuromuscular disorders other than polio. A mother from Chicago who was a member of a Parents Association for the Handicapped contacted other mothers of “handicapped” children and they “got busy.” “We are keeping our fingers crossed in the hopes that you will continue your research for all neuro-muscular diseases,” she told Kenny.190 A few of Kenny’s medical allies were also eager to pursue this new direction of her work. Orthopedist Alfred Deacon urged the director of the Winnipeg’s Children’s Hospital to send a physician to the Institute to study “cerebrospastic” therapies “which would be of great benefit to the Children’s Hosp[ital].”191
Kenny continued to see herself as an independent clinician not bound by institutional restrictions. Even after the Institute’s board refused to open its door to additional cerebral palsy patients, she assured an Illinois mother that “my dermo-neuro-muscular therapy is definitely not for infantile paralysis alone.” Although she was restricted to polio at the Institute she would be happy to examine the child privately and advise the mother “as to the treatment.”192
“ORGANIZED OPPOSITION”
It was not Kenny’s effort to expand her work to other diseases, however, but her claim that her work was hindered by organized medicine that made it a national story. In March 1945 Congressman Donald O’Toole, a Democrat from New York, introduced a resolution calling for a House committee to investigate the “organized opposition” against Kenny.193 Within 2 weeks 1,500 letters were sent to O’Toole’s office in support of Kenny from doctors, nurses, chiropractors, builders, businessmen, housewives, and mothers. Only one letter written by a nurse from Virginia was critical, O’Toole claimed.194 He also wrote to Roosevelt deploring the “lack of cooperation and a degree of intimidation practiced upon [Kenny] … by the medical profession.” As a hearing could not be set up before Congress returned from Easter recess, he respectfully asked the President “to use your great office in an effort to detain Sister Kenny in this country for … a word from you would give new faith and hope to Sister Kenny and would insure her remaining in this country to continue her splendid work.”195 O’Toole, one reporter noted sardonically, was an independent Tammany Democrat who had been elected without support from Roosevelt’s New Deal administration and was “not adverse to starting a move calculated to embarrass the President.”196
To reinforce and broaden such populist support Kenny made it clear that when she spoke of “organized opposition” she was referring to the leading officials of the AMA, not the nation’s “hundreds of fine and conscientious doctors.”197 She urged her supporters to pressure their local congressmen to set up a special committee to investigate her claims “in the interests of humanity,” assuring reporters she would consider as a command any suggestion from Roosevelt that she remain in the United States.198 She heighte
ned the populist outrage by hinting that she would reveal contents of potentially explosive telegrams between herself and O’Connor to such a committee. Some of her supporters who had gained access to the telegrams were unwilling to wait for the formation of a congressional committee. The “All American Christian Auxiliary” of the Chicago Nurses Committee, which Fishbein had identified as an eccentric antisemitic group, urged the public to write to their congressmen and senators “demanding a full congressional investigation into the problems of Sister Elizabeth Kenny.” The group quoted a telegram from O’Connor that was supposedly written during the Argentina fiasco in which he had defended his actions in withdrawing NFIP support for the 2 Kenny technicians. The telegram supposedly read “I have given you HELL and you have paid for it in your Health.”199
It was at this moment that Fishbein chose to break his silence on Kenny. The idea that JAMA had suppressed any scientific evidence about the Kenny methods was, he told the national press, a “preposterous untruth.”200 He gave a lengthy interview to James Pooler of the Detroit Free Press who was writing an investigatory series on the Kenny controversy. Pooler’s first 3 articles, NFIP staff had noted, had been rather pro-Kenny, but Fishbein knew what he was doing.201 In April 1945 Pooler presented Fishbein as a sympathetic character, bemused by the uproar around his efforts to uphold scientific standards. Seated in his office, Fishbein “had the air of a man who would be glad to put his head sadly between his hands.” “We have leaned over backward to give her every break, but we also must save the American people from exploitation,” he explained, for “when people insist they are the only one who can teach something, the doctor is wary.” As the “voice” of organized medicine and the editor of JAMA he presented himself as a judicious assessor of other experts’ views. The critical orthopedic report published in JAMA had been an “honest appraisal from top men in their field”; neurologist Stanley Cobb and most other “nerve-muscle doctors” agreed that her theories were “physiological nonsense.” In a calculated breach of secrecy Fishbein quoted from the NRC committee’s 21-page study that had concluded that the Institute did not have adequate laboratory resources or competent enough staff to handle a research program. To show his own clinical objectivity, Fishbein agreed that her methods lessened pain and psychological fright in the early stages of polio and were therefore “scientific and valuable.” But his attack slid easily to Kenny’s character as he drew a picture of an old-fashioned and inflexible nurse from the Australian bush who refused to deviate from her “ritual of treatment.” At one point, he claimed, she had insisted on using hand wringers to prepare hot packs and refused to use electric wringers. Nor could she adapt herself to scientific confirmation. “It is part of the scientific method that facts shall be published and interpretations based on fact shall be subject to analysis and criticism,” Fishbein reminded newspaper readers, yet Kenny “doesn’t consent to either analysis or criticism.”202 Of course Fishbein’s own well-publicized attacks on any critic of the AMA’s policies suggested that he did not apply this process to medical politics. This denigrating picture of a nurse resisting modern technologies was reinforced by Time later that month. Kenny’s forthright disposition and her insistence that doctors accept her theories, which “many experts say lack proof,” according to Time, had “earned her the nicknames ‘The Duchess’ and ‘Madam Queen.’ ”203