Polio Wars

by Rogers, Naomi

  Worse than the use of testimonials, Perkins argued, was Kenny’s comparison of patients treated by her methods and patients treated with orthodox therapies. Not only did such scenes humiliate the unfortunate, but physicians found no scientific validity in this kind of comparison for, as “each group represents selected cases,” it did not prove “the superiority of your method.” Perkins tried to think of a way that her film could appropriately compare patients, and suggested that a comparison of cases could be valid “if your cases and the orthodox cases represented strictly alternate cases meeting rigid diagnostic criteria upon admission to a given hospital,” and then showing “final results in a consecutive series of cases admitted to a hospital and treated by you, with no omissions made in the series.” And perhaps at the beginning of this reel there should be “a certification by the chief of staff of the hospital that each case met certain (specified) criteria of diagnosis, and that every case meeting such criteria has been included in the series.”

  Perkins regretted that “a carefully controlled study was not conducted on the value of your method when you first came to the United States.” But it was “too late now” for polio’s clinical care had altered so profoundly that he doubted whether anyone “will be willing to treat the alternate cases in such a study rigidly in the manner practiced so widely prior to your coming here.” “Although I know some of the above remarks will not be to your liking,” he concluded, “they have been written in a friendly and constructive manner.”148

  “Constructive, or even destructive criticism, is always helpful,” Kenny replied, noting that Perkins’s criticisms of her film were the only ones “recorded up to date.” She defended her use of testimonials in the film as extracts from “the scientific reports of duly qualified medical practitioners” rather than from lay people. Nor was she willing to accept the idea that the film showed selectivity bias. The patients had been chosen objectively, for they had been “examined in the presence of a group of medical men with Dr. Melvin Henderson as Chairman, and evidence was taken from the doctor who supervised both groups. These cases were selected owing to their similarity.”149 Kenny-trained professionals at the Institute had checked other patients who had been treated by orthodox methods and released “as complete recoveries” 3 years later, and found “there wasn’t one normal child amongst the whole forty cases.” But patients treated with the Kenny method—“the same type of cases and treated under the supervision of the same medical man and presented to other medical men”—were, the physicians all agreed, “normal—as a matter of fact, better than normal children. This can be understood when you take in the findings of science.” In her mind a clinical trial would be torture rather than science. She would reject any “controlled study of a method of treatment that would condemn children to suffer pain from two to four months [when]… as you saw in the film this pain can be reduced to a few days.”150

  Perkins started to answer Kenny’s reply “paragraph by paragraph, but thought better of the idea,” remarking sadly “I thought I probably would get about the sort of answer which I did.” He hoped that she would still heed his advice with regard to her film for he believed it would “definitely help your cause and, personally, I think your cause is worth helping.” “Your difficulties arise principally from your complete lack of conception of what is known as the scientific method,” he concluded in frustration, “but that is simply that, and I doubt there is anything anybody can do about it.”151 Perkins was quite right, Kenny agreed, that she found it “very difficult to conceive just what is a truly scientific method.” Not only had the AMA orthopedic committee, for example, “religiously” avoided studying the Kenny method at the Institute during their investigation, but after their report one of the committee members published a paper in the Journal of Pediatrics that referred to symptoms such as muscle spasm and painful muscles with “contractures and deformities,” which were all based on a concept that was “exactly the opposite of the concept he and his colleagues wrote the paper about.” Further, instead of the purported ideal of scientific objectivity, the AMA report had been full of personal attacks that undermined her personally and hindered the expansion of her work. When these “untruthful” statements were then “distributed throughout the world … the rest of the world has to suffer.”152 Perkins did not answer this second letter and remained eager to use the film.153

  The Kenny Concept was also reviewed quietly by the NFIP. After seeing the film in Minneapolis a local NFIP official told the New York headquarters that Kenny had quoted a letter by O’Connor “in which he recognized the value of her treatment” but that Kenny was “liberal with her cracks when speaking of the medical profession generally.” In his estimation the film was too long and, despite its useful practical depiction of therapies, used too many technical terms to suit a lay audience. Overall, it appeared to be simply a propaganda vehicle centered around a single person: her voice “predominated the whole picture,” and she “was the center of all demonstrations.”154 When the NFIP’s New York office got its own copy, the NFIP’s research director agreed with this assessment and pointed out further that the film used several illustrations from Lovett’s 1917 textbook to show the contrast between his patients and Kenny’s, yet “some of these illustrations were actually used by Dr. Lovett to indicate the deformities resulting from lack of any treatment.”155

  THE FILM IN EUROPE

  The European war ended in May 1945, and a month later Kenny took The Kenny Concept to England where she met up with Mary. It was a horrific time for Mary who had traveled to London to meet her fiancé, Flight Lieutenant Peter Sinclair Jennings, a New Zealand pilot whom she had met in 1943. When Mary arrived she was told his plane had been shot down and that he was missing. It took many months until it was clear that he was dead. Kenny and Mary were guests of one of the physical therapists from Carshalton. Kenny kept Mary busy to try to distract her, knowing “she will be pretty lost and very sad.”156

  News of the AMA report, Kenny discovered, had reached Europe. Undaunted, she convinced Philippe Bauwens, head of the physical medicine department at St. Thomas’s Hospital, to allow her to present her film to members of the British Association of Physical Medicine, a group Bauwens had founded a year before. Kenny showed the film, she boasted later, to “a very appreciative and respectful audience” at the Royal Society of Medicine in London chaired by “Lord Horder, the King’s Physician.”157 According to Kenny, an enthusiastic Australian army physician declared that “all Doctors in Australia should see this film.” He had used his watch to time Kenny on screen correcting a pelvic obliquity. It took her, he said, 7 minutes, yet “orthodoxy could not do this in seven years or seventy-seven years.”158

  In the British Journal of Physical Medicine a different picture emerged. According to this journal, before Kenny’s film was shown, Horder warned the audience that “owing to the controversy which had surrounded her unorthodox concept of the disease” both the British Association of Physical Medicine and the Royal Society of Medicine disclaimed all responsibility for any views expressed in the film. Bauwens then explained that Kenny’s clinical observations had led her to emphasize “the treatment of some peripheral disturbances which the medical profession held to be entirely secondary to the involvement of the central nervous system.” Her new terminology as well as her methods, he admitted, “from the orthodox point of view, appeared to be irrational, if not futile.” Yet, he assured his peers, Kenny did recognize the existence of cord lesions and her film “studiously avoided” most neuropathological topics. Bauwens, who had already seen the film, warned that it “embodied many of the worst features of a ‘Hollywood Movie’ ” and regretted its “exaggerated sentimentality” and “offensive sensationalism.” These defects were regrettable “since [they] … constituted an abuse of the very medium best capable of illustrating those points to which Miss Kenny [sought] … to draw attention.” Bauwens especially disliked the film’s final portrayal of orthodox-treated patients shown side by side
with patients treated by Kenny’s method, a depiction that put “the orthodox method … in a very unfavorable light” and was both “reprehensible” and “misleading.”159

  The physical medicine physicians in the audience seemed to have shared Bauwens’ limited enthusiasm. Harold Balme, a respected specialist who had written on the clinical care of pain, told the Lancet that he had found the film “interesting and suggestive.” Like Bauwens, Balme found some virtues in Kenny’s work. He especially liked her emphasis on the value of very early treatment, the importance of focusing attention on painful and spastic muscles instead of inert ones, and her critique of immobilization. For him her skills in relieving pain and securing relaxed muscles were aspects of modern rehabilitative methods that could be used to treat other serious injuries such as fractures. But Balme drew a clear distinction between Kenny’s methods and her theories. He saw her pathological claims as a “farrago of nonsense” that he felt ruined the film’s value for any medical audience. Notions that the polio virus appeared in the skin and muscles, or that immobile muscles were “alienated,” or that the chief factor in restoring mobility was educating a patient’s mind in “the pattern of movement” were all signs of “jargon … reminiscent of a certain type of ‘osteopath pathology.’ ”160

  Despite his own qualms, Bauwens, like Perkins, was convinced that the film could be remade to attract rather than repel medical audiences. He urged Kenny to make her film less sensational and to highlight “those points which you have observed and which are of great interest to the Medical Profession.”161 Bauwens’ suggestions were expounded in greater detail by Brian Stanford, a London physician who was becoming known as an expert in directing medical films. Stanford argued that Kenny’s film was too long and that “the phraseology” used in her commentary was too obscure for her audiences “to draw a coherent argument.” He urged her to shorten it to appeal to a medical audience that would not want to “assemble … for much longer than forty minutes.” Many physicians, he added, might “come in a critical, and sometimes even an antagonist, frame of mind, therefore the material must be presented in the clearest and most concise manner possible.” Stanford offered to help edit the film, and suggested he travel to the Institute to do this. The Institute’s board of directors agreed to pay his expenses and an honorarium. Unfortunately Stanford found postwar international travel restrictions too difficult and was unable to come to Minneapolis.162

  In August 1945, after the London presentation Kenny traveled to Belgium where she and 2 of her technicians visited the Neurological Institute in Brussels, which had been converted into makeshift wards during that summer’s polio epidemic.163 Leon Laruelle, the director of the Brussels center, was not happy to see Kenny. He told her, she recalled, that “there were several other centers in Belgium that no doubt would appreciate a visit,” a comment that Kenny understood as “a polite way of letting me know he personally did not desire to waste too much time.”164 But Laruelle did agree to have her accompany him and other members of his staff on rounds where Kenny pointed out “in one patient after another…the condition in the periphery that was preventing recovery.” Laruelle allowed Kenny’s technicians to treat a few of the patients, including a woman whose paralyzed face was so stiff that she was unable to sleep. After these demonstrations a number of the doctors asked her to see their patients, and she was invited to show her film first to “a select few” and then “to a large audience.”165 With her typical brashness along with her medical connections, Kenny may have seemed, in war-torn Belgium, to be the personification of the American crusader, free from the trauma and deprivation of war. Certainly the analogy drawn by a local physician suggested this when he commented that her film showed “indisputable evidence of a greater knowledge of the disease. As a matter of fact you have produced an ‘atomic’ bomb.”166

  After seeing the film and its effect on his colleagues Laruelle, Kenny reported happily to Bauwens, became “very cooperative.” He told Kenny that both her film and her work with patients had shown him “conditions he had no idea existed.” Laruelle did not, Kenny noted, “complain about anything in the film but told me it was like a great interesting book which he could read many times.”167 Kenny seemed to have heard this remark as an unambiguous compliment, but perhaps Bauwens heard something else as well, a hint that Laruelle found the film a messy, complex piece of evidence with the clinical results more intriguing than the interpretation. In any case, Laruelle and Kenny began to discuss the idea of sending a group of doctors, nurses, and physical therapists from Belgium for training at the Minneapolis Institute.168 When Kenny returned to Minneapolis, she left behind 2 copies of her film: one with Mary in London and the other at the Brussels center.169

  BATTLES AT HOME

  Kenny arrived home to find herself besieged by reporters who had just read the August 1945 issue of the Journal-Lancet, the local medical journal edited by University of Minnesota physiologist Maurice Visscher and tuberculosis expert Jay Arthur Myers.170 The journal had published a glowing report by John Pohl of 5 years of work with 364 patients treated at the Institute. Pohl described his staff’s increasing enthusiasm and concluded that “continuing observation has served to increase this enthusiasm and to prove the great merit of the Kenny methods.”171 In the same issue, however, an editorial by Visscher and Myers disagreed forcefully. Visscher and Myers highlighted Pohl’s statistics showing that 22 percent of Kenny’s patients had died or had “extensive residual paralysis.” This, they pointed out, was “an account slightly different from that which one reads in the newspapers.” Thus, Pohl had “unwittingly perhaps, performed a real service to humanity in exposing these figures to public view.” Most of all, they disliked Pohl’s enthusiastic promotion of Kenny’s ideas and accused Pohl and other Kenny proponents of deliberately misleading the public and the wider medical community. “The ‘Kenny concept’ has been built up to fictitious importance largely by salesmanship and wishful thinking,” they argued, and “it would not be worth refuting were it not for the international publicity which has been given to the view.” They hoped that “someday the public will be wise enough and sufficiently informed to refuse to be misled by unsound theories.” “Science is the search for truth,” they concluded dramatically, and “it is a misfortune when anything is permitted to confuse that search.”172 “ ‘U’ Medics Clash Over Success of Kenny Concept” said the local papers, and in a confusing mélange noted that Pohl’s results were “far superior to those obtained by any previously known method,” but that, as Visscher and Myers had noted, 22 percent of Pohl’s patients had died or remained “extensively paralyzed.”173

  Kenny had long boasted that almost all Minnesota physicians supported her work, so the editorial was a blow to her pride and to the Institute’s reputation. Deciding that this was an opportunity to target the University of Minnesota and demand an “apology” from Visscher and Meyer’s superiors, she called for a special hearing before the University of Minnesota’s Regents. At the hearing she made much of her recent European experiences, pointing out that her technical film had been shown at the Royal Society of Medicine “by invitation” and that “Lord Horder, King’s Physician [had] presided.” Angry with Visscher and Myers’s remark that her work should not have had international publicity, she assured the Regents that the doctors of England and Europe “were big enough to allow me to present my clinical findings.” She also recognized the attack on herself as a theorist. Visscher and Myers “admit the treatment is all right … [but] I shouldn’t say anything about a concept [yet]… without explaining the symptoms it is impossible to explain the treatment.” Science, she agreed, was a search for truth yet “these gentlemen apparently object to being shaken out of a rut and refuse to accept the truth if that truth takes them out of this rut.”174 The Regents thanked her and expressed their interest in her work, but were careful to avoid any mention of an apology.175

  IN AUSTRALIA

  In Australia, as polio outbreaks became more frequent during 19
45, Kenny’s film gained a small audience, although mainly in Queensland. Charles Chuter, the Brisbane civil servant who had remained her friend and ally since the 1930s, became the film’s Australian agent, promoter, and interpreter. Chuter considered donating the film to the Queensland government, but he knew the dangers of bureaucracy, and in order not to “risk the film being relegated by the State Health Department to the ‘mud of oblivion’ ” he decided to show it first to “representative” audiences and provide short introductions himself.176

  Chuter struggled to find occasions for physicians to see Kenny’s film. Most of Kenny’s clinics had closed during the war, and Sir Raphael Cilento, her longstanding enemy, was still head of the Queensland’s state health department.177 Australian physicians were well aware of the 1944 AMA report, and Chuter had heard that many were now saying “the Kenny bubble has burst in America.”178 Reflecting this widespread antagonism, University of Queensland pathologist James Duhig, a former member of the Queensland Royal Commission, refused to see the film. He had become one of Kenny’s most vocal antagonists. He described her textbook to the Brisbane Sunday Telegraph as “drivel” and argued that American doctors who were Kenny supporters were “of much poorer scientific and professional standing than those who reject her claims to novelty, originality, or superiority.”179 Duhig then informed Chuter that “in view of the highly condemnatory reports of her ideas and methods, particularly in the manipulation of statistics, I would remain extremely sceptical even if I saw the film.”180 Charles Thelander, who had chaired the Commission, also refused to see the film, telling Chuter “he would not believe a word Kenny had to say.”181 Chuter was able to convince a few other former members of the Commission to attend a screening, along with the head of the Brisbane branch of Australia’s medical society, who later assured Chuter he was sure that his colleagues would want to see the film although, he admitted, “there is strong opposition.”182