Polio Wars

by Rogers, Naomi

  As the NSF bill was reintroduced in 1948 a provocative study in Science reinforced Truman’s sense that scientists could not be relied on to put the public’s interest ahead of loyalty to their own institution or discipline. The study, quoted during the NSF Congressional hearings, found that almost 75 percent of the research funds distributed by scientists on the advisory boards of 10 private philanthropies—including the NFIP—went to researchers based at elite, Northeastern universities. Thus, it concluded, “our top scientists are no more able to provide equitable distribution of funds at their disposal than are the politicians they have so castigated.”10 Although Fishbein pointed out to O’Connor privately that the NFIP “comes off very well in comparison with other similar agencies,” the Science study was a blow to the idea of objective peer review, and useful for those who argued that geographic distribution of research funds would be just as meritorious as any other system.11

  An early test of whether the country was ready to apply populist-defined democratic principles to scientific research came in 1945 when Harry Hoxsey, accompanied by 3 Congressmen, traveled to Washington, D.C. to ask the National Cancer Institute for a federal investigation of his anticancer powder. Hoxsey was the founder of his own National Cancer Research Institute in Taylorsville, Illinois.12 The Institute turned down this request, but North Dakota Senator William Langer, a distinctive Plains populist who mistrusted big government, Communists, and Jews took up Hoxsey’s cause. Langer championed Kenny’s cause as well. In 1944 Langer had introduced a Senate resolution proposing $10,000,000 for an Infantile Paralysis Control Board to be chaired by the Surgeon General and composed of Kenny herself and a “leading medical man” from each of the 48 states and Washington, D.C. “to investigate and study the origin, causes, and means of control of infantile paralysis.”13 The resolution did not pass but Langer continued to try to have the government support Kenny’s work. In 1945 he suggested that the federal government establish a national polio clinic run by a board made up not of physicians but of “persons who have had infantile paralysis and have been treated for such disease in accordance with the methods discovered and practiced by Sister Elizabeth Kenny.” He also proposed federal funding for a polio research program to foster the national adoption of Kenny’s method.14

  Hoxsey and others demanded a populist version of medical research, and hoped that the federal government would respond with respectful attention and perhaps funding. This nascent research populism fit awkwardly with a growing anticommunist, antiintellectual populist movement that feared the liberal Eastern establishment and its decadent bureaucracy. Members of the public, enthusiastic about government-sponsored research as an antidote to elitism, hoped that federal oversight would temper the power of elite scientists and physicians.

  In the postwar years many Americans saw the NFIP, a lay-run disease-oriented charity, as old-fashioned and out of touch with modern epidemiological and structural changes in American life. The NFIP’s distinctive style—especially its extensive resources and access to celebrities—was under attack. During the late 1940s, reinforced by public attention to the shift from infectious to chronic diseases, Americans began to see disease philanthropies as often inefficient and led by directors who were “aristocratic, aloof, and egotistical.” Social scientists pointed out that without proper yardsticks to measure the organizations’ effectiveness, many programs were duplicated.15 The solution seemed to be single, federated fund drives such as Community Chest and Red Feather campaigns that were seen as more efficient and more effective.16 In 1947 when Henry Ford II became the new head of the Ford Motor Company he began to organize a United Health and Welfare Fund with the cooperation of the AFL and the CIO.17

  Polio epidemics were still as frightening as ever, but there was now a sense that perhaps too many resources were being used to fight a disease that affected a relatively small number of people compared to the funds being spent on research into diseases such as heart disease and cancer, which, as one science writer noted in 1946, “are the chief killers in America.”18 In 1947, when medical historian Richard Shryock wrote a brief history of medical research in America, he made almost no reference to the NFIP, a striking omission. In a footnote Shryock did compare the amount of money spent on research of serious health problems such as heart disease (17 cents per death) to polio (over 500 dollars) to show that “standard research expenditures are seriously unbalanced.”19

  Across the country communities began to set up United Fund agencies in response to “the nuisance of multiple fund raising appeals.”20 A widely read expose by Selskar Gunn and Philip Platt, financed by the Rockefeller Foundation, of 569 charities (or as they called them “voluntary agencies”) and 143 official agencies out of the approximately 20,000 nonprofit health agencies in the United States found that many had no centralized organization, poor leadership, and, despite vast expenditures, did not meet community health needs. In their opinion, most services performed by individual health agencies should be combined, especially fundraising activities.21 Reviewers praised the study’s “valid and objective analysis” that had pointed out “the emotional, sentimentalized, and frequently misdirected efforts of expensively planned and disproportionately financed programs [and]…the waste, inefficiency, duplications of service, and actual selfishness inherent in unco-ordinated planning.”22 They also noted the tremendous disparity between the resources of the NFIP ($12 million in 1944) compared to other agencies like the American Heart Association (only $100,000 the same year).23

  KENNY AS POPULIST EXPERT

  Kenny’s path from unknown nurse in the Australian bush to medical celebrity had become a familiar tale by the late 1940s, retold in family magazines, her autobiography, and the 1946 movie Sister Kenny. She embraced her celebrity status, and liked to talk to reporters and be photographed. But she did not like to be contradicted and increasingly sought out occasions in which she was surrounded by friends and supporters. “The best seats in every theatre are at her disposal; the Police recognize her and stop the traffic; and altogether I felt on my visit with her that I was with Royalty,” one Australian visitor gushed.24

  Despite her claims of political naiveté Kenny demonstrated a keen understanding of the nation’s medical politics. She had long argued that American patients with polio needed more than improved therapy. They needed to be protected from practice by professionals who understood polio only in orthodox ways. In her technical film, which she showed the Congressional committee, the narrator highlighted her concept the polio, praising the “newer science” based on the “advanced concept.”25 Kenny had also hoped that her Institute in Minneapolis would become a research facility like New York’s Rockefeller Institute. But she and her supporters had come to realize that no scientist was going to base himself at the Institute to do research to demonstrate the veracity of her theories.26 When, despite its deep pockets, the NFIP had rejected the Institute’s formal request for research funding, Kenny’s sense that scientific research was organized by an elite group that funded themselves and their friends was confirmed. “Universities interested in studying poliomyelitis,” John Pohl had noted bitterly to KF executive director Marvin Kline, “are already under the thumb of the National Foundation through the issuance of financial grants.” Like Kenny, Pohl disassociated himself from the NFIP. His daughter Mary who was treated for a mild case of polio in 1946 recalled that, unlike most of her friends’ families, her parents did not contribute to March of Dimes campaigns and “never had anything to do with the March of Dimes.”27 Even though in 1948 talk of a vaccine was only talk, Kenny assured the Congressional committee that no vaccine would be possible until the scientific community accepted her concept of the disease.28

  Throughout her life Kenny tried to balance her role as a medical celebrity (having cocktails with Rosalind Russell and her Hollywood friends), as the people’s healer (attacking medical elitism and rescuing patients from disabilities and from unnecessary orthopedic operations), and as a scientific innovator directing a
research and teaching institute. These somewhat contradictory elements of her public persona had come to serve her well. In a 1947 poll of the 10 most admired living people in the world, Eleanor Roosevelt (sixth) and Sister Kenny (ninth) were the only women to make the list.29

  Being a populist expert, though, was tricky. Kenny yearned to be welcomed as a scientific discoverer, invited to speak at conferences, have her work quoted in medical journals, and see her concepts become the basis for scientific investigation. At the hearings she repeated a promise she had made to her Australian medical mentor Aeneas McDonnell “that I would keep with the duly qualified medical practitioner until he saw the light [for]… I know that if I did veer out a little from the straight and narrow path, that the duly qualified medical practitioners would have nothing to do with me.”30 But she directed an Institute named after herself and promoted a method and theory that carried her name. It made her sound uncomfortably like a patent medicine hawker. Her use of publicity—her many speeches, her technical film, her interviews with local and national reporters—was as extensive as the NFIP’s but lacked the patina of the latter’s elite medical connections.

  By the time she appeared before Congress there were 3 new Kenny centers: in Buffalo, Jersey City, and Centralia, Illinois. In Buffalo Kenny’s work had been promoted by Marvin Israel, a pediatrician whose teenage son had recovered from polio after being treated by his father based on advice from John Pohl. In May 1948, after Israel’s death, a wide movement encompassing local Jewish, Catholic, and Protestant religious groups, as well as the local Variety Club, established a Kenny clinic in Buffalo and made fundraising for it a civic cause.31 In Centralia, a small railroad and coal mining town in southern Illinois, parents had been frustrated during a 1946 epidemic by a lack of facilities that had left their paralyzed children “all night in motor cars, unattended and uncared [for].”32 Kenny and Marvin Kline attended the dedication ceremony for Centralia’s new Kenny clinic in August 1947. The ceremony included benedictions by a priest and a Baptist minister, followed by speeches from the town’s mayor, the head of the local medical society, the state’s health commissioner, officers of the clinic’s advisory committee, and a representative of the International Union of Operating Engineers.33 The Jersey City clinic, opened in April 1948, was featured in Newsweek as “Sister Kenny’s New Center.” It took up 2 floors of the Jersey City Medical Center, a facility that had been expanded in the 1930s by the city’s powerful mayor Frank Hague with New Deal funding. The clinic’s medical director was orthopedic surgeon Marvin (Mal) Stevens, a former navy officer who had been part of the first American unit to enter Nagasaki after it had been bombed. Stevens had gone to Minneapolis in 1947 to study with Pohl at the urging of his friend New York advertising executive and KF promoter Chester LaRoche.34

  While these 3 clinics were a source of great pride for Kenny, who traveled frequently to be part of their fundraising activities, she disliked the local tensions that surrounded them. There were bitter fights in Buffalo over whether an NFIP-funded ambulance would carry paralyzed children to the Kenny clinic; and officials at the Illinois crippled children’s division threatened to refuse to recognize the Centralia clinic since its medical staff had no permanent consulting pediatrician or orthopedic surgeon. Only the Jersey City clinic, supported by Frank Hague’s nephew Mayor Frank Eggers, had political and financial stability.35

  By the late 1940s, although O’Connor was still a powerful force in American philanthropy, Fishbein’s influence was waning. His caustic rejection of any kind of prepaid group practice (even organized by physicians themselves) had alienated patients as well as many doctors trying to give the public alternatives to the attractive government health insurance proposals being debated in Congress and supported by governors such as California’s Earl Warren. After the war, Fishbein and the AMA initiated a fierce campaign against Truman’s health insurance plan and anyone who supported it. In 1947 Truman’s Justice Department began a second antitrust investigation of the AMA.36

  Even before Congress decided to support a new National Science Foundation it had begun to enlarge what became the National Institutes of Health (NIH). Proposals to expand the NIH were enthusiastically received by a number of disease-oriented philanthropies, including the American Cancer Society and the American Heart Association, but not the NFIP. Liberal reformers testifying in congressional hearings during the 1940s castigated Fishbein’s AMA policies and welcomed an expansive role for government in health care and scientific research. Left-wing physicians groups such as the Physicians Forum (founded in 1941) voiced these populist arguments as did other progressive organizations such as the Progressive Citizens of America and the American Veterans Committee. A physician representing the latter during Congressional hearings in 1947 assailed JAMA as a journal that “damns other points of view without presenting them,” creating a “shockingly prejudiced” medical profession, and urged that government health agencies be “placed in the hands of administrators responsible to the public, and not in the control of a private doctors’ association.”37 Although the intense anticommunism of the Cold War later isolated and defeated these groups, such moments were, nonetheless, signs of instability in the power and prestige of organized medicine.

  The state of polio science, moreover, weakened the NFIP’s claim to stand proudly embodying America’s polio expertise without the need for any government oversight. Its promoters praised its breadth of research pursued in universities, medical schools, and hospitals organized in an efficient and democratic way. With more than 2,700 county chapters run by around 30,000 volunteers, the NFIP’s polio program, officials assured Congress, was “the greatest research campaign ever carried out against a single disease by the voluntary effort of a free people.”38 Yet scientists funded for a decade, critics pointed out, had not found a cure; perhaps the government could do it better. Even respected members of the AMA began to express their frustration with the NFIP’s stagnant research program. A Pittsburgh surgeon, outraged that JAMA would not publish an article on the efficacy of curare, complained to Fishbein: “How can the A.M.A. justify the refusal to publish this article when they and the National Foundation, despite the millions of dollars collected, have to date little or nothing to offer the profession, patients, or the public?”39 The association between the AMA leadership and the NFIP had worked well in the interwar years, but with such postwar critiques the benefits were unraveling. With its movement away from the Democratic Party, some of the NFIP’s former allies were no longer falling in line. In a rare comment on polio fundraising Eleanor Roosevelt in one of her “My Day” columns noted that a neighbor had told her “that a considerable organization is being formed to promote Sister Kenny clinics.” “Her treatment should certainly be known in every hospital in the county,” the former First Lady wrote, adding with an edge directed at both Kenny and the NFIP, “she has not found a cure any more than have the people to whom research grants are made by the National Foundation.”40

  KENNY IN WASHINGTON

  By the time she came to Washington in 1948 Kenny was struggling to establish her legacy. Medical texts and public health bulletins on polio rejected splinting in favor of hot packs and muscle training but they often left out Kenny herself. Physicians mixed elements of her method with their own therapies and called this the “modern treatment.”

  Not only was the Kenny method no longer new, but the drama of its promise to heal, and its stark comparison to harmful previous therapies, was waning. The vision of a healing nurse could not trump the public’s fascination with the scientist in a white coat, the drama of the laboratory, and the magical products possible from research. By the late 1940s NFIP posters featured not only a walking child but also a scientist holding a test tube. The prominent University of Cincinnati virologist Albert Sabin told the local medical society in 1948 that “the Kenny treatment is a waste of energy, effort and money. It fills the hospitals with extra nurses and creates an unnecessary bedlam.” The money spent on such techniqu
es, he argued, “could be better used for rehabilitation of the few crippled by the disease and for further research.” Its widespread use was “part of a wave of hysteria,” Sabin concluded, quoting the now familiar line that “what is good about the Kenny treatment is not new. What is new about it is not good.”41

  Kenny’s claims to a theoretical discovery that would alter polio science were increasingly easy to dismiss as the overwrought words of a nurse with good clinical skills who had gone too far. Her results were impressive, but the methods were messy, labor-intensive, and expensive. Not surprisingly, many physicians began to search for other therapies that were more under medical control.

  RESEARCH, PUBLIC RELATIONS, AND THE NFIP

  NFIP officials recognized that public support for science populism threatened their organization. They were therefore eager to use the 1948 hearings to contest the claim that their refusal to fund Kenny’s Institute proved that they were using public funds in an undemocratic way. The NFIP had consistently sought to defend itself by emphasizing that it was both democratic and meritocratic, in fact “the people’s Foundation,” as O’Connor had assured one donor during the polio wars.42 It had also long claimed for itself the role of director and perhaps even instigator of research. During the polio wars NFIP officials had contrasted medical research conducted before its founding—“faltering, unorganized and without coordination”—to research progress afterward.43 In 1948 the foundation boasted of ten years of promising research in its new pamphlet A Decade of Doing and bragged about a new understanding of the mechanism of immunization after Johns Hopkins researchers described experiments showing that polio antibodies in the central nervous tissue of a monkey injected with the live virus could protect the animal from developing paralysis. This research suggested that such antibodies might offer resistance to the “crippling after-effects of this disease” in humans.44