Polio Wars (16 page)

The funding of polio therapies or other clinical research was overseen by the NFIP's Aftereffects Committee, chaired by orthopedic surgeon Philip Lewin. Its members were orthopedists known for their skepticism. Any unusual innovator, especially someone who was not a specialist or who worked outside an elite medical school, was not taken seriously. Indeed the NFIP prided itself on its unwelcoming attitude to aspiring clinical discoverers, especially men or women who had discovered a polio “cure” and therapists who ran alternative healing centers. At his first meeting with Kenny in 1940, O'Connor had made it clear that the NFIP would consider sponsoring her work only if it were supervised by physicians at a recognized medical institution.
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These cautious policies were all efforts to appease the wider culture of American medicine in which skepticism was the sine qua non of the professional, the opposite of the public's interest in every amazing healer. Yet the NFIP was now funding a nurse, who, local papers claimed, was remarkable, perhaps even a kind of miracle worker. Physicians at the Mayo Clinic like physical medicine specialist Frank Krusen had so far kept their distance, a clear difference from city officials and local physicians who had allowed Kenny and her assistants to practice in the city hospital and instruct its nursing staff.

Most of the research funded by the NFIP in the late 1930s and early 1940s had little to do with polio's clinical symptoms. Conferences on polio usually did not include clinicians or physiologists, reflecting both the dearth of physiological polio research and the sense that there were few new facts to be learned. The failure of trials of a chemical nasal spray in the 1930s had led many investigators to question the validity of the concept of the nose and mouth as the virus's natural portal of entry.
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The idea of alternate routes through the body was slowly moving polio away from its fixed neurological categorization. Although Yale epidemiologist John Paul admitted he could offer “no good explanation to account for the presence of the virus in the intestinal tract,” he and his Yale
colleagues were confident that they had found the virus in the sewers of New Haven and New York. This unusual evidence suggested that polio might not solely be a neurological infection and that levels of the virus might be endemic among communities without causing dramatic paralytic symptoms.
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No one was certain exactly how the polio virus spread through the body or from one person to another or what predicted an individual's resistance to developing paralysis. Reflecting this confusion, the NFIP funded studies on the influence of dietary deficiencies (University of Wisconsin); metabolic factors influencing damage to nerve cells (New York University); the effect of chemicals on the virus (Michigan Department of Health); the role of the virus in dust, nervous tissue, and stools (Stanford University); vitamins, calories, and nutrition (University of Pennsylvania and Wayne University); hormones and diet (University of Utah); and epidemiological factors including domestic animals as a reservoir (University of Chicago).
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Kenny's challenge to polio care pointed to a vacuum in medical research and in clinical practice. In every medical textbook the polio virus was believed to damage or destroy nerve cells, leading to paralysis through the disruption or severing of connections between nerves and muscles. But in Kenny's view the polio virus affected not only the nervous system, but also the rest of the body, especially the muscles, tissue, and skin. To explain why some patients improved and others did not she blamed the pessimistic attitude of many professionals, as well as their ignorance of what was causing the patient's symptoms, particularly pain and spasm, which she felt clinicians did not recognize or take seriously. For many patients, she believed, the virus did not destroy the connection between nerve and muscle but left some muscles in spasm, the result of disordered corresponding nerve cells. Connections between nerves and muscles could therefore be repaired through directed muscle therapy. Kenny believed that her knowledge of paralyzed muscles and their function enabled her to see a different disease when she looked at polio patients. Thus, she argued that the whole orthodox concept of polio was incorrect: doctors did not understand the “true symptoms” of the disease and therefore treated the wrong disease.

Still, Kenny's work was easily categorized as continuing elements of already existing polio care rather than as an innovation. Techniques for the management of pain and for muscle training were the province of orthopedic nurses and physical therapists supervised by orthopedists and the small group of doctors who specialized in physical medicine. To defuse any suspicions that local physicians had somehow been swayed by Kenny's personality and by the enthusiasm of the public and lost their ability to judge her work with scientific objectivity, the NFIP needed to organize some form of outside assessment. As a way of identifying this work as a potential contribution to physical therapy rather to the more prestigious fields of polio science or clinical diagnosis, the NFIP decided to send Kenny's supposed peers to assess this work: nationally recognized physical therapists. This was an effort to pigeonhole Kenny as a nurse with a useful technical innovation.

This was a meeting destined to ignite tensions. The therapists came, uneasy about the extravagant claims they had heard but recognizing that local therapists and their medical supervisors were taking this unusual nurse seriously. For her part, Kenny greeted the visitors suspiciously. She had little experience with sympathetic physical therapists. In the 1930s therapists at the Brisbane General Hospital had laughed at her during a clinical demonstration, and the Queensland branch of the Australian Massage Association had rejected her trained nurses from hospital positions as they lacked proper training in physical therapy.

Still, her initial experience in Minneapolis pleasantly surprised her. She had begun teaching a small group of local physical therapists and nurses, and, with the support of senior hospital clinicians, found it possible to challenge their previous ideas and practices. Many of the local therapists had expressed great enthusiasm about Kenny's work. The local branch of the American Physical Therapy Association (APTA), “a very earnest group of women” she recalled in her autobiography, had invited her to dinner to talk about her work. These women, Kenny noted, became “devoted exponents of my conception of infantile paralysis” and later were among the first to get certificates from her training course at the university.
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By January 1941 around 20 physical therapists from the Twin Cities were spending “practically all of their free time” with Kenny, giving up their Saturdays and Sundays.
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Nonetheless, she feared that outside therapists would be likely to judge any innovative clinical practice that looked odd as wrong and harmful.

Kenny's keen sense of the workings of gender and medical authority had left her convinced that changing polio's clinical care could not be achieved solely by convincing nurses and physical therapists. She saw physical therapists and nurses as simply foot soldiers in the war against polio. To have clinical change properly and scientifically achieved, the crucial task, as she saw it, was to convince America's prominent physicians, who could then issue definite statements that would assure their skeptical peers of the worth of her work and the importance of rejecting old ways and embracing the new. These visitors were technicians without sufficient medical training or status to assess her new understanding of the symptoms of polio. This view, indeed, was shared by many orthopedic surgeons who also saw physical therapists as “hands” who carried out doctors' orders, not as specialists with a distinctive understanding of medical practices based on scientific knowledge.

Kenny herself acted not like any ordinary nurse but as a cross between an inventor and a scientific discoverer. She spoke to doctors assertively, sometimes arrogantly. In Australia she had become used to how the worth of her work was linked to her character. In 1937 a Sydney orthopedist had denigrated her with faint praise as “a woman of enthusiasm, energy and organizing ability,” and her Queensland antagonist Raphael Cilento saw her as “a most difficult woman to work with” and “somewhat intolerant of other people's views.”
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Certainly, one of the ways she was “difficult” was the fact that as a nurse—and therefore a woman and a professional inferior—she dared to tell physicians that they were wrong.

FIGURE 2.1
Kenny explaining her method to a group of physicians in a corridor of the Minneapolis General Hospital [1942]. Box 9, Elizabeth Kenny Papers, Minnesota Historical Society, St Paul.

To inculcate clinical change required recognition of the politics of medicine, and its sources of cultural and institutional power. Gender—especially as it was expressed in the hierarchy of medical schools and hospitals—was a crucial ingredient in this equation. Kenny had enjoyed an unusual amount of clinical and professional autonomy as the result of her work as a bush nurse, a private duty nurse, and director of her own clinics and wards. This work provided her with clinical, pedagogical, and administrative experience. She saw the way hospital nurses were supposed to keep their eyes to the floor and their hands behind their backs when they talked to physicians. She taught many physical therapists and nurses who became her friends, but she rarely joined their typical socializing. The close connections she most desired were with physicians; and this goal structured her work in Minneapolis as she prevailed on medical experts to visit her, watch her work, and listen to her lecture.

In the wintry January of 1941 the 5 physical therapists sent by the NFIP arrived eager to see Kenny's work for themselves. There was Alice Plastridge, head therapist at Warm Springs; Gertrude Beard, senior therapist at Northwestern's medical school; Mildred Elson, editor of the APTA's
Physiotherapy Review
; and Florence and Henry Kendall, a husband and wife team who directed the physical therapy department of the Baltimore Children's Hospital-School. The Kendall's 1938 pamphlet
Care During the Recovery Period in Paralytic Poliomyelitis
, which was distributed by the Public Health Service, was one of the defining texts on polio therapy, and Kenny had been given it by the NFIP's executive secretary when she was still in New York.
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These 4 women and one man brought with them the skepticism of science and the pride of professionalism. More than anyone in America they knew the “orthodoxy” of polio treatment and what it had and had not achieved. Kenny's work had already been creating a lot of controversy in physical therapy circles. Everyone was anxious to hear if Kenny was a crazy quack or if she really had a scientifically sound solution to the difficult problems of polio care, including, as one nurse described it, the agony of listening to “frequent fits of crying bordering on hysteria” coming from children's polio wards at night.
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The professional field of physical therapy had moved away from its origins in military reconstruction during and after World War I, and was now practiced by an unusual mixture of disabled male veterans and athletic young women. By the 1920s many therapists worked in the expanding network of veterans' hospitals run by the new Veterans Administration. Outside these facilities, physical therapy was considered a luxury. Most hospital trustees were not convinced that paying for a heated pool, ultraviolet lamps, or exercise tables was necessary, and the physical therapy department in many hospitals consisted of a single therapist working in a basement or a back room. The few physicians who prescribed such therapies and were enthusiastic about rehabilitative medicine were treated with “frank hostility” by their colleagues.
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As growing numbers of polio epidemics made child patients rather than wounded soldiers the defining focus of physical therapy work, the site of practice shifted from
veterans' hospitals to children's hospitals and children's rehabilitative centers (known as “crippled children's homes”). Boosted by federal funding through the 1935 Social Security Act, state services for children with physical disabilities expanded along with continuing support by service groups such as the Shriners.

Polio provided a major impetus to the development of the American physical therapy profession. By the early 1940s polio had become the nation's most prominent disabling disease, although it was not as statistically significant as tuberculosis, birth injuries, or rheumatic heart disease. With funds from the NFIP and from state Crippled Children's Bureaus to pay for care and for orthopedic equipment such as braces and crutches, rehabilitation came to be recognized as a crucial element in recovery from polio paralysis. Nonetheless, the physical therapy profession grew slowly. In 1941 there were only 16 approved schools for physical therapy training, and when war was declared at the end of the year there were fewer than 1,200 qualified physical therapists in the United States.
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