Polio Wars (18 page)

This lecture, which consisted “mainly of her life history and the story of her success against great odds,” the Kendalls said later, “gave us the impression that Sister Kenny would have us accept her work on the basis that she had proved it to a great many Australian and English Doctors.”
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They disliked the way Kenny dismissed their own work and that of other polio authorities and saw her references to physicians who acknowledged the benefit of Kenny's methods as puffery. Kenny was later outraged to read their assessment, which trivialized her detailed discussion of how she had developed her method and defended it against skeptics. In fact, she protested to O'Connor a few months later, “the history of my work and research which formed the basis of this lecture is supposed to be of great interest to all listeners.”
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After the lecture Kenny presented some of her polio patients with before-and-after slides, each showing prominent clinical problems solved by Kenny therapies. One boy at the city hospital had difficulty swallowing. Within 10 hours after she had identified the spasm in his posterior neck muscles to the medical supervisor and explained how to treat it, the patient was able to sit up and eat a hearty meal, and in 6 weeks he made a complete recovery. Another boy at the university hospital was in an iron lung. Kenny had “advised immediate removal from the respirator,” and, after treatment for the spasm in his neck and shoulders and the mental alienation in his anterior muscles, he was able to breathe freely, eat well, and had “all muscles functioning.” A “prominent pediatrician” in Minneapolis had urged her to use splints to aid a girl receiving the Kenny treatment for bilateral foot drop. Kenny refused, arguing that the patient's posterior muscles were in painful spasm and were unable to relax to allow the opposing muscles to return to their normal resting place. After treatment for spasm and mental alienation and without the use of any supports, the girl recovered.
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In Australia, as late as 1940, she had argued that she made “no claims of perfection in my methods [for]… no technique is perfect and that there is always the possibility of improvements as knowledge advances.”
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But in Minnesota this conciliatory tone had disappeared.

Kenny tried to have her visitors recognize that the symptoms she was describing were “exactly opposite to those recognized by Orthodoxy,” urging them “to understand that if I had to make any harsh remarks about the Orthodox method, it was only meant for our mutual benefit. As I understood, we were all out for the benefit of the afflicted.” After seeing Kenny's slides of twisted and stiff posterior neck muscles compared to patients who had received the Kenny treatment and were now normal, Florence immediately remarked that “all of these cases recover anyhow,” adding that this kind of spasm “recovers very quickly.” Hearing this allusion “to a condition that she and her husband deny existed in their book,” Kenny pointed out that Florence “was admitting the source of a symptom that was not supposed to exist.”
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The Kendalls retorted that “there was a confusion of terms,” for the term “spastic” was not the same as “spasm or contracture” and that in any
case orthodoxy did recognize the condition of muscle spasm in acute polio. When Kenny protested that their
PHS Bulletin
had not mentioned the term, they replied that “the Bulletin does not deal with acute but with convalescent poliomyelitis.”
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After this tense encounter, Kenny invited the visitors to be her guests at a luncheon but the Kendalls had already made plans to have lunch with John Pohl. Annoyed at this rebuff, Kenny gave the other 3 therapists who did accept her lunch invitation a “private showing” later that afternoon where she demonstrated the details of her work and put some of her patients in the city hospital “through a severe test to show what she considered normal.”
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Not only did she relax in these less combative environments she also joked and showed a side of herself that the Kendalls never saw.
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On the following day the Kendalls hoped to be shown the concrete details of Kenny's techniques. Instead Kenny began by discussing “certain inaccuracies in accepted theories” including “muscle testing and its dire results.” She then presented some of her recovered patients. “The audience was interested,” she reflected later, “but the task was irksome,” for the observers were looking at results from a treatment for symptoms “they did not recognize.”
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When Kenny finally presented her patients she was challenged by the Kendalls over her diagnoses. In the Kendalls' notes from that day Kenny insisted that a paralyzed foot was now normal, although they felt that it “showed marked proration & flatness of long arch.” When explaining the cause of an arm's paralysis, Kenny claimed it was the result of a spasm in the pectoral major muscle but Henry “raised arm thru range of motion & showed
that
range was entirely N[ormal].”
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Kenny then asked Henry to describe the deformities he saw in certain patients and to explain their cause “according to Orthodoxy.” When he finished she pointed out how his explanations differed from her own views.
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Kenny then shocked her audience by declaring that she rejected any use of muscle testing in polio for “the extreme effort necessary on the part of the patient would only exaggerate the inco[-]ordination” and also cause “further spasm and contractures.”
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This was a direct attack on the physical therapists' standard tool of assessment.

On the third day the physical therapists met Kenny at Station K, her city hospital ward. The Kendalls were eager to see Kenny's techniques in action, but were not surprised when Kenny announced that she first “wished to discuss principles regarding treatment.” Speaking as an expert with a touch of arrogance, Florence told Kenny that “we thought she had a contribution to make in her treatment” and that “by being open-minded and discussing the problem … we probably would find there were not as many points of difference as appear on the surface.”
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The Kendalls saw themselves as trying to be agreeable but Kenny “became very much annoyed” and replied “you say there is no difference between my treatment and yours, and I maintain they are entirely opposite,” adding that she had already proved her work in Australia. After further discussion the Kendalls concluded that “it was obvious that to disagree with Sister Kenny or question her was as great a mistake as agreeing with her.” They said they wanted to discontinue any discussion until the doctors arrived, reminding Kenny that “Dr. Pohl had invited us to observe treatment.” Kenny replied dismissively that “she didn't care what Dr. Pohl had invited us to do, she did not intend to show us any treatment.” With rising ire she also criticized the NFIP “for sending us out” and “permitting us to write a report on the basis of a three-day visit.” The NFIP had told them to stay as long as they needed to, the Kendalls countered, and it was Pohl who had suggested 3 days “otherwise we would have planned to stay longer.”
Unless they were permitted to see treatment, they warned, “we would have to state in our report that we were refused the opportunity,” and Henry angrily added “we're going to stay just long enough to expose you.”
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The meeting broke up when the Kendalls left to talk to Pohl. According to Kenny, she waited for an hour for them to return, but the Kendalls recalled instead that she left the hospital “in a huff” threatening to leave for Australia.
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Alice Plastridge stood somewhat apart from the heated exchanges between Kenny and the Kendalls. Her work at Warm Springs based around its thermal spring pools with patients in the convalescent rather than the acute stage had shown her the potential of muscle exercises and heat. Warm Springs also emphasized functionality over straightening twisted bodies, which may have led Plastridge to be less concerned by Kenny's rejection of testing muscles to assess the exact extent of their weakness. Indeed, orthopedist Charles Irwin, Plastridge's Warm Springs supervisor, had argued in
JAMA
that “no immediate effort should be made to make a complete muscle analysis” in polio for “it causes the patient too much discomfort” and until tenderness subsides “it can't possibly be correct.”
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Plastridge had come to Minnesota with an open mind. She arrived 2 days before her meeting with Kenny in order to talk to local therapists who were being trained by Kenny. These therapists explained some of “the underlying principles of this treatment” to her and tried to clarify Kenny's “seemingly contradictory theories.” With the comment “forewarned is forearmed,” they warned Plastridge about Kenny's tendency to hear every question as a criticism, which was the result, they explained, of her effort “for so many years to get her ideas across and prove the worth of her work” with “ridicule … heaped upon her for so long.” Thus, the “only way of learning her theories” was “to let her do
all
the talking.” Plastridge should therefore not ask questions or raise objections for she might be “singled out for derision and unanswerable questions.” The lessons she learned from these therapists, Plastridge reflected, “made me a little more tolerant of Sister Kenny's peculiarities.”
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Plastridge was especially interested in Kenny's claim to have healed Henry Haverstock, a former Warm Springs patient whose case had professional significance for her. Haverstock's case had been featured by local newspapers with, Plastridge noted, “remarkable claims made about his progress.” She went to examine him herself and sent a separate report to her supervisor in Georgia. Before Haverstock had come to Warm Springs, Plastridge noted, he had been extremely active at home, “even trying to walk.” As a result, his muscles were “so fatigued and so weak” that the Warm Springs staff had advised “complete rest, in plaster” for the first 2 months before he was allowed to exercise in the pools. He was finally taught to walk with the aid of leg splints, a canvas stomach corset, and crutches, and after 4 months was sent home.
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All this equipment had been removed by Kenny who claimed that her method was treating his “true symptoms.”
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In Plastridge's assessment after some months of Kenny's treatment he “showed a very pendulous abdomen and hyperextension of the right knee” as well as a “Trendelenberg limp [the result of a weak gluteus medius muscle].” Haverstock tried to show Plastridge how he could walk but could only manage 3 steps; she felt that the stability that might be gained from using a brace on his right leg and a pair of crutches would have given him more self-confidence and “increased rather than decreased his independence.”
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A year later, Haverstock was featured in national magazines as a college
student who could climb 3 flights of stairs daily to different classrooms and in
JAMA
John Pohl used his case as a prominent example of the worth of Kenny's work.
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But in 1941 Haverstock's limited recovery did not provide evidence to convince visitors that Kenny's methods enabled convalescent patients to improve their strength and functionality. Thus Plastridge did not consider Kenny's results with Haverstock and other patients with long-standing paralysis “very different from those obtained by any conscientious physical therapist.”
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Kenny's results, though, convinced all the visiting therapists that her methods were of great psychological benefit to patients.
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Plastridge, Elson, and Beard had observed her methods in the afternoon session that the Kendalls had not attended. Plastridge was especially impressed with the way Kenny worked with patients whereby every movement was “done with the most meticulous care.” This new method, Plastridge agreed, “aids circulation, muscle tone and (what is most important to Sister Kenny) it aids in keeping up the patients' ‘mental awareness' ” so that “the patient never forgets how to make the effort to move the different parts of his body.”
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Plastridge's positive assessment reflected her more nuanced view of Kenny herself, gained through observing her not only as a didactic lecturer, but as a genial host and as a clinician at the bedside. Unfortunately Elson and Beard left no record of their experiences.

Kenny's belligerent attitude frustrated all of her visitors, but Plastridge tried to separate the woman from the work. Kenny was the kind of person, she admitted, who “raises your ire to the boiling point with her aggressiveness and unreasonableness.” She considered her too “intolerant and impatient” to allow opportunities “for free discussion” and therefore not “a good lecturer or teacher—neither scientific nor logical in her explanations, although she does know her anatomy and probably her neurology.” But Plastridge admired her “imposing, almost majestic bearing [and her] … fine sense of humor,” as well as “her fund of stories and anecdotes from her own nursing experiences and extensive travels.” Impressed by Kenny's “unusually good results,” Plastridge, like many observers, could not believe it was “possible they could all be a matter of chance.” Unlike the Kendalls she was willing to speculate about the validity of Kenny's ideas, concluding that “whether her theories are scientifically sound or not only time and further investigation will prove.” She also anticipated that Kenny's controversial theories would give “a tremendous stimulation to further research in this field” for Kenny's claims had already “made many of us take serious stock of ourselves, and the type of physical therapy we are doing.”
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The Kendalls were given a copy of Plastridge's comments, but they remained unconvinced. They completed their own 13-page report to the NFIP a few months after the visit in which they defended their criticisms of Kenny's work, trying not to discuss their dislike of her character. They had, they said, sought to “distinguish between the real and apparent” value of this new method. “The Orthodox conception,” they emphasized, did recognize “early spasm (which accompanies meningeal irritation),
followed by
flaccidity in muscles (which accompanies onset of paralysis).” Yet Kenny “fails to recognize this transition from the symptoms of spasm to the symptoms of flaccidity.” Her outrageous claim that muscle tests were harmful was part of a pattern of what they saw as a lack of rigor: deficient clinical records and an inappropriate reliance on qualitative evidence.
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Comparing her to the standards of their own well-respected institution, they remarked in their private notes, “SK's notes and charts are kept at home—not at the hosp!”
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The credit Kenny claimed for all recoveries ignored the likelihood that many of her patients had made a spontaneous recovery and therefore made accurate comparisons impossible. Her claims required a thorough statistical study including complete case histories and muscle examinations for all patients at the end of 6 weeks, but “unfortunately Sister Kenny advocates that it [testing] tends to produce ‘mental alienation.' ”
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