Polio Wars (19 page)

The Kendalls openly disagreed with Kenny's assessment of some of her patients, doubted her theories, remained convinced that muscles without proper support would be damaged, and were appalled to hear Kenny reject the muscle test, the major tool of their own clinical and research program. They also disliked her confusing terminology. In their view, “she used terms freely and interchangeably, without regard for clear cut meanings of those terms” and her “knowledge of muscle function was not only very incomplete [but] … quite inaccurate.”
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They had been ready to accept that her unusual terms were the result of language differences, an argument proffered by Knapp who had warned the visitors “how easy it was to misunderstand Sister Kenny because of the differences in the meanings of words—even in English-speaking countries like Australia.”
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But Kenny made clear that she was not just giving new names to familiar symptoms in an exotic accent. Hers was a new language for new ideas. What was new, she tried to explain, were the distinctive symptoms she had identified that made polio—at least in its acute stage—a new disease, rendering any debate based on the orthodox conception of polio irrelevant. The Kendalls interpreted this as sloppy thinking; they did not see clinical signs such as spasm as crucial in the construction of polio itself. Thus, during a discussion of a shoulder whose muscle Kenny claimed was in spasm, the Kendalls found “no contraction.” Their notes read: “When facts pointed out she became confused & made statement—‘We are talking about a diff. disease.' H.O.K. said ‘Oh no—I'm talking about muscles & deformities, not the disease.' ”
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But to Kenny “muscles & deformities” were a critical, neglected element of polio care that proved both ineffective treatment and damaging physiological disruption. Kenny's distinction between “affected” muscles and “alienated” muscles frustrated all the therapists, and the Kendalls concluded that her classification of “spasm” was neither a new symptom nor one that required distinctive treatment. She also seemed not particularly interested in a scientific explanation for the cause of these new symptoms. Her vague comment that muscle spasm was “caused by irritation in the spinal cord” was unconvincing. Of course Kenny also said that she had come to America to find scientific researchers who could explain the complex mechanism underlying the distinctive symptoms she had identified.
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In any case, the Kendalls argued, most of her ideas and techniques were “not so radically different from our own, even though differently applied.” As early as the 1916 polio epidemic, hospitalized patients in the acute stage after leaving the contagious disease hospital were placed in tubs of hot water while pain was severe; thus, “heat, in one form or another, is not new.” The maintenance of a normal mental attitude “has long been taken for granted as one of the most important phases of the recovery period.” As for exercises to regain muscle function, “a great deal depends upon the experience, conscientiousness and patience of the physical therapist” and, whether called muscle consciousness or mental alienation, “that is definitely one of the things we have worked for the hardest.” Many of her techniques were part of standard polio care: hot packs to stabilize body parts and a foot board and a wooden plank under the mattress as methods of immobilization. Such techniques, however, they feared, would not adequately protect weak or paralyzed
muscles. Kenny's early introduction of muscle training, allowing a patient complete freedom of joint movement, was even more harmful. Her claim about the danger of rest made no sense to the Kendalls, for the idea that rest could aid “the inflamed or potentially paralyzed part” had scientific confirmation from studies of polio for almost 100 years. Although these studies, they admitted, were almost all based on clinical evidence rather than laboratory evidence, they were nonetheless so extensive that there should be no debate over “the necessity of protecting weak muscles in cases of nerve injury.”
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She should not, they concluded, be given responsibility in the treatment of patients in the acute stage or “be entrusted with teaching the principles of muscle actions.”
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In their harshest assessment, they felt her idea that “brain power” could be reinvigorated by physical therapy contradicted “the results of scientific studies by the most competent minds in medicine, and accordingly must be relegated to ‘cultism' until further evidence is forthcoming.”
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The Kendalls sent their report to the NFIP and to
JAMA
, but Morris Fishbein decided not to publish it, seeing it as a bitter attack on Kenny's method.
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The Kendalls began circulating their report to fellow professionals but were disappointed to find that the politics of polio had shifted away from their views. When Florence Kendall asked Catherine Worthingham, president of the APTA, for her reactions to the report, she was surprised to find that Worthingham reduced their many objections to the issue of terminology. Although Worthingham agreed that Kenny's choice of terms was unfortunate, Worthingham and the APTA's Governing Board believed “it would be very unwise to bring it up now,” and she reminded Florence there were “so many things that are important to us in our relationship to other organizations that it would be unfortunate to cloud the issues with the discussion of terminology.”
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Thus, as Worthingham was noting obliquely, Kenny's work had drawn attention to the significance of physical therapy in polio care and thereby reinforced the relationship between the APTA and the NFIP, so the APTA would not want to take a public stance against the NFIP-sponsored nurse by making what might seem picky complaints about her terms. During the 1940s NFIP-funded physical therapists' specialized training and professional development contributed to the expansion of the profession in both numbers and respectability.

Following this strategy of cooperation and appeasement, Worthingham asked Kenny to participate in an NFIP-funded study of “Physical Therapy Treatment in Poliomyelitis” a few months after the therapists' visit to Minneapolis. The APTA, Worthingham explained, was sending questionnaires to hospitals, crippled children's schools, private practitioners, charity and governmental agencies, and physical therapy training schools in preparation for a conference to evaluate the collected material and to make “recommendations as to methods of approach.”
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Kenny replied predictably. Such a survey, she said, would be of “no value” for “all observers [had admitted] … that I have evolved a satisfactory and commendable treatment … which holds out more hope for recovery than any other method produced anywhere.” She was “pained and surprised” that money would be spent funding yet another study considering that “for twenty-five years results have been tabled and compared and no advance has been made.”
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This query promoted Kenny to remind O'Connor that the funds of his “very splendid organization” should “be better employed” if they were “used to teach technicians the method while I am still available, rather than go over old ground.” She reiterated her provocative claim that the twisted bodies of disabled children were largely the result of inappropriate and ineffective therapy—“the after-effects of orthodox treatment”—rather than the disease itself.
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Kenny's method rapidly became seen as a legitimate polio therapy. As early as November 1941 Emil Rosner, a physical therapist at the New York Hospital for Joint Diseases, boasted to the Kendalls that he was “familiar with the Sister Kenny Method, the Mayo Clinic Method, the Janet Merrill Method, and the Hansson Method—and your splendid work.”
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Rosner had not recognized that the Kendalls did not consider Kenny's work in the same pantheon as other respected polio authorities.

Kenny did not see the Kendalls' report for some time. Not long after the therapists' visit, she left for Australia, ostensibly to supervise her Brisbane clinic staff during a local polio epidemic. NFIP officials assured her that they would continue to pay the living expenses of herself and Mary, who remained behind to continue the work. The NFIP also agreed to pay for both travel and living expenses of the 2 Australian therapists (Kenny's nephew Stanley Willis (Bill) Bell and Brisbane nurse Valerie Harvey) she would bring back to Minnesota.
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Both Kenny and the medical school needed to prove that Kenny's results were not the result of suggestibility either to her patients or to local physicians. Her trip to Australia helped “spike … a romantic theory in which many had indulged,” a reporter noted later, the theory that Kenny's method worked “by dominating the patient's mind” and that “perhaps she was a faith healer with some of the talents of a hypnotist.”
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Thus, Kenny's absence helped solidify the scientific nature of her work as, under Mary's calm supervision, treatment and clinical improvements went on without her.
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Kenny spent 3 months in Australia. Her medical supporters in Brisbane, in a gesture they considered open-minded, were allowing parents to choose whether to have their paralyzed children cared for by Kenny-trained technicians at the Brisbane General Hospital or in the wards where medical orthodoxy reigned. According to Kenny's recollections “almost eighty percent chose the Kenny treatment.” Nonetheless, she felt such a situation was “not in keeping with the dignity of the medical profession,” and the choice “was not between a better and a worse method … [but] really a choice between the right and the wrong, the correct and the incorrect.” She was further distressed to learn from Abraham Fryberg, the hospital's superintendent, that in the orthodox wards polio treatment was “compounded from as much of the Kenny method as they [the staff] could remember” from her earlier lectures. Not only did such practice suggest a bastardized version of her work, but most of those techniques, she protested, had been designed for convalescent rather than acute care. Unable to alter the hospital's polio admissions policy or its practice in the orthodox wards, Kenny concluded that “I was still a bush nurse who was supposed to know nothing except what lay within the narrow limits of her own sphere.”
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She was, however, delighted to be sent a draft copy of a positive report on her work by Cole and Knapp. She showed the report to Australian government officials, drawing attention to their statement that “we personally firmly believe that this method will be the basis of the future treatment of infantile paralysis.”
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By the time she returned to the Twin Cities, local officials and physicians at the university had decided that her work was worth learning. She was now in charge of wards in both the city hospital (Station K) and in the university hospital (Station 43), and was growing confident that her base in Minneapolis would enable her to alter the minds
of doctors, nurses, and physical therapists across America. “I have a very nice set up at the University,” she wrote to a Brisbane ally, “and am in the proud position of being consultant in all the hospitals of the Twin Cities for all polio cases.”
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Local boosters in Minnesota had already begun to retell Kenny's story as one of civic acumen. “Minneapolis was the only city in America to give her a friendly hearing,” the
Minneapolis Star-Journal
claimed, “previously she had offered her services to New York, Chicago, Denver and San Francisco.”
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The
Star-Journal
featured patients like Bob Gurney, an 18-year-old patient from St. Paul who had been paralyzed by polio “so bad[ly] [that] I could only wink my eyes,” but was now leaving the hospital and planning to return to high school.
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By the time America's 1941 polio season arrived the Kendalls' doubts were subsumed by a wave of professional and public interest provoked by Cole and Knapp's enthusiastic article on “The Kenny Treatment of Infantile Paralysis” published in
JAMA
that June.
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But in print the article looked quite different from the draft Kenny had read. The careful crafting of this report for publication showed the hand of Morris Fishbein who was trying to dampen what the
New York Times
later called the “silent controversy raging behind closed doors in medical circles ever since Miss Kenny introduced her method of treatment in this country.”
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JAMA
was the most important medical journal in North America and as its editor Fishbein was one of the most influential American physicians. Throughout the 1940s
JAMA
's high circulation numbers matched the circulation of the next 6 largest medical journals combined.
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Fishbein wanted to be very careful in approving this first
JAMA
article on Kenny's work. In his role as chair of the NFIP Committee on Information he had “returned it to be dissected by a special committee” and had “finally accepted [it] with some misgivings and published [it] with many deletions.”
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Fishbein asked Frank Krusen, the Mayo specialist in physical medicine, to head this “special committee.” Some of the behind-the-scenes machinations can be guessed at from a private note Knapp sent to Krusen apologizing for asking him “to sign a statement explaining an article you have not seen about work you have not observed.” Knapp added that he had been told this should be done in order to “prevent ‘the report from being misunderstood.' ”
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In another glaring change, the published article did not use John Pohl's name even though he had done much of the work, but Fishbein did publish a separate article by Pohl 10 months later.
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