Polio Wars (20 page)

The preface to Cole and Knapp's published report was full of caveats warning that the report was only preliminary, that “several years must elapse before a definite evaluation of the method” could be made, and that “it is, of course, recognized that spontaneous recovery may occur.” The preface authors did acknowledge that “the currently accepted methods of treatment of the disease are far from satisfactory” and they urged that Kenny's method “should be given a fair trial and should be studied with open minds.” In examples that contradicted this, however, the preface included lengthy quotations from earlier critical reports on Kenny's work by British and Australian physicians.
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In the rest of the article, written in a distinctly different tone, Cole and Knapp not only praised Kenny's “highly refined and detailed method of muscle reeducation” but also her rejection of splinting, a technique that they pointed out did not prevent deformities. With confidence they explained that “obviously in this treatment there is no place for ‘muscle testing' as usually performed … for this testing can definitely cause ‘incoordination' and may slow down the patient's recovery.” The 26 acute patients they had observed treated with Kenny's methods and without splinting were “much more comfortable and cheerful,” and, to date, not one had developed “contractures or deformities
following this treatment.” Most strikingly, they defended Kenny's ideas of incoordination and alienation, explaining that muscle training could “maintain normal nerve pathways and restore those which are damaged.” While they agreed that these ideas were new they made much of the evidence of efficacy. And how had Kenny been able to identify something unrecognized by generations of polio experts? In the Australian bush her “keen, analytical mind [was] unprejudiced by previous contact with theory or training in the prevalent conception of treatment of this disease … [and] without knowledge of postmortem pathologic appearances.”
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Insight through ignorance was a strange defense made by physicians about a clinician. But Cole and Knapp recognized how many of their peers were dissatisfied with not only current therapeutic options but also polio scientists' seemingly endless attention to pathological lesions in monkeys rather than pain and disability in living patients.

The
JAMA
article became the basis of numerous stories in the popular press. Accompanied by a picture of Kenny in a wide-brimmed black hat, a
Time
article described the “new and apparently successful treatment for infantile paralysis—reversing all accepted methods of treating the disease.” “No doctor invented this method,” the magazine noted, “but a nurse in the Australian bush.” Still, in an effort to mend the disturbed gender relations and to make this medical discovery less transgressive,
Time
explained that Cole and Knapp had invited “strapping, soft-spoken Sister Kenny” to work in local hospitals.
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Thus, Kenny was presented as a nurse with stereotypically deferential characteristics whose work had been recognized by insightful medical men.

Kenny immediately saw that this article was not the same as the version she had read in Australia. She identified Fishbein's editorial hand even before O'Connor told her that Fishbein had required the article “be edited and prefaced.”
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Cole and Knapp, Kenny believed, had provided a ringing endorsement of her work. Yet sentences in the draft such as “we have been favorably impressed with this work both as to rationale of therapy and as to results so far observed” were replaced by the more tepid claim that results were better than “previous generally accepted therapeutic procedures.” The sentence “we personally firmly believe that this method will be the basis of the future treatment in infantile paralysis” was missing.
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The most serious alteration in Kenny's view was Cole and Knapp's original statement that “muscle spasm is a constant accompaniment of the muscle pain of acute anterior poliomyelitis, and it may be the real and sole cause of the pain,” which now read “she believes that muscle spasm is a constant accompaniment of the muscular pain of acute poliomyelitis.” Kenny could see the epistemological shift in this phrasing. “The statement was made by the observers, not by me,” she pointed out to O'Connor, but the
JAMA
version “would lead your readers to believe this announcement was made by me. I am not qualified to suggest or make the statement that spasm may be the real or sole cause of the pain. I consider the medical supervisors are qualified to do so.”
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This effort to distant the authorship of medical claims about her work was part of a process she had honed during the 1930s in response to critical reports on her work. Public approval by physicians was crucial for the status of her clinical and teaching work. These alterations, she warned, had “completely cut the ground from beneath my feet as far as teaching my method is concerned.” The NFIP had paid for her to return with 2 technicians in order to teach this method, but “in order to teach, the students must first understand there is something of value to learn, otherwise I would only be wasting valuable time.”
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In June 1941 Kenny and Pohl appeared again before the city's Board of Public Welfare. Aware that he was becoming one of Kenny's most prominent medical supporters, Pohl declared, “I think it would be criminal to treat any child afflicted with acute infantile paralysis by the methods we formerly employed,” praise echoed by the director of the city hospital and by the city's health commissioner. The board voted to fund 2 graduate nurses who would work with Kenny for a year and then be able to “carry on the work.” The board also seconded the university's request to the NFIP for a $10,000 grant to set up a 25-bed polio clinic at the university hospital.
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When the NFIP agreed to fund the new clinic and the training of technicians as well as cover the expenses of Kenny, Bell, Harvey, and Mary Kenny for another 8 months, officials at the NFIP and the medical school believed that these decisions had been made among themselves. NFIP officials, with Fishbein's assistance, hoped to keep Kenny in line and ensure that her clinical and teaching work remained under the supervision of medical school faculty.

But even in this early period, Kenny was able to reach over the heads of NFIP officers and senior AMA members and claim the independence she wanted. She began to complain to local reporters and NFIP officials that the NFIP had not praised the worth of her work publicly. Without a “definite statement” by the NFIP or
JAMA
, Kenny declared, she and her Australian staff would only “carry on for a short time,” and, she told O'Connor, “I am sure my country will arrange for the reimbursement of all funds spent and for my return to Australia.” “Other countries desire my presence,” she reminded readers of the
Minneapolis Star-Journal
, but if her work was publicly acknowledged “I am prepared to stay and teach.”
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At the same time as she was threatening to leave Kenny urged O'Connor and his medical director Don Gudakunst to visit Minneapolis so that she could demonstrate her work and provide them with defining evidence that could be followed up by a formal statement from the NFIP.
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O'Connor tried to explain to Kenny why any visit by him or Gudakunst to Minneapolis would not confirm her work's value, explaining that the NFIP was cooperating with “its grantee, the Medical School of the University of Minnesota” and it would be unwise for the NFIP “to attempt to make any separate evaluation of that method.” He refused to bow to Kenny's threat to leave along with her staff, reminding her that the final evaluation of the work lay with physicians at Minnesota's medical school, which would be done with or without “your continued presence.”
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But his effort to have Kenny recognize the difference between the director of an organization and its expert advisors failed. O'Connor was the head of NFIP; he had agreed to fund her work; he should put the weight of his organization behind it. It made no sense for the NFIP to encourage polio professionals to use her work at the same time the work was continuing to be evaluated. Kenny had come back from Australia determined to have her work formally approved and then spread across the country. She did not see herself as dependent on the medical school or the NFIP, points she reiterated in longer and longer letters to O'Connor.

As the AMA's cultural censor behind the scenes and as a professional editor aware of the lasting power of the written word, Fishbein tended not to put much on paper. He usually responded by phone and thus we do not know how he answered O'Connor who
sent him a copy of an especially long letter from Kenny with the query “How should I answer this?.” Fishbein did send O'Connor a comic note a few months later wishing him “profound sympathy in this affliction.”
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Increasingly Fishbein recognized the potentially unsettling power of Kenny and her work, especially as reporters began to tell the story of a nurse who trumps the doctors and challenges medical orthodoxy. Indeed he was one of the first American physicians to understand the threat Kenny posed in gender relations, medical authority, and professional orthodoxy. But initially he saw her as just another quack, the designation he applied to most of his antagonists. His best-selling 1925 expose
The Medical Follies; an Analysis of the Foibles of Some Healing Cults, Including Osteopathy, Homeopathy, Chiropractic, and The Electronic Reactions of Abrams, with Essays on the Antivivisectionists, Health Legislation, Physical Culture, Birth Control, and Rejuvenation
revised in 1927 to include
the Cult of Beauty, the Craze for Reduction, Rejuvenation, Eclecticism, Bread and Dietary Fads, [and] Physical Therapy
had sought to convince the American public that all these groups should be considered harmful to the progress of medical science.
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During the 1920s and 1930s he had led fierce attacks on alternative practitioners and proponents of government health insurance, and defended medical societies that were resisting group practice. In the late 1930s, after members of Washington, D.C.'s medical society sought to censor local physicians who had formed a group practice, New Deal officials, frustrated with AMA leaders' intransigence over federal efforts to expand health and welfare services, named Fishbein along with members of the local society in an antitrust case brought by the Justice Department. Fishbein was confident that his own power as well as the rising status of American physicians and the AMA would continue, irrespective of the outcome of this case.

Monitoring the Kenny story seemed to Fishbein to be a question of cultural rather than scientific politics. Not only did he control what was published in
JAMA
but as chair of the NFIP's Committee on Information, Fishbein had dictatorial power over the popular press as well. After the publication of Cole and Knapp's
JAMA
article, Fishbein received drafts of numerous articles on Kenny. He approved an article for the
Saturday Evening Post
by Robert Yoder, a
Chicago Daily News
journalist.
¹⁰²
However, Fishbein rejected the overly effusive “Infantile Paralysis Loses the First Round” when its author, freelance writer Walter Quigley, seemed unwilling to be deferential enough.
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Reminding Quigley that he was one of NFIP's medical advisors, Fishbein explained that “for me to undertake to pass on your manuscript” Quigley would need to correct the identified mistakes and his “several unwarranted inferences.” If he did this, “we will be glad to have you indicate to the prospective publisher that the manuscript has been passed on by the [NFIP] Committee on Information.”
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“There are indications that he is trying to be very much of a smart aleck in this affair,” Fishbein concluded in a separate note to O'Connor, and “it is obvious from his manuscript that he knows nothing whatever about the subject.”
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Recognizing the threat behind Fishbein's words, Quigley apologized abjectly, saying he was “anxious to get this accurate” and would “rewrite the MSS to make it correct.”
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But his backtracking was too late, and without Fishbein's approval no magazine agreed to publish Quigley's piece.

Robert Potter, the science editor of the Hearst newspapers' Sunday magazine
American Weekly
, fared better. Potter agreed to “cooperate fully with the Foundation to see that every word of the article and every fact is in accordance with the present medical knowledge.” “There will be no need to try to sensationalize such an article,” he assured Gudakunst,
as “the human interest facts of a nurse in the Australian bush making a contribution to the aftercare of infantile paralysis are so good, in themselves, that the article can stand on its own feet.”
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Fishbein found Potter, unlike Quigley, “was glad to accept advice and suggestions and was most appreciative of what was done for him.”
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Nonetheless, he warned Potter that, like many other writers, he had “approached the subject with a view to sensationalism.” Fishbein proposed the substitution of “remarkable” for “amazing,” “distressing pain” for “terrific pain,” and “the preferable way” for “the only correct way.” Do not say “the Kenny treatment is the answer,” Fishbein advised him, “when the scientific statement would be ‘may be the answer,' ” or “ ‘the medical profession has been fooled too often' … when the correct statement would be that ‘the medical profession has been fooled on occasion.” Potter should also delete the paragraph that quoted Pohl “saying that it would be criminal to treat a child with any method except the Kenny treatment.” It would indeed, Fishbein argued, be criminal not to give a child diphtheria antitoxin “because that technic [sic] is well established,” but there was “not as yet any convincing evidence that the Kenny treatment alone is better than other methods of orthopedic care.” These suggestions, Fishbein assured Potter, were offered “simply to make your article scientifically safe.”
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Potter not only found Fishbein difficult to please but when he traveled to Minneapolis, despite the NFIP's assurance that he would have full cooperation, he found a “gun-shy” Knapp who refused to comment further “without specific authorization from Mr. O'Connor” and Kenny “bottled up like [a] stuffed herring by [the] Docs.” “My private belief,” Potter complained to the NFIP's New York office, “is that I'm getting [a] royal runaround and the brush off reserved for local reporters.” If he could “get nothing better,” he threatened, he could “make a swell yarn out of the run around which would be swell exposure of medical high handedness and stupidity.”
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Potter's article appeared in August 1941, presenting Kenny as a woman with an exotic, rural background and gentle hands.
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And Fishbein began to keep “careful records” on Kenny.
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